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Home My WebLink AboutBuilding Permit #649 - 94 FOXHILL ROAD 3/12/2012Permit N0: 6 t data fpri. , 2 r l lr' i TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION [,- Date Received IWORTANT: Applicant must complete all items on this Daae LOCATION Ql �U,�h`j� /eo PROPERTY OWNER Print MAP N0: '3 _- ,rs,PARCEL: ZONING DISTRICT: Historic District yes no , Machine Shop Village yeno 100 year-old structure yes no TYPE OF IMPROVEMENT PROPOSED USE Resi tial Non- Residential ❑ New Building ❑ Addition ❑ Alteration kbne family ❑ Two or more family No. of units: ❑ Industrial ❑ Commercial ❑ Repair, replacement ❑ Demolition ❑ Assessory Bldg ❑ Other ❑ Others: Wellr Mb?'4 u Eq, 9 R � dpl1e� s �4Y b�+gc� �.. -v' IN;- {wj:� i® WatcrshedD► 's cw- ��-� •�4tiM� �� .i 7_1 7> .}; a n" ,., 1. ��J:�:�1 Cil :� � G �.� �r�l .� ►y 1 � �� (Identification Please Type or Print Clearly) OWNER: Name: -� Phone: Address: CONTRACTOR Name: �f�U� �-C"�_ _ ��/c/� Phone: Address: 94; Supervisor's Construction License: 3 rj j Exp. Date: Home Improvement License: _ / �G Exp. Date: ARCHITECT/ENGINEER Phone: �GJ Address: Reg. No. FEE SCHEDULE. BULDING PER • $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have ac cr tothe guaranty fund Location No.— Date Check # 204 /.or 25090 TOWN OF NORTH ANDOVER Certificate of Occupancy Building/Frame Permit Fee Foundation Permit Fee Other Permit Fee TOTAL I.-, Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑' Tanning/Massage/Body Art ❑ Swimmin Pools ❑ g 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 PLANNING & DEVELOPMENT COMMENTS DATE REJECTED f01 DATE APPROVED CONSERVATION Reviewed on Signature - COMMENTS HEALTH Reviewed on Signature COMMENTS i Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comm Water & Sewer Connection/Signature &Date Driveway Permit DPW Town Engineer: Signature: FIRE DEPARTMENT - Temp Dumpster on site Located at 124 Main Street Fire Department signature/date COMMENTS Located 384 Osgood Street yes no 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 DomBuilding Permit Revised 2011 June/mi 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 o Building Permit Application ❑ Workers Comp Affidavit o Photo Copy of H.I.C. And/Or C.S.L. Licenses ❑ 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 o Building Permit Application Li Certified Surveyed.Plot Plan ❑ Workers Comp Affidavit o 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) o 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) ❑ Building Permit Application o Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses o 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 anust be submitted with the building application Doc: Doc.Building Permit Revised 2008mi AG � � QP 10, JP �.--- CERTIFICATE OF LIABILITY iNSUR,ANCp F DATE(MM/DD/YYYY} THiS CERTIFICATE iS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON—THE CERTIFICATE H0311 OLDER. THIS THiS CERTIFICATE DOES NOT AFFIRMATiVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING iNSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCEF,, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certif7Fate hokler is an ADDITIONAL INSURED, the policy(ies) must Eae endorsed, if SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the Certificate holder in lieu of Such endorsementtal_ PRODUCER i 978-975-1300RNTACT vs Se rea HeInsur.Assoc.Ine NAME: 307North Main St. 978-975-7596 PHONE Andover, MA 01810 Edward Ramirez ADDRESS: cu JJiER ID sz:THC>MA-3 INSURED1NSUR) R S AFF( Thomas Quinn INstaRERA:�listel Group dha Quinn's Cansfirucl3on 868 Mammoth Road INSURER I).. Hartford Ins Co. Dracut, MA 01826 INSVRER0: INSURER D: INSURER E: COVERAGES CERTIFICATE NUMBER; NsiJRER F: THiS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE: BEEN ISSUED TO THE INSUR INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBE EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIM; IMS TYPE OF INSURANCE POLICY NUMBER MIDD MMIO� GENERAL LIABILITY A X COMMERCIAL GENERAL. LIABILITY M021000227 01115112 01115/13 rLAIMS-MADE OCCUR GPlIT AGGREGATiE LIMIT AP1341ES PER: -7 POLICY i i P� � EI LDC AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIREDAUTOS NON -OWNED AUTOS UMBRELLA LIARHCLAI.-AS-MAD=- OCCUR EXCESS LIAR DEOUCTIBLE AND EMPLOYERS' LIAMILITY YIN I ANY PROPRIETOt2PARTNERIEXECUTIVE 41151P704 01/15112 01/15/13 OFFICERAIEMBER EXCLUDFp? Y I N f A l (Mandatory In NH) If yo:, dwrioe under DESCRIPTION OF OPERATIONS I LOCA"ONS f VEHICLES (Attach ACORD 101, Additional Ramgrim Schad.[., If more apace Is inquired) Sole Proprietor Thomas Quinn is ExciWtded underWorkers Comp CERTIFICATE HOLDER CANCELLATION LOWELI-C NUMBER: ED NAMED ABOVE FOR THE POLICY PERIOD DOCUMENT WITH RESPECT TO WHiCH THIS D HEREIN IS SUBJECT TO ALL THE TERMS, 3, LiMITS EACH OCCURRENCE $ 1,000,00 V PREML (Ea occurmnce) $ 100,00 S 5,00 MED EXP (Any one parson) PERSONAL 2 ADV INJURY S 11000,00 GENERAL AGGREGATE S 21000,00 PRODUCTS - COMP/OPAGG $ 2,000,00 COMBINED SiNGLE LIMiT (ES accidtnt) $ $ BODILY INJURY (Perperaon) $ BODILY INJURY (Per accidont) 8 PROPERTY DAMAGE (Per accldont) S $ EACH OCCURRENCE $ S AGGREGATE g X WC STATU- OTW IM1'if� $ 100,00 E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE $ 100,00 F-,L.DISEASE-POLICYLiMiT $ 500,00 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES HE CANCELLED BEFORE THE EXPiRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WiTH THE POLICY PROVISIONS. AUTHORIZA14"t-L- k) EDDREPRESENTATWE 1988-2009 ACORIA CORPORATION. Ali rights reserved. 4CORD 25 (7009109) The ACORD name and logo are registered mark.$ of ACORD 91te &mmom6wld Office of Consumer Affairs and usiness Regulation 10 Park Plaza - Suite 5170 Boston, Massausetts 02116 Home improvement � ctor Registration QUINN's CONSTRUCTION_ THOMAS QUINN 868 MAMMOTH RD- DRACUT, MA 01826 DPS-CA1 v 50N}OgA"101216 T � � �•/�creeaa�Car s Office efConsumerAffairs & BusineaRMulation HOME-iMPCONTRACTOR Reg"lstrabog�;�Q1604 Fxv2i12 Tra 293905 QIJINN'S CONS THOMAS -QUIN DRAGtT IYIA 0826, Undersaretarp -_ NIaccachusetts = Deliartment pf Public Safet% -- Board of Baildina'Reaulations-and-Standards . .' GortstrnCtiora Supervisor.:License License: GS 39732 -- � Y= i rc Restricted to; 00 - W I THOMAS J :`QUINN 868 MAMMOD-1 RD pRACUT, NfA 13182& (bnim�ienrr Expiration: 3f25=2 Tr#. t8m Registnition_ 121604 Type: Individual Expiration: 5/24!2012 Tr# 293905. late Address and return card. Mark reason for change - Address ❑ Renewal F-1 Employment n Lost Card License or registration valid for individut use only before the expiration date. Hfound return to: OtRce of Consumer Affairs and Business Regulation 10 Park Plaza -Suite 5170 Boston, MA 02116 Not valid without signature Resbicted toe 00 00- Unrestricted ! 1G-1 2 Family Homes s 1 Failure to possess a current efiiition of the Massachusetts .States Building Code '• is cause for -revocation of this Neese Refer tw W W W_Mass.Gov/DPS The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations d 600 Washington Street W` Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LeLYibly Name.(Business/Organization/Individual): Address: L.F 11-211-5 jl�� .1� IWI-31-e-11 City/State/Zip: 1JX&9C L-/ Type of project (required): 6. [1 New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10..❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 11&Roof repairs 13.❑ Other *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. $Contractors 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 thepolicy and job site information. Insurance Company Name: Policy # or Self -ins. Lic. #:' Expiration Date: Job Site Address: 9 ci CJ�C�f/CZ �l/% City/State/Zip: A-16) �1/c_1 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 $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Tdo horohv ......... _..a -- -r"-- — - - .. . - - Apyoy an employer? Check tilm appropriate box: L I am a emplo with 4 4. ❑ I am a general contractor and I employeesfull' d/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub -contractors have working for me in any capacity, employees and have workers' [No workers' comp. insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its 3. ❑ I am a homeowner doing all work officers have exercised their myself. [No workers' comp. right of exemption per MGL insurance required.] t c. 152, §1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. [1 New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10..❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 11&Roof repairs 13.❑ Other *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. $Contractors 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 thepolicy and job site information. Insurance Company Name: Policy # or Self -ins. Lic. #:' Expiration Date: Job Site Address: 9 ci CJ�C�f/CZ �l/% City/State/Zip: A-16) �1/c_1 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. Tdo horohv ......... _..a -- -r"-- — - - .. . - - 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,bperate--a business or to construct buildings in the commonwealth for any applicant who has not produced aeceptable. 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 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 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 Revised 11-22-06 Fax # 617-727-7749 www.mass.gov/dia 94 Fox Hill Rd,t w,k 01845-293 October 10, 2011 s Notes ®iag S'/ �1 Roof facets are te1--- ..:=NsL to largest (A to Z) for easy reference. y l V id u v �lJ A � t, 6A. .. lT� � En¢icvrew Quinn's N E T is soomient is p cMded ivdet tice r e Ty E.'agleVev T thnotoy to th,^ er rt ht r f0i theft fn e -al )se Only s rh;eet t'It4e terms aIld i r li os Fr , wsly y -d n b 11, regve or vt et they eyl9ewd for use or EhaleVie f climlogres Sa ices It r na n., eh nrop ty of Eag1eV rvr Techn� ac nrl eav e reerndt r, r ..,t i 't, or !y crliMo the regdests"s .:omr=i v f") V reprodn bon nr disU f , to anyor e nu a de of th r rn;tnr s compzey witfl c1, 11e1� ! w.-Ioel Pe ool c ,,t rs �trii tiV prohihl[ed All asects a, -,d handQng of this eport arr, ,o �.icct to the Terms and conditions previously agreed to lry U _ regi, mo Copyright O 2008- 2011 EagleView Technologies, Inc. — All Rights Reserved — Patents Pending Page 4 i - Contract Ve ToQuinn Employer ID # (978) 265'2390`t f QUINN'S CONSTRUCTION 868 Mammoth Road - Dracut, Massachusetts 01826 Name . Date o Street Address (Not Post Office Box) ' Job Name Citylfown, State & Zipcode - '°' r Job Location 1 Daytime Phone: Evening Phone:5 Job Phone �j f Mailingdress (if different from above) I Salespersons) -='J ems! r.» dontractor Registration #: ?J 5i i Exp. Date: We hereby submit specifications and estimates for:" `�' fi�� .:j�~~~ ('"' ,,�^^ `. ,�-�• ,'tea �'./-r �-• -_ "`- ,-� �. - '� -- __) 1T - ! {'�'`" ..,._.._- . � T";F-~ r'i.i .e' cy �-^,� /..//,C:/ t�,/i"" l�"•� �y'`.�."'" cw...r` s`"`s,�'" y'�% ..�.: �� ".J'.f?,r"-' �..i � +,! G... .r"_l :l -/�.' if ✓ � C.'~t «r i,�w '"s /J I'.� 1-�:i�./`•�,.,�-- .;.�1 , y"�...,� !✓' •�A.,�-/`i'.c"` A.J t' C r .�/ - 1`L✓.!'xi.��_ r J C�' Jf.>".fG's -� e�F'!'..c;.•'< �.�--.C"' ..� ,�-2ey Y / , � � - 1, � ��„".. J +,l ! � f JCF.•s��"' �^S �'%.!i ,f{'"�' lr' r!'�.r c::, . t r � � '"'/' _.l.%C„J r''w� � ,� .%'``�✓ •`"%t-7�'.a✓./..,_..r'.�,f-:�i-"t�''!�.,',/'.�'� _,'C'. `�' i".r`°-� ,✓�3�- �.F�'�',�3'��, �� -'"•��G.,.�i,.2� ..h-"o�t,..�.�' "•:;.%.r'd .f.�'J`�*/ The following scheduled will be adhered to unless circumstances beyond the contractor's cont of arise: Work scheduled to begin://' Expected Date of Completion:/f (Date Contractor Will Be Contracted Work) ` (Date When Contracted Work Will Be Sustantially Completed) TOTAL CONTRACT PRICE AND PAYMENT SCHEDULE THE CONTRACTOR AGREES TO PERFORM THE WORK, FURNISH THE MATERIALAND LABOR SPECIFIED ABOVE FOR THE SUM OF:$- 0 ��*includes all finance charges in this amount Payments will be made accordin to the following SCHEDULE: $_�/ tRpon signing contract ('Not to exceed 113 of the total contract price OR the cost of special order items, whichever is greater*). _ $ By ,/rte l� or upon completion of $ By / / or upon completion of -- --------------- — – ----------------------- – --------- -------------------------------------------------------------------- $ %i/ " it✓c'/upon completion of the contract ('Law forbids demanding•ful�payment until contract is completed to both parties' satisfaction F In order to meet the completion schedule, the following material/equipment must be special ordered before the contracted work begins. (*Law requires that any deposit or down payment required by the contractor before work begins may not exceed the greater of (a) one-third of the total contractor price or (b) the actual cost of any special equipment or custom made material which must be ordered in advance to meet the completion schedule'): $ to be paid for DO NOT SIGN TH12 CONTRACT IF THERE ARE ANY BLANK SPACES Identical copies/,df t `e contract should go to the homeowner and the contractor Home Owners Signature: t_ �`�`� t `� v �`�"�"""` Date: Contractors Si nature: / .mac-,i`� �/t-•J-�/�L.,..r�)�'� Date; You may cancel this agreement if it has been signed bye party thereto at a place other than an address of the seller, which may be his main office or'branch thereof, provided you notify the seller in writing at his main offica�or"branch by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the third business day following the signing of the agreement. P E 1 ol a ICA a a o. 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