The URL can be used to link to this page

Home My WebLink AboutBuilding Permit #96 - 133 GREENE STREET 8/7/2008 BUILDING PERMIT °f No oT bgti TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATIO60 N Permit NO: 6Date Received 4,A°egAT.o �SSACHU . ` Date Issued: Y IMPORTANT:Applicant must complete all items on this page LOCATION ' �'�,- ' ;`` r •, ,�° 4 }`"4 Pdnt PROPERTY OWNER 'r. 1, '1 1 Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no 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 Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF,WORK TO BE PREFORMED: Identification Please Type or Print Clearly) OWNER: Name:Y vim. �`` �; »._ A Phone: (Cii i•1 Address: -? ' �r ri ! �' � �" WC 11451 A CONTRACTOR `Name: t �' + . Phone: t � Address: ,t► Supe s ruction License: ; a Exp. Date: .. � Home Improvement License: Exp. Date. ARCHITECT/ENGINEER 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. Total Project Cost: $ L�� O Pt' FEE: $ �— Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund signature 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/ales 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:*. a Located 384 Osgood Street FIRE DEPARTMENT Temp Dumpster on site yes no Located at 124 Main Strdet 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.$100-$1000 fine NOTES and DATA— For department use ❑ Notified for pickup - Date 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 Copy9 �': d/Or C.S.L. Licenses PY ❑ Co of CAra' � ❑ 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 NOTE: 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 g��y� <7-- per' No. �. Date NORTH TOWN OF NORTH ANDOVER 0 � 9 • ; ; Certificate of Occupancy $ .` Building/Frame Permit Fee $ IqT �cwus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # " 2 lj V Building Inspector The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations t 11 F- �•'`' 600 Washington Street 1\ IMUM I' Boston,MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly r Name (Business/Organization/Individual): VGc� 3 VRA Address: f2�� an.� Ply,,► City/State/Zip:. , nclAy A Vi Phone #: Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ 1 am a general contractor and 1 6.. ❑ New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. t 7• ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. orkers' comp. insurance. 9. E] Building addition [No workers'comp. insurance 5. [ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself[No workers' comp. c. 152,§1(4),and we have no 12.❑ Roof repairs insurance required.] t employees. [No workers' ]3.❑ Other comp. insurance required.] *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy Nformation. +Homeowners who submit this affidavit indicating they are uuing all work and Then hire outside contraeiors 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: T- EJ mkA^0JP-IrAtr1 r,OS�- G Policy#or Self-ins. Lie.#: _7 9\70 g D1 q-1-pl,as-"3— _ Expiration Date: Glop Job Site Address: r 3 3 Gr¢m S4' City/State/Zip: /U A 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. 1 do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Siartature: „n /rte t� Date.• �s 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. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax# 617-727-7749 www.mass.gov/dia NORTH c Town of zAndover No. yo W dower, Mass., T Q - LAKE COCMICHEwICK ADRATED BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT......... ... ..V.. Foundation has permission to erect........................................ buildings on ... ........ /. ........ ........................... Rough Chimney to be occupied as..........r�j.. .....`. '}......... .. .. .................................................................................... y provided that the person accepting is permit shall in every resp t conform t.. 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 ��XZ PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR. l I q UNLESS CONSTR C S ARTS Rough ......... ..................................................................................................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place o�n the Premises — Do Not Remove Final No Lathing or D' s wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. Am& .s_a--; ',:��"uta f (978C96&1860 OFFICEPOOPOSA`978)8846732 FOREMAN CELL Name:SHARON TUTLE Phone:(978)688-5632 State:MA Invoice#:419652 Address: 133 GREEN ST. City:NORTH ANDOVER Contact:BARRY Date of invoice:07-22-2008 WE HEREBY SUBMIT SPECIFICATIONS AND ESTIMATES FOR KIP AND RE-ROOF DETAILED DESCRIPTION: ENTIRE ROOF,FRONT AND BACK WITH DORMERS AND REAR ENTRIES -CAREFULLY TARP AND SECURE AREAS FOR SHINGLES TO COME OFF ROOF WITH MINIMAL DAMAGE TO GROUNDS AND PERSONAL EFFECTS -REMOVE CURRENT ROOF SYSTEM,INCLUDING,BUT NOT LIMITED TO ALL LAYERS OF SHINGLES, UNDERLAYMENT,FLANGES,FLASHING,DRIP EDGE,AND ALL OTHER FOREIGN OBJECTS -CLEAN AND PREP.,AND DE-NAIL ROOFING DECK -"MINOR"CARPENTRY INCLUDED(16'2-X 6"BARN BOARD),$55.00 PER PIECE ADDITIONAL -INSTALL S"WHITE GALVALUME DRIP EDGE TO PERIMETER INSTALL GAF WF,4THERIWI ICH ICE AND WATER SHIELD (BITUTHANE LEAK BARRIER)TO 6'FROM ROOF-TO-WALL JUNCTURE,EVES;VALLEYS,AND AROUND CHIMNEY OR ANY OTHER ROOF PENETRATIONS -INSTALL ICE AND WATER SHIELD FULL COVERAGE TO BACK SIDE SHED DORMER DUE TOO LOW PITCH INSTALL 30W FELT PAPER TO REMAINING OPEN SURFACE AREA -INSTALL NEW 6"GALVALUME STEP FLASHING TO ROOF TO WALL JUNCTURES AND CHIMNEY BASE AS APPLICABLE -INSTALL STARTER COARSE SHINGLES UP RAKE EDGES -SHINGLE TO COVER WITH G_,_LTIMBERLLNE 30"ARCHITECTURAL SHINGLES BY ALL NR.C.A. AND GAF'SPECIFICATIONS AND PROCEDURES.(OWNERS`CHOICE OF COLOR TO FOLLOW) -INSTALL NEW PIPE FLANGES AS NEEDED FOR ROOF PENETRATIONS -LIFT CHIMNEY LEAD AND INSPECT BASE -REPLACE ALUMINUM FLASHING AROUND CHIMNEY -RE-POINT MORTAR UNDER-LEAD SHEATHING -CAP PEAKS WITH GAF HIP AND RIDGE CAP -INCLUDES REMOVAL OF ALL WASTE MATERIAL,OLD ROOF SYSTEM,AND DEBRIS FROM PREMISES. �! kION: INSTALL§,A,F COBRA RIDGE VENT SYSTEM TO PEAK - $375.00 -OPTION: RE-LEAD CHIMNEY $350:00 PTION: RIP.AND RE-ROOF DETACHED GARAGE $2,925.00 E NT TO BE MADE FOR ALL LABOR AND MATERIALS 1/2 UPON SCHEDULING AND N COMPLETION AT THE TOTAL ESTIMATE PRICE OF$4,750.00 ALL MATERIAL IS GUARANTEED AS SPECIFIED,AND THE ABOVE WORK IS TO BE COMPLETED IN A TIMELY MANNER TO SPECIFICATIONS AS LISTED AND IN SUBSTANTIAL WORKMANLIKE MANNER FOR THE AGREED SUM FOUR THOUSAND, SEVEN HUNQRED AND FIFTY DOLLARS SIGNE . '"`� DAT" &8 HOME-O /HIRING AR OR REPRESENTATION THEREOF SIGNED DATE Cp>?kACTOR-kt?_RT%ENfA_T109YF MERRIMACK VALLEY ROOFING AND GUTTERS SERVING MERRIMACK VALLEY AREA OVER 27 YEARS * FULLY INSURED * LICENSED * 14 YEAR WORKMANSHIP WARRANTEE 30+YR MANUFACTURERS'WARRANTEE * MEMBER N.R.C.A. * MEMBER B.T.A. * VISIT WWW.MERRIMACKVALLEYROOFING.COM � VDAC TRAVELERSJ ' WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY CHANGE DOCUMENT WC 99 99 98 ( A) POLICY NUMBER: (7PJUB-0155M05-3-08) CHANGE EFFECTIVE DATE: 05-22-08 NCCI CO CODE: 13579 INSURER: TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA INSURED'S NAME: MVRAG LLC This change is issued by the Company or Companies that issued the policy and forms a part of the policy. It is agreed that the policy is amended as follows: An absence of an entry in the premium spaces below means that the premium adjustment, if any, will be made at time of audit. ADDITIONAL PREMIUM $ 3393 RETURN PREMIUM $ NIL ADDITIONAL NON-PREMIUM $ 187 RETURN NON-PREMIUM $ NIL THE POLICY CHANGE DESCRIPTION IS AS FOLLOWS : CORRECTED CLASS CODES THE FOLLOWING ENDORSEMENT(S) IS ADDED: WC89041500-01 POLICY INFO PAGE ENDT WC890G1400-01 POLICY INFORMATION PAGE ENDORSEMENT m� WC999998 A-01 CHANGE DOCUMENT THE INFO PAGE SCHEDULE(S) ATTACHED REPLACE THOSE ON THE POLICY. 0 0 m 0 o� 0 o= a DATE OF ISSUE: OG-24-08 CL CHANGE NO:001 PAGE 001 OF LAST POL. EFF. DATE: 05-22-08 POL. EXP. DATE: 05-22-09 OFFICE: DIRECT ASSIGNMENT 701 PRODUCER: 24K2F 001793 COUNTERSIGNED AGENT � � -+; Lee -�a,�vrr�auuecLl� o��agaaclu�aeaa . Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 156382 I Expiration: 6%25/2009 Tr# 255933 Type Individual ## JEREMY COITO ; JEREMY COITO s: i 20 PARK ST -t �-'�� HAVERHILL,MA 01.830 . Administrator -- -