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HomeMy WebLinkAboutBuilding Permit #011-2011 - 28 HEWITT AVENUE 7/1/2010 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: 7 l� IMPORT T:Applicant must complete all items on this page LOCATION o7 t7 E w rF VGt" PrinC�n PROPERTY OWNER tF�NG�/a o Uy l o z Print MAP NO: all0 PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New BuildingOne fami Addition wo or more family Industrial Alteration No. of units: Commercial Re air replaceme Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District ater/Se DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) Un QOWNER: Name: 14Aa1��.► EZoj It�� d y Pe: Address: a 06 w r( v F c� , ✓1� ,� CONTRACTOR Name: i7 Phone: o i - Address: cZ's Wit✓ an Supervisor's Construction License:_ ;16-1 � Exp. Date: x""101- Home improvement License: /d 7S- (, Exp. Date: ARCHITECT/ENGINEER Phone: y Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 7d�? FEE: $ el-'' Check No.: �0,�'"� Receipt No.: 023 r� NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund ,pignature 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 i COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes ,elan:ing Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature&Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMf NT Temp Dumpster on site yes '_o12 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 - 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 ❑ 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) ❑ Mass 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 NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit i 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: Doc.Building Permit Revised 2008 Location No. 6// . 2 ° /i Date ° e►ORTol TOWN OF NORTH ANDOVER � A Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 230 :U � �� Building Inspector F ORTH 0 0Andove 0r �. C A K -O over, Mass. 7� P COCHICHEWICK 7�ADRATED S BOARD OF HEALTH P,ERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT............. T.... ` C'© �. �j�............................/............................................................................ Foundation has permission to erect........................................ buildings on ..,;5.2 !..<." / 4.' ................................I............ Rough to be occupied as . Chimney provided that the person accepting this permit shall in every respect 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 Final PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTIO STARTS ELECTRICAL INSPECTOR Rough Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. Office*.emp"�[PS's°0 es License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: x100756 Type: Office of Consumer Affairs and Business Regulation Expiration: �/.2�/2012 DBA 10 Park Plaza-.Suite 5170 • :' I F Boston,-MA 02116 ACO 'ST RLOMITb�m 1 Richard Ru bera 1rt! 44 WEST SIDE DFR? ATKINSON,NH 038 k Undersecretary Not valid without signature i Massachusetts - Department ot• Public S'afetc Board of Buildin!- Re!-ulations and Standards Construction Supervisor License License: CS 25158 Restricted to. 00 RICHARD J RUBERA 44 WESTSIDE DR ATKINSON, NH 03811 Expiration: 8/19/2011 (linuni.ci,ner Tr#: 171 The Comnaonwe¢lth o Afassach .f usetts Department o f£radusfrial Accidents Office of£nveskb ations 600 Washinpon Street -Boston, MA 62111 didWorke ' Cm WWWrmss-ov/ Pensation�nsurance Affidavit: Builders/Contractors/Electricians/Piumbers . .A Iicant Inforynataion PIease Print Legibly Name(Business/Organiza6on/Individuai): Address: City/Sfiate/Zip: Phone#: Armee you an employer?Check the appropt late box: I•L'� 1 am a employer with 4. ❑ I a a 7�[] oject(req7:ed)employees(full and/or part-time) * havehirederalcontractor and I the sub-contractors constructi 2.❑ I am a sole proprietor or partner- listed on the attached sheet odeling ship and have no employees These subcontractorshaveworking for me in any capacity, workers' com . ' ❑Demolition [No workers'comp:insurance 5. ❑ We area..c p insurance. 9 ❑Building addition required.] orporation and its officers have exercised their 10.[]Electrical 3•❑ I am a homeowner doing all work right of e� repairs or additions myself. motion per.MGL .1 LD Plumbing repairs or additions Y [No workers'comp. c. 152,§I(4],and we have no insurancerequimd.] t employees_ 12.13Roof rep ' [No workers comp.msurance required.] 13.[]Other -Amy s^pliceat that checks bos.ttl must aiso a'out f t:secao_n below shoe � homeowners who submit this affidavit indicalin a" ar Werke s'cotn_� . . .t: ,. +Contractors that ch=ic thus box must g the'am dig all•"'or"and -�h�an additional shed showing the rn,of °��c011=Ctc;mu_�t submit a now fiidavit indicating such, same of the snb�cenuactsrs and their workers'co I am an employer that is providing workers'compensation insurance or m employ �'•policy information. information. f y employees Below is the policy and job site Insurance Company Name: r_Ze U , Policy#or Self-ins.Lir. 04 —5 Expiration Date:_ Job Site Address: City/Stats/Zip: Attach a copy of the workers'compensation policy declaration pate(showinb the poky number and a iratio Failure to secure coverage as required under Section 25A ofM xP n date). fine up to $1,500.00 and/or one-year imprisonment,as well as civil G penaltiescan l th to imposition of Of up to$250.00 a day against the violator. Be advised that a co R penalties of a STOP WORK ORDER and a fine Investigations of the DIA for insurance coverage verification. py of statement may be forwarded to the Office of Ido hereby c nde the ns ndercalties o er u or `9l p fP 1 rJ th zt the in f rnauon provided above is true and correeL. • SiQnatur-e. � D Official use sc only. Do not write in this area, to be completed bj,eitj,or toitm.official City or Town: 1Permit/License# Issuing Authority(circle one): L Board of Health 2.Bi ldi.¢g Department.3. City/Town Clerk 4, Electrical 6. Other trical Inspector 5.PIumbinR Inspector Contact person: Phone#- Information an- d Instructions Massachusetts General Laws chapter 152 requires all.employ<--rs to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every pt✓zson in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partaership,•assocization,corporation or other legal entity,or any two or more of the foregoing engaged in a joint.enterprise,and including the Iegal representatives of a deceased employer, or the receiver or tmstee of an individual,partnership,association Dx-other legal entity,employing employees. However the owner of a dwelling house having not morethan three apartroLeuts and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintc:a=ce,construction or repair work on such dwelling house or on the grounds or building appTrb ant thereto shall not because of suchemployment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local Iicensiug'agency shall withhold the issuance or renewal of a licenseor permit to operate a business or to Construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of coimpUmce 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 um-t:fl 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 compleibly,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'comp ensation insurance. If an LLC or LLP does have. employees,apoli.cy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. .Also be sore to sign and date the affidavit. The affidavit should be ivtfsiued t0 the City. Or usvrrt+chat the aut+uCauori f{3r the pe�1lt'or License us bemg reques�.;;d,not the.Department of Industrial Accidents. Should you have any questions regardLg the law or if Voir are required to obtain a workers' compensationpoiicy,please call the Department at the.numbe=r listed below. Self insured companies should enter their self-insurance license number m the appropriate line. City or Town Off coals 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 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 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 stampe=d or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits 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 (Le.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office ofInvestigations would Ire 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,.faxnumbelr__.-- The CarMQnwealtbL orf Massachusetts. Degar mt of Indu thal Accidents Office of hVesti ations 600 Waslia ton Stmt Boston,MLA 02111 Tel. ## 617-727-4900 ext 406 or 1-9 7'7_MASSAFE Revised 5-26-05 Fax #6.17-727-7749 acx� ass._.gov/dia. Rubera Construction Inc. Est.1977 44 Westside Drive Atkinson NH 03811 NSTRUCTION"'c Phone 603 362 8880 Fax 603 3624845 6,.Cwt&Cew of, www.ruberacontruction.com RESIDENTIAL•COMMERCIAL iO.Siil■l'l."+�"'C�`afit7=.b 3iCl.j* "'�' '.. 978.687.2942•603-362-8880 ruI-r a con struc H orx.!--.t.L Date: June 28, 2010 Ron Moody 28 Hewitt Ave N. Andover, MA 978 689-90691 Install wrap around drip edge to bottom edge and rakes Install Silver Birch Architectural shingles Cut out and install ridge vent Install white aluminum trim to two gables only on main house Permit not included Rubera Construction Inc. proposes to furnish labor and material - complete in accordance with the above specifications for the sum of: $ 6,700.00 All material is guaranteed to be as specified. All work will be completed in a workman like manner to standard practices. Any alteration or deviation from the above specifications involving extra costs, (I.e. excavation required for ledge removal etc.)will be executed only upon written change orders, and will become an extra charge over and above this quote. These additional charges must be paid in full before said extra work is initiated. All agreements contingent upon strikes,accidents or delays beyond our control. Acceptance of Proposal - The above price(s),specifications and conditions are satisfactory and are hereby accepted. You are authorized to complete the work as specified. Date Accepted Signature Date Accepted Signature 1