Loading...
HomeMy WebLinkAboutBuilding Permit #018-2011 - 894 GREAT POND ROAD 7/1/2010 NORr} BUILDING PERMIT F TOWN OF NORTH ANDOVER 02 APPLICATION FOR PLAN EXAMINATION Permit NO: r� Date Received e'0 * `' °tep�R^7D r ,l � E Date Issued: 7/ 1V 9SS'9CHt1`- IMPORTANT:Applicant must complete all items on this page �. {4 >° 1 - t s $.ri�c, -+.`q•c$ +; », �j a,�� ; fa1 a fi _�.. �. e # <> S _ t - �_ � t.:,-c1� '`,y ,� a ,r� �ye'. §�Msr If ON '+ E r �"� m 4 c�'"M .r c ,a, � 6 s �e��u �"+ �� s•t`a"4a �. �•�C`'`ram z � '�^ 'fit 7 � y 1� - PRORER�TI(OWR� P NEr a ::-� �� ,t '�_s+•. t+. `�� .Y rs r J�k kj f v ., `--;1�3�h"f'���`° •#•.�K• 4� .$.f �`+'�'rkh-� r P"" 4 �*'�aa ��n:�,��A�`.Pnnt� s`5i ,/� �. '�� "�'7*'air"' ..�„;r`rt'�'t �+1� `[" tyy' �`za.t r "�:Y "'tom+ "'��r '' �,:� 210 �i n tPARCEL.4 fi ZONING DISTRICT. Fiistonc Distract es `ono ��..yks"�. �..,�-na. Macn ne Shop Village ._., 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 � SepticxWell �" r Y `` Vlletl77 ds Floodplain F i r{ Wate�rgs ed D aras"tract y x y Water-/Sewers nom,. j t .f�� � .s..�•. .... _�.-�.. ��,: �.*__:sx,�.. E. � .y,s =s s SCRIPTIOO �WORK TO E PREFORMED, l NF t .S Identi f ati on Pease T ieorP t Clearly) OWNER: Name: Phone �� Address �'".#. } ''�' df*rx♦ } a,r :.a pr.l k ;c i 1 r a� _ 'Y< g'a` - •�p'f `.c ..+_.ter .� U7ii �# t 1r � r� -t £" iT,�{ �yt � -3� t `t r �n SFr�� +-.}v fiLM 1t� #J,s ��'_< #;• ; .. .f. ';-� sy SAri7iTd� � C�ONTRACTORName _h' '' s <� t �r'�a �`1�t# v,Y ?s ' 4 v - `s x j s T sty, t �. ', '_ } r Cr i # :� .,z 1 S ,s t s 2:-y <r., i+' a Lam, �TS�A*+ Ad.tlress= t `' k h.._.PM TIN . +r' i'-s c z. ,a .fix c ss; * az r.- 5 �7 �'k. =7'�' �2 j',r y..•:, ifs ` :. ` - Home,lmprouernent,License ARCHITECT/ENGINEER Phone: Address: Reg. No, s FEE SCHEDULE.BULDING PERMIT.$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ r�©®Or d a FEE: Check No.: t No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund - _.. Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer' r Tanning/MassageBody 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 I CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on ► - Signature COMMENTS No: Zoning Decision/receipt t submitted es Zoning Board of Appeals:Variance, Petition N g p y I Planning Board'Decision: Comments F Conservation Decision: Comments Water & Sewer Connection/Signature&Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT 'Tem` Dum ster on site Located�af 124 MainStreet :t+�� �" "p }4< FireDepartmentfis�gnature/date¢ � S w 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 f : f _ Doc.Building Permit Revised 2010 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) o Copy of Contract ❑ Mass check Energy. Compliance Report ❑ Engineering Affidavits for Engineered products N CTE: 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 l Doc:Building Permit Revised 2008 Location No. d/F - a Date0.1 NORTH TOWN OF NORTH ANDOVER O f S Certificate of Occupancy $ �'�s •t Building/Frame Permit Fee $ � - s�cnus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 230 ,� t Building Inspector NORTI, Town of No. dpC% � IVM D ]� - v dover, ass.17 > " COC MIC ME WICK ��' _ DRATE D 11 BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THISCERTIFIES THAT..........�.. �el` .C..... ................................................../................................................................... Foundation has permission to erect.................:...................... buildings . 4..''��� .. .. ............��............... Rough to be occupied as C'��/ �^�� ���3 Chimney p ..1..... ... .....r�?... ..:u.cy.X.....�f.. ..:........................................................... provided that the person accepting this permit shall in every respet:t 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 CONSTRUCTION STARTS Rough ....................... . ........./ .................................................... Service. BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final No Lathing or Dry Wall To Be Done Until -inspected and Approved by the Building Inspector. FIRE DEPARTMENT Burner. Street No. SEE REVERSE SIDE Smoke Det. 7. Office of'Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registrations �•�58243 Expiratwn`-2F?:_ 011 Tr# 290582. Type,i � >tcl�#y(`orporation BERG DIST MA- 1 JOHN -ERGQAII ........... � si g 661 WEST RD. TEM.PLE,NH 03084°' '%'m Undersecretary Mi jssitchusetts - Depai-Mient (rt' Public Sufet% Board Of Building Regulittiuns :tnd Slitndards Construction.Supervisor License License: CS 26178 JOHN D BERGQUIST PO BOX 218 TEMPLE, NH 03084 Expiration: 6(7/2012 Tr#: 29224 } I The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' 600 Washington Street Boston,MA 02111 www.mass.gov/du; Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl ' J . N e( sines s/Orgizatio ndividital _ ): -A . Address: >1�T 67 City/State/Zip: 'Deav �6)3'1one.#: ( . �'%�� �x3 Are yo an employer?Check the appropriate bog: Type of project(required):. 1. I am a employer with 4. f_1I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g• ❑Demolition working for me in any capacity. employees and have workers' insurance.# 9 ❑Building addition [No workers'comp,insurance comp. required.] 5. E] We are a corporation and its 10-ElElectrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself.[No workers'comp. right of exemption per MGL 12.0 Roof repairs insurance required.]t c. 152,§1(4),and we have no employees.[No workers' 13.[1. Other 1 k comp.insurance required.] b,l' 6>v (� �L 1i *My 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. tContraetors 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. I am an employer that isproviding workers'compensation insurance for my employees Below is thepolicy and job site information. Insurance Company Name: 2�i�J LrJ Policy#or Self-ins.Lic.#: �J� +376 Expiration Date: Job Site Address: -- IEe� CJCity/State/Zip: ?40 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 Ido hereby c fy r the pains an pens s of perjury that the information provided above is true and correct Si afore ^ Date Phone#: O F only. Do not write in this area,to be completedby city or town official n• Permit/License# hority(circle one): Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector son: 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 se,and including the legal representatives of a of the foregoing engaged in a joint enterprideceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the ides there' or the occupant of the re than three apartments and who res therein, p owner of a dwelling house having not more P 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 Lias 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"alllocations 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 Investigations 600 Washington Street Boston,MA 02111 Tel. #617-727-4900 ext.406 or 1-$77-MASSAFE _ __ - Fax#617=727-7749--.._._ _ __ _ Revised 11-22-06 www.mass.gov/dia A. F. Watson General Contracting Estimate 3 Edgemont Street Derry,NH 03038 DATE ESTIMATE# Tel. 603-437-6134 2/15/2007 1318 NAME/ADDRESS Mr.-Donald E.Jaekle Jr. 894 Greatpond Road North Andover,MA 01845 TERMS PROJECT Due on receipt Misc.Repairs ITEM DESCRIPTION QTY COST TOTAL Permit Town of N.Andover building permit fee 220.00 220.00 -Materials Materials Bulkhead 400.00 400.00 labor Carpenter's labor 18 40.00 720.00 Painting Painting 350.00 350.00 Dumping Charg Dump charge 40.00 40.00 Cont.fee Contractors 10%Fee profit+overhead 151.00 151.00 Subtotal labor&Materials 1,881.00 i Materials Materials Door Sills driveway side and front 155.00 155.00 labor Carpenter's labor 4 40.00 160:00 Cont.fee Contractors 10%Fee profit+overhead 46.60 46.60 Subtotal labor&Materials 361.60 .labor. Carpenter's_labor 4_ 40.00.- 160.00. Materials Materials remove siding front check for water damage 200.00 200.00 Cont.fee Contractors 10%Fee profit+overhead. 36.00 36.00- Subtotal labor&Materials 396.00 Materials Materials Install clapboard siding over exposed concrete 350.00 350.00 labor Carpenter's labor 8 40.00 320.00 Cont.fee Contractors 10%Fee profit+overhead 67.00 67.00 Subtotal labor&Materials 737.00 Materials Materials Box gas meter 100.00 100.00 labor Carpenter's labor 3 40.00 120.00 Cont.fee Contractors 10%Fee profit+overhead 22.00 22.00 Subtotal labor&Materials 242.00 "Materials Materials wood shed 0.00 FJCLAP 1/2"x 6"Primed Clap Boards 768 1.20 921.60 Pine 1"x 6"x 16-0"Primed pine 6 11.68 70.08 Windows Window allowance 4 160.00 640.00 Miscellaneous Miscellaneous 200.00 200.00 labor Carpenter's labor 44 40.00 1,760.00 Dumping Charg Dump charge 75-.00 75.00 -THANK--YOU A.F.WATSON TOTAL OWNERS SIGNATURE SIGNATURE Page 1 A. F. Watson General Contracting Estimate 3 Edgemont Street Derry,NH 03038 DATE ESTIMATE# Te1. 603-437-6134- 2/15/2007 1318 NAME/ADDRESS Mr.Donald.E..Jaekle_Jr. . 894 Greatpond Road North Andover,MA 01845 I i TERMS PROJECT I - Due on receipt Misc.Repairs ITEM DESCRIPTION QTY COST TOTAL Painting Painting 1,500.00 1,500.00 -Cont.fee Contractors 10%Fee profit+overhead 516.67 516.67 Subtotal labor&Materials 5,683.35 Materials Barn 9,000.00 9,000.00 Note The Above prices are estimated costs and will be adjusted 0.00 to actual costs. i -THANK--YOU A.F.WATSON TOTAL $18,30 .95 'OWNERS SIGNATURE SIGNATURE Page 2