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Home My WebLink AboutBuilding Permit #Exception - 74 ELMCREST ROAD 11/17/2014 I E I ' NORTF{ FY Qf St,,t° ,6'�4r0 BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATI N Permit NO: Date Received---p Date Issued: 4�S.�{C14US�� IMPORTANT:Applicant must complete all items on this page LOCATION 74 ElmcrestRoad Print PROPERTY OWNER Edward Rayner _ Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no 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 Repairs to existing deck; remove,dog and pour new footings to meet Mass. Code r its, remove and replace areas of rotten decking with PT lumber- remove and g- builri stairs aC needed Identification Please Type or Print Clearly) OWNER: Name: Edward Rayner Phone: 978-09-4773 Address: 74 Elmcrest Rd CONTRACTOR Name: Sha Phone: 978.204.1158 � � Address: 2 Bryant Ave,Hav, Supervisor's Construction Li' f f,, rV 4 515/2016 Home Improvement Licensl ``-L s-zo-ls ARCH ITECT/ENGINEEF Address: -5:s C FEE SCHEDULE.BU! COST BASED ON$12&00 PER S.F. Total Project Cost: $ •0 Check No.: 10•: NOTE: Persons cont racu..b the access to the guaranty fund Signature of Agent/Owner �n#ractor Y 7 . of Noa or BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATI N Z } H C O Permit NO: Date Received ��SACHUS 4 Date Issued: �— IMPORTANT:Applicant must complete all items on this page LOCATION 74 Eimcrest Road Print PROPERTY OWNER Edward Rayner Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes SnoMachine Shop Village yes 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 Repairs to exesting deck, remove, dig and pour new footings to meet Mass. Code [ uireme its, remove and replace areas of rotted decking with PT lumber, removs and rebuiId-stair�asneeded Identification Please Type or Print Clearly) OWNER: Name: Edward Rayner Phone: 978.6894773 Address: 74 Elmcrest Rd it CONTRACTOR Name: Phone: 978.204.1158 Shawn Woodburn Address: 2 Bryant Ave,Haverhill NIA 01835 Supervisor's Construction License: Exp. Date: 093966 5/5/2016 Home Improvement License: Exp. Date: 156311 6-20-15 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: $ 10,000 FEE: $ 120 Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agentl0w6er C� � Signature of contractor -. � � a� BUILDING PERMIT o`No oT 6 �a TOWN OF NORTH ANDOVER 32 yam,, •6 oL APPLICATION FOR PLAN EXAMINATION H T Permit No#: Date Received 79ADAAre �SSACHIIS�� Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION' - Print PROPERTY OWNER ---- ------- -- Print _ too Year structure yes no MAP PARCEL: _.... ZONING DISTRICT: Historic District yes, il :no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family L1 Addition El Two or more family [I Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well 0 Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly Y OWNER: Name: Phone: Address: Contractor Name: ..Phone: Address: Supervisor's Construction`License _ _ ,Exp. Date: Home Improvement License: �. .� Exp. Date:- -_ -_ 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: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund 5i nature of Agent/Owner _ Signa_ture of contractor ., ..g_ O . r... / 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 Reviewed On Signature_ COMMENTS 0 v� CONSERVATION Reviewed on Signature COMMENTS 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 _ Located-at 124 Main Street -Fire Department signature/date 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 No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use) N'j 1-7 - ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 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/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering ineerin g g Affldavlts 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:Building Permit Revised 2014 North Andover MIMAP November 17, 2014 { f s � r - M t 4 t r a v g,iq a .•- n j 1 �A ,�4e Interstates I —SR Horizontal Datum:MA Slaleplane Coordinate System,Datum NAD83, Roads Meters Data Sources:The data for this map was produced by Merrimack yORTM Valley Planning Commission(MVPC)using data provided by the Town of [r EasementsOf ao '4� North Andover.Additional data provided by the Executive Office of e�« r�++O Environmental AffairslMassGIS.The information depicted on this map is C3 MVPC Boundary F 3'?� �L for planning purposes only.It may not be adequate for legal boundary El Parcels ..--- tp definition or regulatory interpretation.THE TOWN OF NORTH ANDOVER MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING ♦ THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT tF moo, �r♦ ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF THIS INFORMATION SSACNUS� 1"=60ft rv ° INTEGRITY 15Uildirr��emodeling Contract Coversheet November 7, In the Year of 2014 Contractor: Integrity Building & Remodeling C.S.# 093933 6 Bryant Ave Haverhill, Ma 01835 978-2041158 For Client: Edward Rayner 74 Elmcrest Rd North Andover,Ma 01845 978-689-4773 For the Project: Rayner Residence Deck Repairs ARTICLE 1. SCOPE OF WORK 1.1 Contractor agrees to furnish all labor; materials and equipment to perform all work described below on above stated project.Allotments where applicable Owner/Contractor Agreement .................................................................................................................................................................................................................. THIS AGREEMENT, made this_7h Day of Nov. in the year 2014. By and between Edward Rayner hereinafter called the Owner, and Shawn Woodburn hereinafter called the Contractor. For the consideration hereinafter named, the said Owner covenants and agrees with said Contractor, as follows: FIRST: The Contractor agrees to furnish all material and perform all work necessary to complete the project ' Deck Repairs' at the Owner's residence on 74 Elmcrest Rd,North Andover, Massachusetts, 01845, SECOND The Contractor agrees to promptly begin said work as soon as notified by said Owner, and to complete the work as follows: Remove existing footings, dig and pour new ones to comply with MA building code. Troubleshoot existing deck for rot and/or damage and replace components/rebuild stairs as necessary to code. THIRD All work will be done at a rate of job direct costs plus 15% of all labor, material, and equipment, etc. All labor will be billed at at rate of$40 per man hour, per man.Any unforeseen issues will be brought to Owners attention immediately. FOURTH. This contract shall not be assigned by the Contractor without first obtaining permission in writing from Owner. 1N CONSIDERATION WHEREOF,the said Owner agrees that he will pay to the said Contractor, a deposit of$1000.00 for said materials and permits. Total estimated job costs are$10,000.00 Billing to be done weekly/biweekly going forward as deemed appropriate to Owner/Contractor. All direct job cost reports will be provided to said Owner upon request. The contractor and Owner for themselves,their successors, executors, administrators and assigns, hereby agree to the full performance of the covenants of this agreement. 6 / I- -�z - � Owner Date Contractor Date Integrity BWlding&Remodeling Page 2 of 2 2014 The Commonwealth of Massachusetts Department of industrial Accidews Office of Investigations ky- 600 Washington Street Boston, MA 02111 www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(BusinessDrganization/Individual): Integrity Building&Remodeling Address: 6 Bryant Avenue City/Stage/Zip: Haverhill,MA 01835 Phone#: 978-204-1158 Are you an employer?Check the appropriate box: Type of project(required): 1.0' 1 am a employer with 4. ❑ I am a general contractor and I 6. New constructio employees(full and/or part-time). have hired the sub-contractors n 2.®' 1 am a sole proprietor orP artner- listed on the attached sheet. 7. 0 Remodeling These sub-contractors have ship and have no employees 8. ®Demolition working for me in any capacity. employees and have workers' 9. [] Building addition [N o workers comp.insurance comp.insurance. required.] 5. 0 We are a co its L6 ration and 10T1 Electrical repairs or additions 3, officers have exercised their i l. Plumbing Q I am a homeowner doing all work ® ng repairs or additions myself.[No workers'comp. right of exemption per MGL 12.0 Roof repairs insurance required.]I c. 152,§1(4),and we have no IN employees. o workers' 13.K1 Other Deck Repair comp. 'insurance required.] *Any applicant that checks box#I 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 state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Liberty Mutual Policy#or Self-ins.Lic.#: WC5-31S-313484-113 Expiration Date: 11/30114 Job Site Address: 74 Elmcrest Road City/State/Zig: North Andover, MA 01845 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 ander die pains andpenaltres QfperjFcy that the information provided above is true and correct. j, Signature: „'i't" �J Date: 11/10114 Phone#: 978-204-1158 dl,foal 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#: 11�s4 :_�� •C2pc:tment of public Snfctf SC } ; '.:.:Ing Regulations and Sftndards �.rtsjvl Super wir Uzonsc:CS-093886 S RA'WN P woo4 •BURN ` 6 BRYANT AVE ` ' Haverhill MA 01$35 r '+ 0 f r.•i .6f�c. ► Expiration Commissioner 05105/2016 ttsf�6A crr Affairs ABirr0- 1 ams>f ENT —town: C"T"'[315 DB.A WOODBL,'RN MA 01$ tT��ler�ccrtrac ''