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HomeMy WebLinkAboutBuilding Permit #619 - 147 CHESTNUT STREET 4/23/2008 BUILDING PERMIT r10RTl•, o0 TOWN OF NORTH ANDOVER 02 '.` *° �°�, APPLICATION FOR PLAN EXAMINATION 7D y Permit NO: Date Received � AreD �SSACHU`��� Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION /Y ed�s I NU1 1 ri?IoJ4✓ l�G 14 Print PROPERTY OWNER At lr 0 . 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 WORTO BE PREFORMED: �A4 rqJA(-'P— YAfw- roq /ij -/)7n pl;� Rz A gi✓ i'mi of PI la Identifcati n Please Type or Print Clearl ) OWNER: Name: ���✓ ��,°�.e Pr�Sa1,,1 — Phone: Address: CONTRACTOR Name: kOrrm e nt) Phone: Address: 90 Q6 ri^ Q�v , Supervisor's Construction License: '70 (} Exp. Date: i o g Home.Improvement Licensee/ 1, -Z Exp. Date: � /0 Cpop 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: $ ,��.�� U FEE: $ Check No.: oC� �� Receipt No.: NOTE: Persons contracting with unregistered contractors do not have acce s t th u rar o�nd Ica�I' Signature of Agent/Owner� Signature of contractor Location No. jI Date NORTH TOWN OF NORTH ANDOVE'' Certificate of Occupancy $ / - �'�s Building/Frame Permit Fee $ s�c„us Foundation Permit Fee $ Other Permit Fee $ `!TOTAL $ Check # Q(//(66 - 2 j 00 Building Inspector 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 a , i F * +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 site yes no Located at 124 Main Street 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 R V V GL e+yr cv.ivL T— VkIL 'k N 6 i. i ❑ 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 .4N " ❑ Photo Copy H.I.C. nd/Or C.S.L. Licenses / Copy o ontr _t -`' ❑ 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 ,I Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 ^tea .Ar ,-' Prime Rg.,oiritp ,- torp;. PO Box 478/New Ipswich, NH 03071/Tel: 60 8784550/Fax: 603-8.78-4646 January 28,2008 cit �_ Joe Pasquale Andover,MA Supply labor and materials to complete;the following. 1; Remove existing shingles and replace with.new.0akridge Pro 30-year AR 2. Install ice and water-shield at valleys and eaves;minim' 3 3. Replace'damaged edge molding at valleys 4. Install new metal edge strip 5. Cut:wood siding at don-ner roof to increase flashing height and install new metal at shingle in ;and ribber roof tie . 6. Remove rubber roof at dormers and:replace using.060 membrane Billy adhered,inspect and repair any damaged substrate, install new%2"wood fiber;insulation and niectiariically attach.to.substrate,add wood nailers at perimeter edge to match insulation thickness,install new metaLedge fascia and pipe flashings and properly tie into shingle:roof and windows at dormer 7.. _Remove chininey.to-roof level=and replace with.-new material;replace damaged flues. 8. Install new lead chimney flashings 9. Remove all associated,debris from site and properly dispose We propose to furnish labor and materials-complete in accordance with above specifications, and subject to conditions of this agreement,for the sum of: Thirteen thousand,eight hundred dollars------- ----- -- ___ - ------------------------- ------ ---------------------($13.,800.00 ). Paymentto"be made as follows:--Up nCompletion 7 - Respectfully submitted, Prime Roofing Corp.. e_1` By: Michael Goen Note: This proposal-may be withdra n if not accepted within 30 days. 3 .00 Y Date of Acceptance: ` - I Board of BuildingRe ulatiofis and Standards g License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: y� Board of Building Regulations and Standards Registrar o)n� 157132 One Ashburton Place Rm 1301 ExNirat bn X410/2009 Tr# 258922 - = Boston,Ma.02108 �l I Tytpe Individual ADAM VAILLANCOtj}2TY ADAM VAILLANCORT; 59 ARMORY RD. �f Not valid without signature l MILFORD,NH 03055-- — Administrator {{ g 1 04/22/2008 TUE 15:08 FAX 001/002 ACORD„ CERTIFICATE OF LIABILITY INSURANCE 04/22/2008) PRODUCER (603)r369-0704 FAX (603)669-6831 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Infantine Insurance, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P.O. Box 5125 HOLDER.THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Manchester, NH 03108 Yvette Michaud INSURERS AFFORDING COVERAGE NAIL# INSURED Prime Roofing Corporation INSURERA: Acadia Insurance Co. 31325 Appleton Business Center INSURER B: P.O. Box 478 INSURER C: New Ipswich, NH 03071 INSURER D INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION DATE IMM/nnlYYI DATE(MM[Dn[YYI LIMITS GENERAL LIABILITY CPA0240287 03/10/2008 03/10/2009 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 2 SO,000 CLAIMS MADE �OCCUR MED EXP(Any one penton) S 5,000 A PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICYFX PRO JECT X LOC AUTOMOBILE LIABILITY CAA0240288 03/10/2008 03/10/2009 COMBINED SINGLE LIMIT X ANY AUTO (Ea accident) b 1,000,000 ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) S A X HIRED AUTOS BODILY INJURY b X NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE b (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT b ANY AUTO OTHER THAN EA ACC b AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY CUA0240291 03/10/2008 03/10/2009 EACH OCCURRENCE $ 1-0-,000,000 X OCCUR CLAIMS MADE AGGREGATE $ 10,000,000 A b DEDUCTIBLE b RETENTION $ $ WORKERS COMPENSATION AND WCA0240289 03/10/2008 03/10/2009 X WG STATU- OTH- EMPLOYERS'LIABILITY I ER A ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT 6 1,000,000 OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYE 5 1000,000 If yes,describe under r SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT b 1,000,00 OTHER DESCRIPTION O OPERATIONS f LOCATIO S/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS E: 147 Chestnut St. Andover MA. IF ax: 878-4646 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL Town of North Andover 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Building Dept BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 1600 Osgood St. OF ANY KIND UPON THE INSURER,ITS AG TS OR REPRE TAT VES. Andover, MA 01845 AUTHORIZEDREPRESENTA71VE f ACORD 25(2001/08) ACORD CORPORATION 1988 I The Commonwealth of Massachusetts Department of Industrial Accidents W Office of Investigations 600 Washington Street Boston, MA 02111 M 5� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lmibly Name (Business/Organization/Individual): Prime Roofing Corp. Address: P.O. Box 478 30 Tricnit Road #13 City/State/Zip: New Ipswich, NH 03,071 Phone.#: (603)878-3550 Are you an employer? Check the appropriate bog: Type of project(required): 1.❑X I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.0 I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g• ❑ Demolition working for me in any capacity. employees and have workers' insurance.$ 9. E]Building addition [No workers comp.comp. insurance p• required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.0 1 am a homeowner doing all work officers have exercised their 11.[1 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.X❑Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.N Other comp. insurance required.] 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 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 am an employer that isproviding workers'compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name: Acadia Insurance Co. Policy#or Self-ins. Lic.#:' WCA0240289 Expiration Date: 3/10/2009 Job Site Address: 147 Chestnut Street City/State/Zip:Andover, MA 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 e fy nder the p 'ns and penalties of perjury that the information provided above is true and correct. Si atnre: Date: 4/22/08 Phone#: .(603)878-3550 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 7a 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 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 1122-06 Fax# 617-727-7749 www.mass.gov/dia NORTH Town of � _ Andover o , dover, Mass., ( • d Q LAKE COCMICHEWICK V RATED BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.... .. ..L .' ...�........... ...�. ... . .V. .. . �r .................................................... Foundation has permission to erect........................................41.1.1i.ngs on.f. .I........... rt.t` ... . ........... Rough to be occU ied as.. . . . Tac�c�eptlingfls ay Chimney p '...... .. .. ... . provided that the persopermit shall in every re ct conform to the terms o e application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Afte tion and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough I PERMIT EXPIRES IN 6 MONTHS Final ELECTRICAL INSPECTOR. UNLESS CONSU ST TS Rough Service BUILDING INSPECTOR Final Occupancy Permit Required w Ocmpy 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. SEE REVERSE S 1 D E Smoke Det.