The URL can be used to link to this page

Home My WebLink AboutBuilding Permit #772 - 72 PADDOCK LANE 6/24/2008BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Z Date Issued: IM�PO�RTANT: Applicant must LOCATION �) ` \\ 1 j ns Date Received all items on this ` \ Print PROPERTY OWNER Lcw c o` Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes Machine Shop Villaqe ves TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One-fam4 �• n � or more family en TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One-fam4 Addi' nwo or more family Industrial Alter No. of units: c Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: ry oo u 5 a o `Cz ► N I VJ t. ,,,,-c—+—YU a p'R-`Z w �.- T, Le: 3 `�- i GgLt6-Cs Identification Please Type or Print Clearly) OWNER: Name: La Zz <z- o,\ Phone: Address: 4J '�: V_ CONTRACTOR Name: i� e�� ro x.2_ Phone: Address:____ Supervisor's Construction License: 7 y Exp. Date: Home Improvement License: I S �7 S-4 Date: \ J 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: $ /_T�"0 FEE: $ a0 Check No.: I )-� -t— Receipt No.: 02. 1 NOTE: Persons contracting ith unregistered contractors do not have access to the guaranty fund signature of Agent/Owri Signature of contract 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 PLANNING & DEVELOPMENT COMMENTS CONSERVATION COMMENTS HEALTH c._ -COMMENTS DATE REJECTED DATE APPROVED Reviewed on Signature Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: Comments Comments 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 Located 384 Usgood Street yes no 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 no ❑ Notified for pickup - Date Doc.Building Permit Revised 2008 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 ❑ 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 2.2008 Location 7� 2 C r No. Date MORTN TOWN OF NORTH ANDOVER f �,y s Certificate of Occupancy $ '�S'•^° • Eta' Building/Frame Permit Fee $ �ACNUS fop Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 2, 27Y Building Inspector CO) m m ITIm CO) CA F) 0 v, C � CO) Cl) 10 0 CD n Z y CD O 'O CL r c) O C; O CL = CO) aCc -0 O C2 CD C� O .�. Q "G d CD CCD O CSD co ao O CDCD y CZ O y Cc CD I F z0 C/)z CD 9 _r�� w y � z dy O m y 0 MO A r.,PaC 3 n M. tz w ' ?� V! -4�a_o.T cn O �. Ca=r 7d rn Co -i O O CO) = O m CO) O m = CI ago m C , 0 O o O ZC - A JF CL ... o a?; � m y ' nI a9CD CA d y = Q ad IE �..CD � cc C=C - CD: y y ; .Ort H = CO CO w . .0 moi � CD CD I O i CO ate: y O H 0 9 cn El - oa � o oCc O ?� °= 70 til z w 7o a tz w n G �. G cn O �. O a 7d yd O , 0 O o C M M O C i? Board of Bu Ids ivy a��/�iaaoac�iuee Construction Supervisor dLicense tandards Lioense: CS 87646 Eit10 KIZ.7n F- 12/19/2009 Tr# 12941 / `1Restrictron 00'`- RYANQ. _. r R- w= ' •, GUTHRiE 234 RUSSELL ST' WOBURN,MA 01801 i Commissioner ✓!ae-�o7.vazonu.P.a� o�✓�aaaac�uaelta U9Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 157543 Expiration: 10/11/2009 Tr# 259976 rrv3 Type: Ltd1iability Corporation NEWMARKET MASSACHUSETTS'PROPERTIES RYAN GUTHRIE 234 RUSSELL ST WOBURN, MA 01801 ~ Administrator ,�: ovr\�k �.\j fF�T f -L -E -Qt q 3 VVI, % l\ -\es C7- 0 E-- SIK s .DEQ NEWMARKET PROPERYIIES ESTIMATE 5/19/08 Laura noweu 43 Phillips Court North Andover MA 01845 Job Description: Enclosed Rear Porch -xemove existing nrst poor porch structure -Frame new porch floor with 2 x 8 pressure treated floor joists -r rame new exterior z x o watts ana sneam. with -r2 mcn prywooa -Insulate walls and finish with drywall and joint compound -Trim all interior window and door casings -Paint all interior walls and trim -auppiy ana mstaii (3) energy star ratea winaows suniiar is style ana size to the winaows on the second floor porch -Install ceramic tile flooring on porch floor over 1/4 inch durock -Install pressure treated lattice underneath deck -Supply and install exterior grade door and door hardware ($300 allowance) -mstan etectricai ouuets per tmiamg code ana aaa exterior porcn iignt (nxture suppiiea Dy nomeowner) -Remove and replace existing siding with new white vinyl siding for first and second floor porches -trip existing sningies ana mstaii new su-year aspnait sningies on roof netween porcnes -Pull building permit and ensure job complies with state building code -Remove swing set -6uppiy an materiais -Clean and remove debris at end of each day Cost ............ 10,750 65 Park St Arlington Ma 02474 Office 888-851-9995 Fax 888-494-4325 - w orxmansmp guaranteea ror one year. tvianutacturer warranty on matenais. -50% deposit upon signature of contract. 50% balance due upon completion of job. l—� Homeowner Scott Zi c - 65 Park St Arlington Ma 02474 Office 888-851-9995 Fax 888-494-4325 441\ The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations .. ; . 600 Washington Street Boston MA 02111 www.mass.g ov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: �,57 fork S� City/State/Zip: A-7 /N% l+ Phone #: Sl) 8 ' cZ / L� -- V Y 3 6 Are you an employer? Check the appropriate box: 1. E�Ll am a employer with 4. ❑ 1 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. I 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 corporation and its required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. IK Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 1 I .❑ Plumbing repairs or additions 12.❑ Roof repairs 13.❑ 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. �M Insurance Company Name: L � \O L( - Policy # or Self -ins. Lic. #: U C- � 3 N S — 3 C( -'2,K5-0 k '& Expiration Date: `f / / o / a f Job Site Address: It,PS Auk 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 ceigfy under the Phone #: v ('f,� O— Z L U VY 3 0 that the information provided above is true and correct. Date• l9 l ?— � I a rd 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 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 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 permit 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 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 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 Revised 5-26-05 Fax # 617-727-7749 www.mass.gov/dia