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Home My WebLink AboutBuilding Permit #305 - 92 PUTNAM ROAD 11/3/2008 c _ NORTH BUILDING PERMIT o*tt,�p ,bgti TOWN OF NORTH ANDOVER o? ' - ` �°�, APPLICATION FOR PLAN EXAMINATION '' 7° * > Permit NO: Date Received v ppRATlp `/ Q� �SSACHl1`a��.. . Date Issued: IMPORTANT:Applicant must complete all items on this.p" ge LOCATION Prit PROPERTY OWNER 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 � � J � DESCRIPTION�OF WORK TO BE PREFORMED: Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: CONTRACTOR Name: fooL Phone: ey Address: d�' 1 l�'�r1 � h� ( 3 Supervisor's Construction License: - d Exp. Date: 0 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: $ e?2 FEE: $ //(,0 Check No.: �/ Receipt No.: `�� NOTE: Persons contracting with unregistered contractors do not have access to the guaran fund signature of Agent/Owner Signature of contractor "'�.--✓" i 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 9 h rsianature COMMENTS �- W U V HEALTH Reviewed on Signature z 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 DEPARTME-NT -Temp Dumpster on site yes 'no Located at 924 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 ❑ Notified for pickup - Date Doc.Building Permit Revised 2008 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 cP Copy Of Contract �. Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hjr�r�a la�-Oa la# s-,.-Ap,licable) ❑ ec nergy ompliance Report (If Applicable) I avlts 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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 U Revised 2.2008 O Location / PU tlyL, 4�1 Rr4l Y No. -3o Date Od NaR,� TOWN OF NORTH ANDOVER 9 4L Certificate of Occupancy $ ��'�s''"°''t�Y• Building/Frame/Frame Permit Fee $ sACMuse 9 Foundation Permit Fee $ Other Permit Fee $ a TOTAL $ 1 Check # 216 tJ Building Inspector "an6 �h- f �+.c. Town NORTH of . . Andover . _ No. _ = do , dover, Mass., 0" COC IC E \y W11 K 1• 7�A004TE0 qS BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT � ..... .. f .• ......• Foundation ✓�.... .... ...................................... ...... .. has permission to erect........................................ buildings on ....... .... ..................... Rough to be occupied as Q ...! �°/�........�' Chimp y ........................................................................... e provided that the person accepting this permit shall in every respect 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 ST TS Rough ........................ ..... ......................................1*.._.... .... .... .. .. Service BUILDING INSPECTOR Final Occupancy Permit Required t0 Occupy Building GAS INSPECTOR Roug PY a P Display in Conspicuous Place on the Premises — Do Not Remove Final h No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE S17DE77] Smoke Det. Cornerstone Building Services 36 Baltimore St Paul M. Soucy owner Haverhill Ma CS license #42063 Ma Reg #111079 976-374-3035 Cost $9ZO0,00 ----------------------------..__-------------_-___-___------------- Submitted To: Job Description John Bartlett Front entry way 92 Putnum Rd. extension. -N.Andover Ma Start Date 10/29/08 Finish Date 11/9/08- - Roof Extension: -Construct a new flat roof extension over the existing front steps. -The new roof will blend in flush with the overhang on the box bay to the left. -Install new IKO green shingles on the existing overhang and new roof overhang. -Install a new rubber roof on the new flat roof extension. -Install new IKO green shingles on the existing slant roof. Siding: 5xtend vinyl siding down to the existing flat roof. -Install new aluminum trim to match. -Install vinyl soffit underneath the new roof. Support System: -Install 2 concrete piers to support columns. -Install 2 new white rounded aluminum columns under the new roof extension. -Install 2 new wrought iron railings in white in the landing and step. Materials Use-IKO roof shingles -- 2x8 kd -- 2x6 kd-- vinyl siding-- aluminum trim-- aluminum columns - wrought iron railings -Total Cost of the project $9700.00 -Cornerstone Building Service's will warrantee all work for 1 full year from the starting date -- 10/29/08 780 CMR R6 and MGL c 142A -Cornerstone will obtain a building permit for the project. -Cornerstone will remove all debris that was generated by the project. rrr.r..rrr---rrrr----.rr rr----- .------rr-rrr------------- .----------- Pa ment -------rrrPayment Schedule: -$3300.00 Down -$3200.00 At completion of roof framing, -$3200.00 At completion. r--r r-r-----r-----------r-------rrr r---------r r r----r-----r----rrr--r-r----rr- All home improvement contractors and subcontractors shall be registered n " g d a d that any inquires about a contractor or subcontractor relating to a registration should be directed to; Registration Division, Program Coordinator One Ashburton Place Room 1301 Boston Ma 02108 --rrr-r--r-r-rrr-rq.-r-rrr r----------------------------------------------------- The homeowner has by law 3 days to cancel this contract. MGL c93s48; MGLc 140D 10 orMGL c255Ds 14 There is no acceleration clause in this contract. No work shall take place prior to the signing of the contract and the homeowner receiving a copy. y � Agreement of Contract: 10/23/08 Do not sign this contract if there are any blank spaces Owner: Contra tor: The contractor and the homeowner hereby mutually agree 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 Officer of Consumer Affairs and Business Regulation and the consumer shall be required to submit to such arbitration as provided in MGL c 142A -------rr---------------r-rr-W r----..-------w-r-Www----rrr-r--W-r-r- ------ Agreement or the above statement 10/23/08 caner: 1 �, ontractor: The Commonwealth of Massachusetts Department of Industria!Accidents 44 Office of Investigations 600 Washington Street r Boston , MA 02111 '- www•mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Eiectridians/Plumbers Applicant Information / Please Print LeQibl Name (Business/Organization/individual): Address: 3 t2i 6� �� City/State/Zip: #A Ver ic �/ f lel 01 Phone 3 S- Are you an employer?Check the appropriate box: l Type of project(required): .El I an. a employer with 4. ❑ I am a general contractor and 1 �y employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.(�J I am a sole proprietor or partner- listed on the attached sheet. 7• ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. com . insurance 5. 9• Building addition [No workers ' p ❑ We are a corporation and its required.] officers have exercised.their 10:❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL I I.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no insurance required.] t employees. [No workers' 12.❑ Roof repairs COMP. insurance required.] 13.7 Other. *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Humeowners who subinii.this affldavli If7ulCfiting they 8i'0 uvii—EN wc% and then hire outside contractors I11ust submit a new at71UaV1L indicating SUCK. XContractors 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 cert' u er the pains and penalties of perjury that the information provided above is true and correct Signature: Date: 11 Phone 9: Official use only. Do not write in this area,to be co►npleted 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 e►nployee 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 inciudin.g 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 o r 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 Usability 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 maybe 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 gvestions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the nurnber.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 infonnation(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 Revised 5-26-05 Fax # 617-727-7749 www.mass.gov/dia ON � 14,n x 3 J ^ I ro r 6 - ryl a 4 ,x 4-S:'. ,7 IS a3 -Lr �� t. � � j f-rvWn� o,� 94- 7j Le,?)p c,\l n oj � D Jarvrv) 0 i Board OrB0�'ft9 u iuue fZ Building Rep's Construction S perviso t�� u r License ndards License: CS B�!Pool 42063 EgPrr 3L7/1957 et►do 3/7/2009 Restrioyoo 00 f Tri 9696 j PAUL M SOUCY 36-A SALTIA40SZ �t HA RE MA 01830` 92. COmrr►issioner Board Or g Re�� HOME I g" la and Standards Registra�noV EMENT CONTRA Expiration; `11107g 11/25/2008 P41 n .. Trr C �nini�.,�.. P 1