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HomeMy WebLinkAboutBuilding Permit #458-15 - 11 HERRICK ROAD 11/10/2014 NORTH BUILDING PERMIT °F.1 -66 TOWN OF NORTH ANDOVER 32 y �-a�.* °� APPLICATION FOR PLAN EXAMINATION �o L Permit No#: 5 J Date Received Are gSSgcHus�� Date Issued: O/14 I PORTANT:Applicant must complete all items on this page J LOCATION I PROPERTY OWNER �GL /" Print 100 Year Structure yes no MAP PARCEL:_/( ZONING DISTRICT: Historic District yes no Machine Shop Village yes o TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ne family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District Water/Sewer DES RIP ONO WORK TO BE 7_Y51VIED, Iden ificat}}'��n--Please Type or Print Clearly / J /� OWNER: .Name: X) Phone: b 3 �1`�C�� Address: 1� �c / /�/�� � � - /� Contractor Nam&6 Phone:_ a-3 -,?b -cam/ Address: Supervisor's Construction License:64 I`7 Exp. Date: �7,J V�� . Home Improvement License; � 1 � Exp. Date. /49 ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ zV�� d� FEE: $ �a Check No.: , Receipt No.: ��` 1'S NOTE: Persons contracting with unregistered contractors do not have access t the guar my fund Signature of Agent/Owner Signature of contracto �' 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 o 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/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) ❑ 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:Building Permit Revised 2014 i Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE'OF SEWERAGE DISPOSAL t Public Sewer ❑ Tanning/Massage/Body Art ❑ Swmm�ing 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 f i PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS I I CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Siqnature s L COMgNTS 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 Driveway Permit DPW Town Engineer: Signature: gn ature• r '' Located 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 21A—F and G min.$100-$1000 fine NOTES and DATA — (For department use) ❑ Notified for pickup Call Email Date Time Contact Name ; Doc.Building Pen-nit 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 L3 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/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And j Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products e 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 o 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:Building PermitRevised 2014 t%O R TF1 BUILDING PERMIT qti TOWN OF NORTH ANDOVER ° APPLICATION FOR PLAN EXAMINATION Permit No#: ,5� ' J Date Received �gssgcHus���� Date Issued: / O IMPORTANT:Applicant must complete all items on this page LOCATION . PROPERTY OWNER <. . : 9` 'Print 100 Year Structure yes no MAP-^ PARCEL L^/J((o ZONING DISTRICT: Historic District yes nco . Machine Shop Village yes c TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ne family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other - ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DES RIP ONO WORK TO BE 7)�RIVIED, Iden ificatj�o j;�Pl se Type or Print Clearly 6 �7_ �_ 7 OWNER: Name: 1 �j--, X� , Phone: (� Address: Contractor Nam &G`_ Phone: Address: Su'P _ �ervisor's Construction_L1 ense:6�>~ tO/y Exp. Date: Home Im rov pement License: l / � Exp. Date: 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: $ /-,P�yb" dy FEE: $ ��- Check No.: Receipt No.: a S-C `, NOTE: Persons contracting with unregistered contractors do not have access t the guar my fund ,Signature of Agent/Owner Signature of contracto Location No. Date l l • • TOWN OF NORTH ANDOVER . „ Certificate of Occupancy $ ,� Building/Frame Permit Fee $ Foundation Permit Fee ✓" $ Other Permit Fee $ TOTAL $ Check# Building Inspector pORTy Town o s _ n over No. - �oh ver, Mass, jo (4 coc«�c«ew�c« 1• U BOARD OF HEALTH PERMIT T Food/Kitchen LD Septic System THIS CERTIFIES THAT ......................... BUILDING INSPECTOR .. .. .................................... . has permission to erect Foundation .......................... buildings on ... . ...... ..... L .......................................... �+ Rough tobe occupied as ..................1.8 ....�.......1?. ...: .. ... . ......n...................................... Chimney provided that the person accepting this permit shall in every respect confor o the terms of the application on file in this office., and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Final 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 CONSTRUCTIO T TS Rough Service BUILDING INSPECTOR. Final GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz 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. 1lepaitni..ent of liiausti,ial Acciaeiits N 1f pce ofInvestikatpons Co n Ge 10 ` B'st©n MA 02114-2017 wyov in ass.aov/dia Wor kers.' Coampensation Insurance Affidavit: Builders/Contracto.rs/Electticians/Plumbca=s Applicant Information Please Print Legibly. Nam.e Business/Organization/Individual Address: > �_ 2)b� City/State/ZipPhone A:re.you p employer? Check the appropriate box: Type of project(required): 1. am a employer with �� 4: [� I.anz a general contractor and I , ' , 6. Q New construction ' employees (full and/or.part-time).* Have hired the sub-contractors i 2.0. I ani a sole proprietor or partner- listed on.the attached sheet. 7. El Reinodeling M These sub-contractors have ' ship and Have no employees 8. 0 Demolition working for me in any capacity. employees and have workers' [No workers"comp.:insurance comp.insurance. 9: 0 Building addition required.] 5. 0 We are a corporation and its 10. lectrical repairs or additions officers Have ekercised their . 3. I arri a homeowner doing,all work 1190:0f ' airs or additions: myself. o workers' comp. .right of exemption per MGL , Y p 12 repairs .. insurance required.] t 152; 1(4),and v ' c we ha e no employees. [No workers' .13.0 Other comp.insurance required.]. .f *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 providinz, wor kers'compensation insurance for niv employees. Below is the policy and job site, information.' In y Name: Company an ` 1/ �l Policy.#or Self-ins. Lie. #: t,W62 : DZ17W Expiration Date:: 1012,��/- Job Site Address: City/State/Zip Attach a copy of the workers' compensation policy declaration page(showinb 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 o f 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 F do hereby certify unde_rtl e pains and penalties of perjury that the inforniation provided above is true and correct Signature: _ Date: . Phone#: G% O.ficial use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License# Issuing Authorify (circle one): 1..Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector {� .6. Other Contact Person. Pl:o OR #: I Aco CERTIFICATE OF LIABILITY INSURANCE' 6/1A8/2014° ' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE QOLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the polity,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). CONTCT PRODUCER NAME: Cathy Beguregard FAX Eaton&Berube Insurance Agency, Inc. PHONE Arc No 11 Concord St - E-MAIL Nashua NH 03064 } ADDRESS:cbeaurea INSURER(S) AFFORDING COVERAGE NAIC INSURER A I INSURED AJCPR INSURER S Arch InSUran AJC Properties LLC INSURER C dba AJC Roofing INSURER 0: clo Mark&Shirley Freeman j 11 Daylily Drive INSURER E I Nashua NH 03062 =R F: CERTIFICATE NUMBER:1663964287 REVISION NUMBER: COVERAGES THIS IS TO CERTIFY THAT 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IN R1 �ODL'SQBRI POLICY EFF POLICY EXP LTR TYPE OF INSURANCE IN WVn POLICY NUMBER MMIDDIYYYV I MMIDOlYYYY LIMITS B i GENERAL LIABILITY I i AGL001113600 4/13/2014 4/13/2015 EACH OCCURRENCE !$1,000,000 X A AGETZ r TED $100,000 COMMERCIAL GENERAL LIABILITY I PREMISES occurrence) CLAIMS-MADE OCCUR I MED EXP(An one parson) 510,000 iIx 500 i PERSONAL&ADV INJURY $1,000,000 i GENERAL AGGREGATE S2 000,000 GEN'L AGGREGATE LIMB APPLIES PER: I PRODUCTS-COMPIOP AGG $2,000,000 iX POLICY PRO- i I LOC I I $ JECT C 'AUTOMOBILE LIABILITY I KA0113773 �i12412014 6124/2015I ` Eeacc —1 Rl x0},000_ ANY AUTO BOC._r INJURY(Per person) S j ALL OWNEDX SCHEDULED I ( BODILY INJURY(Por occident) S AUTOS AUTOS PROPERTY DAMAGE IX HIRED AUTOS X AUTOSWNED j I Per student S $ I I�UMBRELLA LIABI OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I RETENTION S $ A ;WORKERS COMPENSATION WC288300204706 612712014 16127/2015 IX I�STATu- OTHFR- AND EMPLOYERS'LIABILITY Y I N E.L.EACH ACCIDENT $700,000 I I I --LL �� j I ANY PROPRIETORIPARTNERIEXECUTIVE i OFFICERIMEMBER EXCLUDED') i N/A I I E.L.DISEASE-.EA EMPLOYE $100,000 (Mandatory In NH) It yes,describe under i E.L.DISEASE-POLICY LIMIT 5500,000 DESCRIPTION OF OPERATIONS below i I I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space is required) J Fd CERTIFICATE HOLDER CANCELLATION J SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN For Informational Purposes Only ACCORDANCE WITH THE POLICY PROVISIONS. Go AJC Properties LLC 11 Daylily Drive AUTHORIZED REPRESENTATIVE Nashua NH 03062 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD ' I II �e �rsnznzv�zcc fel!/r� f•l�lfar arc/r..mff :3 Office of Consumer Affairs&Business Regulation 4 4."ROME IMPROVEMENT CONTRACTOR � egistration: 153131 Type: Expiration: 90/30/2016 Ltd Liability Corpo' i AJC PROPERTIES DR. MARK FREEMAN 11 DAYLILY DR. _ NASHUA,NH 03062 Undersecretary € IN I � i I I i I I i MARK FRtEMAN I l ID,AYL ILY IDR WE Nashua tai _r4 ^a,or om r ss,c^ r 07/1&201f -- 6 nsr: 7 IM R p S 9 ati n XP tion 1�; Ty p, A CER is Q 1 qvi LY C, HU. ,NH 3002 -- Underseeretarn i I 11 DAYLILY DR NASHUA, NH 03062 ' PHONE: 603-204-2134 www.AJCROOFfNG.com GAF License#MEI 7845 AA MA CSL#96194 MA HID 153131 Roofing Contract Subsidiary'of AJC Properties,LLC. To: Home Phone: Date:Idle R Street: Cel Phone: By: 4t x tr`� �7-Sf3-y,?6 --7- PI/W fi-eT-M40, Ci ,State Zip: Job Address:Same We propose to furnish material and labor complete in accordance with specifications outlined below: EXISTING ROOF consists of #Comp Layers: #Wood Layers: Metal Layers: ROOFING SYSTEM to INSTALL:Manufacturer&Type: Color: fear Off: Comp: Woodshake: Metal: Q' ply Decking: 1/2"CDX ❑1/2"OSB ❑Other ak Barrier: StormGuard El WeatherWatch [J Other Feet�ide along rakes Feet wide along eaves 919tarter Strip Shingles: fro-Start ,—❑,,,�WeatherBlocker 06ther Drip Edge: ®Color: JA `t f E�a' []Other Valleys: ❑Closed Cut ❑Weave ❑Leak Barrior StormGuard OLeak Barrio'WeatherWatch 0400f Deck Protection: El-deck Armor [IShingleMate ❑415 Felt E3#30 Felt (]Other []� stall Pipe Boot(s): C]—I"-3" D- Z-3"-4" [].oKe-Flash chimney(s)$ L I and wall abutment(s)$ D.$tiiingle Fasteners: 1/4"Nails 0 Other Nails per shingle: �? t [MIc Ventilation: 'Cobra Snow Country ❑Cobra Exhaust Ridge Vent E]Other 'Itdge Caps: ❑TimberTex Ejteal-A-Ridge ❑Other y1 ®Magnetically sweep yard for nails/Clean up yard and haul away roofing debris For the sum of:Dollars:($ /y. 4 1 includes labor/material/dumpster,excluding options. 1�11t t' G —r2jrl� -C Kt ( ructions: r Existing Roof Removal:No charge has been made for removing additional layers of roofing,unless specifically stated nbaJe.If additional iayers{si ofr6onng are found during removal of existing roof that exceed i layer:the customer shall pay an additional charge of$40 per 100 sq ft for each additional layer of roofing removed.Additional charge is due upon completion of Nark. Deteriorated or Rotten Wood:No charge has been made for replacing wood.unless specifically stated above.if rotted wood is discovered after removing the existing roofing system.standard 4'x8'plywood used is$65.00 and will be applied each sheet.58.00 per linear ft up to 1--x6`;$10.00 per linearft above I-x6" for dimensional wood lumber and$to petlncar ft for I x composite material. Payment Terms: 113 due at time of contract signing. Contract balance due upon completion of work. # Start Date: weather permitting VISA ma End Date: weather permitting Estimate is valid until: > Financin Options' war. . . ty. � GAFF Manufacturer Warranty%7 1'J *See`brochure GG1^�rZ` 7-7 f D-KC Roofing Labor Warranty 'L ear(s) Acceptance of Contrast:The above prices,specifications,and conditions are satisfactory and are herby accepted.1/We agree to the contract provision on the back side of the contract.AJC Rooting is authorized to do the work as specified.Payment will be itiade.per Payment Terms abo e. Owner: {, J J) r//{ Owner: Date Date AJC Roofing: Date: _ NA110NAL ROOM ' r