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HomeMy WebLinkAboutBuilding Permit #1017-2016 - 38 VILLAGE GREEN DRIVE 3/30/2016 BUILDING PERMIT o� NORTy q 4t�'EO �6. �� TOWN OF NORTH ANDOVER 0 h�.. APPLICATION FOR PLAN EXAMINATION * W� c.coiwew w 1' Permit No#: 1 �� Date Received �S..oAr u Date Issued: 1�� I IMPORTANT: Applicant must complete all items on this page LOCATION U . oe•ey) iPr PROPERTY OWNER __w414 041 b /S A Print 100.Year Structure yes no !MAP C PARCEL: D ZONING DISTRICT: Historic District yes, no Machine Shop Villageyes: no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ne family ❑ Addition ❑Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial Pepair, replacement ❑Assessory Bldg ❑ Others: oDemolition ❑ Other _ QSeptic OWell �❑ Floodplain ��Wetlands ❑ Watershed District. Water/Sewer _ DESCRIPTION OF WORK TO BE PERFORMED: kLe1 Identification- Please Type or Print Clearly OWNER: Name: Karen :tkohbfert�76 Phone: 5:7�E, 3E7 -Jq' 2Y Address: 3� �c Gree Contractor Name: 416'd � t �� Phone: -77 717y1 Email: - Address5 T)�i 5 - iT—hl -7 6 Supervisor's Construction License: Exp. Date: /1, b117 Home-Improvement License: 6 lac Exp: Date: '4 0 ARCHITECT/ENGINEER 6/ r+ Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED OST BASED ON$125.00 PER S.F. Total Project Cost: $ rl 6_7� Check No.: 2-24LP'16 qq:;�3o Receipt No.: ?�61-1 LA NOTE: Persons contracting with unre istered contractors do not have access to uaranty fund 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 e U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ i COMMENTS 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 a. Conservation Decision: Comments Wafter& Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located sgooStreet FI�76 E DEPARTMENT Te p ®u p ter on sit yeses + In© L o� ted at�i1�24 Main Street ireDepartm_nts L I I 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 Call Email Date Time Contact Name F Doc.Building Permit Revised 2014 i 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 4, 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 OTE: 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 4. Workers Comp Affidavit 4 Photo Copy of H.I.C. And C.S.L. Licenses 4. Copy Of Contract Floor/Cross Section/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 OTE: 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 2012 IECC Energy code Engineering Affidavits for Engineered products OTE: 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:Building Permit Revised 2014 Locations t .� J �- 'd f No. V..) U Date-�'� �I�� • • TOWN OF NORTH ANDOVER Certificate of Occupancy $ _ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# 22 4 1;:�4 77o C7 �: Building Inspector tAORTH Town of 0 - o�h � ver, Mass, cocHicHew'C" y1' �l.9S R�ren pxq! � U BOARD OF HEALTH Food/Kitchen LD Septic System k�,,,� 1 PERMIT3., Na BUILDING INSPECTOR THISCERTIFIES THAT ..................................................................� . .................. ................ ............- J ' t � �t Foundation has permission to erect .......................... buildings on .. ........�....... ............................. .....4.... Rough to be occupied as -.. .x .. 1 .4 y ....... ...... .. .......................................... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION S TS� Rough Service ......................... ...................................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. � t , eWE CONTRACT# 0009613 ia t LOWE'S A THORIZED REPRESENI'ATI J NUMBER x it€_,, CUSTOMER t • �sY Z --� F..: b STORE NO. STRtET ADDRESS - STREET ADDRESS- , m CITY STATE ZIP CITY STATE ZIP ,ry'�#�,•. a _ O x ry"" TELEPHONE TELEPHONE dfia . 19 DATE LOWE'S HOME CENTERS,LLC'S MA HIC NO.:148688 4° CASH tuNx LCC REG' y •;€-, z FEIN:56-0748358 f -. - CHARGE - - INSTALLATION STREET ADDRESS CITY STATE --` ZIP P-WL out I s rnd r t � er r S. IPI-111 62 NOTICE TO CUSTOMER—PRICE CALCULATIONS:In order to properly perform-the installation of certain Goods,the Contrail Price may include more Goods than actually will be installed based on the measured square footage of the Project Area.As a result;the parties agree that the lump-sum Price stated in this Contrail is calculated upon both the value of estimated Goods required to fulfill the As (including waste),which may exceed the actual square footage of the,Project Area,and the labor which may be estimated based on.the amount of Goods required to fulfill the Contrail(including waste). By signing this Contract below,Customer acknowledges receipt of this notice and agrees and understands that the Price includes these costs which may not be refunded once the Installation Services are performed. Contract Total Are permits required for this installation?:[O.Yes [ ]No *applicable tax included. a, 1�fA gS NOTICE TO CUSTOMER: Federal law requires Lowe's to provide you with the pamplet Renovate Right.By signing this Contract,Customer acknowledges having received a copy of this pamphlet before work began informing Customer of the potential risk of the lead hazard exposure from renovation activity to be performed in Customer's dwelling unit. NOTE:ff rotted wood is discovered during installation additional charges will apply.You will be given a quote and a change order must be completed and signed by the.customer for any additional charges. Customer must initial. *Any work or material not specified is not included in this contract.Any changes or additions will be at an additional charge for the material and labor. PHOTO RELEASE:Customer grants to Lowe's and Lowe's employees and independent contractors the right to take photographs of the Premises where Installation Services will be performed and all work performed at the Premises related to this Contract,and irrevocably grants to Lowe's all right;title and interest in and to thephotographs for use in all markets and media,worldwide,in perpetuity.Customer authorizes Lowe's to copyright,use and publish the photographs in print and/or.electronically, and agrees that Lowe's may use such photographs for any lawful purpose,including,but not limited to,marketing, advertising,publicity,illustration,training and Web content.By initialing here,Customer agrees to the foregoing. [Customer to initial to the left]. Work is tok4nmence upon reasonable availability of Contractor and/or any special orde or customer made Good(s)which is anticipated to be JYIJII/ [fill in date].Estimated completion date is . [fill in date]. Said estimated substantial completion date isryot of the essence.A statement of any contingencies that would materially change said estimated substantial completion date is as follows: /i)�Art71r� (if applicable,insert a statement of such contingencies). IF THE CONTRACT TOTAL IS$1,000.00 OR LESS Customer must pay in full. COMPLETE THIS SECTION ONLY WHEN THE CONTRACT TOTAL EXCEEDS$1,000.00: Customer to Pay in Full; OR [ ]Customer to use the following papmentschedule: (1)Deposit $ to be paid upon signing contract.Deposit should be 1/3 the total contract price;and (2)Payment of$ to be paid anytime after this Contract is signed and before commencement of installation,INVe authorize Lowe's to do one of the following(check appropriate box below): [. J Charge my/our credit card for the amount of the payment indicated above anytime after the date this Contract is signed; or [ ]Deposit my/our check for the amount of the payment indicated above anytime after the date this Contract is signed;and (3)Final payment of$100.00 to be paid upon completion of the installation and both parties'satisfaction. NOTICE REGARDING ARBITRATION AGREEMENT FOR CLAIMS COVERED BY M.G.L.c 14 e LOWE'S AND OWNER HERE TUALLY AGREE IN ADVANCE THAT IN THE EVENT LOWE'S HAS A DISPUTE CONCERNING THIS CONTRACT,THAT -LOWE'S MAY SUBMIT SU DIS TETO A PRIVATE.ARBITMTTMSERVICE WHICH HASBEEtd APPROVE SY THE SECRETARY OF THE EXECUT= IVE OFFICE OF CONSU RAF IRS.AND BUSINESS REGULATIONS AND.THE OWN R/SALL BE REQUIRED TO SUBMIT TO SUCH ARBITRATION AS PR IN .c14By: Date:2-7 ( Lowe's Hom Cent / B ' u Date: ,1;7 Owner Tignature THE SIGNATURES OF THE PARTIES ABOVE APPLY ONLY TO THE AGREEMENT OF THE PARTIES TO ALTERNATIVE DISPUTE RESOLUTION INITIATED BY LOWE'S PURSUANT TO'M.G.L.c.142A.THE OWNER MAY BE PERMITTED TO INITIATE ALTERNATIVE DISPUTE RESOLUTION EVEN WHERE THE SECTION ABOVE IS NOT SEPARATELY SIGNED BY THE PARTIES. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES AND UNTIL YOU HAVE READ THE TERMS AND CONDITIONS CONTAINED ON THE REVERSE SIDE OF THIS PAGE AND THE FOLLOWING PAGES OF THIS CONTRACT. BY SIGNING BELOW,YOU ARE ACKNOWLEDGING THAT YOU HAVE READ,UNDERSTAND AND AGREE TO THE TERMS AND CONDITIONS SET FORTH ON THE REVERSE SIDE OF THIS PAGE AND THE FOLLOWING PAGE's OF THIS CONTRACT.YOU ARE E TLED TO A COPY OF THIS CONT CT AT THE TIME OF SIGNATURE. WITNESS OUR HANDC S) SEA S)BELOW THIS_91fDAY OF_C t 6 � Low ' rs,L 3y P, 42 1r� oir, ;•i Lowe's Authorized Re Owner' Co-owner or Witness Customer acknowledges rece p f a true copy of this contract which was completely filled:in prior to Customer's execution hereof.You,the buyer,may cancel-this transaction at any time prior to midnight of the third business day after the date of this transaction.See the attached notice of cancellation form for an explanation of this right. 55102 REV. 12/13 FILE COPY o zoos ey registered Lowe'strade.®Lowe's end are gaols design _ are marks of LF Corporation. t ne k.ummvrsweetitn uY lvcassucnuseuaIT Department of Industrial Accidents Office of Investigation .1 Congress Street, Suite Olt 1 r Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/individual): EC,�0.eI . i+ ►ik I _ Address: 5 B06761 City/State/Zip: (} D 1y7 0 Phone #: I `�7 b ' 630-717Y Are you an employer? Check the appropriate box: Type of project (required): 1.❑ 1 am a employer with 4. E] i am a general contractor and I em lovee full a part-time).* have hired the sub-contractors 6. New construction p s ( and/or part time). 1 2. 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition employees and have wolr ers' working for me in any capacity. 9. ❑ Building addition [No workers' comp. insurance comp. insurance.1 � required.] 5. an oration We are a corporation its 10.0 Electrical repairs or additions ❑ P 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [ I No workers' comp, right of exemption per NGL , .❑ Roof repairs i insurance required.] t c. 152. §1(4),and we ha4c no ly employees. [No workers 13"�Other I��tr t comp. insurance required.] `Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. 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 showinb the name of the sub-contractors and state whether or not those entities have cmployees. I I'the sub-contractors have employees.they must provide their workers'comp.polity number. I ani an employer that is providing workers'compensation insurance for mJ7 employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic. #:_ Expiration Date: _ Job Site Address: � 'j ��1�� �f�✓I Dr Ci /State/Zi Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required raider 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 staement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under 4e pqins and enalties o eUu that the infornztion provided above is true and correct. Signature: 4 I Date Phone #: i Official use only. Do not write in this area,to he completed by city or town official. City or Town: Permit[Licenise# I Issuing Authority (circle one): 1. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6. Other C"mart PPrcnn: Phone#- -C 751 u5 Yr I'm/o Jl,1""'(x',41 Q}� � f�t 41fCt'%f"l f: Fit try Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 ti Home Improvement Contractor Reistration Il) m Registration: 162722 ' Type: Individual Expiration: 41612017 Trtt 264520 MICHAEL THOMAS DEMILLE MICHAEL DEMILLE 5 BRISTOL ST SALEM, MA 01970 Update Address and return card.Mark reason for change. SCA 1 4 tii-0S'1 IJ Address [- Renews} ❑ Ll Employment Lost Card �y ��t' Cf't>?Jt)uMrff+'EY7/lft.f;�`/��lrJJar'17.f/.11rlfJ � bice of Consumer Affairs&Business Regotalioo License or registration valid for individul use only GT before the f19E IMPROVEMENT CONTRACTOR expiration date 1.f found return to: egistration: 162722 Type: Office of Consumer Affairs and Business Regulation � xpdration: 41tif20.1 Z individual 10 Park Plaza-Suite 5170 Boston,MA 0211.6 L _____ �.MICHAELJ:HOMAS.OEMItsE _ —___.___ — i 5 BRISTOL ST f - -...._ _SALEMi419Z0 Not valid without signature F= 1. L.S.. Il) r•1 r� Ii> r•1 i r 5 i n. �t p M I Ylb � Massachusetts Department of Public ety Board of Building Regulations and Standards License- CS-082,193 Construction Supervisor MICHAEL T QEMILLE 5 BRlSTQL ST SALEM MA 0197 0 Cz 171 U t Commissioner 101031'2b1T x 0 000 03 V 0n u. 0 00 - N O