HomeMy WebLinkAboutBuilding Permit #414-2017 - 91 WEYLAND CIRCLE 10/19/2016 11 IrAr�0r� -�o
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1 Iv BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit No#: Date Received 1 �qA°RArEo
SSACHUS
F
Date Issued: /U ° r
IlgPORTANT:Applicant must complete all items on this page
LOCATIONS
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pR®PE;RTY OWNER, - / �
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P,Mt. 10b YeaFStr0ure yes no
,
DISTRICT:. Historic D�stricty gess no,,
__
Mact�me Shop�Vrll`age Y. no_ ,,
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building ❑ One family
❑Addition ❑Two or more family ❑ Industrial
❑Alteration No. of units: [i Commercial
repair, replacement 0 Assessory Bldg ❑ Others:
0 Demolition 0 Other w __
' iSeptic ❑wlNell, ❑ Floodplain +�Wetlan sd q'1Natershed District
DES RIPTION OF WORK BE PERFORMED:
TM Cd
GG /S /G -�
CK f'S op�11' 1
Identification- Please Type r Print Cle rlry
OWNER: Name: h h /1 �cA� � i Phone:
Address:
2 (JA;✓2/�
Contractor Name: r�La$ 2 �`'" � Rhone � - - -
Ernail { ��' f _ _ -
- 47 U�64
Supervisor's,Constrns
uctionLicee
Ho
lmpmy, mb_ t`Licenser .� Ll1 7v _ _ _. xp, Date !I 'l 7
E �
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE.BULDING PERMIT.$12.0000 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ ./0)/ _ fa `6v FEE: $
Check No.: Iq f Receipt No.: O��
NOTE: Persons ntractin with unregistered contractors Flo not ave access-to the guaranty fund
5ignature_of_ gen caner Signature of contractor '
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑ Tanuing/Massage/Body Art ❑ SwiUnnmg Pools ❑
Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑
Private(septic tank, etc. ❑ Pennanent Dempster on Site ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING & DEVELOPMENT Reviewed On Signature_
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on Signature
COMMENTS
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< Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
. I
Planning Board Decision: Comments
Conservation Decision: Comments
Water & Sewer Connection/Signature& Date Driveway Permit
DPW Town Engineer: Signature:
d 384
FIRED z '- �. . _..
W.a EPARTMENT ,TempD sten on sitee
�.. od Street �
._.
. ump .- 0�
Located a4f�1 5' -
24xMaintSfreet
FireDe artmentysgnature/date
COMMENTS.
- 1
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 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
o Workers Comp Affidavit
❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses
o Copy of Contract
o 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
o Workers Comp Affidavit
Li Photo Copy of H.I.C. And C.S.L. Licenses
o 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)
o 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
o 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
o Mass check Energy Compliance Report
o 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 i
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
Location �I I W � ll L+i/y I)
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No. T/7 - ,701-7 r Y Date /a' / C/ 0�4 Di Cp
• - TOWN OF NORTH ANDOVER
Certificate of Occupancy $
i Building/Frame Permit Fee $jl/—.7— -
Foundation Permit Fee $
Other Permit Fee $
i TOTAL $
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Check# /
1 Building Inspector
� ► ., .� �
c10R T!1
To'
wn o _ 6Andover
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oh ver, Mass, O# AP
coc"ICNl WICK 1'
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�.9 AOR�TEO r' P��y
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BOARD OF HEALTH
Food/Kitchen
PERMIT T
D I... ... Septic System
THIS CERTIFIES THAT ......... ............�►.o�„�... ,�, ,.�I.��I.y/'�/�,/ BUILDING INSPECTOR
... ......................................
has permission to erect .......................... buildings on Foundation
�f~ !*.&q.,�I.N.� ........� Rough
to be occupied as .............. ......... .. .. Chimney
provided that the person accepting this permit shall in every respect conform 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 Final
Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR
1 or Building Rough
VIOLATION of the Zoning lding Regulations Voids this Permit.
Final
PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR'
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UNLESS CONSTRUCTI TARTS Rough
Service
BUILDINa ...... ...............
PECTOR Final
GAS INSPECTOR
Occupancy Permit Required to Occupy Building Rough
g
Display in a Conspicuous Place on the Premises — Do Not Remove Final
No Lathing or Dry Wall To Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. FBurner
Smoke Det.
Northeast Building and Remodeling,LLC
71 Emily Road
Tewksbury,MA 01876
License#058024
Registration#119724
978-988-9492
978-658-6007
------Residential Contracting Agreement------
Read this agreement and make sure you understand it before signing it.
This agreement has legal force and effect and binds those who sign it.
Date: October 12, 2016
Contract Number: 1625
Customer Name: Robert and Nicole Bertoldi
Address: 91 Weyland Circle
North Andover,MA 01845
Cell Phone: 978-618-3719
Notice: All home improvement contractors and subcontractors engaged in home
improvement contracting,unless specifically exempt from registration by Provisions of chapter
142a of the general laws, must be registered with the Commonwealth of Massachusetts. Inquires
about registration and status should be made to the director, Office of Consumer Affairs and
Business Regulation, Ten Park Plaza, Suite 5170 Boston, MA 02116, 617-973-8700.
Homeowners who secure there own permits or deal with unregistered contractors shall be
excluded from access to the Guarantee Fund.
This Agreement is made this 12th day of October 2016 by and between Robert and Nicole
Bertoldi (hereinafter referred to as Owner and Northeast Building and Remodeling, LLC
(hereinafter referred to as Northeast)
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Replacement Windows:
-Building Permit.
-Remove 8 existing window sashes,jamb liners,exterior casing,stops and outer window sill.
-Install 8 new Harvey Classic vinyl replacement window with insulated glass,six over six grids between the glass
and half screen.
-Install insulation around perimeter.
-Manufacture and install new Azek window stops.
-Install Azek outer window sill and Azek 5/4 x 4 window casing.
-Remove all debris from site.
Total: $6,880.00
Rear Slider:
-Building Permit.
-Remove existing rear slider,interior and exterior casing and stops and door kick.
-Install a new Anderson PS510 white vinyl sliding door with insulated glass,grids between the glass,white
hardware and screen.
-Install insulation around perimeter.
-Install new Azek exterior trim and door kick.
-Install new primed pine extension jambs and casing to interior.
-Remove all debris from site.
Total: $3,750.00
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Rear Door:
-Building Permit.
-Remove rear entrance door,install a Therma Tru 15 lite entrance door with,insulated glass,ball bearing hinges,
and double bore for deadbolt,composite adjustable sill,ultra jamb and PVC exterior casing.
-Install insulation around perimeter.
-Install interior casings.
-Reinstall lockset.
-Remove all debris from site.
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Total:$1,950.00
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Supplementary Conditions:
Engineering Constraints:
During the building stage of the project, certain engineering or building code factors may be
discovered that will require a change to the original design and/or plan.Northeast will try to
maintain the original design to the best of its ability.
Concealed Conditions:
The Owner further acknowledges that concealed conditions such as but not limited to, old or
existing septic tanks,wells, oil or gas lines,water lines or sewer lines, electrical lines, or other
items not expressly contained in the specifications for removal, replacement or relocation are not
part of this contract. It is also assumed that the existing mechanical and electrical systems can
handle the additional load put on them by the improvements provided by Northeast. Any work
arisingout of such unknowns shall constitute extra work and be addressed b change order(if
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necessary)to the Owner. If Owner has any knowledge prior to signing these specifications,
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please list them hereunder or attach them to each set of specifications. All efforts will be made to
pour concrete without the use of a pump truck; in the event that a pump truck is needed an
additional charge will apply.
Insurance:
General Liability, Workers Comp, and Automobile Insurance are carried by Northeast in such
amounts sufficient to fully insure Northeast for liability arising out of the work performed under
this contract. The Owner shall be responsible for having normal homeowner's insurance for
project site.
Measurements:
It should be understood that measurements denoted on any plans or contract are"plus or minus".
These are not and can not be guaranteed due to existing conditions on the existing house.
Govern:
If any questions arise between the plans and the specifications, the specifications shall govern.
Warranty and Guarantee:
All work to be guaranteed for one year from completion of the project. Products to be warrantied
under specific manufacturers warranty program. All work shall be completed in a workmanlike
manner according to standard practices and codes. Warranty void if not paid in full.
Change Orders:
Any Alteration or deviation from specifications involving extra cost, will be executed only upon
written change order signed by both Owner(only one signature needed) and an authorized
representative of Northeast, and will become an extra cost over and above the original contract.
Change orders are due and payable 100%upon Owners signing of the change order.
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Allowances:
When allowances are given for items such as,but not limited to, windows,doors, skylights and
bathroom items,the amount of the allowance refers to the cost of purchasing that particular item
including taxes,pickup and/or delivery charges, special order charges, and any other costs which
may be necessary to obtain the item. In most cases, installation of the particular item has already
been figured into the contract price. If Owner supplies any of the allowance items or any other
in the contract,Northeast shall not be responsible for warranty, repair or replacement of such
items.
Site Access:
The Owner will provide access to Northeast, its subcontractors, suppliers and local officials
required to inspect the site. Owner is responsible for furniture and other personal items to be
moved from construction area.
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.
RESIDENTIAL CONTRACTING AGREEMENT
Robert M. Sullivan Date
Northeast Building and Remodeling. LLC
The above prices, specifications and conditions are satisfactory and hereby accepted. Northeast is
authorized to perform the work as specified; payment will be made as outlined in the attached
payment schedule.
t
Robert Bertoldi Date
Nicole Bertoldi Date ��� /
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PAYMENT SCHEDULE:
$4,000.00 upon contract signing, ordering of materials.
$5,000.00 upon start of window install.
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$3,580.00 upon completion of contract.
Total Contract Amount: $12,580.00
The Commonwealth of Massachusetts
Department of IndustrialAccidents
M 1 Congress Sheet,Shite 100
' d
Boston,MA 02114-2017
-
o�< www mass.gov/dia
Workers, Compensation insurance Affidavit:Builders/Con�t��o s/,l_yectricians/Plumbers.
TO DE FILED MTM TEE PERZ1 n_1' ..Please Print Le 'bl
A '•licant Information v!�/Gl//
Name(Business/Organization/Individual):
Address: /
City/State/Zip.
'6h- kthe appropriate box: Type of project()required):
Areyouanemtyer. .ec
em to ees full and/or part time).* 7. ElNaW'dons�ction
1.[]I am a employer with P Y
2.( I n a sole proprietor or partnership and have no employees working forme in 8. em0 deXliig
any capacity.[No workers'comp.insurance required.] 9. ElDemolition
3.E]I am a homeowner doing all work myself;.[No workers'comp.insurance required]t 10 Q Building addition
<1 I am a homeowner and will be hiring contractors to conduct all work on my property. I will
❑
11. Electrical repairs or additions
ensure that all contractors either have workers'compensation insurance or are sole •.
proprietors with no employees. 12T[�Plumbing repairs or additions
5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.[]Ro6f repairs
These sub-contractors have employees and have workers'comp.insurance.1
14.Q Other
6.❑We are a corporation and its.officers have exercised their right of exemption per MGL c.
152,§1(4),and We have no employees.[No workers'comp.insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy informatiom
Homeowners who submit•this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such
f 11omectors 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:
Lie.
y 6 L f Expiration Date: 71 1
Policy#or Self-ins. � .
/�. J8Y
d
a
LA�dCi /State/Zip: �/%• � (.(J`9Z
Job Site Address:
c of the workers' compensation pohcy declaration page(showing the policy number and expiration date).
Attach a copy 500.00
p e b a fnib u to$Y,
required under MGL c.152,§25A
is a criminal violation punishable y p
as re uu 00 a
e coverage q e of u to $250.
Failure
to secur g and a fin
• and/or one-year imprisonment,as well as civil penalties in the foam of a STOP WORK ORDER
be forwarded to the Office of Investigations of the DIA.for insurance
day against the violator.A copy of this statement may
coverage verification.
X do hereby cer5q under tliepains andpenalties ofperjury that the information provided above is true and correct:
Date:
Si a
Phone#:
0
Official use only. Do not write in this area,to be completed by city or town official.
Permit/License
City or Town' #
issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Phone#:
Contact Person'
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their empl6yees.
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
receivefor trustee 6f 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 b6 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 certificates)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
IndustrialAccidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensatioji 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 Department's address,telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial.Accidents
1 Congress Street, Suite 100
Boston,MA 02114-2017
Tel.# 617-727-4900 ext.7406 or 1-877-MA.SS.AFE
Fax#617-727-7749
Revised 02-23-15 wwwmass.gov/dia
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ea"`�7O42tiQ `��° ��acicraij+ Massachusetts Department of Public Safety
Office of Consumer Affairs&Business Regulation. Board of Building R !
ME IMPROVEMENT CONTRACTOR egulations and Standards
License: CS-058024x5724e istration: 1 -
Type: IIConstruction Supervisor
xpiration: --8I21/ 3�7 DBA
til•:r r.ti
IF
NORTHEAST BUILDIAK-11
&;REIGIO�EL'ING 1 ROBERT M SULLLVAN i��N
f' 71 EMILY RD r o _
ROBERT SULLIVAN ; TEWKSBURY MA 01876
71 EMILY RD �lJ
TEWKSBURY, MA 01876j4�= �
Undersecretary wowl.�
Expiration:
Comrr ssioner 09/20/2017