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HomeMy WebLinkAboutBuilding Permit #898-15 - 159 FOREST STREET 5/11/2015 BUILDING PERMIT NO oT 6q�o TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION ��`"/ _ I 1 Permit NO. Date Received P �^ ��SSACHUS���� Date Issued:14 IMPORTANT: Applicant must complete all items on this page LOCATION 9 ��✓l-�S J SJ /�� ,n Print PROPERTY OWNER Print MAP NOJ96 kPARCEL: ONING 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, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: Identification Please Type or Print Clearly) OWNER: Name: 1�6 �T7" J % s ,•✓x tS 2 Phone Address: /S`� J�o�� ► S �� CONTRACTOR Name: (J � VN Phone' Address: J -F-o� Supervisor's Construction License: (2)(-.%9 1 2 � Exp. Date: a� Home Improvement License: S- Exp. Date:- ARCHITECT/ENG I NEER ate: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: $_ 006 , o o FEE: $ Check No.: 5,�-� ( Receipt No.: � NOTE: Persons contracting with unregistered contractors do not have access to a guaranty fund Signature of Agent/Owner Signature of contractor } Location No. Date�?�� —•- . - TOWN OF NORTH ANDOVER t D rsya Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee Other Permit Fee $ TOTAL $ Q . Check#?777 t 1 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 Siqnature COMMENTS HEALTH Reviewed on Siqnature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes r L Plbnning Board Decision: Comments a 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) ❑ 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 ❑ 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 DEPARTMENTMFORM07 Revised 2.2008 F NORTH q Town of t E ndover o No. h ver, Mass,L^KI •� C OC MIC Naw 1* �,95 R�lTEO I-'PP,`�5 U BOARD OF HEALTH Food/Kitchen PER IT LD Septic System THIS CERTIFIES THAT AT07 �.1.�.I... . . ........................................ BUILDING INSPECTOR � has permission to erect .......................... buildings on ...I............ .. . ...... ... ........ ............. Foundation b Rough tobe occupied as ........ ...... .........*...................... .. .... . .. .... ............................................ Chimney provided that the person accept) g this permit shall in every res t 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 S ELECTRICAL INSPECTOR UNLESS CONSTRU TA Rough Service 3; all ............ .. ............ ................................... ....... 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. r n; rz r r�r_r_ _r - •✓v - - - • -a x - -# a g 2% _ r - 's.• '.h — - e ts�£ am. mnercial Roofing AXI 71 of Masonry _ -y Licensed& Insuredmass ic44riP > 3•F .s,.._x 97s License F#U34100 -3i1 V1f7 ' &•-+ c r e a- (4-24-8487) • Work Vear Hound { -u.i� j �--a° a- ss sa c F� s w .mss ° _ t A Proposal To: Brett Guisinger Date 411/2015 Street: 159 Forest St. 978-337-2135 N.Andover, NIA Roof proposal Brett.gu singer@gmail.com IKG Cambridge 1. Extra caution will be taken to protect building 13. Removal of all work related debris. Planks will be exterior and landscaping as best as possible.(tarps placed under dumpster to prevent any damage to etc.) Magnets run at final clean up. driveway. 2. Remove all shingles from entire house. 14. Building permit included. �. Inspect and re-nail any loose or lifted plywood. 15. Contractor workmanship warranty- 10 years Any compromised plywood will be replaced at an under normal wind and rain conditions. additional cost of$65.00 per sheet of 1/2"CI X. Total roof cost: $ 9,000.00 4. Install heavy gauge 8" white aluminum drip edge IKO Shield Pro Plus Extended MPG warranty: di to all rakes. Existing"dicks"'Vent drip edge will f A full 100% coverage on material, labor and remain as parto /the ventilation system. debris removal for a full r�on pro rated period 5. Install 6' of IKO Armourguard 'zee and water of 20 years. Included to our local referrals and shield along all eaves and top to bottom in all in this proposal at no additional cast. valleys. option: Upgrade to WR Grace ice and water 6. Install Rhino synthetic underlaynient to remaining J shield.(Best defense against leaks from ice sheathing up to ridge. dams) $400,00 additional cost 7. Install all new pipe boots. -*. Option: Install(1)Lomerco IIT 2000 thermo/ 8. Install IKO Leading Edge starter shingles to all `humidistat controlled power vent. eaves. $425 additional cost. No electrical included. 9. Install IKO Cambridge Limited Lifetime *Note*: Please be advised if applicable,valuables in architectural shingles to the entire house. 15 year the attic should be moved or covered due to minor non pro-rated warranty by mfg. (See warrantydebris,dust and asphalt particles that will accumulateinfo) All shingles will be installed and fastened during the stripping process. All Under One Roof not according to mfg. specs. responsible for any damage or clean up that may 10. Counter-flash chimney lead with ice and water occur in attic. ,_ _ shield,tie into new shingles and seal with black �4 rubberized cement. Balance due upon completion 11. Install a new GAF Cobra ridge vent capped with color matched IKO hip and ridge shingles. References available upon request 12. Install (2)new Broan exhaust vents on the roof line. Attic connection included. Highly rated member of the accredited BBB and Angie's List Thank vou! \ AILC li Vrfe"I"19 rYC"LLre VJ IYA"Ja ULrLLLJCLLJ Department of Industrial Accidents Office of Investigations 1 Congress Street, Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): !--41 Vyl -t A p,1 L 1Z�S� Address: &,�, Q/'Z City/State/Zip: ('� �-`�.J �-�l &g4Phone#: 9 0r-l Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4• 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 8. E] Demolition working for me in any capacity. employees and have workers' insurance.: 9. E] Building addition comp.[No workers' comp. insurance P• 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 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof 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: Policy#or Self-ins. Lic. #: Expiration Date: Job Site Address: City/State/Zip: 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. Ido hereby certify un th ams and penalties of perjury that the information provided above is true and correct. Si ature: ` 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#• nlghtfax t;3-4 DATE#UWDDrfYYY) gT1�lT°E tOF t 1AA SRA AFfc�Y �TE�. IS�As p�t7F �BY INE POLICMS BELOW- rtmy cm� na x x� vn c sem W DOM W T m'Ns��►�B �pEPAE{;�ttA71V� A : €maw IsEe sw ,�a�� i . 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You can also view arbitration and Guaranty Fund FundThe list i current as of Wednesday, October g, 2014, Search Resufts NT RESIP ONSi11BE RE61S►TRAIM EXPIRATION l WIDA11DUAL NUMBER ADDRESS DATE STATU., uL UNMR ONE trocar LANZAFAME, j3705? 166 A A4ERRIMACK ST 1 0102120 1 6 Current Vii!+! METHIeUN, MA 01844 Q 2012 Commonweam of Massachusetts. --� Mass.Govt is a registered service mark of the Cortltraar"aafl of Massschusetts. i. I