HomeMy WebLinkAboutBuilding Permit #253-11 - 71 LIBERTY STREET 9/24/2010 BUILDING-PERMIT of "°RTfl
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TOWN OF NORTH ANDOVER '✓:'=_`°
APPLICATION FOR PLAN EXAMINATION
3 -
Permit NO: Y r Date Received
Date Issued:
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
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:
(til CVA,a/ AleV <rettl .5' .
Identification PIease Type or Print Clearly)
OWNER: Name: Phone:
Address:
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ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE.BULDING PERM 2 0 00 OF THE TOTAL ESTIMATED COST BASED ON$125,00 PER S.F.
Total Project Cost: $_ FEE: $ ��
Check No.: Recei t
p No..
NOTE:
Persons conts actcng ,*th unregistered cont'actors do not have access to the
_
1Z1C1a'(7TPtCTF fif=Tn_KF r x 11
Pians Submitted Plans Waived Certified Piot Flan Stamped Plans
TYPE OF SEWERAGE DISPOSAL
Public Sewer Tanning/Massage/BodyArt 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
CONSERVATION Reviewed on Siariature
• Jnr�a
S
rte
I�VNIIV►CIY I
HEALTH Reviewed on Signature
COMMENTS
Zoning Board of Appeals;'Jariance, Petition No: Zoning Decision/receipt submitted yes
Planning- Board Decision: Comments
Conservation Decision: Comments
Wafer & Sewer Connection/S'l�c nature&Date Driveway Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street
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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.966 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
o 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
o 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
,vim-0.0 ^rr��F,~ i r�FS� Plan.
,
❑ u.,eu r-roposed, P Pilot P lay t•
❑ 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
Location
No. Date
NORM TOWN OF NORTH ANDOVER
i �
Certificate of Occupancy $
;'•ry• Building/Frame Permit Fee $
ncNus 1���,,•••—
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check # �
254
Building Inspector
_9k el
- `-136ard of
HOME IMPROVEI4°CNT GOA+'RAG''"02
Registration 1.12850 r
. Expiration. 4%29/2011. Tr# £i27.1 G
Type: DBA, ;' 1
CHRISTOPHER LANE-CONSTRUCTION
CHRISTOPHER LANE
152 FENNO DR
i�t^Lti'LEY,Il4A 01969.
CHRiSTOP►IER
152:,_NNO P
ROWL2Y, W
1icense;r reg�sti$t c.n %zlid for ind'��diilise oni�'4. r
!i,_foi e the ECpira.tion date. if found return to:
Board of Building Regu!ations and standards
ito:.Plce R1301One As}U
Boston,ALI 02tOS — _
NORTH
own 0Andover
o dover, Mass., ' o�
LAKE
COCNIC HE WICK
BOARD OF HEALTH
Food/Kitchen
.PERMIT T Septic System
BUILDING INSPECTOR
THIS CERTIFIES THAT......... ..... a/` ............S.. ..........................................................
Foundation
L-bhas ermission to erect........................................ buildin s on -6-CA% ......A... ....0!................ Rough
to be occupied as.... ...................... 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
PERMIT EXPIRES IN 6 MONTHS
ELECTRICAL INSPECTOR
UNLESS CONSTRU STService
ARTS
Rough
...
........ ................ .................................................
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.
The Commonweizith of Afassachusetts
Department o f Industrial_accidents
Office of investigations
600 Washington Street
Boston,
AIA 02111
Workers' Compensation Fnsurance Amada Www-Mass.bov/dia
Av licant Information vet: Builders/Contractors/Electricians/Plumbers
/
Name (Business/Organization/individual): �l�f -( / /
L-,�
(Business/Organization/individual): -(S ale� nC.- Please Print Le6ibl
Address: /S 11-,:�e-NNU
City/State/Zip, Cow�tA7 V l5 S Phone
#. 7l-Sao--�06 f
Are you an employer?Check the appropriate box:
1•❑ I am a employer with 4. ❑ I am a general contractor and I Type of project(required): .
loyees(full andJorpurt-time).* have hired the sub-contras 6 ❑Near construction
2•LJ 1 am a sole
Proprietor or partner- listed on the attached sheet $ 7.
ship and have no employees These sul� PmodeIing
working for me in any capacity workers' contractors have ❑
g• Demolition
comp.insurance.
[No workers'comp. insurance 5. ❑ We are a corporation and its 9. �[]Building addition
3.[1required] officers have exercised their 10•❑Electrical r
.1 am a homeowner doing all work right of ex repairs or additions
myself. [No workers'comp, c. 152 1 �mption p�MGL 11.❑Plumbing repairs or additions
insurance reaired t (4)t and we have no
q employees. [No workers' 12•❑Roof repairs
that h Pomp.lasUrance required-] 13•❑Other
r"meowners who s eat o. (c sectio:.+e_i�• ^eY"rj' w
llnIDii this affidavit indicating th .i t.. •••-•.
co ��*+n., •. .;�.�:..:,,,,
*Connectors that shed;this box must attar g a o-9 aL cork and then hire outside aOntzactors tl�i:+ eShlrSt d new
hed an additional sheet showing the name of the sub c affidavit indicating such.
I am an em g P 0M1=tots and their worker'comP•Po�Y information.
P�Y�that is providin workers'coin ensation insurance for niy employee& 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 d
Failure to secure coverage as required under Section 25A ofM ate).
fine up to$1,500.00 and/or one-year imprisonment,as well as Glc. 152 can lead to the imposition of criminal
Of up to $250.00 a da agair.nst Penalties in the form of a STOP WORT{Oji and of ire
Investigations of the DIA for tinsurance coverage verificaadvised�tion.t a CePy of���ent may be forwarded to the Office of
Ido hereby certify unti a airs a pe ties o er
.fP iury thQt the information provided above is true and correct
Simature:
717
�
Phone#;
Official use only. Do not write in this area, to be completed bj,cuj,or town ofjiciaL
City or Town:
PermitUcense#
Issuing Authority(circle one):
I.Board of Health Z.Building Department 3. Citv/Town Clerk 4.Electrical Inspector S.plumbing Inspector
Contac Person:
Phone'#
Information an- d Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees.
Pursuant to this statute;an employee is defined as"...every person in the service of another under any contract of hire,
express or implied,oral or written."
An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more
of the foregoing engaged in a joint enterprise,and including t7ne legal representatives of a deceased employer, or the
receiver or tnistee of an individual,partnership,association o$-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 mainte;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 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 coarnpliance 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 contact for the performance of public work um-til acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the work=' 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'comp a nsation 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 siure to sign and date the affidavit. The affidavit should
be returned to the city or town that the auulicS' for the^e cen-se: being requested,not epE.*t.:a It OI
n it or fi s the
Industrial Accidents. Should you have any questions regardin LZ the law, or if you ar e rC;4-'red to obtain a workers'
compensation policy,please call the Department at the numberr 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/liceme 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 citi7-n 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 L1ce 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,fagnumber...
Tle Commonwealth of Massachusetts.
DePar M=t of Industrial Accidents
Office of Inresf gatfons
600 Washm n Street
Boston,MA 0.2111.
Tel. -tut 617-72.7-4900 ext 406 or 1-877-M.ASSAFE
Revised J-26-05
Fax#617-72.7-7 749
vrvrv7.mass.-aov/dia.
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REMODELING CONTRACT
CLS52201 HIC112850
I. Parties
This contract is made and entered into of Sept 23,2010 and specifies the terms of the agreement between
Mark Skorupka homeowner,and Chris Lane,general contractor,whose address is 152 Fenno Dr,Rowley,
MA,to replace front door and replace siding on front and right side on the property located at 71 Liberty St.,
North Andover, MA
II. The Scope of the Work
The general contractor will furnish all the labor, materials, and equipment necessary to complete the
alterations and improvements described below:
Replace front door(supplied by owner)
Replace window above (supplied by owner)
Replace front and right side of house with Hardie Board siding (supplied by owner)
All demo to be removed by owner. All related supplies furnished by owner.
III. Allowances
The following monetary allowances are included in the estimate. Cost of materials and labor above
these allowances will be paid for by the homeowner and will be handled as change orders. Cost of
materials below the allowances will be reimbursed to the homeowner by the contractor.
NONE.
IV. Change Orders
All change orders must be in writing and signed by all the parties.The owners agree that changes resulting in
the furnishing of additional labor or materials will have 50%paid for prior to the commencement of the
extra work. The owners agree to pay the remaining 50% immediately upon completion of the work. The
owners agree that either of them may sign a change order, and that signature will be binding on both.
V. Permits,Licenses,and Approvals
The homeowner will pay for local building and construction permits, and will pay the fees for the
governmental inspections that are necessary for the construction and occupancy of the finished structure,
except as otherwise provided in this contract.The owners will secure and pay for any easements,variances,
zoning changes,necessary modifications of restrictive covenants,or other actions.The owners will indicate
the property lines to the general contractor and will provide boundary stakes by a licensed land surveyor if
the owners are in doubt about the property boundaries.
VI.Insurance and Risk of Loss
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The owners agree to maintain insurance covering the replacement cost of the improvement under contract in
the event of loss through fire, casualty, storm or other disasters, and theft of materials from the site. The
general contractor agrees to maintain liability insurance to protect the owners from liability claims for
damages because of bodily injury, including death, and from liability for damages to property. Before
beginning the work,the general contractor will furnish a certificate of that insurance to the property owner.
VII. Access
The property owner will allow free access to work areas for workers and vehicles and will allow areas for the
storage of materials and debris. The driveway will be kept clear for the movement of vehicles during work
hours. The general contractor will make reasonable efforts to protect driveways, lawns, shrubs, and other
vegetation. The homeowners realize that remodeling is an inherently loud,dirty and disruptive undertaking.
The contractor will make efforts to minimize the disruptions,but will in no way be held responsible for any
problems which may arise or losses which may occur due to the remodeling effort. The hours of
construction are estimated to be 9am to 5pm Monday through Friday, but may at times deviate from this
schedule.
VIII. Site Conditions
The property owners acknowledge that this contract is based upon the general contractor's observation of
conditions. Conditions which could not be known by a reasonable inspection, such as termite damage,
hidden water damage, hidden code violations, or other concealed conditions, may require extra labor or
materials,which are not part of this contract.If such hidden conditions are discovered,the general contractor
will notify the property owner and will attempt to reach an agreement for a change order to this contract that
addresses those problems.
IX. Payment
The owner will pay the cost of all materials used in construction plus delivery and handling costs,the wages
of all workers for the actual time spent on the job, and the cost of all subcontractors. The contractor
estimates that the total cost of labor for the work will not exceed the amount of 4800.00 for the siding and
1440.00 for the door and window installation,with any incidental materials to be paid by owner.No demo
disposal is allowed in this price. This amount excludes the cost of any change orders. Should the cost of
materials or subcontractors rise significantly,the contractor reserves the right to pass those costs along to the
homeowner. Payment for these cost overrides will be handled in the same manner as change orders. Design
and construction consultation fees may be charged by the contractor to the homeowner. If so,the charges
will be handled in the same manner as change orders. Hidden conditions, which could not have been
ascertained in advance and which are in keeping with what would have reasonably been expected will be an
additional charge to the extent that those hidden conditions cause extra expense.
X. Payment Schedule
Payments for the work are due as follows:
A deposit in the amount of$500.00 is due upon contract signing.
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Additional payments will be due as work progresses.
When each payment is due, the general contractor will prepare a statement of money due in writing and
submit it to the owners.All payments are due from the property owner no later than three business days after
receipt of the statement.
Upon completion of punch list items the contractor will obtain all final signoffs on any outstanding permits.
Final payment is due within three business days of obtaining these signoffs.
If payments due to the general contractor are not paid within three business days of the written demand,the
general contractor may suspend work until payment is made.
XI.Warranties
The general contractor guarantees the work will meet trade standards of good workmanship. The general
contractor will make every effort to blend existing textures,colors,and planes,but exact duplication is not
guaranteed.The general contractor warrants that materials of good quality will be selected.The customer is
limited to the manufacturers' warranties for defects in the manufacture of materials.
XII.Signatures
We, the undersigned, have read and understood this entire contract, including documents attached by
reference. We acknowledge that this document constitutes the entire agreement between the parties. This
contract is not binding upon the general contractor th property wners until it is signed by all parties.
Dated: Y/40 Signed:
Contractor
Dated: � � ��gned:
Owner
/ L/
Dated: Signed:
Owner
You may inquire about a contractor registration by writing to the director at One Ashburton Place, room
1301 ,Boston Ma 02108 or call 617 727 3200
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