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HomeMy WebLinkAboutBuilding Permit #110-11 - 217 BEAR HILL ROAD 8/5/2010 BUILDING PERMIT of"°RT"qti TOWN OF NORTH ANDOVER 02 APPLICATION FOR PLAN EXAMINATION '' ~ Permit Noz!© `! Date Received �4A`°""`-`• � ��SSACHUs���y Date Issued: ' -�o. IMPORTANT:Applicant must complete all items on this page '' LOCA:^10N{ J� ��C _ - •t FPROPERTY Print - _ rMAI'j 210 PARCEL _ ZONING,DISTRICT Historic District= .,yes,. no f -- { . Village, _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 s Septic -1%Uell Floodplain Wetlands g °V1/atershedDistrict,� ��_Water/Sewers :� j T _ DESCRIPTI NWO K TO BE PREFORMED: C:L 00 Ide tification Please Type or Print Clearly) OWNER: Name: 366% Phone:bJf 71-77"-- Address:--al 1-77"Address: l Aloar 1"D a COIMfRACTOR 'Nam �-GU ""� Ph "n- Z_ -..+. � r ~- Su.per�vit '8�Q 0 6h411cense Moore°Irnprovernent L�cense,� /.. _rpt spate `jc , -�. �r .,. �.. ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12000 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $�I ��7 FEE: $ Check No.: POP5-5 Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to h uaranty nd Siena urt a of/1 exit/Owner =rS�gnature of.contractor, w _ Location No. � � Date NORTH TOWN OF NORTH ANDOVER ? •. • O i Certificate of Occupancy $ EA Building/Frame Permit Fee $ s�CHus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # ! 2 3 2 Building Inspector 4 i Plans Submitted Plans Waived Certified Plot Plan Stamped Plans i TYPE OF SEWERAGE DISPOSAL Swimming Pools Public Sewer Tanning/Massage/Body Art 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 Signature Reviewed on Si HEALTH g COMMENTS 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 DEPARTMEN ' TemprDumpster onsite yes no Located at 124°MAlh Streetr Fires Department signature/date - 1 Dimension 1 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 2010 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:Building Permit Revised 2008 NORTH BUILDING PERMIT °��t`°� 1 "moo 2 y� :�.16 TOWN OF NORTH ANDOVER ,0 APPLICATION FOR PLAN EXAMINATION //O /f/ Dae Received Permit NO tRid SACHUS Date Issued: 00 ' �r��� IMPORTANT Applicant must complete all items on this page F �I?R®PERTY O.WNER� &J- - _ -, -� s r 7 j es ono. �MAP)210 }PARCEL aZON1NG�D1STRfCT _Hisfonc Distract y MachmeSho Villa a es 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 ; `' Se is �IUell ,i fFlnodplain „Wetlands: Watersheds®_istnct� DESCRIPTI N WO K TO BE PREFORMED: 00 I Ide tification Please Type or Print Clearly) b 7 OWNER: Name: ���?ti � Phone: Address: #CONTIFZACTOR?'Names '' " Phone �- �r 011 `Su ervisors Construction License z _'`�� ExpoDatew p '^d - ent License :- Exp: Date f l -? ;IMome Improvers YIN ' Phone: ARCH HIT ECT/ ENG EER Address: Reg. No. FEE SCHEDULE.BULDING PEER�MIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ II �r1 FEE: $ Check No.: PO05 Receipt No.: - 3) NOTE: Persons contracting with unregistered contractors do not have access to h uaranty nd ` '`•" C,e.Ro+giro of rnn�r�ctnr /�i.. The CommonweQlth ofAlassachusetts Department o f Industrial_•4ccidents Office 01-rnvestigations E 600 Washinbon Street o Boston, M4 0211-7 Workers' Compensation Insurance Affidavit: $uilderslConara Aa Iicant Information etors/Electricians/Plumbers PIease Print Le6ibly Name (Business/Organization/Individual): Address: CJ d���C.� , I C� City/State/Zip: 00 7 4 Phone �3 Are an employer? Ch the appropriate boa: 1• I am a employer with 4 ❑ I am acontractor Type of project(required): employees(full and/or part-time).* have hir d the sub-nirac orandands 6• ❑New construction 2.❑ la m a sole proprietor or partner- listed on the attached sheet $ 7. ❑Remodeling ship and have no employees These sub-contractors have working for me in any capacity, workers coin . ' g' ❑Demolition p insurance. eq workers' comp. inc„ranCe 5. ❑ We are a corporation and its 9- ❑Btdldmg addition_ required] officers have exercised their 10•❑Electrical repairs 3.7,I am a homeowner doing all work right of A °r additions exemption per MGL 11. Plumbing repairs or additions myself [No u�workers comp c. I52,§I(4),and we have no 12.7❑ ir,.ct,ran q ] employees. Roof repairs [No workers' ins 13.❑ comp. urance require ] Other `-a- ?icant that chis box must aso uii oU-f tce secric. bei e• t Homeowners who submit this affidavit indicating th „. e}'a,e ting all aorl and thea hue outside contractors r. Ei ;--rc zstioa !Contractors that this box must at ched an additional sheet showing the '"'shit a new amdavit indicating such. name of the sub-contractors and their workers'comp_poiicy infotrnation. I am an employer that is providing workers'compensation insurance for my e information, rnployec& Below, e is the policy� P c7 and 'fib site Insurance Company Name Policy#or Self-ins.Lic.#: l Expiration Date: f Sob Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration pace(Showing the otic Failure P numb` to secure cov Y number,and era a as r expiration g equired candor Section 25A of date). GL c. 15 f fie u 2 c to$1 50 an lead P 0.00 and/or one-Year imprisonment,as we"as civil t0 the imposition of criminal penalties of a of up to$250.00 a day against the violator. Be advised that a c Penalties m the fora'of a STOP WORK ORDER and a fine Investigations of the DIA for insurance coverage verification. PY of statement maybe forwarded to the Office of I do hereby under the pains penalties op. , fP Juri th4rt the information provided above is true and correct Si�natur , /, .Date:_--.- -f lJ Ph Official use only. Do not write in this area, to be completed by cit),or town of iciaL City or Town: permitUcense# Issuinz Authority(circle one): I. Board of Healtb 2.Buildinb Department 3. City/Town Clerk: 4.EkectricaI Inspector 5.Plumbing 6. Other b Inspector Contact Person: -Phone-#: Information an- d Instructions Massachusetts General Laws chapter 152 requires all smployers 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 Iegal representatives of a deceased employer, or the receiver or trustee of an individual,parmership, association ox-other legal entity,employing employees. However the owner of a dwelling house having not more than three apartnZ ents and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintemance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not be:cause of such.employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state,or Io.cal licensing agency shall withhold the issuance or renewal of a license'or per mit to operate a business or to c onstruct buildings in the commonwealth for any applicant who has not produced acceptable evidence of c03mpliance 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 ml:ff acceptable evidence of compliance with the Mcu_rance requirements of this chapter have been presented to the contracting authority." Applicants -davit completely,by checking the boxes that apply to your situation and if Please 0 out the workers' compensation a necessary,supply sub-contractor(s) name(s), address(es) and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC) or Limited LLability Partnerships I.LP)with no employees other bran the members or partners,are not required to carry workers'comp cation 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 re-tarned to the city ortown rn that the application for the Tercet'or license is being reaues+wd,not th -DepErt TMent.of Industrial Accidents. Should you have any questions reg -the lav-or if you are.re,.i:ired to obtain a workers' compensation policy,please call the Department at the numbe=r 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 Off7ce'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 peraiit/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 peimiits 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 bum leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would like to than 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.ntunber...... The Commonwealth cif Massachusetts. Department of Industrial Accidents Of 5 ce of Inves iaatioas 540 Washington Street Boston,M—A 02111. Tel. 617-727-4900 mt40:6 or 1-877-MvASSAFE Revised 5-26-05 Fax T 617-72.7-7749 ��ru�.mass..aov/dia ORTiy ToVM of And over dover, Mass.,tw_ LAKE -wy COCHICHEWICK ATE D P' 'CC:) `S BOARD OF HEALTH Food/Kitchen .PEKMIT T Lip Septic System BUILDING INSPECTOR D4�4d..THIS CERTIFIES THAT.... ..... ......................................... . ..... .................................................... Foundation has permission to erect.................:...................... buildin on ( ......... /. .................... Rough ................ to be occupied.as......../' !. ........5�.. .... ..7...... .....�.f�.�. R. ............ ---"'.-- ----,-r-----..................... Chimney provided that the person accepting this p�fm'd shall in every respec onform 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 71 PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUC S T'S ELECTRICAL INSPECTOR Rough Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on thel 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. ORTH T0VM o '. . Andover = -a " dower, Mass,e? COC MIC HE WICK ADRATED P,*' `S BOARD OF HEALTH Food/Kitchen .PERMIT T D Septic System BUILDING INSPECTOR DW;�d . .THIS CERTIFIES THAT ` �.... ..... .... ......................................... ...... ................... ............ ... Foundation 14 has permission to erect........................................ buildin on � ,,(. Board Of Burl �ep.trtmen Co Urns Re. t ol'Public nstructio gulatio S.tiett Lrcense: Cs n Superjiso m•tnc/'Stantlar�S Restricted to: 00. X041 License ANNA 67 CV RRAO METH EN BLvb . . old nlhSlr�ryff. - '" Expiration: 3W2011 Tr#: 10204 B7fa�t`Y:o ui ink g`t egu ati s an an ars s License:or registration valid for.individul use only HOME IMPROVEMENT CONTRACTOR before the expiration dale. If found return to: Board.of Building[.egulations.and Standards Registration; 137640 One Ashburton;Place Rm 1301 Expiration: 12113(2010 Tr# 277501 $oston,lvla.02108 3ypei Private Corporation i AG EXTERIORS INC ANNA CURRAO l +r f J 67 LOWELI BLVD;_; - � �{ • METHUEN,MA 01844 Administrator Not valid{without signature AC Exteriors Inc D.b.a. Joes Vinyl Siding 67 Lowell blvd. Methuen,Mass. Anna Currao Proposal (978)686-7235 Submitted to: Work to be performed at: David W Kibler 217 Bear Hill Rd 217 Bear Hill Rd N.Andover Ma 01845 N.Andover Ma 01845 978-687-1572 We hereby propose to furnish the materials and perform the labor necessary for completion of: Strip roof of 1 layer of shingles. Re-nail all loose sheathing Replace plywood as needed for.an additional cost of 55.00 per sheet Apply Grace Ice and Water shield three from edges of roof Apply Grace Ice and Water shield in valleys Apply 301b felt paper to remaining,rod surface up to ridge Install 8"aluminum drip edge. Color. White Install Trim Line Rigid Roll Plus ridge ventilation. Clean up and removal of waste and debris Magnetic sweep of property Dumpster provided and include in price All.material is guaranteed to be as specified.All work to be completed in a workman-like manner according to the specifications submitted per standard practices.Any alteration or deviation from above specifications involving extra cost will be executed only upon written orders and willbecome an extra charge over and above the estimate Contract Price: Seven Thousand Six Hundred Ninety Five Dollars(7695) Payments.to be made upon completion of job Checks Payable to AC Exteriors Inc Respectfully submitted:Anna Currao,President Date:7/12R0I0 Acceptance of proposal-The above prices,.specifications and conditions are satisfactory and are hereby accepted.You are authorized to do the workas specified. above. payment to be paid as outlined f� . Date afore I 08/02!2010 11:51 19786859460 HASBANY INSURANCY VAGV 01 ACC)& CERTIFICATE OF DAEMMrodYY )iJR4 T spa/io THIS CERTIFICATE 15 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 COVEMAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE-OF INSURANCE DOES NOT CONSTITUTE A CONTRACTBETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT. If the cartific25 holder IS an AIS ITI NAL INSURED,the pollay(lesl must b6 endorsed. If§UBROGATION 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 right to the certificate holder in lieu of Such endorsemen s). PRODUCERrUNTAUT NAM Eric 'Tansen Hasbany Traure:nce.Age PH 0NF (978 685-318$ FAx (978) 685-9460 236 Pleasant; Street t No: ss: �zic�hasban .cora Me'rYtlZerl, MA 01844. . PRODu _cus.T.oAnwA _2496 MAIC iJ INSURED ' rINSUl'tl AC E.xt:erioze Ina. Rs:67 Lowell Blvd. RC:M®thuen, MPi 01Bdd ER I Nsu ER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED SEl ow 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 WHCH THIS CE=RTIFICATE 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 SEEM!REDUCED BY PAID CLAIMS, u .. LTR TYPE OFINSURANCE POU.CYNUNIBER �� FOUCSr ~ GENERAL LIABILIT! EACW OCCURRENCE COMMERCIAL GENERA441APILITY DAMAGE'IU RENTED PFtEMI$t;S_CEiO.avtconoe).._ d CLAtAAS.MADE OCCUR --• Y D EXP(Ary ono parses,) S "' """' -• - PERSONAL&ADV INJURY & GF,NERALAGGREGATE S CtEN'L AGGREGATE LIMIT APP LIES PER PRODUCTS-C PRAMP/OP AGG 0 POLICY LOG r AUTBMQBILEUABWTY COhl31NED51NGLELIMI7 $ ANY ALiTQ (Esaccideni) S , ALL O WNE D AUTOS BODILY INJURY(per person) 3 t SChlEDULED AUTOS t30DII.Y INJURY(Per aaaidont) $ WIREDAUTOS PROPERTY DAMAC+E 5 j (Per eccltlent) NON-OWNED AUTOS a • LRELLA LIAR S OCCUR E30 LIAfl EACH OCCURRENCEGLAIMSlMA4E GATE gUDTIflLF ENTION 3 - LRRS COMPEN$ATIgNVWC 601]351©12009 1/i3/10 s/�3/ISLOYERV LIABILITY RIETW9R1PARTNERIEXEGUTNEE,L.EACHACGI NTSEMBERE%CLIAED? NIA 06 NH) E.4,916EASE-EAEMPLQYFg ]crl6e untlerTIO OFOPERATIONSbelow - F•L.DIS EASE•POLICY LIMIT S �QQ. 00t2 CPSCRIPTION OFOPSAArONS/LOCATIONS I VEHICLES (Attah ACORD 101,Additional Rarrnrks Senedule,if morn npgo g is rogdred). - - CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLJCIES Be CANCELLED BEFORE TOWN or-No AATDOWR— THE 01PIRATION DATE THEREOF, NOTICE WILL BE bEUVERED M ACCORDANCE WITH THE t'oLICY PROVISIONS. AUTHpRQED REPRESENTATNE f TRIC ',7ANSEN m 9988pp A >3 CORPORATION. All rights reserved. ACORN Z5{2Qd 5109} The AC.ORD name and logo are registered marks of aC D /�