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HomeMy WebLinkAboutBuilding Permit #582 - 101 ELMCREST ROAD 5/4/2009 ttORTH BUILDING PERMIT TOWN OF NORTH ANDOVER o � APPLICATION FOR PLAN EXAMINATION � p ry Permit NO'J/J Date Received ® �SSACHUS�� Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION 'S Print PROPERTY OWNER. Print MAP NO: PARCEL: ZONING DISTRICT: His District yes n Machine Shop Village a Y es (no0 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 DESCRIPTION OF WORK TO BE PREFORMED: Identification Please Type or Print Clearly) OWNER: Name: Phone: 1'::;7d' vS/ Address: CONTRACTOR Name: cur - ' � / l :Phone: ?`8,;' 711 Address: Mlk Supervisor's Construction License: ze4� Exp. Date: Home Improvement License:' ` '. Exp. Date: ? ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COSTA ED ON$1 0 PER S.F. Total Project Cost: $ f a� 0 a° FEE: $ Check No.: r Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund SLignature of Agent/Owner , / .,/ Signature of contractorlo Location No. J Z Date NOR,h TOWN OF NORTH ANDOVER. + ; Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 2 1991.30 Building Inspector ' 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 Signature COMMENTS HEALTH Reviewed on Signature a 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 DEPARTMENT Temp Dumps o ' ' ,yes/' ,.,, no Located at 124 Main Street Fire Department signature/date ' --o 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 �5 up ❑ 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 ❑ 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 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 Revised 2.2008 V4ORTH ToVM of _� _ 4Andover . No.4,Y8 Z _ `A' S dover, Mass., '.�' • d COCMICKEWICK ADRATED C2 `s BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System 3.0 BUILDING INSPECTOR THISCERTIFIES THAT........... ...................0.;.......................................................................................................... Foundation has permission to erect........................................ buildings on .��. ............. �^.L! A.. ...................... Rough � Chimney to be occupied as..... ....... . . .. ....... 9..&. ......1�.1�!. ......................................................................................... provided that the person ac piing this permit shall in eve espect 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 CONSTRU S Rough ...........................:........................................................ Service BUILDING INSPECTO Final Occupancy Permit Required to Ocmpy Building GAS INSPECTOR ' Rough Display in a Conspicuous Place o�n the Premises — Do Not Remove Final No Lathing or D' 7 Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. ov TE _ . -. cdKip �F�C { # � Stk� tier "N` .s; r f311L.= ,. r•� A,l. x�i'^s..:5"�..iS'� "F"''t r,� �`fYv � oy c t='i't�'s°' ,�. _E'::',�t5<<,2..ta:��,F,':aaf'��� �ag vv.`�% .. J.�;,--wy� .4e`Sf,lFka4k._- £ <'t rs 7.4c , B .�A ?7 t v..f. By �3AH� VAS i 2 ' 44a ..�..� ._. �;.. �°w _� .._,.....,.._.._. U�-'•-'`sv� r'}:G_s..'!2L%�t°� ..r/d.`.!'Jr}l/Q ;' C.s.s o��a��tr :rte �,;� ..... .` .v5�.o�•z+? r L _ .rs. :qt,:�`w;ti..'^' ..S•- :. A.' Xi.c r t:z:,,,:f ..:.7+.2,.vf -+.� i.a4f �"��^wf�',h. ?tits-x :Y..t:. ..�tt i.. , aaYa r s ' .�c'S is j�F'"•i^ ^,,13 Yin�`. -l++,1:3.'t,C£i .,.::"u'^.. --:.x'_':?::.!"Ta•u%btC^.� �'.'�' .. ... 1, r 37 W*045/252008 5/25/2009 5/V/2008 5125/2009 5/2//2008.. 5/25/20 '44304.5,`?:''2009 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations a d 600 Washington Street Boston, MA 02111 V www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Z,-q Address: City/State/Zip: Phone#: 7 Are you an employer?Check the appropriate box: Type of ro'ect re uired am a employer with - - —_Y�—P—J (�1 ) employees(full and/or part-time).* have hired the sub-contractors 6. E]New construction 2.❑ I am a sole proprietor o d o ttac a he t. 7. Remo ship and have no employees These sub-contractors have g. ❑ Demolition workingfor me in an capacity. employees and have workers' y p �'• 9. E]Building addition [No workers'comp.insurance contp. insurance.t required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.E]-Roof 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. xContractors 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: Z;:ZA,y, 1-e Policy#or Self-ins. Lic.#: p-1 s"9J'_ Expiration Date: Job Site Address: /a City/State/Zip: �� c%v e d �� 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 certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: �� ��d �c�C-1 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#: Board of Building Regulations and Standar HOME IMPROVEMENT CONTRACTOR ds Registration; 148422 Expiration;: 9/22/2009 Tr# 133270 Type: Individual LAWRENCE HILDEBRAND- LAWRENCE HILDEBRAND 30 SHERIDAN ST. WOBURN.MA 01801 -,�-- _ _ Administrator _:''=�•, ;�lassachusctts- Qehartment �tf'F'utalic Satct�:, Board of Buildin; RI'�u rti�ans and t:rtltlard ' .Construction Supervisor License License: C.S 90389 Restricted to ,QQ LAWRENCE „HfLDEBRAND �. 30 SHERIDM, ST V WOBURN MA 01801 s M, r . )R I-I{:EIVSE c-- " - �y Expiration: 5/24/2010 C'onumasionc+r'` Tr#; 25739 s _ s IVN RESIDENTIAL R00►FiNG 3 QUALITY 'ROOFING r PROPOSA f��CONTRA i LARRY HILDEBRAND 30 Sheridan Street tk:lr Woburn, MA 01801 t,ii; Ws Name: Owners Address 781.789.9711 Qi SJ i 101 Elmcrest Rd CS090389 ,es City s Zip Code Ownees Home Phone Owner's Work Phone larryhildebrand@verizon.net ,rth Andover 01845 978-886-524`4 978-580-9286 ct Address Project City Project Zip Code Project Phone Date .me 4/25/09 ity Roofing by Lang Hildebrand,hereinafter referred to as"Contractor",hereby proposes to furnish to Owner all materials and labor necessary to roof and/or improve the e premises in a good,workmanlike and substantial manner according to the foil o wing terms,specifications and provisions: ascription of the work and the materials to be used: _ Use-tarps to protect.house_&properly f pm_sh_ q removal&installation - - Remove.all old shingles from the house dispose of in dumpster we will provide.,_ Examine roof deck We will make any minor repairs free of charge up to l sheet of plywood 1)CM the edge of your roof at all the eaves,and all penetrations such as vent pipes and attic vent fans we will install Ice and Water Shield 9 feet from roof edges due to long overhangs. 2)At the edges of your roof,eaves and rakes we will install drip edge and Graf Pro Starter Strip. 3)Install Shingle-Mate.Roof Deck Protection,a breath"membrane -- )Install Timberline Prestrque 30 Year Arblirtectural shnigk—Color r _ —5)-1 Colica-Ridge Venf_ _ - -- _ 6 Install"Rid ge-Ca cf At completion of installation completely clean property of all roofing related debris: ascription of any areas that will NOT be worked on: This list of specifications may be continued on subsequent pages(see page number below) ayment:Contractor proposes to perform the above work,(subject to any additions and/or deductions pursuant to authorized cb ange or s. for the Total Sum of$12,000.00 Down Payment(if any)$ AV_ PAYMENT DUE WHEN AMOUNT PAYMENTS TO BE MADE IN INSTALLMENTS AS FOLLOWS: Balance upon Completion -C� By check upon receipt of invoice for draws as described under "Payment Due When" to the left .. . . . . _ columna ornmencement and Completion of Work: Substantial commencement of the job shall mean either the physical delivery of materials onto the premises or the rrmance of any labor and shall be subject to any permissible delays as perprovision(3)on the reverse side of this proposal/oontract.. Approximate Start Date: Approximate Completion Date: cceptance:This proposal is approved and accepted.I(we)understand there are no oral agreements or understandings between the parties of this agreement.The written s,provisions,plans(if any)and specifications in this proposal/contract is the entire agreement between the padies.Changes in this agreement shall be done by written change r only and with the express approval of both parties.Changes may incur additional charges. Nional Provisions Of This Proposal/Contract Are On The Reverse Side And May Be Continued-On Subsequent Pages(see page num ber below).Read ce To Owner on page two(2)before signing.Read"Arbitration of Disputes"provision on page two(2) provision 10 and the NOTICE following this vision.If you agree to arbhration,sign on the line below bre NOTICE where indicated.Also,sign in the same place on EACH COPY of this contract. NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES ' You may cancel this agreement if it has been signed by a 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 office or branch by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the third �- app and accepted - date business day following the signing of the agreement.See attached notice of cancellation for an explanation of this right. NOTE:This proposal may be withdrawn after_days from ap (contractor) date if not approved and signed by both parties. RPC-C Copyright©1996-2008 ACT Contractors Forms(800)8205656 www.calform.com Page one ofd_Total Pages