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Home My WebLink AboutBuilding Permit #803-14 - 2189 TURNPIKE STREET 5/8/2014TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: V / / IMPORTANT: Applicant must complete all items on this LQCAT�ION' 7P'nnt rPROPE M OWNER A rV77 Print -Fold, ,MAP N® s_ PARCEL ZON;ING�D,IS;TRICT 'Historic D�s1 _ - -Machiine}SF 3tructure� ye�s�, =n o - .TYPE OF IMPROVEMENT. PROPOSED USE Resi tial Non- Residential ❑ New Building 2 One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ A eration No. of units: ❑ Commercial epair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑Septics ❑ 1Nell ❑ FloodplainE`1Netlands, ❑ 1Naters:hed®tstnct' -_ - ow wer Ideqtipeation Please Type or Print Clearly) OWNER: Name:_ Q^ -N Phone:&2 Address: �1 v =w CONTRACTOR "Name _r.- _ - _ Phone: -- - - - r Add'r',ess: a ' `Exp, Date- l _ Supervisor s Construction `License („C j_ _ 4.i nate ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE. BOLDING PERMIT: $12.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S. F. Total Project Cost: $ !,�Zmp FEE: $ �� s Check No.: 6M Receipt No.: 02-1 j NOTE: Persons contracting with unregistered contractors do not have acce to gua n fund natucerof Aent/Ofr Plans Submitted L.j Plans Waived ❑ Certified Plot Plan ❑ tamped Plans ❑ -: Plans Submitted ❑ ,Plans Vllaived ❑ -.....-Certified Plot Plan ❑ Stamped Plans ❑ :TYPE OE SI WERAGEDISPOSAL" Public Sewer ❑ Tanning/MassageBodyArt F] Swimming Pools ❑ Well ❑ Tobacco.Sales -•Food Packaging/Sales ❑ -.Private:(septic tank, etc._ - -- =perriianent Dunpster on -Site El THE..FOLLOWING SECTIONS FOR'OFFICE USE ONLY { INTERDEPARTMENTAL SIGN OFF - U FORM DATE. REJECTER DATE:APPR-OVED PLANNING & DEVELOPMENT` ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes . Planning Board Decision: Com b, Conservation Decision: :Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Towx-2 Engineer: Signature: Located 384 Osgood Street F [RE DEPARTI�Ir NT Temp - umr)-. r on site ..yes no Located at �124;Mair,�Street � ... ``" � � _` . , �.•.. .. .. : _,�. `: , "e ' , Fire Depaitme►�t .COMMENTS -Dimension - Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.; ELECTRICAL:M' ovement-of,Meter Iodation-, mast -or service drop requires approval of .Electrical Inspector Yes No DANGERZONE LITERATURE: Yes No MGL.Chapter166.Sect1on21A=F and G min.$100-$1000:fine NU S t5 anco UA 1 A — (yor aepartment use El Notified for pickup - Date Doc.Building Permit Revised 2010 Building Department The fol wiring is'a list of he required.forms to be filled out for -the appropriate. permit Wbe obtained. Roofh,g, Siding, Interior Rehabilitation Permits Building Permit Application ❑ Workers Comp Affidavit o Photo Copy Of H.I.C. And/0'r 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 cans if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the apw al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm-tted with the building application Doc: Doc.Building Permit Revised 2012 Location 2—t FS q � A WK No. Q V 3 "`I `1 Date TOWN OF NORTH ANDOVER Certificate of Occupancy Building/Frame Permit Fee Foundation Permit Fee Other Permit Fee TOTAL Check #� 7 ABuWing Inspector The Commonwealth of Massachusetts , - Departrnent of Industrigl Accidents Office of Invesfigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workexs' Compensation Ynsurance Affidavit: Builders/Contractors/Elec xxczansll'Iumbe Name (Business/Organization&dividual):, Armee yypWtn employer? Check the appropriate box: Type of project (required): 1. Imo! I am a employer with 4. ❑ I am a general contractor and 1 6. F1 New construction employees (full and/or part time) * 2. ❑ I am a sola proprietor or partner- have hire dthe sub -contractors listed on the attached sheet. 7. ❑ Remodeling ship and'have no. employees. These sub -contractors have 8. ❑ Demolition working forme in. any capacity. workers' comp, insurance, g. Building addition (No workers' comp. insurance 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions required.] 3. El X am a homeowner doing all work officers have exercised.their right of exemption per MGL 11. OTImAft repairs or additions myself. [No workers' comp. c. 152, §1(4), andwehaveno 12. i repairs insurancerequired.] employees. [No workers' 13. ex comp. insurance required.] xAny applicant that checks box #1 must also fill out the section below showing their workers' compensationpolicy information. homeowners who submit Phis affidavit indicating they kdoing all worX and then hire outside contractors must submit anew affidavit indicating such. TContractors that checkthis box must attached an additional sheet showing the name of the sub -contractors and their workers' comp, policy information. X am an employer that isproviding workers' corrtpensadon insurance for my employees .below is the policy andjoB site information. , % _) 1 ) 1 , j fnsuranc Policy ## Job Site Attach a copy o#tine workers' compensation -policy page (showing the policy number and expiration crate). Failure to secure coverage as regniredunder Section 25A ofMGL o. 152 can lead to the imposition of criminal penakties of a flue up to $1,500.00 and/or one-year imprisonment, as well .as civil penalties in the form of a STOP WORD ORDER. and a fine ofup to $250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of thepDkfor iissurance coverage verification. I do hereby ofper, jury that the information provided above i true,,and correct. official use only, (.Vo 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/Towu Cleric 4. Electrical Inspector 5. Plumbing Inspector 6 Other Contact 7Person- 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 iid the service of another under any contract of hire,. express or implied, oral or wxitten." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two ormore 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. ll'owever 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 ofpublic work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please 0 out the workers' compensailon affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s)name(s), address(es) and phonenumber(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 notrequired to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. B0advised thattbisaffidavit maybe submitted tothe Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be retumed to the city or town that the application for thepermit 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 andpxinted 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. hr addition, an applicant thatmust submitmultiple permit/license applications in any given year, need only submit one affidavit indicating current PORGY infommaiion (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 stamp ed or marked by the city or town may be provided to the applicant as proof that a valid affidavit -ii on file for future permits or licenses. A new affidavit roust be filled out each year. Where a home owner or citizen is obtaining a license ox permit not related to any business or commercial venture (i.e. a dog license orpermit to burn leaves eta.) said person. is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance fox 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 Com- mouwoalth ofMoss achumutts - Dep.ad ent ofWusixial Acc%denta " office of 1westivaom ' 600 WashiVcn Street Boaton,, MA 021.11 TQL 9 61.7-72-Z4900 eA 406 Qx 1 -877 - Revised 5-26-05 `ay, 617-727-7749 www.Waagov/did y 113 0 A1•t 25T (G -IT -c) F -P -4: '' _f CEIRTIFICATE OF LIABILITY INSURANCE DATE(WA ICDhrYYI TIHIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND GONFERS NO RIGHTS UPON THE CEaTIFICATE HOLDER. THIS CERTIFICATE DOES ACT AFFIRMATIVELY '{1R mEGATTVELY AMEND, EXTEND OR ALTER TIDE COVERAGE Ar-TORDED BY THE POLICIES BELOW. THIS CEIMFICATE OF INSURANCE DOES id4T CdAtSftTL(TE A t-0-9— ACT BETWEEN THE ISSUING IWSU- kER(S), ALMPORIZED ?.ctrl?EZS� eATWE OR PRODUCERANDTHECEs TIFICATE HOLCIE2. laSFCRcAhIF_ H the ce sm Ie holds! is arr ADDrrIONAL INSURED. the policy(ie-c) must be endorsed. tf SUBROGATION IS WAASO, subject to tE w'6i-an4eon&orss of the porcy, certain policies may require an endorsement. A s ctlrnent on this ceR_iriicate does not Confer rights to tf c PRGcucER "EATON BI BERUBE INSURANCE AGENCY INC Co" 11 CONCORD STREET t NASHUA, NH 03064 PHO E E -IEA iI:SLiXFl] T- AJG PROPERTIES LLC111SUR$LB GIO MARK & SHIRLEY FREEMAN y, . wsuldEltC: "il DAYLILY DRIVE MURMDr NASHUA NH 03062 INSURER E, . -.... :OiFEiiAOE$ CERTIFICATE WUMBERt 17914039 REVISION NUMBER: - 'MS IS TO CERi;FY THATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO TFiE INSURED WAVED ABOVE FOR THE POLICY PERIOD C.DICATED. NunivITHSTANDINGAAY REWIREIAENT, TERM! OR :CPNDITIO,U OF ANY CONTRACTOR OTHER OOCUMENT IPM RESPECT TO WHIGH THS t=R-IFICATE -MAY BE ISSUED OR MAY PERTAIN; THE INSURANCE AFFORDED BY THE. POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TEM%flS, EXCLUSIONS AND CONDn10NS nF .qi -H Pry Ir',Fc I t erre suntyoa hl- AV to n, re o=enr o enr ii en rn. o em .... �` C� ,TR 1 -)FE OF MURANCE ADCC 'IiNSR�1KUD SUB POLICY rrUh;BErt POLICY EFF p(1'p'F POLICY EKP 11191'@ CYEX'Y - LGNrrS ,�-VFRAi LS+ IUTT t EACH OCCURRENCE S F I rJ3161AFRCIAL GENERAL LlA9Uryl C1ASAa•L1ADE OOCUR I f I PR�E�1MISESO(Ea oeamnral S MED Is PERSONAL &AD`! INJURY 'a — GENERJ�LAGC-REGA7E S • - GFH AGCREGATE L:MrrADPL IESPER I iPOLICY PRO- LOC PRODLICIS-CONPICPACG > S A(ROMGHILE LtABK.nY- - CC atBA,JED�q ;NOTE L,1AITS . ANY AUTO ALL UTOS EU O8AUTOS L B DD0.Y INJURY (Per pe=rm 5 U.Y BODINJURY(Pe eccident).g NMI.OWNED HIREC MUTTS IAUTOS P orOs adaZ DAMACE 'S I � ^a utYEviELLA UAB ^CWJR EACH OCCURRENCE ^a EXCESS UAB CLAIMS-NADE AG 4;EC-ATE S CED) RETENTIOI•r S S .. t � S ... woRlcERs cOuP> rrsADDOp . AND ENPLOYEP-47 LIAWLlrY......- ..YIN GFFICERA EMEIER EXOL IANY DEDI ECI.lIT� F (Mandatory in It Ks, dtsariScun- sr vri - N 1 A f WC2-31S-3674,12-013, 7112013' W12014 �'cSTATu' +" ! TD.ZI'L,,% . EL EACH ACC4--*Nr S 1 DO000 EL DISEASE • EA EtdPLOYE S 100000 — E.L. DISEASE -POUCYLIMIT I S 500000 DESCRpTIOe N OFOPERATIONS E.ibs I Il :SCRIPTiON OF OPERATIONS ltACATIONS 1 VEHICLES (A16ach ACORD 4D9,Addillonal Remarks Schedu1c, if mom Gpax is requirod)- lockers compensation Insurance coverage applies only to the workers compensation laws ofthe state of NIA. EAT[FlCATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WrM THE POLICY PROVISIONS_ AUTUORMED REPRcSENTATNE - Jeff, Eldridge k9lubb-LU1UAGUM) CORPORATION -All rights reserved. 'ORD 25 20.10105 . - ( ) The ACORD rsame and logo are registered marks ai ACORD ��..:,�,,,,,,.,�,C,C��_.•:.. e s- A�q< hZ-*- L«c 1o:]12t1's '� S:S6 ani e .e cancsaYs'aa�. �tpzr^ads Hl preszousl,r issu=aqc=r£ifi._acas. Permit Services 401 246 2868 p.2 Flame Street: Cipr. State Zip: 11 DAl'1,II.Y DIC. Nj%Sf1U \, NII 03062 PIM N i 800-511-1399 WWWAAXROOFING.com G,4FLir'- a#A1EJ7845 MA Builder's Lceuse 09t., 194 94A HIC REG #153131 Rogf1 Conlract WISA j I've pmpv,e, to Furnish material and latwr complete ii, accordance with spcciticstlotrs Arca to be completed: Entire house !'resect buildingand landscape Strip do to (i ) laver ofsh inghs and dispose Re -nail or replace decking as needed'" Install 8" t,•hite drip edge to all roof edges Install 6'ot GAF Storniguard ice and water shield to the lowest roof cdeeand 3' at rakes Install GAF Deck Armor over remaining exposed area cf roof Install GAF pro start starter course to all roof i_dges Install GAF Timberline FID, architectural shingles per manufacturer's VMS- ( I S." nails. 6 nails per shingle) COLOR Install GAF Cobra Snma'Country ridge vent ln.,ta2'r GAF Seal -A -Ridge ridge caps in match shingles Re -lead (1) chimney - Replace all went pipe boots - Clean up all debris and perform a magnetic swrep to pick up nails TOTAL: S-5,000.00 Cust.lnitials:�r),<—_ 50 Year GAF Golden Pledge material derect warranty 2 Year AI(' xnr4annocFst...�•.......,.. s.. Date: Nt pricing includes htL•eAnuteri.,i/dumpsrr., ccdudinI oiniwts All worked perterm:d by our installers wiFl be done is accordance ,rich rhe tiatooaal Roofing Contractors Associ aaoa andAs Mnmdaaure� gu3ddincs. ADDITIONAL. WORK: Existing Roof Removal. -No charge has beer., made :br remosine additional layers of meroufg, unless sprcificanv salol under 'fear U(' above Iraddirianai layerersj of ofiag are found rcr d during uoyai .,resisting rmfthat exrecd the n c&, 'Tear 6R the customerirskald pay an additional charge or S.40 ptr so rt, peradditional layer of roofing tentaved.:\dditional charge is due upon romp) Bion of weak. ' •Deterior-ak,d or Rntien Wood; Nn diary, ha, bee utade for rept.,,;.,, word.,,,,lcsa spe;. Pc ill stated under special Instmaions, irtrtted wood is discove-rd amen removing the cxi:;ong rooting the first sneer of standard 4'xN' plywood used is FREE and a 550;7!7 charge wi'I he applied for peh additional shcp, $S.nta per linear F .tp in I "z6" anJ 56'37 per lintar tl .,bete i"xti' fcr dhaensiouai !amber Payment Terms: 113 due at time paperwork is signed. Contract balance due upon completion or work. Start Date: kwather pennitting End Date: weather permitline Estimate ;s valid uni ii: 5129/14 Acceptance of Contract: 71te ab(lVe paces, specilicatiors, and conditions are swislactory and are hereby accepted live agree to the contract provision on the pack side of the contract. AJC Roofing is authorized ;o do the work as specified, Payment will Ix made per payment Perms above. Owner: 1tlillt)2) V f`�o � � 7 ate ATC hoofing: tt fa_ Owner: / Date: Date �ar�Na� R'� CONTIMINORS ASSUG(hT€%N Office *Ifjni+tlrher A fail"s & "Bir'siliess e_,Iu ation HOME iMPROVEMI ENT CONTRACTOR 'Z" Reg istr2tiOn' ,53131 Type: Expiration 101',X30'2014 Ltd Liability Corpc Ajt'PROPERTIES QR,,'. MARK FREEMAN. 11 DAYLILY DR. NASHUA, NH 03062 J c's nne4 94 g -A NNIAIRK FREENTAIN- 1.1 DAYLILY DRIVE" a.jhu,,tNl- 0306 �i'A4/2014 Office *Ifjni+tlrher A fail"s & "Bir'siliess e_,Iu ation HOME iMPROVEMI ENT CONTRACTOR 'Z" Reg istr2tiOn' ,53131 Type: Expiration 101',X30'2014 Ltd Liability Corpc Ajt'PROPERTIES QR,,'. MARK FREEMAN. 11 DAYLILY DR. NASHUA, NH 03062 t9L—* F�0 ti d Y O � O iV W < Z r Ec G0Q O"� O F�0 ti 2 Z m co Z W w CLX LLJw a. S w c �- I oc z W W O W Q W O. d F•-' 2 Wd H H U = Z z z a o~c LL Q O c7 a z c7 z z W o oc co CA a LU o C7 25 m J W LL E m J N � C d W +. O N au N ,O cYa v z cv v t cC a .c v u t v + Y O Q 7 C > fu i v O LL N LL U LL- z 11 2' (n LL. d' LI. 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