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HomeMy WebLinkAboutBuilding Permit #856-12 - 125 MIFFLIN DRIVE 6/4/2012 BUILDING PERMIT t%ORTil ,C"_r.D , 0. TOWN OF NORTH ANDOVER 0 , APPLICATION FOR PLAN EXAMINATION 2- Permit NO: Date Received -0 • 14us Date Issued: IMPORTANT:Applicant must complete all items on this page -V -77;77- L&GA -ION A,nnt OWNER .4 QRERTY'_O R 44� Pe' �A Hn,,nt' - MAPJ4G : PA k, 5"L;V ,10NING0- TICT-: Historic District yes no Machine--.Shbp.ViII e a y. no: TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building __0A__01fames� Addition Two or more family Industrial Alteration No, of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other V an s.- Watershed Qstftt �Sqpjic, Floodplain' e,t - W.aterlSewer DESCRIPTION OF WORK TO BE PREFORMED: AZI'0�11101_e 4 ee Identification Please Type or Print Clearly) OWNER: Name:—J"4�,,C Phone: Address: /o7J— CONTRA ,TQR 'Name�Agm& "01 Address _5 4. Su-pervi-s-o'r"t's-.Con- 'structionLsi'ce xP. _HdJn1e Imp eht1lJAi66ft§b:--.:.:1410:,,r_66i x 136te,.* ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDINGPERMIT.$lZOOPER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ "/Z EP2 FEE: Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the and of&en '.SignatUre:of!6obtradt Or . BUILDING PERMIT °F tAORTFI'% TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received 0 Date Issued: IMPORTANT:Applicant must complete all items on this page _ , !'L iATTRJO K: ll nntVl- PROPERTAYOWNER�_ .11 Pr PhAf - -MAP NO; Q- PARCEL.--(g. - -"Z0NING'b.IS'T­RICT; Histonc4Distnct, es no ........77-7-77 W66-hin`d'Sh'oVill 'yps 0 p.., TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building Addition Two or more family Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other $e ''Wetlands,- 0ic.-. ." We'll - altet9hedlDitffict', :Water'/Sewer DESCRIPTION OF WORK TO BE PREFORMED: Identification Please Type or Print Clearly) OWNER: Name: J/ Phone: Address: lo7J' ,ileei CONTRACTOR Name- WP h 0 n e;.,_2;?eP-_'zi ysp r ,Address: J-6 S-7/,A -77 S bpervi§o­r!&'Con stru ction biden se' 1,40-6-W- Ex ', Date.- 0on!e'Jm0tqvernent1Libense. at e. ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: Receipt No.:. ,2,4o'*2,,r6 NOTE: Persons contracting with unregistered contractors do not have access to the r and sigr'i'a-16-r el-o------- _pature of Agent/Owner. f-contract T- 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 ❑ 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 N OTE: 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 ❑ 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 V®TE: 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 Doe:INSPECTIONAL SERVICES DEPARTMENTMPFORM07 Revised 2.2008 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 Locafedat 124;Mam'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.$10041000 fine NOTES and DATA— (For department use) ❑ Notified for pickup - Date Doc.Building Permit Revised 2008 LocationAl No. Date • - TOWN OF NORTH ANDOVER e y��•►I.IsU��4�' • • • Certificate of Occupancy $ Building/Frame Permit Fee $-4 Foundation Permit Fee $ _ Other Permit Fee $ TOTAL $ — Check#--2�/r � 25350 uilding Inspector NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit at: d 'g\;�, r 0,r��is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150 A. Also, note Permits are required under Fire Prevention laws Chapter 148 Section 1 OA. The debris will be disposed of in: �00� 1b A `le QLe I;l- �C�aorvu a� (Location of Facility) Signature of Permit Applicant G •- 3 — (L Date -. � P //A jSSue- ��,em;7, ---Mec� N42Y 4 ree. MOP./03/2012 22:12 FAX 603 881 8506 FOY INS NASHUA X001 DATE(MWOD/YYYY) RD CERTIFICATE OF LIABILITY INSURANCE 1 6/4/2012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(los)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this Certificate does not confer rights to the certificate holder In lieu of such endorsement(s). CONTACT PRODUCER ME: Sandi Pelletier, CISR PHONE Fact: (603)88.S-1587 FAX Na:(603)eel-Bso6 Foy Insurance Group - Nashua E.M%UL 350 Main St Dr REss;eandi.pAll®tier@foyinsuranca.00m paooucEa p0042261 STAMER Nashua NH 03060 INSURERS AFFORDING COVERAGE NAIC 0 INSURED INSURERA:Ma1n Street America Assurance 9939 INSURER B:*Travelers Pro or Casualt A.J. 'S Home Services Inc INSURERC: 1565 Lakeview Ave - Ste 102 INSURER D, - INSURER E: Dracut MA 01826-3324 INSURE F: COVERAGES CERTIFICATE NUMBER:Maetar 7/2011-2012 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIO(1 INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THI CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERM: EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN R DU POLICY E BY PPO ICY EX CLAIMS.AID ILTR POLICY NUMBER MM/DD MMI DMIYY LIMITS TYPE OF INSURANCE 500,1100 EACH OCCURRENCE 9 GENERAL LIABILITY AMA O REN EMISEb_ cocotte $ 500,1100 A X COMCLAIMS-MADE OCCUR MERCIAL GENERAL LIABILITY 800764 /30/2011 7/30/2012 MED EXP An one ereon $ 500 10,000000 PERSONAL&ADV INJURY $ , GENERAL AGGREGATE $ 1,000, J00 PRODUCTS-COMPIOPAGG S 1,000, .)00 GEN'L AGGREGATE LIMIT APPLIES PER; $ 7X POLICY PROLDC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Es accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Por accident) $ SCHEDULED AUTOS PROPERTY DAMAGE $ (Per accident) HIRED AUTOS a NON-OWNED AUTOS S UMBRELLA LIAR OCCUR EACH OCCURRENCE S EXCESS LIAR CLAIMS-MADE AGGREGATE S $ DEDUCTIBLE S RETENTION $ WC ST U_ OTH- H WORKERS COMPENSATION AND LMPLOYERS'LIABILITY YIN E.L.EACH ACCIDENT S ANY PROPRIETOR/PARTNER/EXECUTIVE❑ N I A OFFICER/MEMBER EXCLUDED? E,L.DISEASE-EA EMPLOYE $ (Mandatary in NH) If yes,describe under E.L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional RomeM(s Schedule,If more epaee Is required) *A request has boon submitted directly to Travelers property 6 Casualty to issue a certificate of insurance as reg, rds Workers Compensation Coverage for the Commonwealth of Ma3sachusetto. This certificate will bo fax separately. CERTIFICATE HOLDER CANCELLATION (976) 688-9542 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFCRE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town of North Andover Massachusetts Attn: Building Department AUTHORIZED REPRESENTATIVE. 1600 Osgood Street Building 20 - Suite 2-36 North Andover, MA 01845 a ti CS ACORD 25(2009108) ®1988.2008 ACORD CORPORATION. All rights reserved. INS025(200009) The ACORD name and logo are registered marks of ACORD NORTIy T 0" Of `� O Amdover , o , dover, Mass., 0 LAKE LAKE COCHICHEWICK A°RATE D T?¢,5�5 S BOARD OF HEALTH Food/Kitchen Septic System PERMIT T D BUILDING INSPECTOR ... . THIS CERTIFIES THAT.....1..f.z.....................rs. 4...1.z;. ........................................................................................... Foundation 6 has permission to erect........................................ buildings ............. Rough lE . . .Q.e✓.�...1�jA1!.d �`S f .J�tl,- . �'[� .... �.�!�/F- Chimney to be occupied as................�. moi. ....... . ,� ,�'............. ,� ...................... provided that the person accepting this permit shall in every respect conform to the terms of 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 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION re_� TS 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. Office of Consumer Affairs and Ausiness Regulation 10 Park Plaza - Suite.5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 122560 Type: Private Corporation Expiration: 9/17/2012 Tr# 204527 A.J.'S HOME SERVICES INC AARON BEAUDOIN 1565 LAKEVIEW AVE. #201 DRACUT, MA 01826 Update Address and return card.Mark reason for change. Address ❑ Renewal ❑ Employment Lost Card PS-CAI 0 50M-04/04-G10I216 �� >��Office oi'�okWer a►rs smess egu a .on License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 122560 Type: Office of Consumer Affairs and Business Regulation ` Expiration: .9/17/2012 Private Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 A" -S HOME SERVICES INC AARON BEAUDOIN. 1565 LAKEVIEW AVE.--k6i DRACUT, MA 01826 Undersecretary Not valid without signature S; Massachusetts- Department of Public SJON Board of Building Regulations 11"d Standard Construction Supervisor Specialty License License: CS SL 100691 Restricted to: RF,WS AARON BEAUDOIN 12 BROOKFIELD ROAD HUDSON, NH 03051 Expiration: 10/18/2013 (7ununixsi1roer Tr#: 5972 Name 1 Address Debbie PataliaPROPOSAL 125 Miffin Drive North Andover,MA 01845 Date Estimate# Fully Licensed and Insured Insurance certificates presented upon 5/9/2012 239-1682 request. Obtaining all necessary permits Terms&Conditions included. REP TELEPHONE Job Site Aaron Beaudoin CSL Lie#100691 AB 978-490-5302 125 Mifflin Drive AXs Home Services HICR#122560 North Andover MA 01845 Item Description Qty Cost Total Roofing REMOVE AND REPLACE ROOF. 12,880.00 12,880.00 -SET UP TARPS TO PROTECT SIDING AND GROUNDS. -REMOVE ROOFING DOWN TO ROOF BOARDS,PREP ROOF(BANG IN OR PULL OUT ANY PROTRUDING NAILS). APPLY 3'OF GRACE ICE AND WATER SHIELD ALONG LOWER EDGES OF ROOF(S)AND IN ALL VALLEY'S AND AT ALL ROOF/WALL JUNCTIONS. APPLY GRACE TRI FLEX 30 SYNTHETIC UNDERLAYMENT TO REMAINDER OF ROOF AREA. -INSTALL 8"(.024")ALUMINUM DRIP EDGE TO ALL PERIMETER EDGES OF ROOF'S-WHITE. -REPLACE ALL APPLICABLE PIPE FLANGES. -CUT INTO CHIMNEY AND INSTALL NEW LEAD FLASHING. 1 -APPLY LIFETIME WARRANTY GAF SHINGLES TO ENTIRE ROOF AREAS.COLOR-OPTIONAL. -CUT ROOF RIDGE OPEN AND INSTALL CONTINUOUS ROLL RIDGE VENT ACROSS ALL ROOF PEAKS. -CLEAN UP AND DISPOSE OF ALL ROOFING DEBRIS. ANY ROTTED WOOD THAT NEEDS REPLACEMENT WILL BE AN ADDITIONAL CHARGE. AT SHED DORMER,BAY WINDOW IN REAR AND SIDE ENTRANCE, INSTALL FULLY ADHERED.060 WEATHERBOND RUBBER ROOFING SYSTEM WITH 1/2"ISO INSULATION BOARD. ADD$300.00 FOR WHITE RUBBER. n � r�,'ii'�.fa�ati =Total $12,880.00