HomeMy WebLinkAboutBuilding Permit #343-12 - 30 GRAY STREET 10/18/2011 TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: w Date Received
Date Issued: -0
IMPORTANT:Applicant must complete all items on this page
LOCATION 30 LJ Si_
Print
PROPERTY OWNER J0 e US� 1 n 5 Unit#
Print
MAP N0: O ,$PARCEL: 63 ZONING DISTRICT: Historic District yes n
Machine Shop Village yes no
100 year-old structure yes no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building WOne family
❑Addition ❑Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
KRepair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
❑ Seotic ❑Well ❑Floodplain ❑Wetlands 0 Watershed District
❑Water/S ewer--
DESCRIPTION OF WORK TO BE PE ORMED: ,
erg �e c ')e.,af
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(Identification Please Type or Print Clearly)
OWNER: Name:_ :Zle_ Phone: -90f
Address:30 c�ir'c q S-/ 616✓4,4,646%&-t- /f/r? D.- 8.80
CONTRACTOR Name: 6Gytd A-ejy Phone: 9P& 0Y aiLSI
Address: 31 �re5c��>o� G/rl�� �arl.►►�'er7c�� di �l3 ,
Supervisor's Construction License: (_ S 6T:Z3 Exp. Date:
Home Improvement License: 1341 Exp. Date: mea 6701 -2a/J
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE.BULDING PERMIT.$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ FEE:
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
;__ignature of Agent/Owner Signature.of contractor
Location &6AA
No. —�. Date o-w
NORT1y TOWN OF NORTH ANDOVER
f s
Certificate of Occupancy $
CMUs<� Building/Frame Permit Fee $ _
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check # I ✓�r�
^ 4 Building Inspector
L
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
I
F.
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 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.$10041000 fine
NOTES and DATA— For department use
❑ Notified for pickup - Date
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Doc:.Building Permit Revised 2011 June/mi
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
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
Doo: Doc.Building Permit Revised 2008mi
NORTfy
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C, -_ dover, Mass.
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'Ll,9S RATED 'C BOARD OF HEALTH
Food/Kitchen
PERM .. IT T D Septic System
BUILDING INSPECTOR
THIS CERTIFIES THAT.....:...... ' .........Cvx�!§N
. .............................................................. Foundation
has permission to erect........................................ buildings on ... ....... . .. .. .. .......r............................. Rough
t0 be Occupied as.... '40.. Chimney
. ............. .. . .. ...... ................ . . .......................................................
provided that the person acc3epting 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
�b PERI UT EXPIRES IN 6 MON S ELECTRICAL INSPECTOR
UNLESS CONSTRU RU 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 FIR_E-DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
Street No.
SEE REVERSE SIDE Smoke Det.
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MA LIC NUMBER CS059757
HIC# 134639
"ADDING VALUE TO YOUR HOME"
CUSTOM INSTALLATIONS
A DAVID BRADY CO
31 Crestwood Circle
Lawrence, MA
978 689 0681 -P
978 689 0682 -F
SPECIFICATION WORKSHEET/ CONTRACT
CUSTOMER NAME CUSTOMER PHONE
Joe & Lois Cushing 978 685 0465
ADDRESS: ZIP CODE:
30 Gray St 01845
CITY: STATE:
North Andover Ma
PROVISIONS:
PLANS& PERMITS:ALL APPROPRIATE PERMITS SHALL BE THE RESPONSIBILTY OF Custom Installations,ALL WORK SHALL BE
DONE IN ACCORDANCE WITH LOCAL AND STATE BUILDING CODE.A DETAILED SET OF BUILDING PLANS SHALL BE PROVIDED,
PLANS SHALL CONSIST OF ELEVATION,CROSS SECTIONS,FLOOR PLANS,AND ANY OTHER DOCUMENTATION DEEMED NECESSARY
BY BUILDING OFFICIAL TO OBTAIN PROPER BUILDING PERMITS.IF PLANS REQUIRE A CERTIFIED ENGINEERS STAMP,THIS COST WILL
BE THE RESPONSIBILITY OF HOME OWNER.SUPPLY OF APPROPRIATE BUILDING PLANS SHALL BE REPONSIBILITY OF Home owner.
OBTAINING PERMITS,AND PAYING PERMIT FEES SHALL BE RESPONSIBILITY OF Custom Installations.ABSOLUTELY NO WORK WILL BE
DONE WITHOUT THE PROPER BUILDING PERMITS.THIS INCLUDES,BUT IS NOT LIMITED TO,ANY AND ALL DEMOLITION WORK,UNLESS
APPROVED BY LOCAL BUILDING OFFICIAL.
UNFORSEEN CIRCUMSTAMCE:GREAT CARE HAS BEEN TAKEN TO PROVIDE ACCURATE PRICING.HOWEVER,IN THE EVENT
THAT"UNFORSEEN CIRCUMSTANCES"ARISE THAT ARE BEYOND THE CONTRACTOR'S CONTROL,ADDITIONAL COSTS MAY BE
INCURRED BY HOME OWNER.IN THE EVEN OF"UNFORSEEN CIRCUMSTANCES",A WRITTEM ADDENDUM TO CONTRACT SHALL BE
PROVIDED BY CONTRACTOR AND SIGNED BY ALL PARTIES BEFORE CONTINUING WITH THAT PARTICULAR ASPECT OF PROJECT.
"UNFORSEEN CIRCUMSTANCES"CAN CONSIST OF,BUT NOT BE LIMITED TO,STRUCTURAL DEFECTS THAT ARE HIDDEN BY SHEATHING,
CERTAIN GROUND CONDITIONS BENEATH GRADE.
DEBRIS REMOVAL: ALL DEBRIS REMOVAL SHALL BE THE RESPONSIBILITY OF Custom Installations.IF CONTRACTOR IS
RESPONSIBLE FOR DEBRIS REMOVAL,A DUMSPSTER OR SIMILAR SHALL BE PROVIDED.FURTHERMORE,JOB SITE WILL BE KEPT IN
A SAFE,PROFESSIONAL,AND WORKMAN-LIKE MANNER.
CONSTRRUCTION PRACTICES:ALL WORK TO BE PERFORMED IN A PROFESSIONAL AND WORKMAN-LIKE MANNER AND BE
DONE IN ACCORDANCE WITH ALL LOCAL AND STATE BUILDING CODES,AND TO CONFORM TO PLANS AND SPECIFICATIONS
PROVIDED.ALL WORK TO BE DONE WITH GENERALLY ACCEPTED CONSTRUCTION PRACTICES.
SCOPE OF PROJECT:
Demo: Existing non load bearing wall within closet
Existing door @ hall closet
Existing non load bearing wall in hall closet
Debris removal: All construction debris to be placed in a contractor provided container and hauled
away
Carpenter/drywall: Provide false wall required to frame in pocket door.
Furnish and install flush luan style pocket door at entrance to bathroom
Furnish and install 1/2"gypsum wall board finished smooth at areas disturbed by demo
Furnish and install trim at pocket door
Plumbing: Plumbing and fixtures to be provided by other
Electric: Electrical and fixtures to be provided by other
Flooring: Flooring to be provided by other
Paint: Furnish and install (1) coat primer/sealer to areas that have received new
gypsum
Furnish and install (2) finish coats of paint to new wall areas, new door, and new trim
Permits: Provide building permit
Fixtures:
MATERIALS: ALL MATERIALS WILL CONFORM TO LOCAL AND STATE BUILDING CODES AND WILL BE AS SPECIFIED IN
DRAWINGS PROVIDED AND APPROVED BY LOCAL BUILDING OFFICIAL.
RIGHT OF DISPUTE:IN THE EVENT OF DISPUTE BETWEEN HOMEOWNER AND CONTRACTOR,TERMS OF THIS SPEC.SHEET
WILL TAKE PRECEDENT OVER ANY AND ALL OTHER FORMS OF DOCUMENTATION.THE CONTRACTOR AND HOMEOWNER HEREBY
MUTUALLY AGREE IN ADVANCE THAT IN THE EVENT THE CONTRACTOR HAS A DISPUTE CONCERNING THIS CONTRACT,THE
CONTRACTOR MAY SUBMIT SUCH DISPUTE TO A PRIVATE ARBITRATION SERVICE WHICH HAS BEEN APPROVED BY THE OFFICE OF
CONSUMER AFFAIRS AND BUSINESS REGULATIONS AND THE CONSUMER SHALL BE REQUIRED TO SUBMITR SUCH ARBITRATION AS
PROVIDED IN MGL.c. 142A.
.....................................OWNER
....................................CONTRACTOR
NOTICE:THE SIGNATURE OF THE PARTIES ABOVE APPLY ONLY TO THE AGREEMENT OF THE PARTIES ALTERNATE DISPUTE
RESOLUTION INITIATED BY THE CONTRACTOR.THE OWNER MAY INITIATE ALTERNATIVE DISPUTE RESOLUTION EVEN WHERE THIS
SECTION IS NOT SIGNED SEPARATELY BY THE PARTIES.
PAYMENT TERMS: TERMS OF PAYMENT ARE AS FOLLOWS:
Total job cost as described above to be$3000.00 with payments as follow:
l/3rd in advance $1000.00
1/3rd after rough plumbing $1000.00
1/3`d upon completion $1000.00
LEGAL:ALL HOME IMPROVEMENT CONTRACTORS AND SUB CONTRACTORS SHALL BE REGISTERED AS A HOME INPROVEMENT
CONTRACTOR WITH THE STATE OF MASSACHUSETTS,ANY INQUIRIES ABOUT A CONTRACTOR OR SUB CONTRACTOR RELATING TO
AREGISTRATION SHOULD BE DIRECTED TO:
DIRECTOR,HOME INPROVEMENT CONTRACTOR REGISTRATION PROGRAM,
P.O.BOX 871,TAUNTON,MA 02780-0871
PHONE:(508)821-9375
HOMEOWNER HAS RIGHT TO CANCEL THIS CONTRACT WITHIN THREE BUSINESS DAYS OF SIGNING DATE WARRANTY OF ALL
MATERIAL SHALL BE THE RESPONSIBILITY OF THAT MATERIAL MANUFACTURER AND NOT THE CONTRACTOE,THE CONTRACTOR
WILL WARRANTY ALL INSTALLATION OF PRODUCT AND CONSTRUCTION PRACTICES FOR A PERIOD OF ONE(])YEAR FROM THE DATE
OF INSTALLATION.CONTRACTOR SHALL ALSO POSSESS AND PRODUCE IF REQUESTED A CURRENT MASSACHUSETTS CONSTRUCTION.
SUPERVISORS LICENSE INQUIRIES MAY BE MADE BY CONTRACTING
BOARD OF BUILDING REGULATIONS AND STANDARDS
ONE ASHBURTON PLACE
BOSTON,MA 02108
PHONE:(617)727-3200 EXT 607
ONLINE:www.mass.gov/bbrs/cslsearch.htm
ACCEPTANCE OF TERMS:BY SIGNING BELOW,HOME OWNER AND CONTRACTOR AGREE TO SPECIFIACTAIONS AS LAID OUT WITHIN
THIS SPEC.SHEET.ALSO,BY SIGING,THIS WILL BECOME A BINDING LEGAL CONTRACT.
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES
CUSTOMER SIGNATURE CONTARCTIOR SIGNATURE
DAVID J. BRADY
1
f
X.... ....... .... ..
0111X-9..............
10/10/2011
DATED: xQ f �/
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): ,�/� iZrcJ,A � IJQ � P A_
Address: 31 �res}z" d,r'e,1 t �.C'�u1 re n e p;,
City/State/Zip: Ai re a e 42l.5 43 Phone #: 9�7� ( g a
Are you an employer?Check the appropriate box: Type of project(required):
1. ( I am a employer with 1 4. ❑ I am a general contractor and I 6. ❑New construction
employees(full and/or part-time).* have hired the sub-contractors
2. ❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7• ❑Remodeling
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 11.❑Plumbing repairs or additions
myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑Roof repairs
insurance required.]f employees. [No workers' 131-1 Other
comp. insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
f 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. I
Insurance Company Name: /� !I� 1L. AAr--k_lrl_
Policy#or Self-ins.Lic. — - Expiration Date: /4old
Job Site Address:-36 G r C q 6+ City/State/Zip 917A n d v,,,r' Ale, 618
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.
I do hereby certi under the pains andpenalties ofperjury that the information provided above is true and correct.
Sign re: . p Q J Date:
Phone#: % 2Ci 22
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#:
� Office of Consumer Affairs&Business Regulation
r
j HOME IMPROVEMENT CONTRACTOR
, Registrati0n #34639
Y Ezpirati0 1212012011 Tr# 291415
757
TYPe • lndw�dus}
c-
DAVID J.BRADY, a
DAVID BRADY _,,
31 CRESTWOOD CIRCLE,
LAWRENCE,MA 01843`` Undersecretary
f
.. Massachusetts- Depaa tmenf of Public Safety
Board of Building;Reg.tjlations and Standards
Construction Supervisor License
License: CS 59757
Restricted to: 00
DAVID J BRADY
31 CRESTWOOD CIR ,: -
LAWRENCE, MA 01843
Expiration: 1/28/2012
(7mm�3i�..io�u r Tr##: 16810