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Home My WebLink AboutBuilding Permit #584 - 74 BLUEBERRY HILL LANE 4/9/2008 BUILDING PERMITo� "°oTH qti TOWN OF NORTH ANDOVER o? 6 o 0 C' APPLICATION FOR PLAN EXAMINATION b Permit NO: Date Received Ar �SSACHUs��y Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION 'Z4 rJe P'nt PROPERTY OWNERg L e {L,1 J Print MAP NO: 9S PARCEL;C q 0 ZONING DISTRICT: J- Historic District yes Re-t Machine Shop Village yes rae- 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 Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: A00 Nem I `t X q Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: CONTRACTOR Name: f� ,es -7e-S4 AA Phone: Address: �+ Supervisor's Construction License: b S y-1 I % Exp. Date: ' 1% ' a oo 8 Home Improvement'License: "'e` t ba.°t Exp. Date: A A 1°t 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: $ �,��0 , FEE: $ -7� Check No.: e3 2-(e Receipt No.: O� U 6 NOTE: Persons contrac ing with unregistered contractors do not have access to th guaranty fund Signature of Agent/Own - _$ g Signature of contractor Location -77 9/c,(kt4, M;1 n r No. Jr�" Date „pRTly TOWN OF NORTH ANDOVER � R 9 ' Certificate of Occupancy $ ;,ssACNUS Building/Frame Permit Fee $ Foundation Permit Fee $ " Other Permit Fee $ TOTAL $ Check # 2 1 064 Building Inspector a 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 CONSERVAT Reviewed on `1 ! �� Signature COMMENTS C) HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature&Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no No >,j=a Located at 124 Main Street Fire Department signature/date COMMENTS L , 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 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 ❑ 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 a Building Permit Application Li Certified Surveyed Plot Plan L3 Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses Li Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (if Applicable) Li 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) o Building Permit Application ❑ Certified Proposed Plot Plan Li Photo of H.I.C. And C.S.L. Licenses Li Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract ❑ Mass check Energy Compliance Report Li 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 i Revised 2.2008 V4 TH 01" Of No. OOOW LA ;= o dover, Mass., • COCMICKEWICK I 7,9 A00;?ATED PPa��(C.1 `s BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT......... s. L................. .,0..Lr.ft.................. .................................. . . � Foundation has permission to erect.............................. buildings on ........ � ....... . ...�..`. Rough to be occupied as.......�1 ...X..�.. .......... irl ........................................ .. Chimney .............................................................. provided that the person acceptin 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 CONSTRUC ST TS _ Rough Service BUILDING OR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal 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. TESTA Building and Remodeling 5 Appleton Street North Andover, Ma. 01845 (978) 682 2023 PHONE / FAX Proposal April 2, 2008 Proposal Submitted To: Paul LeBrun Home Phone: (978) 685-2743 73 Blueberry Hill Rd. North Andover, MA 01845 Job: New Deck Job Description: Obtain permit Complete removal of all demolition and construction materials CONSTRUCTION: Build a new deck of the existing sun room. Deck to be 14 x 10 . Frame deck with pressure treaded lumber and timber tech decking. The railing system will be made out of cedar 2x4 and 2x2 balusters to match the railings from the stairs to the sun room. Dig and pour sauna tubes four feet deep. A finance charge of 1!/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. /Or as�hel�eta to furnish material and labor complete in accordance with above /s ecifications, or the sum of: $6,100.00 Six Thousand one Hundred dollars } qne I to start, one-half when completed. Authorized signature ,- { I reserve the right to cancel this contract if not accepted in_30_days Signaturc cc , Signature ✓lee {,o�rinto?uvea`Cl j BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR 1 Number: CS 054718 Birthdate 06/081.1965 Expires 06/08/2008 Tr.no: 145.0 RestrI84— 00' JAMES M TESTA' 5 APPLETON ST G� N ANDOVER, MA 01845 '"� Commissioner ✓fes B° and °rBui r HOA JZ g Regut E tMP agOns ROVE a°d Sta Reg/str MENT C ndards ation. ONT 120286 RACTOR TTSTAgill TYpe B-9/2006 Jq LD/N A Tiye 261225 SAP LETESrA G&REIyODFL/NG . O N•ANDOVER�7 o f f"� A idminls trator The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 r www.mass.gov/dia ' Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricans/P lumbers Anmicant Information Please Print Legibly Name(Business/Organizationadividual): ) +,,q Address: • City/State/Zip: /V, A Phone A °1 Z 8 ab a 3 Are you an employer? Clieck the appropriate box: 1.❑ I am a employer with ' 4. 0 I am a general contractor, and I [7. Type of project(required):� employees (frill and/or partpart-time).* have hired the sub-contractors 6. ❑New construction 2.® I am a sole proprietor or partner- listed on the attached sheet.' �RemodeIing ship and have no employees These sub-contractors have working for me in any capacity. employees and have workers' 8. 0 Demolition [No workers' comp.insurance comp. insurance.# 9. 0 Building-addition required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their ` roself 11.0 Plumbing repairs or additions y [No workers comp. right of exemption per MGL insurance required.]t c. 152, §1(4), and we have no 12.0 Roof repairs employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workem,compensation Policy information. t Homeowners who suburz t this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. +Contra-tors that check this box must attached an additional sheet showing the narne of the sub contactors and staff wheth-T o not those entities have employees. If the sub-contractors.have employees,they must provide their workers•romp 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 declari fion 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 fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in of criminal penalties-of a 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 covera a verification. I do hereby ce under the pains andpenalties of perjury that the information provided above is true and correct Si afore Date: 3 Phone##: [6. 7Person: ly. Do not write in this area, to be completed by city or town officiaL Pern-dt/License# ity(circle one): lth 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector - Phone#: Information arid Instructions Massachusetts General Laws chapter 152 requires aIl employ6rs 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.occupan of the dwelling house of another who employs persons to do mainte=nance,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,bpera^te�a business or to construct buildings in the commonwealth for any', applicant who has not produced acceptable evidence of co mplianee with the insurance coverage required." Additionally,MGL chapter 1,S2, §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-contractors)name(s), address(es) and phone number(s)along with their cerdficate(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 Departrnent 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 Depart lent at the number listed below. Self-insured companies should entor 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 sureto 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 bum leaves etc.) said person is I-TOT 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: T .e Commonwealth of Massachusetts Department Of Industrial Accidents Ogee of Investigations 604 Washington Street Boston,MA 02111 _ Tel.#617-727-4900 ext.406 or 1-877 MASSAFE Revised 11-22-06 Fax# 617-727-7749 www-mass-govfdia 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 2008 J T Building Department } The following is a list of the required forms to be filled out for the appropriate permit to be obtained. I� 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 1 ❑ 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 i Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008