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HomeMy WebLinkAboutBuilding Permit #28 - 254 CHESTNUT STREET 7/13/2007 BUILDING PERMIT pORTM OFST�ao ,6'9ti TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION * _ Permit NO: Date Received •�q0 Arm "qy �SSACNus�� Date Issued: 13 IMPORTANT: Applicant must complete all items on this page � .. f PRO Y ViNIER ° �. .' ",Pmt z DIno IIQ. Z1V1iG:CISTI1 #. MtS3FICTIICT Ares lIAi �. ' . 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 IMi Septic D,,1t�/ l w.. 7TIii F dofwti WetlaMs Oa'tershe C istrrct €�111/at- -'ewer , DESCRIPTION OF WORK TO BE PR FORMED: <Zr P X2001= .4.- eec�(-r+� S h « ( �'-9 C (2 S I U)1,4j6- + P—t5PC(4 Lc-gi Identification Please Type or Print Clearly) U OWNER: Name: A xl-M o o c,,/ J G-t u FGtu DAA Phone: ! 7E--6 6 5 OY79 Address: c 0V { TIACTC .Nares R. Add,ess. " E , : r Superirisa 's Gar�struoiorl Lcee Epp Ua#e. a Home lnpt-aurert laEpp. Dates „ 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: $ .SOS FEE: $ (P(-) Check No.: -7-�� cy Receipt No.: 12 O NOTE: Persons contracting with unregistered ontractors do not have access to the guaral ty fund N Signature of Agent/Owner Signature of contrac Location aJY C/"O'�vvr s No. a Date +� 6!✓ Na"Th TOWN OF NORTH ANDOVER F 9 Certificate of Occupancy $ CHus �'�;', •E<� Building/Frame Permit Fee $ d � s•►cH Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # ` !� 2U ;s : Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ 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 TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ r ❑ - Private(septic tank,etc. Permanent Dumpster on Site ❑ Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/signature& Date Dr' ewa Permit Located at 384 Osgood Street FIRE DEPARTMENT.-Temp durn'pster on site'' V no Located at 124 Main=Street, ---- Fire Department,,signaturedat,e COMMENTS g 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.$100-$1000 fine NOTES and DATA— For department use ❑ Notified for pickup - Date I .._.........._........._........--- 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 .gar 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 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 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 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 NORTIy c own of t over 0 No. o , dower, Mass., COCMICHEWICK oRATED BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System ...................................................... BUILDING INSPECTOR THIS CERTIFIES THAT.... .. .... .... .. .............. ..........�.�........................�. Foundation haspermission to erect........................................ buildings on ..... 7" �. .. Rough P g .. .........0064+ 1�................ S , r .... y to be occupied as...... 4. Chimney ........ . ........ ...... ..................................................................................... provided that the person accepti this permit shall in every res 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, 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 6 i PERMIT EXPIRES IN 6 MON S ELECTRICAL INSPECTOR UNLESS CONSTRU ST TS 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. TEL.978-372-4031 LETOILE ROOFING CO., Inc. GOOD WORK IS OUR SUCCESS ROOFING and SHEET METAL WORK Of EVERY DESCRIPTION 339 East Road Hampstead, NH. 03841 Since 1918 Contract Date: 7/11/08 CONTRACT SUBMITTED TO: Name:Anthony Giuffrida Address: 254 Chesnut St City:North Andover,MA 01830 We agree to remove and dispopse of existing shingles down to roof deck,install 1-ply felt underlayment,Ice&Watershield along all leading edges.Then shingle with new 30 year Charcoal Grey IKO self-sealing asphalt based shingles complete with new white aluminum moldings and ridge vent.Also install new vinel siding. All material and work is guaranteed to be as specified above.All work to completed in a substantial workmanlike manner for the sum of $5,000.00 With payments to be made as follows: Full payment upon completion. Any alteration or deviation from the above that involves extra costs or labor will be done only on agreement between all parties, and will become an extra charge over and above the estimate. Letoile Roofing supplies 1 Year workmanship guarantee. IKO supplies guarantee after 1 Year has expired.All guarantees are void if payments schedules are not met or paid in full. Home owner responsible for any town or state fees. The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above. ACCEPTANCE OF CONTRACT ✓ 17 Sign Date fe �ommwozcueai o�✓�aaoariz+caella Board of Building Regulations and Standards lug HOME IMPROVEMENT CONTRACTOR Registration: 131516 Expiration: 8/3/2008 Tr# 127431 Type: Individual William G.Letoile William Letoile 38 Lancaster St. C ,.•� � Haverhill,MA 01830 Administrator R INSURANCE BINDER SSR °07/09/ THIS BINDER IS A TEMPORARY INSURANCE CONTRACT,SUBJECT TO THE CONDITIONS SHOWN ON THE REVERSE SIDE OF THIS FORM. AGENCY COMPANY BINDER# 191 Acadia Insurance Company Santo Insurance - Salem DATE EFFECTIVE TIME EXPIRATION 224 Main Street DATE Salem NH 03079 AM X James A Santo 07/10/07 04:35 X PM 08/09/07 PHONE FAX (AIC,No,Ext): 603-890-6439 (A/C,No): 603-890-0315 THIS BINDER IS ISSUED TO EXTEND COVERAGE IN THE ABOVE NAMED COMPA CODE: SUB CODE: PER EXPIRING POLICY#: BINDER AUENCY CUSTOMER ID: LETOI-1 DESCRIPTION OF OPERATIONSIVEHICLES/PROPERTY(Including Location) INSURED Letoile Construction Company L Residential Carpentry William Letoile 339 East Rd Hampstead NH 03841 COVERAGES LIMITS TYPE OF INSURANCE COVERAGE/FORMS DEDUCTIBLE COINS% AMOUI PROPERTY CAUSES OF LOSS BASIC EIBROAD EISPEC GENERAL LIABILITY EACH OCCURRENCE $ DAMAGETOR COMMERCIAL GENERAL LIABILITY RENTED PREMISES $ CLAIMS MADE r]OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ RETRO DATE FOR CLAIMS MADE: PRODUCTS-COMP/OP AGG $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS -PROPERTY DAMAGE $ HIRED AUTOS MEDICAL PAYMENTS $ NON-OWNED AUTOS PERSONAL INJURY PROT $ UNINSURED MOTORIST $ $ AUTO PHYSICAL DAMAGE DEDUCTIBLE 7ALL VEHICLES SCHEDULED VEHICLES ACTUAL CASH VALUE COLLISION: STATED AMOUNT $ OTHER THAN COL: OTHER GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN AUTO ONLY: EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE $ OTHER THAN UMBRELLA FORM RETRO DATE FOR CLAIMS MADE: SELF-INSURED RETENTION $ X I WC STATUTORY LIMITS WORKER'S COMPENSATION E.L.EACH ACCIDENT $100000 AND EMPLOYER'S LIABILITY E.L.DISEASE-EA EMPLOYEE $100000 E.L.DISEASE-POLICY LIMIT $500000 SPECIAL FEES $ CONDITIONS/ OTHER TAXES $ COVERAGES — ESTIMATED TOTAL PREMIUM Is NAME&ADDRESS MORTGAGEE ADDITIONAL INSURED LOSS PAYEE F] LOAN# AUTHORIZED REPRESENTATIVE James A Santo ACORD 75(2004/09) NOTE:IMPORTANT STATE INFORMATION ON REVER DE ©ACORD CORPORATION 199 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston MA 02111 J www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/individual): �v t�� 1)�Ab� Address: 150�� City/State/Zip: �! ;�1 t'0- f J ,= � Phone #: �T— Are you,an employer?Check the appropriate box: Type of project(required): 1. am as employer with_ 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/orpart-time).* have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. $ E] Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its officers have exercised their 10.F] Electrical repairs or additions required.] 3.❑ 1 am a homeowner doing all work right of exemption per MGL I l.❑ Plumbing repairs or additions myself [No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.]t employees. [No workers' 131-1 Other comp. insurance required.] *Any applicant that checks bot.#1 must also fill out the section below showing their workers'compensation policy information. I 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 their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic.#: k F — I 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. I do hereby certify un4er the pains and penalties of perjury that the information provided above is true and correct. Signature: `` Date: Phone#: Official 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#: 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,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 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 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 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 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 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 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 Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax #617-727-7749 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 I 0A. The debris will be disposed of in: (Location of Facility) VVI Signature of Permit Applicant Fire Department Sign off: Dumpster Permit Date