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HomeMy WebLinkAboutBuilding Permit #378 - 10 CROSSBOW LANE 11/13/2007 i BUILDING PERMIT "°oT" qti TOWN OF NORTH ANDOVER 3? 4` ° APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received *�4"°R,Teo� 4' gSSACHUs�� Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION , Print ) .. PROPERTY OWNER—C N_�(L7 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 f Two or more family Industrial ration No. of units: Commercial Repair, replacement Assessory Bldg Others: o i ion Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: �' t✓��� C4 ool w� n o Identification Plepse TLZPe or Print Clearly) OWNER: Name: r Phone:870G 0¢ "�7� Address: v J� CONTRACTOR Name: � � S Phone: C� Address: ( L .1J - L.) tlJ Ml/!f C , Supervisor's Construction License: Exp. Date: Home Improvement License: Y Exp. Date: i ARCHITECT/ENGINEER Phone: i 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: $ (,Q yoC)I CID FEE: $ `77 Z - Z 57 �- Check No.: Receipt No.: � 3 � - '<s NOTE: Persons contracting with unregistered contractors do not have access to th guaranty fund Siignature of Agent/Owner Signature of contractor LocationZD No. Date NORTH TOWN OF NORTH ANDOVER Of+« c ,�,•yG ? • Ow 9 � • i • ; Certificate of Occupancy $ �'7?•+~O'E<'�' MUBuilding/Frame Permit Fee $ / AG S Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 207 J Building Inspec r---- Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public SewerTanning/MassageBody Art Swimming Pools Well Tobacco Sales Food Packaging/Sales Private(septic tank,etc. Permanent Dumpster on Site i THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS I DATE REJECTED DATE APPROVED CONSERVATION COMMENTS DATE REJECTED DATE APPROVED HEALTH COMMENTS I Zoning Boardlof Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes ' I Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature &Date Drivewav Permit i Located at 384 Osgood Street FIRE DEPARTMENT -Temp Dumpster on site yes no Located at 124 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 2 1 A—F and G min.$100-$1000 fine NOTES and DATA— (For department use ❑ Notified for.pickup - Date Doc.Building Permit Revised 2007 rN 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 ❑ Copy Of Contract ❑ 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 i New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo. of H.I.C. And C.S.L. Licenses 1 ❑ 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 I Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 COMMENTS A-WRICAN EAGLE ROOFING, LLC. Newton: 617-244-2477 Billerica: 978-262-0007 North Andover. 978-258-7866 PROPOSAL SUBMITTED TO .� PHONE DATE -7p) 'LSg'-1785 STREET JOB NAME CITY STATE AND ZIP CODE JOBLOCATION ARCHITECT DATE OF PLANS JOB PHONE We hereby submit specifications and estimates for: DEMOLITION: -We will be hanging tarps to protect siding,then remove existing shingles doWn.to bare deck. NEW APPLICATION: - We'll-start by installing 6 feet of ice&water shield along bottom of roof deck, 3 feet around all pipes and chimneys also up any valleys. Tfhe remainder will receive a 30 lb.felt paper. -.The-perimeter will have an 8"white drip edge installed. 1 - We suggest.installing a certainteed Landmark shingle. �0V -All roof ridges will be cut, vented then capped over. -All debris removed daily by dump-truck (no dumpsters). `� - End of job we will run a-3 ft.magnet on wheels to pick-up nails on ground. - Chimneys will be counter flashed with lead. 30 year manufacturer warranty. 10 year labor guarantee. i.R C-0 Si 7co. 4i Peck <,Y% adder I i 'ZOO. CIO Ve PrOPO$t hereby to furnish material and labor-complete in accordance with above specifications, f i'the spm of: Paymerrt to be made as follows: � _ dollars (q&I���-✓`CJS ) 1 All material is guaranteed to be as specified.Alt work to be completed in workmanlike manner Authorized �,(\ according to standard practices.Any alteration or deviation from above speciation involving Signature "�bllt2d� extra costs will be executed only upon written orders,and will become an extra change over and above the estimate.All agreements contingent upon strikes,accidents or delays beyond our _ N e: proposal may be control.Owner to carry fire,tornado and other necessary insurance.Our workers are fully oov- withdrawn-- if accepted within days. ered by Workmen's Compensation Insurance. 17 Zirreptante Of proplWal The above prices,specifications and con- � Signature " ditions are satisfactory and are hereby accepted.You are authorized to do the work as specified.Payment will be made as outlined above. I.. Date of acceptance:' Signature This contract is not transferable i Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR ' RegiStration:,,,149535 Exp iatiQn..�1120/2008 Type- Ltjq Liability Corporation l .: ; AMERICAN EAGLE ROOFING LLC. 3 JEFFREY MARKLIS k 6 SHEDD RD. �; ✓ BILLF;RICA,MA 01862 Administrator NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit at: 10 S is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 111 S 150 A. Also, note Permits are required under Fire Prevention laws Chapter 148 Section 10A. The debris will be disposed of in: Rc'LA) &-t (Location of Facility) a ure of Permit Applicant l sLo � Date The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations w d 600 Washington Street Boston,MA 02111 '�M Sia www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl Name (Business/Organization/Individual): AUY14410 Address: City/State/Zip: 6 ()Iea -161 U - U 1pZ Phone.#: Areyou an employer?Check the appropriate box: Type of project(required):., ' 4. I am a general contractor and I 1. I am a employer with ❑ g 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp. insurance comp.insurance.$ required.] 5. E] We are a corporation and its 10.[] Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.E]Plumbing repairs or additions myself. ' co right of exemption per MGL Y �o workerscomp. 12.[ toof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp.insurance required.] *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 the policy and job site information. Insurance Company Name:(" Policy#or Self-ins. Lic.#: L�/ b�(J Expiration Date: ZZL69 Job Site Address: !� �c� �C Lam/ City/State/Zip: A&-, l A 14) A4 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 c t u der the pain nd penalties of perjury that the information provided above is true and correct Si atur`e: Date: l 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#: _I - _. A CORD DATE,MMA)DIYYYI) TM CERTIFICATE OF LIABILITY INSURANCE 5/2/07 PRODUCER THIS CERTIFICATE IS ISSIEDASA MATTER OFINFOIRMATION James O'Connell Insurance Agen ONLYAND CONFERS NO RIGHTS UPONTFECERTFICATE 754 Boston Rd HOLDER THIS CERTIRCATEDOESNOT AMEND,EXTENDOR Billerica, MA 01821 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER TBA AMERICAN EAGLE LLC INSURER& GRANITE STATE JEFFERY MARKLIS INSURER C: 6 SHEDD RD N BILLERICA, MA 01862 INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. SR ADIYL POLICY NUMBER POUCYEFFECTIVE FOUCYE(PIRff0N IIAFfiS GENERALLIABILITY EACH OCCURRENCE $ 1,000,000 A COMMERCIALGENERALLIAB0.lTY 49678 5/2/07 5/2/08 PRHu11SEs Faooar— a 50,000 CLAMS MADE F—I OCCUR MED EXP(A-M—pars" $ 5,000 PERSONAL&ADVINJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATE LIMITAPPLIESPER: PRODUCTS-COMPIOPAGG $ 1,000,000 POLICY �T LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMB ANYAUTO (Eaaxidant) $ ALLOMEDAUTOS BODILY INJURY SCHEDULED AUTOS (Per P—) $ HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Pg ) a PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANYAUTO OTHERTFHAN EAACC $E _ AUTO ONLY: AGG $ EXCESSIUMBRELLALIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ S DEDUCTIBLE $ RETENTION $ $ WORKERS COMPEdSAT10NAND WCSTATU- O H- B EVSPLOYERS•LIABILITY TBA 5/2/07 5/2/08 RYU _ ER ANY PROPRIETORPARTNERIFJXECUTIVE EL EACH ACCIDENT $ ZOO IOFFICER/NEMBEREXCLUDED? E.LDISEASE-EAEMPLOYEE $ 100 "SPEbd=beV19QdSI3, w", ELDISEPSE-POUCYLMAHT is 500 OTHER D BSGRIPTION OF OFERATKINSI LOCAIIONS I VE H CL.ES I EXCLUSIONS ADDED BY END CRSEMENT l SPECIAL PROVISIONS GENERAL CARPENTRY I CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIESBECANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE SUING INSURER W ILL ENDEAVOR TO MAIL 30 DAYS W RITTEN NOTICETO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DOSO SHALL IMPOSENO OBLIGATION OR LIABILITYOF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTA WES. _- AUTHORIZED REPRESEN ACORD 25(2001/08) ©ACORD CORPORATION 1988 v10RTIy And 0" 0 T f over No - - __ 37Y * --_ - oa dover, Mass. • O COCHICHEWICK 1 �d ORATED )P"e 7�7 ` BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System • BUILDING INSPECTOR THIS CERTIFIES THAT....... 0..��1s� Foundation 1. ............ .............................................. ................. has permission to erect...... ..... buildings on . ........ .�. �. Rough t0 be OCCUpled as.......... �� .s- ........ Chimney provided that the person accepting this perm' II in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes d 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 Vow PERMIT' EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTCST ARTS Rough ... Service BUIL SPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a ConspicuousPlaceon 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.