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HomeMy WebLinkAboutBuilding Permit #391 - 23 WOODSTOCK STREET 11/2/2011 -- 1 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: , ++ Date Received Date Issued: I I IMP1OAR/TANT:Applicant must complete all items on this age LOCATION I/U 010 PROPERTY OWNER Print �2 �rq� Unit# Print MAP NO:_;� PARCEL: ZONING DISTRICT: Historic District yesgno Machine Shop Village yes100 year-old structure 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 t © Se -hc �3We11! I. O,Flood'laui� �,Wetlarids _ ' - � P . -,-.P __� , TJ WatershecllDistnct� Water/,Sew,eV DE RIPTIONOF W RK TO BE PERFORMED: (Ident-ficatio lease Type or Print C arly) OWNER: Name: C! r Phone: Address: )__3 7L CONTRACTOR Name: �e �a IZ,W1 bone: Address: Yle /%QS' f Supervisor's Construction License: �i q a2� Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULD/NG PERMIT-'M00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $� G eel FEE: $ 00 Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to theguarantyfund ` natureofconFra-ctor ,Signature�of A ent/.Ownerf _ g 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 CONSE14VATION Reviewed on Signature I COMMENTS A HEALTH Reviewed on Signature COMMENTS t I Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes 1 Planning Board Decision: Comments f 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 COMMENTS 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 servicedroprequires approval of Electrical Inspector Yes DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— For department use i r i f { ❑ Notified for pickup - Date J 1 Doc:.Building Permit Revised 2011 June/mi J 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 rt 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 j NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg .Permit i 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: Doc.Building Permit Revised 2008mi T Location C)�5 LyC��U�S�fitt No. Date A - )L - � NGRTry TOWN OF NORTH ANDOVER 3 _ � 0 " } ~ 9 i • }�o Certificate of Occupancy $ CHUs t� Building/Frame Permit Fee $ r Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 247 4 Building Inspector 120 Weybossett St—Methuen MA 01844 Phone 978-688-3633 z October 28,2011 Frank Fitzgerald 23 Woodstock St N.Andover,MA We her by propose to furnish the materials and perform the labor necessary for the completion of, We will strip and reroof entire home with certainteed resawn shake architectural shingles. We will install all new drip edge and ice and water shield on lower edge of roof. We will also install ice and watershield where ever a low pitch that requires more protection. We will remove and reinstall the ridge vent. We will remove vinyl siding where necessary to flash from wall to roof and then reinstall siding. We will install new felt paper where ever required.We will also repair all flashing on chimney's and vent stacks.We will provide a dumpster for the debris. Total$7,000.00 Down payment will be$2,333.00 ---~— — iID� Second payment to be made when half complete$2,333.00 Final payment when complete$2334.00 Permit fees will be an additional cliargef-- y Acc ce---------------- ---------------- The Commonwealth of Massachusetts Print Form Department of Industrial Accidents Office of Investigations 1 Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information f, /Ple�a{se Print Legibly Name (Business/Organization/Individual): S' b// c` li 2— Address: dW CIO— Y 0 City/State/Zip: Phone#: 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 employees(full and/or part-time).* have hired the sub-contractors 6. E]New construction 2. I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. ❑Demolition working for me in any capacity. employees and have workers' � 9. E]Building addition [No workers' comp.insurance comp.insurance. 10. Electrical repairs or additions required.] 5. ❑ We are a corporation and its ❑ p 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.M Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.❑Other comp.insurance required.] ;Any applicant that checks box#1 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. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the subcontractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is thepolicy 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby cern under the airs and enald o e 'u that thein or on provided above is true and correct. Si ature: i_ - .. - - - ----- Date Phone#: — Of use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone M The- Comrnonvtirealh of Massachusetts Department of Fire Services Office" of the State.Fire Marshal. P..0.Box.I025 Statr-Road,Stow,MA 01775- APPLICATION FOR PERMIT Date: Andover xermit.NO (City oc•Town.) . (if Applicable) Dig Safe Numb In accordance-with theprovisioos ofMG.L. Chapter ' 10 as provided in Section 527 CMR 34 application is•h,' made Start Date (Full.name ofperson,Finn or Corpora 'oa) 'State clearly Add=s purpose for / —T—� /U/C( U or P.O.Bax City or Town)� Which permit Grp r ato /1ocat i2mster "w fir construction r novas, on Id P[unl i ti'pn of building. Comments: . dumpster must be 25 ' from structure or *covere e . at Give location by street:and no.,or dcscn a in such er to•provi adegaatc idc cation oflocation) Name of competeat-operator Cert'No. (If Applicable) DatcIsmed-rc Dy ( atum of-Applicant) Date of expiration 2 / F=S 50 . 0 Paid Due Cut The -C-6-m monwealth of -Massachusetts Department-of Fire Services Office of the State Fire Marshal P.O.Box 1025 State'.Road,.Stow,MA 01775 PERMIT ' Date: North Andover PermitNO Ci of Town Dig Safe Num er • ( ty" ) (1f Applicable) In accordance with the provisions of M G L.1 4$ Ghagter1Q_asprovided in section 5 7 7 CMR 3 4 " Start Date 72us Peanut is granted to:. Full name of person,Firm or Corporation Permissionto locate dumpster - for construction/renovation/demolition of building. Comments: dumpster. must be , 25 ' from structure if unable to place wifh required Restrictions:c1earance dumps-ter must be covered with plywood or tarp end of 'work -day .at (Give loco'o street and no.,or describe in such a r provicd adequa cntiEcation oflocation)'' Fee P aid.S 50 .00 e. h±•. This Permit will expire• Offre an' g permit i s", N1aNsacbuNetts- Department of Public safetA 3 Board of Building; Re,_,ulatiun.and �Standartk Construction Supervisor License License: CS 69262 JEFFREY SADEZWICZ 120 WEYBOSSETT ST METHUEN, MA 01844 i Expiration: 11/1/2012 f umii.,innrt Tr`: 7195 i Office flConsumer Affairs&�Bdsine sRegulation HOME IMPROVEMENT CONTRACTOR Registration: . 124426 ` Expiration: 6/23/2013 Type: DBA Jeff Sadezwicz,General Contracting Jeffrey Sadezwicz 120 Weybossett Methuen,MA 01844 4 Undersecretary NORTIy ® Of � o , dover, Mass., • 1 Y O LAKE /� COC MIC ME WICK � %ADRATED BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THISCERTIFIES THAT............... ... .. .....��i/...........M... ....... .............................................................. ......................... Foundation has permission to erect........................................ buildings on ..........�3... .,�.d..�` ' . . .................. Rough to be occupied as.........45. ..T........ .• ....................... Chimney C ' provided that the person acc % this permit shall in every re t 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, Aftefation 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 CONSTRUC STS 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.