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HomeMy WebLinkAboutBuilding Permit #465-13 - 14 BUCKLIN ROAD 12/12/2013 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: Date Received Date Issued: 2 zZj IMPORTANT:Applicant must complete all items on this page t 'n cr �__'a�!�v`lff L®CATION� VG IJ✓1 H*- � rk +'Sa� y =-'Cfre•- ..- '+. .aws•ar- PROPER�T�YOWNER PARCELS/�QZONING DISTRICT' `' Historic Distric es nog €F�ff t33'�' '_ , +r �.. %'�9_.r3 `.� - ,-.�tY .,�•'r_t Y..B meq'" y,' TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑AI ration No. of units: ❑ Commercial Vl�epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other 2Y.•� s?»'s 'k nv - t..$ et ; ;D Sept)c Well � h Floodpla n �Wetlands rf ., �® - ershed Distric r S .�'��K "" hn7�;�v-xG.X�.4.�fk Y+ �'"�€ ."`�"�<.+d.:F�.£�p�.�"�� .Z`�-,�x��$�n W ,�,P�., �.�'�.=r^m, � °� +ne�'�e-.•?�, may. `�'i�•.Fw�e. _��i. � t DESCRIPTION OF WORK TO BE PERFORMED: �j'rt rD 1 l-.^v e.c- !;k\^s LO-) Tr.&+t SS 6 � .:2 i 144 6AF Identification Please Type or Print Clearly) OWNER: Name: C 0' C 1 s c• Phone: ®y jl Address: AW" Sq?u' uwrt� . 3rd, ' a ' s t eta 2•d�.rv.+ l ...S '^)' 4rR�f+-'� b $. >,.,�,'�- ,, �.,3 +;'°,yv,. y "'Rr'�„�v ,s.`y.+y� ta.,A-;."'F "4s�'i-` �,�,""; " .tea y:; �'�a. `^�-tr° � {? '" mv ,{ ,. uCONTRACTORName .. �► _ Rhone r ,ter I �� $� '' �. -.:as3. , "9' _."- — y "" ..— s� *-m ;, .3�., .r*.., k �. mF-as {`•. -k F{4C C "3f-?"'MS �`ita r ar°'2`. rr i'6.e?.`, r i .F n.y,=. ��� 't*. + y'Add ress k-7 � h r��� � � � ,9�r� � i� a ✓ . d_, �.3.�Z.:, :� -$. .; ,sE tl�- F w aec"� tai Y �g t 3 f< t a a r fL ,, SUperVisor�s}ConstrucionLicense� � ©d`�l b 'ExpDate23 ��f ys� X ,,,u.-'-a 'yA�.`7u-"�Ma. hre �.4�^sem..:s1 ��',r�e§� � .3". �. .� - sr <�'' � $.`•F 3w � ,m�T =�- - �- .. � t ARCHITECT/ENGINEER Phone: Address: Reg. No. s FEE SCHEDULE.BOLDING PERMIT.$12.00 PER 1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. A" Total Project Cost: $ �/ � FEE: Check No.: Receipt Receipt No.: ��� °��__ NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Sigriature of Agent/Owner : Signature of Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ tamped Plans ❑ -s, Location [/ Date f2 / -- a'. TOWN OF NORTH ANDOVER D 16g6y� � Certificate of Occupancy x C,7 dO �s Building/Frame Permit Fee $— e Foundation Permit Fe �-- g' M Other Permit Fee �— _. t TOTAL Check#= Buildings nspector 26033 i I I I 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 Miter& Sewer Connection/Signature& Date Driveway Permit DPW Towz Engineer: Signature: Located 384 Osgood Street FIRE`DEP.ARTMENT Temp Dumpster on site yes no Located at 124 MainStreet Fire De"pa m t scgnatiare/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 El Notified for pickup - Date i Doe.Building Permit Revised 2010 1 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 El 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 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: Doc.Building permit Revised 2012 tAORTy TOwn , ofndover No. A94 P 17, , h ver, Mass, coc"Ic„e « �i9 gORgTEO �'Pa,`�(`7 S U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT r 65�� ! BUILDING INSPECTOR .......................... . ............................................................................. Foundation has permission to erect .......................... buildings on .Zg..IS.5 1/(A U.............................................. Rough to be occupied as ....................... A”.41. .. .... .... .e. ...................................................... Chimney provided that the person accepting this permit shall in every respect conform 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 CONSTRUCTION ST 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 . 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 j. i Offic ot�o�Ou�era+�)�,Ysiness egu �ieo HOMEIMPROVEMENT CONTRACTOR Registration: 4,,14'5039 Type: Expiration: z-;,1212/2012 Individual ON R0Q HABERSTr7 - -" t Pi,- af- v y l JASON ,HABERSTROH 1-! '20'0 NORTH RD � 'DEERFIELD, NH 03037,- %r Undersecretary 7 Massachusetts-Department of Public Safety..' Board of Building Regulations and Standards Construction Supervisor Specialty 'License: CSSL-100416 JASON R HABASTROH 225 RAYMOND ROAD r DEERFIELR' 03037 Expiration Commissioner 02/13/20-14 r r i P.O. BOX 872, N.ANDOVER MA.01845/P.O. BOX 217 BARRINGTON N.H.03825 768 Washington St., Barrington N.H.03825 To, Karl & Elisa Reppucci, This is an estimate for your roof at the property located at, 14 Bucklin Rd., N. Andover Ma. 01845 GAF COMPLETE ROOF PACKAGE 1. Strip and Dispose of existing roof. 2. Install GAF STORMGUARD ice & water shield. 6' up along bottom edge, 18" in along rakes, 36" were roof meets sidewalls, and along all sides of skylights. 3. Install 8" aluminum drip edge around complete perimeter of roof. 4. Install GAF DECKARMOR underlayment on remainder of roof that does not get ice & water shield. 5. Install GAF PRO-START eave and rake shingles to entire perimeter of roof. 6. Install GAF COBRA VENT along ridge. 7. Install GAF SEAL-A-RIDGE Shingle caps over ridge vents. 8. Install GAF TIMBERLINE HD Shingles to entire roof. Color, THIS PACKAGE ALLOWS ME TO OFFER YOU A 50 YEAR NON-PRORATED WARRANTY. 20 YEARS TRANSFERABLE. THIS PACKAGE WILL BE PROVIDED FOR THE SUM OF, $6,900.00 DEPOSIT OF $3,500.00 UPON AGREEMENT BALANCE OF $3,400.00 UPON COMPLETION Authorized Signature, Date, Please call me with any questions, Sincerely, Jason R. Haberstroh #603-674-3792 HABERJA-01 NPOULIN CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 9/12/2012 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(les)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). PRODUCER CCOWCT Nancy Poulin Clark Insurance PHON 603 622-2855 Fax 80 Canal St A/c o FtI:( ) AIC No):(603)622-2854 Manchester,NH 03101 E-MAIL ES :npoulin@clarkinsurance.com INSURERS)AFFORDING COVERAGE NAIC i INSURER A:Tudor Insurance Company 37982 INSURED INSURER B:Riverport Insurance Company 1st Place Exteriors LLC INSURERC: 768 Washington St INSURER D: Barrington,NH 03825 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD' INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSIRTYPE OF-INSURANCE ADDLSUBR POLICY EFF POLICY EXP I S POLICY NUMBER MM/DD/YYYY MMIDD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000;000 A X COMMERCIAL GENERAL LIABILITY NPP8095455 9/11/2012 9/11/2013 -DAMAGE 10 PREMISES Ea occurrence $ 100,060 CLAIMS-MADE a OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY X PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS Per accident $ $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE FAGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X I O YTATU- O R- AND EMPLOYERS'LIABILITY B ANY PROPRIETOR/PARTNER/EXECUTIVE YIN N WC2883004502-01 2/8/2012 2/8/2013 $ OFFICER/MEMBER EXCLUDED? a N/A E.L.EACH ACCIDENT 100,000 (Mandatory in NH) E.L.DISEASE-FA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Jason Haberstroh is excluded from workers comp coverage CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE GAf THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1361 Apis Rd ACCORDANCE WITH THE POLICY PROVISIONS. Wayne,NJ 07470 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD