Loading...
HomeMy WebLinkAboutBuilding Permit #612 - 31 GLENORE CIRCLE 2/17/2008BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: v Date Received Date Issued: d! IMPORTANT: Applicant must complete all items on this naize LOCATION .31 Ctvlelel Print PROPERTY OWNER - exIEN ry Print MAP NO: PARCEL: 2r ZONING DISTRICT: Historic District yes Machine Shop Village yes v6St�.s.. '67 rye` ...:a., 6 OL 9 1• no no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New BuildingOne fame Addition Two or more family Industrial Alterati No. of units: Commercial epair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District ater/Se r DESCRIPTION OF WORK TO BE PREFORMED: No l Identification Please Type or Print Clearly) OWNER: Name: Phone: 7i,?, 1-,gL3 sIP3 Address: 3 !rr e CONTRACTOR Name:_ ots Of- v e An mi- em, Phone: 7.2 (7.74 2 Address: Supervisor's Construction License: 473'4 7 Exp. Date: U Home Improvement License: ARCHITECT/ENGINEER Phone: Address: Reg. No. /;3010 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 G, 3SG , 6* FEE: $ �32 Check No.: ��Receipt No.:—g I NOTE: Persons contracting with, unregistered -contractors do not have access to the guaranty f nd Signature of Agent/Owner Signature of contractor - Ile -/v g -e Location No. 0107 � - - 'N .4 MI111iL 'AV Check # 2 1 09'i TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ v 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 DATE REJECTED DATE APPROVED Reviewed on Signature HEALTH Reviewed on Signature COMMENTS ef V Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: Comments Commen Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes. Located at 124 Main Street Fire Department signature/date COM [i Ls 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 IIU444, Af ❑ 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 ❑ 4Photo 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 Doc: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 GO t" w Oct12 w° v ; Cf) 0 w z "a w o w° to v E U is w o w w a� a�' w a w a w �, ' c% c ii x O a a�' co0 w z w w w v c� z ,� cin o A o o c o s O_ C L3 C.3 •d a ev ev ® C ZEa y :moo ts m� CD CD CO C.2 me a� C. O O o Z3N . O mm_ J� s c ' N A O rO.V i CMO t� O co z O O CA coh CL. a� O a) 0 ev M: CA 0 .V y C O G7 L O v CL COD C a� CM c o =v m m r�l LU W 19 W LU 19 W N y dCt O U O O � MZ O p S o a +S coo mss U- •N ode O W •E C O � z CD C07 'o V c COD �/ J r� C/) O� 010 S R A 7 =�a�m t� O co z O O CA coh CL. a� O a) 0 ev M: CA 0 .V y C O G7 L O v CL COD C a� CM c o =v m m r�l LU W 19 W LU 19 W N O U A to E PL N � ce ' CIOU z C O S �/ J r� C/) O m `O c c �C N m Z O Z O c 0 r, t� O co z O O CA coh CL. a� O a) 0 ev M: CA 0 .V y C O G7 L O v CL COD C a� CM c o =v m m r�l LU W 19 W LU 19 W N Dr. Henry & May Ty 31 Glenore Circle North Andover, Ma 01845 978-683-8183 SCOPE OF WORK FINISH BASEMENT Lyons Development will not supply the following. Cabinets Bathroom fixtures and mirror Doors and hardware Kitchen fixtures and countertop Any flooring rug or tile Electric fixtures Heating fixtures 3/25/08 Lyons development will install all owner supplied fixtures above inacorrdance with attached plan. Remove walls carpet and interior doors, frame new walls to plan. Reposition vacuum and heat and any wires within walls that are removed. Install electric and plumbing to plan. contractor to supply materials Insulate exterior walls. Hang wallboard and skim coat plaister all walls and ceilings in kitchen bedroom and bath only all others will be suspended ceiling. Supply and install finish trim to match house and cabinets as per plan Install tile in finished area except bedroom. Steel lally columns boxed in pine Paint trim and walls to owners color choices. Remove all trash from work area. OPTIONAL GAS DIRECT VENT HEATER 2,500.00 TOTAL COST OF WORK $ 36,350.00 PAYMENT TERMS: $ 10,000.00 WHEN ELECTRIC AND PLUMBING IS ROUGHED. $ 10,000.00 WHEN FINISH TRIM IS INSTALLED. $ 10,000.00 WHEN TILE IS INSTALLED. $ 6,350.00 COMPLETION OF JOB. Fl Dr. Henry & May Ty 31 Glenore Citcle North Andover, Ma 01845 978-683-8183 SCOPE OF WORK. FINISH BASEMENT Lyons Development will not supply the following. Cabinets Bathroom fixtures and mirror Doors and hardware Kitchen fixtures and countertop Any flooring rug, or tile Electric fixtures Heating fixtures 3/25/08 Lyons development will install all owner supplied fixtures above inacorrdance with attached plan. Remove walls carpet and interior doors, flame nein wails to puri. Reposition vacuum and heat and any wires within walls that are removed. Install electric and plumbing to plan. contractor to supply materials Insulate exterior walls. flang wallboard and skim coat plaister all walls and ceilings in kitchen bedroom and bath only all others will be suspended ceiling. Supply and install finish trim to match house and cabinets as per plan Install the in finished area except bedroom. Steel tally columns boxed in pine Paint trim and walls to owners color choices. Remove all trash from work area OPTIONAL GAS DIRECT VENT HEATER 2,500.00 TOTAL. COST OF WORK $ 36,350.00 PAYMENT TERMS: $ 10,000.00 WHEN ELECTRIC AND PLUMBING IS ROUGHED. $ 10,000.00 WHEN F1N.ISH TRIM IS INSTALLED. $ 10,000.00 WHEN TILE IS INSTALLED. $ 6,350.00 COMPLETION OF JOB. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations d 600 Washington Street Boston, MA 02111 ,. wM SV www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Name (Business/Organization/Individual): Address:_2 f, f N y G -.f e City/State/Zip: Phone #:- 97 !�- 37� o,26 2 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).* 2. ❑ I am a sole proprietor or partner- ship and have no employees working for me in any capacity. [No workers' comp, insurance required.] 3. ❑ I am a homeowner doing all work myself [No workers' comp. insurance required.] t have hired the sub -contractors listed on the attached sheet. These sub -contractors have employees and have workers' comp. insurance.$ X, We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required)':„ 6. ❑ New construction 7. Remodeling & ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12. ❑ Roof repairs 13 -0 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 must submit a new affidavit indicating such. xContractors 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 is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Z v c it; h A n e ,r i L; i Policy # or Self -ins. Lic. #:' 4 Z2-(, of —5--07 Expiration Date: I I / I /VS' Job Site Address:_ 3 1 C,is „ort. C1 ,- NcA 4,JQJ-- 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 Investigations of the DIA for insurance coverage verification I do hereby cert' under the pains and penalties of perjury that the information provided above is true and correct. Si afore: Date: Y 1 7 /U& o�"2 use only. Do not write in this area, to City or Town: Issuing Authority (circle one): 1. Board of Health 2. Building Department 6'.. Other Contact Person: or town official Permit/License # City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 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 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 40,6 or 1-877-MASSAFE Revised 11-22-06 Fax # 617-727-7749 www.mass.gov/dia 04: 17-' `70& iI :011 F.;S 3 S4USii?04 CHASE & t.f_`:T ACORN. ---CERTIFICATE OF LIABILITY INSURANCE PRODUCERTHIS CERTIFICATE IS ISSU5 Chase 6 Lunt LL -C ONLY AND CONFERS NO k F 0 Box 590 HOLDER. THIS ^ERTIFICATI 47 State .L's I�rr� . ALTER THE COVERA rE AFI N wburyport NSl4, 01550 Phone; 9?5-462- 4434 Fax : 975-465-'62'04 AMIUMV Lins Development Corp 291 x att Av Bradf rd MA 1635 COVERAM THE PQLiCIES OF iNSU;WJCt LISTED RELOW -LAVE 7EF_4 MCUEO TO THv INSURED N*!M". ABQVF FCR "HE PJLI:.Y PER'OG ;t1C i( 136 1. !(} F41?NST eNU!NG ANY REUUIRV*NT, TERM OR CONDITION OF cNY C0? 7WI OR OTHER DOCUMEta YVITH RESPECT TC WITCH THIS CERTIFICATE MAY BE ISuUED OR. MAY PERTAIN, THE INSURANCE AFFORDED FIY Riff POLIZIES DE5CR18FD HEREIN IS SUR.JEC:'TO ALL THE TEAMS jXCL1JS(OfX AFiD CONDITIONS Or WC;' �P4OLLVEgSAGGREGATE LIMfrS SHOWN MAY N 146 B_eN R°OUCED UY PAID CLAIMS. LTR IN9RL4 _. TT?E pFENM1iFiANCE i�— PtjLiCYNUAfEERI 'mi-rc •rums". — ; :A I — �M EA(;H OCCURRENCP::�rS PREME p� rim) T NED EYP (Any one peva+) i PERSJKAL .A -]V INd(iNY GENERA;. AGGREC-ATE_ �T-5 PRGl7lK T'S - COUP!OP AGG 1 6 OR 110 Il t 1 DATE (MMrDIDlYY`IY) _ LYON:•�3 04/1 06 AS A NIAFTER OF tHrAO. RMATION WITS'.IPON THE CERTIFICATE D'A'S NOT AMEND, EXTEND OR )RCED BY THE POLICIES BELOYY. INSURERS AFFORDING- COVERAGE INSURER ?c9'1ida-&oftti=1. 'ia:+urineAA INSUriER Fr. INSUIRER C, INSURER F: Cu. Go, LIABILITY I ` Go I COMMERCIAL GENER,EL LLtSILI -Y �_; CcxrrwS rr,.AaE j 7 CCC';R I GEtiL AGC:RECC—A-TTE L,tO,T APP l,!ES P�'R: I POLICY I jE� i ? LOC i �AUrOMOBILE LIABILITY I 4.— A4YAUT0 I 1 ALL -0-,%ED ALTOS SCHEDULEU AVrCS ' I �i H!REO AU,105 ^� NON-C11M['u•A'.I"v3 � CdR.RA;ip, LiS19iLST`f '�._ �� ANY 4UTC- EXCES UMBRELLA LiAVIL(TY 000OR I CLAIMS WAD= DEDUCTIBLE --I}—_� RE'ENYION S WORKERS COMPEN&A'hON AND A ' EMPL0YMX5' LIABILITY ANY PROPRIET'ORMAR ffWERIEXECUTIVF OFFICFFWEL43EP E-KCLUDEDT 1 If Yin, clurrine Uxter SPECALPROVIS10%b ,7w OPERATION$ f Li;Di;ATIONS / CERTIFICATE HOLDER i I I COtA16uEU SPIG'_E VU11 i I (E8 FCCt7d11; S ' I WX LY INJURY $ _ BaDILY INJURY S f (Perfi"Iierna jPROPERTY SAGE S (Pw PX40.11) I AUTOCNLY - Eli ACCIDENT g ---A OTHER THAN ACC I S I —AGG AUTO ONLY: � WH CICCURRENCE _ $ AGGRELWE NA&C 0 !X TORY t_IMPfS EA IZ2iiF3-RGGbA99�5_II17 ; 11 /35 j07 1110) ®06 E.L. EACHACCIOCNT 6100000 E.L. DISEASE - EA EMPLO-E4 $ 10060 ,' DIaEAe:_PULIQY _IMf1 S 500000 To -z of NorUi Andover Building Department Forth Andover MA 01610 SHOULD ANY OF TWE AIGOVE DiOrRIBILD 4'OLICIIX DE CANCELLED "JCEORE THE EXPIRATIO DATE THEREC`F, THE ISSUING I:NSUREIEWIU. ENDEAVOK To MAIL 10 DAYS WRITTEN NSITICE TO TP(E CERTIFICATE H=Cr NAMED TO THE LEFT, BU` FAILURE TO DC SO SHALL IMPOSE NO OBLIGATION On LIABILITY OF ;ANY 19ND UPON INE INSLRER ITS AGENTS OR TION ? S \ 0) 7 2 3 \ { ® G o r 3 "®r S® ads»®�\wwa § E 2 7 ©2�x: \ • �y�� w �k lu 0 ^ ^ ° / w < � j < kj /wLL