HomeMy WebLinkAboutBuilding Permit #94-12 - 247 CHICKERING ROAD 8/3/2011TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO�4� Date Received
Date Issued:
W EIAPORTANT: Applicant must complete all items on this page
LOCATION -2-�A C Ckd_-V' R C�
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MAP NO: _Z�_&_PARCEL: ZONING DISTRICT:
Historic District no
Machine Shop Village no
100 year-old structure VSS, no
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TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
0 New Building
0 One family
11 Addition
0 Two or more family
0 Industrial
0 Alteration
No. of units:
0 Commercial
El Repair, replacement
El Assessory Bldg-
11 Others:
11 Demolition
0 Other
UWell:
UloodA �Pn _ethands
El
J_1_L-�L)%_JLNAJL I JAJ1RJJP VY Ulu I U n -V, UKIVIEL):
1 -1 — _ _ _TJ
OWNER: N
Address: 24 7�
CONTRACTOR N
Address:
Supervisor's Construction License: Exp. Date:
Home Improvement License: Exp. Date:
ARCHITECT/ENGINEER
Phone:
_21 1-a
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: FEE:
Check No.: b"2 5 Receipt No.: ;2
NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfi d
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Location 01 -1
No. IN - Date
011Th TOWN OF NORTH ANDOVER
Certificate of Occupancy $
CHUS Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check # (11-710
24�, 04
Building Inspector
Plans Submitted 11
Plans Waived 11 Certified Plot Plan 11 Stamped Plans 11
TYPE OF SEWERAGE DISPOSAL
Public Sewer
Tanning(Massage/Body Art [-j
Swirruning Pools
well El
Tobacco Sales
Food Packaging/Sales 0
Private (septic tank, etc. El
Pennanent Dumpster on Site El
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
DATE REJECTED DATEAPPROVED
PLANNING & DEVELOPMENT 1-1 11 —
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:
Comments
Conservation Decision: Comments
Water & Sewer Connection/Signature & Date. Driveway Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street
FIRE DEPARTMENT - Temp Dumpster on site
Located at 124 Main Street
Fire Department signature/date
COMMENTS
yes
061
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.$10041000 fine
NOTES and DATA — (For department use
Ll Notified for pickup - Date
Doc:.Building Permit Revised 2011 June/mi
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
o 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
ci 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)
L3 Building Permit Application
Li Certified Proposed Plot Plan
u 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: Doc.Building Permit Revised 2008mi
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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 defitied as "an individual, partnership, association, corporation or other legal entity, or any two or more
of the foregoing engaged in ajoint 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. However the
owner of a dwelling ho i use 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 commonwealthnor 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 prese*nted 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 (LLQ 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 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 returned to the city or town that the application for the permit or license is being requested, not the Deparlanent 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 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 sure to fill in the permit/license number which will beiised 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 bum 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
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA. 02111
Tel. 4 617-727-4900 ext 406 or 1-877-MASSAFE
Revised 5-26-05 Fax # 617-727-7749
www.mass.gov/dia
Ntassachusetts De i4l
_(Irneilt of
Board of Buildin',,, kegulailOns ariq Stanila-0s..'
.-�Qqhstruction Supervisor
Licen�e'
�Jc nse:tS 99551
'Regiridted to: 00
PETER ALLARD
-2 CARVER ST
BEVERLY- IMA 01915
Expieatiori: 3/25/�012-.
TIM,
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tion
HOME IMPROVEMENT CONTR ACTOR
n�l Office
of Consumer Affairs & B siness Re ula
Registration:
�. 4-137667 Type�
Expiration. �'l"271�12012 Private Cor '
lz_i . poratioi
BU ING �AINTJA�NCE-JG,
ORP,
PETER
ALLARD
14-15 WILLARD . S . . . . . .
PEABODY, MA 01 o
Undersecreta
08/01/2011 MON 13:27 FAX 7819325837
WMAW"
CONTRACT
0001/002
U.S. Rooting
a division of Building Maintenance Corp.
P.O. Box 3118
Peabody, MA 0 1961 -3118
Telephone: (978) 532 -6300
Fax: (978)977-0803
The Owner(s) of the premises described below ("Job Address"), hereby contract with and authorize U.S.
Roofing, a division of Building Maintenance Corp. ("Contractor"), to furnish all necessary materials,
supplies, labor and workmanship, and to install, construct and place improvements at said Job Address,
according to the following specifications, terms and conditions:
I. Owner's Name: In Town Veterinary Group, LLC
247 Chickering Road
North Andover, MA 01845
2. Job Address: 247 Chickering Road
North Andover, MA 01845
3. Specifications Contractor agrees to perform the following services in a good and
workmanlike manner: Includes the Front, Left side, and Rear Entrance roofs as well
as the Mansard roof that faces the 99 restaurant.
— Remove all existing shingle layers down to exposed roof boards
— Dispose of all debris in a legal landfill
— Install 72" widths of GraceO Ice and Water Shield at all gutter edges;
including all valleys and roof penetrations
— Nall Grace TRI-FLEX8 High Tech Roofing Underlayment over all remaining roof
surfaces
— Install 8" aluminum white drip edge to all roof perimeters
— Install Certainteedtm 30 -year Architectural shingles to all roof surfaces; storm
nailing each (six nails per shingle)
— Flash all roof penetrations Including eight (8) skylights according to National
Roofing Standards
— Cap ridge with Certainteedtm 30 -Yr cap shingles
— Repair small upper left roof
— Clean all gutters at completion of project
4. Extras: Wood Deck Replacement: Provide and install matching wood deck due to existing rot
found (IF needed) at an added square foot cost Cost of Work: $ 4.00/per square foot
S. Warranties; The above work comes with a Cortainteed Roof System Warranty
(furnished to Owner from Certainteed directfy) and a written a warranty (furnished by
Contractor) for labor
6. Payment Terms: The Base cost of the contract is $ 12,675.2Q Payment shall be rendered
in the following manner:
To be billed on percentage completion basis: 100% due upon successful completion of all work;
6. Attorney's Fees: In the event of default, the Owner shall pay costs for collecting amounts owing
including, without limitation, court costs, expenses and reasonable attorney's fees, in addition to
any sum that the member may be called on to pay.
08/01/2011 MON 13:27 FAX 7819325837
2002/002
Entire Acireennent: This contract constitutes the entire agreement between the parties and any
prior understanding or representation of any kind preceding the date of this Agreement shall not
be binding upon either party except to the extent incorporated in this Agreement. The Owner
agrees that Contractor has made no statements, promises, commitments or representations not
contained herein.
9. Modification: Other than that required as a result of paragraph 4 above, any modification of this
Agreement or additional obligation assumed by either party in connection with this Agreement
shall be binding only if evidenced in writing signed by each party or an authorized representative
of each party.
10. Unforseen circumstances: Contractor is not liable for delays due to weather, strikes,
accidents, acts of God or other circumstances arising out of causes beyond its reasonable control
and without its fault or negligence.
11. Governinci Law: It is agreed that this agreement shall be governed by, construed, and enforced
in accordance with the laws of the State of Massachusetts
IN WITNESS WHEREOF, the parties have signed their names hereto:
Date: B-1-2011 Date:
U.S. Roofing, by its agen , —.--In Veterinary Repo��Jt
0 %gepentative
Willard H. Murray P Vie d N a m e: _Te F_ p lNJ 0 VCj" ;"A'V-V k-,
List desired shingle color:
(Please Print) —r,'o � e 4
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