HomeMy WebLinkAboutBuilding Permit #672-13 - 332 CAMPBELL ROAD 4/16/2013TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit N0: Date Received
Date Issued:
IMPORTANT: Applicant must complete all items on this page
-71
.'_
LOCATION
- .. Print;
PROPERTY OWN.ERi _
Pririt 100 Year.0ld:St�ucture yes no,.:..
MAP,NQ: PARCEL: ZONING DISTRICT: 'Historic.District yes no.
_.
Machine Shop Village ye& no;
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
❑ One family
❑ Addition
❑ Two or more family
❑ Industrial
❑ Alteration
No. of units:
❑ Commercial
❑ Repair, replacement
❑ Assessory Bldg
❑ Others:
❑ Demolition
❑ Other
}` ❑ `Septic; .� 1Nell
' ".tlds
t❑,F
�kWatef%Sewer ` '
DESCRIPTION OF WORK TO BE PERFOKMEU:
Identification Please Type or Print Clearly)
OWNER: Name: Phone:
nAArocc
. ti'
rCONTRACTOR 'Name.:_ .- _ _. � r..._.�_ Pone. ., -• v n'
Address
,.�
;.Supe_rvisors;r "onstruction :License: _ Exp- "Date
s s
Hometlmprovement License ;Ezp
ARCH ITECT/ENGINEE
Address:
Phone:
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: $ FEE: $
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Signature of Agent/Owner T 3 Signature of,contractor
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stampe i 'P0's ❑
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9 BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit N0: � L — Date Received
Date Issued: - L
IMPORTANT: Applicant must complete all items on this Datie
LOCATION 3?7 a r o trite .I —JRl�)QJ
pORT1{
o i p
h
Print
PROPERTY OWNER Pr�.6 O tb(-tg' —n
Print
MAP NO: PARCEL ZONING DISTRICT: Historic District yes
Machine Shop Village ves
TYPE OF IMPROVEMENT
PROPOSED USE
bO i V, a,a-O
An A Gj QU
Residential
Non- Residential
❑ New Building
VOne family
, ►
B'Addition / De.,:- k
❑ Two or more family
❑ Industrial
❑ Alteration
No. of units:
❑ Commercial
❑ Repair, replacement
❑ Assessory Bldg
❑ Others:
❑ Demolition
❑ Other
❑ Septic ❑ Well
❑ Floodplain ❑ Wetlands
❑ Watershed District
❑ Water/Sewer
k4n C�) a. 0 eAl � llt l P,� e o n � (`� 4 LT J �
46.Cdk
%et(%\ TJo„461� 6.rthn t>n +v A� (PXlo 5r.4rtXw&ji f-dJtJ (2,4
Identification Please Type or Print Clearly)
OWNER: Name: K�3b U K(`dc()
c7e,� <r� p7tan
Address: 3 a
Gdlh
bO i V, a,a-O
An A Gj QU
CONTRACTOR
Name:
, ►
Phone:
S7(F-S`Co9 --
—I&M-11111=1aft Win
Address:
/3,+ Paudiv 0 S WkA d �-
Supervisor's Construction License: C5,
MOP Exp. Date:
Home Improvement License: /C13 Exp. Date:
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE: BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COSTBASEDON $125.00 PER S.F.
Total Project Cost: $ (rJ , UqD FEE: $ 1
Check No.:Receipt No.:
NOTE: Persons contracting with u �istered contractors do not have ac ess t the ua anty fund
Signature of Agent/Owner, Signature of contracto
4
?3
Location
Date '
Check #-eV
26287
1
TOWN OF NORTH ANDOVER 4�
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
'A
Building Inspector
Plans Submitted ❑
s `y
Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑
Tanning/Massage/BodyArt ❑ ...
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
SERVATION Reviewed o
DATE REJECTED
El
DATE APPROVED
COMMENTS
,HEALTH
t
COMMENTS
Reviewed on IVC
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 Towi Engineer: Signature:
Located 384 Osgood Street
FIRE DEPARTMENT - Temp Dumpster on site yes no
Located at 1241Main Street
Fire Ddpartinerit-signature/date'
i
Dimension
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
Total land area, sq. ft.:
ELECTRICAL Movement of Deter location, mast or service drop requires approval of
lectrical Inspector Yes No
�AN�ER®NE LITERATURE: Yes No
AGL Chapter 166 Section 21A -F and G min.$100-$1000 fine
)oc.Building Permit Revised 2010
Building Department
artment
The fol awing 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
a 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
o 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 app: al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
must be subm;¢ted with the building application
Doc: Doc.Building Permit Revised 2012
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APR/09/2013/TUE 09:20 AM FAX No, P,001
ACORa�
CERTIFICATE aF LIABILITY INSURANCE
DATE /OD/YY
vd/094�os/zol3
PRODUCER (617) 946-8600
John M. Biggio Ina Agency
399 Winthrop Street
WinthropHA 02152,
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED 13Y THE POLICIES 13ELOW,
INSURERS AFFORDING COVERAGE NAIL #
INSURW
FMC. Roalty &
PO Barr 92
North Andover
Construction
MA 01845-
INSURER AHarle SVille
INSURER B; AIM Mutual InouranGe
INSURER C:
INSURER D:
INSURER E;
COVERAGES
THE P01JCIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAME? ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY
REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECTTO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,
THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN I$ SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.
AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR LTR
N R
7YPEOFINSUHANGE
POLICY NUMBER
DATE(IEFFECTIVE
AU OYY)
PDATE (MMIDOITY)OLICY N
LIMITS
A
North Andover MA 01645
GENERAL LIABILITY
SPP 97481K
10/04/2012
10/04/2013
EACH OCCURRENCE $ 1,000,000
DAMAGE
AMA ETODENTED $ 100,000
PREMISECLAIMS
COM MERCIALGENERAL LIABILITY
MADE ❑R OCCUR
/ :
/ /
MED EXP one $ 5,000
PERSONAL & ADV INJURY $ 1,
-000,000
GENERALAGGREGATE $ 2,000,000
I I
I
GEN'LAGGREGATE LIMIT APPLIES PER;
PRODUCTS -COMPIOP AGO $ 2,000,000
POLICY 79& LDC
AUTOMOBILE
LIABILITY
ANY AUTO
COMBINED SINGLE LIMIT :
(Ea acddenO
BODILY INJURY
(R -P—) $
ALL OWNED AUTOS
SCHEDULED AUTOS
/ /
/ /
HIRED AUTOS
NON-0WNF,A AUTOS
/
/ /
BODILY INJURY
(Per accldem s
PROPERTY DAMAGE $
(Per accidenE)
GARAGE LIABILITY
AUTO ONLY -EA ACCIDENT $
OTHER THAN EA ACC $
A14YAUTO
I /
/ /
AUTO ONLY: AGG $
A
EXCESSIUMBRELLA LIABILITY
7 OCCUR FICLAIMSMADE
CmR 47158P
11/05/2012
10/04/2013
EACH OCCURRENCE $ 1, 000, 000
AGGREGATE $ 1,000,000
S
DEDUCTfBLEE
$
RETENTION $
$
WORKERS COMPENSATION AND
EMPLOYERS' LJABILITY
ANY PROPRIETORIPARTNERIEXECUTTVE
APIC 7027586012012
06/29/2012
06/29/201
WWCC ��pp77UU- �I
TORYLIMIT& OER
6,L,EACH ACCIDENT $ 100,000
E.LDISEASE- EAEMPLOYE $ 100,000
OFFICERIMEM89REXCLUDED9
1I yos, dasedW under
SPECIAL PROMSIONS bWW
/ /
/ /
E.LDISEABE-POLICYUMIT $ 500,000
OTHER
DESCRIP71ON OF OPERATIONSILOCArONSMEHICLEWEXCLUSION5 ADDED BY ENDORSEMENUSPEGIAL PROVISIONS
CERTIFICATE HOLDER CANCELLATION
( ) (975) $24-2319
SHOULD ANY OF THE ABOVE DESCRIBED POLIGIES OF CANCELL90 larWORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, RUT
Town of North Andover
FAILURE TO 00 SO SHALL IMPOSE NO OBLIGATK)N OR LIABILITY OF ANY KIND UPON THE
1600 Osgood
INSURNK M AGEAS 0 PRE$GN TIVES.
AUTHORIZED REPRES NT
North Andover MA 01645
nM I
ACORD 25 (2004/08) , )(CACORDCORPORATION 1988
*„:. INS025 (o,o6),o9 ELECTRONIC LASER FORMS, INC. - (800)327-0545 Page M of 2
Nlass,tchusctt% - Department of Puhlie '+Yeti
Board of Buildin- RegOations and htandard%
Construction Supervisor License
License: CS 86883
NOEL L COSTANTINO .�
13A PAULINE ST
WINTHROP, MA 02152
cry_ Expiration: 12128/2013
+mmikil Ener Tr#: 7485
✓lze �omox4nai�lit. a����t!a,�aac�uQe�d
Office of Consumer Affairs & Business Regulation
HOME IMPROVEMENT CONTRACTOR
Registration: 143050 Type:
Expiration: 6114/2014 DBA
COSTANTINO REALTY + CONST.
NOEL COSTANTINO
13 PAULINE STREET
WINTHROP, MA 01841 Undersecretary
WHO W7 W
0M I
Phone: 978-569-3519
Fax: 978-824-2319
E-mail: noel@fmcconstruction.biz
Online: www.fmcconstruction.biz
Mail: P.O. Box 92, North Andover, MA 01845
HIC Registration: 143050, Exp. date: 6/14/2014
Tax ID: 271 468 346
MA CS License: 86883, Noel Costantino, General contractor
Date: 4/7/2013
Customer:
Rob Obrien
332 Campbell Road
North Andover, MA 01845
Description of labor for deck project:
1. Attach a new 18' ledger board to the house and frame out for an 16' x 18'
deck footprint
2. Install proper deck ledger flashing and install new frieze board above ledger
as needed
3. Dig and pour four new concrete footings, install 2x 10 support beam on top of
6x6 posts and frame deck structure with 2x10 pressure -treated lumber
4. Provide one 5' wide stairway to ground level (stairway will be centered on
driveway side of deck) ending with a concrete pad on grade
5. Install (10) 4x6 posts to deck and stair frame
6. Install approximately 290 sq. ft. of pressure -treated decking to joists and stair
framing and construct railing and baluster system with pressure -treated stock
7. Relocate existing dryer vent through new ledger board
Payment Schedule:
The cost to build the above project is $15,650. This is a labor and materials quote
based upon the initial consultation. A non-refundable deposit of $200 will be
required to secure the start date*. The remaining payments will be made as follows:
➢ First day of construction 6500
➢ At the start of the second work week 6500
➢ Completion of project 2450
*work will commence on April 15`h and should be significantly completed by April 26`h
i J0�4 LICENSED
BB�INSURED J
NAT -28333-1
View examples o_f our work at:
www.fmcconstruction.biz
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NOTICE OF CANCELLATION
You may cancel this transaction, without penalty or obligation, five business days after
FMC Realty & Construction, Inc. receipt of the signed proposal and deposit. If you
cancel,. any property traded in, any payments made by you under the contract or sale, and
any negotiable instruments executed by you will be returned within ten business days
following receipt by the contractor of your cancellation notice, and any security interest
arising out of the transaction will be cancelled. If you cancel, you must make available to
the contractor at your residence, in substantially as good condition as when received, any
goods delivered to you under this contract or sale; or you may, if you wish, comply with
the instructions of the contractor regarding the return shipment of the goods at the
contractor's expense and risk. If you do make the goods available to the contractor and
your contractor does not pick them up within twenty days of the date of cancellation you
may retain or dispose of the goods without any further obligation. If you fail to make the
goods to the contractor and fail to do so, then you remain liable for performance of all
obligations under the contract.
To cancel this transaction, mail or deliver a signed and dated copy of this
cancellation notice or any other written notice to the contractor at the following address:
FMC Realty & Construction, Inc.
P.O. Box 92
North Andover, MA 01845
I hereby cancel this transaction
Buyer's signature
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i LICENSED
"1 BBS INSURED
NAT -28333-1
Date
View examples of our work at:
www.fincconstruction.biz
a, a The Commonwealth of Massachusetts
Department of Industrial Accidents
. Office of Invadgadons
600 Washington Street
Boston, Mas& 02111
www.mass gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organizarion/Individual) : 1 kQ_ �Q�T•�T � Q L t� C�<1% / N t��� cpl� 4�i l•��
Address: St�
City/State/Zip: f-.c,.,,o . ,tkA fld iS X Phone#:__
Are you an employer? Check the appropriate box:
1. Lam an employer with
4. ❑ I am a general contractor and I
employees (full and/or part time).*
have hired the sub -contractors
2. ❑ I am a sole proprietor or partner-
listed on the attached sheet
ship and have no employees
These sub -contractors have
working for me in any capacity.
employees and have workers'
[No workers' comp. insurance
zomp. insurance. $
required]
5-f, We are a corporation and its
3. n I am a homeowner doing all work
officers have exercised their
myself [No workers' comp.
right of exemption perm MGL
insurance required] t
c. 152, § 1(4), and we have no
employees. [no workers'
comp. insurance required.]
Type of project (required):
6. ❑ New construction
7. C Remodeling
8. L Demolition
9. C Building addition
10. F Electrical repairs or additions
11. C Plumbing repairs or additions
12. L Roof repairs
13.I--0ther DQ,C_�—
*Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information.
tHomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
$Contactors that check this box must attach 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 thepolicy and job site
information.
Insurance Company Name:/ /ti ,y ,�U2�
Policy # or Self -ins. Lie. #:
k03U
76)218C U d(t a-
Expiration Date: G' aq// b
Job Site Address: ?5,3 c�
Ca�,P(QJ
t &A
City/StatelZip:
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 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
$250.00 a day against violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the
DIA for coverage verification_
I do herby certify u0#'�he pains and pen alties of perjury that the information provided above is true and correct
Date:
Print Name: 04\ Phone #: 1-72-S-67
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):
I.Board of Heath 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact person: Phone #:
MORTGAGE INSPECTION PLAN
City/Town NJoEZT\A At-VooyEtZ ,MA
Date: / 1 Co J °� °� Scale: 1 u = \0 0
'vs\Lha
Owner: �a.u�ST Buyer. ®�R\EN
Deed Ref. PlanNo. CoVl c.)
Drawn per Cityffo-vn of X11 P" Assessors Map
01
C PO? r)y-
To: H �] \1h1EM A�� MORS' � ACS c CO'(Z� , --
I hereby certify that the above Mortgage Inspection Plan was prepared for use in connection with a new Mortgage and is not untended or represented to
be a property line or land survey. It cannot be used for establishing fence, hedge, walls or building lilies. No responsibility is extended to the land
oNjnter, occupant or buyer. The location of the original building(s) as shotim hereut vas in compliance .iZtlt the local applicable zoning bylaws ineffect
when constructed, with respect to horizontal dimensional requirements, to lot lilies or is exempt from violation enforcement action under Mass G.L.
Title VII, Chap. 40A, Sec. 7, wnless otherwise shown herein. Subject building(s) lies in a flood zone designated Zone: X and
slto�vn on FIRM Map Community -Panel # 25oog a Dated: (-/2 / 3 lob No.
JCD, INCORPORATED, LAND USE R DEVELOPMENT CONSULTANTS 4 AUTUMN LANE, METI-IUEN, MA 0 1844-3177 978-683-9932
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All home improvement contractors and subcontractors engaged in home
improvement contracting, unless specifically exempt from registration by Provisions
of Chapter 142A of general laws, must be registered with the Commonwealth of
Massachusetts. Inquires about registration and status should be made to the
Director, Home Improvement Contract Registration, One Ashburton Place, Room
1301, Boston, MA 02108 (617)727-3200
TERMS AND CONDITIONS
WARRANTY INFORMATION:
The Contractor warrants that the work furnished hereunder shall be free from
defects in materials and workmanship for a period of one year following completion and
shall comply with the requirements of this agreement. In the event any defect in
workmanship or materials, or damage caused by the Contractor, his subcontractors,
employees or agents, is discovered within one year after substantial completion of any
job, including cleanup, the Contractor shall, at his own expense, forthwith remedy repair,
correct, replace, or cause to be remedied, repaired, or replaced, such damage or such
defect in materials or workmanship. The foregoing warranties shall survive any
inspection performed in connection with the agreed-upon work.
All warranties for equipment supplied by the Contractor under this agreement
shall be those given by the manufacturers of such equipment, which shall be and are
hereby passed through directly to the Owner. Under such manufactures' warranties, the
Owner may be required to register or mail in a warranty card or other evidence of
ownership and use of such equipment in order to activate such warranties. The Owner's
failure to mail in or register such documentation, which failure voids the manufacturer's
warranty, shall not create any responsibility for the Contractor to warranty such
equipment. The warranty gives the Owner specific legal rights, and Owner may also
have the other rights which vary from state to state. Under Massachusetts law, sales of
goods carry an implied warranty of merchantability and fitness for a particular purpose.
All material is guaranteed to be as specified. All work to be completed in a workmanlike
manner according to standard practices.
SPECIFIC TERMS AND CONDITIONS:
• Any and all construction -related permits shall be the obligation of the contractor
to obtain.. Homeowners that secure their own construction- related permits or
deal with unregistered contractors shall be excluded from access to the Guarantee
Fund
• Permit fees associated with the project are the customer's responsibility and will
be added to the final billing
�i
, ,&EPA
NAT -28333-1
Sim!!
INSURED
View examples of our work at:
www.fmcconstruction.biz