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Home My WebLink AboutBuilding Permit #239-12 - 1500 SALEM STREET 9/20/2011 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: U ]IMPORTANT:A plicant must complete all items on this page LOCATION /-D U SAZ � l ST / , Print PROPERTY OWNER !� �/�� / D Unit# Print MAP NOA06"A PARCEL: 7 ZONING DISTRICT: Historic District yes no Machine Shop Village yes no t 100 year-old structure 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 n. - - --- - !® S pt� c �M�W_e11 iOFloodplain U►letlandsUm Wat re sheci4Dst ct - NWater/Sewer DESCRIPTION OF WORK TO BE PERFORMED NY s/ P/M C- 'tel s /,�1/c �/�"JAI C c/►S r L t-, c<� di /� ii•�� s c , -�- II� (Identification Please Type or Print Clearly) OWNER: Name: -3-6 1 1 Phone• 0 7/ 6 Address: 16-00 CONTRACTOR Name: Phone: G 3-- Address: '3 S I p Irl r��A t_ I- 4? 2 A c C- Supervisor's Construction License: ] 3 5 Exp. Date: p b Home Improvement License: Exp. D s p ate. z v�/ � i3 ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ 0, y� C' ° FEE: $ Check No.: 7 ZZ� Receipt N NOTE: Persons contracting with unregistered contractors do not h ccess othe guaranty fund Crnnafiiro nf��rYAi4 i in�nar:. ` ' Crrtnafi rrc n 'inn 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 Permi Addition or Decks ❑ Building Permit Application -u ;Certified Surveyed Plot Plan o Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses o 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) o 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 o Mass check Energy Compliance Report o 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.Build' ing Permit Revised 2008mi 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 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 i Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. j 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.$1oo-$1000 fine NOTES and DATA— For department use Ll Notified for pickup - Date i Doc:.Building Permit Revised 2011 June/mi M LocationA!J w —�W6, .fr— No. a Date ,.OR,►, TOWN OF NORTH ANDOVER 0 w A }'e Certificate of Occupancy $ +SsCMUSE<�' Building/Frame Permit Fee $ p Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # ` - - 1? 4622 Building Inspector NORTH Town of No. 3 0E 0�, hover, Mass., F, �Z-/� T O LAKE coCHICHEWICK SRATED P? C2 BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT..............,O C� N..�...... ........................................................................................................ Foundation has permission to erect........................................ buildings on ....00..... t4 J�................................... Rough �S,. . . ............................... to be occupied as c �!�(i� Gl�i:.: ?��bi�-,f.....:.�....,!Ce 5F-,,:�t�... JrI Se, , :.... .FC Chimney provided that the person acce t n this permit shall in eve respect conform to the termifof the application on file in P P P � � P nl P PP � 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 UNLESS CONSTRUCTION STARTS Rough ; met.................................................... Service BUILDING INSPECTOR Final 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. SEE REVERSE SIDE Smoke Det. °mvn� � �rsiness egn aho Office,o onsmer airs. HOME IMPROVEMENT CONTRACTOR Type: Registration 1'1 _ 2595 j 3 Expiration x/9[2013 "Individual GA E.LISS GARY LISS 13 STONEWALL TER j ATKINSON,NH 0381'1-;V`">= Undersecretary Massachusetts- Dcpanmcnt of Public Safety Board of Buildinl- Re!-ulations and Standards Construction Supervisor License License: CS 53506 GARY E LISS 13 STONEWALL TERR ATKINSON, NH 03811 I Expiration: 3/30/2013 Commissioner Tr#: 13129 ATE(MM/OD/YYYY) ACORQ CERTIFICATE OF LIABILITY INSURANCE D09/19/2011 PRODUCER 603.382.4600 FAX 603.382.2034 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Insurance' Solutions Corporation ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 60 Westville Rd ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Plaistow, NH 03865 Marialana Costa INSURERS AFFORDING COVERAGE NAIC# INSURED Gary Liss dba Gary Liss General Contractor INSURERA: MMG Insurance Company 15997 13 Stonewall Terrace INSURERB: NorGUARD Insurance Company Atkinson, NH 03811-2148 INSURER C: 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 ADD'L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR NSR DATE MMIDD/YYYY DATE MM/DD/YYYY GENERAL LIABILITY SCO117891 02/20/2011 02/20/2012 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $ 250,000 CLAIMS MADE I OCCUR MED EXP(Any one person) $ S,000 A PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY PRO LOC JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR F—I CLAIMSMADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION GAWC219970 06/15/2011 06/15/2012 X A - T AND EMPLOYERS'LIABILITY TORY LIMITS ER ANY PRO PRIETOR/PARTNER/EXECUTIVEa E L EACH ACCIDENT $ 100,000 B OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Mr & Mrs John Reid IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR 1500 Salem St REPRESENTATIVES. N Andover, MA 01845 AUTHORIZED REPRESENTATIVE „ [Marialana Costa/MLD ACORD 25(2009/01) ©1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts Department of Industrial Accidents p � Office of Investigations rttt 1 600 Washington Street i Boston, MA 02111 {i www.massgov/dia . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information / Please Print Legibly Name (Business/Organization/individual): V/�A e ' /1 S S ! ' Address: 13 S 16 1,-) E \/k/AT-JE W A ( E City/State/Zip: AT I�1 i\�S 6/l1 114 03 e f t Phone #: . D 3 - Are yo n employer?Check the appropriate box: Type of project(required): I. I am a employer with 'Z 4. ❑ 1 am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. E]New construction 2.E3 am a sole proprietor or partner- listed on the attached sheet.t � [r�'F�emodelmg ship and have no employees These sub-contractors have 8. Q Demolition working for me in any capacity. workers' comp. insurance. (� [No workers'comp.insurance 5. ❑ We are a corporation and its 9. g addition Building Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself. [No workers'comp. c. 152, §1(4),and we have no 12.❑Roof repairs insurance required.]t em to ees. [ o workers' 13.❑Other comp. insurance required.] *Any applicant that checks bo) l 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 their workers'comp.policy information. am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:-_C- �-A (2 ]` S C © , Policy#or Self-ins. Lic.#:-6A VV C Z �( � D Expiration Date: (o 16- 2 0% Z Job Site Address:/,4_DD -564L/t11 S7-. City/State/Zip: , /A/-J J)0 V/ IZ /,/JA- 0 1 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 DCA for insurance coverage verification. !do hereby certify u e he pains and penalties of perjury that the information provided above is true and correct Signa e: Date: 2 61X/ Phone 3 6 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): L6. oard of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector ther ntact Person:- Phone#• proposal Gary Liss 9/2/11 page 1 of 2 ow."ctor �3 Str�ne To: Mrs, and Mrs. John Reid Atkinson, NH 03811 1500 Salem Street 603-352-5185 N. Andover,MA• www.gsrylissbuilders.com j Quote includes labor and material for the following remodeling,which entails: - Remove existing siding - Install CertainTeed Monogram"Arctic Blend"siding with paper beneath - Install CertainTeed Cedar Impression siding(flagstone?)on lower part of house front all Replacedecaying fascia boards with new tri�rn and cover with aluminum - IrusWl vented vinyl soffits and drill existing where needed - Vinyl corners to be Traditional "Super Corners" - Prep bottom of garage foundation to receive new siding - install new Harvey Vicon Classic double hung windows(17 total); windows to have brickmold(908)casing, grids between glass,energy star rated - Remove existing large windows on end of Douse and frame to receive new double hung window, insulate and sheetrock interior j - Relocate front entry door using"Smooth Star" fiberglass door - Install new"Smooth Star'9-lite door in rear with new storm door i - Install new window and doer trim(new units) - Install new Harvey kitchen casement window - Cut back deck to receive 20' decking - Remove existing decking and rails - Install new Timbertech Xl,M decking on deck and stairs - Install new Timbertech white railing - Install white PVC boards on perimeter of deck Body of deck to be fastened with"Conceal Loc" system(no screws showing) Building permit Price$50,41£.00 Page 2 of.. Payme t Schedule $ 5,004.00 Deposit 1 windows ordered $10,000.00 windows delivered/work begins $10,000.00 siding begins $10,000.00 '/z siding complete $10,000.00 Siding complete $ 5,416.00 Deck/job complete Acceptance of Proposal The abovep prices,specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payments will be made as outlined above. 7 Submitted by: Gary Liss Accepted by: