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Home My WebLink AboutBuilding Permit #176 - 95 HILLSIDE ROAD 9/2/2009 - - —..–A BUILDING PERMIT F NORT# O TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATIONn Permit N0: 176 Date ReceivedArED OL 9q Date Issued: SSACHus�� IMPORTANT Applicant must complete all items on this page rx. ME— i . , „ u. 5ax ,}t'>'u.n `r ,?u, :c� '�, caa _s` l , ,ya ' ' "ii✓" ' '' '. '.? ' w". s ''°` ' �fr `' � - -3`-4 ' "` ' -:a-t`"AgwN NINE - £i�i ,.,�, �va C + .- > -�=� x R Y A'? �� c SIG I �sfl �cl�� x�kk TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential NewBuildin . 9 One family Addition Two or more fam[Iy Industrial Alteration No. of units: - .�: _ Commercial Repair, alacemenl P Assessory Bldg Others: Demolition Other }z r U � ;�-+1 �.Y'rs"F'- - d z' "} �`z� '@'x+'fi .,� �'�sarg�-s„rm-- --� ,yw3, -' s,-.•. wuU01 WWI 4�kt DESCRIPTION OF WORK TO BE PREFORMED: Identification `Please Type or Print Clearly) M OWNER: Name: 1 � � Phone: Address: t W ' "�1H ry i„` , v.. ®.� Set �� OD�i...:. 7_ "� ` 'U+-�11 �""a.�. d�, Room' ��}sm”� =usw axA' u�1��.�cf4�.. '',,St'�ari t 1� �L� "r � ��'�, i��• ,t'�'a �' '.,�".'��,k' ?y3i"t G' .a��"s.-�,. s nrr fir$x�aa'"t��,'"t�`-w'"''.' '� +R r„«. ;s`. 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-',l FEE: $ �� 7 Check No.: Receipt No.:�� 3�3 NOTE: Persons contracting with unregistered contractors do not have access to the g ra Signfire ofiA �nt/O�runer ,Sr „nature o�F contract -- r _ Plans Submitted Plans Waived Certified Plot Plan Stamped Plans 'ans '4 TYPE OF SEWERAGE DISPOSAL C Public Sewer Tanning/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 Signature �t COMMENTS HEALTH Reviewed on Signature COMMENTS 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 Drivewav Permit DPW Town Engineer: Signature: Located Ca38C 4�Osgood "dr'FJ..r:-t.l. ate`�. C c�- A + "�P. ..�! t OCateC g € �. r � .w ,.....a�cr. � -+:� xt„x��- �4.�u#��,r:`_�.�±".`f'�a'�4;:;�,i5.'� � :�.��{xn';,Y ;w.'F��s.4�'�:."•4-a 5r�y3�.-�i �:.f'`yr a.. �''%- '� �w't-`'rte";3* zf k w5#'�,."� -h.��,-r,€,,.rr�..:�'e.tu4E � '=,.�6f k''�ri{:?� ��t i"a S �- ".:�V�slYdi�l��l.�.u�t,��'�u�� 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 I ❑ Notified for pickup - Date i Doc.Building Permit Revised 2008 / 1� P_ BuildingDepartment p ent The following is a list of the required forms to be filled out for the appropriate permit to be obtained. 4 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 o 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) o 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) 1 ❑ 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 Revised 2.2008 04 Location No. Date MORTM TOWN OF NORTH ANDOVER _ O .. D ° Certificate of Occupancy $ Building/Frame Permit Fee $ '`�F sACMusb Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # /o '223o3 Building Inspector 1, C _NORTH '9 Town O Andover . b0 o doves, Mass., T da f COCMICMEWICK y�. ADRATED . S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THISCERTIFIES THAT....................... .. . /1...........................:.......................:..:.................. Foundation has permission to erect.............................:.......... buildings on ......(7 .. 7!.. . '`.U.F.... C�............................. Rough to be occupied as / (�`� Chimney p' .. ......`................................................................................ ................................... 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 PERMIT EXPIRES IN 6 MONTHS Final ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough .................. ........... ^....... ... .... ......... . Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough 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. Burner Street No. SEE REVERSE SIDE Smoke Det. t C 0nIPnoezweidik ofMassachuse#S kf J1 D of Iftdus&ial Accidents of IestiQatiorr.� 600 T rashirrgtan Street BOSZOn, MA . OZIII r� . Workers' Com enation Ins' N'1 W-"2=S grry/iia A. id iicant Information. ur'anee Af£itlavi Btrers<Cuatr'acfors/Eiecf�-iciarYs/Pinmbers Piease Print LeQ'bi Name(ausinrss�argeraizaEion/Indiviaiiel); q. ' Adr[IeSs: / /i✓ti// �re 2 , �4 JLS . Citystafe/ � M 7l Phone#: . y � Are you an Y ::Ploy er4 k.the$ rnPP prrate box: h am;a piayer with T 4. ❑ I am a 3'Pe of Project em — general contractor P�,oYe'-s(full and/or part-time).' have Ind and I 6. [],New am:a sole the sub-corttzact ❑. construction . shipa no a for or partner. listed on the attached sheetRemodeiiag and have no employees . Thome st6-contractors have working for me in any capacity. worked'. comp.insurance, 8' ❑Demolition [No workers'camP.insu=ce. 5. ❑ We 9. Buil di a co oration ❑ addition and ' on re vire rP its d.] I ofrrcers 3, have exercised 10. I th ' E1e., ' am fl homeowner err ❑ ~ureal repairs xadditions doing all work right ce examption'P�MOL I I.�]Plumbing myssl£ (Mo-workers' ng regatta or additions insuranc:. c I��, §I(4),and we have no I2. required.].t. ..=Pj�'e--&[No worms' ❑Root repairs ' 3 eppiicattttiw MP- insusancemquh&j I3.7.0ther checks bo�'!t l must also 5tt out the section below showing their warkert'bourpeesetion policy infnmuuion _ t 4 meowners who submit this affidzwk isdicffiitt 4Caaoactors that check this box moat g��sts 8omg �'° •end tion kite owaide cenmmk is most submit a teew clr d sn sdd.�tiaas1 shacr showing.ohe nwm of thesub-contreotinn eiul affidavit ind' S such' ! an errsfoyer that isIDT rg:►perl._^s'..,r; hmtr 4 "F s:ic;ur tan. iafornzatenrL % irisrirwrcejor irry.=F*=, Bello v.;r.tl ePUAL-Y Anjob sin Ins -ance Company Name: Poi iay#or Salf ins.Lie. #: . Sob Sita A.ddrms- AtEsch atopyo'the workers' co CnylStatrlZiP Qt Pensataoa policy dW-Eftrafioo page(showing the Faiiurro to recta a covetagc as required under Section 25A of po r'number and e IvIC3L c. 152 can lead to the imposition of crap' xpi�fion dafe� . fine up to$1,50Q.00 and/or one-year hnprisorurtertt;as w.1I Of up to 5250.00) civil penalties in'the form of a nal pets}ties of a �3 agarrLSt the vi018tDr. Be advised that a c t3f this S7Y)P WORK ORDER and a nue Investigations of the DIA•for ins � statement may be forwarded to the urance coverage verin""cation. D ice of I do h *cty ptsanpe�rcriti ofpe Si r3royat fize infaTmadon Prn nd ed above is&ice and corma Phone#: Date: Official use only. Do not wrrite sit tilt area,to be conrplett-dofjrra[ bJ'do or town City or Town: Authority(circle one Perm Issuing it7L:icease# b rri ): 1. Boa rd of R ealth L Buri di g De fOtber pafwent 3.C'tt /T ow a t:l e tic 4. E lectr-►'21 Inspector :5. Plumbing Inspector Contact Person: Phone#: Information a ild Inkructions- M&-xazhuseM General Laws_chapter 152 enquires all emp Icy=to provide workers' compensation for their employees. Pursuant to this statute,an empinyet is defined as"..everyperson in the service of another under any contract Aire, express or implied,oral or written," An employer is defined as"an individual partnership,am<:%dia6on, corporation or other legal entity,or any two ormOrr, of tlae'famping engaged in a joint enterprise,and includi"g the legal represcntativ=of a deceased employer,ar 9re ==iver artrustce•of an individual, erste' ,associatiazr or other le mti em i in i ees. 'R the l� rP .l?� �': P oY g�P oy ovvever owner of a dweiiing house having net more thea thew aprirtrnerrts and who resides therein,or the occuparrt of the dwelling house of another who employs persons to do maimtenance,construction or repair wcirlc on such dwellinghouse or on the grounds or building appurt cnam thereto shall net b===of such employment be d—:med to be an employer." MGL chapter 152,625C(6)also states that"every state ate-kocal licensing agency shat withhold the ismanaeor renewal of a license or permit to operate a business or rto construct buildings in the commonwealth for any apPTcaut who has not produced•acceptable evidence.of compliance with the.insurance coverage required." Additionally, MOL chapter 152, §25C(7)states"Neither tiro wminonweahth nor any of its political subcivisions shall enter into,arty cont act for the perf==c:e ofpublic wail- nrttil•acceptabit evidence of compliance with the insmioce. mquirecntnts.of this diapter have been pr winftd to.the co►Tttractirrg autharity." ApPii®its .. Please fill out the workers',compensation•Mndavit completely,by chocking the boxes that apply to.your situation and,if necessary► supply sub�cot tors)name(sl ad&W9(es):attd phone numbers)along with their certificates)of. insurance. Limited•Liabiiity Companies (LLC)or Limited Liability Partnerships(LLP)with no employ=s otherthan the members orpartnes,are notre luied1to carry workers'=�-rnpensrttim irsraance. Van LLC or•LLP does have empioyees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Acciderds for confirmation of insurance coverage. Also Ese sure to sign and date the affidavit The affiidavh should be returned to the city or town that the application for the ph or License is being requested,notit'tite Departznant of Industrial Acoidwta. Should you have any questions regia-ding the law or if you are required to obtain a workers` Compensation policy,please-call the Dcpartriient atthe•nurnber.listed below. Self-insured companirsshould enter their s®lt=iFrsraancc Iiconac number jon ire sporoPriata iisty. City or Town Off iris Please be sure Lieut the afudavit is compiett and primed 6glbly. The Depar iment 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 tie-applicant Please be SUM to fill in the perrnitfliconse number which v►-M be used as a reference number. In addition,an appiicant that must submit multiple permit/license appiicatians in any given year,need only submit one affidavit Indic ming urmnt policy`information(if necessary)and under"Job Site Adds-ess"the applicant should write"all locations in (city or town)"A COPY of-the affidavit that has b- n.officiaily stamped or marked by fie city or town may be provided to the applicant as proof that a*valid affidavit is on file for femme permits or li=nes. A new affidavit must be framed out each year. Where a home owner or citizen is obtaining a ticeuse or permit not related to any business or commercial vertrao (i.e. a dog iicense or permit to bum leaves atc.)said person is NOT.requimd to-mmpletc this af-&vk Tic Office of investiNdions would like to thank you in advance for your cooperation and should you have any question, please do not hesitate to give us a call The Depamnent's address,telephone and fax number, The Commonwmmlth of lvfassachusetts D spar mznt of Lndmbial Accidaats Office of Envest igat~ions 600 'Washington Street Bcrsfon, MA 02111 TeL 9 617-7274900 i=406 or 1-977-MASSAFE Falx T4 61 7-722_7-774 R:vised 5-26-05 Www.lagsS_gov/ a HAMMER CONSTRUCTION GENERAL CONTRACTORS _ PRESIDENT EDWARD J.HAMMERSLEY i MA CON.LIC.079909 TEWKSBURY,MA.,978-804-5395 MA.HIC.REG. 134356 COMMERCIAURESIDENTIAL Company/Customer Charles MacNeil Estimator EJH Date 7/6/2009 Project Checked:By Same Date Address Notes Removal of old windows&trim. Installation of new windows& i Job Description Estimate# trim. Stain to match existing interior trim. Repair&install CSI Division/Account Estimate Due exterior trim&siding. Materials Labor Equipment Subcontract Total Item Description Quantity Unit Crew,@ MH/Unit Aanhours E Unit$/Ext.$ Unit$/Ext.$ Unit$/Ext.$ Unit$/Ext.$ $ Interior Trim 16 $204.00 $ 3,264.00 Exterior Trim 16 $45.00 Per $ 720.00 Labor Per Window 16 $255.00 $ 4,080.00 Disposal $500.00 $ 500.00 Permit Fees $350.00 $ 350.00 Interior trim pricing will vary depending on style of trim. High end$5000.00/Low End$1,889.00. Dumpster may be rented by customer or Hammer Construction. Permit fees approximate figure-determined by Town of North Andover. Hammer Construction will be responsible for all removal&installation of windows. Preparation of trim to include sanding,staining,puttying of holes&lacquer finish. All exterior trim to be new&match existing trim according to house characteristics. If any damage is uncovered during removal of old windows, contractor will consult with homeowner on best remedy before any needed repairs take place. Windows to be paid direct from homeowner to glass contractor. All other payments to be as follows: Permit Fees:Can be paid directly to the Town of North Andover-Approximately$350.00 Materials: Paid to Edward J.Hammersley Material/Paint Manhours Material$ Labor$ Equipment$ Subcontract$ Total Totals Thls Sheet Estimate# Estimate Details Sheet 1 Of 2 HAMMER CONSTRUCTION GENERAL CONTRACTORS PRESIDENT EDWARD J.HAMMERSLEY MA CON. LIC.079909 TEWKSBURY,MA.,978-804-5395 MA.HIC. REG. 134356 COMMERCIAURESIDENTIAL Customer Charles MacNeil Estimator EJH Date 7/6/2009 Project Checked By Same Date Address Notes Continued From Page 1 Job Description Estimate# CSI Division/Account Estimate Due Materials Labor Equipment Subcontract Total Item Description Quantity Unit Crew,@ MH/Unit kanhours ExI Unit$/Ext.$ Unit$/Ext.$ Unit$/Ext.$ Unit$/Ext.$ $ Labor:Paid to Edward J. Hammersley Disposal Fees:Can be paid direct to Waste Management-Approximately$500.00 Windows:Paid direct to glass company-J&B ALL MATERIALS TO BE PAID FOR UP FRONT&IN FULL BEFORE INSTALLATION BEGINS. Thank you for considering Hammer Construction for your contracting needs. Materi alnt Manhours Material$ La r$ Equipment$ Subcontract$ Total Totals This Sheet Estimate# Es ate Details S W 2 Of 2 }\ v 1 i. gk.. Ain �•, t .�,�� a I £ 3 ''�°''�i..a'}k! r,1>^�a� rx' F' ix s rr� ! �its .�.. w R FNk� .+e,yra trr^s'a{yan w. ••h - fir -fir•i-.rrv'F.3'ea.?'._ry i r-• e:ei Y+? s w' tttj04Wxi :�+�r•kj tlnadls* Tam 2'7ro- �"'i . ,y+��t.-4'��t��y ,r3 '•' �.�uk„�+�� i tv��*ikaa a.... X.ti"�'�ra 1,. . k Hqt d fl �8 6 30_x;• Ks 7. r { Y U.S DCparttTient of tabby 15- F Occupational Safety' rid Heath Admmistratron ' � � `sem :.�r,�3 tK+�`�Aa; ,k'�,�`�F..� s .,,,°r rR." {'• - 1.� ' '. A, � .. has sucoessfuliy completed a t4nour Occupational Safety and Health Training Course m d 'onstru��tife�lth _ q (Trainer) (Date) y } Bo&o oYS 4 r Construction Supervisor License �t 11 Lice. se: " Birttd4te10/9/1973 E —"-Ft3/9/2009 Trl� 6845 0 s on_0 {{ } EDWARD HA ��iEl' i 45 TRULLBROOK lA �'�- -� ', TEWKSBURY,MA 01'86= Commissioner ... . � k kir . . Itl - -_- ter+ `� -_ - '-�.�.cw•'.��"r"�. 71 • ,p� . �o�r>rnzanusra/bli o� aaaar/euaelta C_\ Board of Building Regulations and Stiindanh HOME IMPROVEMENT PONT N ( Registration:, 134356 Ezpiratian .11/5/2009 Tr# 261161 t' tType'DBA HAMMER CONSTRUCTION-GENERAL CONTRACTORS EDWARD HAMMERSLEY a 45 TRULL BROOK LANE.:. 1 TEWSBURY,MA 01876 Administrator s: i I i