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Home My WebLink AboutBuilding Permit #208 - 31 SILSBEE ROAD 9/17/2009 BUILDING PERMIT of"°DT"q� TOWN OF NORTH ANDOVER c APPLICATION FOR PLAN EXAMINATION Permit NO: O Date Received �^4 �gSSACHUs Date Issued: -01k IMPORTANT: Applicant must complete all items on this page LOCATIONt Print PROPERTY OWNER 4 .nf ,, ,A y Print MAP NO: -70 ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Buildingne famil D Addition Two or more family Industrial Alteration No. of units: Commercial (eeair, rep a`�cem n Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: VIA/V4-Sf141N6 < ?et,e4i cc �el G C— Identification Please Type or Print Clearly) OWNER: Name: &E-V l Ae�A(V 0AICIt — Phone: Address: I X660 -IV'Av�J� IVW- CONTRACTOR Name: Phone: 605—bff— ;M7 7 0 Address: d',� '• j}�r 1ye 54v.�m , Aj 47 eF-7.� Supervisor's Construction License: 33Z-3k- Exp. Date: -5--20 ze Home Improvement License: /a( 7 Exp. Date: %o`Z!'' ZC1 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: $ ?,C� FEE: $ 3 �— Check No.: ' l6 Receipt No.: -� NOTE: Persons contracting with unreisteyred co ctors do not have access to the guaranty fund Signature of Agent/Owner ignature 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 I I 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 Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Str et FIRE DEPARTMENT -Temp Dumpster op site ye } �no Located at 124 Main Street Fire Department signature/date Cil x,13 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 o 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 Location No. -Z Date MORT1y TOWN OF NORTH ANDOVER O F R D Certificate of Occupancy $ amus E Building/Frame Permit Fee $ s� `* Y Foundation Permit Fee $ Other Permit Fee $ (� TOTAL $ Check # / 2 2- 4 uiiding inspector 1 RICK McCULLY V)roposal Page No. 603-8W-2277 of Pages NORTHEAST CUSTOM EXTERIORS RESIDENTIAL REMODELING 8 PRESTON DRIVE •SANDOWN, NH 03873.603-887-2277 LICENSED AND INSURED PROPOSAL SUBMITTED TO: DATE: - o NAME:��EV/!'✓ �,�r�7�� JOB NAME: STREET: STREET CITY STATE ^/. ��` ZIP CODE: CITY&STATE: TZIP CODE: /V � Ci/1��t.� c �1 PHONE: 976 s 6 1 _ �7�- �jr 0-97 - 7 4 -275-J� We hereby submit specifications and estimates for: 1,C;4 LLC V%11y4— ✓`f611V C cvl/ 1294(A1 5e:- KAla-7 /-VcLcr43 - /'v20V16 f- 4_.j-6,-,7e_ 7—o i.v� G�7`4J�iC-�-�J /�;'�i-/.'✓_ ?2�-z-� S C�E...i� (✓iii.+Y L .5 i�i�C� �� .�rL e%�/�v�.,� om roV-'c46C- 1'ca 2E:51?'(c' 7cs) �sz`^ !G/spa c_ L ��✓ / icy <<� T 1141 ollrCl 7L 5/6 1Y,4 � 7720 , acs �PCZ/}7C'� /TC�tn 5 ��^,�-�Ge�ve-�` Gi"*�� i=rte J,✓r�,,;,/}"�;� rev sr'�e=t'i icry fir/-'a4/N7 ��c�:JT''eL'ol'cl'•YCcaLv��rnr; � /c'C-�'t.�L 0��.�Cz� Gam'/ems' ,. We hereby propose t furnish labor and materials - complete in accordance with the above specifications, for the sum of • dollars ($ ) with payment to be made as follows: 7- / Cf- ✓G , ,�j L� /fc�✓/' Z Cin /ACL: r C�,O rA.,4t13 U�cn✓ cm�✓/�c�7"�a All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices. Any alteration or deviation from above specifications involving extra costs, will be executed only upon written orders, and will become on extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire, tornado and other necessary insurance. Our workers are fully covered by r en's Compensation insurance. Authorized Signature 2eeeptanee of Proposal The above prices,specifications and conditions are satisfactory and are hereby accepted.You are authorized to do the work as specified. Payment will be made as outlined above. Auepted: Signature %'� 1 ' Date SignatureC` �T�{ NOTE:This Proposal may be withdrawn by us if not accepted within days. NORTH It Town of Andover 0 . �: No. 0,0 dover, Mass., LAKE COC ,C HE WICK .CK RA-rED BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT...... ..........0..N..v � ............................................................................................................... Foundation has permission to erect........................................ buildings on .....3-1...........It.....L....S.... C ........................... Rough to be occupied as.... .(...........LA4 L .................................................................. ..... Chimney ' il.. ......... Vr...... provided that the person accepting this armit 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 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRU7C�5§ TS Rough Service BUILDING INSPECTOR Final Occupancy Permit Required to Ocmpy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final 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. Board of Building Regulations and Standards License or registration valid for individul use only U HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 101779 Board of Building Regulations and Standards Expiration: 6/29/2010 Trla 267900 One Ashburton Place Rm 1301Boston,Ma.02108 Type: DBA NORTHEAST CUSTOM EXTERIORS Richard McCully 8 Preston Dr Sandown, NH 03873 Administrator Not valid without signature Massachusetts- Department of Public Safetc Board of Building Rei-ulations and Standards Construction Supervisor License License: CS 33238 Restricted to: 00 l RICHARD A MCCULLY 8 PRESTON DRIVE' SANDOWN, NH 03873 f t('FNCF Expiration: 5/20/2010 ('ununissil,ner Tr#: 26469 ♦,i k p t v_v �Q SIM RICHARD A 8K RW DR SAN DOWN NH 03873 i The Commonwealth of Massachusetts k� Department of Industrial Accidents affice of Investigations 600 fEashington Street Boston, MA 02111 c j www mass.gov/die . Workers' Compensation Insurance Affidavit: Boulders/Contractors/Eleetricians/Plambers Applicant Information Please Pant Legibly Nar a (Business/Organiza6orLnndividual): Adr�ress: ,2E�?Qn/ �l City/ 5tate/Zig: 54otIj0WA. 1At6'73 Phone#: . 11®3 997- 22177 . Are you an employer?Check.the appropriate box: ,Are I am a employer yr with 4, Type of Pr'o1�(required): P Y ❑ I am a general contractor and I employees(full and/orpart-time).* have hired the sub-contractors b. ❑Naw construction . 2. I am.a.sole proprietor or partner- listed on the attached sheet. 7• (Remodeling ship and have no employees These suis-contractors have 8. [�Demolition working for me in any capacity. workers' comp.insurance. [No workers comp. insurance 5. 9. ❑Building addition p ❑ We are a corporation and its required.] officers have exercised their 10•❑Electrical repairs or additions 3.❑ 1 am s homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself.[No-workers'comp. cw 152, §1(4),'and we have no insurance. ired. .t 121[ Roof repairs -required.] .employees.[No workers' comp. insurance required_] 13.(]Otho~ '`Y applicantthat cheeks bo>s a l must also fill out the section below showing their workers'bompensation policy information. t Iiameowner¢who submit this ff idavit indicating they ars daing all work and then hie outside conuactom most submit a new affidavit indite gum ;Catrtraetorc that check this box reustarteehed art sdd.iotutl sheat showing.the name of the sub-contsactom and their workers'cent~,policy inf wa&n. I am an eMPloyer that iS proviai"tng workers'COMP insurance or informratiort f m1'emrployee� Below it the po&7 andjob site . Insurance Company Name: ' Policy#or Self-ins.Lie.#: Expiration Bate: Job Site Address: . City/Statrzip: 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 farm 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 cerfi, der the pains and attics of perjwy that the information provided above is trice and eontea Si time: Date: Phone#: ,7—L Z-77 E only. Do not write in this area,m be completed by dV or town.ofciat Town: Permit/License# hority(circle one): Health 2.Building Department 3.City/Town Clerk 4. Electrical Inspector 5. PEr son• " Phone#: Information a nd Instructions Massachusetts General Laws chapter 152 requires all emp foyers to provide workers'compensation for their employees. Pursuant to this statute,an emtployee is defined as"...every person in the service of another under any contract of hire, ; express r o i oral o implied,o r wrttten. An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or mom 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 t3he commonwealth nor any of its political subdivisions shall enter into any contract for the perfonrim ce of public work until-acceptable evidence of compliance with the insurance requirements of this chapter have been presmited 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):acrd phone riu mber(s)along with their certificates)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'ccnripensahon insurance. Kan LLC or LLP does have empioyees,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 nurnber listed below. Self-insured companies should enter their self insurance license number on tile'appropriate line. City or Town Officinis 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 pennittlicense number which Kilt 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 beenoffieiaily stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for futam permits or licenses. A new affidavit must be filled out each year. When a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog iiemse or permit to bum leaves etc.)said person is NOT required to complete this afridaviL 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 L-ndustrial Accidents Office of Investigations 600 Washington Street Boston, IIIA 02111 TeL #617-7274900 ext 406 or 1-8.77-MASSAFE Revised 5-26-115 Fax 4 617-727-7749 www.mass.govldia