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HomeMy WebLinkAboutBuilding Permit #697 - 6 LAVENDER CIRCLE 5/11/2010r.,R,ry BUILDING PERMIT ot,t��° ,bgtio TOWN OF NORTH ANDOVER so? APPLICATION FOR PLAN EXAMINATION Permit NO: Date ReceivedAT D �SSACHUS���� Date Issued. -4--//'f d IMPORTANT: Applicant must complete all items on this page LOCATION :. `1-;_a 1141t.1C1C-1` ri•'C-6"2�'-T�J'c' �5, Print PROPERTY OWNER ZT'fln 4,�', c`lt-Is•IJ rr �r �.- .Print MAP 2`10?(p_ PARCEL: / ONPNG DISTRICT: Historic District yes no Machine Shop Village ves no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One fa q Additionmore family Industrial eration No. of units: Commercial Others: epair, replacement Assessory Bldg Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: iaennncation Please 'Type or Print Clearly) OWNER: Name: Phone: Address: CONTRACTOR Name: Address: s ►r Supervisor's Construction License: 421-Y��a Exp. Date: 45 Home Improvement License: /, ARCHITECT/ENGINEER Phone: Address: Reg. No FEE SCHEDULE. BULDING PE IT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ d 46 FEE: $ &00 Check No.: d Receipt No.: 03 ` NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund SignatureM of Agent/Owner Signature of contractor 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 DATE REJECTED PLANNING & DEVELOPMENT COMMENTS /6/ I%i DATE APP OVED ,ill D ONSERVATION Reviewed on Signature COMMENTS EALTH Reviewed on Signature �COMME Zoning Board of Appeals: Variance, Petition Planning Board Decision: Conservation Decision: Comments Comments Zoning Decision/receipt submitted yes Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: FIRE DEPARTMENT - Temp Dumpster on site Located at 124 Main Street Fire Department signature/date COMMENTS uocatea 5564 vsgooa Street yes no Dimension Number of Stories: Total land area, sq. ft.: Total square feet of floor area, based on Exterior dimensions. 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 2010 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 o 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 Pian 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 2008 \ @ m e LO L Z 0 co LU % oo co ±r2 o ) \ ) to 2 u. \ « z - � z (0 eam. ®§ 2 \ 2 y dl$ \\� \/§\\; :F- \< / \± «©7 \�: ,LU e : ».2E -Z'-: .�e \ k42) / � CO / s - < \k. < < j & . / S - \ \ � o o G o �.z. \ � 0 A W D a M y p 69 p Q O cm CIO O Of p co.0 t z Q Q u U) O I U 0 4-21 i.� 2 V CD O E co co CL C13 cm ca W os y E .� cc .� CD ® E... cc 0 0— CM< ca 0 CCCC co co co c CL nW+ w O v U X. O v w r2 c ti w IDA 0.4 w cn GL x Q C7 w w w •CL= C z cid Q o cn a M y p 69 p Q O cm CIO O Of p co.0 t z Q Q u U) O I U 0 4-21 i.� 2 V CD O E co co CL C13 cm ca W os y E .� cc .� CD ® E... cc 0 0— CM< ca 0 CCCC co co co c CL nW+ C C p 31 O z mom~ LU •CL= C (� y p'd 0.0 LLJ ® 2 cm ® ® 0 � 0:5 5 � •5 c � cc a M y p 69 p Q O cm CIO O Of p co.0 t z Q Q u U) O I U 0 4-21 i.� 2 V CD O E co co CL C13 cm ca W os y E .� cc .� CD ® E... cc 0 0— CM< ca 0 CCCC co co co c CL nW+ f \j V Bonenfant Construction Co. 1806 Salem St. North Andover MA01845 978-689-2066/978-807-8925 MA Home Improvement Contractor #157687 MA Construction Supervisor License #CS42212 Job Name Job Location Mullin Residence 6 Lavender Circle North Andover, MA 978-682-6524 Scope of Work Same This project is the remodeling of basement to include a new half bath, workout area, wet bar area and home theatre area. The following work will be performed: BATH: --sewer lift pump, plumbing, concrete cutting/replacement --toilet/vanity sink/fixtures/allowances---$500 --tile installation (tile not supplied) --bar sink plumbing FRAME: --2x4 framing --furring of walls with plumbing --boxing sofits around existing beams --fiberglass R-13 insulation in walls --frame existing walll and install new vinyl double -hung window and repair siding as needed ELECTRIC --add subpanel and work as discussed with electrical contractor and homeowner DRYWALL --1/2 gypsum drywall and 3 coats joint compound CEILINGS --acoustic tile 2x2 drop ceiling on 2x2 grid --ceiling tile to be approved by homeowner --tie in with sofits r✓ FINISH TRIM --6 panel molded prehung paint grade interior doors with brass passage sets and hinges --2 1/2 Jalco casings to match style of existing home trim --5 1/4 speed base baseboard paint grade --trim new window -2 1/2 Jalco paint grade PAINT --2 coats latex eggshell wall finish --2 coats semi -gloss latex paint on trim BAR --unit similar to design provided by homeowner; plans to be revised to include provisions for electric kegorator in place of foam ice box as designed. Construction details to vary, design to be similar. Plans to be reviewed with homeowner prior to build --construction to be stain grade red oak. --includes sink/faucet allowance ---$150 --laminate bar top surface (formica or similar) --stain/clear finish --laminate counters on half wall to match NOTES --rubber flooring (exercise room) provided by homeowner --wrapping columns in rope or similar to be done by homeowner --purchasing floor the not included --allowances based on rough estimate of cost for described materials --Kegorator or similar not included here --Any significant changes to plans or unforeseen cost overruns to be discussed with homeowner prior to any work being done. --Movement of water heater covered here, but purchasing of new unit or additional features to new unit (alarms, shut offs, emergency drains, etc) to be additional and agreed upon between plumbing contractor and homeowner TOTAL COST OF PROJECT (as described above) $44,700. ALLOWANCES (prices are subject to change upon obtaining quotes prior to work being done) --duct work $1,200 --sprinkler $1,500 --carpet $2,000 if Mullin Page 3 of 5 HIC#157687 Permits are required. It is the obligation of the contractor to secure such permits as the homeowner's agent: NOTE: Owners who secure their own permits or deal with unregistered contractors are excluded from the Guaranty Fund provisions of MGLc.142A Work to begin during week of May 17, 2010 Expected Completion Date: June 30, 2010 Bonenfant Const agrees to perform the work, furnish the material and labor specified above for the sum of $44,700 to be paid as follows: -10% deposit at contract signing -30% on completion of framing/insulation -10% when rough utilities complete -20% when drywall and trim complete -10% when interior paint/ceilings complete -10% when utilities complete -10% when final sign -off by inspector on project. HOME James v� Date CONTRACTOR: i E, MMM -P, 6 , IVA, . t: I W___ .? iRnh,-rt : • - Date You may cancel this agreement if it has been signed by a party thereto at a place other than an address of the seller, which may be his main office or branch thereof, provided you notify the seller in writing at his main office or branch by ordinary mail posted, by telegram sent or by delivery, not later that midnight of the third business day following the signing to the agreement. See attached notice of cancellation for an explanation of this right James Mullin Page 4 of 5 HIC#157687 Note: All home improvement contractors and subcontractors shall be registered and any inquiries about a contractor or subcontractor relating to a registration should be directed to: Director, Home Improvement Contractor Registration One Ashburton Place — Room 1301 Boston MA 02108 617-727-8598 Unless otherwise noted within this document, the contract shall not imply that any lien or other security interest has been placed on the property. ARBITRATION The contractor and the homeowner hereby mutually agree in advance that in the event 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 Secretary of the Executive Office Consumer Affairs and Business Regulations and the consumer sha tie required to submit to such rbi atio as provided in .G.L. c. Contractor. Homeowner: Date: Date: ACCELERATION OF PAYMENT Homeowner's Financial Insecurity -Contractor may not demand payments in advance of the dates specified on the payment schedule in cases where the homeowner deems him/herself to be financially insecure. Contractor's Financial Insecurity -In instances where a contractor deems him/herself to be financially insecure, the contractor my require that the balance of funds not yet due be placed in a joint escrow account as a prerequisite to continuing the contracted work. Withdrawal from said account would require signatures of both parties. James Mullin Page 5 of 5 HIC#157687 NOTICE OF CANCELLATION YOU MAY CANCEL THIS TRANSACTION, WITHOUT PENALTY OR OBLIGATION, WITHIN THREE BUSINESS DAYS FROM THE ABOVE DATE. IF YOU CANCEL, ANY PROPERTY TRADED IN, ANY PAYMENTS MADE BY YOU UNDER THE CONTRACT OR SALE, AND ANY NEGOTIABLE INSTRUMENTS EXECUTED BY YOU WILL BE RETURNED WITHIN TEN BUSINESS DAYS FOLLOWING RECEIPT BY THE SELLER OF YOUR CANCELLATION NOTICE, AND ANY SECURITY INTEREST ARISING OUT OF THE TRANSACTION WILL BE CANCELLED. IF YOU CANCEL, YOU MUST MAKE AVAILABLE TO THE SELLER AT YOUR RESIDENCE, IN SUBSTANTIALLY AS GOOD CONDITION AS WHEN RECEIVED, ANY GOODS DELIVERED TO YOU UNDER THIS CONTRACT OR SALE; OR YOU MAY, IF YOU WISH, COMPLY WITH THE INSTRUCTIONS OF THE SELLER REGARDING THE RETURN SHIPMENT OF THE GOODS AT THE SELLER'S EXPENSE AND RISK. IF YOU DO MAKE THE GOODS AVAILABLE TO THE SELLER AND THE SELLER DOES NOT PICK THEM UP WITHIN TWENTY DAYS OF THE DATE OF CANCELLATION, YOU MAY RETAIN OR DISPOSE OF THE GOODS WITHOUT ANY FURTHER OBLIGATION. IF YOU FAIL TO MAKE THE GOODS AVAILABLE TO THE SELLER, OR IF YOU AGREE TO RETURN THE GOODS TO THE SELLER AND FAIL TO DO SO, THEN YOU REMAIN LIABLE FOR PERFORMANCE OF ALL OBLIGATIONS UNDER THE CONTRACT. TO CANCEL THIS TRANSACTION, MAIL OR DELIVER A SIGNED AND DATED COPY OF THIS CANCELLATION NOTICE TO: Robert A Bonenfant, Bonenfant Construction, 1806 Salem Street, North Andover MA 01845 NOT LATER THAN MIDNIGHT OF NO WORK WILL BEGIN UNTIL THIS TIME EXPIRES Date: X James Mullin Bonenfant Construction Co. 1806 Salem St. North Andover MAO 1845 978-689-2066/978-807-8925 MA Home Improvement Contractor #157687 MA Construction Supervisor License #CS42212 Job Name Job Location Mullin Residence 6 Lavender Circle North Andover, MA 978-682-6524 Scope of Work This project is the remodeling of exterior deck. The following work will be performed: Same Set of exterior stairs to be built and installed Existing railings to be removed and replaced with a vinyl rail system All trim to be removed and replaced with Azek trim boards Risers and skirt boards of new stair to be Azek Decking material to match existing TOTAL COST OF PROJECT (as described above) $5,769. r -,b Mullin Page 2 of 4 HIC#157687 Permits are required. It is the obligation of the contractor to secure such permits as the homeowner's agent: NOTE: Owners who secure their own permits or deal with unregistered contractors are excluded from the Guaranty Fund provisions of MGI-c.142A Work to begin during week of May 11, 2010 Expected Completion Date: May 14, 2010 Bonenfant Const agrees to perform the work, furnish the material and labor specified above for the sum of $5,769 to be paid as follows: -25% deposit at contract signing -75% on completion of job HONKOWNERS: Jar "'§ i Date CONTRACTOR: '-&- --Bonenfant Aa Date You may cancel this agreement if it has been signed by a party thereto at a place other than an address of the seller, which may be his main office or branch thereof, provided you notify the seller in writing at his main office or branch by ordinary mail posted, by telegram sent or by delivery, not later that midnight of the third business day following the signing to the agreement. See attached notice of cancellation for an explanation of this right ,1,. 0 James Mullin Page 3 of 4 HIC#157687 Note: All home improvement contractors and subcontractors shall be registered and any inquiries about a contractor or subcontractor relating to a registration should be directed to: Director, Home Improvement Contractor Registration One Ashburton Place — Room 1301 Boston MA 02108 617-727-8598 Unless otherwise noted within this document, the contract shall not imply that any lien or other security interest has been placed on the property. ARBITRATION The contractor and the homeowner hereby mutually agree in advance that in the event the contractor has a dispute concerning this contract, the contractor may submit such dispute to a private arbitrate service which has been approved by the Secretary of the Executive 0. is of Consumer Affairs and Business Regulations and the consumers required to submit to such arbitratiog as provided in I".L. c. 14 LON..i� L.t •rs/�t iii Date: "_5— XO Date: `� e ACCELERATION OF PAYMENT Homeowner's Financial Insecurity -Contractor may not demand payments in advance of the dates specified on the payment schedule in cases where the homeowner deems him/herself to be financially insecure. Contractor's Financial Insecurity -In instances where a contractor deems him/herself to be financially insecure, the contractor my require that the balance of funds not yet due be placed in a joint escrow account as a prerequisite to continuing the contracted work. Withdrawal from said account would require signatures of both parties. A,, James Mullin Page 4 of 4 HIC#157687 NOTICE OF CANCELLATION YOU MAY CANCEL THIS TRANSACTION, WITHOUT PENALTY OR OBLIGATION, WITHIN THREE BUSINESS DAYS FROM THE ABOVE DATE. IF YOU CANCEL, ANY PROPERTY TRADED IN, ANY PAYMENTS MADE BY YOU UNDER THE CONTRACT OR SALE, AND ANY NEGOTIABLE INSTRUMENTS EXECUTED BY YOU WILL BE RETURNED WITHIN TEN BUSINESS DAYS FOLLOWING RECEIPT BY THE SELLER OF YOUR CANCELLATION NOTICE, AND ANY SECURITY INTEREST ARISING OUT OF THE TRANSACTION WILL BE CANCELLED. IF YOU CANCEL, YOU MUST MAKE AVAILABLE TO THE SELLER AT YOUR RESIDENCE, IN SUBSTANTIALLY AS GOOD CONDITION AS WHEN RECEIVED, ANY GOODS DELIVERED TO YOU UNDER THIS CONTRACT OR SALE; OR YOU MAY, IF YOU WISH, COMPLY WITH THE INSTRUCTIONS OF THE SELLER REGARDING THE RETURN SHIPMENT OF THE GOODS AT THE SELLER'S EXPENSE AND RISK. IF YOU DO MAKE THE GOODS AVAILABLE TO THE SELLER AND THE SELLER DOES NOT PICK THEM UP WITHIN TWENTY DAYS OF THE DATE OF CANCELLATION, YOU MAY RETAIN OR DISPOSE OF THE GOODS WITHOUT ANY FURTHER OBLIGATION. IF YOU FAIL TO MAKE THE GOODS AVAILABLE TO THE SELLER, OR IF YOU AGREE TO RETURN THE GOODS TO THE SELLER AND FAIL TO DO SO, THEN YOU REMAIN LIABLE FOR PERFORMANCE OF ALL OBLIGATIONS UNDER THE CONTRACT. TO CANCEL THIS TRANSACTION, MAIL OR DELIVER A SIGNED AND DATED COPY OF THIS CANCELLATION NOTICE TO: Robert A Bonenfant, Bonenfant Construction, 1806 Salem Street, North Andover MA 01845 NOT LATER THAN MIDNIGHT OF NO WORK WILL BEGIN UNTIL THIS TIME EXPIRES Date: X James Mullin The Commonwealth of Massachusetts Department o f fradustrial _accidents Office of I'Mestigations 600 Tf7ashington Street Boston, AIA 02111 wwW.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers mlicant Informafion n=- Name (Business/Orgmization/Individual): Address:- leo 6 5 City/State/Ziye'A �t 6 Phone #:919 Are you an -My loyer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a o general contractor and I 2�employees (full and/or part-time).* have hired the sub -contractors I am a sole proprietor or partner- listed on the attached sheet t ship and have no employees These sub`contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp, insurance 5. ❑ We are a co required -] m 3. ❑ I aa homeowner doing all work Myself [No workers' comp. insurance required.] t IForahon and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees_ [No workers' COMP. insuranc Type of project (required): 6. ❑ New construction 7. ❑ Remodeling B. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.0 Roof repairs e = ^reatured J I 13.❑ Other Z' Ii -at 41 most _Iso iu out r.'ce Se'-'Qm+ L_II�� OShowingShowing=^_ Orrm—s' ccomp=.-Amcomp=.-Amw.... �. ... ��� ' I3omers that chi box eownwho suhmifthis affidavit indicating }}, are ao all work and r cy tion Contractors that check this box must attached an additional sheet showing the thm hire outside contractors r{aus,. submit a new affidavit indicating such. same of the sub -contractors and their workers' comp. polic I am an employer that is providing workers' compensatioy information. n 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: Attach a copy of the workers' compensation policy declaration page (showingCity/State/Zip: Failure to secure coverage as required under Section 25A of MGL c. 152 can lto ththe e impoolicy sition criminal nd expiration date). fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORKiuj penalties ae of up to $250.00 a day against the violator. Be advised that a copy o f � statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification Ido hereby cer%ti un r the s anddppen, alties of per, jury th!z information provided above is true, and correct Official use only. Do not write in this area, to be completed bj, city or town officiaL City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/TOvvn Clerk 4. Electrical Inspector 5. Plumb 6. Other ingb Inspector Contact Person: Phone #: Information an- d 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 peon 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 I-- gal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association ox- 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 maim- mance, 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 10cal licensing agency shall withhold the issuance or renewal of it license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of commpliance 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 inc=ce 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 (LLT) with no employees other than the members or partners, are not required to carry workers' comp easation 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 insur- a coverage. Also be sore to sign and date the affidavit. The affidavit should be returned to the city or tovm that the appliCauou for the pe'rrmait QZ 1:Cense 2S lie. re pW .ng . cuested, not e.Deparr^e rr or Industrial Accidents. Should von have any questions regarding the law or if you are mT' a red to obtain a workers' compensation policy, please call the Department at the numbesr 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 than 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 fndustzial Accidents Office of Invesiibations 600 Washington Street Boston, MA 02111 Tel. # 617-72.7-4900 eat 406 or 1-9 77-MASSAFF Revised. 5-26-05 Fan; # 617-72.7- 7/749 vrvrw.mass... a ov/dla. 5'-9" HW TANK C '•9 SEWER �\ EJECT.) i .m N -4oCL. ARATH Z C SINK & VA 0° LALLY COLUMN (TYPICAL) m NEW EXISTING NEW WINDOW 6' SLAG E:)R WINDOW m WW 4 �m (D� N \ V \ Nim \ 2'-0' 3'-0" 5'-6" QI 1 C�4 SECTIONAL \ \ Z SOFA \ U II w W TV / ~ Q 1--o II N'�' / o m ° II U10W,C. F- p NI \\, U EXISTING I I / + N I PIPE WAST AREA I I N / / 1'-5" V-5" I I T_8-21" 3'-0„ 3'-8.2 0 FALSE COLUMN � p � (TYPICAL) HALF WALL CEILING SOFFIT EXER ROO (TYPICAL)\ LLu=-7,, +L 444 F==t'-] ACCEPTABLE VIEWING ANGLE EXISTII` STAIRS STRU Tl COLUMN %Z BASEMENT PLAN Location ve." let. // (� No. Date Certificate of Occupancy NORTH TOWN OF NORTH ANDOVER ' L Certificate of Occupancy $ �'�s',•°' Eta s�CMus Building/Frame Permit Fee $ Cp Foundation Permit Fee $ ° Other Permit Fee $ 4 TOTAL $ Check # �T 23 i Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING c =BOE' ....Frici$.)E. USC'oli�' BUILDING PERMIT NUMBER: Z77 DATE ISSUED: • r SIGNATURE: "1 4�1�11t� Building Commissioner/I for of Buildin Date CF!'Tir"M 1 CrTII TNT 1.1 Property .address: WGNDER CIt�CuE W�WAf=CR-, MA. 01045 1.2 Assessors Map and Parcel Number: ql�$l Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: 12,710 07-f- 30. co Zoning District Proposed Use Lot Area (so Frontage R) 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required I Provide I Required I Provided , Required I Provided 1.7 Water Supgfy M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 SewepBe Disposal System: Public 1 Private ❑ ZOOe Outside Flood LMunicipal @-(Gs4w On Si1P Disposal System Z SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record KR19QE%,1Aou im Name (Print) r / Si 2.2 Owtier of Record: �.�cklE Off, �P>6Y� Na& Print Telephone Signature T, SECTION 3 - CONSTRUCTION SERVICES to LA%WE R GRCcg7 40 • A MZJUR . KA. 0184F Address for Service : S,ArMa aS AeogE Address for Service: 3.1 Licensed Construction Supervisor: _ %wEY R AND;ews e�OAuo�ws tt�Co. �Nc. Licensed Construction Supervisor. =re fiLV(CI� MA . o I%2- @ 272 •-rUo Telephone Home Improvement Contractor .ompany Name KA•0f Not Applicable ❑ e5 09 TqQQ License Number '3-14 -Ole Expiration Date Not Applicable ❑ f 13 7�2. Registration Number • POOLS BY -A&flioff ryb1% Gunke Co., Inc. 1-800-272-7946 Ext. 25 (Voice Mail) MARK O'HEARN 6 Republic Road, No. Billerica, M901862 FAX 978-671-0165 Website: www.poolsbyandrews.com Email:marko@poolsbyandrews.com i POOLS BY r Gunite co., Inc. 1-800-272-7946 Ext. 25 (Voice ) MARK O'HEARN r 6 Republic Road, No. Billerica, MA 01862 � I FAX 978-671-0165 Website: www.poolsbyandrews.com Email:markoC�? poolsbyandrews.com -',,fiECTION 4 - WORKERS COMPENSATION (M.G.L C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes ....:..❑ No ....... 0 SECTION 5 Descri tion of Proposed Work check all applicable New Construction V I Existing Building ❑ 1 Repair(s) 0 Alterations(s) 0 Addition 0 Accessory Bldg. ❑ I Demolition ❑ I Other a"' Specify SW14M1QG PXSL.. Brief Description of Proposed Work: 1 m SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit a licantx�, Q Ff}N ESC x Y 3 kr I . Building ae+ 2..1 oco r (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction Q 3 Plumbing Building Permit fee (a) x (b) 4 Mechanical HVAC 5 Fire Protection 6 Total (1+2+3+4+5) 2 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHENi OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT Y'C Gej If lem 09 1, \ l e -r' -C v�LL_ L A� las Owner/Authorized Agent of subject property Hereby authorize NIAQI<-.�IEf�J C��,10Wrslt E 1p.luC. to act on My beha , i all ma p e s relativ t w uthorize by this building permit application' ^( Si nate e Owner Date SECTION 7b OWNER/AUTHORIZED A1` ,,, AGENT DECLARATION I, 0, C T ,as Owner/ thorized Agen f subject property Hereby de tare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TItvIBERS I ST 2ND 3 KD SPAN DIMENSIONS OF SILLS DUvIENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHBVINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE EW * R.7; c c ' m c •cam o � C (A O C V C; C� �\ •CC cv ea `o N� ECF a L' ) w., CL ` N (10 E � vfti m MA m c C.:, co cm H o A c oa •� CO � m o0o cm a c M m NmC = m iOO N AmbH yO. N O m LL. •N m C O N �dt Z C, v•N O • ui CJ W co C 4D cm F- O cry CL m '� O= J Z = CO � o (a O F- r - 006 S O ICP -4 z O U co O CD O v Z CD CL O y CD I Com_ CO)CD • gW W M� �M�y� CD CL ~ _ G3 O im" CO Q c CL a CD Q E o � � d O ♦0., c Z CL V CO) O C CO2 0 N U) W W ce W U) w° cn U F- r2 0 w � W V W H w a W W w°' cn w c c ' m c •cam o � C (A O C V C; C� �\ •CC cv ea `o N� ECF a L' ) w., CL ` N (10 E � vfti m MA m c C.:, co cm H o A c oa •� CO � m o0o cm a c M m NmC = m iOO N AmbH yO. N O m LL. •N m C O N �dt Z C, v•N O • ui CJ W co C 4D cm F- O cry CL m '� O= J Z = CO � o (a O F- r - 006 S O ICP -4 z O U co O CD O v Z CD CL O y CD I Com_ CO)CD • gW W M� �M�y� CD CL ~ _ G3 O im" CO Q c CL a CD Q E o � � d O ♦0., c Z CL V CO) O C CO2 0 N U) W W ce W U) w° cn U w° r2 Q U w � W 00 w2' w a W W w°' cn w 00 w�' w rA 0co cn Q c c ' m c •cam o � C (A O C V C; C� �\ •CC cv ea `o N� ECF a L' ) w., CL ` N (10 E � vfti m MA m c C.:, co cm H o A c oa •� CO � m o0o cm a c M m NmC = m iOO N AmbH yO. N O m LL. •N m C O N �dt Z C, v•N O • ui CJ W co C 4D cm F- O cry CL m '� O= J Z = CO � o (a O F- r - 006 S O ICP -4 z O U co O CD O v Z CD CL O y CD I Com_ CO)CD • gW W M� �M�y� CD CL ~ _ G3 O im" CO Q c CL a CD Q E o � � d O ♦0., c Z CL V CO) O C CO2 0 N U) W W ce W U) �a FORM - U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all -necessary approval /permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements. APPLICANT GxWCO• IFIL M0I ll (1 , ° PHONE x-95 ASSESSORS MAP NUMBER 01 q e LOT NUMBER SUBDIVISION LOT NUMBER 2& STREET LQ FKQE R ORCL.tr STREET NUMBER G ............................................................................ OFFICIAL USE ONLY ............................................................................ R1': TI S OFT ENTS V44471Ae-- ■.■■ 0008 ■ ■.0000.■ ■'.,■■.................................... ..• DATE APPROVED � � 4 VOV g � CON RVATION ADMINISTRA OR I DATE REJECTED DATE APPROVED— IQ,j� DATE REJECTED IMM !Kbs I ©v\ eoi) COMMENTS rd V, FOOD INSPECTOR - HEALTH SEF`TIC .MSPECTOR •• HEALTH COMMENTS PUBLIC WORKS — SEWER / WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT COMMENTS RECEIVED BY BUILDING INSPECTOR DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED THEC0W0AWE4L2H0FA1tMCHU,SV7S Office Use only DEPART1t�VTOFPUBLICSAFL7Y Permit No. BOARD OFFIREPREVEW0NRWULATI0AS527CI1R 12.00 Occupancy & Fees Checked APPLICATIONFOR PERMIT TO PERFORMELEClRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACI-RISSTS ELECTRICAL CODE, 527 cMR 12:00 (PLEASE PRAT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) Owner or Tenant Owner's Address Is this permit in conjunction with a building permit: Yes M No M (Check Appropriate Box) To the Inspector of Wires: Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead M Underground No. of Meters New Service Amps / Volts Overhead Underground No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No. of Lighting Outlets No. of Lighting Fixture, No. of Receptacle Outh No. of Switch Outlets No. of Ranges No. of Disposals No. of Dishwashers No. of Dryers No. of Water Heaters No. Hydro Massage Tubs OTHER No. of Hot Tubs Swimming Pool Above Below ground 0 ground No. of0il Burners No. of Gas Burners No. of Air Cond. Total Tons No. of Heat Total Total Pumps Tons KW Space Area Heating KW Heating Devices KW KW No. of No. of Signs Bailasis No. of Motors Total HP No. Generators No. of Emergency Lighting Battery Total KVA FIRE ALARMS No. of Zones No. of Detection and Initiating Devices No. of Sounding Devices No. of Self Contained Detection/Sounding Devices Local� Municipal a Other Connections hst==Coeua Rmanttothetag =Ti2&a NbmdRBMGn=alIaws IhmeaastartLiabtlityhtratmPblicymdtdrtgCrnTlete (�,o�ordssthsWrtd$ YES NO Itmeabnitbadvalidpttdofsametot4e06iceYES Ifjmhmedxd(edYES,plemthetW foocraWbydmkirtglhe > LRA CE Q BOND a OTHER (Pleasespmify) WatktoStmt hqvcfimDWbRaVesW Signedundcr ePataftiesd*0.ay. FIRMNAME EtmakdVaiLtec11P1e6dWcdc $ Fbal li�seNla Lioalsae L1toeNo B(>i=Td.Na Adc�rcc Alt.Td?Nh OWNER'S INSURANCEWAIVER;IamawdwdrtlheLxmsedDmnott themm=ammWa-tai)gmWewmaimtasm4medbyNImmdmsctGaoaiLam aodthat;nysgmkncnihf pmkEWba6mwaiAsdmIwmmrl i (Please check one) Owner � Agent Q �••i Telephone No. PERMIT FEE $ Town of North Andover Building Department The following is a list of the required forms to be filled out for the appropriate per to be obtained. FOR ROOFING, SIDING, INTERIOR REHABILITATION PERMITS 1) BUILDING PERMIT APPLICATION 2) DEBRI REMOVAL FORM 3) WORKERS COMP AFFIDAVIT 4) PHOTO COPY OF H.I.C. AND/OR C. S.L. LICENSES 5) COPY OF CONTRACT 6) FLOOR PLAN OF PROPOSED INTERIOR WORK FOR ADDITIONS / DECKS 1) BUILDING PERMIT APPLICATION 2) FORM U 3) MORTGAGE PLOT PLAN 4) DEBRI REMOVAL FORM 5) WORKERS COMP AFFIDAVIT 6) PHOTO COPY OF H.I.C. AND C.S.L. LICENSES 7) COPY OF CONTRACT 8) FLOOR/CROSSSECTION/ELEVATION PLAN OF PROPOSED WORK WITH SPRINKLER PLAN AND HYDRAULIC CALCULATIONS (if applicable) 9) MASCHECK ENERGY. COMPLIANCE REPORT (if applicable) FOR NEW CONSTRUCTION (SINGLE AND TWO FAMILY) 1) BUILDING PERMIT APPLICATION 2) FORM U 3) GROWTH MANAGEMENT BYLAW 4) CERTIFIED PROPOSED PLOT PLAN 5) PHOTO COPY OF H.I.C. AND C.S.L. LICENSES 6) WORKERS COMP AFFIDAVIT 7) TWO SETS OF BUILDING PLANS (one to be returned) TO INCLUDE SPRINKLER PLAN AND HYDRAULIC CALCULATIONS (if applicable) 8) COPY OF CONTRACT (if applicable) 9) MASCHECK ENERGY COMPLIANCE REPORT 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 application. V) Ln V) 4� 7� V) CV) 0 73 cn Q) Lr) U V) V) V) V) •Ln 4-j LO Ln bO 0 -7j' V) ct LI) 7z V) r,4 -r7q V) V) CL) CL) TZ bjO S C) `...1.1i V) > V) CL) — — 1--) --- -C) Ln cz — Ln V) t'Z V) \0 Z.) L) cz 7, L") 7z Ln V) _J cz P-4 Ll -4 — 0 ti — V) ✓V) Lr v, V) V) V) cz brj V) V) 7= cn Ln.moi (f) Lr) L) Ln Lr) 7z Q) biri Z) 7 --LZ) by , - VII bjD Ln cn 4-d Ln bl) LO L. C) 7z Lo L) LI) OE r L:- : --.q L) 7z L) p -77' V) '-4 L,) ✓ V) m Ln y v� r wt `` cr t � ►s r Q N Z Q J p m W U o� e c Ch J._ c CD Nu io I C, O 3 ` %I c � Q S U W G r v � O I_ v. < o R / rt C J AD Lu -W+ a O 9 _ N • _ � co J¢ o� e c Ch J._ c CD Nu c J CC C R ••� L U U I C, 3 ` %I ri a � Q S U < o Q. - It I_ v. < o R / a' c z O e Lu -W+ a 0 9 _ _ • _ � _o J¢ N E -Ch c U ZG0 ou < " cc LAJ O '�-J o > G fZcl) a F -a cz tm CiN ` N�cAY z= �m c " 3: ZZD OT � pQZZ < ai Qiv = t c � c c JJ♦' D LtlC c zc - r o r 3 0 >_ R R C ii 3:. Nc- C L: ^ < w c W- Ci V- .ri ci •� c L c . } J Z 0 a c 0 ID C7 Z a 0 C LL uj Q z 0' H Q U a J CC C R ••� L U U I C, 3 ` %I ri a ! < o Q. - It v. < o R / a' c z O e I� ,c LI l . } J Z 0 a c 0 ID C7 Z a 0 C LL uj Q z 0' H Q U a e LI l } J Z 0 a c 0 ID C7 Z a 0 C LL uj Q z 0' H Q U a EMERGENCY AMENDMENT TO 5ECTION421.10.1 (9.1) SWIMMING POOL ALARM5 At its June 9, 1998 meeting, the DDK5 voted to amend the above Section of the building code by emergency action to clarify the permi55ible audible alarm activation period. Delete the wording 'The alarm shall sound continuously... for a minimum of 30 Seconds immediately after the door i5 opened" and replace with; "The audible warning Shall commence not more than 7 Seconds after the door and door Screen, if present, are opened and shall Sound continuously fora minimum of 30 Seconds" 780 CMR: STATE. BOARD OF BUILDING REGULATIONS:AND STAIN, D.: THE MASSACHUSETTS STATE BUILDING CODE 54 inches (1372 mm) from the:bottom;ofwthe gate: private pools. (a) the release mechanism, shall be located; on .the The: maximum slope permitted between point D, pool side of the gate at least. three. inches. (76 mm) and the transition., Point shall: not exec eed one unit below the top of the gate;.;and,(b) the gate and;barrier vertical to three units horizontal (1 3),in private and shall not have an opening greater than ih inch (13 public pools ;D, is theipotnt directly under the end nun) within 18 inches (457 nun) .of the release of the diving .boards. D is the point.at which the mechanism. floor begins to slope upwards to the transition point. 9. Where a wall of a dwelling serves as part of See`Figure 421.11.. the barrier, one of the following,shall apply: 8'0" 9.1. All doors with direct access to the pool Figure 421.11 through that wall shall be equipped with an WATER DEPTHS AND.. alarm which produces an audible., warning DISTANCES BASED ON BOARDHEIGHT when the door and its screen, if present, are FOR ALL PUBLIC, SEM LPUBLIC AND opened. The audible ,,. warning shall PRIVATE POOLS = commence not more than seven ,seconds after. the door and screen door,, if;present, are TYPICAL. POSITION of .TIP . . Opened and shall sound COnilnt30usly: for a OF. SOARQ.RELATIVE.TO. PT. A minimum of 30 seconds. The alann.shall WATER UNE have a minimum sound ,pressure rattn of 85 dBA at ten feet (3048 min) and the sound of PT. A PT. a PT. C" ` PT. D the alarm shall be distinctive. 'from other z household sounds such as smoke alarms, 15 .. - telephones and door bells. "The alarm shall c c S TRANSITION POINT automatically reset under all conditions. The alarm shall be equipped with manual means, such as touchpads or switches, to deactivate temporarily the alarm fora single 3 openinc- from either' direction. ""Such Such Table 421.1 1(1). deactivation shall last for -not more than 15'LMUM WATER DEPTHS AND seconds. The deactivation touchpads or. ' DISTAiNCES BASED ON BOARD switches shall be located of least 54 inches HEIGHT FOR ALL'PLTBL.IC POOLS (1372 mm) above the threshold of the door. r Minimum depth at a Distance. Minimum 9.2. The pool shall be equipped with an Board height . D. T directly under between :. depths at approved power safety cover. end of board D, and D, D, 10. Where an above aground pool structure is 2.," (y3 meter) 70" 8'0" 8'6" used as a barrier or where"' the barrier is 2-6- ('/< meter) 7"6"- ` " 9'0" 9'0' mounted on top of the pool structure; and the means of access is a fixed or removable ladder 1 meter 8'6" 10'0" 107 or steps, the ladder or steps shall be surrounded. 3 meter 11.0.. 10.0" by a barrier which meets the -requirements of Note a. 1 foot =,304.9 grim: 780 CMR 421.10.1 items 1 through 9. Are- movable ladder shall not constitute an accept- Table 421.11(2) able alternative to enclosure requirements. MINIMUM WATER DEPTHS AND DISTANCES BASED ON BOARD HEIGHT 421.101 Indoor private swimming pool: All FOR PRIVATE POOLS walls surrounding an indoor private' swimming pool shall comply with 780,CMR 421.10.1, item 9. 421.10.3 Prohibited Iocations: Barriers shall be located so as to prohibit permanent structures, equipment or similar objects from bei cr used to climb the barriers. 421.10.4 Exemptions: The, following shall be exempt from the movisions of 780 CMR 421.0. Note a. I foot = 304.8 mm. istances depth! 1 41 Dinimum Board heightbetween Di. Minimum a directly under depth at D-, end of board and D 2 ' 1'8" ('fz meter) 67 77 7'6" 2'2" (1/9 meter) 610" 76" $10" 2'6" ell teeter) 7'5" 8'0" S-0- 344. (1 meter)` 8'6" 9'0" 9.0.. Note a. I foot = 304.8 mm. I O t QD NLr- , _ N ' PROPOSED STOCK ` PILE AREA77 / ry r • LOT 25 cam/ cio LOT 5 r J i i LOT 26 / \'', �` \���� f / j •,,,,` � � . � 1 / ��/ill; —_J LOT 27\ 4" LOAM & SEED41'r rbb. ,° co V 1 14 LOT Y -Y•-,"/' . SLOT .28 Is - LOT 4 °w bryoy EX _ 25 --_ LOT3 v LOT 2 ' r — --.. yam — z )2— , , LOT A LOT 1 G4 IPA o i 1 _. CONSTRUCTED POCKS -F• ..., � `� i ' • ' , ._ �' s `� _� WETLAND/DETENTION POND LOTFr. _ 1 4268 -S.f. - '0.33 Ac. N DRAINAGE & UTILITY 15.03' EA SEM EN T IT: 27 ?9 Ac. °' l Ui ` ,> O� D) � (O 19.52' 23 PHm M. IIIJ•��6�N16N IV0�1-Cui�Q�(E N 4 l THE PREMISES AND THAT THE BUILDING IS LOCATED 9*aws-4 � FNCE VJM4 92� llxt'C441 kJ&LA IS INTENDED rOR ZONING AS SHOWN. THE-MUCTURC SIIOWN CONFORMS ONLY. IT WAS PREPARED TO THE ZONING LAWS RELATIVE TO REQUIRED SETBACKS OF 4 W 127.38 046 a 0. WITH THE STRUCTU_RMSHOIMN LOCATED TO TIME F.E.M.A./H.U_D. FLOOD INSURANCE RATE YAP, 29.4' BY AN INSTRUli1_Wf SURVEY. THIS PLAN COMMUNITY PANEL NO. 250098 0006 C z T 10.� LOT 26 r c 3) � < 1 12 7,6 3 U.<<J S. F. Ac. Tn rn I ut' I-UUIVUR 11UN '12- ELEVATION=271.28 2L I -UC a1 txxz5 21.1' N.29.53' 44" E 109..4-7' " PEACHTREE LANE v o a) M 4 l THE PREMISES AND THAT THE BUILDING IS LOCATED 9*aws-4 � _ v IS INTENDED rOR ZONING AS SHOWN. THE-MUCTURC SIIOWN CONFORMS ONLY. IT WAS PREPARED TO THE ZONING LAWS RELATIVE TO REQUIRED SETBACKS OF FROM EXISTING PLANS _AND RECORDS THE MUNICIPALITY WHEN CONSTRUCTED_ ALSO. ACCORDING 046 a 0. WITH THE STRUCTU_RMSHOIMN LOCATED TO TIME F.E.M.A./H.U_D. FLOOD INSURANCE RATE YAP, 29.4' BY AN INSTRUli1_Wf SURVEY. THIS PLAN COMMUNITY PANEL NO. 250098 0006 C SHOULD NOT BE USED FOR PROPERTY DATED 6/2/1993,. THE STRUCTURE IS NOT LOCATED UNE DETERMINATION_ IN AN ESTABLISHED 'T00 YR.R.001) HAZARD ZONE_ v M.0 MARdIWNDAM&ASSCW.;LP, r D=90'00'00" Tn R=30.00' L= X17.1.2' WE HEREBY CERTIFY THAT WE HAVE EXAMINED �ESS�O�OQ' l THE PREMISES AND THAT THE BUILDING IS LOCATED 9*aws-4 � IS INTENDED rOR ZONING AS SHOWN. THE-MUCTURC SIIOWN CONFORMS ONLY. IT WAS PREPARED TO THE ZONING LAWS RELATIVE TO REQUIRED SETBACKS OF FROM EXISTING PLANS _AND RECORDS THE MUNICIPALITY WHEN CONSTRUCTED_ ALSO. ACCORDING WITH THE STRUCTU_RMSHOIMN LOCATED TO TIME F.E.M.A./H.U_D. FLOOD INSURANCE RATE YAP, BY AN INSTRUli1_Wf SURVEY. THIS PLAN COMMUNITY PANEL NO. 250098 0006 C SHOULD NOT BE USED FOR PROPERTY DATED 6/2/1993,. THE STRUCTURE IS NOT LOCATED UNE DETERMINATION_ IN AN ESTABLISHED 'T00 YR.R.001) HAZARD ZONE_ CEi I IED UNDAAMON PLAN LOT 26 PEAOHTREE.TARMS MARdIWNDAM&ASSCW.;LP, -----_N.-0RTH-_AER M 04CMUMN.WMID PLMININC CONSULTANT'S DEVEMPMENT.-A-L.C: s2."I"ot�'IVAL ' i 1E. 3uiiE T PEACHIRM nmr - . _. � eax��3s. ..:4'R+�� � );L43 8-5121 - � �_.: _D., . y'�$i�, �CALE.�1- 3D, 4 d (d � DA=T�'. 2f 1.1 /04. ,,.ANDD�IER'�iI�A Arm•'&h,.}}iffiK'SNi.�1YwarnAtl���.__-�F'���$'.�+ S•ii2'x."E•1YIICS9'Mf.'�S:iV+'� 9- 00 = — CM 76 jj-,ja-jj 4A lu -M (D E 12 > > < Co cr) Ln 0� tL CIL I ID N N N 0.- 0... cc C6 < im U_ OD cr,2 wo < <::z coal) .CD -lz Lu - .0. -IU Ir a- V3 V3l­J-__J 0 -Ul C4> >0 -W la _46 ui MAI_ I WB ..w L www (D 2 0 AD XD 10 Of'e < N —to — - 13 .c CL -a M . - (D 03 aD 10 Lo CL r_ (D > 0 Q C3 0C LLm Co M w co x m (a in to w < m z w 0 M z cl) 0 AlchL Z2 0 cO Aj 0 ui 0 afw2u- mu - 44d 4- < w w o -o M.Z­w m oc 0 U. 0-0 <c;--Z— -D (D Zo Z. ci 0 T W ID IL co LO crc,4 lu .'s 4v ado*" CD r-_ k6ti: CQD in r. 01 o P CL 0- Im .,C2 L -0 . x . c 0, ; J.- 0 Ul- m CD - , m - IL _j CL(DO N. C2> L 0 in (D -M IM (D (D (D 4701 _F3 -a -70 CD :.co &a Coto t4 JW p h; 9- id - = — CM 76 jj-,ja-jj 4A lu -M (D E 12 > > < Co V) ID Ln 0� tL CIL EmCm 0.- 0... cc cl ic--: < im U_ OD cr,2 wo < <::z .CD -lz Lu - .0. -IU Ir a- V3 V3l­J-__J 0 -Ul C4> >0 -W la ui MAI_ 9- J.- 4A lu -M (D (D IL < Co V) ID Ln 0� tL CIL -to At cc cl ic--: ir- .CD -lz Lu - .0. -IU Ir a- V3 V3l­J-__J I.- -Z fA ic ui MAI_ I C-4 W. L www (D 2 0 a- m S- . = Of'e < N —to — - CL —8 < r4 N Dy CD -M (D (D IL < Co V) ID Ln 0� tL CIL -to N cc cl ic--: ir- -lz V3 V3l­J-__J -U-- MAI_ I C-4 W. a- m S- . = N —to — - 101i a <3 i in co = LLm Co M w co x m (a in to w < m z N_3 LL (s) LL (D CQ 0 ui 0 afw2u- mu - r4 N Dy CD in m ND V 0 V4 V) ID Ln 0� V4 N cc in m ND ✓gyp �a�, �P..�1.� BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR I Number. CS 027999 ��----=-� Birthdate: 0311411934 Expires: 0311412006 Tr. no: 17751 Restricted: 00 RODNEY P ANDREWS 1647 LOWELL RD AW" CONCORD, MA 01742 AanaC mis oner 1 fes`, ✓�ec 'Vo�n�»a�rum.�ufl`I�i o�.eft'a::J[��e � Board of Building Regulations and Standards . HOME IMPROVEMENT CONTRACTOR s Registration: 113772 Expiration: 711612007 Type: Private Corporation License or registration valid for individul use only before the expiration date. If found return to; Board of Building Regulations and Standards One Ashburton .Place Rin 1301 Boston, N3.02106 ANDREWS GUNITE CO., INC. RODNEY ANDREWS 6 REPUBLIC RD N BILLERICA, MA 01862 Administrator Not vali wltbout slgnature t DATE (WAfDOfYYYV) AQ -080„ CERTIFICATE OF LIABILITTIN6URA1�.CB ANEIRM� 03/03/05 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Kittredge Insurance Agency Inc HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 1558 Otis St., P.O. Box 1129 ALTER THE COVERAGE AFFORDED BYTHE POLICIES BELOW. NOrthboro MA 01532 Phone: 508-393-7744 P'ax:508-393-6983 INSURERS AFFORDING COVERAGE NAIC## INSURED INSUREAA Acadia Insurance CcmpLnl INSURER B: INSURERC: Andrews mite Co., Inc. 6 Rerblic Read Norti� Billerica M& 01862 INSURER D INSURER E r COVERAGES THE POLICIES OF INSURANCE USTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWR'HSTANOING 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'.TFRMS, EXCLUSIONS AND CONDITIONS_ OF F S_ UCH POLICIES, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS Nbm LTR 13 Li INS TYPE OF INSURANCE POLICY NUMBER I GATE MMIDO DATE IMWDR= LIDS GENERAL LIABILITY EACH OCCURRENCE j$1000000 A X X COMMERCIAL GENERAL LIABILITY CLAIMS MADE X❑ OCCUR CPA0136208-10 Q3/O1/Q5 03/01/06 i PREMISEs Eaoowrence1 1$250000 MED EXP (Any crteoerson) IS5000 PERSONAL A ACV INJURY IS1000000 GENERAL AGGREGATE 1$2000000 GENIL AGGREGATE LIMIT APPLIES PER: 1 POLICY n M F-1 LOC PRODUCTS -COMPfOPAGG S 2000000 r� X AUTOMOBILE LIABILITY ANY AUTG MAA136210-10 03/01/05 03/01/06 COM B[NED SINGLE IJMiT S lOOOOOO (Ea agmem) X X �gi X I ALLOWNEOAU70S SCHEDUIiED AUTOS j HIRED AUTOS I NON -OWNED AUTOS ` i1 ( { t r 1 1 i f BODILY INJURY S jPerpers ) I BODILY INJURY I S { (Par acmdem) j !ROP dl) DAMAGE S GARAGEUAgILIIY - AUTO ONLY -EAACCIDENT IS ANY AUTO • OTHER THAN EA ACC S AUTO ONLY: AGG S A EXCESSfUMBRELLA LIABILITY X OCCUR LI CLAWSMADE CUA0136211-10 I 03/01/05 03/01/06 EACH OCCURRENCE S'1000000 AGGREGATE l000000 5 " HDEDUCTIBLE B RETENTION S I Is A WORKERS COMPENSATION ANDI I EMPLOYERS' LIABILITY ANY PROPRIETORlPARTNERtEXECUTbvE OFFICER/MEMBER EXCLUDED? Id es descibeunder SPECIAL PROVISIONS be" WCA013 6.213 -10 03/01/05 I 03/01/06 I IgOAYLtMITS ER E.L. EACH ACCIDENT I 5 3.0Q0000 E I DISEASE - EA EMPLOYEE) S ,100 0 0 0 0 E.L. DISEASE-POLICY'LIMIT S 1000000 OTHER DESCRIPTION OF OPERATIONS! LOCATIONS I VEHICLES) EXCLUSIONS ADDED BY ENDORSEMENT f SPECIAL PROVISIONS O>pechee Construction Corp. is included as Additional Insured with respect to General Liability and Auto Liability as required by written contract. ACORD 25 (2001108) CANCELLATION OPEC001 SHOULDAWOFTHEABOVE OESCRIBEDPOLICIESBECANCELLEDBEFORETHEEXPIRAT10N1 DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO NWL 20 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO 00 SO SHALL IMPOSE NO OBLIGATION OR LIASMnY OF ANY IGND UPON THE INSURER, ITS AGENTS OR + i REPR!!aggqNM1 ENTATIVE NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit at: �p�CIRC is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL C 11, S 150 A. Also, note Permits are required under Fire Prevention laws Chapter 148 Section 1 OA. The debris will be disposed of in: c. I(eo , (Location of F Fire Department Sign off:�- Dumpster Permit of Permit A Date 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 Address: City/State/Zip: IV)91-1� 5U01CA A. 61UO2Phone #:(EM) 2:r-2- 7g4(o Are you an employer? Check the appropriate box: 1. [0I am a employer with 30 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. $ ship and have no employees These sub -contractors have working for me in any capacity. [No workers' comp. insurance required.] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t workers' comp. insurance. ❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. [P -Kew construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. El Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs 13. Other 5W1MMt*46 'Any applicant that checks box #1 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 their workers' comp. policy information. I am an employer that is providing worke+,rs' compensation insurance for my employees. Below is the policy and job site information. e ti ��71+8(f gVIG �� KP D� Insurance Company Name: A6aJC� Policy # or Self -ins. Lic. #: W CA 0136Q[3 , �O � ,' Expiration Date: '" _0(0 Job Site Address: G wyend6/ c0cbe City/State/Zip: 117. Q*15- 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.#nder,iVp#r and penalties ofperjury that the information provided above is true and correct. Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # _[a -05 - Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. 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