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HomeMy WebLinkAboutBuilding Permit #468 - 1542 SALEM STREET 12/7/2011 NORTH BUILDING PERMIT -1"o '6 TOWN OF NORTH ANDOVER 02 a� 6 APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received �R,T.o �y SSS GNU SES �/ A Date Issued: ! IMPORTANT:Applicant must complete all items on this page LOCATION 15-41) �0..... r (7 Print PROPERTY OWNER or Print MAP NO,-206- PARCEL: ZONING DISTRICT: Historic District yesno 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,A&RTe Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: Identifica ' Please ype or Print Clearly) OWNER: Name: ��� � O Phone: Address: 1 J 4a Sc3S'4— AJ, A-f�.IoU.9—r p1 S(kj CONTRACTOR ,Name: U Ya'I,OA Ly , 0,C- Phone: 9 ` f 66'V02 3-- Address: Xp�1, SCJ 3 a � � r / Supervisor's:Construction License: 1 (, 33k Exp. Date: 1Ac l� Horne Improvement License ykyq 3 Exp. Date: i /gid! ARCHITECT/ENGINEER Phone: j' Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BAS ON$125.00 PER S.F. V Total Project Cost: $ 1en !dFEE: $ Check No.. D i Receipt No.: �--3 J — IOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund §ignature of Agent/Owne Signature of contractor C . Plans Submitted Plans Waived Certified Plot Plan Stamped Plans 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 THE FOLLOWING SECTIONS FOR OFFICE USE__"ONLY - INTERDEPARTMENTAL SIGN OFF - U FORM t' DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMtNTS 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 924 Main Street Fire Department signature/date 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 I 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 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 ❑ 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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 I Revised 2.2008 T Location Sk � No. Date f a w- NORTIy TOWN OF NORTH ANDOVER O:�tNo .•,�O 3? �_ • O AL FO. s w 9 ' Certificate of Occupancy $ CMUSE Building/Frame Permit Fee $ Foundation Permit Fee $ rg Other Permit Fee $ TOTAL $ Check # F 23767 Building Inspector ORTF1 TO" of Andover lit .. ........... CAM No, 4pe' ,,za (t o a dower, Mass., ION COC MICMEW1 �� A°RArEv `SS BOARD OF HEALTH Food/Kitchen .PERM IT T D Septic System �i BUILDING INSPECTOR THISCERTIFIES THAT........... .. .. .......................... ..+......................................... ....................................... Foundation P 9 trq.lu. .........o ... f �... °ugh has ermission to erect..............:......................... buildin s on ............. ..... � • — t0 b8 OCCUPIed.aS..........leyieht� ♦,,......,..,,, himney �. provided that the persois permit shall in every respect conform the 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 j VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough. Final PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUC STARTS ELECTRICAL INSPECTOR Rough .............................................:.......................... 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. Massachusetts Honie Improvement Sample Contract This f!"in satisfies all basic Tequirements of the state's Home implrivemen't Contractor Law(MGL chapter 142A),but does not'include standard !Wgifage to protect homeowners. Seek legal advice If necessary. Any person planning home improvements should first obtain a copy of a , Massachusetts consumer guide to home improvement"before agreeing to any work on your residence.You may obtain a free copy by calling the Office of Consumer Affairs and Business Regulation's Consumer Information Hotline at 617-973-8797 or 1-888-283-3757. Homeowner Information Contractoi Information am ompany Name , Ncx) t t!L C� StreelJAddress(d not use a Post 0111ce Box address) Contractor/Salesperson/Owner Name a rt ct -�c Ciity�/fowa State Zip Code usiness Address(must include a street address) W•/� 0� A/ -( �GCR.v� Jam' Daytime Phone Evening Phone ity/To State Zip Code O 186 y Mailing Address(ll different from above) rosiness one ederal EmplcyerID err 5.5.Number i-awrequeresWalmanhomeim- Home provemeatContmciarReg.Numher Hxphatiandrte provemest contractors have • aad RElGharlaa n1IIahG ' The Contractor agrees to do the following work for the Homeowner: �b 3•T � .� 33S-- -1 Tbesm e m a r o mp e e speer g e e, ran e o rti inas-n-ey eon ace Required.F'ermlts-The following building permits are required Proposed Start and Completion'Schedule-The following schedule will andill be securod by the contractor as the homeowner's agent, be adhered to unless circumstances beyond the contractors control arise (Omars who secure their own permits will be excluded from the Guarant3i Fund provisions-of : �Date when contractor will begin contracted work MGL chapter 142A.)' . Date when contracted work will be substantially completed. Total Contract Price and Payment Schedule The Contractor agrees•to perform the work,furnish the material and labor specified above for the total sum of (.) Payttjehts will be made according to the following schedule: S upon signing•conttact(riot to exceed 1/3 of the'total contract price or the cost of s acral order items wh' • P . whichever is greater) by __ /�/ or upon completion-9f $ by _/_/_•or upon completion of upon completion of the contract (Law forbids demanding full payment until contract is completed to both patty's satisfaction) The following material/equipment must be special 5 to be paid for ordered before the contracted warl-begins in order S to be paid for to meet the completion schedule.(**) NOTES:(*)Including all finance charges(**)Law requires that any deposit or down-payment required by the contractor before work begins may not exceed the greater of(a)one-third of the total contract price or(b)the actual cost of any special equipment . Por costo . which must be acre]oideredin advance m made material special ce to meet the completion P Express Warranty-Is an express warrntity being provided by Hre cantraetnr? No Yes Inil terms of the warrapty must be attached to the contra ctl Subebntractors-n✓•contractor agrees to be solely responsible for completion of the work described regardless of the actions of any third paity(subcontractor utilized by the contractor. The contractor,further agrees to be solely responsible for all payments to all subcontractors fo materials and labor under this-agreement r Contract Acceptance-Upon•signing,this document becomes a binding contract under law. Unless otherwise noted within this document,the contract shall not imply that any lien or other security intere'sthas been placed on the residence. Review the following cautions and notices carefully before signing this contract • Don't be pressured into signing the contract Take time to read and fully understand it. Ask questions if something is unclear. • ' Make sure the contractor has a valid Home Improvement Contractor .eeistretiott The law requires most home improvement connectors and subcontractors to be registered with the Director of Home Improvement Contractor Registration_ You may inquire about contractor registration by:writing to the Director at One Ashburton Place,Room 1301,Boston,MA 02108 or by calling 617-727-3200 or 1>800-223-0933. • Does the contractor have insurance? Check to see that your contractor is properly insured. • Know your rights and responsibilities. Read the Important Information on the reverse side of this form and get a cop Guide to the Home.Improvement Contractor Law. y of the Consumer 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/hermain office or branch office by ordinary mail posted,by telegram sent or by delivery,not Later than midnight of lite third business day following.the signing of this agreement. See the attaclrerl notice of cancellation form for an explanation of this right. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES!!! Two identicat copies of the•wntractmust be completed and signed. One copy should go to,the homeowner.The other copy should be kept by the contmctar. Homeowner's s Sign tune - ontractor's Signature Date , Date/ Page No. of Pages i r Builders License # 58443 Home Construction Reg. # 109288 D � go (781)944-1994 (978)664-2557 "The Areas Oldest Roofing Company" £ P.O. Box 637, North Reading, MA 01864 P PO ALS I ED TO NE r _ DAT 73 ST 1 !-- t JOB NAME _.G7 CITY,STATE XVIPIC ODE 1 JOB LOCATION We hereby submit specifications and estimates for: Recommended Optional 5-n 11 re f (Included in price) (Not included in price) Rip&Remove all shingle debris from roof&job site: di layer ❑2 layers ❑3 layers or more Repair/or Replace any roof decking; not to exceed 50sq.ft. (additional at$1.70 per ft.) Install 8"aluminum drip-edge/and rake-edge along entire perimeter. Choice of mill,white or brown W/ Install ICE&WATER underlayment along horizontal eaves, valleys, sidewalls,sky-lights and chimneys I Install premium base sheet underlayment between roof deck and roofing shingles Install 30yr CertainTeed/GAF/Tamko or IKO architectural roof shingles I 0 40 year ❑50 year ❑60 year ❑Lifetime See manufacturer warranty policy for more details Install new aluminum vent-pipe flange (s) r P/ Chimney(s)-counter-flash and re-step existing flashing ❑Cut&Install new lead flashing Ridge-vent/exhaust vent with low profile design, hidden by shingle caps " ❑Soffit-ventilation ❑Roof lo, ,c r-vents • Seamless style aluminum gutters-custom fabricated at job site by our own gutter machine r ❑Downspouts ❑Leaf gutter guards p� Other r' t 3=//1 -r 0 1rtrl�t�f t�'ruv V0 �� � y , *Please Note:All items in roof attic should be removed or covered due to falling roof particles,at time of roof tear-off Price includes all items above that are checked only/others may be priced separately upon request. I r jJrvrpusr hereby to furnish material and labor-complete in accordance with above specifications,for the sum of: Total price not including options. dollars($ 67 IJ I ). Payment to be made as follows: 30%deposit required before ordering materials.Balance due in full upon day of completion. Please make all payments out to Kenneth Duval, mailed to: P.O. Box 637, No. Reading, MA 01864 Late charges of$50 per week for all outstanding bills due upon day of Authorized h % completion. Signature l�rn J -Accepting proposal means agreeing to the terms of the enclosed binder Note:This proposal may be contract. Please sign contract&return top copy(white)with deposit. withdrawn by us if not accepted within 3 days Massachusetts- Delru-iment of Public SafetN Board of Building Regulations and Standards Construction Supervisor License License: CS 58443 Restricted to: 00 KENNETH P DUVAL PO BOX 190/72 NORTH ST N READING, MA 01864 Expiration: 12/10/2011 ('ommisiuner Tr#: 10475 Office of Consumer Affairs&B siness Regulation HOME IMPROVEMENT CONTRACTOR Registration: .,.:167338 Type: > Expiration -9/10/2012 LLC D AL ROOFING -L0 KENNETH DUVAL', 72 NORTH ST 4a pz NO.READING, MA 01863 " _ Undersecretary NOTICE N W NOTICE TO a TO EMPLOYEES �` EMPLOYEES 0 / y S The Commonwealth of Massachusetts DEPARTMENT OF INDUSTRIAL ACCIDENTS 600 Washington Street, Boston, Massachusetts 02111 617-727-4900 — http://www.mass.gov/dia As required by Massachusetts General Law, Chapter 152, Sections 21, 22&30, this will give you notice that I (we) have provided for payment to our injured employees under the above mentioned chapter by insuring with: THE TRAVELERS INSURANCE COMPANIES NAME OF INSURANCE COMPANY P.O. BOX 1450 MIDDLEBORO, MA 02344-1450 ADDRESS OF INSURANCE COMPANY (7PJUB-023ON91 -9-10) 03-1 1 -1 0 TO o3-ii -ii POLICY NUMBER EFFECTIVE DATES GILBERT INS AGCY 137 MAIN ST READING MA 01867 NAME OF INSURANCE AGENT ADDRESS PHONE# o DUVAL ROOFING LLC 184 PARK STREET 0 0 NORTH READING MA 01864 a— EMPLOYER ADDRESS EMPLOYER'S WORKERS COMPENSATION OFFICER (IF ANY) DATE MEDICAL TREATMENT The above named insurer is required in cases of personal injuries arising out of and in the course of employment to furnish adequate and reasonable hospital and medical services in accordance with the provisions of the Workers' Compensation Act. A copy of the First Report of Injury must be given to the injured employee. The employee may select his or her own physician. The reasonable cost of the services provided by the treating physician will be paid by the insurer, if the treatment is necessary and reasonably connected to the work related injury. In cases requiring hospital attention, employees are hereby notified that the insurer has arranged for such attention at the NAME OF HOSPITAL ADDRESS 002991 W20P1G02 TO BE POSTED BY EMPLOYER The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Hanle (Business/Organization/Individual): Duval Roofing, LLCPO Box 637 _ No. Reading,g} MA 01664 City/State/Zip: Phone #: I -19- 66 7 c�5-5_ -7 Are an employer? Check the ropriate box: Type of project(required): 1. 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.❑ 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 workingfor me in an capacity. employees and have workers' y p �'• 9. ❑ Building addition [No workers' comp. insurance comp. insurance. required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their ILDPI repairs or additions myself. [No workers' comp. right of exemption per MGL 12. oof repairs insurance required.]t c. 152, §1(4), and we have no employees. [No workers' 13.❑ 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 is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: a v l Policy#or Self-ins. Lic. #.-1TCl f�� 3 �f Expiration Date: Job Site Address: �5 -Z sah,,,� City/State/Zip:1J6 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 here4ceif der the pains andpenalties ofperjury that the information provided above is true and correct. Si nat Date: Phone#: 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#: