HomeMy WebLinkAboutBuilding Permit #856-12 - 125 MIFFLIN DRIVE 6/4/2012 BUILDING PERMIT t%ORTil
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TOWN OF NORTH ANDOVER 0 ,
APPLICATION FOR PLAN EXAMINATION
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Permit NO: Date Received -0
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Date Issued:
IMPORTANT:Applicant must complete all items on this page
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-77;77-
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OWNER .4
QRERTY'_O
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MAPJ4G : PA k, 5"L;V ,10NING0- TICT-: Historic District yes no
Machine--.Shbp.ViII
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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&
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Address
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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
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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