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.
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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:
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Policy Periost ONE. YEAR -from 09/13/05 to 09/13/06
This declarations page together with the policy jacket, the policy form and any endorsements, completes this policy.
M.
Coverage begins at 12:01 A. Standard Time at the covered premises.
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Basic Annual Endorsements State Taxes Total Annual Add'I/Return
$635 $635
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Bldg./Location 1
Address if Different
Mortgagee Information
Business Description SIDING INSTALLATION
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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
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" 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
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. . ..........................................:............................. 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.................. .........................