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HomeMy WebLinkAboutBuilding Permit #585 - 90 SPRING HILL ROAD 3/8/2007 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: eNus�t� IMPORTANT:Applicant must complete all items on this page LOCATION c PROPERTY OWNER ko Y a -* Print ► Reo d In G Print MAP NO.: PARCEL: ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES 0 TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑New Building VOne family ❑ Addition ❑Two or more'family ❑ Industrial ® Alteration No. of units: ❑ Repair, replacement ❑Assessory Bldg ❑Commercial ❑ Demolition ❑ Moving relocation ❑Other ❑ Others: ❑ Foundation only DESCRIPTION OF WORK TO BE PREFORMED gernetie X15i,✓�7 /u f .S%�l� �el Y r 5 ? Identification Please Type or Print Clearly) OLOIOeI,� �17�_ OWNER: Name: y I-e�'1 e-, Pead,k G Phone: 6F511- '1'71 Address: AJ/�A!, C ls� CONTRACTOR Name: -s � Phone: / Address• ,/ D�� y dlo� /2Ds'0 5 — Supervisor's Construction License: Exp. Date: Home Improvement License: f.7 01 Exp. Date: ARCHITECT/ENGINEER eatA _>'►1A 1 -F PName: Phone: Address:_1�o 0 VN\,q . S �-tx �p,2 Reg. No. FEE SCHEDULE.BULDING PERMIT.•,512.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost :$ /0, boo. FEE:$ 1 l- Check No.: Receipt No.: Page I of 4 TYPE OF SEWERAGE DISPOSAL Tanning/Massage/Body Art ❑ Swimming Pools ❑ Public Sewer ❑ Well F1Tobacco Sales ElFood Packaging/Sales ❑ Permanent Dumpster on Site ElPrivate(septic tank,etc. El Permanent Meter location to project NOTE: Persons contracting with unregistered contractors do not have access to t e g4rantyu Signature of Agent/Owner Signature of contractoPlans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY- INTERDEPARTMENTAL NLYINTERDEPARTMENTAL SIGN OFF-U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS G FIRE)DEPARTMENT -Temp Dumpster on site yes no Fire Department signature/date 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 Building Setback ft. Front Yard Side Yard Rear Yard Required Provided Required Provides Required Provided Dimension Number of Stories: Total square feet of floor area,based on Exterior dimensions. Total land area, sq. ft.: NOTES and DATA— For department use Page 3 of 4 Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORMOS Created JMC.Jan.2006 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 Addition Or Decks ❑ Building Permit Application —a--Sir-� tPlan_ Workers Comp Affidavit Photo Copy of H.I.C. And C.S.L. Licenses 0 Copy Of Contract Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And .1I.ydraulit-C-akulations-(If Applicable) ,a—Mas&ezee E ergy Compliance Report (If Applicable) 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 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:BPFORMOS Page 4 of 4 Location, No. a j Date 'V MORT1y TOWN OF NORTH ANDOVER 0� � o 1ti 0 n . i ; : Certificate of Occupancy $ cMusEtt� Building/Frame Permit Fee $ Foundation Permit Fee $ 9 Other Permit Fee $ TOTAL $ Check #//" 200 - ) �' Building Inspector r1ORTH TONM Of 0 Too T O - L A © dover, Mass. 3 COCMICME WICK 1' �.9 S ADRATED P '0�yPER IT T D 5 BOARD OF HEALTH Food/Kitchen Septic System ......U • THIS CERTIFIES THAT................�!... ..... • BUILDING INSPECTOR . .. . .......... ..... ... Foundation has permission to erect............ .......................... buildin s on ��. SIA-26�.�.�'. � Rough LI �.................... to be occupied as �'' • ..... .. .............�.... .......... �................ Chimney provided that the person accepting this permit shall In every respect onform to the terms of the application on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Final Buildings In the Town of North Andover. VIOLATION of the Zoning or Building Regulations Voids this Permit. PLUMBING INSPECTOR Rough I S1 PERMIT EXP Final IBES IN 6 MONTH UNLESS CONSTRU ELECTRICAL INSPECTOR 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 No Lathing or Dry Wall To Be Done Final Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT Burner Street No. SEE REVERSE SIDE Smoke Det. CER`f iFICATE OF INSURANCE GENEI 1L AGENT ISSUE DATE(MM/DD/YYYY) 02/28/20C•7 F,. 1 . I Insurance Brokerage of MA, Inc. --- :avis Strnet This certificate is issued as a matter of information only and confers D0Ug:I.as, MA 01516 no rights upon the certificate holder, This certificate does not amend,extend or alter the coverage afforded by the policies below. AGEN(.;Y NO. 02007 — UO INSUH.;) COMPANY AFFORDING COVERAGE �:�s:, Ui'�3r.�a2 t Nautilus 127suranee CoMpany ciba : ,i). Haridy .9 N.:,rth Store }toad f)(!X1: NH 03038 C:L7VE11'AGES 1 r,is i:• to certify that the policies of insurance listed below have been issued to the insured named above for the policy period indicated, not witlisvinding any requirement, term or condition o'any contract or other document with respect to which this certificate may be issued or ntay r.:-again, the insurance afforded by the policlefdescribed herein is subject to all the terms, exclusions and conditions of such policies. Limlts:shown may have been reduced by paid claims, POLICY POLICY T)'pI'Or INSURANCE POLICY NUMBER EFF.DATE EXP.DATE LIMITS MM DD MM DD GENF.F':ALLIABILITY NC632732 02/27/2007 02/27/2008 G5NE PAL AGGREGATE $2, 000,000 --omn•-ercial GL 119 ..ccurren� PRODUCTS C:OMPL/OPS AGGREGATE $2,000, 000 17 ::laims Madc PERSONAL)z ADVFPTISING INJURY Gener:.1 Agg Limit Applies Per (Any one person or organization; $1, 0U0, 000 Policy EACH OCCURRENCE $1, 000, 000 Project DAMAGE TO PREMISES RENTED TO YOU Location (Any onepromisu:,y $ 100, 000 MEDICAL EXPENSE (Anyone person) $ 5,000 EX(;ES:i/UMBRELLA LIRE UTY EACH OCCURRENCE AGGREGATE ] G.r:ess Liability $ $ Iii;-brella Liability I ' Occiirrenee r . Claims Made L] D:-ductible $ (••] Fc:ention $ OTHF;!-. S $ :3;:SCi;!IPTION OF OPERATIONS/LOCATIONS/RESTRICTIONS/SPECIAL ITEMS y� Cairy/PairtLing/Siding CERTIFICATE HOLDERCANCELLATION Should any of the above described policies be cancelled vs-1 or.i.e Reading before the expiration date thereof, the issuing company will �•i(• S),1•ir1gl1i.11 Road endeavor to mail 10 days written notice to the certificate Nc Fuldover MA 01845 holder named to the left, but failure to mail such notice shall Impose no obligation or liability of any kind upon the company, its agents or representatives, AUTHORIZED REPRQ86N.TA IV,E l TOTAL P.01 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 Le ibl Name(Business/Organization/Individual): a L,44/JO Address:/ 6/ (S`rlr�-� City/State/Zip: e1-Lf- v Phone.#: lD.j Are you an employer?Check the appropriate box: Type of project(required):. 1.❑ I am a employer with 4. ❑ I 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' 9 ❑Building addition [No workers'comp.insurance comp. insurance. required.] 5. ❑ We are a corporation and its 10.❑Electrical 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.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no employees. [No workers' 13.[1 Other comp. insurance required.] 'Any 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. 1Contractors 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 is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.M 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 covers a verification. I do hereby certify unde sins an penaides of perjury that the information provided above is true and correct Si afore: Date: �— 7 _ Phone#: 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." 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"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-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 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 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/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 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 Department 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 www.mass.gov/dia The Commonwealth of Massachusetts lip-4� Department of Fire Services Off-ice of the State Fire Marshal P.O.Box 1025 State Road,Stow,MA 01775 PERMITDate: North Andover permit No - (City of Town) (If Applicable) Dig Safe Num�yer In accordance with the provisions of M.G.L 14 8 Chap.ter__]_0 as provided in section S 7 7 (MR 34 /l Start Date This Permit is granted to: Full name of person,Firmor Corporation Pennissionto locate dumpster for construction/renovation/demolition of building. Comments: dumpster must be . 25 ' from structure if unable to place with required Restrictions:clearance dumpster must be covered with plywood or tarp end of work -day at (Give location by street and no.,or describe in such nner to provied adequate identification of location) FeePaids 50.00 �� ��U�y,., Fire Chief This Permit will expire (Signature of of(al granting permit) Offical granting permit Title) R. 0 Handy Doss Urquhart 603-818-1923cell Proposal no. 010 14 North Shore rd 6033432-2434 home Sheet no. 1083 Derry;NH 03038 ruhandycogyahoo.com March 4,2007 Bob&Valerie Reading 90 Springhill rd North Andover,MA Description of Work: Renovate ceiling styles from flat to vaulted style allowing for less tunneling of existing skylights. Remove existing ceiling materials including blue board, insulation, ceiling joist. The existing ceiling joist are to remove one at a time, a new 2x8 scissor joist is applied so as not allow existing rear wall to move. At opposite side of room where existing ceiling joist connect, disconnect end of living room ceiling joist add a new scissor joist to form a new vaulted style ceiling under existing roof line.New inside pitch should be a 5 - 6 pitch. Cut in small access door to attic space. Add 6 new 6"recessed lights; install R 30 craft faced insulation, 3d strapping, %2 blue board with plastered finish. Finish trim around chimney if ness,paint by homeowner. Agreement: Any alteration or deviation from the above specifications involving additional cost will be executed only upon written orders, and will become an extra charge over and above the estimate. Preexisting or unforeseen code violations and/or hazardous materials that need to be corrected will also accrue an additional charge. Dispose of all building material Clean job site For the sum of $ 12,800.00 Respectfully submitted, Approximate job time 10 days Payment in 1/3 $4,200.00 start $4,200.00 '/2 Ross Urquhart: $4,400.00 finish Date: C � — Accepted by: Date: �yw� � amo��xmn�moa urm.w'•ds�•gaol.oo:++aumi.la:i�:�ori»n WN 31YCC�Q A9031tl'1f4�1Y'J ... _ -.. .. - J OJOW N 133HS 74 -zio i suoi PPV VLOZ'CN16Z icos Smc py i" -p 6-sJS .=1� _ - _- y, 18380li. tea. 4 . .. ... "I —zic; 713 f /— . i T——7- ILL �'7,)0r X2aSSIj j � . �� � P '',J S3•L -voJ/�7 �i�z; / -.,� ,�y� L7 ;v�,d,ciX� �t� r: rtr; " ���� h✓iJ�� > r..�1j>3' 8xz �Fll lb `oL�i7 to a This _,5 CA� II uJB,x C�a�t�c aw I. _ - .I j (.C�or.�.E;IJ .�.- /✓EcJ ��fl�_ % i _ .. - - tr-rvlwy t_oo/� _... . ` - zy OF ry - _.,Porch . y� MASYS l-�,l\ f�a No.29174 OD t{" OF SNEETNO CALCULATED BV DATE - - - _ .. .. - .. .... - ,f CNECNE - 1 D BY DATE Ross SCALE H ENTRAN 3 1434 432434 earra�mr+r�rmr�:mr�rsa�.R.r�A,.T.n uo..Aac�xe,mmm