The URL can be used to link to this page

Home My WebLink AboutBuilding Permit #115 - 208 SUMMER STREET 8/9/2012 BUILDING PERMIT o "°oT" TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION � � 1 * �o Permit NO: Date Received e~ P �1 A°q�reo�pP�•(y / �SSAC US�� Date Issued: 22 [� IMPORTANT:Applicant must complete all items on this page LOCATION Print PROPERTY OWNER ryl .I N Print 'MAP NO: PARCEL: ZONING,DISTRICT: Historic District yes.rn Machine ShopVillage ge yes 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: S� , 3-L-- \J Identification PleaseTye or Print Clearly) OWNER: Name: -ffrrl(,j Phone: Address: olO% 5V YYl (yW--(L CONTRACTOR. Name��5�-U6 �V t CQJ� Phone:T:,q -:�-4S l �A<` Address: V`J � S� � I✓1 -- 0��1�0 Supervisor`s Construction License:3 -Exp. Date: a--! Home Improvement License: ' S Exp. Date; Ll 3 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: $ �- G<Jo'o FEE: $n �— Check No.: Co - i Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contractor 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 HEALTH-- Reviewed on Signature COMMENTS t Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes i Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature&Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPAR ENT - Temp ®urm:pster on site yes L-ocated -M raw all Main Street Fire Department s-15-655t 7UNI d 7506�111111111111111111111111 1111111 -COMMEND 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 L_..._._ -------_._..........._.___....---._... - ---..... j 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 1 ❑ 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 Location �)✓y`!/Y�. S No.� Date �--- • - TOWN OF NORTH ANDOVER • r;��ll;lsl)yr9�� 1 Certificate of Occupancy $ Building/Frame Permit Fee $ Lam` r ti Foundation Permit Fee $ Other Permit Fee $ TOTAL $_. Check# '� 25601 Building Inspector -•'�=- iia;>:3ci3FFYL'tY�- I�li):31'tF331`nt t.Ff i�SYj9�FC �F3r�l't� $tFafil of Building i2cum ation s and StanttaF'ds License: CS 93403 SEAN OCONNOR ' 26 CHESTNUT ST ' SALEM, MA 01970 t• ��- Expiration: 12/31/2013 {'uirn3i�ci„nrr Tr=• 7996 jegu Nuoon Office of Cassa CTpR vlome 1MPROVEME�T COFITRA {ype: `l Registratton 123553 DBA ��t;j±:��;-�1 Expiration: 31.612013 preserve Painting' Sean O'Connor 'r.. �6 <� Amo` 203 WASHy INGYOtd;;T: Undersecretar SALEt+h,mKW970 ; f� II 203 WASHINGTON ST.#256 PRESERVE SALEM,MA 01970 SERVICES cal-pentryI painting IroofingIgutters PHONE:978.745.8745 FAX:978.745.3476 SALES@ PRESERVESERVICES.CO M Matt Cumm ings Date Bid:7/31/2012 208 Summer St Estimator:Aldemir Freitas North Andover MA, 01845 Email:aldemir@preserveservices.com (978) 688-0109 Mobile.t617r 610-1711 matt@cummingselectronics.com ROOFING ESTIMATE COMMENTS * INCLUDES : MAIN HOUSE , GARAGE ,BACK PORCH AND RUBBER FRONT ROOF. PRIOR PREPARATION PERMITTING: All permits will be obtained in accordance with the law as required. DISPOSAL: A dumpster will be placed in an area designated by the homeowner. ROOFING PREPARATION SHINGLE REMOVAL: Remove all layer(s) of old shingles. UNDERLAYMENT FELT: Install 15 lb felt on all areas not covered by ice and water shield. ICE AND WATER SHIELD: Install 3 feet of ice and water shield on eves and valleys. Install as necessary on other areas. FLASHING DRIP EDGE: Install drip edge on all perimeters. CHIMNEY(S): Install or rework the flashing around all chimney(s). VENTILATION RIDGE'VENT: Install ridge vents. LOW PROFILE: Install low profile vents. ROOFING MATERIALS 'ASPHALT SHINGLES: Install architectural shingle 30 year. LOW SLOPE/FLAT: Install rubber roofing. PRICING Basic $ 11360 Sales Tax $ 0 Total Price $ 11360 including Labor&Material Payment Terms: 20%deposit(day of start); 30%progress; 50%end of job McNisa/Amex S O'connor Customer Signature *Above additional prices includes all discounts and coupons discussed prior to estimate. The above quote is valid for 60 days. *Warranty: Craftsmanship: Kyron Inc. DBA Preserve Services warrantees all work performed for a period of 2 years. If any problems occur we will cover the cost of labor and materials. For the warranty to be valid the invoice that was presented at the time of completion must have been paid in full. Materials: The duration of the manufacture's warranty is specified in the materials section above. Licenses: Home Improvement Contractor(HIC): 123553 Protection: It is required by law that roofing contractors have a home improvement contractor license. If a contractor is properly registered, you are entitled to limited protection by the Residential Contractor Guaranty Fund up to $10,000. (The above is a only a summary of Massachusetts General Law 142A) To check our license or our competitors go to: http://db.state.ma.us/homeiml)rovement/licenseelist.asp and license 123553. Constructor Supervisor(CS): 93403 The construction Supervisors license is under an individual's name,not a company name. To check Sean O'Connor, owner of the Kyron Inc. DBA Preserve, license go to: http://db.state.ma.us/dps/licenseelist.asp select Construction Supervisor and license 93403. Insurance: r Worker's Compensation: Our policy is under Kyron Inc. DBA Preserve Services Protection: Covers the injury of a worker employed by the contractor doing work at your home. To check our policy or our completions go to littp:Hmass.gov/dia/ on this page go to"check worker's compensation proof of coverage"our license is under Kyron Inc. Liability Insurance Our policy is under Kyron Inc. DBA Preserve Services and has limit of$1,000,000. Protection: Covers your property in the event of accidental damage up to a dollar limit specified on the policy. To check our policy we will have to contact our insurance company. ,4`oRv® CERTIFICATE OF LIABILITY INSURANCE DATE/2012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT BO ton Insurance NAME• Yri Boynton Insurance Agency PHONE . (781)449-6786 AIC No:(781)449-4269 72 River Park Street ADDRESS: PRODUCER 00004109 Needham MA 02494 INSURER(S)AFFORDING COVERAGE NAIC 9 INSURED INSURER A XaX Specialty Kyron Inc. INSURER B-Iartford Insurance DBA Preserve Services INSURER C: 203 Washington Street,#256 INSURER D: Salem,MA 01970 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADD R POLICY EFF POLICY EXP LIMITS LTR N R WVD POLICY NUMBER MMIDD (NIMIDDNM GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 GE TO RENTED X COMMERCIAL GENERAL LIABILITY DA M SES Me occurrence) $ 50,000 A CLAIMS-MADEX❑OCCUR MX013100002122 /23/2012 /23/2013 MED EXP oneperson) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/0P AGG $ 2,000,000 X POLICY n PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMB $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE $ HIRED AUTOS (Per accident) NON-OWNED AUTOS $ UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION S $ B WORKERS COMPENSATIONX WC STATU- DTI+ AND EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE Y/N E.L.EACH ACCIDENT $ 100,000 OFFICERIMEMBER EXCLUDED? r--1E.L. (Mandatory in NH) 560DB0523N00912 /20/2012 /20/2013 E.L.DISEASE-EA EMPLOYEE $ 100,000 If yesdescribe und TIOer DESCRIPN OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION 1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE William Rohr/WRR ACORD 25(2009109) 01988-2009 ACORD CORPORATION. All rights reserved. INS025(2oogoe) The ACORD name and logo are registered marks of ACORD 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 Name (Business/Organization/Individual): �'c- <7 -"V\, Address: E.,J -s City/State/Zip: Phone#: Au an employer?Check the appropriate box: Type of project(required): ,tel dam 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 2.E] 1 am a sole proprietor or partner- listed on the attached sheet. # ? E]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. ElWe are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑Roof repairs insurance required.]f 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. f 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. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: �� S. N Policy#or Self-ins.Lic.#: Q—}tZ�f:) 7 1 Expiration Date: Job Site Address: �U - A- '�5 City/State/Zip: pwd"Oo c, L 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 penalties of perjury that the information provided above is true and correct./ Si nature: ' Date: ® O 1 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#: V L NORTH ■ { 1 r t 1, 6 . ver 0 No. 11 �.K. h ver, Mass, • �e COC MICNEW.CK s U BOARD OF HEALTH LDFood/Kitchen PERM Septic System Tz2l BUILDING INSPECTOR THIS CERTIFIES THAT ......... ... .. ..........:.......:......................I... . ! ................................... has permission to erect buildings on ... Foundation .......................... .� ........... !4ljll� . ... . ................... g • ..... Rough to be occupied as .....................:at .. :........ ..........".'�'....... .............. .. .. ...........a '... Chimney provided that the person acceptinhis permit all in every respect conform to th erms of the applic on 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final Final PERMIT EXPIRES IN 6 NTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTI TAR Rough Service r_-. �. .................. .. .....................:.:............................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz 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. SEE REVERSE SIDE