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HomeMy WebLinkAboutBuilding Permit #87 - 11 SECOND STREET 8/1/2008 BUILDING PERMIT of pORTH�o ,bgti TOWN OF NORTH ANDOVER o? '.` -~ *° o°�, APPLICATION FOR PLAN EXAMINATION 70 Permit NO: Date Received y Date Issued: �S n- � ` ok SSACHUS� IMPORTANT: Applicant must complete all items on this page LOCATION /L/3 . 2 4 �Sf . Print PROPERTY OWNER Ann RP4 to Print MAP NO: `3d PARCEL: 03 ZONING 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 DESCRIPTION OF WORK TO BE PREFORMED: S'� A Rood = ngtCAA� Y\CLO �bc� Identification Please Type or Print Clearly) OWNER: Name: An Q P gL6 r2ee1U Phone r Address: t —t 3 , ►�� CONTRACTOR Name: --Z rt-tZ Phone: R7 7 Address: Supervisor's Construction License: 0s-t r Exp. Date: 7-41 ,_z,c5 ,c Home Improvement License: 10 50' Exp. Date: Za 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: $ 5 '7 6 - 5,U FEE: $ 7 3 Check No.: Z& ��" Receipt No.:��3�0 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund signature of AgentJOwner gSignaturemmofcontractor�,�� �'�F 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 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 Departmentsignature/date COMMENTS i 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 - Date Doc.Building Permit Revised 2008 i 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 Li 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 o Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract Li Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) o 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 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) o Copy of Contract o 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 Location//— No. ocation /No. Date " ,.ORTq TOWN OF NORTH ANDOVER � • 1 LA " Certificate of Occupancy $ sACMUs<�' BuildinglFrame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 2 - 3 J Building Inspector J*N*R 7. All Types of Home Improvement 114 Hale Street, Suite 204 i I 1-lave0hill, MA 01830 s i Haverhill,MA: (978)372-4088 Boston,MA: (617)423-3559 +r Andover,N4 A: (978)475-3723 Nashua.NH: (603)595-2272 - Woburn,MA: (781)937-4212 Portsmouth,NH: (603)43 3-18 11 Natick,MA: (508)653-2200 Manchester,NH: (603)666-5502 www.jnrgutters.com Fax: (978)372-0360 Toll Free Natimrwide: (800)966-9238 PROPOSAL SUBMIT , dOpUIU PHONE 978-269-4513 DATE 07/30/2008 STREET 11-132 11111-111113 2nd St. JOB NAME ROOF f CITY,STATE M Oftid&eT,MA 01845 JOB LOCATION j I ARCHITECT JOB PHONE Ale j1t11yw-5V hereby to furnish m ial and labor-complete in ace rdanc th specifications below, for the sum of: Payment to bejnade as follows: dollars(3-15—n"15 I w I I' it t A _ Note:this proposal may be ..<er— j I Signatore _ withdrawn by us if not accepted within `i rm- - tiWe hereby submit specifications and estimates for: J-N-R WILL STRIP THE SHINGLES FROM SAID BUILDING AND DISPOSE OF IN A LEGAL FASHION. WE WILL BE APPLYING AN ALUMINUM DRIP EDGE AROUND THE PERIMETER OF THE ROOF. THEN A 15LB, 'I WEIGHT FELT PAPER WILL BE APPLIED TO ROOF DECK. THE SHINGLES THAT WILL BE USED WILL BE A 30 YEAR ARCHITECTURAL DESIGNER STYLE. (CUSTOMER WILL HAVE THE CHOICE OF THE SHINGLE COLOR) ANY ROOF BOARDS NEEDING REPLACING WILL BE AN EXTRA CHARGE AT THE END OF THE .i !i JOB, THE JOB SITE AREA WILL BE CLEANED ON A DAILY BASIS. ANY REMAINING OR STRAY NAILS I WILL BE PICKED UP USING A MAGNET. THIS IS OF COURSE TO PREVENT ANY INJURIES FROM Ij HAPPENING. WE CARRY$2 MILLION DOLLARS LIABILITY IN ADDITION TO WORKERS COMPENSATION INSURANCE. THIS IS TO PROTECT YOUR EXPENSIVE INVESTMENT AND TO PUT YOUR MINDS AT EASE I I KNOWING THAT I TRULY PUT FORTH EVERY EFFORT TO PROVIDE ALL CUSTOMERS WITH THE HIGHEST QUALITY STOCK AND PROFESSIONAL SERVICES. PRICE INCLUDES SIX FEET OF ICE AND WATER SHIELD. i PRICE INCLUDES RIDGE VENT. I NOTE: i j PRICE INCLUDES CERTAINTEED 5-SURESTART PLUS COVERAGE WHICH INCLUDES: • 1000/a COVERAGE FOR 15 YEARS ON DURATION, MATERIALS & LABOR, TEAR-OFF, DISPOSAL j AND WORKMANSHIP. I NOTE:WHEN WE DO THE ROOF ESPECIALLY IF YOU HAVE A SPACE IN BETWEEN YOUR ROOF BOARDS, THERE WILL BE SOME BLACK SOOT (DEBRIS) FROM THE ROOF. WE RECOMMEND THAT YOU COVER YOUR POSSESSIONS WITH PLASTIC. JNR CANNOT BE HELD RESPONSIBLE FOR ANYTHING THAT IS IN YOUR ATTIC NOR THE DEBRIS CAUSED FROM REMOVING THE SHINGLES. 1;ACCk'.}Jt'11tCt Of J�rJOVVEiZd - The prices,specifications and conditions listed above and on the back of this form are satisfactory and are hereby accepted. You are authorized to do the work as specified.Payment will Signatut be made as outlined above. Date of Acceptance: ' ,,�> Signature �S ✓fze �rynz moazasetz`l�. e f���aa�arA%�i ,� :,card of Building,RebulaGc,s ..;?stand:..us �U– =` `j� HOME IMPROVEMENT CONTRAC G;<. Registration: 108503 Expiration: 8/19/2008 4 Type:`Supplement Lard ,!N R GUTTERS, INC I K.-F-ViN FRANCIS l x1830 Jf�e �oo�vnaarruec /i o ✓��a�aaeluweCla Board of Building Regulate s and Standards Construction Supervisor License License: CS 80515 Birthdate: 712111965 — Expiration: 7/21/2009 Tr# 78 Restriction: -:00 KEVIN M FRANCIS 31 LAWRENCE ST HAVERHILL,MA 01830 Commissioner 03/04/2008 11:30 FAX 978 531 4857 B R McCARTHY 10002/002 —" —MAR. 3. 2008 6- 14PM ASSOCIATED INSURANCE N0. 8340—P, 1/1 SSUE DATE 03/03/2008 ROb[1CI?R 'nM C RTIPICATE IS ISSUED A5 A MA R OF ft*VFMATION ONLY AND K McCsothy Durance AgenOY CONFERS NO RIGHTS UPON Ii CSR CATS HOLDS-77115 CERTlF1CATE DOES)40T AMM'E7(MWD OR AL TJ16 COVERAGE AFFORDED BY 7716 nc VOUCIRS ambw. 10 Centennial Dtivo COWAMS AFF RDING COVERAGE "body,MA 01960 St11tED N R Gutters Inc COMPANY A AIM.Mutual It a Ca &40 Lens=Street I LETTER averhill,MA 01830 CT OR a mER DOCUMENT VVi JH RfsSPI:CT TRIS 1S TO C1iRT1FX TEAT ISU 7 k1E POI CIES OF IND]1V0 ANY RSQUIIibMENT', PERM OR CONDITION 0 ANY CO POtiICIETHEPOLICY B.DFSCRI[3ED HEREIN 5 SUBJECT PERIOD Q4D1CATED,NOTa11TH5'fAN I0 WHICH THIS CE1l'fiftCATB MAY 18185 DOR MAY pFItTAM,i7 NistBiANC6.AFF0RbED BY TO ALL THE Tm cE J3FICATO0NS AND OpNp ON$Of SUCH POLICIES_LNJTS 69OWN AY HA 9B6N R1:DUC1�0 Cis• muco] co TYrs OF 114suwco roucv x"mm "TI cMolp » t►ATC Mit Lra �1,w000.1®GwTs (;pwLALuAmLm PR V Goh�lOPAO� �,t;ADV.QOtIRY � �jp C@�nr.11AEILIrV OCCuumce �QCIAMBMADB© � ME ANAG8(AW��� �OWt=,jACONTR M01MKW- MBD. (Nymep�lo�) $WMA AUTObUMWZw�� gpp 9 ouuar ANY AYYO � •ILOWN04101 %mm=AUTos eOD Y"URY �nwtn'os V� NONVWNIM AVMI CALAGR LOu.trr rll Ml7YDAiiAGB: ocamas�+te Excsueeunw UMORiu.+iO 0TN6ASfGN"W3UAV" A WORXXW COMYBNSATlON AND X 6MPLOYEP$T.IA81Ixrw EL ACCMPM 100,000 09/Z0/200$ IL sr�-FOLMU 500,000 A 7013435012007 09/20/2007 140,000 rN� BYCL SL5E—EACH Co RNM pES,CRitrT[ON OF OF 0RLOCAT1ONSa i 13'► 01 T1�ANY OF TIS A80VIYbESC��A. :CW.S BS C�1NGT�J A�1ORE TME t37�IRA110N DATE NBRP.bP,T}tE yggtrLJa COMPANY Wul, .... . VOR TO n No N L LWOOSB NTO u ON pt pERNAWMDT072tE1�PlrNTPA1>Jl7 . :TO MAILSUCHNOT[C59A�1]. R LtA6EnY OF ANY XWD l7EON THE COM jm'ITs AGENT'S OR REPtt1+�FfATNeS kytg0=Zp On=WATM The Commonwealth of Massachusetts Jj) Department of Industrial Accidents '1 0 r�f 1 IIl1 Office of Investigations e• 600 Washington Street Boston MA 02111 www.tnass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Z- r1- Address: — c{y L c.►n e, e s4C_r S' City/State/Zip: V -,eA V�11 ✓n 0 0 1%3 0 Phone #: 9 r?'�_ 20Z464' Are you an employer?Check the appropriate box: Type of project(required): 1.�?I am a employer with Z 0 - 7 5 4. ❑ I am a general contractor and 1 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 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9• ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself.[No workers' comp. c. 152, §1(4), and we have no 12.E] Roof repairs insurance required.] t 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. +Hunieowners who submit mis aiiidavii indicating they arc 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 their workers'comp,policy information. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: i V✓\ Policy#or Self-ins. Lic.#:--7 0 (2S '7 Expiration Date: 9 --e p .00 F Job Site Address: I I- 13 D n 8 City/State/Zip: k, ��dot�n " l� 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. /do hereby certify under the pains andpenalties of perjury that the information provided above is true and correct Signature: Date: l- 200 T Phone#: ?� 7 2 y p 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#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance g coverage. Also be sure to sin S b and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below.ow. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax# 617-727-7749 www.mass.gov/dia ORTH ® oAndover ........... -No. - �� - -_ o dover, Mass., O t- LAKE 1. i� COCMICKEWICK 7,p ADRATED �� 7 S BOARD OF HEALTH Food/Kitchen 1 s _ Septic System PERMIT T D .,i BUILDING INSPECTOR THIS CERTIFIES THAT.........tWPM—.YX...........Pr1..p... .0.cafpe....................................................................................... Foundation + has permission to erect................................. buildings on .../f...../L?.......C2 ...�3..? ........................... ....... buildin ....... Rough j to be occupied as.. �........#.................�!Lo.. .. ...".'� ............................................................................_............. Chimney provided that the person ac opting this permit shall every respect 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 / PERS EXPIIES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONS UT'S Rough Service BUILDING INSPECTOR Final Occupancy Permit Required to OccuP1 Building GAS INSPECTOR Rough Display in a Conspicuous Place o'n the Premises — Do Not Remove Final No Lathing or D■ y Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE smoke Det. REVERSE SIDE