HomeMy WebLinkAboutBuilding Permit #481 - 66 EQUESTRIAN DRIVE 2/13/2008BUILDING PERMIT
TOWN OF NORTH ANDOVER o?
APPLICATION FOR PLAN EXAMINATION � 70
�7 L:
Permit NO: Date ReceivedD /
i 9q
�.q �AATlD I.PR t.�S
Date Issued: rT' (-5 " 6
IMPORTANT: Applicant must complete all items on this pate
LOCATION (Q Cr,Q(J,$f
ot _
PROPERTY OWNER /'Yt' tor ti.c� P/ a_ � Lk
)40 //,/ MA k- r I h�0 /l �
Print
MAP NO: PARCEL: ZONING DISTRICT: Historic District yes
T- Machine Shop Villaae ves
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
New Building
One fami
Addition
Two or more family
Industrial
Iteration
No. of units:
Commercial
replacement
Assessory Bldg
Others:
Demolition
Other
Septic Well
Floodplain Wetlands
Watershed District
Water/Sewer
DESCRIPTION OF WORK TO BE PREFORMED:
=XIS i itiC, . v {�
R g cy e- .Sc e'e �eK
Por -kc-, c\ -
3 9 t5 6o � o—,3o o
Identification Please Type or Print Clearly)
OWNER: Name: M ! Chg e C- a_ %�5/ MaAGe', e/11' Phone: 4 7 `$ 2,08 gc(oo
Address:
CONTRACTOR Name:
Address:T�'-1 AI U 9,WeA c G e, tyly c- D 15 C;L
F
Supervisor's Construction License: (21-3 3 % - Exp. Date: /Oao / 0
Home
License:
ARCHITECT/ENGINEER
Date: / /
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: $ NO O 0 O FEE: $_
Check No.: a71r Receipt No.: oCZP07 7 S7
NOTE: Persons contracting wi ,unre ' tered c ctors do not have access to the guaranty fund
Signature of Agent/Owr�er 'gnature of contractor C
Location t r��r r" .✓ r , . -' /-,� �✓�'
No.y Date �� c
40*TM
TOWN OF NORTH ANDOVER
'
Certificate of Occupancy $
sACNUS tis
Building/Frame Permit Fee $
R
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check #
20:�;J
4
Building Inspector Inspector
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 DATE APPROVED
PLANNING & DEVELOPMENT
COMMENTS
DATE REJECTED DATE APPROVED
CONSERVATION
COMMENTS
DATE REJECTED DAT PPROVED
HEALTH
LL
COMMENTS 6 r�S
ram vA119r,
��) ✓�/ �1 /+�1��, ' .f i�fid . ®� Zoo 9 J
ZoniT g Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Commen
Water & Sewer Connection/Signature & Date Driveway Permit
Located at 384 Osgood-Strdet
FIRE DEPARTM;ENr— -Temp Dumpster on site yes rf --no
Located at 124 Main Street
Fire Department signatureldate
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
MGL Chapter 166 Section 21A —F and G min.$100-$160-0- fine
No
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
❑ Building Permit Application
❑ Certified Surveyed Plot Plan
❑ Workers Comp Affidavit
❑ Photo Copy of H.I.C. And C.S.L. Licenses
❑ Copy Of Contract
❑ Floor/Crossection/Elevation Plan Of Proposed Work With .Sprinkler Plan And
Hydraulic Calculations (If Applicable)
❑ Mass check Energy Compliance Report (If Applicable)
❑ Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
New Construction (Single and Two Family)
❑ Building Permit Application
❑ Certified Proposed Plot Plan
❑ Photo of H.I.C. And C.S.L. Licenses
❑ Workers Comp Affidavit
❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
❑ 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
a 2
'sYt S _s � t iF;SRv-. ;� ; ��` .9R«a� ". l'�h 11' t �! t f_ " }':` .d'4 t 'T }� ;a 1tK•� -
iFx
' i ��Y .• x �.� � "r � � 1�� wy4 N} �Z IT-'�:� Twp: R • � .* :?.:r
x
iGi c r :4 4 !sir ti " f tt 1 -
�l
t i.�t � #,S 't .�'..r•' > �a � ,4.., _ . } F r.* ! jt^� 1 " t '� ti � R ,,�t�
,,. � �, t t Fes' yt 10• ;rt
Z� a s Tis � }x �. df ,..�"°���"'-'ctf+� '4,, �� Jt�i � f �•�ss ti � � ���z +�r t '
fit• `
�". nl.■ 1� � `� �t.._ _ ti 1 4 �4 y _ + r:: Rw � i�,f 1 � .;_
t'.4` j +
� .''.� ! 3 «z `'^t y � *�4 T �•y t t ,� � a '' y"" rte' t
All
It
Zi
...k�� �; t ,�,+ s 7S ?- iri � � �+� �ttx, i � • 2 .a 4 ��. " ,t! t � ��. _
q
. • L ti '� R � ..gym.
. .. _ ...._.. � 4� �'�.r�. .tl, (" ".{ .— _ � ,,yyep•- t yy Y
If
MORTGAGE. PLOT
$s,
j3Z'
C,3S.�
c,,9.y�,
O IVI N
1 qqg.
411'D:S11RVf�•
STREET ADDRESS (ht4 cw ig Moan+
OWNER: P 4,14. LL2m E Q 1-rY BUYER: * K6v-l5u S/
DEED REFERENCE: Z'7-71.1 G Z SCALE
r
LAN REFERENCE: 985-7 1-1r 11 DATE: ' � 1z -'1 -1993
: 13 Y 3A&IkS MoATM-6c 6OP-9.EREBY CERTIFY THAT'THE ABOVE MORTGAGE INSPECTION PLAN WAS PREPARED FOR USE IN CONNECTION WITH A NEW
RTGAGE AND .IS NOT INTENDED OR REPRESENTED TO BE A PROPERTY LINE OR LAND SURVEY. IT CANNOT BE USED
R ESTABLISHING FENCE, HEDGE, WALLS OR BUILDING LINES. NO RESPONSIBILITY IS EXTENDED HEREIN TO THE LAND
NER OR OCCUPANT. THE LOCATION OF THE ORIGINAL BUILDINGS) AS SHOWN HEREIN WAS IN COMPLIANCE WITH THE
CAL APPLICABLE ZONING BYLAWS IN EFFECT WHEN CONSTRUCTED, WITH RESPECT TO HORIZONTAL DIMENSIONAL
REQUIREMENTS, OR IS EXEMPT FROM VIOLATION ENFORCEMENT ACTION UNDER M.G.L;TITLE VII. CHAP. 40A.' SEC. 7,
113 UNLESS OTHERWISE SHOWN HEREIN. SUBJECT BUILDING(S) LIE(S) INA FLOOD,ZONEi DESIGNATED FLOOD ZONE G
AND SHOWN ON FIRM MAP COMMUNITY PANEL # ZSou q B - oo1 S B DATED: & -I Z - I 93
MEISNER BREM CORPORATION ' ATTORNEY: ob�R,i' W. L�4voI E
151MAIN STREET, SALEM, NH OW79 603 893--3301 MORTGAGEE: Vi4kot25
190 UTRETON ROAD, WESTFORD, MA 01886 • (508; 692-2505 PLAN NO.: �" to 30 ; 41
o Q I
lui
}
-)
0
to
D
o.
0
TO (0��
>D
n�4m
D —/I 0 O
moo
om
�Z
N mO
C:
X
X m
10 N
o' t) o'
3 CD 7
� 0 �
ND00S
CD CO
O
N
O
Ul
V
O
o
CD
O
CD
0
Z W.
o o
cn
Cl)
o
°►�
j
b
CD
m
o �
o
CD
00
51 w
O
'(9 CL
W D
N
W. U)
E
Z
�O.
O
M
VVV
U
Uo
w
rn
i
LL N
Q O
U
I
�U
J
°°LU��
g
i
o Q I
lui
}
-)
0
to
D
o.
0
TO (0��
>D
n�4m
D —/I 0 O
moo
om
�Z
N mO
C:
X
X m
10 N
o' t) o'
3 CD 7
� 0 �
ND00S
CD CO
O
N
O
Ul
V
O
o
CD
O
CD
0
0
cn
cn
CD
4
o
°►�
CD c
b
CD
o �
o
CD
00
O
-�--1--� -
_
----------- -
MASSACHUSETTS HOME IMPROVEMENT CONTRACT
HOMEOWNER INFORMATION
CONTRACTOR INFORMATION
Name
Company Name
Michael and holly Marcinelli
RNA Remodeling LLC
Street Address (no post office box)
Contractor/Owner Name
66 equestrian drive
Raymond D'Auteuil Jr.
City/Town, State, Zip
Business Street Address
N. Andover, Ma
9 River Street
:Daytime Phone Evening Phone
City/Town, State, Zip
Billerica, MA 01821
978-208-8400
Mailing Address, if different from above
Business Phone Federal Employer ID
978-372-7547 86-1159783
E -Mail Address, if available
E -Mail Address
RNAremodeling@comcast.net
Contractor Registration #: 149139 expiration date: 28 Nov 2009
Construction supervisor #:093377 expiration date 10 Oct 2009
WORK TO BE PERFORMED AND MATERIALS TO BE USED
Contractor Agrees to do the Following Work for Homeowner:
Convert screen porch to 3 season room including:
Sliding windows TBD.
French door. TBD.
Flooring TBD.
Finish interior TBD.
Demo existing railings and screen and frame new walls
Install new windows
Glue and screw tongue and groove % sub flooring to existing floor
Insulate Floor ceiling and walls.
Clean up and debris removal. Mello's @ 160.00 a ton
All work performed to code and sign -offs are contractors responsibility
WORK SCHEDULE
The following schedule will be adhered to unless circumstances beyond the contractor's control arise:
Work Scheduled to Begin: Jan 28`. 2008
Expected Date of Completion: February 28`n 2008
page 1 of 2
,_J
TOTAL CONTRACT PRICE AND PAYMENT SCHEDULE
The Contractor agrees to perform the work, furnish the material and labor specified above for the SUM of
$ estimated at 14.000 + permitting costs
Payments will be made according to the following SCHEDULE:
This contract is for labor at $ 50.00 per hr. per man. + Material cost. Material is provided by
contractor and paid for weekly by customer at invoice cost. All invoices and materials costs will
be paid at the end of every workweek with invoices provided.
*In order to meet the completion schedule, the following material/equipment must be special ordered
before the contracted work begins:
Windows and doors
SIGNATURES
n NOT THIS CONTRACT IF THERE ARE ANY BLANK SPACES.
omeo er' ljoture ontractor's Si e
4i 1 / ??-) 16 E3
Date Date
REQUIRED PERMITS
The following building permits are required. It is the obligation of the contractor to secure such
permits as the homeowner's agent: List any and all necessary construction -related
permits: Building
NOTE: Owners who secure their own permits or deal with unregistered contractors are excluded
from the Guaranty Fund provisions of MGL c. 142A.
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
page 2 of 2
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
d 600 Washington Street
` Boston, AL4 02111
www.mass.gov/dia '
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
pAlicant Information Please Print t,euihl
Name (Business/Organization/Individual): A�,a L 0 Art;eV t L rj U ,4
Address:
City/State/Zip: /&, 1Ce,9ec c -c
Are .you an employer? Cheek the appy
L ❑ I am a employer with
employees (full and/or part-time).*
2.94 am a sole proprietor or partner-
ship and have no employees
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
Phone .#:— q 2 3 - 97 oZ — 7 ,- 6 %
late box:
4. Q I am a general contractor and I
have hired the sub -contractors
listed on the attached sheet
These sub -contractors have
employees and have workers'
comp. insurance.$
5. 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 reouired.l
Type of project (required)`
6. ❑ New construction
7. Remodeling
8. Demolition
9. Building. addition
10.❑ Electrical repairs or additions
11 -[1 Plumbing repairs or additions
12.0 Roof repairs
13. ❑ Other
*Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information.1
t Homeowners who subant 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 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 and penalties of perjury that the information provided above is true and correct
Signature: 0
Date: i —
Phone #:
Official.use only. Do not write in this area, to be completed by city or town official
City or Town: Permit/License #
Issuinb 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."
i
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 license or permit to,bperate�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, §25CM 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 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 callthe 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 permit/license number which will be used as a reference number. In addition, an applicant
that must submit multiple permiVhcense 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 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
640 Washingt cm Street
Boston, MA 02111
Tel. # 617-727-4904 ext.40,6 or 1-877-MASSAFE
`
Revised 11-X22-06 Fax 4 617-727-7749
www.mass.gov/dia
LLI
z
c �
Q v
o
�Cc
=
o�
3y�
o
0.
.is �t0E= Z
• " ^`IIEE Q
�Oom
o
o
�: v :mc E �O
h Ma
3 C/)
cm m N
_m
Cc cac
O'
M-
. N W
av m
m
Zcm
14. C)
�1 Q
:mC=,r m a
V N O
ecvZ o
C2 .� om
oao c
E :gym= .o
= mms 3 N
d
COO �... N t r.. m_..
NdMD
C=CD
.., .�
.GO aro = Z
*='I
m •N O \\
C.3 o oma= g W
V3 a 0320-0
_ O y O
�— 0- CL -0-m -9
CO
z
u
C/)
f
CD
Cl
CD.
0
s
z °'
CL
O y
D �
CD pm
i C
C
U3 p 'O
y CD
FE m m
Q CD
� F.— .0
CL �...
O � CO
CD
0 0
env o a
0- cm<
CO3 C
O+_-� ccC
.�
CD
CD CL
�..� CO)
c C
.0 C
ev
CLH
0
00
w2
0
V)
O
w
w°
�°'
U
w
O
w
o
u:
w
a
O
U
a
w
W
o
w
cii
iw
p:
O
a
ca
w
w
v
r�
z
cn
Q
cn
LLI
z
c �
Q v
o
�Cc
=
o�
3y�
o
0.
.is �t0E= Z
• " ^`IIEE Q
�Oom
o
o
�: v :mc E �O
h Ma
3 C/)
cm m N
_m
Cc cac
O'
M-
. N W
av m
m
Zcm
14. C)
�1 Q
:mC=,r m a
V N O
ecvZ o
C2 .� om
oao c
E :gym= .o
= mms 3 N
d
COO �... N t r.. m_..
NdMD
C=CD
.., .�
.GO aro = Z
*='I
m •N O \\
C.3 o oma= g W
V3 a 0320-0
_ O y O
�— 0- CL -0-m -9
CO
z
u
C/)
f
CD
Cl
CD.
0
s
z °'
CL
O y
D �
CD pm
i C
C
U3 p 'O
y CD
FE m m
Q CD
� F.— .0
CL �...
O � CO
CD
0 0
env o a
0- cm<
CO3 C
O+_-� ccC
.�
CD
CD CL
�..� CO)
c C
.0 C
ev
CLH
0
i %�..3 •cif x
\ 1
1 .
�r
f.
f -
1
i
---
I
--
-�-
-
_
--I--i
-
-�-
--
---I-
-
--
(
I
C
I-
i
---
O
-�
i
-
--f`
I
--
L i
L-4-
r
I
i
r.-
xfi!co
it
tj
F
I
l
I
I
��-
it
I
r
t
�