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HomeMy WebLinkAboutBuilding Permit #1 - 197 WINTER STREET 7/2/2007 BUILDING PERMIT "°pT" qti t alt °,, o TOWN OF NORTH ANDOVER ti APPLICATION FOR PLAN EXAMINATION 1 D Permit NO: Date Received "`�"�`�`• Date Issued: 2 ACHU`-+���y IMPORTANT Applicant must complete all items on this page �+ y e - a M 00 - x r Wii�rt ik, TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial k1o'2epair, replacement_ ❑ AssessoryBldg ❑ Others: ❑ Demolition ❑ Other Se t`rc Lle * 47011 � � g. x DESCRIPTION OF WORK TO BE PREFORMED: f I S7 Identification Please Type or Print Clearly) OWNER: Name: G 1491'3 1� bb 1 Phone: Address: '1 t.� r'n? S ✓ IJ4 yrfF-; 3?.'€ r l S r M 101 CTO . I A(�Cf t�eSS h xz l I , ,� •y4 a4MIt. �tperriso 's�ons�C�c#io L lnse p g r � �� .. , p Atex ARCHITECT/ENGINEER Phone: i Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$1200 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ job , 5 7 F � EE: $ i Check No.: / :�- d s---- Receipt No.: a03,5-3 NOTE: Persons contracting with unregistered contractors do not have access to the g ranty and Sirtiure t/O 9;0, .... ,.�.._ R A ,Signature d cont"raotor 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 ❑ p Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ I THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS i DATE REJECTED DATE APPROVED 11 El CONSERVATION COMMENTS DATE REJECTED DATE APPROVED i HEALTH El El COMMENTS 'v 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 ' Located at 384 Osgood Street FIRE DE�'ARtMEI T T; nem umpster t� Located1 Mofn krreet '— �F!i 4 De artm nt sig atur � - F x- a,suers 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 i I i ❑ Notified for pickup - Date Doc.Building Permit Revised 2007 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 y' ❑ 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 DEPARTMENTMIZORM07 Revised 2.2007 Location /a No. Date . K; No"TM TOWN OF NORTH ANDOVER yip h 9 Certificate of Occupancy $ sACMus<� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 20353 Building Inspector 261:1 4.tL QDMID 1JtL§ ,Q: r° o'"0 Chi Haisi�debtiai & Commercial Ronfl�w�9 AH T lllli� CHIMNEYS P��1 o-R,Ea����tv:a�-CAPPHEo ExI � lork Mass soC! Cfea d P,oraff K4v mrn4&•gprraie Ser-=& .tui (924-8481) TK &'E, &r�w t. h—v We 081 "Fear IfUrIVnd. � t I . .'. � • rid ,. s , -�., .�.' 1 " s,.. 'R."7 � � �1JI.E:y:1:7 • a Proposal Submitted To: Date: Chris Kool 5-13-2007 Street: City, State & Zip: 197 Winter Street Andover, MA 01845 Vinyl Siding Proposal 1. Strip all existing masonite siding. 2. Apply breathable Tyvek house wrap. Total Amount:$15,900.00 3. Apply metal coverage along all windows and rakes. Warranty by manufacturer: Vinyl Siding carries a 4. Trim all soffit with perforated panels. lifetime limited: 5. Apply light blocks and house picket blocks. 6. Install certainteed monogram .046 premium vinyl Our workmanship: Guaranteed for up to 10 years siding to entire house. under normal circumstances. 7. Install composite trim along the garage doors and side entry. If you have any questions about this proposal you may 8. Remove gable vents. contact me directly at(978) 618-2985. 9. Electrical meter will home owners responsibility. 10.Remove shutters and reinstall existing. *Note* Available with the job all new.032 gutters 11. Remove all work related debris. and downspouts on front main,back main, and one 12. Includes building permit. side on the lower addition. Cost: $975.00 Payment schedule: 1/2 payment at 1/2 way point. Final due upon completion. Of PrpSrl',_ TJI ..� rce±; 6i ,at Ong. AcCePIA " atid r ,oi itimis are mtisfoory mid ars hcrchy acr-cpteod. You are autho ind W do tl1-c w04-as 4**cifM, Pay'Meni. S gnalurc %V111 be;nadL'.,as Oufflnud aNNT ° aof AcR �i �� eY_. C _ tgtaatt�r., , v . ..: .r-L0 (MMIR ; Chimneys Residential & Commercial Roofing All Types Of Siding CHIMNEYS POINTED-REBUILT-CAPPED Expert Masonry Work Mass Toll Free f_4Roof Leaks Experts Licensed& Insured 1-800-WAIT-4-US Locally Owned&Operated Since 7976 tom~_ License#034200 (924-8487) IKO tea& ?Zoom or �Aohosi We Work Year Round Proposal Submitted o Phone Date Street Job Name City,State&Zip Code 64 105 j Job Location Job Phone We Propose hereby to furnish and labor in accordance with specifications below, for the sum of: 17 i� fJ '? ed�► lil�.��A) Dollars ($ �� ® ' 6c� ). All material is guaranteed to be as specified. All work to be completed in a workmanlike Authorized manner according to standard practices.Any alteration or deviation from specifications be- Signature: low involving extra costs will be executed only upon written orders,and will become an extra charge over and above the estimate.All agreements contingent upon strikes,accidents NOTE:This pr sal may be or delays beyond our control, Owner to carry fire,tornado and other necessary insurance. Our workers are fully covered by Workmen's Compensation Insurance. withdrawn by us if not accepted within 9" days. We hereby submit specifications and estimates for: S TRAP� /Fc-r £'fit,eZ-(74,W Cs 0 Install 3 feet of special "Save Seal" ice and water barrier protection along all bottom edges of roof and top to bottom in each valley.*roof is stripped, we will apply conventional ice and water shield ( - ) ft. high in the same locations previously described and tar paper will cover the remaining bare wood. Any rotted or damaged boards will be replaced at ( ) per linear ft. or( S'6,a� ) pe r s h eet of p lywood. /4/2-1;477--�V pvwa`, 's4�s,,Qs Pass.7-d e-c 'Install heavy gauge aluminum drip edges along every edge surface of each roofline.$6i-4,-2:- Cover entire roof (s) with s, premium grade shingles (Color of choice). �rC�= Id Replace all pipe boots where possible. Seal all flashings with clear Geo-Cel sealant. No black tar unless previously applied. &Remove all work-related debris. 0"C' ontractor warrants roof against all leaks due to defects in his workmanship for 12 years under normal circumstances. Local current references and proof of workman's compensation insurance gladly given. Remarks: 3 i r�fS aot='12•r=f�✓�c-r( �f Y 3� ��f /_-�-'`c i it����'7 Lr�yrn�-�; ,�-�'e f. Acceptance of Proposal- The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment Signature: will be made as outlined above. 06 Date of Acceptance: . '� Signature� The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations s 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): Q 4`40�!1 d� '� `�✓�' Address: 3 City/State/Zip: Phone #: ""`` Are you an employer? Check the appropriate box: Type of project(required): I am a,employer with 4. ❑ I am a general contractor and I 6. ❑ New construction employees (full and/or part-time).* have hired the sub-contractors Z.❑ I am a sole proprietor or partner- listed on the attached sheet. t . .7. 0Remodeling ship and have no employees These sub-contractors have 1.8. ❑ Demolition, working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.0 Roof repairs insurance required.]t employees. (No workers' 13.0 Other comp.insurance required.] *Any applicant that checks box#I 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 tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. 1 am art employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. j Insurance Company Name: (syr /� /� %-)TVA I Policy#or Self-ins. Lic. #: ALJ C -" / y !�yv Zao� Expiration Date: Job Site Address:_ Q( l 0 t�'t J 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. 1 do hereby certify in.der th p ins art penalties of perjury that the information p►ov . 7B Dided a ove true and correct Date: St afore: _ _ / Phone#: 9 S 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-if Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Pluntbing In 6. Other Contact Person: Phone#: INTERNET INSURANCE Fax:97B6870149 dun 4 ZUU/ 13:3c r.ul 4CONLY CERTIFICATE OF LIABILITY INSURANCE 08704/2007 PrAxw:6R Un CEitTInGATE IS WSUE D AB A MATTER OF INFORMATION 1nt8tliel irmurarmsOILY AND CONFERS NO RIGHTS UP" THE CERTIFICATE y HOLDER.THIS CERTW MTE DOES NOT AMEND,EXTEND OR 522 Chickering Road ALTER THE COVERAGE AFFORDED 6Y THE POLICIES BELOW: North Andover,MA 01845 tN9I AFFORDtNO ODY®tA� MAIC 0 n NORFOLK A'DEDHAIM INSURANSE COMPANY JOHN LANZAFAIhME anal DBA ALL UNDER ONE ROOF KIeuR� 30 TEMPLE DR METMUEN,Mo►01844 f. �pvERAt;;Es Tic PO11CM'3OF I>iBINIA M UMW BELOW HAVE BEEN NMD TO THE OWURED NAAW AWft FOR THE POLICY FERIDD#9WATED.N07WTHSTANDING ANy REOtMREMENT,TERM On INION OF ANY CONTRACTOR OTHER ANT NIM'rM RESPECT TO VOOCH TMG CERTIFICATE MAY SIE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORD>D1 BY THE POLICIES OESCRIBEO"ERM 18 SUWCT TO ALL THE TERMS.EXCLUSONS AND CONDITIONS OF SUCH PC AGGREGATE LIMITS 6WWM MAY HAVE SEEN REDUCED BY P9MD CLAitwM. W OF wavAl" POLICY RUNIM yffimaw WITS A Gamftu1111H.ITY RWI433A OW007 8/312008 EACH OCCUMENU s lmoo,000.00 COW&MCIAL GENERALLUWUTY I $t,owoco a ® CLAM LAWS p) occuot MED EXP(Atlp ene POttall i o4woo PFR80NAldAOVNVJURY t t.pD0,Q00.80 OENERALAtt0RE0i1TTi t E.�.�O.CO ENT.AOGRE611TE LNNT APPLIES PER PRODIICT6-COMP/.OP AM !2,DOO,OAQ.00 ri POLICY rimomcTnLOC AUT011IMMUPAUTY I StNBLE LIMIT ANY AUTO ALLOWNEOAUTOs sCIgOULED AUros Iw ° fomAms �DILY W s NON4*01 DAUTO® OARAWWAftffV 'AUTO ONLY-EA ACCIDENT : AM AUTO . EA ACC s � I ,► _ amccl RNIIBAELLA LIABIIM EACM OCCURRENCE S OCCUR CL ms M WfHAGGREGATE 1 OEDUGTISI.E _ RETENTION S t e � OM A*o AwC70094"012003 11/18/2008 11/812007 LRM1T8 M.E �EXI T E. EACH ACCIDENT t A L- tOd 00Q.00 Mg U Lit PR!' E.LoiII61 -mewl s BYECtOD;s00.00 YL4 blow £L.DME1S.POLICY UMR E 4401000.00 am CE1IPTCATE HOUM CANCELLATION SIWYLOAW IM TME ANDO StAN90M PCUM M IIW CANCEU.EO BEFORE THE EXPNIATt01 BATS THEREOF.TNi 11111 1 NSR IAIQL ENOE%WOMO TO AA L 30 DAYS WRITTEN NOTICE TO TN6 CERTNICJtTc HOLOER HALOED TO YK LFT.SLIT PALM TO OO 60 SMALL WP=NOOK.NSANONOR LIA2LW OF ANY RIND W0N THE RISYRWt.ITS AVIRM OR �wTo 1 (TATIYE � _ w, NORTH Town of No. yy �, o , dover, Mass., 7 'r` Q LAKE A- 2 COCMICMEWICK �AQRATED P`9 �� qS U BOARD OF HEALTH Food/Kitchen Septic System PERMIT . T D �J • BUILDING INSPECTOR THIS CERTIFIES THAT.........M....( C.A.IaLs..... a.... ................. ....................... .�........... ............................ Foundation has permission to erect......................................... bk1 " s on .�.91...... t .......;.�................... Rough P Q Chimney to be occu ied as.... .......' ......V..1►.. .. ....... �. L .....�jrovided that the erson ac tin this ermit she res ect conform"to the terms of the ap kation on file inP P P g P r1l P Finat this office, and to the provisions of the Codes anws 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 CONSTRU S TS 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.