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HomeMy WebLinkAboutBuilding Permit #738-11 - 32 BRIGHTWOOD AVENUE 5/3/2011TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: ' IMPORTANT: -32- Bri l4& Date Receiveda,7C/ must complete all items on this MAP NO: 6 7 PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building .f'One family $❑ ddition -*p et,*— ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition❑ Other e f t ❑ Se tics ❑,Well 3 f i ..k D Flo o d laui� Wetlands i tt r i t `® WatershedoDistrict f� �''. .YM� `P } *T° ! fes. h '.y •6 . C IY i ( C K �• '- -e _.Yg nF.q(-.RTPTION OF_WORK.TO BE PERFORMED: Identification Please Type or Print Clearly) OW ^_ J OWNER: Name: ��e&r� A&A-ior' Phone: 78-467 /sem Address: 3y'�4�i�weod ftirG . lJD• ..do��Wlrf' CONTRACTOR Name: �(�/i �► -rwt Phone: 6487 704o Address: 7 oar v CJvV9- Supervisor's Construction License: /aT2. $� Exp. Date: ,3W2.o13 Home Improvement License: 0 5 '% Exp. Date: $ zD /- ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE. BULDING PERMIT. $92.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $925.00 PER S.F. Total Project Cost: $ �%. ASO FEE: $It Check No.: T 3 Receipt No.: NOTE: Persons coniragtzn� uregied contractors do not have access to the guaranty fund 4`ficrif%(lWKiii' Location . e —//1, l d d 21-// MOR7M TOWN OF NORTH ANDOVER Certificate of Occupancy $ / Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # qI3� 24119 Building Inspector Plans Submitted ❑ - Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ well ❑ Private (septic tank, etc. ❑ Tanning/Massage/BodyArt ❑ Tobacco Sales ❑ Permanent Dumpster on Site - . `n, -I Swimming Pools ❑ Food Packaging/Sales ❑ _ r THE FOLLOWING SECTIONS FOR OFFICE' USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed onf` COMMENTS DATE APPROVED HEALTH Reviewed on igrreture° 1 �' COMMENTS • s 5. ,• >i Vr • y rr 4 r- �J Zoning Board of Appeals:pVariance,. 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 COMNIENTS Dimension Number of Stories: Total square fleet of floor area, based on Exterior dimensions._______ Total land area, sq. ff.:_ 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 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 a 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) o 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 o 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 OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals aL the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. one copy and proof of recording ist be submitted with the building application Doe: Doe.Building Permit Revised 2008mi 0 z mi 4 CAN O N C O Q: m cmC m 0 cm C N O t .r 0 Z O 0 i...l 2 44,6 O co O L O v Q. O CO) CO CM ca co M co M �MM EW W CD CD CD C3- ~_ CD O � a� CD o O O Q a CMa c o_�� /c/c� v,Y •V J .O � co Zco O d V caccC _— Ccc CL C CO) 0 Lli U) W W W v b °o w u v cn O A ox o w o w U iv G i�. 0 U a o cb i� G rw O. a W a: cn ro is. a H a: iS. z w v q . w o z cn - Q cn mi 4 CAN O N C O Q: m cmC m 0 cm C N O t .r 0 Z O 0 i...l 2 44,6 O co O L O v Q. O CO) CO CM ca co M co M �MM EW W CD CD CD C3- ~_ CD O � a� CD o O O Q a CMa c o_�� /c/c� v,Y •V J .O � co Zco O d V caccC _— Ccc CL C CO) 0 Lli U) W W W c c g� c o C2 O C O C.3 C2 CL C ev C ;= O O O N O CD S2 'L V N O = O O C.3 mrm c A : N ;gym ti0 m � = m C CID CC N O N E o. ' aV L N m m o CMo = dCt C3y O J " �' Z cco� ��oa0 m :gym= = m m +Z o ~ 40+ N !C* c =_ m mLLJ •FA � N .cm Ouj Ca w •N ® V O p C_ y CL m� O� A �O = A .� C*H 4- C2.4- m mi 4 CAN O N C O Q: m cmC m 0 cm C N O t .r 0 Z O 0 i...l 2 44,6 O co O L O v Q. O CO) CO CM ca co M co M �MM EW W CD CD CD C3- ~_ CD O � a� CD o O O Q a CMa c o_�� /c/c� v,Y •V J .O � co Zco O d V caccC _— Ccc CL C CO) 0 Lli U) W W W Alassachusetts Home IM-orax- nt' S ample Contlrh.ct This dorm satisfies all basic requirements of the state`s oma 3 I to protect homeowners. Seek legal advice IIfnecessaatyVe.A.n3�person pcja„ningl, �Lchnpter 1Q2AJ, but does noC include standard = "i�titssacbusetts consumer guide to home i improvements should first obtain a copy of na mprpvement" before agreejng to any work on your residence. You may obtain a free copy by calling the Office of Consumer Afiajrs and Business Regulation's Consumerluformation Bodiac at 617-973-8787 or 1may obtain a . Homeowner Information Contractor Information ame iJL+1` W/ Street ' ALe,-- omp�y amt o Address ( o use a post Office Box address) +2 2 , / i"od�t Conutcr Sale ' sperso�n/ Owner amt City/Town N State Zi Code P ' -• ries 'i� t J F.•► t ' usiness Address (mast ' clude a street address) &� Da ephone / Evening Phone �.�d ,ityrrovro state ap—C-de �k� Mailing©Addreeiss at different rrom above) � ` 'G 7- I Business Phone ederal EmplayerIDerr S.S. Nmnber liIDre9�cWamosttmmeim Home pmvemeotCasaat pmvrmmtwnmctUmbaves oriie¢,Nvmhs Hxpcatiendue The Contractor agrees i:o do the -following work for the Homeoneed=�� Req tiired Permits-- The foilowini buildjng permits are required Proposed Start and Completion Schedule -The fnlIowing schedule will and nil] be scoured �tythe conib for as the homeowner's agent, be adhered to unless circumstances beyond the contractnYs control arise (Owners who -set tl,'r ,�e;t �� permits will be excIAded from_#Itt~ Ott ut�%Fund provisions -of ate when contractor will begin contracted work. MGL chapter 14 27 Gni'/Date when contracted work will be substantially completed. Total Contract Pcice and Payment Schedule ' The Contactor agrees to pelfonn the worly furnish the matt rjal and labor specified above for the total sum 6f- I'ayrrients will be made abcording to the following schedule: $1 upon signing"contract (motto exceed 113 ofthe'total contract price or the costof'special orderitnms, whichever is greater) S by t_ + I or upon completion -of S by __/_j .or upon completion of S upon completion of the contract (Law forbids demanding full pay mentuntil contract is completed to both party's satisfaction) 17te following inateriad/equipment must be special $ to be paid for i ordered before the contracted wo&begios in order 5 to be paid for to meet the completion schedule,(**) NOTES; (*) Inclndjng 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 totN contract price or (b) the actual cost of tmy special equipment or custom made material which must be special ordered:in advance to meet the completion schedule, uu ncaorPi - t ne•1:ontmotor a - - - - •�• W� �me warren must be attached the contract paity%pubcontmetor. utilized by the contmotor, solely contractor further grce o be. solely'responsr6letion of the work ie far alled of the actions of any third a ' a d aborunderthis- a cement Payments to all subcontractors fur Contract Acceptance - Upon signing, this document becomes a binding contract under law. Unless otherwise noted within this document, the cantract shall not imply that any lien or other security intcresthas 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 timc to read and fidly understand it Ask • ' Make sure theontractor has A . li game 7m questions if something is unclear. vemenr Contractor 7z�.-�;s�hom � law requires most home improvement contactors and scgisl tion by to be registered vntir the Director ofHome Improvement C.ontractar Registration. you may inquire about contractor registration by,wridngto the Directorat One Ashburton Place, Room 1301, Boston, MA 02108 or by calling 617-727-3200 or M00-223-0933. • Does the contractor bavc insurance? Check to see that your contractor is properly insured, • Know your rights and responsibilities.Bead the Important Information on the reverse side of this form and get a copy of the Consumer Guide to the Homolmprovement Contractor Law. You may cancel this agreement if it has been signed at a place ofiii r than the contactor's normo[ place of business, _ contractor in writing at his/her main office orb* office by ordinary mat7posted, by tele provjded you notify the. third business day fotInwing.the signing o€this agreement See the attached notice of eancelIaLon form for Bnle�xplan of laof this knight of die DO NOT SIGN TFIIS CONTRACT IF TIdERE ARF BLANK Two identical capics ofthecontractmustbe completed and signed. One ACES!! ! ` �py�iouldgatothe}mrneownQ othcrcop haul kept by the contmmor. Homeow,e s Signature Contractor' ign tore 1ate Date / STRUCTYONS':. This form.is used`to`verify that all necessary approvals/perm ts-from Boards'And Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: �/y���i ��-����� S Phone AS%r-a-�y? LOCATION: Assessor's Map Number Parcel Subdivision W.,A- Lot (s) Street l`'���n�'St. Number _32 - ************************official Use Only************************ RECOMMENDA IO S AGENTS: Con se a Lin A inistrator Comments Town Planner Comments Food Inspector -Health Sem ptic Inspector -Health Comments Date Approved Date Rejected Date Approved Date Rejected Date Approved Date Rejected Date Approved Date Rejected Public Works - sewer/water connections - driveway permit Fire Department AM 4e&ed by Building Inspector. Date a /Y/�/ L 1994 (c) Boston Survey Solhvare PREPARED. 02-23-1998 SCALE. 1 inch = 30 feet CERTIFIED TO: PEOPLES MORTGAGE CORPORATION The permanent structures are approximately located on the a, yj<r' ground as shown. They either conformed to the setback f uz JOHN! requirements of the local zoning ordinances in effect at J. the time of construction, or are exempt from violation en- o RUSSELL forcement action under M.G.L. Title VII, Chapter 40 A, 17 Section 7, and that there are no encroachments of maj improvements either way across property lines except as �• t shown and noted hereon. NOTE: This is not a boundary or title insurance survey. This plan w¢s prepared n by the Massachusetts Board of Registration of professional engin s and land used for recording, preparing deed descriptions, or construction. yG vC, According to Federal Emergency Management Agency N Wraps, the major improvements on this properly fall in an area designated as Zone CD /�ommunity Panel No: 4. Effective Date: NOTE: Zone C is areas of minimal flooding (no shading). This designation is not based on an elevation certificate. :e to procedural and technical standards for Mortgage Loan Inspections as adopted 250 CMR 6.05, and use for any other purpose is prohibited. This plan is not to be 0 z x OF as c O a O a O c w 'r O o LE co a cin o Cd w° .c : rL° v 9 U � w a �' a°' a, w W W a2 v 5� cit c w C7 w�' cu w a w a w� o z cn v Q o cn CD CO O co O O v co O H C C — O Om CO2 O co E co M M�y� • co CD co C ~ '4-0 CD O� oma' CD 0 0 cc o oma. CL tM< c Ccc/�•Y Q J .O CD CO2 Z m CL V y cc R CO) 0 LLI UA w W W W c o as c `cam O c 'r O C.3 C) •M nc M CD m c p i U3 �+ c i :mom o c y O m m e CL y m m o L Z3m m m y m • � y m - :mo =C.2 L y m m _ dC.c Jm8= ��=21_ m y m c = m m3 H 0+ d O b - LL, eCOD c y m m :5 -6 t LLJ'm O m �t A CO) J . c _ `r .y 0o ® c CJ Vi CL m =" �'_ H a 0 -m CD CO O co O O v co O H C C — O Om CO2 O co E co M M�y� • co CD co C ~ '4-0 CD O� oma' CD 0 0 cc o oma. CL tM< c Ccc/�•Y Q J .O CD CO2 Z m CL V y cc R CO) 0 LLI UA w W W W �/e -Vanvnwozur Office of ConsumerAffai us nesg -+- ul HOME IMPROVEMENT CONTRACTOR Registrae4o.108511 Expiration: -8/1912012 X611 SMITH CONSTRUGTLON Co.. Kevin Smith - { 63 INGLEWOOD ST N Andover, MA 01845: 4 i Undersecretary �lassachusctts - Department of Public S:rfeh Board of Building Regulations and Standards Construction Supervisor License License: CS 102589 Restricted to: 00 • KEVIN SMITH 63 INGLEWOOD STREET NORTH ANDOVER, MA 01845 c --7�7'� Expiration: 3/5/2013 ('orruni :vioncr Tr#: 102589 il,d / R tr0T- 3Z, 5rl vuood ve , e .)I 0.�. & Tp y 4 PT— Po se`s 12-� ` 64n1c.,z��,/Z, Poey-S 4 2 —zx/z 1,97— Q '4/2- & 4&/'' V���� -V,7 d5 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 onother 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 1•o 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 T52,' §25C(6)-als& states that "ever'y state or local licensing agency shall withhold the issuance or h R � renewal of a license or permit to operate a busines's or to cansfruct buildings in+tiie 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 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 for confinnation 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 surd'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 pen-nit/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 pen -nits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or pennit 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 DeparimenCd address, telephone and fax number: t r The Cornmonwealftof Massachusetts j , Dep artmerzi of Industrial Accidents Office of Investigations 600 Washington Street: Boston} MA 02111 Tel. # 617-727-4900 ext; 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 5-26-05 www.mass.govldia 4N; The Commonwealth of Massachusetts ` Department of Industrial Accidents Office of Investigations f 1= 600 Washington Street a M? Boston, MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Name (Business/Organization/Indi `idual): Address: & 3 icy' City/State/Zip: 11 Phone #: 176 18 7-70 Are you an employer? Check the appropriate box: I. ❑ I am a employer with 4. ❑ I am a general contractor and I nployees (full and/or part-time).* have hired the sub -contractors listed on the attached sheet. # 2. atn a sole proprietor or partner- ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. 5. ❑ We are a corporation and its [No workers' comp. insurance officers have exercised their required.] 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] 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 12.0 Roof repairs 13. ❑ Other *Any applicant that checks box # 1 must also fill out the section below showing their workers' compensation policy information. t 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. 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 fonn 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 certify underlhepalps ad penalties of perjury that the information provided above true and correct _. .._- _ - Phone # 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