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HomeMy WebLinkAboutBuilding Permit #554-16 - 135 JOHNNY CAKE STREET 11/5/2015 BUILDING PE F "o oT" PERMIT o TOWN OF NORTH ANDOVER oa h�>t� ", 6460 APPLICATION FOR PLAN EXAMINATION '' 7° K q. Permit No#: Date Received ATEo 0a`�y gSSACHU5�� Date Issued: V f 1 IMPORTANT: Applicant must complete all items on this page TV x A, � `�4 e --r Pring ; v 77M �II2IT�VF ANE_' . . r� a �1f 1©D ear Sfruc ure �y o 1RUMN,AZ®:NIrNG `IrS R�ICT. H std c ts�f�c n' Y Ino ` k;. �- tache e S' © V y -- I h ,�fl QR, Lyes k 04 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 L®fSeptic 0"Wel d. D;CFIo©d s Ia lid'Wetland ❑ UUates'etlDistrict LL w - t DESCRIPTION OF WORK TO BE PERFORMED p C 'I/'VC'V'C--C�v Identification- Please Typgg or Print Clearly OWNER: Name:_T,=>vv\ Cn Wx ,&40 V-U Phone: Address: �1VJ- t , Codi#,racf® Namep Cc) z _ a I�'�h©�ne I, Em_ail'� , , , r 73z kAddfress , '' h + �'lyiome Ipr©uementLice:se - ; C J x : ®ate: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ 1 0 e) FEE: Check No.: Receipt No.: ' C NOTE: Persons cont cting with unregistered contractors do not have access to a lnty fund �g;nat�uofY�gent/,Owner�fi: �' s ` � S'ignatu e�ofcontract¢ 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 ❑ I 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 c. HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes c Planning Board Decision: Comments 'C Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FAZE -PARTMEN `1Ter pQuq)-s dr anosi l yes • � � x gin© �_ �" r Locatetl at24 Main S e e Departmen sign„a�ture/d C©�MM=�E TSS 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) I I ❑ Notified for pickup Call Email Date Time Contact Name ......................—------- ----- -- Doe.Building Permit Revised 2014 j 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 a 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 VOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ BuildingPermit Application pplication ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Cross Section/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 DOTE: 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 ❑ 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 COTE: 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 Location No. Date k • - TOWN OF NORTH ANDOVE)l h Ce tificate of Occupancy $ 1 ..� Building/Frame Permit Fee $ Foundation Permit Fee $ $ Other Permit Fee TOTAL ? $ T Check `s—# Building Inspector F_ 7 NORTH '.� ve' 'o e p No. b �. h ver, Mass o coc1ic"t..c. ��A�R"�TED ►'4�,�'�5 S U , BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT ..........0000.�*O%w....... .. .. ....... .................................................... BUILDING INSPECTOR Foundation has permission to erect .......................... buildings on ..... . ........... `�� p g 1. �,..... .... Rough to be occupied as ............ ..... Pis ..... .... .. ............. ................................................ Chimney provided that the person acceptingermit shall in every respect confor 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 CONSTRUC TS 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 YY No Lathing or Dry all To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. Fully Licensed and Insured Member of MA Better Business Bureau ® � �( Member of NH Better Business Bureau ,a GAF Cert.ME#20212 L HIC Reg#166661 5`x¢5 Owens Corning Preferred Contractor#212828 MA CSL#104728 OSHAour Construction Safety 30 HY Trainin 9 w EPA Lead Safe Certified General Contracting, LLC 51 S. Broadway#2214 • Salem, NH 03079 (603) 89 0-0084 110 Stevens Street#141 Andover, MA 01810.• (978)475-0095 PROPOSAL EMITTED TO PHONE DATE STREET c_ ` 9 3✓ �nlnry si f E-MAIL CITY,STATE, D ZIP CO,,ppE rJOB LOCATION - r Completely protect the home with tarps to catch falling debris. Respect and protect shrubbery and flower beds. Strip off 6 layers of roofing material down to the bare roof.deck. Inspect the roof deck for structural defects. Determine the condition of the underlying plywood or boards, and repair and replace as necessary*, Inspect roof ridge for proper 11/2" spacing on either side of ridge for maximum exhaust ventilation. Cut in if necessary. Install new heavy gauge t•�)�n PQr (color) - u", _drip edge at roof eaves. Install '!'7 C(L.r 6 AA-bp and water shield to meet manufacturer's specifications (i.e. 6 feet from roof edge, 3 feet centered in valleys, around all skylights, chimney bases, roof penetrations and at all sidewall transitions). Install C7 IM-A0 0--a-0LDCG.1� breathable roof deck protection to remainder of the roof deck. f Install new heavy gauge U.SAA42 (color) i4�` vfr"n� tom► drip edge at roof rakes. Install starter strip at roof eaves and rakes. Install (I_t'.AfCe_t, Ley-i twrerl�s Lf,W!J Slesired color._r/3ip (color) 47 Install new flashings to meet manufacturer's specifications. (i.e. sidewalls, chimneys, skylights and roof penetrations). Install (feet) of CoLJ(c�- 15A) 6�tY ridge vent at roof ridge to allow maximum ventilation. Hand nail to ensure proper fastening. Install I�f�2 (feet) of i/Z,`69distinctive hip and ridge cap. Hand nail to ensure proper fastening. Thoroughly clean up and dispose of all roofing debris on property. Magnetically sweep property for nails. I Notes: �`xt �, ��w �e•Z t`ak5�/t('V%) ;;4 Edmunds General Contracting will: • Obtain all necessary construction-related permits to complete this project. • Perform work as efficiently as possible without sacrificing quality. • Furnish and install all necessary materials to complete the project. Provide a thorough clean-up and disposal of all debris gereiated durng projE;ct. I Edmunds General Contracting LLC agrees to commence work on/or about and described work will be completed in about�� days. Product Upgrade 1: Product Upgrade 2: Contractor's employees are fully covered by workmen's compensation and liability It is further agreed that this contract may be assigned by the contractor,and also insurance. that the obligations hereof shall bind and apply to their heirs,successors or estates Upon completion of the above work,all undersigned agree to execute and deliver to of the parties. the contractor,their joint note in accordance with his(their)above obligations as Edmunds General Contracting LLC guarantees all workmanship performed for requested by contractor.Upon refusal to do so,contractor may at its option declare years. the entire contract price or so much as then remains unpaid,immediately due and payable.It is agreed that,if permitted by law,contractor shall be paid by the We will register factory enhanced warranty owner(s)all reasonable costs,attorney fees,and expenses,in addition to the providing yeaXce' al defect coverage and_years of amount due and unpaid,that shall be incurred in enforcing the terms and conditions workmanship defect cough for: of the contract and/or any lien in connection herewith. _n _the additional cost of 'Edmunds General Contracting LLC will provide the materials,labor and disposal to replace up to 64 sq.ft.of roof decking and 20 ft of fascia at no additional cost. 1 Any additional materials including labor and disposal will be replaced at '7C? per sheet or s !+s.4._0 linear foot. Edmunds General Contracting, LLC agrees to furnish the material and All material is guaranteed as specified.All work to be completed in a workmanlike manner according to standard practice.Any alteration or deviation from above specifications involving extra costs will be executed only upon written labor complete in accordance with the above specifications;for the sum orders,and will become an extra charge over and above the stated contract price.Contractor is not responsible for of L 1 e,)e ,3 ate, A lJ l damage due to high winds,tornadoes,hurricanes,fire or other hazards.Owner(s)agree to carry fire tornado and other -� �.4/�+®J �tiC_ dollars($ / ) necessary insurance.Contractor is considerate of owner's landscaping and but due to the nature of the roofing Z�(�U � � ��✓ installation some damage may occur.We attempt to minimize any damage,and will not be held responsible if any �•©(:j �� damage occurs. contractor is not responsible for any damage to the interior of property,including pre-existing Payment Terms: conditions(Le,water stains,crumbling plaster,exposed nails)or conditions resulting from application of materials as specified above.Items in the attic may need to be covered by the owner.Contractor is not responsible for damage • A (not to exceed 1/3 of the total contract)deposit of +' is caused by!cc dam build-up.All agreements�areontin ent upon strikes,accidents,or delays beyond our control. p due upon start of work.The balance of 4 1 lij jos due when work Authorized Signature: is completed to the satisfaction of all parties. dmunds General Contracting LLC •.A finance charge of 1.5% per month (18% per year)will be charged on Note: This proposal may pe withdrawn by us if not accepted within past due accounts over 30 days �\t days. ZCLepta=Vrropo5alo5al -The above prices,specifications,and 00 NOT SIGN THIS CONTRACT IF THERE ARE B NK PACES.conditions are hereby accepted.You are authorized to do the work ast will be ade as outlined above. Authorized Signature, )) ��Date of ac0 �J�' Authorized Signature: All home Improvement contractors shall be registered.Any inquiries about a contractor or subcontractor relating to a registration should be directed to:Office of Consumer Affairs and Business Regulation,10 Park Plaza,Suite 5170,Boston,MA 02116(Phone:617-973-8700). Owners who secure their own construction-related permits or deal with unregistered contractors shall be excluded from access to the Guarantee Fund provisions of MGL.c.142A The owner will receive a signed copy of this contract before work will commence.The owner has three(3)business days to cancel this contract and incur no penalty.Correspondence should be directed to Edmunds General Contracting LLC at the above address. Rev.01/13 The Commonwealth of Massachusetts Department of IndustrialAccidents d 1 Congress Street, Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information \\ / y Please Print Legibly Name (Business/Organization/Individual): wwy�} Address: P,0 ( A 22l 1'l 5 CO C City/State/Zip: Phone#: (o o 3 G5 - -7 73L Are yo n employer?Check the appropriate box: Type of project(required): 1. I am a employer with employees(full and/or part-time).* 7. []New construction 2.F1 am a sole proprietor or partnership and have no employees working for me in 8. �Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 4.F1 10 Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.[]Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.[]Roo repairs these sub-contractors have employees and have workers'comp.insurance.: ' 6.FJ We are a corporation and its officers have exercised their right of exemption per MGL c. 14. then 1L 152,§1(4),and we have no.employees.[No workers'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 state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. i fain an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. i - u Insurance Company Name: �;� � r �-W' Policy#or Self-ins.Lie.#: W C 2 ?a j!& f21 Z S Z— Expiration Date: t /Z_Co It rj Job Site Address: 1'� �n.V�,W �� S� City/State/Zip: \ k-VvJ Attach a copy of the workers' compensation olicy declaration page(showing the policy number and expiration ate). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verificatio I do hereby cXelderre pains and penalties of perjury that the information provided above is true and correct. Si natur•: Date: Phone#: 3Q - -7 7 Official usko n1yAo 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#: I' 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-contractors)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 Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel. #617-727-4900 ext.7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia Office bf Consumer Affair sBusiness galation i OME IMPROVEMENT RType: I egistration =166661 6121(2016 Corporation Expiration -. EDMUNDS GENERA}"CONTRACTING,LLC. j t DAVID EDMUNDS 18 ASHFORD RD HAMPSTEAD,NH 0 i Undersecretary (7License or registration valid for individul use only j before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Boston,MA 02116 Ad&utnature Massachusetts Department of Public Safety Board of Building Regulations and Standards j 1 License: CS-104728 Construction Supervisor DAVID C EDMUNDS nrf� n • P.O.BOX 2214 SALEM NH 0300 Expiration: Commissioner 10/0312017 J i r' r' i