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HomeMy WebLinkAboutBuilding Permit #800 - 12 GARDEN STREET 6/14/2006 ISI f 40RTH 7 O tt�ao,•�NO 3?t.�,, ...,,, • OL ^' TOWN OF NORTH ANDOVER o s" APPLICATION FOR PLAN EXAMINATION SSACHUSE (P Date Permit NO: V� P Date Received: ( / Date Issued: IMPORTANT: Applicant must complete all items on this page Ii LOCATION Print i PROPERTY OWNER e Print MAP NO.: �t PARCEL: '� ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non-Residential ❑New Building Wne family ❑Addition 0 Two or more family ❑Industrial Cklteration No. of units: epair,replacement ❑Assessory Bldg ❑Commercial ❑Demolition ❑Moving(relocation) ❑Other ❑ Others: ❑Foundation only DESCRIPTION OF WORK TO BE PREFORMED Identification Please Type or Print Clearly) � 1 OWNER: Name: Phone: !q 7 C 79/ Address: `� G6} D�!�( 55 r ature No, AAIOCIy�4 11%, CONTRACTOR Name-a)UYCk-k Phone: 9?Fr:G(S/-c26 Address: P0 8 (, 3 -2 NU ft4C) Is-6 Cy Supervisor's Construction License: Exp. Date: Home Improvement License: / 0 5aee Exp. Date: ARCHITECT/ENGINEER Name: Phone: Address: Reg. No. FEE SCHEDULE:BULDING PENT.S10.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED OILY S125.00 PER S.F. Total Project Cost :$ '�i�o2C�O x10.00=FEE:$ Check No.: / Receipt No.: 71� Page 1 of 4 Location /a a No. r�f<) Date NORT1y TOWN OF NORTH ANDOVER 419 Certificate of Occupancy $ low cwust< Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # Building Inspector TYPE OF SEWARGE DISPOSAL Swimming Pools El Art ❑ Public Sewer Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ F1 Permanent Dumpster on Site ❑ Private(septic tank,etc. NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner V Signature of Contractoe Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF-U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ I ❑Water Shed Special Permit ❑ Site Plan Special Permit ❑ Other COMMENTS r�t DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS Zoning Board of Appeals: Variance,Petition No: Zoning Decision/receipt'submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer connection signature&da Temp Dumpster on site yes_no_ Fire Department signature/date Building Permit Approved and Issued by: Page 2 of 4 Building Setback (ft.) Front Yard Side Yard Rear Yard Required Provided Required Provides Required Provided DIMENSION Number of Stories: Total square feet of floor area,based on Exterior dimensions. Total land area,sq. ft.: NOTES and DATA—(For department use) Page 3 of 4 Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 Created IMC.Jan.2006 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 i ABuilding 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 Addition Or Decks ❑ Building Permit Application ❑ 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) 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 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:BPFORM05 Page 4 of 4 Page No. of Pages i i Builders License # 58443 Home Construction Reg. # 109288 Both Aj 9 ==valJ& MM 4w ,am AL Ahm MrM Rullpfin.,,4-� LLC (781) 944-1994 (978) 664-2557 "The Areas Oldest Roofing Company" r P.O. Box 637, North Reading, MA 01864 I PROP ALS 0 PHONE DATE r u STRr / / r rb ' ME ` ' caro. Qy( p, �j/ CITY,srA Arlo ziP c j r r J r 90 l� '-" / - f I r, � We hereby submit specifications and estimates for: Recommended Optional _; (Included in price) (Not included in price) t� Rip& Remove all shingle debris from roof&job site: CY1 layer 0 2 layers J 3 layers or more _- a •� Repair/or Replace any roof decking; not to exceed 50sq.ft. + Install 8"aluminum drip-edge/and rake-edge along entire perimeter. Choice of milr,white pr brown • Install ICE&WATER underlayment along horizontal eaves,valleys,sidewalls and sky-lights&chimneys _— --- _-� 4, Install premium base sheet underlayment between roof deck and roofing shingles • Install 25yr CertainTeed/GAF/Tamko or Owens&Corning traditional 3-tab roof shingles J 30 year Install 30yr CertainTeed/GAF/Tamko or Owens&Corning architectural roof shingles C. r a40,yearY FO 50 year ❑Lifetime -- -- - -------- See manufacturer warranty policy for more details 1 *✓ Install new aluminum vent-pipe flange(s) V Chimney(s) -counter-flash and re-step existing flashing ❑Cut& Install new lead flashing • Ridge-vent/exhaust vent with low profile design, hidden by shingle caps - ❑Soffit-ventilation ❑ Roof louver-vents Y • Seamless style aluminum gutters-custom fabricated at job site - - ❑downspouts — - - ---- ---- --- � "� -- ✓ Other__4_, 1. , , r t r _-sem__f -L-4-L '- f_ -- ---- - --- 'Please Note:All items in roof attic should be removed or covered due to falling roof particles,at time of roof tear-off Price includes all items above that are checked only/others may be priced separately upon request. 'Xi e Prapas$ hereby to furnish material and labor-complete in accordance with above specifications,for the sum of: Total price not including options. dollars($ t Payment to be made as follows: 30%deposit required before ordering materials. Balance due in full upon day of completion. Please make all payments out to Kenneth Duval, mailed to: P.O. Box 637, No. Reading, MA 01864 Late charges of$50 per week for all outstanding bills due upon day of Authorized completion. Signature -Accepting proposal means agreeing to the terms of the enclosed binder Note:This proposal may be contract. Please sign contract&return top copy(white)with deposit. withdrawn by us if not accepted within 3 t days NORTH ANDOVER BUILDING DEPARTMENT"' Tel: 978-6$8-9545 DEBRIS DISPOSAL. FARM In accordance with the provision of MGL c 40 S 54,a condition of Building Permit at: is that the debris resulting from this work shall be disposed of in a property licensed solid waste disposal facility as defined by MGL 11,S150A. Also, note Permits are required under Fire Prevention taws Chapter 148 Section 10A. The debris will be disposed of in: (Location A Facility) Signature of Permit Applicant Fire Department Sign off: Dumpster Permit Date ✓<ze -Po7nmw�,uuea�i a��i�aclucael2a Board of �. Building Regulations and Standards License or registration valid for individul use only HOME IM?RO [MENT CONTRACTOR before the expiration date. If found return to: Registration: 109288 Board-of Building Regulations and Standards Ek-ira-`_ion: 9/C.',20-C. One Ashburton Place Rm 1301 Type: DEA Boston,Nla.02108 DUVAL ROOFING Kenneth Du.,nl 72 NORTH ST N. READING,MA 01864 Administrator Not valid without signature i I i i i The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street WO Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information r,, yal Reef:.... L L G Please Print Legibly Name (Business/Organization/Individual): PO Box 637 Reading, MAO!864 Address: City/State/Zip: Phone #: Are you an employer?Check the appropriate box: Type of project(required): 1.b am a employer with� 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or pa time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. t ?• ❑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.El Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.E] Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12&1 roof repairs insurance required.] t employees. [No workers' 13.7 Other comp.insurance required.] *Any applicant that checks box#1 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 their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: fir/ / Policy#or Self-ins.Lic.#: 3 ���� /�► a C� Expiration Date: Job Site Address: l C;2 City/State/Zip:�/�1� 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. I do hereby certify under pains and penalties of perjury that the information provided above is true a correct. Si nature: Date: 3 Phone#: 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 coverage. Also be sure to sign 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. 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. # 617-7274900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax#617-727-7749 www.mass.gov/dia WORTH Town of t 4Andover 0 + _ - No. �►" �, - LA O dover, Mass., I� COCMICHEWICK Ids RATED 7 E BOARD OF HEALTH Food/Kitchen PERMIT T. Septic System -A BUILDING INSPECTOR THIS CERTIFIES THAT..................... ... .......... ............ ............. .......................... . Foundation has permission to erect........................................ building n .. ..... ..... .............. ................................... Rough • Chimney to be occupied as..... ........................................................................................ provided that the p rson accept! this permit sha Min every spect conform to the terms of the application on file in Final this office, and to the provisions the Codes and By-Laws elating 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 PERMIT EXPIRES IN 6 M NTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTI TS Rough .. .. .. ... .. .... ..... ... ............. Service LDING 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.