HomeMy WebLinkAboutBuilding Permit #331 - 50 SUTTON HILL ROAD 10/26/2009 TOWN OF NORTH ANDOVER
r . APPLICATION FOR PLAN EXAMINATION
Permit.NO: 1 Date Received
Date Issued: '6
IMPO TANT:Applicant must complete all items on this page
LOCATION
F
Pent
PROPERTY OWNER �t:�. r VC rvt
NtAP.NO: PARCEL: ZONING DIST�tICT; Histotic,bistrict yes In
Mach hop Village yes
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
New Building One family
ddition Two or more family Industrial
Iteration No. of units: Commercial
Rep r, replacement Assessory Bldg Others:
Demolition Other
Septic. WeillFloodplain Wetlartcls Watershed District
� .
Water/Sewer;
DESCRIPTION OF WORK TO BE PERFORMED:
Kwplr agw, su A, T, V/ 9-Ow- t it a&15C /e6,,JjA4,U &v 0 k
dentificat.i Please T e or Print Clearly) _
OWNER: Name: l� �— r�,v>r+ �ti1//�oyl c4�t/ Phone: I �— 7 - Z36 v
4 Address: &C 121�
CONTRACTOR Name Ivy, ox Phone; 7t/- '; 7 -r Z
Address:
r
Supervisors Co nstructlorhjcense °U Exp. Date;: .
r
Home improvement License- _ Exp. Date: 115i 16
ARCHITECT/ENGINEER Phone:
Address: - r Reg. No.
FEE SCHEDULE:BOLDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ 2 b U U FEE: $ t`o
Check No.: - SS- Receipt No.: 22 e
NOTE: Persons contracting with unregistered contractors do not have access to he gu an f d
igratureof Agnt/Owner Signatire ofcontractor _ �
f
Plans Submitted Plans Waived Certified Plot Plan Stamped Plans
1 TYPE OF SEWERAGE DISPOSAL
f f
Public Sewer Tanning/MassageBody 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 APPROVED
PLANNING & DEVELOPMENT
COMMENTS
CONSERVATION Reviewed on Si nature `
COMMENTS
HEALTH Reviewed on Si nature
COMMENTS
Zoning Board of Appeals: Variance, Petition No:
Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision:
Comments
Water & Sewer Con nection/sici nature& Date
Driveway Permit
DPW Town Engineer: Signature:
Located 384 Os ood Street
FIRE DEPARTMENT - Temp Dumpster on site. yes no
Located at 124 Main Street
Fire Department signature/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
4
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1
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❑ Notified for pickup - Date
i_— _._......--.._.__.._-..........................._........----....—_............._.._........-- --.._........................._ .._................_._....._.._._. -----...........-- _.
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Doc:.Building Permit Revised 2008
I
J
Building Department
t
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
❑ 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
i ❑ Mass check Energy Compliance Report
s ❑ 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: Doc.Building Permit Revised 2008
I�
Location
No. / Date 14-,26'0 f
MORTM TOWN OF NORTH ANDOVER
O
0 s
A
Certificate of Occupancy $
CHUS Building/Frame Permit Fee $ �i
Foundation Permit Fee $ a
Other Permit Fee 41
TOTAL $
Check #
22564 Building Inspector
NORTH
c
Town of
No. 37 -=. -
o. dover, Mass.,/h • 01(• O
coC MI CMEwICK y1.
ADRATED
`s BOARD OF HEALTH
PERMIT T D Food/Kitchen
Septic System
BUILDING INSPECTOR
THIS CERTIFIES THAT.........S.. . ...................................... Foundation
has permission to erect .................................... bu' ings on ..... ................. ... ..• Rough
to be occupied as......mwwp .......... . .. ............. ................... . ...............................................................
Chimney
provided that the person accepting this permit sha I in every respect conform to the terms of the application on file in Final
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 CONSTRU< N STARTS Rough
........... Service
BUILDING INSPECTOR
Final
Occupancy Permit Required to Ocatpy Building GAS INSPECTOR
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.
IFSEE REVERSE SIDE Smoke Det.
Quinlan & Rand
34 Trinity Court
North Andover,MA 01845
Phone 508-682-1570 • 508-521-4196 1
Proposal Page No. of \ Pages
PROPOSAL SUBMITTED TO PHONE DATE �
STREET JOB NA E
SQ-Mot4 kL L 0M1 � CL1Yl�1 t��i1�O1114T1 �V
CITY, STATE AND IIP CODE JOB LOCATION
ARCHITECT DATE OF PLANS JOB PHONE
We hereby propose to furnish materials and labor necessary for the completion of:
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WE PROPOSE hereby to furnish material and labor—complete in accordance with above specifications,for the sum of:
dollars (LZ
Payment to be made as follows:
All material is guaranteed to be as specified. All work to be completed in a substantial
workmanlike manner according to specification submitted,per standard practices. Any altera- Authorized
n.
tion or deviation from above specifications involving extra costs will be executed only upon Signature
written orders,and will become an extra charge over and above the estimate. All agreements Note: This proposal may be
contingent upon strikes,accidents,or delays beyond our control. (honer to carry fire,tornado withdrawn by us if not accepted wit days.
and other necessary insurance. All subcontractors are covered by personal liability insurance.
ACCEPTANCE OF PROPOSAL The above prices, specifications and condi-
tions are satisfactory and are hereby accepted.You are authorized to do the work
as specified. Payment will be made as outline above. Signature
Date of Acceptance: Signa r
Quinlan & Rand
BUILDERS
34 Trinity Court
North Andover,MA 01845
Phone 508-682-1570 • 508-5214196
Proposal Page No. t of Pages
PROPOSAL SUBMITTED TO PHONE- DATE
C7� )
STREET JOB NAE '
SQ TTOk J�tLL OA-P "�'StLiYiGia RQNOLIA-??6r.
CITY, STATE AND ZIP CODE JOB LOCATION
ARCHITECT ___fDATE OE PLANS JOB PHONE
We hereby propose to furnish materials and labor necessary for the completion of:
0J I*hM '5114 f W6 2 KCn, &W(L(&r0 1124-e91"45 R(L -51-ft ILL 51TLA-�
gzoAk_-> fit7 C FL(L (Z-,A-.j tN(t5 fA'S1Ttj '"( .5TUDS �(c rt D � a iT�- LV Ati-5 "To
B(t_ LN t.i i y'l t — t l I V S0 i.A-i>0-1V ,
�.NST1rYCL S0SVIGLjDL0 cC►LMk 'pW.rjL "j It ~S �d Q C/C 77tCs ATg D,Fs=,�/1!�✓1 ca5�7
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t/Z" BLVf, &44ZO w/ 576-tl to#r nitsixR ad ALL wrr4'5
1,1;5 1-,(D'. �P9'VrC M1KA4.1tIq 'yq wlho i3ftTt; Ar�� I-YW�t.afZ9'il� SKt2i
— S aN
WE PROPOSE hereby to furnish material and labor—complete in accordance with above specifications,for the sum of:
Payment to be made as follows: dollars(s Zl J'7J l
/
All material is guaranteed to be as specified. All work to be completed in a substantial
workmanlike manner according to specification submitted,per standard practices. Any altera- Authorized
tion or deviation from above specifications involving extra costs will be executed only upon Signature
written orders,and will become an extra charge over and above the estimate. All agreements
contingent upon strikes,accidents,or delays beyond our control. (Avner to carry fire,tornado Mote:This proposal may be
withdrawn by us it not accepted wit
Y Pe liability insurance.
and other necessary insurance. All subcontractors are covered b personal liabili days.
ACCEPTANCE OF PROPOSAL The above prices, specifications and condi-
tions are satisfactory and are hereby accepted.You are authorized to do the work
as specified. Payment will be made as outline above. Signature
Date of Acceptance: Signa r
13n��f1'�Rfl'8?fi � f�•,tfiYi`'�P�f(�1;.�
HOME IMPROVEMENT CONTRACTOR
Registration- 111089
Expiration 11/25/2010 Tr# 277125
l Hype
Partnership
y
QUINLAN& RAND BUfLDERS =y
TIMOTHY QUINL74N
34 TRINITY CT
N ANDOVER, MA 01$4544" ;- Administrator
IS
✓I�ze fDamz�rtoau�Pa%, a yR�
Board of Buildiug Regulations and 9tandar`t!s
Construction.Supervi6orLicense. ^i
Licensee: CS 55288
Expt�3an ,A,/ 010 'T-r,# 25448 {
ResWtW qc
TIMOTHY R WIN LAW t:
' 34 TRINITY CT
NO ANDOVER,-MA 01845 Commissioner
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, llL4-02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers�
Applicant Information Please Print Legibly
Name (Business/Organization/Individual):-- in Ilan PIWI
Address: 3
City/State/Zip: KorA AokJoverf MCI , Phone#:
Are you an employer? Check the appropriate bog: Type of project(required):
1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. Q New construction
employees(full and/or part-time).* have hired the sub-contractors
2. 1 am a sole proprietor or partner- listed on the attached sheet.$ 7• Remodeling
ship and have no employees These sub-contractors have 8. Q Demolition
working for me in any capacity. workers' comp. insurance. 9. Q Building addition
o workers' comp. insurance 5. ❑ We are a co oration and its
P rP
required.] officers have exercised their 10.Q Electrical repairs or additions
3.❑ I am a homeowner doing all work right of exemption per MGL I LQ Plumbing repairs or additions
myself. (No workers' comp. c. 152, §.1(4),and we have no 12.Q Roof repairs
insurance required.] t employees. [No workers' 13.0 Other
comp. insurance required.].
*,".,-ry applicant that checks box#1 must also fill out the section below showing their workers,compensation policy;::formation.
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-contractorsand their workers'comp.policy information.
I am an employer that is providing workerscompensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lic.#: Expiration Date:
Job Site Address: 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 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.
Ido hereby certify under thepa' d ald of perjury that the information provided above is true and correct
Signature: (/� G 'A�/V
Date: lD -a 3- O
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#:
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 or other 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 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 Vocal licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct 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 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-contractor(s)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 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 confirmation 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 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 permit/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 bum 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 Department's address,telephone and fax number:
The Commonwealth.of Massachusetts
Department of Industrial Accidents.
Office of Investigations
600 Washington.Street
Boston,MA.0211.1
Tel. 4 617-7274900 ext 406 or 1-877-MASSA-FE
Revised 5-26-05
Fax 4 617-72.7-7749
w-A-A,.mas ..govddia