HomeMy WebLinkAboutBuilding Permit #518 - 51 FOXHILL ROAD 4/2/2009Permit NO:
Date Issued:
BUILDING PERMIT of q
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
:5-31
:C — 3 1 — D?
Date Received
�'P�°A.trsns ►pP y.(y
Machine Shop Village ;yes n
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
. Non- Residential
New Building
One family P1
Addition '�"^
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
OWNER: Name:
DESCRIPTION OF WORK TO BE PREFORMED: ' i
1?19 0 1 Td }ee.41e o .�, E)4,S-r &ZxvX ZO)e,Z 2
Identification Please Type or Print Clearly)
t. C -f- S'O-c 13VCHIf Z-
ARCHITECT/ENGINEER Phone:
Address: 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: $_���D� FEE: $�C�
Check No.: ��3,o Receipt No.: (� U
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Location �`e' C44, L -z—
No. Date
TOWN OF NORTH ANDOVER
S
°1 Certificate of Occupancy $
Building/Frame Permit Fee $ a <
\sS.�....ck
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check #
21905
Building Inspector
Location
No. Date
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check #Z/
22074
Building Inspector
M
Plans Submitted Plans Waived Certified Plot Plan Stamped Plans
TYPE OF SEWERAGE DISPOSAL
Publi
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
i
PLANNING & DEVELOPMENT
COMMENTS 1-1,"Off I.—
CONSERVATION Reviewed on
DATE REJECTED
DATE APPROVED
47
0� '' v d 1412f2 PcNi�o
COMMENTS zz
HEALTH Reviewed o Sianature
COMMENTS
t
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:
Dimension
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
'ZvK.2Z
i
Total land area, sq. ft.:� SQ
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 2008
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
❑ 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)
U 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
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-� The Commonwealth of Massachusetts
I r
Department o
.f Industrial Accidents
;... `'IM Lr Off1ce of Iftlenigutions
600 Was zz n Street
MA 02111
Workers' Compensation Insurance.Affjcjavi
Applicant Information t: guilders/ContractorslElectricians/Plumbers
Please Print Le�ibiv
Naine (Business/OrganizationMdividual):S171e yf
G
Address:
City/State/Zip:
Phone
Are you an employer? Check the appropriate box:
I . ❑ I am a employer with 4. ❑ I am a gena ral Type of project (required):
econtractor 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 or; the attached
ship and have no employees These solo -ca tractors have $ 7' ❑ Remodeling .
wort.-ing for me in any caparity. workers' comp. insurance. g' ❑ Demolition
[No workers' comp. insurance 5. We area corporation and its 9. KBUilding addition
3. ❑required.] ofiicen have exercised.their 10 1_I Bectical repairs or
I am a homeowner doing all work right of ex additions
myself. exemption per MGL 11.❑ Pltmtbing repairs or additions
y [No workers' comp. c. 152, � 1(41, and we have no
insurance required.] t employees. [No•workers' 1240 Roof repairs
comp. insurance required.) 13.[] Other
*Any appit ant that cheeks box # 1 .must also fill out the section below showing their workers' compensation policy information.
+ Homaowueth l ch submit .ibis aifidavtt indicatitrg iEiey are uut[i� adt :t:rr- Kiri Eason hire outside twniraciurs rnusi sunt ti a new amaavti
(Contractors that check this box.must attached an additional sheet showtte the mane. the of t. e „ b-contn ctors and their woricets' oom . of i indiceing scch.
I am an. employer that is providing workers' co ensatioa � p P c} information,
information nsuranee for ng' employees. Below is the policy and job site
Insurance Company Name:
Policy # or Self .ins. Lic. #:
Expiration Date:
.lob Site Address:
Attach a copy of the workers' CEt/State/Zip:
compensationotic declaation
page (showing the po!!cy number and expiration bate).
.Failure to secure coverage as required under Section 25A of MGL c.
fin152 can lead to the imposition of criminal penalties of a
of up to S250'.00e up to $1 a day gainst the violator. Be adv'
500.00 and/or one-year imprisonment as well.. as civil penalties in the form of a STOP WORK ORDER and a fine
.ised that a co
Investigations of -the DIA for insurance coverage verification. copy of this statement may be forwarded to the Office of
'-v"•LLe` LLe P and P=aujies ofperjur,I' 6zat the informnfinn provided above is true and correct
ure: .
#: % (P E�O �� j Dat°.: ,�',.50---p
Official use only. Do not write in this area,--------
lobe completed by city or to wry official
City or Town:
— Permit/License #
Issuing Authority (circle one):
I. Board of Fieatth 2. Ruiiding Department 3. Ch3�oh'n.Gierk 4. Electrical Inspector S. Piumbirt'
6. Other e' Inspector
Contact Person:
Phone#:
Information 2 .nd 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 includirmg the Iegal representatives of. a deceased employer, or the
receiver or trustee of an individual; Ipartnership, associati on 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 dweiling 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 o. r local licensing agency shall withhold the issuance or
renewal of a ficense or permit -to operate a bnsiness or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence Qf 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 worle 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 compi-etely, by checking the boxes that apply to your situation: and, if
necessary, supply sub-contractor(s) name(s), address(es) and phone numbers) along with their certificates) 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. at ththis affid-a.vit may .be submitted to the Departrnent of Industrial
Accidents for confirmation of insurance coverage. Aliso be sure to sign anddate Yhe.affidavi_t: Theaffidavitshould
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 iaw or if you are required to obtain a wark,-rs'
compensation policy, please call the Departament at the narinber:listed below. Self-insured companies should enter their
self-insurance license number on the appropriase line.
City or Town Officials
Please be sure that the affidavit is complete and printed leeibh . The Department has provided a space at the bottom
of the affidavit foryou to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permitliicense number which will be used as a reference number. In addition, an applicant
that must submit multiple permitAicense applications in arty giver, 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 starnped 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 I►ceases. A new affidavit must be filled out each
year. Vinccm a home owner or citizon is obtaining a license or permit not related to any business or commercial venture
(i.e. a dog license or permit to burnleaves 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 €mdustrial Accid=ts
Office of ixtvesfigatioas
600 Waddington Strewt
Boston; ILA 02111
Tel 4 617-727-4900 C= 406 or 1-8:77-MASS.AFE
Revised 5-26=05
Fax 4 61 7-72.7-7749
wvt w-M.-iss.gov/dia
The Commonwealth of Massachusetts
Department ®f Fire Services
Office of the State Fire Marshal
P. 0. Box 1025 Stite Road, Stow, MA 01775
PERMIT Date: - �
North Andover PeriuitNo
( City of Town)(If Applicable) Dig Safe Num er
In accordance with the provisions of 1vt G.L.I 4 $'Ghapter_l_(L as provided iu section 4
Start Date
This Permit is granted to
Full name of person, Firm or Corporation
Pennissionto locate dumpster _ for construction/renovation/demolition of building.
Comm dumpster. must be. 25' from structure if unable to place with re uired
Restrictions: clearance dumpster must be covered with 1 wood or tar _ end of work •dav
at
( Give location by street and no,, or descri a in such �c
Fee Paid$ 50.00
This Permit will expire 0 ( Signature of offical granting permit )
of location )
Fire Chief
Offical granting permit ( Title )
NOTE:
1) THIS PROPERTY IS CONNECTED TO THE n
MUNICIPAL SEWER SYSTEM.>>•
2) THIS PROPERTY IS NOT LOCATED WITHIN S O
90S
THE WATERSHED PROTECTION DISTRICT.
ZONING BOARD OF APPEALS APPROVAL:
ZONING BOARD OF APPEALS APPROVAL IS
NEEDED TO CONSTRUCT THE PROPOSED
FARMER'S PORCH AS SHOWN.
ZONING INFORMATION:
ZONING DISTRICT : R2
MIN. BLDG.
SETBACKS:
FRONT
30 FEET
SIDE
30 FEET
REAR
30 FEET
ASSESSOR
INFORMATION:
MAP 37C PARCEL 38
DEED REFERENCE:
BOOK: 110 PAGE: 345
OWNER INFORMATION:
ERIC & SUZANNE BUCHHOLZ
51 FOXHILL ROAD
NORTH ANDOVER, MA 01845
LOT AREA
27,863 S.F.f
PORCH 55.0'
R=127.38'
L=116.13'
i
�96p�1 FOXHILL
S�
I CERTIFY THAT THE STRUCTURES SHOWN WERE LOCATED
BY AN INSTRUMENT SURVEY AND EXIST ON THE GROUND AS SHOWN.
PLOT PLAN OF LAND
P5 / FOXHILL ROAD
NORTH ANDOVER, MASS.
PREPARED BY:
JOHN D. SULLIVAN III, P.E.
22 MOUNT VERNON ROAD
BOXFORD, MA 01921
(978) 352-7871
SCALE: 1"=40' DATE: 9/22/08
/
o
110.0'
�h
h N PROP. 1 STORY
�h NN ADDITION
z
N W
avII
(O N)
20.0
55.8'-
5.8'
0
04
a
EX. BULKHEAD
2 CAR EX. 2 S.
20.4'
GARAGE
WD. FRAME
EX. BRICK
STRUCTURE
CHIMNEY
13.0' ,�
#5
20.9'
^i
5•
EX. 1 FOOT
EX. ROOFED
42. p
21' 1
SECOND FL.
PORC
OVERHANG
PROP.
FARMER'S
PORCH 55.0'
R=127.38'
L=116.13'
i
�96p�1 FOXHILL
S�
I CERTIFY THAT THE STRUCTURES SHOWN WERE LOCATED
BY AN INSTRUMENT SURVEY AND EXIST ON THE GROUND AS SHOWN.
PLOT PLAN OF LAND
P5 / FOXHILL ROAD
NORTH ANDOVER, MASS.
PREPARED BY:
JOHN D. SULLIVAN III, P.E.
22 MOUNT VERNON ROAD
BOXFORD, MA 01921
(978) 352-7871
SCALE: 1"=40' DATE: 9/22/08
09%05%2008 14:39 FAX 6103 497 2521 ELLIOT INS AGENCY Z002
ACORD CERTIFICATE OF LIA131LI
F+IVVVGER
ELLIOT INSURANCE AGENCY
1't NORTH MAST STREET
P.O.80X 428
GOFFSTOWN, NH 03045
INSURED STEVEN & SYLVAIN LEBEL
i LESEL CONSTRUCTION
I 36 NASHUA ROAD
j PELHAM, NH 03076
I
I
TY INSURANCE DATE (MMIDDIYYYY)
0910512008
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 BY THE POLICIES BELOW,
INSURERS AFFORDING COVERAGE NAIC #
INSURER A, NGM INSURANCE COMPANY
INSURER a LIBERTY MUTUAL INS. CO.
INSURER C:
INSURER D,
INSURER E:
' rHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY I3E 155UED OR
MAY PERTAIN, THE INSURANCE AFFORDED 6Y THE POLICIES DESCRIBED HEREIN 15 SUBJECT YO ALL THE TERMS, EXCLUSIONS ANO CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
I INSR DD'L 3- Nm TYPE QF POLICY EFPECTNE POLICY EXPIRATION
• POLICY NUMBER LIMITS
GENERAL LIABILITY EACH OCCURRENGE S ,1000,00
0.
iF
g occur
em
A X COMMERCIAL GENERAL LIABILITY I MPK86836 06/2912008 0612912009 DAMAGE fO RENTED $ 5O0 GOO.
CLAIMS MAGE I ^ I OCCUR MEQ EXP (Any one ereon $ 10,00 D.00
}I — PERSONAL B ADV INJURY 500 OOO.
,I l GENERAL AQGREGATEj 1 ODO ODD.`
4 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPlQP AGO $ 1 OOO GOO.
X POLICY Pc O LOC
AUTOMOBILE LIAOILITY
COMBINED SINGLE LIMIT
l ANY AUTO (Ea ac6dent) $
ALL OWNED AUTOS
BODILY INJURY
! SCHEOULEDAUTOS (Per person) $
HIRED AUTOS
s BODILY INJURY { $ `
NON -OWNED AUTOS (Per accident)
1
PROPERTY DAMAGE
(Per uci0ant)
t
GARAGE LWBILITY
AUTO ONLY • EA ACCIDENT $
ANY AUTO
f OTHER THAN EA ACC $
AUTO ONLY: - AGG S
IEXCESBIUMBRELLA LIABILITY EACH OCCURRENCE $
OCCUR CLAIMS MADE AGGREGATE $
i —
S
DEDUCTIBL
E
RETENTION S
$
WORKERS COMPENSATION AND WC STATU- OTF{.
B
ANY
PL ERS' LIABILITY 6ZZUB•386OB62.3.07 11/1512007 1111512008 E,L, EACH ACCIDENT $ 100 000.
ANY PROPRIETORlPARTNERIEXECUI'IVE
Oyes, de/MEMBER EXCLUDED, EXCL. f E.L. DISEASE • FA EMPLOYEE S 100000,
If yes, tleacnue under
SPECIAL PROVISION a nw E.L. DISEASE - POLICY LIMIT $ 900 000.
OTHER
DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES ! SXCLU$IONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
1
COVERING CARPENTRY OPERATIONS BEING PERFORMED
FAX :978-664-1450
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
EA
HASHEM CONSTRUCTION DATE THEREOF, THE ISSUING INSURER WILL ENOVOR TO MAIL io DAYS WRITTEN
f 135 MAIN STREET NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, OUT FAILURE TO DO SO SHALL
NORTH READING, MA 01864
IMPOSE NO 09LIOATION OR LIABILITY'OP ANY KIND UPON THE INSURER, ITS AGENTS OR
' REPRfiSENTATIVES.
AUTHORR 6P 63ENTATIVE
E ` ,
ACOJRD 25 (2001108) ®ACORD CORPORATION 1988
t f �
Hashem Construction, Inc.
133 Main St. (Rt.28)
No. Reading, Ma. 01864
978-664-4191
Contract for Additional work to 51 Foxhill Rd. No. Andover
Owners: Eric & Sue Buchholz
Contractor: Hashem Construction, inc.
Job Description:
March 30,2009
Construct a 20' x 22' family room off the rear of existing family room on 4' poured concrete
frost wall. 2x6 walls and 2x10 rafters with vaulted ceiling. Andersen windows per plan and one
8' slider. Open rear wall to new room with 2 columns and header. Hardwood floor, 2 coats
paint walls and trim. Insulate 9" floors and ceiling, 6" walls. Hardy board siding and shingle roof
to match existing. Extend heat and a/c off existing system.
Price for the above is $ 60,000.00 payable as follows;
$ 20,000.00 upon signing, $ 20,000.00 when frame enclosed with roof, $ 20,000.00 upon
substantially complete.
Not including landscaping, plans, exterior painting.
Work to begin approx. 14 days from permit issue and complete approx. 90 days from start.
:V