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HomeMy WebLinkAboutBuilding Permit #524-11 - 26 MILTON STREET 1/5/2011TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Issued: / —S /I IMPORTANT: Applicant must Date Received all items on this LOCATION Print PROPERTY OWNER 7to /�.lr`SS -14, I Print MAP NO:PARCEL: 2S ZONING DISTRICT: Historic District yes o Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Assessory Bldg ❑ Commercial &Repair, replacement ❑ Others: ❑ Demolition ❑ Other t WatershedDis: ®�SepcW_ell �' ` loodplam ❑ Wetlands F t ` e�❑ •.�®Water/Sewer,. _ - - -- � _ _._ ._ � - �._ _ � `tet ��'���` �,��r�'���� �r.�•�� DESCRIPTION OF W OKK Tu tjt; r�xrvtuv�li: 6 . Identification Please Type or Print Clearly) OWNER: Name;0(41211. Phone: 6/7 6 7f -OC/6 Address: din elf �n of CONTRACTOR Name: �C�G�� A14 Phone: 0-9,6 Address: q6 HA 11.S7't' Supervisor's Construction License: Exp. Date: 12 - Home Improvement License: /�-710t Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE. BULDING PERMIT. $92.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $925.00 PER S.F. Total Project Cost: $-- 116 )a FEE: $ Check No.: Receipt No.: 3O NOTE: Persons contracting with unregistered contractors do not have access to theuaranty fund 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 ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Muss check Energy Compliance Report (If Applicable) - ❑ 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) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products JOT'E: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit n all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals iat the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording lust be submitted with the building application Doc: Doc.Building Permit Revised 2008mi r Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art E] Swimming Pools ❑ Well El Tobacco Sales ElFood Packaging/Sales El Private (septic tank, etc. ❑ ,Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED PLANNING & DEVELOPMENT COMMENT DATE APPROVED El CONSERVATION Reviewed on SicLnature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: Comments 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 COMB 4ENTS 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.$10041000 fine r Doc:.Building Permit Revised 2008 Location • )�/ .17 No. ���� Date MOR,M TOWN OF NORTH ANDOVER 0 w 9 Certificate of Occupancy $ s�CMUst Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check #_ 2 3 8 v 9 Building Inspector r N I T E R United Home Experts & f B a n HOME United Painting Co., Inc. IWICE El °' 200 Butterfield Dr. Suite I Full Worker's Compensation Coverage Ashland, MA 01721 $4,000,000+ Liability Insurance Coverage Industry leading Warranties 508-881-8555 FAX 508-881-5584 Flexible Payment Plans available www.UnitedHomeExperts.com Family Owned and Operated PROPOSAL MA HIC License # 157108 MA Constr. Supervisors License RI REG # 22948 RRP License # NAT -28008 Project: 6 Bid Date: I z h Igo Attn: �q vt-A1kvz Phone #: W _� OW D q ( b Company: Work #: d Address: Fax #: Email:,,, J _ N tSS ' u-4, u. . Q City, St. Zip: p.,, Jv OY ^ of �Clo V -e i' M a yS Heard of us by: ani. J Gl/ Base proposal as per attached scope of work: Alternates: Any additional customer requested carpentry work will be billed at per hour + materials. 4_0a Q! -E. e1K 2. n cwt n. fAk ,J lP 0-ee—�o,Aw Prices good for 14 daysS 4t do,, apdo PAYMENT: A non-refundable deposit of 1/3 of ALL ACCEPTED PROJECTS is due upon authorization in the amount of $ , with 1/3 of EACH PROJECT due upon half of completion of EACH PROJECT, and the balance of EACH PROJECT due upon completion of EACH PROJECT along with any additional work requested by customer. Job type Scheduled Forecast Date $ Price Notes Material l d Dumpster size, location, date PERMITTING: The signature on this proposal authorizes a representative of United Home Experts to sign for and obtain any permitting necessary to complete this project. Contractor signature/ Date Customer si nature Date � g OFFICE COPY The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations gli t 600 Washington Street a la i� Boston, MA 02111 1- n www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): 017r VG'/74" c C , Address: 20:) 604eA,'eza QJ City/State/Zip: &- jar , A 017�,�_ Phone #:1� ?3 0-0s(2c, Are you an employer? Check the appropriate box: I. VI am a employer with �— 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ 1 am a sole proprietor or partner- listed on the attached sheet. t ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ I atn a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.0 Electrical repairs or additions 11.0 Plumbing repairs or additions 12.❑ Roof repairs 13. ❑ Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy # or Self -ins. Lic. #: C�,/r,d (p ��� �� Expiration Date: Job Site Address:_ ' �o, )"- :)S f City/State/Zip: Al AQ, && Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains andpenalties of pejury that the information provided above is true and correct. Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # -s- Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: 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 in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the, legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or -on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." 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 produced acceptable evidence 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 any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to cavy workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confinnation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the pen-nit/license number which will be used as a reference number. In addition, an applicant that must submit multiple pen-nit/license applications in.any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future pen -nits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or pen -nit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street - Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFB Fax # 617-727-7749 Revised 5-26-05 www.mass.gov/dia m m X m Y, m mm I r� Cn CIO Oz� Cn rn .0 cn Cn C_ O O O O O O tC 0 CCP o. CO A C 0 CO) CL0 N Vf m C ?co10 d Z �. y O N G. O C m y.. ® 0 m Cl) cl C C � - C y �_ ma=rM y O O N o Cc CD : a O N m .0 O .O.r ONscj:SZ: � a CD a N 0 0 o Lr CD O Vl C),o S a m m N � d ycl !i : o L� Q C� O N %� N p l O CDCA j �V O m : as 00 Wow t a 3 �-- CAo RC07 � i3 m o S ,. y ci Co �- CD cn E; d v, =; - � tz 7d a� y�� Z w � � d CO) C7 CD n Z y 'o. O n � C. r c O? CL CDc CO) ):NCO � Cl t7l CD o p CD o CL CT 0 d CD CDo CD c O co) CLS. p y Cl I C c g CD y p o 1 CD Z R. O CD O CCD I r� Cn CIO Oz� Cn rn .0 cn Cn C_ O O O O O O tC 0 CCP o. CO A C 0 CO) CL0 N Vf m C ?co10 d Z �. y O N G. O C m y.. ® 0 m Cl) cl C C � - C y �_ ma=rM y O O N o Cc CD : a O N m .0 O .O.r ONscj:SZ: � a CD a N 0 0 o Lr CD O Vl C),o S a m m N � d ycl !i : o L� Q C� O N %� N p l O CDCA j �V O m : as 00 Wow t a 3 �-- CAo RC07 � i3 m o S ,. y ci Co �- CD cn E; d qoGa o =; - � tz 7d a� y�� Z w � � Ct1 t'" n z w %O a- '� � tz b x w n � :� A a o• G7 � cn ^ � al a 7C � Cl t7l -z O H 0 0 c Siding Scope of Work Project Name: J A q-{,{, A 4 Area for work to be performed: NOT included areas and surfaces: Building Yes No 7Dumpster (if needed) 8r Rubbish Removal: Yes NoPermitting:�„ Q Location: I\ r, t V iJ Surface Preparation & Details O 1 x YES NO Notes: _�'j /tq.c n'� e"' i,C .2�, /iy f ✓t fah kf frj— Removal of existing la ers of sidin : Remove / Reinstall electrical meter if needed):�.� Remove / Reinstall light fixtures where needed): Sheathing rot replacement priced additional) at $� per 4x8 ft. section or $ t ?per board ft. *additional* Moisture barrier Installation: Type: p� cl{ e1 Insulation installation: Type: Siding fastener type: ..� S t S 6k - Window and Door flashin : ;4g /-� Siding 1 to-be;installed: iyti(,' 'Texture:: (j,) oo �" ,�,��.{ .� ; :j -� Exp: Color: Siding 2 to be installed: Texture: Exp: Color: Trim Features and Accents Corner boards Window Frames Door Frames r '. age Door Frames O 1 x O 1 x O 1 x O5/4 x O 5/4 x 5/4-;x ; % x O V 1 x Cellular PVC F 1 xCellular PVC , � C% 1 X �{ Cellular PV 5/4 x C) 1 x ellular PVC O _ With Sill Nosing vo �i)s-� , Q�ac� ���{ (moi- r Ne eatherstripp' Other: Other: Ge A^ O ( J.,." Other: [� SI �j Other - Color: Color: Color: C or: keboards + Eave (roofline trim) Other: Soffits utters x O Hardie soffit smooth O 5/4 x V `P`'� ILY0 (vented as needed) 2 piece PVC inyl efs O 1 (� p (2" strip vent where needed) Hardie panel smooth Vai-sedel Vinylhutters x ellular PVC (2" strip vent where needed) Pairs: O PV t. -d alum um wrap �0 D-5 hidden vent vinyl soffit Porch CeXngs Other. Size: Other) }"Yb14 n1" PPkt� 041 VC tongue and gr e Colof� Coloe Color. Vln 1 beaded porch cellln Gable Vents: (circle one) Included - NOT Included # 12x12 Color: # 12x18 Color: #_ 18x24 Color: Specialty Gable Vents: 4 - Gutters: Included - NOT included -Quoted as separate option Areas: F,, Ir/ Type: Seamless aluminum Color: w It ii k Size: c' Downspout Size:2 "A 3 N Guards: Yes 0 No , Guard color. ko A.) - Notes and Options: i Specific Items NOT Included: We understand the following items are NOT included: t rr Pe vo t t-'1 c1Rk &t,) t T +v V"' ; Storm window and Storm door installation All other required permits or historical society approvals All Areas and surfaces not mentioned above t t iw� 1. C{{ r.� -ri •�•� r v f 1 `l�rr�(� n a_ r -- Clarifications: Basic clean up will be observed at the end of each working day, thorough at.project completion. We understand that if needed landscaping will be cut back away from the house by the homeowner or others prior to starting the work. See Definitions and Conditions on the back of this contract set for explanations of terms. -73 -' - 3 �oD Project Name: SIDING ESTIMATE SHEET REP: Address: 1ZW 'V*&r0*WaV-V-R A F-A491� POqF,4,c� t 0I Ell .......... .. .................... OT 9 OIL-, TOTALS, -T b, A _r1ohi L 0 square -fz square bum ter job $ job aide $ job xcesstne height, job Storm�fs;R/R- squ are $ job $ d" ' Opt 0 insulations !-, ' -,:squar square I 14 7� z - are es, 1i)tion b"w u �CfornerBkiiidi- ze,14 A- v- iv -1 I 7 J-11 --- wifildi)" tDO-0, rlifiI;Daqi 7 t $ir"Ag-O' P r,s* Doili.: F i,,_ 7, r $, -77 W t�+lin ft f.�_ $ 2 :4� AIV -11 A 1h J- d3 z cl -t"'i J6,; 'in I n , i ' ' $ n ad: n ftu"04�1" 0 69 irla�e+nri`slp$'neV;Lvc!) 57 60 h74f $ p a , ;" 7, a a $ I$ - $ s ft. �J ftE 5q: Gutters -2T 3 r floor $ K" �q er floor 2__ $ Jer $ 21in ft 0'! Others W6,,& 914 10, ?k .131 -7 Project Name: {� d-6 P - PAGE 2 ST �e cnnn� �r Zvi►nTr Ali) lilnvlolf y Vyi •v Vl' T Vl\l1 The base proposal reflects furnishing labor and material to complete the window replacement, roofing, remodeling, carpentry and/or siding work following.professional standards as follows: Areas for work to be performed:........................................................... . ................................................................................. ......................................................... . If dumnster_ location : . . . . . . . ....................................... Item Included Not Included 1) Removal of existing windows -- # of windows ( _ ) � Exterior Color 2) Rubbish removal X Quantity Included 3) Flashing, insulating and caulking for new window Double hung 4) Necessary Permitting W t c7jc7j b006 Window/ Door Products New Construction Replacement Window Style Manufacturer+ Model Interior Color Exterior Color Glazing -Grid Pattern Quantity Included Double hung �� , b hen Pr if em42k W Otto- (T bo wt b006 D Ghw"- V 5( s u Stu f_ nu SPECIFIC EXCLUSIONS: We understand the following surfaces are to receive no work: ♦ All items/areas.not mentioned above ♦ Interior painting/staining of windows Clarifications: Basic clean up will be observed at the end of each working day, thorough at end of job. See Definitions and Conditions on the back of this contract set for explanations of terms. W'HI"I'I: - C UST01ME R COPY YELLOW -FIELD COPY Pl\.."K-OFFICE COPY Project Name: T4 ,m /J t k PAGE 2 w-npir nu wnpw 0. A-jAloSIV The base proposal reflects furnishing labor and material to complete the window replacement, roofing, remodeling, carpentry and/or siding work following.professional standards as follows: Areasfor work to be performed:........................................................... . ....................................................:........ ............................................................. ............................................................................. Ifr. .......................................................... Item 1) Removal of existing windows -- # of windows Included Not Included 2) Rubbish removal X Exterior Color 3) Flashing, insulating and caulking for new window Y- Quantity Included 4) Necessary Permitting Double hung Sim, hj_o<< P> rsA (,v4zp_ IN( i,�f °toy tY Window/ Door Products New Construction Replacement Window Style Manufacturer + Model Interior Color Exterior Color GlazinR -Grid Pattern Quantity Included Double hung Sim, hj_o<< P> rsA (,v4zp_ IN( i,�f °toy tY S 56 oV S"wt&j �j c S(W a u, st y e 6 U I- T a SPECIFIC EXCLUSIONS: We understand the following surfaces are to receive no work: ♦ All items/areas.not mentioned above ♦ Interior painting/staining of windows ♦ ' ao_4 1 c Clarifications: Basic clean up will be observed at the end of each working day, thorough at end of job. See Definitions and Conditions on the back of this contract set for explanations of terms. yv Rt 1 A:'.- t., t:J 1 Ll4YULK 1 -UP Y YELLOW -FIELD COPY PINK-OFTICI {_'(.SPY Massachusetts - Department of Public Silfcty pard of Building=e�jR < �. ulations and Sta' ndards . Construction Supervisor License .. v -License: CS 99801 - Restricted to: 00 JOHN ATLIF` 46 MAY STREET WORCESTER, MA 01604 Expiration 2/912012 i ('onnni+sioner Tr€: 99801 j— U90f"ce"COnsumerAff",Ila iii & Business Regulation HOME IMPROVEMENT Li Li Registration:- he 157108 01 Expiration:: -95/2()11 .10 Type ;uPtn Card Bo UNITED HOME EXP_ ERTS I JOHN ALTIF 200 BUTTERFIELD DR STE I ASHLAND, MA 01721 Undersecretary or registration valid for individul use c� :he expiration date. If found return to: if Consumer Affairs and Business Regu,l L Plaza - Suite 5170 MA 02116 konva—lid�wi*iLtU�signature \ fWassachusetts - Department of Public S.tfety '"Pard of Buildino Regulations and Stanthirds . Construction Supervisor License c. License: CS 99801 Res !,dto: 00 , JOHN' ATLIF s 46 WY STREET ' :. WORCESTER, MA 01604 Expiration 21912012. ` Commissioner issioner Tr#:.99801 Office of Consumer Affair%t & Business gutnoan op ' HOME IMPROVEMENTCONTRACTOR Registration: 157108 Expiration: tLz ., Type Su0plc3m9;nt Card UNITED HOME EXPERTS' JOHN ALTIF 200 BUTTERFIELD DER STE l ' y ASHLAND, MA 01721— ---_ Undersecretary Lic ,n; or registration valid for individul use c lief rtthe expiration date. If found return to: j Of c of Consumer Affairs and Business Regu, w10'.a k Plaza - Suite 5170 Bos c, MA 02116 j t 'koivalidQith�ytsigtuiture J��-