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HomeMy WebLinkAboutBuilding Permit #709 - 111 GLENNCREST DRIVE 6/2/2008 BUILDING PERMITo `&ORoT" qti TOWN OF NORTH ANDOVER ?`b�s? APPLICATION FOR PLAN EXAMINATION Permit NO: O Date Received to �SSACHU`'�.( Date Issue : IMPORTANT:Applicant must complete all items on this page LOCATION / / 6_16 t<C / not PROPERTY OWNER If-& A 0Y Print MAP NO- PARCEL: ZONING DISTRICT: Historic District yes no 2_10 /°`f q — 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: Identification Please Type or Print Clearly) OWNER: Name: Y,-�>14 �aL oY LC= Phone: Address: CONTRACTOR Name: Phone: Address: Sl- c) ;717 Supervisor's Construction License: �G ��� Exp. Date: Home Improvement License: ` Exp. Date: a Z V 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: $ /0, F o 6 0 FEE: $ 1:30 r Check No.: y� �� Receipt No.: 2&&�! NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fu d ignature of Agent/Owner Signature of contractor Location No. Date d NaRTM TOWN OF NORTH ANDOVER F: • .. AL 9 ` Certificate of Occupancy $ s�CMUs Building/Frame Permit Fee $ 130— Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 21196 v 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 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 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 - 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. i 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 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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 The Coininonlr'ecrlth of'Massachiisetts Depa,-1/11ent oj-Indrtstrial Acciclerrts ' office ofIII resti, fitions 600 i1'ashirrgtorr Street Boston, AM 02111 Jill Vill.mass.gov1din Workers' Cort petrsation Insurance Affidavit: Builders/Contractors/i"'lectricians/Phil ibers ApWicant Information Please Print Legibly Natue (Business/Organizatiort/In(tividual):_ t4r joi qCf� Address: City/State/Zip: Phone /(:_ !q/--> Are you an employer? Check the appropriate box: Type of project required 1.al am dernploycr with ) 4. ❑ 1 ani a general coutlactor and I employees (full and/or part-titre).' have hired the sub-contractors ❑ New construction,2.❑ 1 am a sole proprietor or partner- listed on tic attached sheet. t 7. ❑ Remodeling ship and have no employees 'Fiese sub-contractors have 8. Demolition working for me in any capacity. workers' comp. insurance. y. ❑ Building addition [No workers' comp. insurance 5. ❑ We arca corporation and its required.] officers have exercised their 10.0 Electrical repairs or additions 3.❑ I.ani a homeowner doing all work right of exemption per MGL ILD Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no 12.❑ Roof repairs insurance required] t employees. [No workers' collip. insurance required.] 13.0Other 'Any applicant that checks hox fl must also fill out the section Wow showing their workers'compensation lxllicy ill rtnntion: t notneowncrs who sulnnil this atTidnvit indicaling they are:doing nil work and then bite outside contracturs mast sulnitit a new affidavit indicating such lConttaclots that check lhisbox trust attached ail additional sheet silowillg the"Lillie UrthC sal-coil I,actors and their workers'comp.policy i"fornwlion. I am an employer that is providing wo►-hers'compensation insurance for n+y employees. Below is the policy and job site Mformalio►r. Insurance Company Name: A E m M i U-K J Policy H or Self-ins. Lic. #: /IJ L sJ 6 Ijs/ Expiration Date: 11/61 f d $ Job Site Address:_ / // �r f r.�t C/z �Zq _City/State/Zip: /4/4 Attach a copy of the workers' compensation policy-declal-ation page (showing lite policy number and expiratiou 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 lie form of a STOP WORK ORDER and a fine of up to$250.00 a day against tic violator. Be advised that a copy of this statentcol may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify unde the pains and penalties of pe►jn►y that the injornration provided above is true and correct signature: Phone N: 9'1 jF . - -7 f– -7Ts/ Official use only. Do not xvite in this area, to be completed by city o►•torten official. City or Town: Pernlit/License # Issuing Authority (circle one): 1.Buard of health 2. Building Department 3. Cityf['own Clerk 4. Electrical Inspector 5. Plumbing itispector 6. Other — i Contact Person: I'hone tic M NORTH 0TNM o 6Andover No. 7o9 74 70*-�r:� dover, Mass., o C OC MIC NE WICK RATED i"' C2 `S BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT A4#1......% . Zoaw .... .. Foundation hapermission to erect.................... . �/� �r � .. ... Rough P buildin s on ... to be occupied as..... ......... .............. ..... �.. . .d.�tnforim ......p�. ... .................................... Chimney provided that the person accepti this permit shall in every respe to the terms 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 3 d . PERMIT' EXPIRES IN 6 MONTHS UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR Rough Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR 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. SEE REVERSE SIDE Smoke Det. HowE 904VOVEWEW CC1UFRAiCYM a-raves tw VIONAIM 400L Ift I retam tai: ?° 137:r57., OmAlbb arutw lits R m 1381 �= We I trm t2fit4 Mm.am Type= Qf3�. ko4LER C44E HOOF JOHN LANZAFAW rr , 158 A MERRI MACK;S_ "ETHEUN,MA 418 is A t , tS M"20 4afi" E00M Two 11855 @i .1OM W LP4#Z1wFA E 30TEMPLE DR L4ETI"UEK MA 0844 mer InILKNLI InaURANUt tax:9786870149 Nar 19 2008 12:01 P. 01 ACORV CERTIFICATE OF LIABILITY INSURANCE DATE(MMlb"Vvy) 0311512008 TW CERTIFICATE IS I&$=AS A NATTER OF INFdkMATION uftrI't+5t lnsurartm gency ONIY App CONFERS NO MGM UPON THE CERTIFICATE Chickering R t "MAW TW CEMOVATE DOSE NOT AHEM,>OMW OR [NOM Anrl0"I 01845 ALTER THE+ AFFORDED W THE POUCIES BELOW. I NUPSl6 AFFORDMrp CMERAU NATC R INQt m-V NORFOLK&DEDHAIA INSURANCE COMPANY JOHN NZAFAME VaLwim&- AIM DBA A UNDER ONE ROOF 30 t.E DR " c' MWE MA 01844 " E 'AWf he POLICIES OF I LISTED SHOW HAVE IM LSSU M TO THF INSU�NAMEIDA90VE FOR THE POLICY POW 114DICATED.N01WITHSTANDING REOiNR W. OR CONOrnON OF ANY CONTWT OR OTNER DOCLAIESIT MIRTH RESPECT TO YWMM TWS'CERTIRCATE IW1Y 9E I,S&llEO OR MAY PWAIN.THE IN E AFFORDED BY THE P©LiCIES DEEGRIBEQ wREIN IS SOWECf TO ALL TME TERM6,EXCCL�OSIg AND COThy BE IS OF OR POLO 8,AGWRE" L%M 30som%my HAVE saw REDUM Sy PAID CU1MA&. t TYPE IIIRANCE 1'O!JCY NIIMlfll tlllTf A GENERAL R0401433A 091032007 06/0312008 EACHOCtXREOICE &1,000.000.00 J CONYMARC OV&PAL LIAGUTY 1,000,000.00 CLAIW E © OCCUR P Eaooc�snx i MED E)W(AnY eM po M 85,000.00 I MONAL i AOY stpAY &1.000-DOO.00 Party s Y.O000.00 N'LADtY PROJECT RE TELYlTAPEj LOCCiEj OgOPRODUM_COMPMFAGG S?,000,000.00 ANY AUT C9 xo11ED 61NOLE L"T s ALL 0AUTOS 8CWOUL AUTOS rP.ll t efsREO s s1LFT06 (pj Y t GARAGE LIAN TY ANY AUTO AUTO ONLY-EA ACCIDENT s O TRAM EA ACC S ONLr ,� s SXC91SM M LIAJTI/ EACNOLCURR NCE c OCCUR Q CLAMS MADEEAC" t RETE ;TIOs B rERr LIAML `AM° AWC?004464012007 1110812007 i 110812008 s __ TORY LIMIT$ Y PR Rt TOIRFA� TwItm IECUTIYE E L EACHAt'.CiiDENT = 400,000.00 M QKO bb IMIrlR Ed 01iEJ115'EA 61FLOW S 100.000,00 ME4�IAL PR blow OTMER E L D18EA8E POLICY LIMIT :50<.000.00 IRTiFlCAT! CANCELLATION Ge*Ma ANY OR TOTE ABOVE MVIUM POLE W CANCUM UPORE WE EX14RATION "15 T"maw.TOE sp pm SISSWaE1t ML OMAVOR TO NAIL 30 DAY&NIRA'TEN 109 TO TEE CMTWVATE NDLDER MAMW TO TME LEFT,BUT FA1f.YRi TO DO 90 am LL 1 POK NO OIILI"7"OR""W"or AW MO UPON TMi IOMAM 95 AGMTS OR fflWME#TAW4M AUTM01lmE SAA k A sigma• IllYluuc aur jJIIVIIC , Iu1l11JC1 vl %IJC BOA 111A411HICt3/AlIC4\Cll.at a U1114111111,11 Iul ua w 14111 w 1c3pullu "ItI III MC shortest reasonable time as determined by the federal Communications Commission,not to exceed 30 days, 6 IT '75 0 • UNOIE AlkAggal Big40MIE R404OF Chimneys Residential 81 Commercial Roofing � Types Of to M CHIMNEYS POINTED-REBUILT-CAPPED Expert Masonry Work Siding Hoof LeaJ�rs FxFerts Licensed& Insured Mass Tout Free '-c�;P= License#034200 Locally 03vneYf do Operaierl Strte 197G a 1-800-WAIT-4-US 4-84T) 1924-8487} IKO G�uPl' 'I�Za�1n n� 9r1lr✓s we Work V xon�la I / - Date Proposal Submitted To Phone e7 ' ��� � ' Street Job Location Job Phone City,State&Zip Code We Propose hereby to furnish and labor in accordance with specifications below,for the sum of: Dollars l L J - .L/�'. - tom 17w,to All material is guaranteed to be as specified.All wort:to be completed in a workmanlike Authorized manner according to standard practices,Any alteration or deviation from specifications be- Signature: low involving extra costs will be executed only upon written orders,and will become an extra charge over and above the estimate.All agreements contingent upon strikes,accidents NOTE:This prop I may be or delays beyond our control,Owner to carry fire,tornado and other necessary insurance. withdrawn by us if not accepted within days. Our workers are fully covered by Workmen's Compensation Insurance. rez Fn cifications and estimates for: 1W� -- 04)L - ��' pecial "Save Seat" ice and water barrier protection along all bottom edges of roof in each valley.*roof is stripped,we will apply conventional ice and water shield h in the same location previously described.and tar paperwill cover,the remaining bare wood. Any rotted or damaged boards will be replaced at{ ) per linear ft. or ( ) per sheet of plywood. !d Install heavy gauge aluminum drip edges along every edge surface of each roofline. drover entire roof (s) it -fiberglass, premium grade shingles ` (Color of choice). Lc— U Replace all pipe boots where possible. Sea( all flashings with clear Geo-Cel sealant. No black tar unless previously applied. O'Remove all work-related debris. Contractor warrants roof against all leaks due to defects in his workmanship for 12 years under normal circumstances. U Local current references and proof of workman's compensation insurance gladly given. Remarks: n_s7 tt �ac2c i Qac='S acral �c'1uc="Gzc� c� 't�: , -^�t) } � = tip t eptance of Proposal - The above prices,specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment Signature: will be made as outlined above. Date of Acceptance: Signature: A. Portland 400 Warren Avenue, Portland,ME 04104 207-797-7950 Fax 207-797-5846 Bangor 35 Godsoe Road,Bangor,ME 04401 207-947-8112 Fax 207-947-4386 A..L.. an LeaZt,n..dr Auhurn MF n491n 9r17_7R4_1595 Fav 2n7_7R4-nX;69 Eastland 00 Warren Auenue,Rortland,UE 04104 207-2977:7950 Eal 207,797-5946 w Bangor 35 Godsoe Road,Bangor,ME 04401 207-947-8112 Fax 207-9474386 ,nA ACO%C r....Qn7 70A nRL:0