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HomeMy WebLinkAboutBuilding Permit #393-2017 - 41 PERLEY ROAD 10/12/2016 nv'� \ 1 r10RTH BUILDING PERMIT °�`�c�`'E°.A;bq't'o TOWN OF NORTH ANDOVER . APPLICATION FOR PLAN EXAMINATION ' Permit No#:�� Date Received '°R,rED Jlr" c5 gSSACHUS Date Issued: lo- IMPORTANT: Applicant must complete all items on this page { Pnnt, PRN PEROTV OWN,NER' - "`®� �" _ Pnnt1 t3©lY'ear Str ctlire` yes nog MAP'' PARCEL .�� Z®NI,N DIST�Rl i Hist©tic ®�stnctd n•© � G Y�� Machine Shop Vrllage�' ye nod TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential 0 New Building U-One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ElAssessory Bldg El Others- ❑ Demolition ❑ Other _ -- `�-_�`Y •� TOR �; WatershedltDistrict&� DiSeptic ❑Well �; l]� dpin1111/elands �3 _ .�'Wate;�/5evver�. .•- - �-_._ �:'� . ..�,� - .•�_�. .....-- __ �-�'�.�...�_� �.. ---�----..R�. -e_._.�- DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: a Phone: Address: Contras©r Name f'o sL ( 'hone ; O a - I S I eru�s'orrs Constructlont License r 'i[' A, - L H,o 1 t e�Imp,rouementF.License Exp: ®ate• ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. II Total Project Cost: $ 33 FEE: $ Check No.: too Receipt No.: '310 contractors do not have access to the guarantyfund eyed contra g NOTE: Persons contracting with unregistered Si nafurexof;Agent/Owner,. ti - oritracto�• 1 3 s .� 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/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 NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:Building Permit Revised 2014 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 PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Si9 nature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Plan ping Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRED PE ARTMENT Te p®ump9teK(05site Locatetl at124 IVlainSt�t� Fire De_partme_nts�ignatur}eLdate. 4 COMM. _` p - . MIT F Dimension Number of Stories: 'Z 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 foricku Call p P Email E Date Time Contact Name Doe.Building Pennit Revised 2014 { r Location U No. 3/ 3' d kol - Date /0 ! - L a/6 • - TOWN OF NORTH ANDOVER i Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ i Other Permit Fee $ TOTAL $ Check# builds Q Inspect6r i NORTIHI '9 Town of � _ 6 ndover 0 aZ y h ver, Mass, . � 'Qp [OC NIC Nl WICM ' � �•9 °R�rEo �Pa��y S V BOARD OF HEALTH PERMIT Food/Kitchen Septic System THIS CERTIFIES THAT .....?.Cr�{ .J,11 /! ... BUILDING INSPECTOR ............................. has permission to erectq/ P ..Icy M.5.. Foundation .......................... buildings on ...... ...... ... ....... Rough tobe occupied as ........... .'.t.'...v.�C.S.e.......... ......... .s.C'.`.. ........................... 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS 2CONSTRUCTION S Rough ... Service .. ..... .... ..... BUILDI.....I...... ..... Final NG N CTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building 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. a i www.ReviseEnergy.com Revise Energy Home Performance Contractor 5 South Summer Street,Bradford,MA 01835 CONTRACT N1'R A CT 978-914-2214 FAX(401)784-3710 /�1 !1 Page 1 PROGRAM CMA-HPC CUSTOMER PHONE DATE CLIENT# WORK ORDER James Holloway (781)962-3973 09/21/2016 440464 00001 SERVICE STREET BILLING STREET 41 Perley Road 41 Perley Road SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP North Andover,MA 01845 North Andover,MA 01845 JOB DESCRIPTION AIR SEALING:Provide labor and materials to seal areas of your home against wasteful,excess air leakage. This work will be performed in concert with the use of special tools and diagnostic tests to assure that your home will be left with a healthful level of air exchange and indoor air quality.Materials to be used to seal your home can include caulks,foams and other products. Primary areas for sealing include air leakage to attics,basements,attached garages and other unheated areas(windows are not generally addressed.) This will require(1)working hours.A reduction in cubic feet per minute(cfm)of air infiltration will occur,but the actual number of cfm is not guaranteed. At the completion of the weatherization work,and at no additional cost to the homeowner,a final blower door and/or combustion safety analysis will be conducted by the sub-contractor to ensure the safety of the indoor air quality. I $85.00 WALLS:Furnish and install blown in Class I Cellulose to(1378)square feet of shingle and/or clapboard exterior walls.The butt of the upper course of your wood siding is cut to drill holes into the wall sheathing behind.The holes are then plugged and the wood siding is reinstalled using stainless steel finish nails.Touch-up painting,if needed,will be the customer's responsibility. Invoicing will occur upon completion of installation.Homeowner has received a copy of the EPA's Renovate Right Lead-Safe information guide explaining the potential risk of the lead hazard exposure from the weatherization work to be performed.Your signature is your acknowledgement of receipt and agreement to proceed. $2,549.30 CRAWLSPACE:Provide labor and materials to install(225)square feet of 6 ml polyethylene over open ground in designated crawlspace/earthen basement areas. $173.25 CRAWLSPACE:Provide labor and materials to install (148)square feet of R-10 rigid Thermax insulation to the crawlspace perimeter wall up to the sill and against the band joist. $547.60 www.ReviseEnergy.com Revise Energy Home Performance Contractor 5 South Summer Street,Bradford,MA 01835 CONTRACT 978-914-2214 FAX(401)784-3710 Page 2 PROGRAM CMA-HPC CUSTOMER PHONE DATE CLIENT# WORK ORDER James Holloway (781)962-3973 09/21/2016 440464 00001 SERVICE STREET BILLING STREET 41 Perley Road 41 Perley Road SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP North Andover,MA 01845 North Andover,MA 01845 JOB DESCRIPTION Total: $3,355.15 Program Incentive: $2,185.00 Customer Total: $1,170.15 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***One Thousand One Hundred Seventy & 15/100 Dollars $1,170.15 AUTHORIZED SIGNATURE-Revise Energy CUSTOMER ACCEPTANCE NOTE:THIS CONTRACT MAY BE WITHDRAWN BY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE DAYS. IILC %_Uff1//9V/LPVV"tt/L Vf LYl uJJu�Ii uJG66J v37i� Department of IndustrialAccidents Office of Investigations d I Congress Street, Suite 100 moo` Boston,MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Building Science & Construction _ Address:300 Trade Center Suite 3690 City/State/Zip:Woburn, MA 01801 Phone #:781-353-2455 Are you an employer?Check the appropriate box: Type of project(required): 1.M I am a employer with 8 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no Weatherization employees. [No workers' 13.OF Other comp. insurance required.] *Any applicant that checks box#I 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 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 the policy and job site information. Insurance Company Name: Hartford Underwriters Insurance Inc Policy#or Self-ins. Lic. #:UB-9F620983-16 Expiration Date:4/11/2017 Job Site Address: MA City/State/Zip: Wld Attach a copy of the workers' compensation policy decitration 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 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 statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: Kyle Martine ` Vim., Date:9/27/2016 Phone#: 781-353-245 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#: r�r�rr•�iHr+ami�//r��'�aw�r/rrtk+lla O!'�Ice odC�nw�erAf�!�nieeuReEabl�a r YE tVEMB1'E f;014TRA�T�OR DBA .µ,��w•��yy i W601M7 MR PgRWU JACKSON OORCHEMMA M24all affity � „y g I' log M 3!ratibn.