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HomeMy WebLinkAboutBuilding Permit #667-16 - 299 WEBSTER WOODS 5/1/2018 BUILDING PERMIT ®& `AO RYH TOWN OF NORTH ANDOVER � - L -?In4s AJ 6't SCP-vv' APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received //30 oil �RA°RATED Pea'�5 ACI4usE4 Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATI®N C135-b6--& Pr'nt P R©P E RITjtY ®W E' � � ' a !t���ti �/v` '� LNTrn-ft ear S rue ure yes no MPF P/aRCEL Z®NfNG DISTRi THistoric District no p� Village ye no. TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building VOne family ❑A dition ❑ Two or more family ❑ Industrial Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ky�.e . «vat+^ '�Z'.w,,. ',""- �. Septic 0 ,, � ' Well �� �' ' ® Floodplain ; ®Wetlands ® Watershed ®'stnct0. � Water/S e t.._ t � r DESCRIPTION OF WORK TO BE PERFORMED: "KE M-D E L e5aIn£ny T- 7'0 N L f D ATti it s a nor �(.��-tie-�{! - G,� ��►Dow (-•e ss - W4 LLS S V seol U e O( L►G � I r lol Identification- Please Type or Print Clearly OWNER: Name: P4v ( * 7"t r Al it `( 2 iv TCA- Phone: 77 2 - S 70 - 4?03F Address: CIO/ W t-S!;TC - w o u b s Contr c or Name. pw u ; _ __ T� &5 n�f 'Pho e Ernail .�nct��_S ..�CQr✓1 ._ .. Ad d resIS ... .. r:, :, :� "h 'v ,�, fit,•. �. `�, Supervisors Construe ion License Com !./_(?:. a Mate Home Impro ement LRe:n�see,t ate Z ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED OWN$1125.00 PER S.F. �Cost:Project �0 d Total Pro1" 7Y�Dov FEE: $ C eck No.: Receipt No.: � ergo s contra re�isterecl coaatrc� r� �u� a access to the�uce�canty fund Plans Submitted ❑ Plans Waived.[] Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL �/ T. : Public Sewer u Tanning/MassageBody 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 o U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on l f / Si nature ju COMMENTS W �� �-�.� �- ���� v� t� 0�✓ C� �¢ + 0— HEALTH Reviewed on Siqnature 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 AFIRE DEP`ARTMEIV jg_x�Xev—®u�mpster�on site yes `` $ `�"t °°=" " Locsted at 124 Main M# r x ; reet Fire D p'rt a si nature/date `I° �. * °-++�1+� w +, r+ui A •� �.{"" # i'i, d�;i r„ r +e cx; Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of IVlete>t^ location, mast or service drop requires approval ®f 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 ease) i ® Notified for pickup Call Email Date Time Contact Name Doc.Suilding 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 m"' Building Permit Application ✓ 1( Workers Comp Affidavit ,/ V Photo Copy Of H.C ✓ And/Or C.S.L. Licenses m/ Copy of Contract Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products OTE: 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 DTE: 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 ATE: 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 Clerics 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 Location w A No. W Date • • TOWN OF NORTH ANDOVER Certificate of Occupancy $ i Building/Frame Permit Fee $ M} Foundation Permit Fee $ a Other Permit Fee $ TOTAL $ Check#Qt r 29749 � r 2 9 7 4 9 Building Inspector Enter construction cost for fee cal - North Andover Fee Cakulation Construction Cost 74,000.00 m $ - $ 888.00 Plumbing Fee $ 111.00 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 111.00 Total fees collected $ 1,210.00 299 Webster Woods 667-2016 on 12/2/2015 Remodel Basement with bathroom NORTIy own of o No. (061- 20 Lh ver, Mass, coc 7.95 RATED U BOARD OF HEALTH Food/Kitchen PER IT T L D Septic System THIS CERTIFIES THAT ................ ...1101.............S.��.... ..... BUILDING INSPECTOR .............. ...... ... ......................... has permission to en ..... buildings on ... ��� . Jo Foundation .................... 0 ..... .... Rough to be occupied as �.d`�:'.`�...... .. �!1�!k.� ................ a... �C ��?✓.......... n Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in 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 Voids1his Permit. Rough Final PERMIT EXPIRES IN.6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO Rough Service .................. ........ .... .................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building- 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. Smoke Det. fr rrt. POOL - 6-0 - i _ -7 rc, Rw�rt jivb_ aid _ w _ - - - S 3 0il 0 1 The Commonwealth of Massachusetts r Department oflndustrialAccidents 1 Congress Street, Suite 100 ' Boston,MA.02114 2017 sJ•y`�t www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legib, Name(Business/Organization/Individual): r 4 V/ g✓Tc_A P'1 S '01914 �y TG�V��►S e-N�/d C[-� Address: 15' ST A e v/ D it City/State/Zip: NO - 4 ry.DOVZ l- MA Phone#: 17 Are you an employer?Check the appropriate box: Type of project(required): LF1 I am a employer with employees(full and/or part-time).* 7. []New construction 2. am.a sole proprietor or partnership and have no employees working for me in 8. [�Ieemodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.Q I am a homeowner doing all work myself[No workers'comp.insurance required.]t 10 ❑Building addition 4.F1I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12. Plumbing repairs or additions 5.F1 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.Q Roof repairs These sub-contractors have employees and have workers'comp.insurance.# 6.Q We are a corporation and its officers have exercised their right of exemption per MGL c. 14. Other 152,§1(4),and we have no.employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. I Homeowners who subs fit 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 state whether or not.those entities have employees. If the sub-contractors have employees,'they must provide their workers'comp.policy number. lam an employes that is p/'oviding workers'compensation insurance for my employees.'Below is the policy and job site information. Insurance Company Name: S Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: 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 MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DTA for insurance coverage verification. I do hereby certify under the pains annd�pe�nalties of perjury that the information provided aboveistrue and correct. Signature: �. / -� Date: Phone# Of 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#: Informati®n 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 lire, 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 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-contractorr(s)name(s),address(es)and phone numbers)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 foi•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 Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel. #617-727-4900 ext.7406 or 1-877-NUSSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia This form satisfies all basic requirements of the state's Home Improvement Contractor Law(MGL chapter 142A),but does not include standard language to protect homeowners Seek legal advice if necessary. Any person planning home improvements should first obtain a copy of"A Massachusetts Consumer Guide to Home Improvement"before agreeing to any work on your residence.You may obtain a free copy by calling the Office of Consumer Affairs and Business Regulation's Consumer Information Hotline at 617-973-8787 or 1-888-283-3757 or on our website. Homeowner Information Contractor Information Name Company Name PA V I 4 T 1 r-F-,9 4 /A/T E GNwS Arm qb cL/'N G Street Address(do not use a Post Office Box address) Contractor/Salesperson/Owner Name W e&sr.-k W 8o ps f A v l gumillov S Cityfrown State Zip Code Business Address(must include a street address) No • A/voorck rn 01 S Al is- 15T11 y hrL Daytime Phone Evening Phone City]Town State Zip Code A14. 111V W,/rf-Il. 014 41 F k S Mailing Address(It different from above) Business Phone I Federal Employer ID or S.S.Number Havcrvgvvrncm C-tr d-R%.Numb¢ I Fapbadoa date law regdres that most home avalld mmtmetneontm.Y p /�/069/0S J • acid seV#tratbv avmber The Contractor agrees to do the following work for the Homeowner. (Describe in detail the work to completed,specifying the type,brand,and grade of materials to be used,useadditional sheets if necessarv.) livish BASIE/►>rE� 7-0 /AILLU& CL j#PP,e9 4� rh R 00M / �y.� 0�',¢'r C.b T• v Room To ov G1-vAr— fe/I-et 5 w•Naow. ' Re//9oE W,,^60 rw S Required Permits-The following building permits are required Proposed Start and Completion Schedule-The following schedule will and will be secured by the contractor as the homeowners agent: be adhered to unless circumstances beyond the contractor's control arise (Owners who secure their own permits will be excluded from the Guaranty Fund provisions of Ilko Lp(f late when contractor will begin contracted work. MGL chapter 142A.) 11/31'["Date when contracted work will be substantially completed. Total Contract Price and Payment Schedule The Contractor agrees to perform the work,furnish the material and labor specified above for the total sum of. (*) Payments will be made according to the following schedule: Cq�fsS $It 00 0 upon signing contract(not to exceed 1/3 of the total contract price or the cost of special order items,whichever is greater) l w, $240M by!/ or upon completion of_j?[Sv4 CoA S4U Gft 0 N /NUPW bI ft / ,-AeAn C.4C—/ $ 1S*j860 by / /_or upon completion of F10vI-S 1/1 f/iH 1/Rq $ upon completion of the contract. (Law forbids demanding full payment until contract is completed to both party's satisfaction) The following material/equipment must be special $ to be paid for ordered before the contracted work begins in order to meet the completion schedule.(**) $ to be paid for NOTES:(*)including all finance charges(**)law requires that any deposit or down-payment required by the contractor before work begins may not exceed the greater of(a)one-third of the total contract price or(b)the actual cost of any special equipment or custom made material which must be special ordered in advance to meet the completion schedule. Express Warranty-Is an express warranty being Provided by the contractor? ❑No Yes fall terms of the warranty must be attached to the contract) Subcontractors-The contractor agrees to be solely responsible for completion of the work described regardless of the actions of any third party/subcontractor utilized by the contractor. The contractor further agrees to be solely responsible for all payments to all subcontractors for materials and labor under this agreement Contract Acceptance-Upon signing,this document becomes a binding contract under law. Unless otherwise noted within this document,the contract shall not imply that any lien or other security interest has been placed on the residence. Review the following cautions and notices carefully before signing this contract. • Don't be pressured into signing the contract.Take time to read and fully understand it. Ask questions if something is unclear. • Make sure the contractor has a valid Home Improvement Contractor Registration. The law requires most home improvement contractors and subcontractors to be registered with the Director of Home Improvement Contractor Registration. You may inquire about contractor registration by writing to the Director at 10 Park Plaza,Room 5170,Boston,MA 02116 or by calling 617-973-8787 or 888-283-3757. • Does the contractor have insurance? Ask the Contractor for his insurance company information so that you can confirm coverage,or ask to see a copy of a"proof of insurance"docum ent. • Know your rights and responsibilities. Read the Important Information on the reverse side of this form and get a copy of the Consumer Guide to the Home Improvement Contractor law. You may cancel this agreement if it has been signed at a place other than the contractor's normal place of business,provided you notify the contractor in writing at his/her main office or branch office by ordinary mail posted,by telegram sent or by delivery,not later than midnight of the third business day following the signing of this agreement_ See the attached notice of cancellation form for an explanation of this right. DO NOT SIGN THIS CONTRACT IF THERE ARE NY BLAN PACES!!! eco identical wpm of tbe contract oast be completed and siged One copy AWd go to the /Attar s Id be kept by the contractor. 4, i Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supen-isor License: CS-059105 .r� is Y PAUL G-HUTCHVTS �, T 121 FARNUM ST: North Andover NROP f Expiration Commissioner 05/05/2016 Of fice of Consume ArAff &gusi°�� ac�zuQe ' ME IMPROVEMENT CONT ess Regulation RACTOR 179M iration:-,71-12%2Q16�, Type: =_ DBA HUTCHINS HOME IMP VE PAUL HUTCHINS 121 FARNUM STREET NORTH ANDOVER MA 01845 ' '-- "� Undersecretary .