HomeMy WebLinkAboutBuilding Permit #316 - 51 LINCOLN STREET 10/12/2011 �i
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received
Date Issued:A2
IMPORTANT: Applicant must complete all items on this page
LOCATION f L.r✓►Eon
Print
PROPERTY OWNER SCa I( Unit#
Print
MAP NO: 05&.OPARCEL:-ZONING DISTRICT: Historic District yTo I
Machine Shop Village y100 year-old structure y
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building ElOne family
❑Addition ❑Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
)a Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
- e _
>]'Septrc O'Well' ❑Flo:odplaiiij 0 Wetlands; _ (] Water tDi' �g
=a -
IET Watei%Sewer e
rsfied stnct
DESCRIPTION OF WORK TO BE PERFORMED:-
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(Identif
IcaRn Please Type or Print Clearly)
OWNER: Name: 11f:?Mb L,)/Z(<col
Address: S'( Li(1cd
CONTRACTOR Name: �Z�- �v (�1%i2dJ Phone:
Address: -7 t/y �✓
Supervisor's Construction License: Exp. Date: 9 as a U 3
Home Improvement License: _J /G 7a y Exp. Date:
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE.BULDING PERMIT.$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $_ /, /gyp FEE: $ �0
4?03�0
Check No.: S l 701-3
Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have accessto the arae fu
Signature ofxAgent/Owner rH, , :;
-Si of�confraetor�
A
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
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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 APPROVED
PLANNING & DEVELOPMENT ❑ El
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on Signature
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COMMENTS
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Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submittedyes
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 124 Main Street
Fire Department signature/date
COMMENTS
Dimension R
Total square feet of floor area, based on Exterior dimensions.
Number of Stories:__ _______
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Total land area, sq. ft
LECTRICAL: Movement of Meter location, mast or service drop requires approval of
E I
Electrical Inspector Yes NO
DANGER ZONE LITERATURE: Yes
No
MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine
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NOTES and DATA— For department use
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❑ Notified for pickup - Date
Doc:.Building Permit Revised 2011 June/mi
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
o Building Permit Application
❑ Workers Comp Affidavit
o Photo Copy of H.I.C. And/Or C.S.L. Licenses
❑ Copy of Contract
❑ Floor Plan Or Proposed Interior Work
o Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit i
Addition or Decks
❑ Building Permit Application
o Certified Surveyed Plot Plan
❑ Workers Comp Affidavit
❑ Photo Copy of H.I.C. And C.S.L. Licenses
o Copy Of Contract
o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
o 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)
o Building Permit Application
o Certified Proposed Plot Plan
❑ Photo of H.I.C. And C.S.L. Licenses
o Workers Comp Affidavit
o 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
a 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 co and
. g Y roof of recording
copy P
must be submitted with the building application
Doc: Doc.Building Permit Revised 2008mi
Location
No. Date `
N°ITh TOWN OF NORTH ANDOVER
f w
a
}'er4�'; Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check # � �05 /�z 7013
2 Building Inspector
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NORTH
Town of - Andover
AOLz - - I � - lo
C, o clover, 1Vlass.,
COCNIC..WICK y�`
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A�"gATE O PP�,�"`
S BOARD OF HEALTH
PERMIT T
x Food/Kitchen
Septic System
BUILDING INSPECTOR
THIS CERTIFIES THAT......(Sm.)DO40........ �+..�s...
Foundation
has permission to erec ......... ........................... . buildings on ... .I.............�r..l!`�i�.......... a �....... Rough
to be occupied as. !►.1... •••:• r L.e' Chimney
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provided that the person accepting this permit shall 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, Alteratibn 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`
i/ UNLESS CONSTRUCTI S ARTS
Rough
.................................................................... Service
BUILDING INSPECTOR
Final
Occupancy Permit Required to Occupy 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.
SEE REVERSE SIDE Smoke Det.
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Br�ar'dot.
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58024 sor License trYh
ROBERT M S
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MA 01876 "
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Office of �e ..
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x 119.724 TRACTOR on
NORTHE." piration-X8/21/271 013,_ T
AST gUILD/NGs ===- DBA Ype:
ROBE &RENIppELING
71 EMILY RD i
TEwKSBURY MA 01878
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Undersecretary
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Northeast Building and Remodeling,LLC
71 Emily Road
Tewksbury,MA 01876
License#058024
Registration#119724
978-988-9492
978-658-6007
------Residential Contracting Agreement------
Read this agreement and make sure you understand it before signing it.
This agreement has legal force and effect and binds those who sign it.
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Date: October 5, 2011
Contract Number: 1115
Customer Name: Barbara Driscoll
Address: 51 Lincoln Street
North Andover,MA 01845
Home Phone: 978-688-1000
Cell Phone:
Notice: All home improvement contractors and subcontractors engaged in home
improvement contracting,unless specifically exempt from registration by Provisions of chapter
142a of the general laws,must be registered with the Commonwealth of Massachusetts. Inquires
about registration and status should be made to the director,Office of Consumer Affairs and
Business Regulation,Ten Park Plaza, Suite 5170 Boston,MA 02116, 617-973-8700.
Homeowners who secure there own permits or deal with unregistered contractors shall be
excluded from access to the Guarantee Fund.
This Agreement is made this 5th day of October 2011 by and between Barbara Driscoll
(hereinafter referred to as Owner and Northeast Building and Remodeling,LLC(hereinafter
referred to as Northeast)
Front Stair Railings:
-Remove existing deck boards from bottom step and around upper 4 x 4 supports.
-Remove existing 4 x 4's and railings from upper platform and stairs.
-Install six new cedar 4 x 4 railing supports and bolt into existing framing.
-Install cedar railings and 2 x 2 cedar balusters. Two upper platform railings and two stair
railings.
-Install six new pressure treated deck boards where they were previously removed.
-Remove all debris from site.
Supplementary Conditions:
Engineering Constraints:
During the building stage of the project, certain engineering or building code factors may be
discovered that will require a change to the original design and/or plan.Northeast will try to
maintain the original design to the best of its ability.
Concealed Conditions:
The Owner further acknowledges that concealed conditions such as but not limited to,old or
existing septic tanks,wells,oil or gas lines,water lines or sewer lines, electrical lines,or other
items not expressly contained in the specifications for removal, replacement or relocation are not
part of this contract. It is also assumed that the existing mechanical and electrical systems can
handle the additional load put on them by the improvements provided by Northeast. Any work
arising out of such unknowns shall constitute extra work and be addressed by change order(if
necessary)to the Owner. If Owner has any knowledge prior to signing these specifications,
please list them hereunder or attach them to each set of specifications. All efforts will be made to
pour concrete without the use of a pump truck, in the event that a pump truck is needed an
additional charge will apply.
Insurance:
General Liability, Workers Comp,and Automobile Insurance are.carried by Northeast in such
amounts sufficient to fully insure Northeast for liability arising out of the work performed under
this contract. The Owner shall be responsible for having normal homeowner's insurance for
project site.
Measurements:
It should be understood that measurements denoted on any plans or contract are"plus or minus".
These are not and can not be guaranteed due to existing conditions on the existing house.
Govern:
If any questions arise between the plans and the specifications,the specifications shall govern.
Warranty and Guarantee:
All work to be guaranteed for one year from completion of the project. Products to be warrantied
under specific manufacturers warranty program.All work shall be completed in a workmanlike
manner according to standard practices and codes. Warranty void if not paid in full.
Change Orders:
Any Alteration or deviation from specifications involving extra cost,will be executed only upon
written change order signed by both Owner(only one signature needed)and an authorized
representative of Northeast,and will become an extra cost over and above the original contract.
Change orders are due and payable 100%upon Owners signing of the change order.
Allowances:
When allowances are given for items such as,but not limited to,windows,doors, skylights and
bathroom items,the amount of the allowance refers to the cost of purchasing that particular item
including taxes,pickup and/or delivery charges, special order charges, and any other costs which
may be necessary to obtain the item. In most cases,installation of the particular item has already
been figured into the contract price. If Owner supplies any of the allowance items or any other
in the contract,Northeast shall not be responsible for warranty,repair or replacement of such
items.
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Site Access:
The Owner will provide access to Northeast, its subcontractors, suppliers and local officials
required to inspect the site. Owner is responsible for furniture and other personal items to be
moved from construction area.
Arbitration:
The contractor and the homeowner hereby mutually agree in advance that in the event that the
contractor has a dispute concerning this contract,the contractor may submit such dispute to a
private arbitration service which has been approved by the Office of Consumer Affairs and
Business Regulation and the consumer shall be required to submit to such arbitration as provided
in MGL c 142A.
Northeast Recognition:
The Owner will allow Northeast to display a job sign at a location visible to the,main street in
front of the site for the duration of the project.
Northeast Building and Remodeling,LLC
RESIDENTIAL CONTRACTING AGREEMENT
Robe M. Sul van Dat
Northeast Building and Remodeling, LLC
The above prices, specifications and conditions are satisfactory and hereby accepted.Northeast is
authorized to perform the work as specified,payment will be made as outlined in the attached
payment schedule.
Note: You as the Owner,may cancel this agreement at any time prior to midnight of the
third day after the date of this transaction. See the attached notice of cancellation form for
an explanation of this right.Do not sign this contract if there are any blank spaces.
Barbara Driscoll Date
PAYMENT SCHEDULE:
$500.00 upon contract signing,ordering of materials.
$650.00 upon completion of contract.
Total Contract Amount: $1,150.00
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legiblv
Name (Business/Organization/Individual): / l
Address:_ ` ee-- c( row(
City/State/Zip: phoneAre you you an employer?Check the appropriate box: Type of project(required):
1. ❑ I am a employer with 4. ❑ I am a general contractor and 1 6. ❑New construction
employees(full and/or part-time).* have hired the sub-contractors
2 I am a sole proprietor or partner- listed on the attached sheet.t 7. 'Remodeling
ship and have no employees These sub-contractors have 8. ❑Demolition
working for me in any capacity. workers' comp.insurance. 9. ❑Building addition
[No workers' comp. insurance 5. ❑ We are a corporation and its
required.] officers have exercised their 10.[:]Electrical repairs or additions
3. ❑ 1 am a homeowner doing all work right of exemption per MGL I L❑Plumbing repairs or additions
myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑Roof repairs
insurance required.]t employees. o workers'
comp. insurance required.] 13.❑ Other
*Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information.
I 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 their workers'comp.policy information.
I am an employer that is providing workers'compensation 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: 61 6A %lVr'� /Y �— City/State/Zip: 4,1./Av6wn !✓h9. Ol�tf�
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.
I do hereby certunder the pains and penalties of perjury that the information provided above is true and correct.
Si nature: p, U Date:
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#:
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