HomeMy WebLinkAboutBuilding Permit #107-15 - 25 HERRICK ROAD 7/30/2014 TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: V Date Received
Date Issued: iL4
I PO TANT:Applicant must complete all items on this page
M r
LOCATION � � -/_ _
PROPERTY OWNER
rlrlt-
Print 100 Year Old Structure yes o _
MAP NO: PARCELt�ZONING DISTRICT: Historic District yes no
Machine Shop Village yes no
.TYPE OF IMPROVEMENT. PROPOSED USE
Residential Non- Residential
❑ New Building ozne family
❑Addition ❑Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
p Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District
❑Water/Sewer
DESCRIPTION OF WORK TO BE PERFORMED:
dentification Please Type or Print Clearly)
OWNER: Name: auC- Phone:
Address:
CONTRACTOR Name: �a�n o�,/ �2G-' Phone:
Address:
Supervisor's Construction License: a�' 2 Exp. Date:
Home Improvement License:--- l 0 S Exp. Date: 1-4 Z 2`I/
ARCHITECT/ENGINEER Phone:
s
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.: Receipt No.: r '�
NOTE: Persons contracts"Mithunre istered contractors do not have access to the guarantyfund
ignature}.of�A-ent/Qwner_ Slgnat_ure of contractor _
Plans Submitted LJ Plans Waived ❑ Certified Plot Plan ❑ tamped Plans ❑
- Plans Submitted ❑ 'Plans-Waived ❑ Certified Plot Plan ❑ .. Stamped Plans F1
TY-PE:0F SEWERA E.DiSPOSAL
Public Sewer ❑ Tanning/MassageBody Art ❑.. . ..Swimming Pools ❑
Well ❑ Tobacco.Sales -Food Packaging/Sales ❑
-Private.(septic tank,etc._ . ❑ Permanent ID'unpster on Site ❑
THE_FOLLOWING SECTIONS FOROFFICE USE ONLY
_ INTERDEPARTMENTAL SIGN_OFF - U FORM
I
REJECTED: . DATE:APPR-OVED
PLANNING& DEVELOPMENT ❑ ❑
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
I
HEALTH Reviewed on Signature
COMMENTS
Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
`0 Water& Sewer Connection/signature& Date -Driveway Permit
DPW Tow ]Engineer: Signature:
Located 384 Osgood Street
FIRE DEP�4RfiMr i1IT Temp Dempster on site ..yes no
Located at-124Mair Street ,
e"partme►4signature/date .s- .�. a,.•. ;,_ .t...:'-' . ,a-
COMMENTS
-Diii'iension ,...:.
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-.Chapter166.section 21A=F and G min.$100-$1000 fine
NOTES and DATA— (For department use
El Notified for pickup - Date
I
Doc.Building Permit Revised 2010
Building Department
-'~The fohnwing i"s'a list of 1he req uired.forms to be:filled outfor:theappropriate.permit to.be obtained.
Roofir4g, Siding, Interior Rehabilitation Permits
o., Buildin Permit Application
ppllcatlon
a Workers Comp Affidavit
❑ Photo Copy Of H.I.C. And/O'r°C.S.L Licenses
❑ Copy of Contract
o Floor P
Ian Or Proposed Interior terror 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 caws 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.}ted with the building application
Doc: Doc.Building permit Revised 2012
Location
No. "" Date
• • TOWN OF NORTH ANDOVER
. Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
i Check# `;i `[
/
' v2
Building Inspector
I
NORTH
own of :_.ITAndover
0 '
�
No. 161 - 115 *y
T Zh
pip%
h ver, Mass,
CO[HIC HI WICK �It-
�,95 a�reo rQa��S
U BOARD OF HEALTH
Food/Kitchen
PERMIT T LD Septic System
THIS CERTIFIES THAT ........ ... .... ....
BUILDING INSPECTOR
a(T has permission to erect .......................... buildings on ...... .........�..����..�. . .I�.�r.......�1 A. Foundation
Rough
to be occupied as �.. .... '1. O � y
...................... .......... .................�.... ................................................ Chimney
provided that the person accepting this pe mit shall in every respect confo to the terms of the application Final
on file in 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
Final
� .
PERMIT EXPIRES I46JO0 NT ELECTRICALINSPECTOR
UNLESS CONSTRUCSTS Rough
Service
........... ......................................................... Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Required to Occupy Building 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.
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Residential & Commercial Roofing
C > ' All Types Of
6rAN YS POINTED 'i EU1L 1'-CAPPED Expert Masonry Work
Siding
Licensed& Insured
Mass Tall Free ' �� y
Lac '!� V'n- t>lrcr4[.eu 4t c.as .t ?v License#034200
i-800-W IT-r-tJS
{024 84G7 � � ' `°�.�'� `•� ,�av, f7;�•"!�' r� We ENorc6c Year Round
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Proposal To: Dave Rule Date 7/2/2014
Street: 25 Herrick Rd. 978-764-3310
N. Andover, MA
davrule4
� Roof proposal gmail.com @
IKO Cambridge/Certainteed Landmark
L Extra caution will be taken to protect house 12.Removal of all work related debris. Planks will be
exterior and landscaping as best as possible, placed under dumpster to prevent any damage to
(tarps etc.)Magnets run at final clean up. driveway.
Q 2. Remove all shingles from entire house. 13. Building permit included.
3. Inspect and re-nail any loose or lifted roof 14. Contractor workmanship warranty: 10 years under
boards. Amy compromised roof boards will be normal wind and rain conditions.
lacecl at an additional cost of$2.75 per lineal
rep Total main roof coSt:
foot of lab spruce. Garage: $1 ��0.00 .�AP
4. Install 1►eavy g ,
auge 8" white aluminum drip g y� -
li edge to all eaves and rakes. t ` `
5. Install 6' of IKO Armourguard or Certainteed • Direct MFG. Extended warran
ice and water shield along all eaves and top to Fully transferable, 100% coverage
bottom is all valleys. pro rated period of 20 years. Please see info
� 6. Install 1 KO roof guard or Certainteed Diamond packet in material folder.Offered and included
Deck synthetic underlayment to remaining in this proposal to our referred homeowners at
sheathing up to ridge. no additional cost.
7. Install ,I I new pipe boots.
8. Instal! 11:0 or Certainteed Leading Edge starter *Note*: Please be advised if applicable,valuables in
sliingk:s to all eaves. the attic should be moved or covered due to minor
9. Install i 1;0 Cambridge or Certainteed Landmark debris,dust and asphalt particles that will accumulate
Limited Lifctinle architectural shingles to entire during the stripping process. All Under One Roof not
hUt►SC. 15 year non pro-rated warranty by mfg. responsible for any damage or clean up that may
10 year i I'Ccitainteed is chosen. All shingles occur in attic.
will bk: i,►stc►lled and fastened according to mfg.
sl)e.c`.
-Balance due upon completion
10. Cut a;l �c\v lead flashing into chimney.
Co►1n1�!'JilS11 with ice and water shield and seal. -References available upon-request
11. List�►l1 1lcvv GAF Cobra ridge vent capped with
color n.::i cl cd IKO or Certainteed hip and ridge -Highly rated mem r of the ac edited BBB and
A_ nzie's List
Thank you!
The Commonwealth of Massachusetts -
De alrtment ofIndusNg1,4ccidents
P
Office of Investigations
600 Washington Street
Boston,MA 02111
www mass gov/dza
Workers'Compensation bsuran.ceAffidavit:Buffdear/Cont°acti:oxs/Electriclans/Pliimbers
Applicant Information Please Prim LegibXy
Name(Business/Oxga izationftdn`vidual): All u-4_0-e—A o) ,l, OR t:�
Address: � ����� ZV
City/State/Zip: N",q!1 Phone If: 17��
Are you an employer?Check the appropriate box: Type of project(required):
1.01"am a employer with '� 4. ❑ I am a general contractor and I `
._._� 6, New construction
employees(£all and/or part-time).* have liiredthe sub-contractors
2111 am a sola proprietor or partner listed on the attached sheet.T 7. []Remodeling
ship and•have no employees These sub-contractors have 8. []Demolition
working forme in.any capacity. workers'comp.insurance. 9. ❑Building addition
[No workers' comp.insurance 5. ❑ We are a corporation and its
required.] officers have exereised.their 10.E]Electrical repairs or additions
1L Plumbing repairs or additions
3111 am a homeowner 4oing all work right o£exemption per MGL ❑ g p
myself.[No workers'comp. c.152,§1(4),and we have no 12.❑Roofrepairs y
insuraucerequired.l? employees.[No workers'
comp.insurance required.]
XAny applicant that checks box#1 must also fill outthe section bel6w showingtheir workers'compensation policy information.
I Nomeowners who submit this affidavit indlcating they Aire doing allworg and then hire outside contractors must submit anew affidavit indicating such.
Contractors that checkthis box must attached an gdditional sheet showingthe name of the sub.-contractors and their workers'comp.policy information.
I am an employer that is providing workers'compensation insurance formy employees Below is the policy andjoh site
information.
Insurance Company Name: ��` A-- VK4, \- '"'rl
Policy#or Self ins.Lic.#: /4WC-'4+a1 1-44-:2`(514 Expiration Date:
elL2��zt( a
Job Site Address:
IJ''a"'O'"`4 City/State/Zip:_ C�ix- )�
Attach a copy of the workers'compensation.poliey declaration page(showing the policy number and expiration date).
Failure to secure coverage as requI dander Section 25A of MGL o.152 can lead to the imposition of criminal penalties of a
:fore 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
of up to$250.00 a day against the violator. Do advised that a copy of this statement maybe forwarded to the Office o£
investigations of the AIA for insurance coverage verification.
Ido liereby certbp under the pains and penalties of penury that the information provided above is true and correct.
Si ature• Date: zn (?z.i
Phone#• �� ``1 J--If 3
Oficial use ortly. .Do not write in this area,to be completed Try city or town official.
City or Town, Pernnit/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#:
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 orimplied,oral orwritten.."
An employes 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. However the
owner of a dwelling house having notmore than three apartments and who resides therein,or the occupant of ffic
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 employes."
MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or p ermit to op erate 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,beenpresented 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-contractors)name(s),address(es)and phone number(s)along with their cextiixcate(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 tarty 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 thepemnit 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 andpriated 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. In addition.,an applicant
thatmust submit multiple permit/license applications in any given year,need only submit one affidavit indicating current
policy information(if nec ess ary)and under"Yob Site Address"the applicant should write"all locations in (city or
towb.)."A copy of the affidavit that has been officially stamped or marked by the city or town maybe provided to the
applicant as proof that a valid affidavit-ii on file.for future permits or licenses. A new affidavit must b e 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 etc)said person is NOT required to complete this affidavit.
The Office of lnv4gations 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 aid fax number:
`rho Carr>x 011W.0axthO M_auachusP#s -
Depaftent ofWustrial Accidents
Off toe Qfhmstigationa
600 Wafagto 81=-<
Boston,MA 02111
TOL#G M` 27 4•9QQ ext 406 ox 1-$77-
MA����
Revised 5-26-05 `ay, 617"727'7749
WWW-Maagovaia•
f icy` eel C•e�itsurrtcr .4ItL, 1k (3usines6 Regulation - lVlass•11c1V
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o,�eual,,, ,S�te the v c Qi c i itegumbon
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EXPIRATION STATUS
REGISTRANT RESPONSIBLE REGISTRATION ADDRESS DATE
INDIVIDUAL NUMBER
NAME 1010212C 14 Current
pit urtoEa car+ aot�f tANZAFAME, 137457 166 A FINACHAROBUILDING
JOHN N, MA 01844
Ply
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rd 2412 CO,Wwnwea1th of massamuseR6
lvf*of rt,t't m nnrv?8ttrotARP �a�h�5etts 1ass.GQv���.(�C��l�1!�?�� - i
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N�SSSa � d Slat»at:+s
board,.,
`Cons
License:CS-06020
JOHN W LAN
30 TEMPLE DR ; V. -
METHUEN MA bit
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