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HomeMy WebLinkAboutBuilding Permit #149 - 114 WAVERLY ROAD 8/25/2006 TOWN OF NORTH ANDOVER NORTH APPLICATION FOR PLAN EXAMINATION Of 4t-•o �tio . • , • 0 . O Penn it NO: Date Received At Date Issued:_ sS�eNuse IMPORTANT: Applicant must complete all items on this page LOCATION 41Y 6)avek. Print J PROPERTY OWNER r.,- c/S 4.lL Slee, j /� Print IAP NO.✓ PARCFI.: �o� ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF INIPROVEIMENT PROPOSED USE Residential Non- Residential New Building `/One family . Addition Two or more family Industrial C \Iteration No. of units: epair, replacement C Assessory Bldg _' Commercial Demolition Moving(relocation) Other - Others: Foundation only DE ,CRIPTION OF WORK TO BE PREFORMED �Lls�c�c.(h.—�c N• Identification Please Type or Print Clearly) OWNER: Name: l SDS 6j1 at-4�.- `� � Phone: Address: fit/ vee CONTRACTOR Name: racer L� ( aafl2�L Slc����roa 41- hone• �17�-��7-2,0 address: t M0�fi S'1— ' Supervisor's Construction License: D r i 3 Exp. Date: AI 7 Iluntc Impro�cmcrrt License: COLPJf Exp. Date: 1;3G Ob' ARCI-IITI CT,ENGINEER Name: Phone: 'Lddress: Rcg. No. FEE SCHEDULE:BULDLVG PERMIT-510.00 PER 51200.00 OF THE TOTAL ESTIMATED COST BASED 0A-S125.()0 PER S.F. Total Project Cost.:s xl2.00=FEE:$ Check No.:. & 62 Receipt No.:,�� Parte lot 4 TYPE OF SEWERAGE DISPOSAL _ Tanning;Massage%Body Art Swimming Pools Public Sewer _ Tobacco Sales Food Packaging;Sales Well _ _ — Permanent Dumpster on Site _ Private(septic tank,etc. _ Electric Meter location to project :MOTE: Persons Contracting with unregistered contruetors du not have access to the gnaranty J'und Sionature of Agent/Owner Signature of contractor Plans Submitted Plans Waivedr1 � Certified Plot Plan !'. Stamped Plans THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF- U FORM DATE REJECTED DATE ,APPROVED PLANNING & DEVELOPMENT ❑ ❑ ❑Water Shed Special Permit ❑ Site Plan Special Permit 0 Other CONINIENTS DATE REJECTED DATE APPROVED CONSERVATION CONINIENTS DATE REJECTED DATE APPROVED HEALTH CONINIENTS Zoning Board of Appeals: Variance. Petition No: Tonin« Decision:receipt submitted }cs Planning Board Decision: Comments Conservation Decision: Comments 'i atcr& Sewer connection,Signature& Date Driveway Pci-mit Temp Dumpster on site yes 110 Fire Department si-nature,date_ _� ..„ l/ � ,► L�s1G 6 0 Building Setback (ft.) Front Yard Side Yard Rear Yard Required Provided Required Provides Required Provided i Dimension Number of Stories: Total square feet of Floor area, based on Exterior dimensions. Total land area, sq. R.: NO'rES and DAT;1—(For department use) Fa!x 34 l I J.:eI(1SUI-P;-1RPvILNI:M11lakM,lj 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 o Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract Floor Plan Or Proposed Interior Work Addition Or Decks ❑ Building Permit Application ❑ Surveyed Plot Plan ❑ Workers Comp Affidavit a 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) 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 ❑ :'v1ass check Energy Compliance Report 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:1'tiSV1-' F10N.\L. VR\R L!l UP:P.1R'I'\IIiV'Pa3PI Q)R\1115 _ Location No. A/9V � Q Date NORTH TOWN OF NORTH ANDOVER O? • • OA + ; , Certificate of Occupancy $ sACNUSEt� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ ' Check # f 19518 9�LBuilding Inspector—/--- ------ NORTH Town of Andover 0 No. JAI9 _ T - A dover, Mass., HEWICK �A ORATED S _ BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.............. ....... ... ................ ...................... Foundation has permission to erect........................................ buildings on ..& ......�j�� .....�........... Rough t0 be OCCUpled aS.... .. . —"--- &---- ­ --- ..................................... Chimney . . . . . . . ........ provided that the person accepting this pe shall in every respect conform to the terms of a application on file in Final this office, and to the provisions of the s and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andove . PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final �� , PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTR � STA.. TS_ Rough .................. .... ...... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building m 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. - ` The Commonwealth of Massachusetts Department of Fire Services Office of the State Fire Marshal P.O.Box 1025 State Road,Stow,MA 01775 PERMIT Date: North Andover Permit NO Dig Safe Num er (City of Town) (If Applicable) ,4 In accordance with the provisions of M.G.L14 S Chapteer1Q_as provided in section 5 97 CMR 34 Start Date This Permit is granted to ��� fh L 4 / �' Full name of person,Firm or Corporation Permissionto locate dumpster for construction/renovation/demolition of building. V : dumpster must be 25 ' from structure if unable to place with required ns: clearance dumpster must be covered with 1 wood or tar end of work day T---T (Give location by street nd no.,or describe in such manner as to provied adequate identification of location) Fee Paid$ 50.00Fire Chief This Permit will expire, Zo—Xl- 6(Signature /of of tcal granting pernut) Offical granting permit (Title) �� TN1C PFPMIT M1 ICT RF C`nWgPU-1 V11 1C1 Y P01CT1=n 11Pr)P1 TNF PPFMICFC ��� .. .`r� �/re (inoirrn�.n{cu.allf- ��:-T�trauzr,.lrr�sn,�t BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR f _ Number: CS 028043 ..: a Birthdate: 10/05/1946 a' Expires: 10/05/2007 Tr. no: 4862.0 Restricted: 00 GERARD E OUELLETTE 31 PIEDMONT ST t, METHUEN, MA 01844 f/ Commissioner 4 .�� .�e.Lnrv�yvrruyncupa�t� �`:i'�,craaacluee�d —_ Board of Building Regulations and Standards } HOME IMPROVEMENT CONTRACTOR Registration: 102049 Expiration: 6/30/2008 Type: Individual GERARD E.OUELLETTE Gerard Ouellette 33 Piedmont Street Methuen, MA 01844 Deputy Administrator ;/ The Commonwealth of Massochnselts j Deportment of Industrial.Iccidents Office of Investigations 600 Washington Street Boston, AN 021 I T Ivww.Mass.CFO v/ilia Workers' Compensation Insurance Afftdasit: Builders/CuntrictorsiElectriciansi Plumbers Applicant Information Please Print Legibi Address: �J C iq State,Zip/ ---LJL 1�` �' �� T Phone 17��F7—�! U r_1,11Fiz e you an employer?Check the appropriate box: Type of project(required): I .un a employerwith }. ❑ I am a general contractor and I 6 ❑ New construction employees 1Full and'or part-timet.* have hired the sub-contractorsI am a sole proprietor or partner- listed on the attached_.heet. ` ' ❑ Remodeling ship and have no employees These sub-contractors have S. [] Demolition working For me in an capacity. vorkers' comp, insurance. 9 5. El We are a corporation �md its ❑ Building addition [No workers' comp. insurance officers have exercised their 10.❑ Electrical repairs or additions required.] of 3.❑ 1 iin a homeowner doing all work right of exemption per FICC I LE] Plumbing repairs or additions myself.[No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs � nsurance required.]} employees. [Vo workers' I3.�ther Sl vt f K(ecus _ comp. insurance required'.] I — IN Ipplicant that dvxks box,I I mu:;t.IL,o IiII :ut the codon below:,hawing their workers'compen_aticn pulley inlorniation. I Ii.nieostiers tvllt)..IIhrnit this Afitlavit Indicating Ihey are doing AI work;Ind then hire outside ct:nlractors must xubmit anew affidavit indicating uch. I .titractcrr,that.heck this Nix must.uCtched:tit.Idditicnal:beet;howine the name-;f the,uh-contractors and their`.vorkers'comp,policy micrniatit)fl. 1 am an employer drat is providing workerscompensation insurance Jar my emplulvees. Below is the policy and job.vile i n%nrmuliun. In�:urance Company dame: Polio 'i)r Self ins, Lic. ' :-------------------------___..-- Expiration lob Site.Address: City State Lip: ----- — — — -- - ..__ ittach a copy of the workers' compensation policy declaration page!showing the policy number and expiration(late). Failure to .ccure covcr:ge as required under Section 25.1 of MOL c. 157 can lead to the imposition ul'critninal penalties of a tine up to S1,500.00 and,or une-;­_ar imprisonment,as well as civil penalties in the form ofa STOP MRK t?RDER And a tine t-tp to'S_50.00;t day against the v iolator. Be adv i;.ed that a copy of this tatement may be Forwarded to the t lftice of (n`-+r tl�aticns c(the DLA for insurance I.;oecr.i e tcriticcttion. fu hereby cerfquntler the pains)end pentrllies g1'pequiy that the in%)rmoliun provided above is true rn d correc•l. G eJ ;� ,'' ,! r...i-,L=-- ,r •!r l Pis ,i r ,'ti• �t(�rJcrl"t{: ;{• �r.r re ;ri�'.�ul. -- �._.:_--------il �I h ,.•'tAdhig i.T9!"'d�P'l'.'$ ... '•i i 2 r_ "( '. 'r •�1.7 'kC. ' nWJKrVL'I AML uzijnAn muwuAL P 1tu. inzu iAn%, VVMYAnx SMALL CONTRACTORS POLICY RENEWAL CERTIFICATE Policy # R0311023 .arced OUELLETTE, GERARD E Agent SAMEL INSURANCE AGENCY, INC Insured 31 PIEDMONT ST Phone (978) 474-0810 METHUEN MA 01844 Agent # 20790 FORM OF BUSINESS: ......................v::w..,. ....... ...............r:-r.�.�::::.�:::r::::.�:::::::::.vr:.�:::::riJ:?F:i'•iiii'+:f::!vJ:!3:??-J:•JJii: :-Ji!-:J:4:"!�riJr:++f J:i:iJ:?4:`.h:..•-�.�.�.�. ........................ rv::rev+�.:!?•i:+fri:^:•�i?i:::.>:::::::.�:R'4'-:f--:::r...,. ...................., r.�::::::::::::}}Y+J'vJ'-JiiiJ}":: ... v:v::::nv::::::::::::::�hr1.?:•..,.?......,._._:.:..:v:.:::•:?!.. .... ...:.:w::.v.......e... ...r....r......:-.....:J:iJ ...,....:..-... .. ..................:..:..................................f:x:::::: r..... .. ......r................. .r:lf.•:�•:::::::rr.:4::::r::•::::n........,.,v.,.,....r.rv:::.�•.�+•:.••:::-::--:ii':•Ji:.::•v:: :...._:.:.:.... v:.v::,-+.fv. ..:::v:;... ..r.......n...........:.... ... .......:......v.........................n.r.........._._....._.....,..:::•::N..f............f..................::r:::::::...:...•>.?i Yf.!3:?•�.��.�ii:+:�?!!Siiii:::.::.f.:?v:?r '}��y�a♦SCJ v.f.•.:•1.!v:::::.?v:.v:::.�:::-:.::r:.f+?..:1?.:::::::.:::.::.:.�::::.:-::, . 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Basic Annual Endorsements State Taxes Total Annual Add'I/Return $635 $635 :... /r:+x•,•.•..... ..•.;..•..•• ......:.r.... ... .. r r..:r� .r� .,� .. .. .J.. is%!!:?�%�}::iiiiiiiii::Fi�::-i:is is is i:�"r.•ii:-Jilif:YFi: ,. ._... :..:r::Ji'r.i''/.r,.,•.v::•••. ....... ... f. -.x. ::. :.: ::.v..•.r.•... ... ... ... :. .•f.r. ../. ..4::.. n:. .. ,. ::.,..,.;?:.:?:.:r...:.r;!-::!._,;;:..:?�r`frir.;r.'::•J;J::j(i,:,::i::::�:??c-ra:-:-:;ii:J" :+xc?:. Bldg./Location 1 Address if Different Mortgagee Information Business Description SIDING INSTALLATION ..n "-J•Jf?tt+:rr.-::+•5:?-.t?%?••7.�f5:-Yir:•J:+-J::•::-ir:>:=:_JiJ ?+::-::ry;.::.ra:Ji;:=J::::�•J+ :.:.....r::.::r::�::-::r::::.:...:.::::::.:.(iii•:.-..... ....... . ....: .. ..:.. .r.r ;r:r r1.+r:!-:r:::.:::Ji..:+-JJJ-•:::•:::::... : POLICY DEDUCTIBLE $250 BUSINESS PERSONAL PROPERTY Limit $10,000 Incluaed TOTAL PREMIUM PER BUI LDING $635.00 EXCEPT FOR FIRE LEGAL LIABILITY, EACH PAID CLAIM FOR THE THE FOLLOWING COVERAGES REDUCES THE AMOUNT OF INSURANCE WE PROVIDE DURING THE APPLICABLE ANNUAL PERIOD. PLEASE REFER TO PARAGRAPH 0.4 OF THE BUSINESS LIABILITY COVERAGE FORM. LIAR & MED EXP (OCCURRENCE/GEN AGG/PROD COMP OPS AGG) r MEDICAL EXPENSES $300/ $600/ $600 Included DAMAGE TO PREMISES RENTED TO YOU $5 Included $50 Included - :•�r:f+rte?.-f.?-" SEE ATTACHED PAGE ..�1�`:3�.... lG. ?L�lE%T#.:1•'!tlf'31T1S •:: .,r :::.:.: . ..... . . .. 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F. .....:. f :•.'�:4Jii:?4:?vti}r•iii:;:v;+?.:!:i?.!.!?.i:?•:. _ ::..;.;::................: " EHARD E. OUELLETTE SIDING - ROOFING 33 PIEDMONT ST. METHUEN MASS. 01844 I/we, the owner(s) of the premises mentioned below, hereby contract with and authorize you as contractor, to furnish all necessary materials, labor and workmanship, to install,construct and place the improvements according to the following specifications, terms and conditions, on premises below described: Owner's Name ./k.r-1- K.V'S.......W.L.��.��!^-�.....�A. e!.�LL,_ ..............................................:.......................................... / / , /,, Job Address ..... f. :......(.UGtI/.......... .... ..............................................City ��. � State . ..�'( ..(........... /- SPECIFICATIONS ... . Q v �e.....` ... t S i v _ U.:e ...1-/..1.j......v,!.r` f ..............c� ''! / ................. �- .V�t b �... L!!t ..��.`�- . O he. ..... t 4 5 . ....x.4 . . l d1 �Cc ..... . . ..�...:�.......(.., .. � .� ..... � .�..... .. .. ... �.... ..................... ,. .s.......................... SP- ............. SS C. .. ... � .s..�SI.G..... � .u. � ...... u G.! o% c�..- .. . . . te, ....................(.uw..........C'. `�cSS..I.tJ 1 -.. . .......I.. At......aYl �. u. .-...` i. -.... l�c .�.......6 f!_44 a. ..1�.a. :vim. ..... : . . ............�` ?.... ... !/E=........................ ..........,.� lj'1s.1. !� .... .. ./.. 1!1.......................... .............................................................................................. . . ..........................................:............................. l..7Lo-. .......................... /3 Is nd 1 r to cost � .. ..... .. .... .. Payable ✓ n !!��C a ................-� .... ............. aya�le on ............. .. d' d materia s ts. Contractor will do all of said work in a good workmanlike manner. Upon completion of above work, all undersigned agree to execute and deliver to contractor, their joint note in accord- ace with his (their) above obligation and a completion as requested by the contractor. Upon refusal to do so, contractor tay at its option declare the entire contract price or so much as then remains unpaid immediately due and payable. It is greed that if permitted by law contractor shall be paid by the owner(s),all reasonable costs,attorney fees and expenses, i addition to the amount due and unpaid, that shall be incurred in enforcing the terms and conditions of this contract id/or any lien in connection therewith. It is further agreed that this contract may be assigned by contractor; and also that the obligations hereof shall bind id apply to their heirs, successors or estates of the parties. The undersigned warrant(s) that he is (they are) the owner(s) of the above mentioned premises and that legal title ereto stands of record in his (their) name(s). PROVISO: This contract shall be void and of no effort if credit approved of owner(s) is refused. There are no representations, guaranties or warranties, except such as may be herein incorporated, if any, nor any' q:reements collateral hereto, nor is this contract dependent upon or subject to any conditions not herein stated. Any sub- uent agreement in reference hereto shall be binding only if in writing and signed by all parties. gva inn n1 th;e eon ef. }+PfOrP 0.0r1r damages eac . n Receipt of a copy of this contract is hereby acknowledged,and it is further acknowledged by the undersigned that the regoing provisions have been read and the contents thereof understood and that no representation or agreement not here_ contained shall be binding upon the parties and that all of the agreements and understandings of said parties are con- ned herein. Owner or Owners are not responsible for Property (Damage or Liability while job is in operatio9h Z0 G6 IN WITNESS WHEREOF, the parties have hereunto signed their names this....419t,.......... day of.... . . ... ..... I ....... cepted: Sign .... . .. . . . ........................... Signed ..... ...................I.................. .........................