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HomeMy WebLinkAboutBuilding Permit #122-15 - 245 BLUE RIDGE ROAD 8/4/2014 BUILDING PERMIT oNo oT b�tio TOWN OF NORTH ANDOVER 02 APPLICATION FOR PLAN EXAMINATION ' O uy Permit No#: Date Received ��ssqT►+ug���y Date Issued: -1141 IMPORTANT: Applicant must complete all items on this page LOCATION rn�}C� P in� PROPERTY OWNERJO YJ/ -' �'Jj , ,Y MN Print 100 Year Structure yes no MAP PARCEL:.0� ZONING DISTRICT: Historic District yes o Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building XOne family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial )'Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESC IPTION OF WORK TO BE PERF RMED: Id ntificatio - Pleas _ ,ype or Print Clearly OWNER: Name: �)Dhf/y t// / Phone: !??011'^ Address: —?Z/Lf 611014— 4e ,1J6f,4 li�n Contractor Name: Phone: 0 Address.- __L �, I //� Supervisor's Construction License: C 3--,C _(,`?,?36 Exp. Date: bo 141 Home Improvement License: 17 1 Exp. Date: _A/4z2o/t� ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$,112.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $�v)�y� FEE: $ 6 J Check No.: �c (e 2, Receipt No.:C), NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contractr Location No.�L .� Date • - TOWN OF NORTH ANDOVER • • Certificate of Occupancy $ _ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check#R5-6-4-R Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street_ FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use) ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application o Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract ❑ Floor Plan Or Proposed Interior Work Li Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks o Building Permit Application L3 Certified Surveyed Plot Plan ❑ Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract Li Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) o Building Permit Application o Certified Proposed Plot Plan Li Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) a Copy of Contract o Mass check Energy Compliance Report o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:Building Permit Revised 2014 NORTH Town o � ,, Andover No. �a '. ver, Mass, O h 1. coc�icHew�c.c v S U' BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System WILDING INSPECTOR THIS CERTIFIES THAT ........(:Z. ......................................... ..................... �� �•�� • Foundation has permission to erect .......................... buildings on ... .. ... ......•••••• Rough -_ S• L ...• Ti �1.. .. ........ Chimney • .. to be occupied as ........... .. .. ..1...•••••• •••••• .. . provided that the person accepting this permit shall in every respect confo to the term of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and PLUMBING INSPECTOR Construction of Buildings in the Town of North Andover. Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR Q UNLESS CONSTRUCTIO T Rough Service .................. ... ...................................................I Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Final Display in a Conspicuous Place on the Premises - Do Not Remove FIRE DEPARTMENT No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. Townof NORTH t E : ,T� Andover .,. No. +� ver, Mass, o� 1 X1,9 A°R�reo ►`Qa,�,�y S U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System .•• BUILDING INSPECTOR THIS CERTIFIES THAT ......... 0.4..... �......................................... .............. �•�� �G• ,I�� Foundation has permission to erect .......................... buildings on ... .. ••• Rough -' +...S.�r,,► ,IL,, ..... . .��,t.. ........ .t. tl to be occupied as ... .. Chimney provided that the person accepting this permit shall in every respect confor to the term of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and PLUMBING INSPECTOR Construction of Buildings in the Town of North Andover. Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR T Q UNLESS CONSTRUCTIO Rough Service .................. ... .................................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Final Display in a Conspicuous Place on the Premises - Do Not Remove No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. t �* Massachusetts -Department of public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-079336 . JOSEPH A CLEMYNT. 1 LITTLE POND RD MERRIMAC MA 101860 9,21 Jy „ �r�,`,�` Expiration Commissioner 0912712014 — --_ ,}��---_ _ C��fie�pomvrr2a�rzcUeaCC�o��/�aac��irtelY,d, . 2-\ Office of Consumer Affairs&Business Regulation ME IMPROVEMENT CONTRACTOR b egistration: ;1719.18 Type: xpiration: 5%112016 Individual —JOSEPH A.CLEMENT JOSEPH CLEMENT 1 LITTLE POND RD I MERRIMAC, MA 01860 Undersecretary The CommonweaM ofMassachusefts - DepaYf�ne�to�'.�ic��sf�rcc�Acczc�e�fs • . Office o,f Investigafeons 660Washine n,Street .Boston MA 02111 wwly MaSYgovIdla 'too rkex$i Compen.gatlon insurance Affidavit:BWldexsiContractorsffllectriciansl?TimnbexO .A 11cant Jbho cxnatio I Please�xzn�Le�itlbly -Name usinessl0rganizaiion/1'ndividual): 1rri�C,���•� 1�VG1� Address: iPV IDv &0Y,,_ Cx tS tater a�`'� la- ©31 . Phone#: 9?gc� �C� Y, Are y rE an,employer?Check the appropriate box: Type of project(required): I.VI am a employer with _ 4• ❑1 am a general c ontractor and I 6. Now canstraction f employees(piand(orpaxttime).* have liiredthe sub-contractors 2,[] I am a sole proprietor or partnex listed on the attached sheet T 7• ❑Remodeling ship and`hava na employees These smb-contractors have 8. [(Demolition comp,isurace, worlring formeinany capacity. workers , Building addition 'corn. .• urance 5, []We are a corporation and its e 's o additions ' o worl��ers � 'I0. Electricalx air x p ❑ p officers have exercised.their T equired.] II.. Plumbingre airs or additions 3.[] X aim a hom eowuex doing all work right of exemption per MGL rep ah o mo workers'comp. c.152,§I(4),andwehaveno 12.P Roofrepairs insuxancerequired.�� employees.jNowoxkexs' I3.�Othex 1N�`�' comp.insurance required.] -Any appiicautthatchecks box#I must also fi110utthesection belowshowingt e,1rwbrkers`compensationpolicyInfounation. Homeowners who submitihis affidavit indicatingthey Cse doing allwoorXand then bira outside contractors must submit anew affidavit indicating such. xContracfors that aheckthis ba must attached as additional sheet showI the name ofthe sub.-contractors andtheir workers'comp,policy information. I arra an employsN that is providing workers'cornpe isation insurance formy mTloyeeg Berory is tiie,paliey'Mrijolr site ira,farmatior�. /�, �• . Iusuxance Company Name:. A IS �+ aM L) -U J\ iSuC'Pn(W Cb _ . olicy#or Self-iM.Lit.#' cry r - A7 - �Ao�-�1 " i A pExpiration Data: '�Q�� j e ( e� t �J CitytState/.Zip:r rob Site Address,— nn . ohcydeclaration a e showin(showing-the olfcy number and e_ irationt date)a copy of Me workers compensationT . Failure to secure coverage as requiredunder Section 25A.ofMGL o.152 cam lead to the imposition of eriminalpenalties of a fmo up to$1,500.00 and/or one-year imprisonment',as well as civil penalties in the form of a STOP.WORD ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations ofthe DIA.for insurance coverage vex%fication. ado Hereby cert under•ilie�iains ax�clpenalties a�per•Jury t cation- at irefvr�nrrtzon providecia�ove is true and eo�teet, Si at�zre: Date: Offyeial nese ortly. .Do not write in this area,to be eoircpl'eted by city or town offieial, City or Town: Pexmit/License# Issuing.A Authority(circle ane): 1.Board of Health 7•Bail'lding Department 3.CitylTown Clerk 4. Electrical Inspector 5.Plumbing Eispecto;r' 6.Other Andover's honest PoOntin Co. 1j- DATE 7/29/2014 P.0 Box 201 Proposal # 4768-14 No. Andover , MA 01845 Customer ID 4304222 Phone 978-689-3637 or 888-201-6438 Proposal Submitted To: Quotation valid until: Name : John & Mary Ann Quint Prepared by Mike Bouchard Address : 345 Blue Ridge Road City, State : North Andover Ma. zip : 01845 Phone : (978)430-4222 Comments or Special Instructions: Description AMOUNT Remove and replace siding, board, insulation etc..due to water damage. Third down and Balance due at time of completion TOTAL $5,000.00 Respectfully Submitted ACCEPTANCE OF PROPOSAL The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payments will be made as outlined above. + ' Signature DATE: Signature Information and Instructions . Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person iii.the service of another under any contract of;hire; ~ express orhaplied,oral orwritten:' An.eoTloyq is defined as"an individual artnershi associatio co oxation of other le al enti or an two ox imoxe ',.A �p p� g ty y ofthe Foregoing engaged in a joint enterprise,and includingthe legalrepxesentatives ofa•deceased employex,.or the receiver O-r-Mistee ofan.individu &a al,partnership,association or other legal entity,employing employees. however the owner of a dwelling house having notmore thanthree apartments aud who xesides therein,orthe occupantoft7ie dwelling house of another who employs poisons to do maintenance,construction ox repair work ort sucli dwelling house ox onthe grounds orbuilding appurtenant thereto shallnot because of such employment be doomed to be an employes." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not pro duced.acceptable evidemce of compliance with the insurance coverage required." Additionally;MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into airy contract for the performance ofpublic work until acceptable evidence of compliance with the insurance requirements ofthis chapterhavebeeupresentedtathecgstractingauthority." Applicants Please 0 out the workers'compensailon affidavit completely,by chobldnng thio boxes that apply to your situation and,if necessary,supply sub-confractor(s)namo(s),addresses) along with their certificate(s)of insurance. Limited Liabiffty Companies (LLC orLimited Liability Partnerships(LLP)vnth no employees other than the members orpartners,are notrequiredto carry workers'compensationiusurance. TfanLL Cox , P doeshave employees,apolicyis required. Be advisedthatthis afddavitmay be submitted to the Department of Industrial Acoidents fox confirmation of insurance coverage. Also be suxe to sign and date the affidavit. The affidavit should he returned to the city or town that the application fox the permit or license is being requested,not the Department of Tudustrial Accidents. Should you have any questions regarding the law or if you are xequired to obtain-a workers' comp eiisationpolicy,Plea-so call the Department at the number listed below. Self-insured companies should enter their self insurance license number on the appropriate lime. City or Town.Officials Pleasebe sure thatthe afudavit is complete andprinted legibly. The,Department has provided a space at the bottom of the affidavit foxyou to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be-sure to B1inthe permit/license number whichwill be used as a reference number, In,addition,an applicant thatmust submitmultiple permit/license applications in any givenye,ar,need only submit one affidavit indicathng current policy information(ifnecessary)and under"Tab Site Address"the applicant shouldwiite"all locations in (city or town.).".A copy of the afCtdavit that has been officially stamped or marked by the city or tov�n.may be pxovided to the applicant asProof 1hatavalidaffidavit•isou:Wae brfutuxepemzitsorlicenses. Anew afddavitmustbeffedout each year.Where altome owner orcitizenis obtainingalicense or.permitnotrelatedto anybusiness or commercial venture (Le.a dog license orpermit to burn leaves etc.)saidperson is NOTxegahcd to complete this affidavit. The Office of Investigations would like to thank you inadvance for your cooperation and should you have any questions, ,please do not hesitate to give us a call. The Department's address,telephone amid fax number: Tho CQMMORWealth 0fMMUIRG- metiI Tk .al!=Ut QXZudu�Wal AceldmM Ofte ofl1gvesQgat[o)R,% 6bG Wasblngtan fteo BQ)AQn, 021.11. T01 GM2,1_4900 W406 Ql 1-877;11 A .Revised5 26-0S a 617"727"774