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Home My WebLink AboutBuilding Permit #162 - 267 CHICKERING ROAD 8/30/2006 APPROVED TOWN OF NORTH ANDOVER NORTH n Dnr rry n rrn�.T ��R PLAN EXAMINATION o�tt�to + 6 �6 0 Permit NO: Date Received 0 Arm Date Issued: -9W 42 �9SSACHUS�� IMPORTANT: Applicant must complete all items on this page LOCATION 67 �U t r t A Amt PROPERTY OWNER A �._ Print MAP NO.: PARCEL: S ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑New Building ❑One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: >Repair, replacement ❑ Assessory Bldg ❑ Commercial ❑ Demolition ❑ Moving(relocation) ❑ Other ❑ Others: ❑ Foundation only DESCRIPTION OF WORK TO BE PREFORMED I1 /1 Ari-,byG 6v d !`C wt /� hen �-Q,� k-11r, Imo„• I x.60— CJ b e Iden ification Please Type or P . t Clearly) OWNER: Name: -t / f I i Phone: Address: Ab oloijoiv Ave- t-sh L,t, u CONTRACTOR Name: �G��_v... 13v.r 14e Corj. LL L Phone: (-113_ 73 3 -%:133 133 Address: 37 o-re o e, r-ct� 0 //4 Supervisor's Construction License: C 5 6O7 9 3 Exp. Date: 6- 0 Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Name: Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost :$ a , ydFEE:$ :3 Check No.: Receipt No.: ��7 Page I of 4 Loc ation�61 L 4 No. Date NC11T1y TOWN OF NORTH ANDOVER 3? � •got 00 + ; : Certificate of Occupancy $ owl— Building/Frame Permit Fee $ ss�CMuse Foundation Permit Fee $ Other Permit Fee $ i TOTAL $ Check # 19533 Building Inspector TYPE OF SEWERAGE DISPOSAL Swimming Pools ❑ El Art ❑ Public Sewer Well F1Tobacco Sales ❑ Food Packaging/Sales 11 Permanent Dumpster on Site ❑ Private(septic tank,etc. ❑ Electric Meter location to project NOTE: Persons contracting with unregistered cont r tors do not have access to the guaranty fund Signature of Agent/Owner c Signature of contractor Plans Submitted ❑ ns Waived Certified Plot Plan ❑ tamped Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF-U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ ❑Water Shed Special Permit ❑ Site Plan Special Permit ❑ Other COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ A COMMENTS I 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 Temp Dumpster on site yes—no— Fire Department signature/date Building Setback(ft.) Front Yard Side Yard Rear Yard Required Provided Required Provides Required Provided Dimension Number of Stories: Total square feet of floor area,based on Exterior dimensions. Total land area, sq.ft.: NOTES and DATA—(For department use) rC *401?0 M S Page 3 of 4 46- Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 Created 1MC.Jan.2006 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 �P Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work Addition Or Decks ❑ Building Permit Application ❑ 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) 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 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:BPFORM05 Paur 4 44 NORTH 0VM Of over 0 No. 1 � o 11. dower, Mass. 'O T O ?' LA COC HICMEWICK V A0RATE0 `S E BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System 1 ... BUILDING INSPECTOR THISCERTIFIES THAT..... .. ........... ...i .....'..�!...r......................................................19......................... . Foundation has permission to erect........................................ buildings on ....0��. -....Gtfic .,h�... ......... Rough to be occupied as...... ...AL. irA.� Chimney provided that the per o accepting this per shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Cod 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 Bit PERMIT EXPIRES IN 6 MONTHS Final ELECTRICAL INSPECTOR UNLESS CONSTRUC S_ Rough . ... . ... .. . . .. ... .... .. ..... B ........ Service UILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR --- Rough Dispiay 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. 06-25-2006 02:CTPM FROM-ALIEN AND BURKE CONSTRUCTION +4137337153 T-060 P.002/002 F-135 Allen & Burke Construction L.L.C. August l 8,2006 Mr.Tom Wilburn Ninety Nine Restaurant&Pub 160 Olympia Avenue Woburn,MA 01081 i Please find below the price quote for work to be done at the Ninety Nine Restaurant& Pub located in North Andover,MA. We propose to furnish all labor,material and equipment for the pitched roof area as detailed below for the sum of$26,000.00 1. Remove and dispose of existing shingle roof down to roof deck 2. Install a layer of icetwater protection membrane at eaves and valleys 3. Install a layer of 15#asphalt saturated felt under-layment 4. Install new 30 year architectural shingles in the color of your choice 5. Install new aluminum drop edge at all eaves and rakes 6. Contractor will guarantee the work for a period of 2 years against any defects in workmanship 7. Provide the manufacturer's 30 year shingle warranty. If you have any questions or need additional information,please feel free to call my office at(413)733-8233 or my cell (413)374-1010. To accept this proposal,please sign and date below and fax back to(413)733-7153. Tom Wilburn--Acceptance Signature pate 37 Warehouse Street* Springfield,MA 01118 (413)733-8233 * (888)792-5688 * Fax(413)733-7153 www.allenandburke.com 06-25-2006 02:07PM FROM-ALLEN AND BURKE CONSTRUCTION +4137337153 T-860 P.001/002 F-135 Fax Cover Sheet Allen & Burke Construction L.L.C. To: ..... 1 From: C J� 4 Fax#: Date: *)as) .2s D 6 679) Total Pages Including Cover: ;. Comments `e" 7t; 9 q /V.�. 4OXIAr 37 Warehouse Street*Springfield,MA 01118 (413)733-8233 * (888)792-5688 *Fax(413)733-7153 I, Wee C'rY,�e-nrcnu�aj�� ,llcr a+f�, �ls BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 077938 Birthdate: 06/08/1967 Expires: 06/08/2008 Tr.no: 27243 Restricted: 00 JOHN BURKE 19 CAMELOT LANE WESTFIELD, MA 01085 Commissioner The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street \I Fifl Boston, MA 02111 www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Allttr, �t �Urbb L L Address: 3.7 WA-1-thou6 , 61ri' City/State/Zip: r n f /L41//I Phone Are you an employer. Chec he appropriate box: Type of project(required): 1.�o I am a employer with I S-" 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I 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 required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ 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' 13.❑ Other comp.insurance required.] *Any applicant that checks box#I must also till out the section below showing their workers'compensation policy infonnation. t 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 infonnation. I am an employer that is providing workers'compensation insurancefor my employees. Below is the policy and job site information. /� Insurance Company Name: f" m C'm G_a� p t u✓�.+�<<.- e Policy#or Self-ins. Lic.#: Jc _W6 D_ `�/ V Expiration Date: r 3—o Job Site Address: / k'C. e t City/State/Zip: ✓Vi ✓l Attach a copy of the workers'compensation polideclaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 5A 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 u e t e pains and penalties o perjury that the information provided above is true and correct. Si nature: Date: V 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 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 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