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HomeMy WebLinkAboutBuilding Permit #697 - 141 REA STREET 4/3/2012 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit M-69 Date Received Date Issued: IMPORTANT::Applicant must complete all items on this page LOCATION /'f�ez S% Print PROPERTY OWNER 6VIL6W &Z' Unit# Print MAP NO: PARCEL: 3 ZONING DISTRICT: Historic District es no Machine Shop Villag yes no 100 year-old structure es no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building KOne family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: 0 Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other �r ITic ff,Well( ~l 1 odplam; ®Wetlands y �Wat re shedlD)stnct ` ❑Water/Sewer _ _ _ _ _ " ,� �:� � �� �=���� � DESCRIPTION OF WORK TO BE PERFORMED: (Identification Please Type or Print Clearly) OWNER: Name: �'C " �' "f Phone: i Address: CONTRACTOR Name: Phone: ��eF Address: ��� ��// 2 S U� ��C C�/� 6) Supervisor's Construction License: /��lx) Exp. Date: -���/a' Home Improvement License: �y7 a Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED CO JTBASED ON$925.00 PER S.F. Total Project Cost: $ -7 % FEE: $ � 1 � Check No.: / �f'�-!vC/ r---.Receipt No NOTE: Persons contracting with unregistered contri%ctors'do;not.have�&c ess to the guaranty fund Si gnatureofPAgent/.O:wner , ,;#cactor - O --- --- ----- _.__ G. 4 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ ;f I 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 ❑ ` I 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 I i Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes 'Co. Planning Board Decision: Comments Conservation Decision: Comments I Water & Sewer Connection/Signature& Date Driveway Permit n DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp umpster gn.site, yes V�> '' no Located at 124 Main Street , , •,, Fire Department signature/d to 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 I NOTES and DATA— For department use ❑ Notified for pickup - Date Doc:.Building Permit Revised 2011 June/mi - F I 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 i ❑ 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) o 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 2008mi Location/X/ li�e4 '5/ No.� Dated • ' TOWN OF NORTH ANDOVER i Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ TOTAL $ E Check# 25381Building Inspector The. 1�6.mmonwealth of Massachusetts Department of Fire Services Office ice of the State Fire • Marshal P.0.Bax 1025 Sr+ite Road,.Stcw,MA 01775 PERMIT Date: V-2 North Andover )Permit No Di Safe Nvm er (City of Town) (If Applicable) g In accordance with the provisions of k G.L.14$Chapter 10 as provided in section U-7 amR 34 Start Date This Permit is granted to:. Full name ofpersoq irm or Corporation Permission to locate dumpster for construction/renovation/demolition of building. Comments: dumpster. must be . 25 ' from structure if unable to place with required Restrictions:clearance dumps-ter must be covered with plywo. od or tarp end of 'work -day at a %Z111/d- ( ive location by sheet and no.,or cnibc in such manner as to provied adequate identification.of location) FeePaids 50.00 Fire Chief This Permit will expire- � G ' � (S i o..offical granting permit) Of£cal granting permit (Title) - T EIN#51-050-3313 Haverhill MA 978.374.9224 MA Reg.HIC#149221 mde Lawrence MA 978.687.7339 '�' MA Lic.UCS#78130 Hampton NH 603.929.9224 BBB. Single-Ply License#1711 oof�wrg Hampstead NH 603.329.8200 -�,�w.T932 Co. Toll ree 1.888.SOS.ROOF 265 Winter Street Haverhill MA 01830 t�1 l j *Factory Trained *Factory Certified . Name: Date: * Telephone f _ 1t.TO llo e: Email:x,, _ Billing Address:J �t !"I t� City: *� '— State: Job Address: f City: State: Scope of Work trip and Re-roof ❑Re-roof Approximate Roof Area: Prepare for re-roofing by ensuring all safety measures in accordance with OSHA standard regulation landscape is properly protected. VleRemove.existing layers of shingles down to roof deck and dispose of in a legal fashion fro a du ite. EAnspect wood deck,if we discover any rotted wood,replacement will will performe at*$ ' � per LFfor roof deck boards. If substantial deck rot is discovered,re-sheathing of roof deck can be performed at*$ per S.F.If individual sheets are found to be rotted/or de-laminated,removal,disposal and replacement will be performed at*$ per sheet.If any trim boards are rotted, replacement will be performed at*$ per LF for new pre-primed pine.Insp2rsiding at roof line and all flashing behind siding,if we discover any damaged flashing or si mg at the roof line,replacement will be performed at*$ If wood deck,siding,and flashing is sound,we will re-nail any loose wood to rafter s eck,and prepare for roofing. ZInstall 8"drip edge to all rakes and eaves.Color ErApply ice&water shield(UNDERLAYMENT)as per manufacturers'specifications and/or 4G-A-pFly`ppemium-(U•NI)E44L-AYI ME VTj-te-tile-13aliffee-of-4he-ear-pesed-woed-deck : Ae-flash all plumbing stack pipes,and any roof penetrations as required and dictated by good roof practice to ensure water tightness. Z If upon inspection,we discover chimney lead to be worn or deteriorated,r acement will be performed at*$ einstall a new: Year ElTraditional � Architectural ElDesigner Color '01Furnish and Install a new shingle over style ridge vent system ❑Sotfit vent system `❑ A11 debris generated by Lambert Roofing Co.,Inc.will be cleaned up and disposed of from the job si %inalegalfaso . erno circumstances w' 1 the watertight inte rity of the building be cotIaad.Special Note . Aj WIA UPON COMPLETION AND PRAMENT IN FULL,ROOF SHALL HAVE A WORKM16 V G RANTEE FOR A PERIOD OF�� YEARS HONORED AND ISSUED BY THE LAMBERT ROOFING COMPANY AND YEAR HONORED AND ISSUED BY THE SHINGLE MANUFACTURER. its UPGRYI--*$ _. *Denotes potential additional costs above the total.estimated price. TOTAL CONTRACT PRICE AND PAYMENT SCHEDULE The Contractor agrees to perform the work, furnish the materials and labor specified above for the total sum of: $ (Dollars) Payment will be made according to the following work schedule: $ deposit upon signing contract $ t : , by—/—/—or upon completion of upon completion of contract. (Law forbids demanding full payment until contract is completed to both parry's satisfaction) You may cancel this agreement if it has been signed at a place other than the contractor's normal place of business,provided you notify the contractor in writing at his/her main office or branch office by ordinary mail posted,by telegram or by delivery,not later than midnight of thf third business day following the signing of this agreement. See attached notice of cancellation for for an explanation of this right. f Ot SIGN THIS CONTRACT IF THERE ANY BLANK SPACES Acce tafa of the Contract Proposal Home Owner(s)Sign (s): "� a uuk�e ` .,r+ Date: Contractor's Signature: Date: / / X.nArw lamhartrnnfina ram The Commonwealth ofMassachusetts -Department oflndustrial.Accidents Office oflnvestigations 600 Washington Street 5� Boston,MA 02111 www.m7ss goo/riia • Workers' Compensation Insurance Affidavit:Builders/Contractors/EIectricians/Plumbers Applicant Information Please Print Le�biy Name(Business/Organization/Individual): Address: City/State/Zip: /�'� `G �' Phone#: '�� '�' Are you an employer?check the appropriate box: L a employer with 4. ❑Tama general contractor and T 'pe of project(required): employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2. T am a sole proprietor or partner- listed on the attached sheget.t 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp,insurance. [No workers'comp,insurance 5. ❑ We are a corporation and its 9• ❑Building addition required.] .officers have exercised their 10•❑EIectrical repairs or additions 3. I am a homeowner doing all work right of exemption per MGL l 1.❑PIumbing repairs or additions myself.[No workers'comp. c.152,§1(4),and we have no insurance required.] 12.E]Roof repairs r1 ]�r employees.[No workers comp,insurance required.] 13.❑Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. T Homeowners who submit this affidavit indicating they are doing all work affidavit and then hire outside contractors must submit a neer fidavit 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 emplayeY that is providing workerscompensation insurance/oY my employees Below is the policy anrd job site information. Insurance Company Name: �^ Policy#or Self-ins.Lie.#:_ '° Expiration Date: •% Job Site Address: , City/State&ip:_4de;&el J � Q/ py� Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). 4 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.D9 for insurance coverage verification. fP J ry ` r do Izer'eby certify under the pains[rndpenalties o er'u that the information pro above is true and correct. Date: Official use only. Do not iVrite in this area,to be completed by city or town o rcial City or Town: Permit/License# Issuing Authority(circle one): , I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electric 6. Other al inspector 5.Plumbing Inspector Contact Person: Phone#: NORTH TVM o of over .. 0 : : . o , dower, 1Vlass., COCHICHEwiC. V 7�A�RATED '9S BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT............... . .. .I. w�........... ....lvw. ..... .......................................................................... Foundation has permission to erect........................................ buildings on.....�. .�........... ...... .. ............................... Rough #o be occupied as.... I�I.�OO Chimney ............................. �.................... ................................................... provided that the person accep ing th permit shall in every respect conform he 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 T T UNLESS CONSTRUC S S Rough Service BUILDING INSPECTOR Final ! i 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. Smoke Det. SEE REVERSE SIDE - CERTIFICATE OF LIA131LITY 1S�UDATE tb1BUDp y -;'IJ R jwiCA T it IS t. ' , 8SUED AS A MATTER OF INFORMATION QNtY ANQ C 03/09/201 CER i IFi_' E F DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND IRS NO RIG S bPON THE AFFORDED CERTIFICATE FICATi E BOLDER. T4 LLLOb�'. THIS CERTIFICATE OF INSURANCE DOES, NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. BY THE PQL1Ci '' �` f ti,e ce cate holder is an �A.DDtTIONAL tNSUREt�,the pottcY( sI Susi be ea; a;ssct. if RER(S), AtITHORk . *,r0RTA, t lfr?ii"+'i]S a�?Si Cahn lieu S tttt?patiCy,ceRdiir pOtiC125 rit3jr rEquire�n endorsEmertt. .�StateF7Seit�an.tftES CB[tpi;iCatE CtQ2S 1'IOt Ctfs'!f@i't'ifjtet5 t4 certificate r SUBROGATION IS WAIVED,subject � �� ,v.e2r!s i.si o ssaci�e>zctorsEment(s). ^+ CONTACT ,7'erxald �- A-GE�]Cs1 1NC. A E: haliie.t:'a5 PttOroE (9781 7�$-5905 !FAX __r�r`scn F��=ez� e grid ---- I O[sr E-tkAIL .- .. vtC -LTerI'6�C�a..11cZ2E.].IIS'3rance.COM 01970-0511 INSURERS AFFOROtNGCQVERAGE -- IFtSIIRERk:.�%en�+Ca 5>AeC3aIt Ins. CO. l NAIL:: INSLIRER B;Saa et y Insurance C! fl la .:..wTut'Je'�": KC�a' 1Y1 CompanytNSURERC:Alters, nxceSfa Sc Surplus - a-_ tNSeJREREIC rtis Insurancer j -- '-'-2_ i-alit an MA 01830- :La'JE y TES CERTIFICATE P¢ L IJ 'O r'cr?Ti.r'y' UMBER: REVISION NUMIBEW `i '-,T TH POLICIES OF INSURANCE LISTED BELOW HAVE $EEN iSfiJE U'"t;0ATHSTA;N,r ING ANY REQUIREMENT. TERM tQ TO THE INSURED NAMED ABOVE F r_ r3F i S OR CONDITION OF ANY CQ:NTRACT OR OTHER DOCUMEN?' 440TH RE EHT POLli1t>iCl �Io AND !SLic,,, O'F MAY PERTAIN. THE Ih2St3ftAN E AF,{1R>aED BY THE POLICIES DESCRIBED H REI+! .S SlJF33ECT TO ALL H F -t ` lCiIVt3 OF SUGI!POLICIES.LIMITS SHOWN MAY HAVE BEEN REOUvFt3 BY PAID CLAlivi$, THE r_RiL@: TYPE OF iNSU ANCE �AD©E. U 01:1 EFF . >=P"•.!1--.3iLi^rblilill ! POLICY NUM9ER POLICY EXP ! ^------�.._.�__.—_--- ! PJIlDD: ;—"-S 78130 RICHARD J LAMBERT 94 PICADILLY RD HAMPSTEAD, NH 03841 61212012 ------------ 30062 @ Office of Consumer Affairs and usiness Regulation 10 Park Plaza - Suite 5170 Boston,.Massac4�setts 02116 146me improvement U�% or Registration Registration: 149221 Type: Private C Expiration: 12/6/201 T.G.L.R-C dba Lamb��rt Roofing .M . RICHARD LAMBERT 265 'WINTER STREET HAVER'HiLL, MA 01830 Update Address and return card. Address r* D Renewal j