HomeMy WebLinkAboutBuilding Permit #627 - 295 BRENTWOOD CIRCLE 4/23/2008BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
4 Permit N0: k91 Date Received 0
Date Issued:
IMPORTANT: Applicant must complete all items on this page
LOCA
M
MAP NO: PARCEL: ZONING DISTRICT:Historic District yes no
Machine Shop Village yes no-
TYPE
o-
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
New Building
One family
Addition.
Two or more family
Industrial
Alteration
No. of units:
Commercial
Repair, replacemen
:?
Assessory Bldg
Others:
Demolition
Other
eptic Well
Floodplain Wetlands
Watershed District
Water/Sewer
DESCRIPTION OF WORK TO BE PREFOTRMED:
OWNER: Name: (J
Address: r2gS 99-e 1tu)Vv-b r
or Print Clearly)
- 9'ZSY05�
CONTRACTOR Name:_ -P %,('- Phone: `` v 3 S
Address: & a V`N1Q/1 0(42, /lAw7 A Alf 02 $5"
Supervisor's Construction License: 6E 'aV? Exp. Date:. ` "`�C7
Home Improvement License:
ARCH ITECT/ENGINEE
Phone:
Address: Reg. No.
: 1.2 -a9'
FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Total Project Cost: $ 3 4/ GL5 FEE: $ �169
Check No.: 0q10 ( Receipt No.:
NOTE: Persons contracting with uJlregister,qd contractors do not have access to tete gioranty fod
Location U d11 C -/,l v
No. 4D Date a3. 0�-
NORTh
TOWN OF NORTH ANDOVER
�• • OL
9
Certificate of Occupancy $,
Building/Frame Permit Fee $ yy�
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check # 0101
21 102 Building Inspector
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
PLANNING & DEVELOPMENT
COMMENTS
CONSERVATION
COMMENTS
HEALTH
COMMENTS
DATE REJECTED DATE APPROVED
Reviewed on Signature
Reviewed on Signature
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 Usgood Street
FIRE DEPARTMENT - Temp Dumpster on site yes no
Located at 124 Main Street
Fire Department signature/date
COMMENTSQK-Fr/�`. Ri/aC �� ��`�-Z-���
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 Call Email
Date Time Contact Name
Doc.Building Pennit Revised 2014
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/Cross Section/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
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: Building Permit Revised 2014
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The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
' d 600 Washington Street
Boston, MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information l' nn f Please Print f,e2ibly
Name (Business/Organization/Individual): 5 � // c / t n-'ee-
Address: a VM ?4 G
City/State/Zip: /V r0A / IVl 030_9 Phone #: (�2 g X60 `f3 T q
Type of project (required)':
6. ❑ New construction
7. ❑ Remodeling
8. ❑ Demolition
9. ❑ Building addition
10.0 Electrical repairs or additions
11.❑ 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.
I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors mustsubmit a new affidavit indicating such.
$Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have
employees. If the sub -contractors have employees, they must provide their workers' comp. policy number.
I am an employer that isproviding workers' compensation insurance for my employees. Below is thepolicy and job site
information.
Insurance Company Name:
Policy # or Self -ins. Lic. #:_
Job Site Address:
Expiration Date:
City/State/Zip:
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 $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
I do hereby certify der t e pains and pe hies of perjury that the information provided ab ve is true and correct
Si atuie: /� IDate:
Phone q? ? � 3 6 0 - f �,g1
only. Do not write in this area, to be completed by city or town officiaL
City or Town: Permit/License #
Issuing Authority (circle one):
1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
61., Other
Contact Person:
Phone #:
Are ,you an employer? Check the appropriate box:
1. ❑ I am a employer with 4. ❑ I am a general contractor and I
employees (full and/or part-time).* have hired the sub -contractors
2.6 I am a sole proprietor or partner- listed on the attached sheet.
ship and have no employees These sub -contractors have
working for me in any capacity. employees and have workers'
[No workers' comp. insurance comp. insurance.$
required.] S. ❑ We are a corporation and its
3. ❑ I am a homeowner doing all work officers have exercised their
myself. [No workers' comp. right of exemption per MGL
insurance required.] t c. 152, §1(4), and we have no
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.❑ 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.
I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors mustsubmit a new affidavit indicating such.
$Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have
employees. If the sub -contractors have employees, they must provide their workers' comp. policy number.
I am an employer that isproviding workers' compensation insurance for my employees. Below is thepolicy and job site
information.
Insurance Company Name:
Policy # or Self -ins. Lic. #:_
Job Site Address:
Expiration Date:
City/State/Zip:
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
I do hereby certify der t e pains and pe hies of perjury that the information provided ab ve is true and correct
Si atuie: /� IDate:
Phone q? ? � 3 6 0 - f �,g1
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
61., 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,operAe.-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 -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' 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 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. # 617-727-4400 ext 406 or 1-877-MASSAFE
` Fax # 617-727-7749
Revised 11-22-06
www.mass.gov/dia
STEPHEN LSE
BUIL DING & CARPENTRY
6 Hayman Circle
Newton, NH. 03858
H#603-382-3648
C#978-360-4384
................................................................
April 22, 2008
Will and Chris MacNally
295 Brentwood Circle
North Andover, MA. 01845
H# 978-975-1052
W# 781-897-1771
Dear Will,
The following proposal is a detailed list for the siding work to be done on your
home.
• Remove existing leaf guards, Gutters and Downspouts. Reinstall later
• Remove existing vinyl siding and wood siding.
Remove existing corner boards, Rake boards, Soffit and Facia boards and
window casings.
• Remove existing building paper.
• Remove all light fixtures and install new PVC trim block behind each. .
• Install new Tyvek building wrap to all exterior of house.
• Install new PVC trim boards:. 5/4" x 6" lock miter corner boards.
5/4" x 5" flat window casings.
2 pc's. 1 x3 with 2" vent strip for soffits.
1 x 8 and 1 x 3 facia boards.
1 x 8 and 1 x 3 rake boards.
• Existing front door trim to stay as is, Fix bottom right corner with
horizontal 1 x 12 pine just like the left side was done. If you want to do
new PVC trim around the front door it would be extra.
• No PVC trim will be installed around casement windows in sunroom.
Kitchen window and 2 back sliders will have casing and sliders will have
5/4 x 8 kick boards.
• Remove lattice from around sunroom and up to hot tub, Install PT 2 x 4
frame work to provide nailing for 1 x 3 vertical PVC trim.
• Remove and install 2 blocks and new dryer vent hoods.
• Replace existing gable vent with new 14" x 20" wood vent.
• Install new Certainteed fiber Cement Siding 5/6" x 5 W" @ 4"" to the
weather, Smooth siding will have a 2 coat custom color, Cabot "SHALE".
2 5y warranty
• Siding will also be blind nailed.
• Any rot that is found will be repaired, but is not included in the cost
below.
• Debris removal is included.
• Painting of the new PVC trim is not included, But I will paint one coat of
acrylic latex in white for a additional cost of $1800.00 �s rAdAN-,P M1110
• Soffit and facia above back slider to stay as is.
• Siding and trim on garage and office to stay as is.
• Siding and trim on front of house at side entrance to stay as is.
• Permit fee is extra, Raiming is metpa and rot repair is extra. New front
door trim would also be extra.
Total cost for the above listed items is $34,645
Payment schedule: $6000 at sighing
$4000 at start of job
$3500 each Friday and bal. due at completion.
Respectfully submitted,
i �r
1