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HomeMy WebLinkAboutBuilding Permit #201 - 29 PADDOCK LANE 9/15/2009 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: d IMPORTANT: Applicant must complete all items on this page LOCATION or VC l-A Print PROPERTY OWNER_'i_c—ft-,, ktIrN I-M k t',,51- Print MAP NO: PARCEL:OzZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residen ' Non- Residential New Building O�familAddition family Industrial Alt n No. of units: Commercial Re air replacem-anD Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: -A Gh lsd L-- 01P&U l/ll xs Identifica 'on Please Type or Print Clearly) OWNER: Name: IU Phone: 6 �4'Q6s`� Address: CONTRACTOR Name:_ ' III�-IQM-71bW 1W2 Phone: C��$ 23>t4.�-Z� 3 Address: '- (" i-A-5,�- �v"f" 'hCli[ ►fit tit a 44- Supervisor's Construction License: S'---4 54 Exp. Date:3-4 - 2-b10 Home Improvement License: )b F+So Exp. Date: 2b 1 (� 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: $ ,21,71--14 .• 4A FEE: $ 9 Check No.: y Receipt No.: I;Z 11/ NOTE: Persons contracting with unregistered contractors do not have access to the guar ty 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 L b- 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 - 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) o 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 ❑ 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 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. Xb/ Date �S o NORTN TOWN OF NORTH ANDOVER � 9 i y Certificate of Occupancy $ s' tt� Building/Frame Permit Fee $ sAcmus Foundation Permit Fee $ Other Permit Fee $ _ TOTAL $ Check # 2 2 �, 1 6 Building Inspector NORTH TONM of : 4Andover No. 7100) 0o dover, Mass. �/ Oz o = LA f f COCMICMEWICK y�. ADRATED S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System J BUILDING INSPECTOR THIS CERTIFIES THAT.................................�.� . .....1-4..................................................... .� Foundation has permission to erect....... ............................... buildings on.... !! ...©. :. .. ?..G.�11'.................... Rough to be occupied as......... ..... . ,� �- `....> . . . :.. ........./.... .... /... dor..! '.................................... Chimney provided that the person accepting this permit shall in eery 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 ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough ............................ a �.....—...-.�.................................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal 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. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): I Z- 7 MI ixl�1 Address: �5'-_)— g City/State/Zip: "&r'hf L1L--AJ Phone#: Are Yru an employer?Check the appropriate box: Type of project(required): 1. I am a employer with 2. 4. ❑ 1 am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. t 7• KRemodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9. ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL I L❑Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.] t employees. [No workers' 13.❑ Other comp.insurance required.] *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. $Contractors 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: 6 P—m F-mi"4 Policy#or Self-ins.Lic.#: 66 Expiration Date: V.2— 0— 2Q)CpQ Job Site Address: oe 2A nory lI Lx A City/State/Zip: [IA MA, (aARA-5 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. 1 do hereby certify ung r the ns d penalties of perjury that the information provided above is true and correct Signature: Date: Phone#: ' f 263 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# 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 carry 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 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 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 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 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 (i.e.a dog license or permit to bum 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-MASSAFE Revised 5-26-05 Fax#617-727-7749 www.mass.gov/dia '✓�re-Vantirrrt�rtu�eulcst n��y�.a9Nr.Cstti6e��4 - . Board of Building Regulations and Standards i Construction Supervisor License License: CS 57754 Expiration: 3/4/2010 Tr# 20207 Restriction:TO WILLIAM D HOPE 589 CHICKBRING RD REAR N ANDOVER,MA 01845 Commissioner Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 101730 Expiration: 6/29/2010 Tr# 267903 Type: Private Corporation HRH CONSTRUCTION INC. William Hope 589 CHICKBRING RD.REARQ.00.�.� N.ANDOVER,MA 01845 Administrator r COAsunur Offift home, I'M I I. blistill .mea �0°0ay"�L* Aosr�tap, Qsdard 8nmea�ner in>re oa �imi6ap d �9 Sw oba 'ZI A Haft ��� aotttseap�O��� GtyR Street Ofta Noft Pboac eas(Itdr�eattroa,aC ? `-� DCoae --�•.�"°°'a �-ZG� 'tel . Aft f86— mows atadeor,.b;,1iE�tK.3ba me,a�ti,.y,6e�sif a 6 '2—e2pi C7 ccs t�2 ee andwMbencuradbylbe > n (Ownerswlrose t�,� wMbe �•a�ab s �t�ul ewJuded�m s6p 15 M 1ST OOp° �uo�artse MM Cb>ltr j '��Fmd Of =Ll�l,r"tlt:` -r21� z •� , C"PC.'Ya �U11-1J11u� �L'li2 i Y2LQAL Total Commit Priee m+dP�aymtyttScbed� Complete& Contractor ogees to pufa m the work ft M the Mucrisl and bbm,Vecilled above for the Goal stop of P"mcats wpi be made according to the followin t, gschedplc S 1 2S signing oota�(not fo 1 tete" 5 (S-` sTx-"Zr t2wnftMPrk*-q S i GC7 by orupon""coon of ► 6�Cost mat orderitetn;wbieheves is grater) s 12--- , tad 6 by, / � C S� � �S \J i 1?a��t� h2c2'�1 �s�'2 17Q b� °r°p°n °f ►�C5xt2 t VT�` liSL�1Crtu�� -t n comp on L��T �i fJ t6 c� ire!iel c5'Y tti (Laws�bidsa ,gam r� Lit- As vi j The follophig�PSOMmmtbe V s •.5. �nh8et is camptddd to bOtlt party's satisf y paid ibr tomixtthe comp lKSlaslpord4 2 ^i toirepddfor l -r NOTES; 1�; 5� ,r� -4. %e r)nO'e itagnit ft--�(•;)t.awreq,kwth t whiehmmt6a SwMof(R)0OD'tbadadf6etaW a(b)dOPOI8°pt bydwccn"cWri ��o aP l ordered in edwna m area the�i�ioo srhedalCM 1f1Y 4 i for orq uredo otateriil _gam Sabeoubacn-fhe �osmrmed6teet'+onC�fbewodtd� afffieaetionsC� and °°�°tt'esae5� 6eso�etpffirr�" tbsd CouiradAcapi"am TJO ° m�iidamaaeat Po3martttoml' tor c�oUy befotistgaarg' ototberseattuy artaatLta bean3tlaom i�t gyDd whin do�+�t the ' the ®atioos and noticrs aft Daft bepaw0dfi"S MtSeeor Tiitet�tomdad tae:theeoo�r.--_�i*a1N8ame; �.... �t�s®dit Att�i• ta >bbeteg wAitiai�iaeegtrd7laate �1++►ugtaftesaowtbome- + a6nnbp*ribgbOCDiroesorsQacAsllmdop Yartie�ry M30W +ightsaon (�� baieC��gn•eo�gd Bntd4.1tA4tl�arb�r . Does tbe000trarsar dm CrurdeGatbe2�ome �tadtiits7spottaot �i�a?th'amdpaodS�a�jafrtneCoa� . Co�orLatr. You map caoad tltes agito®ea2 i[tt Las ba>l ata 'a m ma- cakearbeaaeita� t�ttdtem�tyw'saotttrlpiiaew� Provided � � tfiaiAee�i�'ett 9� by DO ee y �8p0°tseptarb�r a�tbe NrRA(,'1`IF g1pp �m�raa EAB AMWY�SSPACBS!n riot Coauactor's/Si>>>a� 4 eaC Ir 1�� ��FB�� r�f$ te{�p�� Qj FI � o i ¢ 0 Ifi� Yfai f i HF.H CONSTRUCTION Scope of Work 29 Paddock Ln. North Andover. Ma. July 29,2009 Overview: Remove and replace existing siding, 17 windows, and front door. Existing siding and exterior trim will be removed,new Tyvek house wrap will be installed, and existing windows will be removed and replaced with new Marvin windows per the attached window schedule provided by homeowners. Existing interior window and front door trim will be removed as carefully as possible in hopes of reuse, if any is damaged or unable to be reused it will be replaced with new pre primed trim to match existing as closely as possible. New siding is to be JamesHardie 5/16 x 6&1/4"color plus in Country lane Red.New siding will be installed per the Manufactures installation instructions. New exterior trim will be Windsor 1 or similar. New front door and storm door are to be Thermatru fiberglass door type CCA260 with 4 block detail shelve and two sidelights. Storm door; Larson storm door 250-17. An allowance of $2404.13 is included in the contract for the new front door,storm door,and required hardware per information supplied by the homeowners. There is no allowance for any painting,interior or exterior,plumbing, electrical, air conditioning, or heating work of any kind in the scope of work, drawings,or contract. 15 of the 17 windows and the new front door are to be installed in the same existing rough openings as the windows/door removed,two standard double hung windows will require that the existing window sill height be lowered to accommodate the new windows,no other re-framing of these or any other window or door openings is included in the contract. r t ' Miscellaneous: HRH Construction accepts no responsibility for any damage to existing landscaping in work areas. HRH Construction will provide an on site dumpster and porta-potti for the duration of the project. All waste,scraps,and cut offs will be placed in the dumpster for removal upon completion of the project. The site will be kept clean and orderly and swept daily. HRH Construction accepts no responsibility for the structural integrity,level, or plumb of any existing structure,wall, floor or ceiling.Homeowner understands that while repairs to level or support existing structures may be required, for example,to provide adequate support or a plumb wall for kitchen cabinets,they are not included in the contract price. No changes to the Contract, Scope of Work,or Drawings will be undertaken without a signed change order. No painting or staining of any kind,other than that specifically stated is included. It is the homeowner's responsibility to remove all personal belongings from the work area prior to work commencing. Homeowners are to provide sufficient off street parking for the dumpster&HRH Construction tool trailer and provide a dedicated 20amp duplex electrical outlet within 100 feet of the tool trailer. While every effort will be made to minimize any dust or mess,homeowners understand that due to the nature of the work some mess and certainly some dust contamination of non-work areas is inevitable. While standard permitting fees are included in the contract total there is no allowance for any additional meetings that the building department may require,nor is there any allowance for any engineering or meetings with other boards, such as Historic, Conservation,Planning,or Health. Schedule dates are tentative and include no allowance for weather days. Changes to the contract or Scope of Work will impact schedule dates. Homeowner: /`%�"� d Date: G 3a CJ HRH Construction: AX110 Date:�N HRH CONSTRUCTION.P.O.BOX 5164.ANDOVER.MA 01845 978-314-7263.hncconstruction@comcast.nct I