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Home My WebLink AboutBuilding Permit #270-12 - 201 DALE STREET 9/30/2011 i TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: J � 1 Date Received Date Issued: '� IMPORTANT:Applicant must complete all items on this age LOCATIONO i - Pr' t _ PROPERTY OWNER Unit# r Print MAP NO: 'T`' PARCEL:ZONING DISTRICT: Historic District yes no j Machine Shop Village yes no 100 year-old structure yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building CIOne family ! ❑Addition ❑Two or more family ❑ Industrial 4 ❑Alteration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other (]►Septic3 '❑I1We11; ❑►Floodplain phWedgi s. (] WatershedI?i,-n,`- O'Water/Sewer; DESCRIPTION OF WORK TO BE PERFORMED: - V (Identification Please Type or Print Clearly) OWNER: Name: ik(S K A-�q> STE P4f AUbE* Phone: 79) 66-,165? Address: 02 t- -i )(Jo , #4 n&L v e, y� CONTRACTOR Name: I)A V i S I N o u hw v iQ K//y G-- Phone: `�Z-Zo 1 �� pV16�tI S( ®S�j=o Address: Rb / M A - 0 Iq 2 V Supervisor's Construction License: � Exp. Date: by ^' Home Improvement License: f 177 1 ?j 7 Exp. Date: 9 3, 12 ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ ,� �' FEE: $_ _ I Check No.: i Receipt No.: C4- NOTE: NOTE: Persons contracting with unregistered contractors do not haveccess to the cca�anty f r ;Signature=of Agent/Owner Signature of:contractor'',.. Location No. Date NORTIy TOWN OF NORTH ANDOVER O:�« o .0,x•0_ F R 9 Y . Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 24641 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 Signature COMMENTS I HEALTH Reviewed on Signature j COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes f j Planning Board Decision: Comments E I 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 I COMMENTS I I Dimension Number of Stories:_Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of dieter location, mast or servicedroprequires approval of Electrical Inspector Yes DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$10041000 fine NOTES and DATA— For department use LJ Notified for pickup - Date Doc:.Building Permit Revised 2011 June/mi r I riature of contractor'.a -. 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 1 ❑ 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 i ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses f ❑ 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 i 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 ❑ Engineering Affidavits for Engineered products VOTE: 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 a must be submitted with the building application nd proof of recording Doc: Doc-Building permit Revised 2008mi I COMMENTS CThe 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 Name (Business/Organization/Individual): 24V(S W OO-b (A)n2 W1 iUG— Address: �J 5T, City/State/Zip: Z-1 Phone #:_r9'-7 9 12)$ 0-7 J Are you an employer?Check the appropriate box: Type of project(required): 1. ❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction ployees(full and/or part-time).* have hired the sub-contractors 2. I am a sole proprietor or partner- listed on the attached sheet. 1 ?• ❑Remodeling ship and have no employees These sub-contractors have 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 required.] officers have exercised their 10.F1 Electrical repairs or additions 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,[�oof repairs insurance required.]t employees. [No workers' comp.insurance required.] 13.❑ Other *Any applicant that checks box#1 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. 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. I do hereby certify under the pains and enalties ofperjury that the information provided above is true and correct. Si nature: - Date: 3Q Phone#: O Z__ — U 7 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#: NORTH ONM Of No. 0 odover, Mass. � • �- LAK > COC MIC HE WICK �oRATE D v U BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT......... a.NVo...........PO4AMPNOW... .........D;�6 Foundation has permission to erec ..................................... buildings on .'.......... ...... ... ......�... Rough • to be occupied as .I..r ....... ..... �....... ..... �K!1 !!...... Chimney p' ..... ............ provided that the person acce Ing this permit shall in ev respect conform to 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final aim PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUC N S ARTS 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 Until Inspected and Approved by the Building Inspector. Burner Street Street No. SEE REVERSE SIDE Smoke Det. Davis Woodworking 68 Main Street Boxford,MA 01921 TeL 8-882-2071 Fax:978-887-7214 J t 4 Davis Woodworking MA#CS 57105 Home Improv. #117187 RRP Lic. # LR000020 Fully Insured CONTRACT PROPOSAL To: 7/30/11 Mark and Steph Aude 201 Dale Street No. Andover, MA 01845 For: Re-roof 580 sq. ft. of roof area to replace 3-tab shingles w/25 year Certainteed brand charcoal colored shingles. Re-roof 196 sq. ft. of rubber roof. Removal of all old material and rubbish to be disposed of by 15 yard dumpster furnished by Mello Disposal of Georgetown MA. Replace 32' of framing, 64 sq. ft. of sheathing, 26' pine facia to be replaced with Azek composite white colored facia trim, 72 sq. ft. of 1/4"AC plywood soffit, and 32' of white aluminum flashing. Chimney is to be counter-flashed behind existing lead flashing with new lead flashing at areas of repair only. Any area discovered to be found needing repair will be worked on at an additional expense to be determined at the time of discovery. Remove and do not replace 15 ft. wooden rain gutter at roof edge on south side of patio. Painting to be done by owner. Work to begin on or before Oct. 17, 2011 and be completed by Oct. 28, 2011, weather permitting. Total cost of project is $10,776.00. A deposit amount of $3,592.00 is to be paid at the acceptance of the proposal. A progress payment of $3,592.00 is to be paid at approximately 2/3 completion of the project, and $3,592.00 is to be paid at the completion of the job. Contractor to carry all permits for this job. Acceptance of thi proposal: r Signed: Date: 3- Signed: Date: �5 /