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HomeMy WebLinkAboutBuilding Permit #526-2017 - 1030 JOHNSON STREET 11/16/2016 I O� t%ORTH q °i BUILDING PERMIT TOWN OF NORTH ANDOVER � p APPLICATION FOR PLAN EXAMINATION -29"sb� * Permit NO: Date Received " °q<a• . �AATlo Date Issued: 1,6 Z2 9SSgc►+us�� IMPORTANT:Applicant must complete all items on this page LOCATION I d 30 <_A)�1 V 10 V1 1 1 P'nt PROPERTY OWNER &l) I NCS �� k ev­ MAP NO ld / PARCEL:AA4 BONING DISTRICT: Historic District yes no Machine Shop Village yes no 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 Id1enttification Please Type or Print Clearly) OWNER: Name �U t �1�JGrCs [I�Q,� Phone: _749 �, 9 Address: CONTRACTOR Na n `L Phone: q3"4 To�,� L Address: 909,(, G (,17 (� ao - -M A nx 94 Supervisor's Construction License: 5-1 Exp.Exp. Date: G1l I Home Improvement License: 2 Exp. Date:, /d ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLD/NG PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 P F Total Project Cost: $ do FEE: $ Check No.: Receipt No.: NOTE: Persons conn ctm vith unre istered contractors do not have access to the guaranty fund Signature of Ag Signature of contract, —� �� A •� 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 ❑ ❑ COMENTS CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ 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 Located at 384 Osgood Street FIRE DEPARTMENT -Temp Dumpster on site yes no Located at 124 Main Street Fire Department signatureldate COMMENTS BUILDING PERMIT �oRTK 1 OF�ztan ib E ` ` TOWN OF NORTH ANDOVER APPLICATION FOR.PLAN EXAMINATION '- '- y Permit No#: Date Received 'by �R tTED ,-'? SsgCHU Date Issued: LVUORTAN'T:Applicant must complete all items on this page l _ LOCATION. 4 ,1 DD Ybar,StffibWre yes ' no yPARCELY, ZONING D1STRICTLL�. Historic Distract` yes no Machine Shop`Village__ "yes no" 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 0 Septic 01%Vell ° El Floodplain n Wetlands 1N8fershed Disfnct' EJ.Water/Sewer. . - DESCRIPTION OF WORK TO DE PERFORMED: Identification- Please Type or Print Clearly' OWNER: Name: Phone: Address: Contractor Name:::.: . ::.;; Phone:... Address:_ Supervisor's Construction License Home lrnprovement ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. notal Project COSI: $ FEE: $ Check No.: Receipt No,_ _ NOTE: Persons contracting with unregistered contractors do not have.access to the guaranty fund 1 Signatu�e_of_Agent/O:wper Signature of contractor- ...1 Plans Submitted ❑ Plans Waived 0 Certified Plot Plan ❑ Stamped Plan- ❑ TypF OF SEWERAGE DISPOSAL Public Sewer El 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 e U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature j COMMENTS I - S 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 Connection/Signature&Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT' = Temp Dumpster on site yes no Located at 124.Main Street Fire Department signature/date COMMENT t -imension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: i� ELECTRICAL: Movement of Meter location, mast or service drop.requires approval of Electrical Inspector fres No ®ANGER ZONE LITERATURE: fres No MGL Chapter 166 Section 21A—F and G min.$10041000 fine NOTES and DATA— (For department use) ❑ Notified for pickup Call Email r ate Time Contact Name Doc.Building Permit Revised 2014 ;. , 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.1.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 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 o Certified Proposed Plot Plan o 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 act i ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products 40TE: 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:Building Permit Revised 2014 mac/ Location No. S —��7`Z Date !/ /60/� • TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $J(6 ✓ r Foundation Permit Fee $ Other Permit Fee $� TOTAL $ Check#7 ' Building Inspector � NORTf� Town of 2 n over 62 h ver, Mass A_ COC MIC MI WICK`I 5�' 7 RAre o �"Pa fJ BOARD OF HEALTH Food/Kitchen PERMI L D Septic System THIS CERTIFIES THATBUILDING INSPECTOR ............ P,4-0�... Tip /.!c. ,��rC., .. .... . Foundation has permission to erect ................. ....... uildin so;11�11 9 YO... +.. !!f... .��................. Rough tobe occupied as ....... ... .... ........ ....... ... ............................................................... Chimney provided that the person accepting this ermit 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 IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONST TIO Rough - - Service ... .......... ........ .......... Final BUILDI INSP CTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building 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. Smoke Det. Page No. of Pages xn � Builders License # 58443 Home Construction Reg. # 167338 DuvaIAL OO ,nLLC (781)944-1994 (978)664-2557 READING NORTH READING P.O. Box 637, North Reading, MA 01864 U Please visit us at www.duvaIroofing.com PROPOSAL SUBMITTED TO PF�ONE 7 r DAT704 �" t f� it P?NE / STREET CITY,STATE AND ZIP CODE ! rr We hereby submit specifications and estimates for the items checked in boxes below: j i ❑Rip& Remove all existing roof related debris from roof as well as job site with our own disposal truck. NO DRIVEWAY DUMPSTERS LI 1 layer of existing roof shingles ❑2 layers of existing roof shingles ❑3 layers or more of existing roof shingles -- _- ..... ... . --- 0'Replace any damaged roof decking; not to exceed 32sq.ft. (additional at$1.70 per sq.ft.) 0 Install 8"Aluminum Drip-edge/Rake-edge along entire perimeter(Choice of hit") rown or Mill) — - - ­ . 1111._- 1 --- - _ _ - I—--- - 1111. - 0 Install ICE&WATER UNDERLAYMENT on all horizontal eaves �sidewalls, skylights,chimney flashing and valley areas (� - - __ - _. ­11-1­1....__.- - _- —1---- - -—-- ...__ ............._ --- --- Install a premium base sheet underlayment(felt)that is in compliance with the asphalt shingle manufacturer chosen by the homeowner - Lyinstall The Homeowner's Choice of the selected Tamko/IKO or GAF Limited Lifetime Architectural Roof Shingles "See individual manufacturer's warranty for specific details or please call us with any questions ---r=--- - -_ —. LJ Replace all existing bathroom louver and/or exhaust pipe(s)with new aluminum flanges _............. _- - --1111 -- -_- 1111 - ❑Chimney(s) -counter-flash and re-step existing flashing ❑Cut& Install new lead flashing © Install a continuous low profile Ridge-Vent on all ridge lines ❑Soffit-Vents ❑ Roof Louver-Vents Sess Aluminum Gutters-Custom fabricated on site with r own gutter machine 2Downspouts ft at additional 0 Leaf Guards ❑Attic Insulation- Increase existing R. value to R. value with our own blown-in insulation machine exclusively using GreenFiber cellulose insulation 0 Other ' --1_.� 1111 1111 - 1111 _.—,—� — -____l _ 1111- 1111__ _._ _ ._ _.� '�•___-_ .� 1111_ J ------ .1_--..1111 . 1111__ 11111111 ________.___-. 11111111 1111..1111 `Please cover all items of value in attic to protect from dust and debris We Propose hereby to furnish material and labor-complete in accordance with above specifications,for the sum of: ��USVTotal price not including options. dollars($ ---------1111-- — -----..___.---- Payment to be made as follows: 30%deposit required before ordering materials.Balance due in full upon day of completion. Please make all payments out to Kenneth Duval, mailed to: P.O. Box 637, No. Reading, MA 01864 Final Payment is due upon day of completion and is subject to the Authorized supplemented Terms&Condition sheet when scheduling. Signature r THIS PROPOSAL IS VALID FOR DAYS DUE TO FLUCTUATIONS IN MATERIAL& DISPOSAL PRICES. The Commonwealth of Massachusetts z Department of Industrial Accidents d I Congress Street, Suite 100 Boston,MA 02114-2017 www mass gov/dia NVorkers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY Applicant Information Please Print Leeibly Name (Business/Organization/Individual): Duval Roofing LLC Address: P.O. Box 637 City/State/Zip. North Reading, MA 01864 phone#: 978-664-2557 Are you an employer?Check the appropriate box: Type Of project(required): l.a I am a employer with 8 employees(full and/or part-time).* 7. []New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition I[]I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10❑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 11.0 Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.ap ROOf repairs These sub-contractors have employees and have workers'comp.insurance? 6.❑We are a corporation and its officers have exercised their right of exemption per MGL C. 14.❑Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box 41 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 Travelers Insurance Company Name: Policy#or Self-ins.Lic.#:7PJ U B-023ON91-9-15 Expiration Date:3/9/17 Job Site Address: 1030 Johnson St City/State/Zip: No ANdover 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 cern der the pains and penalties of per'ury that the information pro> �elle�i�true and correct Si natur� Date:Qv Phone#:978-664-2557 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#: � tl� jtiYZ t (':/Ir�jf!Z�J���� G Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Cbxtractor Registration Registration: 167338 Type: LLC Expiration: 9/10/2018 Tr# 419291 DUVAL ROOFING LLC. A; , KENNETH DUVAL -w '; `na jnj P.O. BOX 637 E NO. READING, MA 01864 �;:x RC1 r >. w Update Address and return card.Mark reason for change. Address Renewal Employment Lost Card SCA 1 as 20M-05/11 uoziotIZ1, :uoi;eJidx:j —`aauoissiwwo0 , ., Wit . 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