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HomeMy WebLinkAboutBuilding Permit #522 - 74 BLUEBERRY HILL LANE 3/13/2008Permit NO: 5'22, BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received �, (tLlG �6*ANO °; Residential Non- Residential New Building 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 i mM �y. t`�'GyZ OWNER: Name DESCRIPTION OF WORK TO BE PREF RMED: © 2 C-\ 0 at- Q rc: "i )r C�1 Anre es Please Type or Print Clearly) ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE. BULDING PERMIT. $12.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $� al FEE: $ Check No.: 3 � Receipt No.: 2 Oma! F1 NOTE: Persons contracting with unregistered contractors do not have access to t^ guaranty fund Location No. S �-`- / Date �Z TOWN OF NORTH ANDOVEk Certificate of Occupancy $ ' Building/Frame Permit Fee $ 35 6 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 20991 Building Inspector Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL ublic 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 r `K DATE REJECTED DATE APPROVED HEALTH COMMENTS 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 Located at 384 Osgood Street Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: r 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.s100-$1000 fine 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 w w a CG o w a cn O U z z G� •� / - U a GOGO O w Cl) W to r", o��Q. a con w A w cin Q cn D J Co R � E " Amo N m CD s cm - v H Q L C cc o� C3 o CDa m y C H Vi~ CA_ yO" m w!�: W c s •L a� O C • LU E60i O f � O) 0 y a m-5 0:6 x v .0 C2 M S awm A r^ � z O Z E � a CA r ' zCO O cc o w U cm CD v ) ac C/� os w C CID •� 0 cm c •C N m 0 Z O s 0 LU 0 U) LLI U) W W W N G� •� / - W Q �l�.l Qu W u p o��Q. O.L C y v s O Co R � E " Amo N m CD s cm - v H Q L C cc o� C3 o CDa m y C H Vi~ CA_ yO" m w!�: W c s •L a� O C • LU E60i O f � O) 0 y a m-5 0:6 x v .0 C2 M S awm A r^ � z O Z E � a CA r ' zCO O cc o w U cm CD v ) ac C/� os w C CID •� 0 cm c •C N m 0 Z O s 0 LU 0 U) LLI U) W W W N G� Oc � m � C y v s i�; ca C.3 a� ac R cv .r o •m. c W.O kl CD om m c y Co R � E " Amo N m CD s cm - v H Q L C cc o� C3 o CDa m y C H Vi~ CA_ yO" m w!�: W c s •L a� O C • LU E60i O f � O) 0 y a m-5 0:6 x v .0 C2 M S awm A r^ � z O Z E � a CA r ' zCO O cc o w U cm CD v ) ac C/� os w C CID •� 0 cm c •C N m 0 Z O s 0 LU 0 U) LLI U) W W W N ✓lie Ponina?wie¢1�/ a�✓f/laaoac�uiaelJQ BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: -SCS. 054718 Birthdate 06/08/1965 Expires 06/08/2008 Tr. no: 145.0 JAMES M TESTA 5:APP.LETON ST N ANDOVER, MA 01845 '" Commissioner p� ✓tte iJo�remamrue¢i e�✓[Ccaaoa�itc6el�6 Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration:, 120296 Expiration: -..11/19/2009 Tr# 261225 Type: DBA. TESTA BUILDING &#2EMODELING r» JAMES TESTA 5 APPLETON STREET N.ANDOVER, MA 01845`_ Administrator 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 Applicant Information Please Print Legibly Name (Business/Organization/Individual):-Te-5 Su A 1 A .3.. [Z A i Address: T City/State/Zip:_ No jq rjjo, tri4 Phone.#: Are ayou an employer? Check the apps 1. ❑ I am a employer with employees (full and/or part-time).* 2. I am a' sole proprietor or partner- ship and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3.0 I am a homeowner doing all work myself. [No workers' comp. insurance required.] t riate box: 4. 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 reguired.l Type of project (required):., 6. 0 New construction 7. (Remodeling 8. 0 Demolition 9. [] Building. addition 10.0 Electrical repairs or additions 11.0 Plumbing repairs or additions 12.0 Roof repairs 13.0 Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. +Contractor 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-contractorshave 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 Investisations of the DIA for insurance coverase verification I do hereby certnder the pains and penalties of perjury that the information provided above is true and correct. Sienatur`e: Date: J1 Phone'#: 0'i 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." r 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 Iicense 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, §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 -contractors) name(s), address(es) and phone number(g) 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 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/hcense 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 D, -Part Hent 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 11-.22-06 v w.inas&8ov/dia .. Building and Reodein 5 Appleton Street North Andover, Ma, 01845 (978) 682 2023 PHONE I FAX Proposal February 7, 2008 Proposal Submitted To: Paul LeBrun Home Phone: (978) 685-2743 7$1 Blueberry Hill Rd. North Andover, MA 01845 Job: Sun Porch Job Description: Complete removal of all demolition and construction materials CONSTRUCTION: Remove the fir flooring , all the screens and the ceiling . Install a ridge beam and make the ceiling cathedral . Double up the floor joist, plywood the floor with % fir plywood. Frame the walls to receive the windows with the transoms above each window. Trim the windows outside with finger jointed primed pine and under windows re use the siding that A finance charge of V/2% per month (18% per year) will apply to all accounts over 30 days past due. In the event collection activity is required the customer shall be responsible for all costs associated with collection, including reasonable attorney's fees. I propose hereby to furnish material and labor complete in accordance with above specifications, for the sum of: $29,592.00 Twenty Nine Thousand Five Hundred Ninety Two dollars One- half to start, one-half when Authorized signature I reserve the right to cancel this contract if not accepted in_30_ days Signature � Q Jvi . ;.c.,a� Signature a will come off the ceiling and the interior of the porch. Build a new set of stairs with Trex decking and P.V.0 risers. Re use the railings that are existing. Remove the skylight and patch in the shingles as close as possible. Plaster the ceiling , above the windows on the far wall and the wall against the house. Trim out the windows on the inside to look like the picture you showed me. There will be raised panel under the windows. There will be crown molding at the top of the window / wall. The windows will be Terratone on the outside and pre finished white on the inside. There will be wood snap in grills terratone on the outside and white on the inside. Prepare the floor for tile . Tile the floor and grout the floor. ELECTRICAL: Install four recessed lights in the cathedral ceiling . Outlets and switches to code. There will be an electric heater on the wall of the main house. Install a rope light above and behind the crown molding. There is no allowance for the or grout. There is no allowance for painting or staining. 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: 7 Y (Pf ori 6-ee 2 l is that the debris resulting from this work shall be disposed of in a proper y 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 I OA. The debris will be disposed of in: yin -110 `-T P- ---Aj s %erL 5 + K 4--+ o -,_. (Location of Facility) /�1 2 c�; � r -a3 --C -1-0 4-,) --J —z7 -- z ignature of Permit Applicant Date