HomeMy WebLinkAboutBuilding Permit #252-11 - 64 FOXHILL ROAD 9/24/2010 BUILDING PERMIT of NORTH
TOWN OF NORTH ANDOVERo2 4; �'- • o�
APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received
Date Issued:
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IMPORTANT Applicant must complete all items on this page
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TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
New Building One family E/
Addition Two or more family Industrial
Alteration No. of units: Commercial
Repair, replacement Assessory Bldg Others:
Demolition Other
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DESCRIPTION OF WORK TO BE PREFORMED.
J� O&S -J AAA&e- %oAS Z_ c-i 1&b&-WS
Identifican Please T e or Print Clearly)
OWNER: Name: �'#eA+- , ' 9 / Phone:
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Address:_ (l� � i��c �� /V
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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: $ Z-�
V FEES$
Check No.: 1� ` ,, Receipt No.: a'3
F P
NO4 amu..
TE Persons conte actcng with un b�stered tractors do not have access to the guaranty fund
S�nture Pf..�Agent/Ouurier SignatFm
ure;
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 DATEAPPROVED
OVED
PLANNING & DEVELOPMENT
COMMENTS _
I
CONSERVATION Reviewed on Signature
i
COMMENTIS
HEALTH Reviewed on Signature
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
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Planning Board Decision: Comments
Conservation Decision: Comments
Water & Sewer Connection/Signature & Date Driveway Permit
DPW Town Engineer: Signature:
384 Os ood Street
IRE� eRTMF»T TermDump er on srte no .. r; z
'tocatedrat 9AAWL am Street;
Y
F�reeparxmer�ts�
Dimension
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
Total land area, sq. ft.:
ELECTRICAL: Movement of Meter location, mast or service drop requires approval of
Electrical Inspector Yes No
DANGER ZONE LITERATURE:. Yes No
MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine
NOTES and DATA— (For department use)
❑ Notified for pickup - Date
Doc.Building Permit Revised 2010
4
i I
Location r
No. Date l�
00PTIV, TOWN OF NORTH ANDOVER
s
�• ; ; Certificate of Occupancy $
;7d''�'•''<�' Building/Frame Permit Fee $ �
suwus� ,
Foundation Permit Fee $ '
Other Permit Fee $
TOTAL $
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Check # ✓��
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234t�
Building Inspector
NORTH
Tovm of Andover
xi On
.... ....... ....
No.
0 � r ass. •d• � �
Y Q LAKE"CK
over, Mass.,T—
COCHICHEA y�.
DRATED i` ��
BOARD OF HEALTH
Food/Kitchen
.PERMIT T Septic System
` �� � BUILDING INSPECTOR
THIS CERTIFIES THAT 6 vuv.4 .......
.................................................. Foundation
has permission to erect.................:...................... buildings on .....(V. .......f—SA /•f I..................................... Rough
T
to be occupied as•... ...lung.r..�A r�i ! tlh, ..... ...?.I .M!►.... ......�.�..�I il...... � ney
provided that the person accepting this p;cit shall in eve�l respect conforijo the terms of the application on fi 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 PERMIT EXPIRES IN 6 MONTHS
ELECTRICAL INSPECTOR
UNLESS CONSTRU STARTS
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.
i
Hashem Construction,lnc.
133 Main St. (Rt.28)
No. Reading ,Ma. 01864
978-664-4191, 978-807-9080 cell
Home Improvement Contract
Owners : Gunther& Pamela HoffmanA
64 Foxhill Rd. No. Andover,Ma. 01845
978-688-0341, 978-828-7747 cell
Contractor: Hashem Construction,Inc.
John J. Hashem Jr. Pres.
Home Improvement Reg. # 116025
Job: 64 Foxhill Rd. No.Andover,Ma.
Start date 9/30/10 or 10 days from issue of permit, completion 45 days from start.
Permits to be obtained by contractor. Owners who secure their own permits will be
excluded from the Guaranty Fund MLG chapter 142 A.
Contract Amout: $ 29,850.00 Payable $ 9,850.00 upon signing of this contract, $ 10,000.00
when siding removed and trim boards installed, $ 5,000.00 when doors and windows
installed (exept garage doors), $ 5000.00 final upon completion.
All Home Improvement contractors and subcontractors shall be registered, inquiries directed
to: Office of Consumer Affairs and Business Regulation
10 Park Plaza, Suite 5170 Boston,Ma. 02116 617-973-8700
Cancellation rights: Owner has no later than midnight of the 3rd business day from signing of
this contract to cancel and receive a return of all deposits.
All workmanship warranteed for 1 year
of installation. Contractor not responsible for
performance of products which Owner shall deal with manufacturer.
/ Page 1 of 2.
�"-�`'`�` ��✓ /Yyt cam_-,,�_
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Home Improvement Contract cont. Page 2 of 2.
Description of Work and Materials:
Remove front siding&trim, install Tyvek over sheathing, wrap corners.
Install Azak or similar PVC corner boards and trim 5/4 x 6 on corners, 5/4 x 4 on small corners
and windows and doors on front only. 1x 8 PVC or as needed to wrap transom windows over
front entrance.
Two rear corner boards replaced by 5/4 x 6 PVC. Two new facial boards 1x10 PVC over garage
and over front entrance windows to replace existing ones.
Replace 2 foyer windows with Andersen fixed glass units of similar size in territone color.
Replace front entrance unit with sidelight and trim interior casing. Allowance $1,500.00
for unit only. Also replace garage side door with similar steel door unit . $300.00 allowance.
Remove and replace siding with Clear red cedar shingles R&R on front of house.
Install 2 new garage doors and runners (no openers) $ 2,200.00 Allowance. Install new PVC
trim around garage doors with 5/4 x4 casing on front.
Install bead board vinyl ceiling over front door.
Install 2 new sections of gutters, one over 2"d floor over garage and the other over entrance.
Remove all debris from job. Does NOT include any painting.
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES.
G'.
2-
OWNER
-
O NER date TRACTOR date
The Commonwealth of Massachusetts
Department of Industrial Accidents
�'' "� 1• Office of Investigations
600 Washington Street
Boston,MA 02111
\moi www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Le ibl
c
Name(Business/Organization/Individual):
Address:
City/State/Zip: M� / ` P Z) MA Phone #: 7 F �` y
Are you an employer?Check the appropriate box: Type of project(required):
L❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑Newconstruction
employees(full and/or part-time).* have hired the sub-contractors .
2.
El am a sole proprietor or partner- listed on the attached sheet. $ Remodeling
ship and have no employees These sub-contractors have 8./❑ Demolition
working for me in any capacity. k workers' comp. insurance. 9. ❑ Building addition
[No workers' comp.insurance 5. V1 We are a corporation and its
required.] officers have exercised their 10.❑ Electrical repairs or additions
3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions
myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs
insurance required.]t employees. [No workers'
comp. insurance required.] 13.0 Other
*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 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: City/State/Zip:
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do Hereby certify under the pains andpenalties of perjury that the information provided above is true and correct.
Signature: Date:
Phone#: tie7
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: Permit/License#
Issuing Authority(circle one):
1. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone#:
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire,
express or implied,oral or written."
An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more
of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the
receiver or trustee of an individual,partnership,association or other legal entity,employing,employees. However the
owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the
dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally, MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary,supply sub-contractor(s)name(s),address(es)and phone numbers)along with their certificate(s) of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the pen-nit or license is being requested,not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy,please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the pen-nit/license number which will be used as a reference number. In addition,an applicant
that must submit multiple pen-nit/license applications in any given year,need only submit one affidavit indicating current
Address"the applicant should write all locations in (city or
policy information(if necessary)and under Job Site A pp ( tY
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 pen-nits or licenses. A new affidavit must be filled out each
year. Where a home owner or citizen is obtaining a license or pen-nit 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
Office of Investigations
600 Washington Street
Boston,MA 02111
Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE
Fax#617-727-7749
Revised 5-26-05
www.mass.govldia
eat �a
Office of Consumer Affairs&Business Regulation
HOME IMPROVEMENT CONTRACTOR
Registration�y1'4%25 Tr# 294721
iration �10f2012
Exp'
u�- oJporation
Type'!'. P,f.. "Ilk ;
HASHEM CONST�f i
JOHN HASHEM k
` -! F^
133 MAIN ST Undersecretary
N.READING,MA 01fiS4. : .
Yl.tSSa�hu��tts- Deportment of Public Sxfct�
Of Buildin'�Rc`-ul.rtion`Licensetndurds
Boar(l ervi;or
Construction Sup
License: CS 40870
j
Restricted to: 00
JOHN J HASHEM JR
136 KARA DR 45 I
N ANDOVER, MA 018 I
Expiration: 71112011
Tr#: 17663
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