HomeMy WebLinkAboutBuilding Permit # 11/30/2015 i
BUILDING PERMIT �V*D 1 p"
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION _
n�o w w -A
Permit N® o Date Received Al ®S' Y�6�RA1EoeP4ay��
Cwus�s
' Date Issued:
IMPORT T:Applicant must complete all items on this page
./ �� f„// / �� rJ ,rrr, ✓ r, ///� / / / � � r / //
���'��1�/��/��/�, � f ✓r %� r / rf” / /rl %, rr ,,/ r/ �/�i G �r� l /�///�i(, � /��/>lro!
d�� � ( I � �;"-1- I r , � r ,�/; l r„r,/ ✓�, ilei// %/1;r'�Ir�! r�'✓ !� /� J IJl���/��,,
,
PROP °
�' Il Y- r P ��r OOYear Struefure ll,Jl "l4 es6 no i;
nit /Ilrrlrr
� � OYrrrfr, ,,.,1P 1,611
�, r. �;, f.. ,ul a ,��y�o/i %///�HISt061C�1d IStrlCt�r
', ZONING DISTRICT ��,��//l/i,,r,//�/.
�1 r 1
�, r °-,l ,. , , , „ r
��l f ,,r,✓ � P � � _,
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building ['One family
❑A41dition ❑ Two or more family ❑ Industrial
Alteration No, of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
/r UVetlands ❑ 1Natershed,District
i,Ir,We I ❑ Flood Iain, ❑„ r r i
'r / /,.. 9f, r.11 Y r a .r / 6.,, /. , r .,. r „, ,. ,. ✓ ., / //... /
r ,
/ l�
DESGRIPTION OF WORK TO BE PERFORMED:
Identification- Please Type or Print Clearly
OWNER: Name: P,4v t 71 7- Phone: '77 a S70 - 4YO3F
Address: q01 W 5TC1L Woo b S
Contractor,,°Name � r , , rl . ,Phone
r ,
/ire
/ irr/ „ / ✓ IGl / /J.r / / y r, YI P ., /, 1/ ��, 1 r J � J/(� ,
�i,�// ,,,,,//�/// 1,�n/I„//��/f � /li,/////v//�%/�/r',6�/%�fl i✓ ,�,/ ,/d`i �/ r� / ,,; li / �� tl � � , // � >(r/r�f�„%:=.:r
/.,,l.//.rNr// /l,r/;�/.,Yr l � ^1 1 � %r/ r �//i ..f. �,�r ,...(% ,% ,. /� 1/„/tir%/ / r/� '�. - •,����rl ,. /-� r r ,�� a�
/ r 1
/v������/,�f>�r/�1✓,lfl�i/�r fff 1G1 ,�rr r// r( ,, r„, / ,,J, I/ ,✓,�/i�% / ,/ / �t f ,r,,r�i, � r //l�/i //,
,Ho elm .rovement License / ExE Date / /j/rai%✓, 1 l. ! �, /u/ i/%„
�.rl??�F/�
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE;BULDING PERMIT:$1200 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ 7t o FEE: $
Check No.: QLh Receipt No.:
lit F. erso s contra registered contrast rs do not have access to the guarantyfund
'o Agenf/Ow:er nature of_contractor
Plans Submitted ❑ Flans Waived.F1 Certified Plot Man ❑ Stamped plans ❑
TYPE OF SEWERAGE DISPOSSA/L
Public Sewer u Tanning/Massage/Body Art ❑ Swiuuning Pools El
Well ❑ Tobacco Sales ❑
Food packaging/Sales ❑
Private(septic tank,etc. ❑ PerznanentDumpster on Site ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING & DEVELOPMENT Reviewed On Signature_
COMMENTS
CONSERVATION Reviewed on I - l % Si nature
.,. ..
COMMENTS .
HEALTH Reviewed on Signature
COMMENTS
Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Water& Sewer 9N r C®nrtactl®fit/Sr nature
Date-g
Drivewa
Permit v
DPW Town Engineer:,Signature:
FIRE'DE 11 Temp-,Dumpsfer on site yes.
Located 384 Osgood Street
Located at 124 Main"5��eet '
Dep rumen Signaure/date
COMMENTS
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
m"' Building Permit Application
u!( Workers Comp Affidavit
V Photo Copy Of H.�7 1 C AndlOr ✓C.S.L. Licensesv""
ur/ Copy of Contract
Floor Plan Or Proposed Interior Work
u Engineering Affidavits for Engineered products
OTE: 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
• Floor/Cross Section/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
OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
New Construction (Single and Two Family)
u Building Permit Application
ci 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)
ci Copy of Contract
• Mass check Energy Compliance Report
• Engineering Affidavits for Engineered products
:)TE: 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
Doe:BidIding Permit Revised 2014
NORTH
E I
U v
It
L
® y
No. ®Y,61
_
Z
ver, TOOJL*
O LAKE . r, ass,
114 COCMICHE WICK y�-
�9S°RATEo PQa,�gS
U BOARD OF HEALTH
Food/Kitchen
Septic System
THIS CERTIFIES THAT BUILDING INSPECTOR
................ . .. ............... .. ... .... ................... ...... ... ...............
has permission to ere . buildings on ... ', t Foundation
_ ®. Rough
A� oug
to be occupied as ...K�MA.Lk(,.,,,...,..'...... .. . ...... ...........L D... k: .[.J!� .. .. �.... .... chimney
provided that the person accepting this permit shall in every respect conform to the terms of the application Final
on file in 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 1N,6 MONTHS ELECTRICAL INSPECTOR
LESS CONSTRUCTIO Rough
Service
.................. ............. ................................... Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Required to Occupy Buildiu Rough
Display in a Conspicuous Place on the Premises — o ofRemove Final
No Lathing or all To ,Be Done FIRE DEPARTMENT
Until Inspected and Approvedthe Building Inspector. Burner
Street No.
Smoke Det.
ROOOL
6-0
UTs
l—/a-c/ (Zcw
041
0
cz
The Commonwealth oflMTassachusetts
Department oflndustrialMccidents
I Congress,street Suite 100
Boston,MA 02114-2017
www.mass.gov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH TEE PERMITTING AUTHORITY.
Applicant Information ®� 7- Please Print Legibly
Name (Business/Organization/Individual): P4y/ f/.,. �'�r� 7) �u������
Address: i I A e
City/State/Zip: No 0V D#y/_ Iy1 Phone#: 977 60
Are you an employer?Cheek the appropriate box: Type of project(required):
1.❑I am.a.employer with employees(full and/or part-time).* 'l, Q New construction
2.�am a sole proprietor or partnership and have no employees working for me in 8. Memo delirig
any capacity.[No workers'comp.insurance required.]
9. ❑Demolition
3.Q I am a homeowner doing all work myself.[No workers'comp.insurance required.]t
l0FJ Building addition
4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will
ensure that all contractors either have workers'compensation insurance or are sole 11.Q Electrical repairs or additions
proprietors with no employees. 12.Q Plumbing repairs or additions
5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.n Roof repairs
Theso sub-contractors have employees and have workerscomp.insurance.$
6.E]We are a corporation and its officers have exercised their right of exemption per MGL c.
14.F1 Other
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 information.
I Ilomeowners who sulimit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such
tContractors 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.
Yam an employer that is providing ivorlcers'compensation insurancefor nzy employees. Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins,Lia#: 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 MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do Hereby certify under the pains andpenalties ofperjrary that the h formation provided above is true and correct.
Sinature: o Date:
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#:
This fort satisfies all basic requirements of the state's Home Improvement Contractor Law(MGL chapter 142A),but does not include standard
language to protect bomeownem Seek legal advice if necessary. Any person planning home improvements should fust obtain a copy of"A
Massachusetts Consumer Guide to Home Improvement"before agreeing to any work on your residence.You may obtain a free copy by calling the
Office of Consumer Affairs and Business Regulation's Consumer Information Hotline at 617-973-8787 or 1-888-283-3757 or on our website.
Homeowner Information Contractor Information
Name Company Name
PA V I 4 T 1 FFigiv 4 Zwrae, 14 ut r-ArwS A rfn oiirL/N G
Street Address(do not use a Post Office Box address) Contractor/Salesperson/Owner Name
W Eg5 r-k W Oo a PA v l N,n S
city/rcwn State Zip Code Business Address(must include a street address)
NO • 1ro00VC/t PW11 Or S dI !S iOticy h&
Daytime Phone Evening Phone Cityfrown State Zip Code
. 4N0(jr44t_ PO4 41 f kS
Mailing Address(It different from above) Business Phone I Federal Employer ID or S.S.Number
ilvmrLgvosem iCovhslorRcg.Nw�hx E,puvtion dao
Isw requires that most home
tmpnreegla mmntton r 069/os-
1
6 9/0/ /�/�off,
ara6d segtstnilou number Jl �p
The Contractor agrees to do the following work for the Homeowner:
(Describe in detail the work to completed,specifying the type,brand,and grade of materials to be used,use additional sheets if necessary.)
(-INtSh BASIEWC&j T'U /NGLL16 JC_ 0DDI.t9 /3,I}TIt R oovY1 / Fl-y•�'l 0 Fit C-
h
F
T: v Jtoom - To ItvC- .v,1F Eel reSS w•Naow, ' Re/14r_r_ W.,nrpowS
Required Permits-The following building permits are required Proposed Start and Completion Schedule-The following schedule will
and will be secured by the contractor as the homeowner's agent: be adhered to finless circumstances beyond the contractor's control arise
(Owners who secure their own permits will be
excluded from the Guaranty Fund provisions of J40�M(5ate when contractor will begin contracted work.
MGL chapter 142A.)
/Date when contracted work will be substantially completed.
Total Contract Price and Payment Schedule
The Contractor agrees to perform the work,furnish the material and labor specified above for the total sum of: (*)
Payments will be made according to the following schedule:
C- 9'/'Q S 5
$ 00 U upon signing contract(not to exceed 1/3 of the total pcontract price or the cost ofspecial/order items,whichever is greater) eve^ Jb tv
$�by / /_or upon completion of Kdv4 II CLIA sou GT t 0 N /��U/�b�/!�! �!/ ' rr(A C—
$ S O D O by / / or upon completion of F-1 a 1 Plum b i.t�, �e/e t�r t L�{-/ P1 y} 5T C rt
$—A AV upon completion of the contract. (Law forbids demanding full payment until contract is completed to both party's satisfaction)
The following material/equipment must be special $ Y to be paid for '..
ordered before the contracted work begins in order
to meet the completion schedule.(") $ IY to be paid for
NOTES:(;)Including all finance charges(*s)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 contract price or(b)the actual cost of any special equipment or custom made material
which must be special ordered in advance to meet the completion schedule. '..
Express warranty Is an express warranty beine provided by the contractor? D No D Yes(all terms of the warranty must be attached to the contract)
Subcontractors-The contractor agrees to be solely responsible for completion of the work described regardless of the actions of any third
party/subcontractor utilized by the contractor. The contractor further agrees to be solely responsible for all payments to all subcontractors for
materials and labor under this agreement
Contract Acceptance-Upon signing,this document becomes a binding contract under law. Unless otherwise noted within this document,the
contract shall not imply that any lien or other security interest has been platted on the residence. Review the following cautions and notices
carefully before signing this contract.
• Don't be pressured into signing the contract.Take time to read and fully understand it. Ask questions if something is unclear.
• Make sure the contractor has a valid Home Improvement Contractor Registration. The law requires most home improvement contractors and
subcontractors to be registered with the Director of Home Improvement Contractor Registration. You may inquire about contractor
registration by writing to the Director at 10 Park Plaza,Room 5170,Boston,MA 02116 or by calling 617-973-8787 or 888-283-3757.
• Does the contractor have insurance? Ask the Contractor for his insurance company information so that you can confirm coverage,or ask to
see a copy of a"proof of insurance"document.
• Know your rights and responsibilities. Read the Important Information on the reverse side of this form and get a copy of the Consumer
Guide to the Home Improvement Contractor Law.
You may cancel this agreement if it has been signed at a place other than the contractor's normal place ofbusiness,provided you notify the
contractor in writing at his/her main office or branch office by ordinary mail posted,by telegram sent or by delivery,not later than midnight of the
third business day following the signing of this agreement. See the attached notice of cancellation form for an explanation of this right-
DO
ightDO NOT SIGN THIS CONTRACT IF THERE ARE NY BLAN PACES!!!
ssro idemical mpies of the wntmct must be completed orad signed.One copy should go to fhe ho r. other co s Id be kept by the contractor.
t r ignare ' 1-
�k-
Co ctor's Signature
Massachusetts -Department of Public Safety
Board of Building Regulations and Standards
Construction Supen•isor
License: CS-059105
PAUL G.-HUT"S
121 FARNUM STS
North Andover AfA 01845
Expiration
Commissioner 05/05/2016
092-11 ool��zoattire�c��/ i/f��lJ42cfLU41
Office of Consumer Affairs&Busi ess Regulation
ME IMPROVEMENT CONTRACTOR
egistration: 179313
xPirat►on 7/1712016-, Type:
- DBA
HUTCHINS HOME IMPROVEMENT
PAUL HUTCHINS
121 FARNUM STREET'r,
NORTH ANDOVER,MA 01845 � '-- -
Undersecretary