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Home My WebLink AboutBuilding Permit #131-12 - 13 HARWOOD STREET 8/16/2012 NORTH/ BUILDING PERMIT ucD ;6q �o TOWN OF NORTH ANDOVER i - • . p APPLICATION FOR PLAN EXAMINATION 1 Permit NO: Date Received �SSACHUS�� Date Issued: 0r:((e IMPORTANT:Applicant must complete all items on this page LOCATION. a - Print PROPERTY"OWNER' F�I �� (� ty i Ra - Print MAP'NO: _PARCEL � ZONING_ DISTRICT:,- � Historic.District yes. - Machine Shop Village. yes; no. TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other sip,ip p0 - Flood p .Iain Wetlands_ 1Natershe&Dist�ict Septic Well Water/Sewer: DESCRIPTION OF WORK TO BE PREFORMED: Identification Please Type or Print Clearly) 8 8�7 5�f y OWNER: Name: JV/nJy DAA Ive�Rc-. Phone: 91 Address: s _ CONTRACTOR 'Name:W� Phone 0c8/ 5 /111.I - ,Address: +5 L/6Q:c nc sr L yAJN ,�/r�.4 c� 19 oV Supervisor's,Construction License: ---.Exp: Date: a'rc7" o�J Y Home Improvement L_icense:. �:�1/ 7 8. . . Exp. D`a_te: . a'S'a�� Y - ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASE ON$125.00 PER S.F. Total Project Cost: $ ��' cf�� °� FEE: $ Check No.: /T I Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Sigriature of Agent/Owner Signature:of contractor 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 q ture 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 siteyes no. Located at-124 Main Street I Fire'Department signature/date- COMMENTS I 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.$100-$1000 fine NOTES and DATA— (For department use) ❑ Notified for pickup - Date I Doc.Building Permit Revised 2008 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 NOTE: 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 VOTE: 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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 Location /y �L'v//l�Vd d No. — Date ��--- • ' TOWN OF NORTH ANDOVER x'1LED • I • Certificate of Occupancy $ Building/Frame Permit Fee $ wFoundation Permit Fee $ ,, Other Permit Fee $ e TOTAL $ Check#� 25617 Building Inspector I I The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: /S ire p an 5T City/State/Zip: L-/1.)1%J MA- OJ90Y Phone#: 9 e/ 5577 /2 / Are an employer?Check the appropriate box: Type of project(required): 1. I am a employer with _ 4. El am a general contractor and I 6. n New construction employees(full and/or part-time).* have hired the sub-contractors F1 7. Remodeling 2.El am a sole proprietor or partner- listed on the attached sheet. 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 10.El Electrical repairs or additions required.] officers have exercised their right of exem tion er MGL J. P repairs or additions 3.❑ I am a homeowner doing all work p p myself. [No workers' comp. c. 152,§1(4),and we have no 12.tj Roof repairs insurance required.] employees.[No workers' 13.❑Other, comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. i 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. f am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. /// Insurance Company Name: C 9A/2T/S Policy#or Self ins.Lic.#: �5/ 7 �� 7 Expiration Date: Job Site Address: 3 �i4k woad S T City/State/Zip: AJ O ANda✓u'.!11 A v/S 15 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 the�pains and penalties of perjitry that the information provided above is trite and correct. Signature: 4 Phone# 961 .S t S /alt - 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.#617-727-4900 ext 406 or 1-877-MASSAFE evised 5-26-05 Fax#617-727-7749 Office 6r�°h m"1 C0NTRACTOR ., HOME IMPROVEMENT Type �. 141778 private Corporatic.a Registration: ,y,. Expiration: 21.512014 �M TfZF.HANT E R CONSTRUCTION INC' 1 WILLIAM TRAHANT TR ET.=,� ,-, 215 VS ERONA Et t Undersecretary LYNN,MA o1g04 Massachusetts-Department of Public Safety 190 Board of Building Regulations and Standards Construction Supers isor Specialty i .. License: CSSLA01220 WILLIAM R T-1 215 VERONA`'STREET �- LYNN MA x,1904 %� ' Expiration Commissioner 02/10/2014 Page No. of Pages WM. TRAHANT JR. CONSTRUCTION, INC. 4TH GENERATION ROOFING 215 Verona Street LYNN, MASSACHUSETTS 01904 (781) 599-1211 • (781) 844-4551 • FAX: (781) 581-0855 H.I. LIC. #141778 PROPOSAL SUBMITTED TO i PHO E DATE � d t 1 � ) rr� t 7� 74.? ��- STREET 4LI - ^' + ��'�hon.1�GL?DO�C 8 - `t 82 -S Ra- ale CITY,STATE and ZIP COD JOB LOCATION 16 4ildbar F-1*1 I We hereby submit specifications and estimates for: We hereby submit specifications and estimates for: __ SHINGLE ROOF __ _ FLAT/RUBBER ROOF entire roofEl Sweep entire roof clean R lace any bad boards up to 100 linear feet ❑ Strip entire roof � (Y1� ll ice and water barrier first'- feet up roof El fasten down ISO board insulation Insta __ _ —__ Inst ice and water barrier in all valleys and along dormers ❑ Install 060 Rubber Roofing on entire roof Install 151b. felt paper on remainder of roof —� El Install metal flashing around perimeter of building _ In _II eight inch drip edge _—(��-}�--�~ ---- 0 Flash chimney(s)),pipe(s)`and wall(s) — -A— --------- I tall ridge vent ❑ Edge caulk,all seams FI h or re-flash chimney(s) 5njStRt( NEW l.EAc>IF NFEA�� ❑ Install new copper center drain Ins II new pipe flanges El Other: colk nstall-t-W-year shingle ❑ ethers ❑ Clean up all debris _ ❑ Install gutters and downspouts ❑ Labor and materials guaranteed 100%for five years ~� ❑ Install trim coil --------_----------__._____—__ ❑ Install new fascia boards Pkecu ❑ Install new rake boards ❑ Install sky light(s) ❑ of KCle _p all debris-____—________________________.__________—_______ _ La and materials guaranteed 100%for five years All shingle roofs are nailed by hand. e propose hereby to furnish material and labor — complete in accordance with above specifications, for the sum of: Total Price($ 1t 90n **IF YOU ARE HAVING YOUR ROOF STRIPPED, PLEASE COVER ALL VALUABLES IN ATTIC, ASS + G�?� WE HAVE NO CONTROL OVER DEBRIS THAT MAY FALL THROUGH ROOF BOARDS.* � ��•r. Y�� Yom.'" All material is guaranteed to be as specified.All work to be completed in a workmanlike manner according to standard practices.Any alteration or deviation from above specifica- Authorized A �-2;-7 tions involving extra costs will be executed only upon written orders, and will become an Signature /( �� extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control.Owner to carry fire,tornado,and other necessary insurance.Our workers are fully covered by Workman's Compensation Insurance. [dothe yf� nrr Q'l Proposal—The above prices,specifications ditions are satisfactory and are hereby accepted.You are authorized to Signature ° -- -ork as specified.Payment willbe made as outlined above. .,,,A., r,ryAcceptance: (I }�F:...•f Signature yellow copy to above address. I V NORTH -own of s ndover No. _ yy Y =,13R"h h • • ver, Mass, CoCNICKIMCK 111. �•9 A°R�teo �Pa,��(5 S V BOARD OF HEALTH PERMI'T T LD Food/Kitchen Septic System ,1 THIS CERTIFIES THAT f. ..0�.. .� �. �.1.. �� BUILDING INSPECTOR .................. . . ...:....... ......... ........................................ Foundation has permission to erect ......... ............ buildings on ....'.. ......... .. . . i�. .�...�.d..+*...•••••••••••• Rough to be occupied as ......... .... ......!n!!'.... .................................................. Chimney provided that the person accepti g this permit shall in every respect c form 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 M NTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTlqtAT Rough Service ... ................................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building 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. SEE REVERSE SIDE