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HomeMy WebLinkAboutBuilding Permit #758 - 407 MARBLERIDGE ROAD 5/26/2010BUILDING PERMIT o�"�;U "qti TOWN OF NORTH ANDOVER� t p APPLICATION FOR PLAN EXAMINATION Permit NO: / E- Date Received r to5 °q �.,.. �• ,. °Rwren PP� .(5/ Date IMPORTANT: Applicant must complete all items on this nate LOCATION r not PROPERTY OWNER �,,t c��� e ,r a- 4z2;1J Print MAP. 210 PARCEL: 7N ZONING DISTRICT: - Historic District yes no Machine Shop Village yes no TYPE OF -IMPROVEMENT,, : PROPOSED USE Residential Non- Residential New Building Addition Two or more family ` Industrial Alteration No. of units: Commercial Repair, replacement AssessoryBldg Others: Demolition Other Septic'Well' Floodplain Wetlands Vatershed,District Water/Seaver UtSGKIF I ION OF WORK TO BE. PREFORMED: t, #qivd" 601) )<i- Identi'dcation Please Type or Print Clearly) (� / OWNER: Name: Kav Mor �GIC��ecir�7 Phone: 9 92- gt 4 Address: O mc(`uo- (ZC CONTRACTOR Name U i W 5 AJ Phone: % Address: C5 c f (� 41 Supervisor's Construction License: Co Li Exp. Date:_2/z2-b?— Home Improvement License: 1 Exp. Date: / I ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED C/gST BASED ON $125.00 PER S.F. Total Project Cost: $ 9,60c),oa FEE: $ ! U0 Check No.: �6��' Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guayanty fund re of Aaent/Owner Signature of contractor(.A)Pl 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 ❑ 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 u 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: Building Permit Revised 2008 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 APPR VED ANNING & DEVELOPMENT \ 1 COMMENTS CONSERVATION COMMENTS Reviewed on Sianature 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 Street FIRE DEPARTMENT Temp Dumpster on site _yes no Located at 924 Main Street 4ire Departmentsignature/date 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 2010 Location _` 2 r No. Date TOWN OF NORTH ANDOVER /• 0 s Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # /�� e s 23'US Building Inspector Massachusetts Home Improvement Sample Contract This form satisfies all basic requirements of the state's Dome Improvement Contractor Law (MOL chapter 142A), but does not include standard language to protect homeowners. Seek legal advice if necessary. Any person planning home improvements should first obtain a copy of"a , Massachusetts consumer guide to home improvement" before agreeing to any work on your residence. You may obtain a free copy by calling the Office of Consumer Affairs and Business Regulation's Consumer Information Hotline at 617-973-8767 or 1488-283-3757. homeowner lnrormaaon Contractor Information Q nJo`l �� e dUSom :VbIA�e1ueC`a a ( r Street Address (do notus a ost Office Box address) Contract or Sale son/ Owner Name 10wn State J Zip Codeusiness A dress ( ust include a streeta dress) t DVSIPA OIY45 6tno mi D a ime Phone Evening Phone .ity/'CownState Zip Code��o� Mailing Address (It different from above) Business PhnWA 2 eral Employer ID or S.S. Number JAZA • - The Contractor agrees to do the following work for the Homeo taw requires that most home w- pr"veMmt wWractors have ■ rad ¢giahatioo aumbc Hame provemem Contractor Reg. Numbs Expiration date - ner: . m e O mD e e e r F T ,, I _ _- __.- OU -0eiz-A, -i fifdoj �- f✓,N. 6�L�-c��Vv��rs p6i^G� �� UlraW N�S Required. Permits - The following building permits are required and will be secured by the contractor as the homeowners agent, (owners who secure their own permits will be excluded from the Guaranty Fund provisions of MGL chapter 142A.) T..tol D"-- ....a ID_ ...-.,....0 a.a.. r., Proposed Start and Completion Schedule - The following schedule will be adhered to unless circumstances beyond the contractors control arise 2016 d kk-, Date when contractor will begin contracted work. 10 Date when contracted work will be substantially completed. The Contractor agrees to perform tire work, furnish the material and labor specified above for the total sum of FR 006,op (*) Payments will be made according to the following schedule: $ / Oj0ib coupon signing contract (not to exceed 1/3 of the total contract price or the cost of special order items, whichever is greater) Ar— or upon completion -of ROV I $ �O by _/_/_ or upon completion of Sdd-"Upon completion of the contract. (Law forbids demanding full payment until contract is completed to both party's satisfaction) The following material/equipment must be special $ to be paid for ordered before the contracted workbegins in order S to be paid for to meet the completion schedule.(**) NOTES: (*) Including 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 total contract price or (b) the actual cost of any special equipment or custom made material which must be special ordered in advance to meet the completion schedule. Express warraniv -Is an express warranty belne Provided by the contractor? No Yes (all terms of the warranty must be attached to the contract Subcontractors - Thd-tontractor agrees to be solely responsible for completion of the work described regardless of the actions of any third party/subcontractor utilized by die contractor. The contractor further agrees to be solely responsible for all payments to all subcontractors for materials and labor under this aereement Contract Acceptance - Upon signing, this document becomes a binding contract under law. Unless otherwise noted within this document, the contract shall not imply that any lien or other security interest has been placed on the residence. Review the following cautions and notices carefully before signing this contracL • Don't be pressured into signing the contract Take time to read and fully understand it. Ask questions if something is unclear. • Make sure the contractor has a valid Home Improvement Contractor Reeistration The law requires most home improvement contractors and subcontractors to be registered with the Director of Home Itnprovement Contractor Registration. You may inquire about contractor registration by :writing to the Director at One Ashburton Place, Room 1301, Boston, MA 02108 or by calling 617-727-3200 or 1-800-223-0933. • Does the contractor have insurance? Check to see that your contractor is properly insured. • Know your rights and responsibilities. Read the Important Information on the reverse side of this form and get a copy of the Consumer Guide to the Home Improvement Contractor Law. You may cancel this agreement if it has been signed ata place other than the contractors. normal place of business, provided you notify the contractor in writing at his/her main office or branch office by ordinary mail posted, by telegram sent or by delivery, not later than midnight of tiie third business day following. the signing of this agreement Seethe attached notice of cancellation form for an explanation of this right. nf% Ar/lry+ rnT!"TwT TTrrn r•.- . acv ..v. u.aa.trrx i iiip l.Vl\ 1 itLEll.l 11' 111EKL1. AKE NY BLANK SP CESM Two identical copies of t contract st be co leted and signed One copy should go to meo . The other copy shout t by the tractor. 2 Homeowner' gnature Contractor's Signature Date Date Contractor Arbitration The Home Improvement Contractor Law provides homeowners with the right to initiate an arbitration action (as an . alternative to court action) if they have a dispute with a contractor. The same right isnot automatically afforded to a contractor, however. The contractor would have to resolve any dispute he/she has with a homeowner in court unless both parties agree to the optional clause provided below. This clause would give the contractor the same right to arbitration as is afforded to the homeowner by the Home Improvement Contractor Law. The contractor and the homeowner hereby mutually agree in advance that in the event the contractor has a dispute concerning this contract, the contractor may submit the dispute to a private arbitration firm which has been approved by the Secretary of the Executive Office of Consumer Affairs and Business gula ' nand the consu er shall be required to s bmit to such arbitration a prov' ed In Massachusetts General Laws c Homeow er's Signature Contractor's Signature NOTICE: The signatures of the parties above apply only to the agreement of the parties to alternative dispute resolution initiated by the contractor. The homeowner may initiate alternative dispute resolution even where this saction is not separately signed by the parties. Homeowner's Rights A homeowner's rights under the Home Improvement Contractor Law (MGL chapter 142A) and other consumer protection laws (i.e. MGL chapter 93A) may not be waived in any way, even by agreement.' However, homeowners may be excluded from certain rights if the contractor they choose is not properly registered as prescribed by law. Homeowners who secure their own building permits are automatically excluded from all Guaranty Fund provisions of the Home Improvement Contractor Law. The contractor is responsible for completing the,work as described, in a timely and workmanlike manner. Homeowners may be entitled to other specific legal rights if the contractor guarantees or provides an express warranty for workmanship or materials. In addition to guarantees or warranties provided by the contractor, all goods sold in Massachusetts carry an implied warranty of merchantability and fitness for a particular purpose. An enumeration of other matters on which the homeowner and contractor lawfully agree may be added to the terms of the contract as long as they do not restrict a homeowner's basic consumer rights. If you have questions; about Your consumer/homeowner rights, contact the Consumer Information Hotline (listed below). Execution of Contract The contract must be executed in du licate and should not be signed until.a copy of all exhibits and referenced documents have been attached. Parties are also advised not to sign the document until all blank sections have been filled in or marked as void, deleted, or not applicable. One original signed copy of the contract with attachments is to be given to the owner'and the other kept by the contractor. Any modification to the original contract must be in writing and agreed to by both parties. Contracted work may not begun until both parties have received a fully executed copy of the contract, and the three day recission period has expired. Accelerated Payments A contractor may not demand payments in advance of the dates specified on the payment schedule in cases where the homeowner deems him/herself to be financially insecure. However, in instances where a contractor deems him/herself to be financially insecure, the contractor may require that the balance of funds not yet due be placed in a joint escrow account as a prerequisite to continuing the contracted work_ Withdrawal of funds from said account would require the signatures of both parties. Additional Information If you have general questions or need additional information about the Home Improvement Contractor Law or other consumer rights, or1f you wish to obtain a free copy of "A Consumer Guide to the Home Improvement Contractor Law," contact: Consumer Information Hotline Office of Consumer Affairs and Business Regulation 10 Park Plaza, Room 5170, Boston, MA 02116 (617) 973-8787'or 1-(888) 2833757 If you want to verify the registration of a contractor or if you have questions or need additional information specifically about the contractor registration component of the Home Improvement Contractor Law, contact: Director of Home Improvement Contractor Registration Bureau of Building Regulations and Standards One Ashburton Place, Room 1301, Boston, MA 02108 (617) 727-3200 or 1-800-223-0933 For assistance with informal mediation of disputes or to register formal complaints against a business, call: Consumer Complaint Section Office of the Attorney General (617) 727-8400 AND/OR Better Business Bureau (508)65.2-4800 (508)755-2548 (413)734-3114 A. F. Watson General Contracting 3 Edgemont Street Derry, NH 03038 Tel. 603-437-6134 Cell # 603-661-5360 NAME/ADDRESS Mr. Raymond Maclean 407 Marbleridge Road North Andover, Ma. 01845 Estimate DATE ESTIMATE # 5/14/2010 1418 V W NLKJ 3AXN 11 UKn I s 1li' / &""�V""' V 41 E3- .... 4 VIVO,% \ TERMS ' PROJECT Due on receipt 'ITEM DESCRIPTION QTY COST TOTAL Permit Town of N. Andover building permit fee 850.00 850.00 Engineering Engineering Plot Plan 950.00 950.00 Excavation Excavating For Foundation and Rough grading. 2,800.00 2,800.00 Foundation Install a 12"x 24" footing and a 10"Poured foundation 6,500.00 6,500.00 wall. Frame Mat., Framing Materials as follows: 0.00 0.00 sill seal Sill seal roll 2 15.00 _ 30.00 2x6x16'PT 2"x 6"x 16'-0" Pressure Treated Wood 12 11.82 141.84 LVL 13/4"x 11 7/8"x 24'-0" LVL 1 113.99 113.99 I Joist 11 7/8" X 16-0" I -Joist 19 27.71 526.49 1 Joist 11 7/8" X 20'-0" I -Joist 11 34.64 381.04 Rim joist 11 7/8" x 160" 16 26.12 417.92 ADH. Subfloor adhesive tube 10 3.99 39.90 avantech 4'X 8' X 3/4" T&G Subfloor 22 18.95 416.90 Joist Hanger I- Joist Hangers 19 3.75 71.25 Anchors 1/2" X 4 1/2" Lag bolts & washers 24 3.29 78.96 Miscellaneous Miscellaneous joist nails, 8d & 16d nails 150.00 150.00 2x6xl6Spr 2"x 6"x 16'-0" K/D Spruce 24 7.20 172.80 2x6x8 2'x 6"x 8'-0" K/D Spruce 135 3.50 472.50 2x10xl2 2"x 10"x 12'-0" K/D Spruce 10 10.20 102.00 4x8xl/2CDX Tx 8'x 1/2" CDX Plywood 36 13.45 484.20 24SPRUCE 2"x 4"x 8' Spruce stud 100 2.84 284.00 2x4x12 2"x 4"x 12'-0" K/D Spruce 12 3.30 39.60 1x3xl6strapin 1"x 3"x 16'-0" Strapping 48 2.10 100.80 2x1Ox14SPR 2"x 10"x 14'-0" K/D Spruce 26 14.17 368.42 2x12xl6SPR 2"x 12"x 16-0" K/D Spruce 1 23.97 23.97 2x8x2OSPR 2"x 8"x 18'-0" K/D Spruce 13 14.75 191.75 2x10xl6SP 2"x 10"x 16-0" Spruce 20 13.35 267.00 2x6x16Spr 2"x 6"x 16-0" K/D Spruce 20 7.20 144.00 THANK - YOU A. F. WATSON TOTAL SIGNATURE Au lx� V W NLKJ 3AXN 11 UKn I s 1li' / &""�V""' V 41 E3- .... 4 VIVO,% \ A. F. Watson General Contracting 3 Edgemont Street Derry, NH 03038 Tel. 603-437-6134 Cell # 603-661-5360 NAME/ADDRESS Mr. Raymond Maclean 407 Marbleridge Road North Andover, Ma. 01845 Estimate DATE ESTIMATE # 5/14/2010 1418 OWNERS SIGNATURE r:)-- , SIGNATURE TERMS ' PROJECT Due on receipt ITEM DESCRIPTION QTY COST TOTAL Plywood Tx 8'x 5/8" CDX Plywood 19 16.55 314.45 Tyvek Tyvek Air Infiltration Barrier 106.00 106.00 Ice & water s Grace Ice & Water Shield 3 92.00 276.00 lx8azek 1" x 8" x 18'-0" AZEK TRIMBOARD 6 48.96 293.76 1x3xl2azek 1" X 3" X 12'-0" AZEK 10 16.37 163.70 Windows WINDOW ALLOWANCE: 12 270.00 3,240.00 2-8 Steel Insulated steel door unit 3'-0"X 6'-8" 2 350.00 700.00 Vinyl Siding Certainteed Monogram Siding in a color 12 70.00 840.00 1PieceCorner One Piece Vinyl Corner 4" Face 4 12.50 50.00 J -Channel 3/4" Vinyl J -Channel in White 12 3.55 42.60 Starter Aluminum Starter Strip 9 4.25 38.25 Light Block Vinyl light block 7 8.50 59.50 Exaust vent Exhaust vent mount master 2 9.50 19.00 Inside Corner Inside Corner Post 1 9.50 9.50 Siding nails 1 1/2" Aluminum Nails 5 6.95 34.75 Insulation INSULATION ALLOWANCE: 1,500.00 1,500.00 BlueBd. Blue Board & Plastering Per sheet 56 70.00 3,920.00 Doors Interior Door Units 1,200.00 1,200.00 Trim Interior window trim & base boards 350.00 350.00 Floors Oak Flooring 520 5.50 2,860.00 Tile TILE ALLOWANCE: 1,150.00 1,150.00 Materials Materials farmer porch as follows: 0.00 0.00 PT Wood 6"x 6" x10'-0" Pressure Treated Wood 2 28.83 57.66 2x8xlOPT 2"x 8"x 10'-0" PT Wood 30 8.89 266.70 THANK - YOU A. F. WATSON TOTAL OWNERS SIGNATURE r:)-- , SIGNATURE A. F. Watson General Contracting 3 Edgemont Street Derry, NH 03038 Tel. 603-437-6134 Cell # 603-661-5360 NAME/ADDRESS Mr. Raymond Maclean 407 Marbleridge Road North Andover, Ma. 01845 Estimate DATE ESTIMATE # 5/14/2010 1418 i OWNERS SIGNATURE-411;dLC I(Q o,,,.,, o SIGNATURE TERMS PROJECT Due on receipt ITEM DESCRIPTION QTY COST TOTAL 2xl2xl2pt 2"x 12"x 12'- 0" Treated Wood 14 19.69 275.66 5/4 x 6 x 16 5/4 x 6 x 16 PT wood 66 15.54 1,025.64 Miscellaneous Miscellaneous, screws, joist hangers & nails 150.00 150.00 4x4PT 4" x 4" x 8'-0" Pressure Treated Wood 5 8.44 42.20 2x10xl0 2"x 10" x 10'-0" K/D Spruce # 2& BTR 15 8.60 129.00 2x8xl2KD 2"x 8"x 12'-0" KD Spruce 37 7.58 280.46 Plywood 4'x 8'x 5/8" CDX Plywood 1 20 16.55 331.00 post sleeve Post Sleeve 4" x 108" 5 89.75 448.75 lx8azek 1" x 8" x 18'-0" AZEK TRIMBOARD 10 48.96 489.60 1x3xl2azek V X 3" X 12'-0" AZEK 4 16.37 65.48 1 x6azek 1 " X 6" X 18' AZEK 3 37.08 111.24 Soffit Vinyl Soffit in white 40 8.75 350.00 Roofing Roofing Allowance 2,900.00 2,900.00 Allowance Allowance for ramps 1,500.00 1,500.00 labor Carpenter's labor 550 40.00 22,000.00 Electrical Electrical work Allowance 8,500.00 8,500.00 Plumbing Plumbing & Heating Allowance 9,500.00 9,500.00 Subtotal labor & Materials 81,710.23 Cont. fee Contractors 10% Fee profit + overhead 10.00% 8,171.02 THANK - YOU A. F. WATSON TO?ALI $89,881.25 n i OWNERS SIGNATURE-411;dLC I(Q o,,,.,, o SIGNATURE The Commonwecelth of Massachusetts Department of Industrial _accidents Office ofInveslz,ations 600 R'ashirig ton Street Boston, MA 02,11 , WWK'•Mass;gov/dia Workers' Compensation insurance Affidavit: Builders/Contractors/Electricians/Plumbers Mficant Information w Name (Business/Organization/Indivi dual): I Address: City/State/Zip:_ A e r �, bi WZY Phone #: �3 7 6 �3 Are Mran em l0 9 C p yer. heck the appropriate box: 1. I am a employer with __ 4. ❑ I am a 2. ❑employees (full and/or part-time).* I am a sole g—emJ contractor and I have hired the sub -contractors proprietor or partner- ship and have no employees listed on the attached sheet t working for me in any capacity. These sub -contras tors have workers' comp. insurance. [No workers' comp: insurance 5. ❑ We are a corporation 3. [1required.] am a homeowner doing all and its officers have exercised their .1 work myself. [No workers' comp. rit of gh exemption per MGL c. 152, § 1(4), and insurance required.] t we have no employees. [No workers comp. MA11 au Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. []'Building addition 10. El Electrical repairs or additions 11.❑ Plumbing repairs or additions 12•7 Roof repairs ce I3.7 Other `Il n3 aF*aFicaat that ch� bor �l mus, also rYi ont the ae- "t2QaahQl:^.^.n (.:heir wori:em' comY..�"'_8 ....i. _ I"ctOaeth who submit this affidavit indicating they are doing at.' work and thea bice outside rt msacton niu,M sub"i" a Ee:v affidavit indicating such. +Contractors that chr.,.); this box must A -tta^hed an additional sheet showing r_ the name of tree sub-contzactois and their.„•k wr— ...,,• Gm Puryer mat is providing workers' coin enation -T. r_ ..••U•,r,Ua information. P &"rance for my employees Below is the oli r P �7 and job site Insurance Company Name:Je t i S 1 Policy # or Self -ins. Lic. #: We, q 3� 4D Expiration Date: l 2- Sob Site Address: �d city/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing, Failure to secure coverage as required under Section 25A ofMGL c. 152 can lead to ththe e®imposi6onlicy hof er and expiration date). fine up to $1,500.00 and/or one-year imprisonment, as wellas c=V Penalties in the form of a STOP WORK ORD criminal penalties of a Of up to $250:00 a day against the violator. Be advised that a c� a fine Investigations of the DIA for insurance coverage verification. PY of statement may be forwarded to the Office of true and correct. Information an- d 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 t3ae legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association ox- other legal entity, employing employees. However the owner of a dwelling house having not more than three apartmLents 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 licens*mgagency shall withhold the issuance or renewal of a license or permit to operate a business or to r`onstruct 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 unt3l acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the comma cling 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 number(s) along with their certificate(s) of . . insurance. Limited Liability Companies (LLC) or Limited Liability partnerships (LLP) with no employees other than tine members or partners,, are not required to carry workers' comp easation 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 confirmation of instance coverage. .Also be stare to sign and date the affidavit The affidavit should be ret arne-d to the city or town that the application for the pera�t or license is being; reauestad, not the .Deaarcz:ent. of Industrial Accidents. Should you have any questions regardimg 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 p=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 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 burn leaves etxr.) said person is NOT required to complete this affidavit:. The Office of1rivestigations would Ince 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,f ix-mumb=-..... The CommonvrealtbL of Massachusetts Department of lndusstHal Accidents Office of In esticgatfo.ns 600 washmgton Street Boston, MA 0.2111. Tel. # 617-72.7-4900 cxt406 or 1-977-MASSAFE Revised 5-26-05 Fa-: # 617-727-7749 vrvru7.1nass.-aov/dia. E' ORGY CONSERVATION APPLICATION FORM FOR LOW-RISE RESIDENTIAL NEW CONSTRUCTION and ADDITIONS 7-80 CMR Appendix J ArAufz,Applicant Name: \jot ow Site Address: 47kiwH1,P_ to Y )e l'rY __IV l,-1 ©3is Use Group:�C_ Date of Application: /o Applicant Phone: 60-71T,(p6 Applicant Signature: Compliance Path (check one): ❑ Prescriptive Package (Limited to 1- or 2 -family wood frame buildings heated with fossil fuels only) Package (A through KK from Table J5.2.1 b): Heating Degree Days (HDD65) from Table J5.2. la: (For items d. through i., fill in all values that apply from Table J5.2.Ib: a. Gross Wall Area sq.ft f. Wall R -value R- C R. b. Glazing Areal sq.ft. g. Floor R -value R- t`t c. Glazing % (100 x b _ a) % h. Basement wall R- d. Glazing U -value U= i. Slab Perimeter R- e. Ceiling R -value R- J, Heating AFUE ❑ Component Performance: "Manual Trade -Off' (Limited to wood or metal framed buildings only) Climate Zone (from Figure J6.2.2) ❑ Zone 12 El Zone 13 El Zone 14 Attach Trade -Off Worksheet from Appendix J, [and HVAC Trade-off Worksheet, if applicable] ❑ K4Scheck Software Attach Compliance Report and Inspection Checklist printouts E3 Home Energy Rating System Evaluation 9 1 2 3 Home Energy Rating Certificate (HERS rating score must be 83 or higher) ' Systems Analysis OR ❑ Renewable Energy Sources .ch Mass Registered Architect or Enaineer Analysis 9 A-LTERNATIVE FOR ADDITIONS ONLY: Wall + Ceiling Area 5-200sq.R". b. Glazing Areal 130 sq.ft. c. Glazing % (100 x b _ a) 2.0; ADDITION with Glazing % (c.) up to 40% may use. 780 CMR Table J1.1.2.3.1 below: G lazing Area may be either Rough Opening or Unit dimensions. Based on NFRC Iisting. Applies either to every unit, or to area -weighted average of all units. R-30 ceiling insulation may be used in place of R-37 if the insulation achieves the full R -value over the entire ceiling area (i.e.- not compressed over exterior walls, and including any access openings.) ❑ "SUNTROOM9i addition (greater than 40% glazing -to -wall and ceiling gro s area) Attach "Consumer Information Form" from 780 CMR Appendix B. Official's Name: Official's Signature: O z LIM q.. a G u 0z w° E cit z r. G LE 0 tN. -!-:g •C2 � a � a u o. � co r. d. a w I= 0 V)- Q. 0 C/) 6 tN. -!-:g •C2 o. C.) cs 42 0 CL ca Si CD A-- CD hf CL E CA 0 CA cm ca o to Ce CD CC ON cm *0 E �4 CMO C20, CD CC) C3 b - cE :ono cm c CC*- g CD CL 0 CA) Ic COD 1 06= 3 z LU C.3 ts C0 03 -., ca CL ig - 0:6 CD co 0 cl . CL 6 M UI (f1 n C:) DRAWINGS PROVIDED BY: PROJECT DESCRIPTION: SHEET TITLE: NO. DESCRIPTION BY DATE •+, m a 0 ' A. F. Watson General M r- N Tn Maclean Proposed Addition O 3EdgemontStContracting Floor Framing Derry, NH 03038 603-437-6134- a I II 24' i 2 m a o w 0 v a o w � m 3 N = = a fa V 44 3 n i l rn C w 10'-3 1 /2" .a � y T rn rn rn O � N 0 Q O \ n X C-� 4 N Z II � o N o 4 (o rt (A % w r- r / b O cn O o0 .+ ; 19' 1/16" - Z i 91 e Cq 1Ij 3'-5 1 /16� H N 44 k AN r m -77 777 18'-7 7/8" 5'-3 1/2" 2.3 13'-9 5/8" 40' M UI (f1 n C:) DRAWINGS PROVIDED BY: PROJECT DESCRIPTION: SHEET TITLE: NO. DESCRIPTION BY DATE •+, m a 0 ' A. F. Watson General M r- N Tn Maclean Proposed Addition O 3EdgemontStContracting Floor Framing Derry, NH 03038 603-437-6134- ci. ---— 24' I II v o w o N � N - - - - - - --- N U11 N N N -Cp x II -A I I N to v N I rn 44 o ------I - N 00 o _ c_> W II 0 N ! II C 10'-3 1/2" � II V (p Ut 1 (� r 0— o� - L 011 o - �- w o - N N 0 _ NT A O o pt Z G) \ O n 11 y _ 0 co -n r- ® 0 cn ® 0 aD 47 M Cii Z , � rTe� N d X 0 n - `D o --- - C 3'-5 1/16' °o ca M o m X 3 tQ s+ !� °- N N CD n N OD ' N — fl. r 1-& -h O N o 7 @ SL O O ` M (D d a o C� D o M 0 o °' Q 0 3 O 18'-7 7/8" 5'-3 1/2" 2'-3" 13'-9 5/8" 40' N M mI (n D m Ln0 in N O m DRAWINGS PROVIDED BY: A. F. Watson General 3 Edgemont St Contracting PROJECT DESCRIPTION: Maclean Proposed Addition SHEET TITLE: Ceiling /Roof NO. DESCRIPTION BY DATE ~O Derry, NH 03038 Framing 603-437-6134 - N I m D to � m V • r� �mgm rA�; ME Nmo�� R CT Cr CD C^^ CL m CID Z n C Cf) = m z ZZ m Z 0 G) m z N x O 0 0cn—i --I �Cn r-rn �Cn> Zym v > F mr n O W O r v DRAWINGS PROVIDED BY: A. F. Watson General 3 Edgemont StContracting —n D dk1 p Z 0 n Z 0 -0 XC M D 0O 0 c 4 D m z 2 z m C/) O —� G) m On C El 1-_ _m I - C L Q CCCCCCCCC CI /��• z l\� + c P c CCCCC -�I C C C I—III—I I—I I I c v c a qc V h - P V PV V C 0 V 6 >ZO OOZ —I X�v WmD R CT Cr CD C^^ CL m CID Z n C Cf) = m z ZZ m Z 0 G) m z N x O 0 0cn—i --I �Cn r-rn �Cn> Zym v > F mr n O W O r ti m DRAWINGS PROVIDED BY: A. F. Watson General 3 Edgemont StContracting —n D dk1 p Z 0 n 0 -0 XC M 0O 0 c 4 D 2 z 2 z m C/) O G) m On K z D z m ti Q DRAWINGS PROVIDED BY: A. F. Watson General 3 Edgemont StContracting rr SHEET TITLE: dk1 T z -0 XC M 0O 0 c 4 y y ;uD Cn n m w m C/) (7 W W7'IZ g m —go 2'n 70 ZOmO mCC)0� COm o �WO- G -i -n ;o .AZO= ;U L Nrn Q DRAWINGS PROVIDED BY: A. F. Watson General 3 Edgemont StContracting PROJECT DESCRIPTION: Maclean Proposed Addition SHEET TITLE: NO. DESCRIPTION BY DATE Derry, NH 03038 603-437-6134 - 4- DRAWINGS PROVIDED BY: PROJECT DESCRIPTION: SHEET TITLE: NO. DESCRIPTION BY DATE -i F. Watson General Maclean Proposed — m Addition First Floor Plan 3Edg,—,stContracting — Dc", NN 03038 503-437-6134 - U) (n m D A. � ' m r m 00 0 ib a 0 ----------------------- 1 DRAWINGS PROVIDED BY: A. F. Watson General 3 Edg—om St Contracting Derry, NII 03038 003-437-5134 - LO SHEET TITLE: Foundation Plan NO. DESCRIPTION BV In --- ED D A -DI 'ED m o m N o ----------------------- 1 DRAWINGS PROVIDED BY: A. F. Watson General 3 Edg—om St Contracting Derry, NII 03038 003-437-5134 - PROJECT DESCRIPTION: Maclean Proposed Addition SHEET TITLE: Foundation Plan NO. DESCRIPTION BV UgfE --- -- N U1 0 DRAWINGS PROVIDED 0 PROJECT DESCRIPTION: SHEET TITLE: NO. DESCRIPTION BY DATE m � m A. F. Wat o Generai Maclean Proposed Addition Elevation View 3 Edgemont St Con a ting Derry, NH 03038 603-437-6134 - O O D i I i D I I ii!ij jilt 1 li ��II ij' o III I O I hill Illlli'j III Wk.I'i� illli;�!Illi! i IIII'' I I I�I I� D IIj �Ilj �II�I�II �Illl 61 lIII�Ifj Iill Illll�lll;l t �III!�I I;II ,�IIi!I �ji�ll�i !i ,'il!hI ;iIIIII o a, li�l!li IIS o iI it 11111i illII�I!ii, Ilii ilI!I!'�� 'II�I;j!� I• I O � ILII 1i�4� VIII, II N U1 0 DRAWINGS PROVIDED 0 PROJECT DESCRIPTION: SHEET TITLE: NO. DESCRIPTION BY DATE m � m A. F. Wat o Generai Maclean Proposed Addition Elevation View 3 Edgemont St Con a ting Derry, NH 03038 603-437-6134 - .. a' � --'-----` DRAWINGS PROVIDED BY: A. F. Watson General Derry, NH 0303S 603-4 37-6134 PROJECT DESCRIPTION: Maclean Proposed Addition SHEET TITLE: Elevation View NO. DESMPTION BY DATE m � � ITT � |||~^� � --'-----` DRAWINGS PROVIDED BY: A. F. Watson General Derry, NH 0303S 603-4 37-6134 PROJECT DESCRIPTION: Maclean Proposed Addition SHEET TITLE: Elevation View NO. DESMPTION BY DATE Massachusetts - Department of Public SafetN Board of Building Regulations and Standards Construction Supervisor License License: CS 63168 Restricted to: IG ARTHUR F, WATSON , 3 EDGEMONT ST DERRY, NH 03038 Expiration: 2/12/2012 t' inanissiuner , Tr#: 16906 �,,, file �aes�nanu�rxl� n�'�.�,¢ct�ac�ierdP� Board of Building Regulatiors.and bttied .. = HOME IMPROVEMENT CONTF fOR 0 Registration:. 118848 Expiration: 4/28!2011 Tr# 28'i6 ; Type; DBA A.F. WATSON GEN`:CONTRACTING ARTHUR WATSON'. 3'EDGEMONT ST� a EDERRY, NH 03038 ldincRr,ira�t, x BUILDING PERMIT opt Leo 6�ti TOWN OF NORTH ANDOVER APPLICATION. FOR PLAN EXAMINATION Permit NO: ��� Date Received 5 nate Icci earl TYPE OF IMPROVEMENT. PROPOSED USE Residential Non- Residential New Building,-.. "AEfam(y ` Addition Two or more family ` Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other DESCRIPTION OF WORK TO BE. PREFORMED: �Aa i v>'luQ 5 OWNER: Name: Type or Print Clearly) ARCHITECT/ENGINEER Phone: Address: Reg. No FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED CTT BASED ON $125.00 PER S.F. Total Project Cost: $ 16U0, vt FEE: $ Check No.: �?66e Receipt No.: 41?10te NOTE: Persons contracting with unregistered contractors do not have access to thle guayanty_fund �i BUILDING PERMIT O�tLeo qti TOWN OF NORTH ANDOVER APPLICATION. FOR PLAN EXAMINATION 70 W -(0 /J © Permit NO: Date Received ❑atP. ISCl1Art' TYPE OF IMPROVEMENT. PROPOSED USE Residential Non- Residential New Building£ ?rte:;f�mily.' . Addition Two or more family Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other DESCRIPTION OF WORK TO BE. PREFORMED: was OWNER: Name: Kc; #qlvd.", C-04) &:� - .. j p4e e. Type or Print Clearly) ARCHITECT/ENGINEER Phone: Address: Reg. No FEE SCHEDULE. BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED CqST BASED ON $125.00 PER S.F. Total Project Cost: $ R Iwo, o, a0 FEE: $ Check No.: (?66e Receipt No.: aOte NOTE: Persons contracting with unregistered contractors do not have access to the guaFanty fund