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HomeMy WebLinkAboutBuilding Permit #328 - 89 MARIAN DRIVE 10/23/2009 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION iarla:rs Print PROPERTY OWNER s, ►int MAP NO: ,PARCEL: .4-t-1- ZONING DISTRICT: Historic District yes no _ E Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residen ' Non- Residential New Buildingne family Addition Two or more family Industrial 6ile,ration No. of units: Commercial Repair replacement Assessory Bldg Others: DUMolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) OWNER: Name: 7 i Phone: �70. -__7� Address:_ Mat to, CONTRACTOR Name: � �t � G�7� Phone: �� _� -��7� � Address::_� Cary VPC Sr y�oJ y M4 o t Tl( Supervisor's Construction License: Exp. Date:_ t /ZO,12 _ Horne Improvement,'License: a ' �` Exp.. Date: � 7'�/t� 3 I 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: $ `J��O Do FEE: $ z/1� Check No.: '19 1>C' C� Receipt No.: 22 5-( 0 NOTE: Persons contracting with unregistered contractors do not have access to t e guar fund ignature of Agent/Owner Signature of contractor 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: Doc.Building Permit Revised 2008 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 CONSERVATION Reviewed on Signature COMMENTS . HEALTH Reviewed onSic inature 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 Drivewav Permit DPW Town Engineer: Signature: Located 384 Osgood Street EIRE DEPARTMENT -Temp'Dumpster on site yes no Located at 124,Main Street Fire Departmeht.signature/date COMMENTS I Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: i 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 r Location No. Date N011T1r TOWN OF NORTH ANDOVER 3?0�,•`•o I•,hO O D Certificate of Occupancy $ J�c►aSEtBuilding/Frame Permit Fee $ y� Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 22560 Building Inspector NORTH Tol"M of R over No. ,3,m2$ T A K E dover, Mass., 3 CoC MIC MEWICK AORATED PPP ` �C `s BOARD OF HEALTH PERMIT T Food/Kitchen Septic system f BUILDING INSPECTOR f THIS CERTIFIES THAT ` �/ ..............................!�� Foundation y has permission to erect........................................ buildings on � /��7 , ��' r Rough .................. ................. .................................. . C of s ! �/ G O el"X4' FS' Chimney to be occupied as......................1� .:,' ...............�L ...... ....... "..... t`..:.T..l............... ............................. ...I... .... provided that the person accepting t ih s permit shall in every repect conform to the ter sof the application on fl a 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 CONSTRUCTION STARTS Rough ............................ ............................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Om cpy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To BeDone FIRE DEPARTMENT' Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. i 4 s I X I Board ofludding Regulations and Standards f HOME IMPROVEMENT CONTRACTOR �. Registtatlon, 160893 Ex lia- 9110/2010 TO .2745.4 CYPRESS CONSTRUCfiION RUSSELL PASCpE �. { 28 CENTER ST ANDOVER,MA 01$10 Administrator 1as%'chusetts- Dela:it��t,�4tt rt# t'itlilic �at'ci� Bn,}tct.til'Buiitlirz Rc-;iolxticstt4.tcitantiartls Construction Supervisor License License: CS 99275 Restricted to. 00 RUSSELL PASCOE 28 CENTER STREET r ANDOVER, MA 01810 —•�--�' ��y�` EXpiration 411/2012 C'{r�t�ac3s�iniirr ;fir`. 99275 „ r v a � r ^ t , r Cypress Construction Your Green Remodeler October 19,2009 Estimate Cypress Construction Estimate for: Nathan Kennedy c/o Russell Pascoe,President 89 Marian Dr Ma License: 99275 Hic 274544 N Andover,MA 28 Center St Andover,MA 01810 Site address: 89 Marian Dr 978-886-9746 N Andover,MA I. Proposed Work: Replace rotten deck substructure and support roof. BasicRepair.......................................................... $ 1,800 Includes labor and limited materials.See stock list for items that you need to purchase. Options: options are in addition to the basic repair. The prices include labor and material. Option 1 (basic railing between posts) ........................ $1,400 0-1 Option 2 (investigate and repour concrete) .................. $ 1,400 Option 3 (frame out for future) ................................. $ 2,500 SPECIAL CONDITIONS General:This bid expires 6 months from date above. Billing.Upon acceptance(contract sign date),a deposit of 25%will be required and a start date will be chosen.Another 25%will be due on the start date.The balance is to be paid upon completion. Changes:Any changes to the above outline will result in a change order.A change order will be priced and approved before the change can be enacted.This amount will amend the billing amount and schedule. Stock.This bid is for labor unless otherwise noted.Material will be subject to a handling fee of 30%above cost and added to the total amount due. Allowances:This amount is for the purchase of the doors.If the doors cost more,the additional amount will be added to the contract price.If the doors cost less,the difference will be credited. Special Order Items:Any item ordered including special order items(ie doors)ordered before the start date will require full payment before the order is placed.This will assure the project will proceed on schedule. Schedule: A schedule will be drafted and amended as the situation requires. Permit:I will be responsible for the permit.The cost of the permit is not included. LEGAL NOTICE: 1.- Notice: a.That all home improvement contractors and subcontractors shall be registered and that any inquiries abouta:contractor or subcontractourelat ng to a registration should be-directed to: Registration Division,Program Coordinator One-Ashburton Place Room 1301 Boston,MA 02108 Tel:-(617)727-3200-ext 25239 b.The contractor's registration number must be on the first page of the contract c.the homeowners three day cancellation rights under MGI,c"93 s 48;-MGL c 140D s 10 or MGL c 255D s 14 as may be applicable. d.All warranties on the owners rights under the provisions of 780 CMR R6 and-MGL c 142A e.Whether any lien or security interest is on the residence as a consequence of the contract. N A 2. An enumeration of such other matters upon which the owner and contractor may lawfully agree. -N A 1 Any other provisions otherwise required'by the applicable laws of the Commonwealth.NIA 4.Permit Notice:Every contract shall contain a clause informing the owner of the following: a.any and all necessary, construction-related-permits b.that it shall be the obligation of the contractor to obtain such permits as the owner's agent c.that owners who secure their own construction-related permits or deal with unregistered-contractors shall be excluded.from:access-to-the Guarantee Fund. 5.Acceleration of payment:No contract shall contain an acceleration clause under which any part or all of the balance not yet due may be declared due and-payable because the holder deems himself to be insecure.However,where the contractor deems himself to be insecure he may require as a prerequisite to continuing said work that the balance of the funds due under the contract,which are in the possession of the owner,shall be placed in a joint escrow account requiring the signatures of the home improvement contractor and--the--owner for withdrawl. 6.No work shall begin prior to the signing of the contract and transmittal to the owner of a copy of such contract.By signing,you agree to the terms of the contract. 7.Arbitration: "The contractor and the homeowner hereby mutually agree in advance that in the event that the contractor has a dispute concerning this contract,the contractor may submit such dispute to a private arbitration service which has been approved by the Office of Consumer Affairs and Business Regulation and the consumer shall be required to submit to such arbitration as provided in MGL c 142A." DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. er C- t Je !LoDate '� Q�f / %L, Date l �� NOTICE:The signatures of the parties above apply only to the agreement of the parties to alternate dispute resolution initiated by the contractor.The owner may initiate alternative dispute resolution even where this section is not signed separately by the parties. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, M4-02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): /C c�� � 6_scn-e -0ZA C4p(eS& C Ing Address: Zq \2n +R City/State/Zip: ,4 �r W4 ©(5 to Phone#: �' ^ moo'Com-- 97q 6 Are you an employer? Check the appropriate bog: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. New construction employees(full and/or part-time).* have hired the sub-contractors 2. 1 am a sole proprietor or partner- listed on the attached sheet.t 7• ❑ Remodelin l gg ship and have no employees These sub-contractors have 8. ❑ Demolition working for me 'many capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5• ❑ We are a corporation and its required.] officers have exercised their 10.El Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.[] Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.] t employees. No workers' 13.� Other Qp�a, comp. insurance required.] .iIiy applicant,that checks box 1-3-=als:.Pill out the section below showing their workers'cmnrnc.a_tio Policy.n.fQr1o..in n. 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. 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 $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under and penalties of perjury that the information provided above is true and correct Signafore: / Q Date: ZZ Phone#: T' g r$��_ ! //6 Official use only. Do not write in this area,to becompleted 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 apartrnents 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 Iicensing 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-contractors)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 cant'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 permittlicense 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 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 fnvestlgations. 600 Washington Street Boston,MA 021.11. Tel # 617-7274,900 ext 406 or 1,877-MASSAFE Revised 5-26-05 Fax 4 617-72.7-7749 vvw-w.mas.s.govfdia