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Home My WebLink AboutBuilding Permit #578 - 27 MEADOW LANE 4/9/2008 BUILDING PERMIT Of r10RTHt,.bo 06�ti �.r bb.tt •6 O TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received �s A°q�rcn �SSACH�15�� Date Issued: O IMPORTANT:Applicant must complete all items on this page LOCATION Q '7 _Ilea oLo L,ttil C� Print PROPERTYOWNER KOrek) 1-G�tltleoJ Print MAP NO:gSG#V PARCEL: ` ZONING DISTRICT: Historic District yes no L45-G 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: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: Identification Please Type or Print Clearly) r OWNER: .Name: Ka ,/v PhKrhlen� Phone��7o 3�i4g Address: Q9 Me,Jr,,zL rJ CONTRACTOR Name: 134.,,i1c%.,s 1►l< Phone: 9,7 - 6 coli-503 Address: (_ 3 / !�Oe1c 5"+ Supervisor's Construction License: Q5 '7-/q7Y Exp. Date: /- 2y-.2o,:77 Home Improvement License: / Seo'4 z Exp. Date: 2 2 - ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ c� �.dCY� FEE: $ Check No.: a `�/ Receipt No.: (O NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contractor 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 DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT 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 924 Main Street Fire Department signatureldate 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) �'S, 6(GK— LI Notified for pickup - Date --._................................................................................._.-......................................................................—_.................._........................................._.. ..............................................................................................................................................................._............................................... Doc.Building Permit Revised 2008 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 o 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 o Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) Li 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) o 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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 Location CY No. Date NpRTq TOWN OF NORTH ANDOVER 3?O:�.. ° :•'stip F pw r a Certificate of Occupancy $ ;�s'••°'Eta' Hus Building/Frame Permit Fee $ �- �c Foundation Permit Fee $ Other Permit Fee $ �TOTAL $ Check # ! 2 o 5J Building Inspector VAORTH h (a 'CA9M }( _ 0 LA f o dover, Mass., � • o T C ✓�,, COCHICHEWICK � s ADRATED pPa\ '- I`S BOARD OF IiEALTH I Vj 3D Food/Kitchen Septic System � BUILDING INSPECTOR THIS CERTIFIES THAT...... .r ..........C.9.....q ...... ................:................................................................. Foundation has permission to erect........................................ buildings on .. .4...........M.C..A..C9.Q.W4.............1. Rough to be occupied as....S.I& .... � '.8.:: .... .....Q .uo. ... .PAA.�I;f.J �. .....�........5.�..C:.) :r�...� Chimney provided that the person accepting this per shall in every respe conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final ® UNLESS C,ONSTR�J� T TS ELECTRICAL INSPECTOR Rough �.�... Service BUILDING INSPECTOR Final Occupancy i ea- ra.it Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises -- Do Not Remove Final Ng No Lathing or Dry Wall i o Be Done FIRE DEPARTMENT !Until inspected and Approved by the Building Inspector. Burner Street No. IL SEE REVERSE SUDS Smoke Det. The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations 600. Wiishingtox Street . oston, MA 02111 www,mass.gov/dia Workers'. Compensation Insurance Affidavit: Builders/Contractors/Eleetrica A Iicant Information ns/Plumbers Name (Business/Organ;,ation/IndMdual): c Q �� (� PIease Print Le 'bI . �� 1cI iS ,r Address: if City/State/Zip:_-M t ,,_, MQ Phone.#: SF--/3 zL Are you an employer? Check the appropriate box: 1.❑ I am a employer with 4. ❑ I am a general contractor and IF ject(required). employees (full and/or part-time).* have hired the sub-contractors construction 2•❑ I am a sole proprietor or partner- listed on fibs attached sheet delingship and have no employees Thesc sub-contractors haveworking forme in any capacity. employees and have workers' lition [No workers' comp.insuranceomp. insurance.$ 9. ❑Building-addition regtured] 5. [v We are a corporation and its 10. 3.❑ I am a homeowner doing all work 10.[]Electrical repairs or additions officers have exercised their m r if mp right 11.❑Plumbing repairs or additions ys [No workers' co ri t of exemption per MGL insurance required.]t c. 152, §1(4), and we have no 12.E]Roof repairs employees. [No workers' 13.❑ Other °Omp• insurance required] 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Hameov.:zers who submit this affidavit indicathtg they aro doing all work and then-hire outside cont�,.tors must submit a new affidavit indicating such. iCont-actors that check this box must attached an additional sheet showing ub-contractors and state whether or not those entities bout the narne of the s employees. If the sub-contractors.have employees,they must provide their war kers'comp:policy number. am an employer that is providing workers information. 'compensation insurance for my employees. Below is the policy and job site Insurance Company Name:_ —r Policy#or Self-ins.Li c. Expiration Date: Job Site Address:_ a`1 .m rr„alUt,J L_�v City/state/zip:_ yy do 4C Attach a copy of the workers' compensation policy declaration page(showing the policy number and expirationdate. te). 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 Investisations of the DIA for insurance coverage verification. Ido hereby certify under the pains•and enables ofperjury that the information provided above is true and correct Si ttu e: Date: Phone#: — 7Other only. Do not write M this area, to be completed by ctty or town officiaL a: Permit(License# hority(circle one): Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspectorson• Phone#: Information an d 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 p=rson in the service of another under any contract of hire, express or implied,oral or written." r 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 appurteaaat thereto shall notbecause of such employment be deemed to be an.employa." MGL chapter 152,§25C(6)also states that"everstate or local licensing agency shall withhold the issuance or renewal of a license or permit to,bpera!te-a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of co mpliance with the insurance coverage required." Additionally,MGL chapter 1ti2, §25C(7)states'"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for,the performance of public work urntil 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-contractors)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 carry workers' componsaiion insurance. If an LLC or LLP does have employees., a policy is required. Be advised that this affidavit maybe submitted to the Department of Industrial Accidents for confirmation 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 s ireto fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating cmrent 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 pmmaits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related-to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.) said person is 2-JOT 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. T�e Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 W shirg� Street Boston,MA.02111 Tel.#617-727-4900 ext.406 or 1-8.77 MASSAFE Revised 11-X22-06 Fax # 617-727-7749 www.mass-gov(dia / L'G,xr3oc�C�wiel' dal-/jam/ 4iria3{HY,l({eCI'L✓f1.- F�j "' Stall Boa:d of 1111i, IiegnNT CONTRACTORdy viome IMPROVEN►E — Registration: 145042 Expiration: 12121212008 Type;`Supplement Card BUILDERS IMG• STEEPLE CHASE J JOSEPH CLEMENT.:' MAPLE ST MA Ad,ninistrator 153 p1844 NIETHUEN, �eilb �� °�✓ St�,dy. flze ufations and C ��d g a onstrisor License Board 0€ction CCS Sup u 74478 ti se; Uce.n112411964 Tr# 9142 + > Birthdate: °w ExP�ration; 112412Q09 Restriction- 00 2, M CLEMENTI �G- JOSEPH Comrniss�on 153 MAPLE ST 44 METHUEN,MA 018 l Construction Contract 1 ' A. Date of Execution 4-4-08 B. Parties Contractor: Steeplechase Builders, Inc. 153 Maple Street Methuen,MA 01844 (978) 688-5036 MA Home Improvement Contractor Registration# 145042 Federal Identification#20-1906118 Contract executed by: Christopher D. Smith Joseph M. Clementi Principal, Director of Planning Principal, Production Manager Steeplechase Builders, Inc. Steeplechase Builders, Inc. Homeowner: Karin Pantleon 27 Meadow Ln North Andover Mass. 01845 (978) 873-1991 C. Project Address 27 Meadow Ln D. Proiect Summary 1. New Hardie Plank Siding and Shutters 2. Replace Doors and Windows to Breezeway 3. New Overhead Garage Door and Window 4. Replace Column to front Entry E. Proiect Cost $27,347.00 X 111EU (� ' o4-,ol 1200 Yi Homeowner Signature(s) Date Date Con a for Signatures