HomeMy WebLinkAboutBuilding Permit #521-2017 - 120 MARTIN AVENUE 11/15/2016 t Y
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Permit NO: !:,;al - 222/? Date.Received
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Madhine-S.op Vh gle yes -no
TYPE OF °MPROV5MENT PROP08ED s_inE i
Residentiai i Non-Residentiai i
❑� ..
❑Addition ❑Two or more family. � ❑ Industrial �
' ❑ " i',_a c'$:s% c],'" i 7�P,`6��'�: ❑ �lyu L i(.-kRi1•
P'Repair,
replacement. ❑Assessory;Bl o -Others:
tl Sontic . Ci lilell
i . 0 F node .in ❑Aet ands n ifflaters> n Ois.6r:,
j
U.water/sewer
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Identification Please Type or Print Clearly) -
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OWNER: Name: ��' Phone: 9'76-68 Q'l10
Address: lelo Mh"tj AVF
iC IAA' V GQ r.Uarrnd: R -4�tgc5l— P-of 1 t�ph,6r z: 003_ 153_�"
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Address; 1 .� _ ��� ._ Q CI_
Supervisor's Construction License. f� / 7��- Exp. Cate; )ZAi&
�. Node Improvement License'. EXp. Date.-
1S7Z8 22 /7
ARCHITECT/ENGINEER Phone:
Total Prolect Cost: $ 3 )/ E FEE: $
Check No.: �_S �/ Receipt No.:
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I�AORTJI
BUILDING PERMIT
TOWN OF NORTH ANDOVER 0
APPLICATION FOR.PLAN EXAMINATION
co ON.
Permit No#: Date Received
�SsaCINU
Date Issued:
EVRORTANT:Applicant must complete all items on this page
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40� DD—Year
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TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
0 New Building 0 One family
El Addition El Two or more family 0 Industrial
0 Alteration No. of units: 0 Commercial
0 Repair, replacement 0 Assessory Bldg El Others:
0 Demolition 0 Other
ft.,f
b,*S'6*p'tfid M We
0 Floodplain M Wetlan s El V _
,va ers e, District
EI.Water/Sewer
DESCRIPTION OF WORK TO BE PERFORMED:
Identification- Please Type or Print Clearly'
OWNER: Name: Phone:
Address:
6dritr-86-tbrName:,:
i Nd
Phone:;
-C
Supervisor's p, d—e
� t at
nse.i.,;
% .
Home Im
REJbot,License
E - 4
ARCHITECTIENGINEER 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.
i—I.Total Project Cost: $ FEE: $
Check No,: Receipt No,.
Persons contracting wide unregistered contractors do not have:access to the guaranty fund
Sigri ii Vie: gen_ qweer sidnbturo of cohtrabtorJ
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
o Building Permit Application
o 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
o Building Permit Application
D Certified Surveyed Plot Plan
❑ Workers Comp Affidavit
o Photo Copy of H.I.C. And C.S.L. Licenses
o Copy Of Contract
o Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
o 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)
o Building Permit Application
o Certified Proposed Plot Plan
o Photo of H.I.C. And C.S.L. Licenses
o Workers Comp Affidavit
❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
• Copy of Contract
act
o Mass check Energy Compliance Report
o Engineering Affidavits for Engineered products
40TE: 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:Building Permit Revised 2014
C , A
`Plans-Subtirnitted ❑ Plans Waived Certified Plot Plan ❑ Stamped Plans ❑
IYP ,bF 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
PLANNING & DEVELOPMENT Reviewed On Signature_
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
COMMENTSN
F
-)imension
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
Total land area, sq. ft.:
ELECTRICAL: Movement of Hueter 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)
`4 i
❑ Notified for pickup Call Email y
ate Time Contact Name =
Doc.BUding Permit Revised 2014 _. ,
Location
No. Date
• • TOWN OF NORTH ANDOVER
Certificate of Occupancy $ �
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check# NS( 1-1 ilp
!�
31193 f' Building Inspector
F_ 1 i NORTH .
: w : . : ve-
0 :.
No.
h ver, Mass, � • �,� • �b
COC«IC«ew.cw �.
�A0RArEt)
U BOARD OF HEALTH
Food/Kitchen
PER..MIT T LD Septic System
RX70-4.4--o7. BUILDING INSPECTOR
THIS CERTIFIES THAT .... ...........................�..........
has permission to erect .......................... buildings on Ja.0.......YA.m&1'
!'T.
AV
... Foundation
* Rough
to be occupied as
............... .�../�.........0...........Ae............................................................ Chimney
provided that the person accepting this permit shall in every respect conform to the terms of the application Final
on file in 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
PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
UNLESS CONSTRUCTIC TS Rough
co ® - - - Service
.......... .. ... ..................................................... Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Required to Occupy BuildinLy 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.
Smoke Det.
MA. H.I.C.REG#157288
_J Talbot Roofing & Contrasting, Inc. Salesman: tL
LICENSE#CS SL 101775 Residential,Commercial&Condominium Roofing Solutions
FED ID#26-0661197 1-888-755-1535 / 603-755-1535
www:talbotroofing com-
NAME: ] AregCk 4 S AZA A )?_ilA4qA+3 ADDRESS: ij A W
HOMEPHONE#:�j�a87- )V10 CELL#:�_S_00_ 7 EMAIL:
1. Contractor agrees to do the following work: FV24# T OF /1149/N t4W
2. Install tarps from roof to ground to protect the house&landscaping.
3. Remove existing layers of shingles and dispose of them properly.
4. Inspect for rotted wood.Will replace roofing boards at$3.75er foot and 1 2"
p / plywood at$2.00 per square foot.
V14gv-
5. Apply--& feet of e&Water Shield to all eaves and 3 feet to all valleys/openings.
6. Apply Synthetic Fiber Reinforced paper to remaining area.Name: IAJO/?00f_
7. Install Heavy Duty 8 inch drip edge to all eaves and rakes.Color to be: hite- Mill--Brown--Copper
8. Install new pipe flanges to all existing pipes.Aluminum/Copper
9. Install ertaintee GAF Architectual Shingles to manufacturer's specifications,to include swift or pro starter shingles to all eaves.
10.Shingle Name__L. *A"-) 6Lk2_X t>A Color J� 11 j
11.Install EF
Rid /Timbertex Customed Cap on all ridges and hips.
12.Install Shin levent Two Ridge vent to all ridges t
g g g o ensure proper'ventilation.
13.Re--lead Chimney YES N0.New lead will be sealed with Geocel.
14.Worksite will be cleaned on a daily basis and all areas will be gone over using a 3--foot magnet.
1S.All necessary permits will be the responsibility of Talbot Roofing&Contracting.
16.Talbot Roofing&Contracting will supply customer with Liability and Workers Cornipensation Insu,2nce Cc. �ficate prior to any work being
performed.
17.Upon completion and payment in full,your new roof will have a v.o(kmanshio vr_arrant fo-a =-ic.�cf S years issued by Talbot Roofing&
Contracting and ZO years honored by the shingle maufactu ar
The Contractor agrees to perform the work, furnish the materials and labor specified
above for the sum of: $ f��
Payments to be made as follows:
$ QUU upon signing contract(not to exceed 1/3 of total contract price.)
$ by J / or upon completion of halfway point.
by or upon completion of work specified.
Contract Acceptance:Upon sigm g,this document becomes a binding contract under law.
DO NOT SIGN THIS CONTRACT IF THERE ARE enry nt AM.coe�Gcni
Owner Signature__ - .(! - '`� Cnntrnrfnr1t cienv. _
T he Commonwealth of Massachusetts L t
Department of Industrial Accidents
' Office of Investigations
I Congress Street, Suite 100
Boston,MA 02114-2017
wwwmass gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Piease Print I.,e2ibly
Nalrie(Business/Organization/Individual):
RJ.Talbot Roofing and Contracting
Address:8 Joan Ave.
City/State/Zip:Hudson, NH 03051 phone 9:603-755-1535
Are you an employer?Check the appropriate box: Type of project(required):
1.01 I am a employer with 4. FZ] I am a general contractor and I
employees(full and/or part-time).
* have hired the sub-contractors 6. ❑New construction
2.01 I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling
ship and have no employees These sub-contractors have g, E]Demolition
working for me in any capacity. employees and have workers'
[No workers' comp.insurance comp.insurance.:
9. �Building addition
required.] 5. We are a corporation and its 10.0 Electrical repairs or additions
3.01 I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.2 Roof repairs
insurance required.]t c. 152, §1(4),and we have no
employees. [No workers' 13.01 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 state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lic.#: Expiration Date:
Job Site Address:120 Martin Ave. City/State/Zip:North Andover
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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby cern under theains andpenalties o er'u that the information provided above is true and correct
_
i
Sign re.
Phone 4: (o--O:yC`76- — /���
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: Permit/License#
Issuing Authority(circle one):
I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#•
Office of Consumer Affairs and Business Regulation
10 Park Plaza - Suite 5170
Boston, Massachusetts 01 2116
Horne.Improvement Contractor Registration
Registration: 157288
T—wp Ltd Liability Corporation
Expiration: 9/20/2017 Tr# 270178
RJ. TAI-BOT ROOFING&CONTRACT-ING
ROBERT TALBOT
0 JOAN AVE. ,--_ _
HUDSON NH 03051 -----
Update Address and return card.Mark reason for change.
SCA 1 as 20M-05117
`—' angy.Rf. o `�—
_. .. ...._....,,,.�,,,..,,_,.;.... . v mnlnvmonf I.nct('aryl
Massachusetts-Department of Public Safety
�f Board of Building Regulations and Standards
Construction$ii}iCi"v:ivir$jtrtiialIi'
, .
License:CSSL-101775
ROBERT J TALBQ`T t
5 JOAN AVE
HUDSON NH 03551
Expiration
Commissioner 12i53P 0%
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