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Home My WebLink AboutBuilding Permit #207 - 263 FOREST STREET 9/23/2008 BUILDING PERMIT o` NORTH q op TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO:�11 Date Received %rev �7 gSSACHUs�� Date Issued: �d'J o IMPORTANT:Applicant must complete all items on this page oll ell) LOCATION ►'� . PROPERTY OWNER _ eW •J�/'SOS Print I,, Print MAP NO/ PARCEL: ZONING DISTRICT: Historic District yes no 'Machine Shop Village yes no I TYPE OF IMPROVEMENT PROPOSED USE Resid Non- Residential New Building QOne family Addition Two or more family Industrial t No. of units: Commercial Repair, replaceme Assessory Bldg Others: Demo i ion Other Septic Well Floodplain. Wetlands -Watershed District Water/Sewer ODrCRIPTIONOF WORK TO BE PREFORMED: 2 1 C,(4!5 e- // e-4-r' e-Z_V /W�_ zQce4t of'- ��yy AvC� is tion Please Type or Print C early) _?00 NEER: Name: 8w S SSC-)k? Phone�7 7S �— - 66C, 7 Address: 2- 6 3, CONTRACTOR Name: ' t/i t/ /t_Wmy ,y S Phonef c�,O?,) :3 5- 723-2- Address:.... 2Address: - H o c)-?(i Supervisor's Construction License: exp. Date: LHorne Improvement License: I U 2 Exp. Date: 12-Lao 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: $ G `600 FEE: $ a- Check No.: ��J-j Receipt No.: D� SJ NOTE: Persons contracting with unregistered contractors do not have access,to t guaranty fund ignnaature of Agent/Owner Signature of contracto Locationr� a S No. O��' Date b �oRT� TOWN OF NORTH ANDOVER oL ID • i a Certificate of Occupancy $ �ss+cNusEBuilding/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # � 2151 Building Inspector 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 CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Siqnature 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 yes no Locatedat124 Main Street Fire Department signatureidate COMMENTS i 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 Doc.Building Permit Revised 2008 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 o Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses o 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) [3 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 Li 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 L3 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 Dor.INSPECTIONAL SERVICES DEPARTMENTMITORM07 Revised 2.2008 TH NOR ,9 0 0 _: Andover , No. o o�W11 dover, Mass., . COC MICME WICK V 0,RATED 1 ` BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THATFoundation ............. .......... Ian.. has permission to erect................. ...................... buildings on ....i ..... . 3.. ................................................... Rough ' et Chimney tobe occupied as................. ....:.......... . . ......... .. .......... ....... .. .......................................................................... provided that the person accepting thi permit shall in every respect ceform 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 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO TARTS �� 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. The Com nonwealth of Massachusetts Departr,zent of Industrial Accidents (office of Investigations 'L % 600 Washington Street Boston, MA 02111 t'3S4 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: 32- City/State/Zip: City/State/Zip: C'f-,67`7 Phone #: Z C s -7? , 21 Vou an employer?Check the appropriate box: Type of project(required): I am a employer with 7 4. ❑ I am a general contractor and I 6. New construction m employees(full and/or part-time).* -contractors hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. t 7. ❑ 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 required.] officers have exercised their 10:0 Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL l 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' comp. insurance required.] 13.❑ Other *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit.dhis affidavit indicating they are doing ail work arid 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. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: L ( �i15U"e,_ -e C001/2C,h t Policy#or Self-ins. Lic.#: ( 2_! � O(2-2) XYZ g D Expiration Date: Z a Job Site Address: 2661 d`e g r f- City/State/Zip: /U6 A1,VJC)V-<_e- 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 ereby ce ify u r the pains d penalties of perjury that the information provided above is true and correct Si at Date: Z Phone#: Offcial use only. Do not write inn 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 -'rovide 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 or more 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 cant'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. # 617-7274900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax# 617-727-7749 www.mass.gov/dia Date:9/23/2008 11:07 AM Sender's Fax ID:603-890-0315 Page 2 of 2 ACORD. CERTIFICATE OF LIABILITY INSURANCE OP ID CA F7DAtTE(MM0DIYYYY) EDMUN-1 9 22/08 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Santo Insurance - Salem HOLDER.THIS CERTIFICATE DOES NOT AMEND.EXTEND OR 224 Main Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Salem NH 03079 Phone:603-890-6439 Fax:603-890-0315 INSURERS AFFORDING COVERAGE NAIL# INSURED INSURER P: Western World Insurance Co INSURER B: Acadia Insurance Company Edmunds General Contracting INSURER C: David Edmunds PO Box 2214 INSURER D: Salem NH 03079 INSURER E: COVERAGES 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 WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY EFFECTIVE POIXTUIPIRIMOW LTR S TYPE OF INSURANCE POLICY NUMBER DATE(MMIDDIYY) DATE MMIDDIYY LIMITS GENERAL UABILRY EACH OCCURRENCE $1,000,000 A X COMMERCIAL GENERAL LIABILITY NPP2096378-1 04/02/08 04/02/09 PREMI'SE S(Eeoccurence1 $50,000 CLAMS MADE F:;-1 OCCUR MED EXP(Any one person) s 5,00 0 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE s2,000,000 GEMLAGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $2,000,000 POLICY jEo- LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Eeaccidert) $ ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ IPer accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ ALTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR F �CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ TIT $ WORKERS COMPENSATION AND X TORY LIMBS ER B EMPLOYERS LIABILITY ANY PROPRIETOR/PARTNERlEXECUTIVE WC282800042501 04/02/08 04/02/09 E.L.EACH ACCIDENT $100000 OFFICERVEMBEREXCLUDED? E.L.DISEASE-EA EMPLOYEE $100000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $5500000 OTHER DESCRIPTION OF OPERATIONS f LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION TOWNNOA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL.ENDEAVOR TO MAUL DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO Do SO SHALL TOWN OF NORTH ANDOVER IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR 166 OSGOOD STREET REPRESENTATIVES. NO ANDOVER MA 01845 AUTHORIZED REPRESENTATIVE James A Santo ACORD 25(2001/08) 0 ACORD CORPORATION 1908 e �fze >°omrnoauve o�✓�laaaac�zu� Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR f Registra„(ion., 159028 �jEPlet!on 010 Tr# 265669 t � - EDMUNDS GEN , fvbNTRACfr�NG- DAVID EDMUNDS ?r � 32 BANNISTER.RDY�� SALEM, NH 03079 Administrator E Fully Licensed and Insured • Member of MA Better Business Bureau L O O� r Member of NH Better Business Bureau 53 S. Broadway#2214 1 10 Stevens Street#141 S Salem, NH 03079 ' Andover, ;� MA 01810 (603)890-0084 General Contracting (978)475-0095 _ Newton, MA 617 527-ROOF HIC Reg#159028 ( ) GAF-ELK Cert.ME16226 PROPOSAL SUBMITTED TO r PHONE DATE }} STREET E-MAIL CITY,STATE,AND ZIP CODE JOB LOCATION Completely protect home with tarps to catch falling debris.Respect and Protect shrubbery and flower beds. Strip off existing roofing material down to the bare roof deck. Thorough clean up and disposal of all roofing debris on property.Magnetically sweep property for nails. Inspect roof deck for structural defects and condition of plywood or boards.Repair and replace as necessary'. Install 6'of GAF-ELK Weather Watch Granulated Ice and Water Shield at roof's eaves. Install 3'of GAF-ELK Weather Watch Granulated Ice and Water Shield centered in all valleys. Install a 2'x2'collar of GAF-ELK Weather Watch Granulated Ice and Water Shield around all existing vent pipe penetrations. Install GAF—ELK Weather Watch Granulated Ice and Water Shield at chimney base. Install GAF-ELK Deck Armor breathable roof deck protection to remainder of the roof deck. Install new 8"L and R .24mm heavy gauge A� (color)galvanized drip edge at roof's eaves and gable rakes. Install GAF-ELK Pro Start pre-cut starter strip at roof's eaves and gable rakes. Install new Never Leak vent pipe penetration boots to all existing vent pipe penetration. Carefully strip off existing siding from cheek walls. Inspect sidewall deck for structural defects and condition of plywood.Repair and replace as necessary'. Install GAF-ELK Weather Watch Granulated Ice and Water Shield 1 1/2'on the roof deck and 1 1/2' up the cheek wall eaves for superior protection against Ice damning and wind driven rains. install C.'. f _ - •E , ' r - ;.,�.: ` 'It desired color.1" r P= -'A� (color) Install new aluminum 8"x8"step flashing against cheek walls. Inspect ridge for proper 1 1/2"spacing on either side of existing ridge beam to allow for maximum exhaust ventilation.Cut in if necessary. Install (feet)of GAF-ELK Cobra /- ridge vent at roof's ridge for maximum exhaust ventilation.Hand nail to ensure proper fastening. Install Timbertex distinctive Hip and ridge cap.Hand nail to ensure proper fastening. Thorough clean up f nd disposal of all roofing debris on property.My�agnetically sweep property for nails. Edmunds General Contracting prohibits smoking on customer's property.'- Edmunds General Contracting will Furnish and install all necessary materials to complete roof replacement. Edmunds General Contracting will provide a Thorough clean up and disposal of all debris generated during roof replacement. Edmunds General Contracting will recycle all asphalt roofing debris generated during roof replacement. Edmunds General Contracting will obtain all necessary permits to complete roof replacement work. Edmunds General Contracting guarantees all workmanship for the life of the roof system. Edmunds General Contracting will include exclusive GAF-ELKS" year Weather Stopper System Plus warranty. Edmunds General Contracting offers hand nail roof services at no additional charge.(yes/,no) Edmunds General Contracting will replace up to 2 sheets of Cox roof decking and 20'of fascia at no additional cost to the customer.Any additional replacement or repairs will be brought to the attention of the customer and additional arrangements will be made to address repairs. S Ey Ask me about Smart Money financing. "Roof Now,Pay Later." Thank you for the opportunity to bid on your roof replacement work. We fllropoge hereby to furnish material and labor- complete in accordance with above specifications, for the sum of: 5 f < 1 ') . /I - ./ .s'J., ,a - dollars ($ �" � C,f �—) Payment to be madee as follows: All material is guaranteed to be as specified.All work to be completed in a workmanlike manner Authorized Signature: according to standard practices.Any alteration or deviation from above specifications involving , extra costs will be executed only upon written orders,and will become an extra charge over and above the estimate.All agreements contingent upon strikes, accidents or delays beyond our Note:This proposal may be'withdrawri control.Owner to carry fire,tornado and other necessary insurance.Our workers are fully covered by us if not accepted within days. by Workmen's Compensation Insurance. LCthe ce of J)ropoaf The above prices,specifications and e satisfactory and are hereby accepted. You are authorized to s specified.Payment will be made as outlined above. Authorized Signature:reptance: f �: { Authorized Signature: