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Home My WebLink AboutBuilding Permit #541 - 24 FAULKNER ROAD 3/25/2008BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: 2 f� Date Issued: Date Received TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family A n I wo or more family Industrial Alteration No. of units: Commercial _-Repaiii replacement Assessory Bldg Others: Demolition Other Sepik 1%1fe11 f�odplair Wetlandsiershed District WaterlSewer DESCRIPTION OF WORK TO BE PREFORMED: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE: BOLDING PERMIT., $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ h 0 0 FEE: $ _? '� Check No.: r` �/ l 4 6 6 2 3 Receipt No.: 4;�/ 03 NOTE: Persons contracting with unregistered contractors do not have access to the guarantX fund Location No. Date `df --o0 �oRT� TOWN OF NORTH ANDOVER O?o• `"`D I•,ho w � p Certificate Occupancy $ of s�� a ��' Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 610 )- Check # 2i013 Building Inspector W 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 DATE REJECTED DATE APPROVED CONSERVATION COMMENTS DATE REJECTED DATE APPROVED HEALTH COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments, Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit Located at 384 Osgood Street Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/MassageBody 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 COMMENTS HEALTH COMMENTS Zoning Board of Appeals: Variance, Petition No: Planning Board Decision: DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED Comments Zoning Decision/receipt submitted yes Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit Located at 384 Osgood Street 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 MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine NOTES and DATA - (For department use Notified for pickup - Doc.Building Permit Revised 2007 No 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: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 O OW o L2cn a o U O '� or. c w° ao' U w V C7 a O w is w" a W w W �°D O rs: " �' C w a O U 00 w z W a w GWG w a~i " rA o z C/) v Q o (/)— o CD c c � O ` C h O C cc O V •d'O CL. C ev ev C �L O h � m C M s O p. N CD �� m C :C c: E • �m m a c ca Me m3 QO N m O .L C C H O O m atc� m m m c �r c o a Q •°-' O c Z `a c CD s co c c c E- m m m c 'c = m:0 3 N ~ r0.. y O r � m CODID Z W O .0 •+ 'O t Go CLM = - C2 -0o .y O_ v •`m v CD H COD a g mom= o s w aw m > 9 191 CD O a L O 4-0 c.3 Z co G. O CO) Vropogat ftse Of Free Estimates 105 Haverhill Street Fully Insured Methuen, MA 01844 THOMPSON'S ROOFING (978)691-1355 Shingles - Slate - Rubber Roof Single Ply - Copper Work PROPOSAL SUBMITTED TO PHONEDATE s__ Z��,LI U Nadine Sobrado 1c8 3-14-08 STREET JOB NAME 24 Faulkner Road CITY. STATE AND ZIP CODE JOB LOCATION North Adnover MA 01845 ARCHITECT DATE OF PLANS JOB PHONE We hereby submit specifications and estimates for: Strip off all roof shingles on house, garage and back sun room Ran[ai1 al'_ '.oc ., board: Install .032 white drip edge around roof line Apply ice and water shield 6 ft. up all along edge and in valleys Apply 151b. felt paper on rest of roof area Reshingle with a GAF timberline 30 Architect shingle Install new flange around soil pipe Cut in 3 box vents on back side (Remove antenna and all work related debris 30 year warranty on material 5 year guarantee on labor construction lic. #060112 improvement #128612 UP Vroe hereby to furnish material and tabor — complete in accordance with above specifications, for the sum of: Six thousand four hundred dollars ($ 6 , 400 .00 ), Payment to be made as folms: $2,400.00 start of job balance on completion All material is guaranteed to be as sperMe IAN work to be oanpbted in a worietarMa nwiner 9 t o standard p 1 Any dWation or deviation from abaft I j adra costs will be eoacut only upon w tMm orders and wtp becona anoverand above the estimate. AN apreertwKs conftent upon strikes, accidents Or delays beyond orr control. Owner to tarty fire, tortado and otter necessary i swance. Our workers aro fully Nola: This prof a" be ..M*k� IMI VMWa udffvknwn bw ua N not accented widin days_ sueptatue Of frupoga[ —The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. PaymentJfwil be made as outlined above. Date of Acceptance: e� 1 1 0 ?A s _� l :,. a ✓oAl9,/G,' BOARD OF'BI�ILDlN.G .RECU,LATIONS License: CONSTRUCTION SUPERVISOR Numbe "CS. 060112 Birthdate,' 08904/:1956 Expires 08/04/2008 Tr. no: 28784 Recteci:; 00• THOMAS T DOYLE . 8 WEST ST SALEM, NH 03079�� Commissioner !{� Board "Building R g =� HOME l Regulations and Standards MPROVEME Registration; NT CONTRACTOR 128612 -Aeration 412&2009 TYPe: DBA Trr 12.477 THOMPSON S ROOFING THOMAS DOYLE 8 WEST ST SALEM, NH 03079 terry - Administrator ACORD CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDlYI'YY) PRODUCER 04�26�2007 ON THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATI Pelham Insurance Services, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P.O. Box 960 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 122 Bridge Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BEI ow Pelham NH 03076 INSURED Thomas Doyle dba Thompson's Construction & 8 West St Salem NH 03079 INSURERS AFFORDING COVERAGE INSURERA Nautilus NSURER B Associated Ind of MA NSURER C NAIC # COVERAGES INSURER E 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 WHIC1tTH1SCORT. F4rATE-M Y--,f-;SSpCO OR HTAY-PERTAIN, THE INSURANCE AFFORDED BY THE POuC(ES_OE RFBED- IIER€1Y 1S SUEsJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. '4 AD- L .TR INSRD TYPE OF INSURANCEi POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION DATE (MM/DD/YY) DATE (MM/DONY) LIMITS A GENERAL LIABILITY NC 644138 04/15/2007 04/15/2008 �10- DAMAGE TOR ENTE E 1,000,000 MERCIAL GENERAL LIABILITY DAMAGE 70 RENTED CLAIMS MADE 0OCCUR PREMISES Ea occurrence $ 50,000 GEN L AGGREGATE LIMIT APPLIES PER POLICY n �ECOT I LOC AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS GARAGE LIABILITY IANY AUTO EXCESS/UMBRELLA LIABILITY OCCUR �I CLAIMS E.iADE DEDUCTIBLE I RETENTION S B WORKERS COMPENSATION AND IAWC 7012214012007 EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNEWEXECUTIVE OFFiCERJMEMBER EXCLUDED I[yes.JesCnbe under SPECIAL PROVISIONS bele OTHER 04/21/20071 04/21/2008 DESCRIPTION OF OPERATIONS!LOCATIONS/VEHICLE S/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS roofing :' 17 Kn011Crest Dr., Andover, MA for Judith Brasseur CERTIFICATE HOLDER CANCFI I ATI ON 978 623-8320 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Town of Andover EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 36 Bartlett St 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT - FAILURE TO 00 SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHn RI7Ffl acoocccr.ir., T,,.� r - , - - � ( one person) S _11000 ADV INJURY S 1 , 000 , 040 GREGATE $ 2,000,000 COMPIOPAGG $ 1,000,000 COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) S BODILY ;NJURY (Per acodent) $ PROPERTY DAMAGE (Per accident) S AUTO ONLY - EA ACCIDENT $ OTHER THAN EAACC $ AUTO ONLY AGG $ EACH OCCURRENCE MS AGGREGATE $ S IS CIDENT S 100,000 -EA EMPLOYEE 100,000 POLICY LIMIT $ 500,000 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www-mass.gov/dia WorkeW Compensation Insurance Affidavit: ]Builders/Contractors/Electricians/Plumbers Name(Business/Organiza.tion4ndMdual):_ .,.,, se. • 1 [.ad Address: City/State/Zip: M -e Y-' Ac e, Areyou an employer? Check the apps L ❑ I am a employer with employees (full and/or parttime).* 2. ❑ I am a sole proprietor or partner- ship and have no employees working forme in any capacity. [No workers' comp. insurance required.] , 3. ❑ I am a homeowner doing all work myself. [No workers' camp. insurance required.] t Phone A 691 r 3 r j riate box: 4. ❑ I am a general contractor and I have hired the sub -contractors listed on the attached sheet These sub -contractors have employees and have workers' comp. insurance.$ 5. ❑ We are a corporation and its Officers have exercised, their right of exemption per MGL c. 152, § 1(4), and we have no . employees. [No workers' comp. insurance reouired.l Type of project (required).` 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building.addition 10.❑ Electrical repairs or additions 11. ❑ Plumbing repairs or additions 1 oof repairs 13.❑ Other *Any applicant that checks box #1 must also fill out the section below showingtheir workers' compensation t I, t •Iiorneowncrs who submit this of davit indicating they are doing all work and then hire outside contractors must ubmit a new affidavit indicating such. 'Contractor that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities . employees. If the sub -contractors -have employees, they must provide their workers, p ' co ofic3' number. have I am. an employer that is providing workers' compensation insurance for my employees. Below is the policy.and job site information. Insurance Company Name: CC'3S G C_ car Policy # or Self -ins. Lic. #: 20 V12- -f o f `LO it Job Site CC,p Expiration Date:__ City/State/Zip: A" 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 Investi£ations of the DIA for inmrrnnnp I do hereby certiA the pains •and penalises of perjury that the information* provided above is true and correct /5 ?/ - / ? S—s- aelat..useonly. Do not write in this area, to or town official. 3-ZS=aB" City or Town: Permit/License # Issuinb Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 6. Other 4. Electrical Inspector 5. Plumbing Inspector Contact Person• 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 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, of any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or fire receiver or trustee -of an individual, partnership, association or other legal entity, employing employees. however 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 "ever state or local licensing agency shall withhold the issuance or renewal of a license or permit to,bperattera btisiness 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 1.52, §25CO) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for. the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if 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 Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If.an LLC or LLP does have employees, a policy is required. Be advised that this affidavit maybe 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 returned to the city or town that the application for the permit 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 callthe 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 and printed 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 suieto fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/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 permits 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 burn leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank 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 number: The Commonwealth of Massachusetts Departnment Qf Industrial Accidents Office e of InvestiFgat oms 600 Washington Street Boston, MA 02111 Tel. # 617-.727-4300 extAN or 1-877-MASSAFE ` Fax # 617-727-7749 Revised 11-X22-06 _ www.mass-gov(dia NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit at: is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150 A. Also, note Permits are required under Fire Prevention laws Chapter 148 Section 10A. The debris will be disposed of in: (Location of Facility) Signature of Permit Applicant Date