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HomeMy WebLinkAboutBuilding Permit #145 - 190 ACADEMY ROAD 8/19/2009 BUILDING PERMIT o* No or" qti TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: ' S Date Received �,9 q�q^rep "k. SSACHUS� Date Issued: ` IMPORTANT:Applicant must complete all items on this page i LOCATION D Dr 4z&&e, PROPERTY OWNER G' Print MAP NO: PARCEL: ZONING DISTRICT: Historic Di rct a /no Machine Shop Village Sy6s 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 r DESCRIPTION OF WORK TO BE PREFORMED: t it Q� 5/47 _ r V entif afion Please Typ or Print arly) OWNER: Name: ' Gj Phone. rd Address: CONTRACTOR Name: 4W h Phone: Address: Supervisor's Construction Licenser%c Exp. Date: - U Home Improvement License: / a47( Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING P . MIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: FEE: $ Check No.: Receipt No.: 2 -2 I S NOTE: Persons contracting with unregistere contractors do not have access to the guaranty fund Signature of AgenVQ)gner _Signattare of contractor Locationy Vim/ I� No. Nr 1 Date 1 / N�RTM TOWN OF NORTH ANDOVER h 9 L a Certificate of Occupancy $ ..�:_. / Building/Frame Permit Fee $ i Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # Buildin�Insl�o, � f 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 II' DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature COMMENTS j HEALTH Reviewed on Signature o 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 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 ...................-----...................__..__.. _ ...........--................ -----------._....................................._._...........-.....-----------.......................................--- Doc.Building Permit Revised 2008 j 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 ❑ Building Permit Application- ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan OrProposed 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 Revised 2.2008 J t4ORTty I 01fm OfS 4Andover Q ,...,ti ,ti:,,,,. .• .� r,.. TT �O LAKE o Y` dower, Mass., 0 - . COCHICHEWICK V1 �A"ATE D PPS` BOARD OF HEALTH .. '. f. M y r`' Food/Kitchen Pt Septic System BUILDING INSPECTOR ® (......., ... , . ...,.... .j.q� � THIS CERTIFIES THAT........... ... .............. ,...................................................... Foundation has permission to erect........................................ buildings on..1. aca....... d.. .: ..... ......(..&®................. Rough w w a *toherimnspection, � .... Chimney to be occupied as.... .... .... .......�r........(v,.�.�-.�..� �.�!, ................................................... provided that the person a -;pe ting this permit shall in e�lery respect to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating 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 6qb .., THS ELECTRICAL INSPECTOR UNLESS CONSTR C O ARS Rough Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises v 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. 8 / 25 / 2008 3 : 07 , 46 PM 8740 2 02 /02 v�iSti S� 1 n S. rY�h PRVDi1/ r 3 ? see>4 y a f s..I�'u. v 1�1 ISSUE DATE 08,�7 M0 CLR �. '\ilrui III (Mance Aoellcy Inc THIS CERTIFICATF 11 ISSUED AS A MATTER OF WFORNIATION(NIN AND CONFERS NO RIGHT UPON THE CERTB�ICATE HOLDER.Ti HS C1(k-1'I.FIC;A'I E' Box 511 DOES NOT AMEND. XTEND OR ALTER THE COVLRAGI;A FUitI�ED 13\' hi TF rn IS.de ,MA 01970 POLICIES BELOW SURED —^— C'OIVIYANIFS AFFORDING CON/1 R•+�G �l GL RC IIIc jdba Lambert Roofing Co. COMPANY A A.I.M. Mutual Insurance Co 1265\Vwter Street LETTER HaverUL MA 01830 +�i?Y"'c: �r ��SiuIZ ifs ,� ' .. � �;.. � . •.q""*2h*1:n} ;�*;x.:!�'.vL�.S�Syt'},a,t is +�4 "i"A""'�" THIS IS TO CERTIFY THAT THE POLICIES OF"INSURANCE LISTED BELOW HAVE BEE ISSUED TO THE INSUREDNAAiEllABOVL IhOR T.HE YC II (ss}�5+'fF I iffs. PERIOD INDICATED,NOTWITHSTANDING ANY REQUIREMENT TERM OR CONDITI SS ANY CONTRACT OR OTHER E)ABC) ENT WITH kLSY TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE FORDF..D BY THE POLICIES DESCRIBED HEREIN IS SUM 1 'PCI.41.E THF'PERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SH WN lO MAY HAVE BEEN REDUCED Ey PAfll CLAIMS. 1 rR L' TYPE OF INSURE ANC -'- _ POLICY NUMBER POLICY EFFECTIVE PO LIC r ERPIRATION DATE(Ii M/DD/YYI DATE 04MIDD/YY, LIMITS C:ENER4L LIA©ILITN' '�_—I':r.11vILI;;IALr^ENLfWL LIABILITY t—_- :•L.4IIe1:'MRDE�� FEF^ IIAI .l•:,L,+ II P f �(•, _.._ - ...___...._____ R _I— I — , I AUTOMOBILE LIABILITY MED E\PEIJ>t;(AJ,yune p;;n„) l ---'—'-"---- ___ ._ ,r iM1SIT �'ItJ::FINED :L`: - LIMIt ANY AIITr:- ALL(rV•'NED AUTOS PjDIL`r INJURY S'HEDULED AUTirE (Per l,erson) L I t^ IiNIF.ED AIITO, � I-�--tl.+'•fiP.OL LIABILITY ei�DIL1'INJI,I r.V I .- (Pel xcldenU �6 EXCCSS LIANI L[T 1' - �--- j PRiJF ERTV UP.tAAI�E_ 6 - __01PIP.P.ELLA FORM A ORF. ATE ,:ITHEk THAN MiFOfiM ;{ �r - OPIMRS COMPENSATION AND -I .' i;'pS W EMPLOYERS LdABILiTY TATLI-i'ORY LIMITS O"I-HEF f X HE PROPRIETOR/ FAPNJERS\EYEcuTIVE EL EACH ACCIDENT S 1.000(1Ot) rFF!CI EP.S AR E �-, INrL �_�p_{CL 6009966012008 08/28/2008 08W/20094�20�9 EL DISEASE--POLICY LIMIT - 1,000.I)(m — EL DISEASE--FAC ii I C'ONIMENTS/DESCRIPTION OF OPERATIONS OR LOCATIONS: En�LOVEE s 1,000,000 )O,!)(IO IbVORKERS'CONff'ENSATION COVERAGE APPLIES TO MASSACHUSETTS EMPLOYEtS ONLY I I i I I .•n` #A+ 7 .. I' EOULD ANY OF 7—ABOVE DESCRIBED POLICIES BE CANCELLED BEFCI,.c THE E V'(R,9TTON r'AI,P l L�RHOF,THE ISSITLNG CO ANNAMED S'SVn L,ENDEAVOR TO MAIT,IU WRITTFN NOTICE TO THF.CLRTiT-11 OLDFR TO THE ,BUT FAII_LTRP TO MAdL SUCH NO'tIc'E SI-SP1I.rN)p OSE NO UbLICiA'flCi R LIABILITY OF ANY IQND(PON THE COMPANY,ITS AGENTS OF RE:NRESL;YI A 1 IVES. _LTTHORIZED REPRESENTA�IVE 4791 i i T . G . L . R . C . INC . , DBA / LAMBERT ROOFING s� neT$ /k/"I amee �_ v s�e-s saa o. In business since 1932 March 5,2009 ATTN:NORTH PARISH CHURCH, SUBJECT: FOR ROOF REPAIRS @ 190 ACADEMY ROAD NORTH ANDOVER, MA 01845 PHONE: (978) 687-7948 ROOF REPAIRS AT NORTH SIDE LEADING EDGE approx. 72' T.G.L.R.C., Inc. will ensure the North Parish Church that we are fully insured by requesting a certificate of insurance be drafted for Workers Compensation, General / Auto Liability and a$5,000,000 Umbrella,policy sent by fax and via US mail to the required party. Pre-pare for re-roofing by ensuring all safety measures are taken in accordance with OSHA standards and landscape is properly protected A pre-construction walk thru will be executed to observe existing conditions and parameters. 1) Remove existing lead coated copper sheet metal panels at leading edge on north side of Church approx. 72' as discussed with Deb Putnum and Dave Torrey down to roof deck and dispose of in a legal fashion from the job site. Inspect wood deck and perimeter trim, if we discover any rotted wood replacement will be performed at time and materials. ($65.00 per man per hour plus material cost). If wood is sound we will re-screw any loose wood to rafters, sweep deck and prepare for roofing. 2) Remove all necessary courses of shingles above panels till a clean bond is made between existing shingles and ice and water shield and newly applied ice and water shield and shingles. TWO SIXTY FIVE WINTER STREET HAVERHILL, MA. 01830 (978) 374-9224 (FAX) 521-5791 OR VIA E-MAIL LAMBERTROOFING@AOL.COM OR VISIT US ON THE WEB @ WWW.LAMBERTROOFING.NET EIN# 51-05033313 UCS# 078130 f —2— JUNE 10,2009 3) Apply new Certamteed ice and water shield from approximately 4' up the roof transition where the metal panels ended and tuck and seal under the existing ice and water shield and place down over the fascia. 4) Install metal (Aluminum) "F8 drip edge" to eave of roof (perimeter) as required. Color to be: white and install an additional strip of ice and water shield over the I fasteners to prevent water infiltration due to potential ice damming in the future. 5) Furnish and install a new "Certainteed Landmark Premium" 50 Year Architectural (algae resistant) style shingle roof system using a hurricane nailing system recommended in the northeast regions. Color to be: Match existing 6) Re-Flash any base tie-in to side walls as required. All debris generated by the T.G.L.R.C., Inc. will be cleaned up on a daily basis and disposed of from the job site in a legal fashion. Under no circumstance will the watertight integrity of the building be compromised. T.G.L.R.C.INC. agrees to commence described work in on or about Qune/July 2009) and the described work will be completed in about(2)working days. T.G.L.RC. INC.shall not be held liable for delays due to circumstances beyond our control. T.G.L.R.C. INC, may not be held liable for any damages to landscape,attics and/or fixtures due to circumstances beyond our control. T.G.L.R.C. INC. shall not be held liable for pre-existing conditions including but not limited to mold and/or wood rot. Defective, faulty,rotted or worn building counterparts such as but not limited to siding,gutters,masonry,plumbing, and windows that jeopardize the watertight integrity of the building are not covered under the roofing warranty. The following work includes all labor,materials and disposal needed to complete your job in a professional workmanship like manner. EXCLUSIONS: Prevailing wages, performance of other work trades including but not limited to unrelated carpentry, unrelated metal work, plumbing, electrical, masonry,siding,windows,gutters,unless otherwise contracted for via change order. i Any unrelated/non contracted construction work will be billed out at $65.00 per man per hour plus materials. TGL'RCrnc DBA Lambert Roofing Co. 41- i ,� i � Estimate 265 Winter Street f'�/► o S Haverhill, Ma 01830 Date 8/18/2009 I ?k_ J �� Name/Address Ship To North Parish Church 190 Academy rd. 140 Academy Road North Andover North Andover,Ma 01845 JOB# Terms Rep 338 Due on receipt RC Item Description Qty Cost Total Repair Roof repair See si 3,800.00 3,800.00 ed contract Cpp , LA_t �� - Total $3,800.00 Phone# Fax# E-mail Web Site 978-374-9224 978-521-5791 info@lambertroofing.com www.lambertroofing.net 1 f The Commonwealth of Massachusetts r Department of IndustrialAccidents Office of Investigations 3 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): , •f '� Address: City/State/Zip: P---: Phone Phone #: Are you an employer?Check the appropriate box: 1. am a employer with 4. ❑ I am a general contractor and I Type of project(required): employees(full and/or part-time).* have hired the sub-contractors F6. ❑New construction 2. 1 am a sole proprietor or partner- listed on the attached sheet. 7. E]Remodeling ship and have no employees These sub-contractors have g, Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp, insurance.# 9. EJ Building addition required.] 5. E] We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself [No workers'comp, right of exemption per MGL insurance required.]t c. 152, §1(4),and we have no 12.[] Roof repairs employees. [No workers' 13.F1 Other compinsurance 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 rovidin p g workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: C�`Z Policy#or Self-ins.Lie.#: � �� Expiration Date: j�t �p Job Site Address: City/State/Zip: 40u// Attach a copy of the workers' compensa on 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 and h nd penalties of perjury that the information provided above is true and correct. Si nature: Date: Date: Phone#: d ' s a2 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 a 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-contractors)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 be 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. 4 617-727-4900 ext 406 or 1-8:77-MASSAFE Revised 4-24-07 Fax##617-727-7744 www.mass.gov/dia