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HomeMy WebLinkAboutBuilding Permit #450 - 56 MAPLE AVENUE 1/2/2008 BUILDING PERMIT °f"O�T a��o TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION * ,� 0 Permit NO: Date Received � "oqAgo SSACHUS� Date Issued.; c�"o IMPORTANT: Applicant must complete all items on this page LOCATION '' t 11'PROPERTY"'OWNER", ��'�i2..� �"I•'1.S ,� ,,,fnnt :.1VIAP Nth: : PARCEL: -ZONING DISTRICT r _}iis#oric Da's#nc# yes no Machine Shop Village yes.. no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration No. of units: 2 Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic Well �Floodplain U, etlands V1/a#ershed D stricf' Water/Sewer 4, DESCRIPTION OF WORK TO BE PREFORMED: 'S OL.L k- (A> Ia-t`T,c., M2 Ro� —�,.►��1rt.� ,�r� A-�© An 3!N �T1nRcnn Identification Please Type or Print Clearly) OWNER: Name: T)ETC--rt PrNE> 7AtJlce DTIS Phone: Address: 5� ����� Pr✓1; CONTRACTOR NamecJ+%.rt' Imo` �` Phone, c' - 3 Address: tr/7i1�niJC Supervisor's ConstrtaG#ion License . Exp, Da#e Home Improvement.'Licers Exp.. ARCHITECT/ENGINEER Phone: Address: 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: $ , o00. o o FEE: $ CheckNo.: ( Receipt No.:_ � NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature ofNAgen#%C�wner _Signature of contractorT Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL 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 DATE REJECTED DATE APPROVED CONSERVATION COMMENTS DATE REJECTED DATE APPROVED HEALTH COMMENTS i r 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 Located at 384 Osgood Street FIRE'DEPARTM`ENT TemptDumpsteronsite yes> k no Located at 124'Mao.Street "XY h y` Trt Fire DeRartments�gnature/late =' 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 2 1 A—F and G min.$100-$1000 fine NOTES and DATA— For department use ❑ Notified for pickup - Date Doc.Building Permit Revised 2007 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 j ❑ 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) i ❑ 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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 j ✓axe -Vo-mmzrn�ruea/��i o�✓�/�aeaac�ivael7a BOARD OF BUILDING REGULATIONS ; .t License: CONSTRUCTION SUPERVISOR - Number: CS 065674 1 � Birthdate: 03/23/1968 j Expires: 03/23/2008 Tr.no: :20581 ' Restricted: 00 WILLIAM J FERRIS 231 A N END BLVD: SALISBURY, MA 01952 Cominissiorwr NORTty T01" 0Andover V . � .�: VO No. 11SQ M _ CS o dover, Mass.. y 0 LA COCHICHEWICK RATED C5 `S BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System 0404AW ��,.� BUILDING.INSPECTOR THIS CERTIFIES THAT... . ............... ............................................. ................................................. Foundation has permission to erect.... ..................... ......... buildings on..op....... W ..... ........ �........................ Rough 4to be occupied as .4....... 400010 A �..h Chimney 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, 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 3�t� • PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTR TS Rough. ............ .... ................................................................. Service BUILDING INSPECTO Final Occupancy Permit Required to Ocmpy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Dobe FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. The Commonwealth of Massachusetts Department of Industrial Accidents " Office of Investigations d 600 Washington Street t Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricans/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): �cJ �T J �.PtS c COA-iST2vL i 1O.-s Address: 2-31 tJ. ;_x> &VA City/State/Zip: SAS-isb✓czy MA, 019S2- Phone.#: °I7$-SSZ- 3733 Areyou an employer?Check the appropriate boa: Type ofro ect required ' 4. general contractor and I p J ( )'' 1.El I am a employer with I am a❑ g 6. E]New construction employees(full and/or p -time * have hired the sub-contractors ?�,[❑ I am a sole proprietor partner- listed on the attached sheet. 7. ®Remodeling . G' \ These sub-contractors have ship and have no emplo 8. ❑Demolition working for me in any capacity. employees and have workers' 9. E-]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 11.7 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 employees. [No workers' 13.❑ Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who sub-..t 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 isproviding workers'compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name: Z v 0L (_11-A ryy_42,CAI/ Policy#or Self-ins. Lic.#: Expiration Date: lljiW. O rj Job Site Address: Pi/'VC City/State/Zip:_ N. 45. 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 certify under the pains and penalties of perjury that the information provided above is true and correct. Si ature: Date: k [- 07 Phone 1#: : q 7� Ste' 37 33 Offccial.use only. Do not write in this area,to be completed by city or town officiaL City or Town: Peradt/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.1 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"ever state or local licensing agency shall withhold the issuance or renewal of a Iicense or permit to,opera'te-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-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 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 maybe 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 youare 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 permittlicense number which will be used as a reference number. In addition,an applicant that must submit multiple permittlicense 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 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 Ofice of Investigations 600 Washington Street Boston,MA 02111 Tel.#6:17-7274000 ext.406 or 1-877-MASSAFE ` Fax# 617-727-7749 Revised 11-22-06 www.mass.gov/dia ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDO/YY 12/31/07 FER�RWI2 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIO ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE T. A. Sullivan Ins. Agcy, Inc. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 344 S. Union St. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW Lawrence, MA 01843 Phone: 978-683-4700 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A, Patrons Mitral Insurance Co. 14923 W'1tk am Ferris INSURER B: Mass.Workers Co .Assi ed D)BISURER C: Buit to Last Construction 28 Back River Rd INSURER D: Amesbury MA 01913 INSURER E COVERAGES THE 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 BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.POLICY EFFECTIVE POLICY FX ION LTR NSRd TYPE OF INSURANCE POLICY NUMBER DATE MMfD DATE MMID LIMITS GENERAL LIABILITY EACH OCCURRENCE $ t IQ KEN COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurence) $ ; CLAIMS MADE F—]OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ POLICY JJEECaT F1 LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ (Per accident NON-OWNED AUTOS PROPERTY DAMAGE $ (Per accident GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSNMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTIONI6 A WORKERS COMPENSATION AND TORY UMITS ER B EMPLOYERS LIABILITY 6ZZUB996XS34807 01/28/07 01/28/08 EL EACHACCIDENT $ 100000 ANY PROPRIETOR/PARTNERfEXECUTIVE OFRCER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 100000 If yes,describe under EL.DISEASE-POLI hY LIMIT $500000 SPECIAL PROVISIONS below OTHER A Commercial Applica CTR0001303 11/12/07 11/12/08 A Property Section CTR0001303 11/12/07 11/12/08 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION PFi'1'MOT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL /6/1 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Peter Otis IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR 56 Maple Street TREPRNITATIVES. fNorth Andover MA 01845REPRES`FNTATIVE � � �„" / Arron 9r I4nniIng% n A(npn( nRPnRATInN I � 1 BUILT TO LAST Construction 231 North End Boulevard Salisbury, MA 01952 (978) 852-3733 William J. Ferris, Contractor CONTRACT To: Pete Otis Date: December 29,2007 Re: Renovations of Residence 56 Maple Ave,No. Andover,MA Scope of services Built T o Last Construction will be responsible for the following: - Demolition o Minor renovations may be done on 1"and 2nd floor to be determined - Interior framing of a 30' x 15' attic bedroom o Shore up floor framing over master bedroom o Patch in missing sub floor and add underlayment o Frame in knee walls (42')with 2 accesses o Frame '/Z wall at stairwell - Interior framing of an 8' x 8' attic bathroom - Remove, relocate and replace attic gable window(Andersen 400 series) - Frame in and install Velux skylights - Insulate all exterior walls and ceilings and ensure proper venting - Blue board and skim coat plastering plaster throughout - Electrical o Outlets, switches and smoke detectors as required by code o 1 cable/phone jack o Electric baseboard as needed o Bathroom overhead fan/light and GFCI outlet o Light fixtures provided in allowance - Plumbing o Install 3/4 bath(shower stall,toilet and vanity) o Provide all rough materials and labor o Drain line, bathroom location and size still to be determined o Fixtures and faucets provided in allowance - Finish Carpentry 0 2 '/z"Colonial casing throughout 0 4 '/2" Colonial baseboard throughout 0 2 6-panel hollow core door into bathroom and closet o Bookshelves and built-ins to be determined - Flooring o Carpet throughout main area o Linoleum provided in bathroom o All flooring out of allowance - Painting o Prime and finish coat on all affected areas o White semi gloss on all trim o One off white color only - Allowance $3300.00 - The following will be purchased from the money allotted in allowance o Bathroom fixtures and faucets(materials) o Electrical fixtures(materials) o Flooring(labor and materials) Terms and Conditions 1. Contractor agrees to furnish all necessary labor, materials, tools and equipment to complete the work outlined in the scope of services. 2. Contractor shall provide copies of a valid builder's license and proof of liability and workers' compensation insurance prior to commencement of any work. 3. Contractor agrees to complete the Scope of Services in a timely, professional manner in accordance and in compliance with state and local building regulations. 4. Contractor agrees to clean all debris from construction only and to keep job site in a clean and workable condition at all times S. Homeowner shall be responsible for any costs occurring from engineering or architectural plans and site work and any costs incurred from permitting, zoning board of appeals, planning or DEP. 6. Homeowner shall be responsible for any costs incurred from hazardous materials found during construction. 7. Homeowner is responsible for contacting utility companies for disconnect and new hook ups, cable,telephone,gas and electric and any costs that results from these services. 8. Manufacturers' warranties will be turned over to the homeowner and become the homeowner's responsibility to file and pursue any defects or problems that may occur. 9. Built To Last Construction Company will provide a one-year, limited warranty on any and all carpentry completed within the scope of this project. 10. Any materials, products, or labor not specifically mentioned in scope of services is not covered under contract and will be paid for out of allowance fund or billed to homeowner. 11. Homeowner is responsible for any price increase in materials prior to signing of contract. 12. Homeowner (not lender) is ultimately responsible for payment upon completion of services and receipt of invoices. SCHEDULE TIME PROJECTED E LE C M The following is an estimated time schedule for informational purposes only. This schedule may be adjusted as needed to address unforeseen circumstances,including but not limited to hidden obstacles,bad weather,sub-contractor scheduling conflicts,etc. It is our goal to complete the work in a timely fashion. Week 1 Demolition and re-framing of attic area Week 2 Rough Plumbing and electrical,roofing, skylights and window Week 3 Finish rough plumbing and electrical. Rough inspections Week 4 Insulation blue board and plastering Week 5 Finish carpentry Week 6 Painting Week 7 Flooring,electrical and plumbing finish PAYMENT SCHEDULE The payment for the contract will be as follows 10%upon signing of contract $3300.00 20%upon commencement of project $6600.00 30%upon completion of utilities and inspections $9900.00 30%upon completion of blue board and plastering $9900.00 10%upon completion of project $3300.00 TOTAL COST $33,000.00 P_&&_ w,,, Pete Otis, Homeowner William J. F rris, Built to Last Const. �� ��►N 2� � fiv Ka C� GF l2 r Location No. Date MORTM f TOWN OF NORTH ANDOVER �,y F G� 9 i � ° ; + Certificate of Occupancy $ Building/Frame Permit Fee $ -� C14 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 5-7 I 20884 Building Inspector F