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
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WatershedDis:
®�SepcW_ell �'
` loodplam ❑ Wetlands
F t `
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•.�®Water/Sewer,. _ - - -- �
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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.
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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
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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:
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/iy
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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
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$ job
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Project Name: {� d-6 P - PAGE 2
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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(
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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:
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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
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