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HomeMy WebLinkAboutBuilding Permit #418 - 28 DUNCAN DRIVE 11/16/2011 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: p ORTANT:Applicant must complete all items on this page LOCATION O arc I', Dr- i Print �jj PROPERTY OWNER Pct h r �r Unit# ,'1l Print MAP NO: 0"I� PARCELp/7/ZONING DISTRICT: Historic District yes no Machine Shop Village y s no 100 year-old structure es no TYPE OF IMPROVEMENT PROPOSED USE Resid al Non- Residential ❑ New Building ne family ❑Addition ❑Two or more family ❑ Industrial ❑Alt tion No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other i �j eptic� Well' ¢� �� 0 F odplainl ©Weflarids puT t A(j WaershediD strict, }� O�Water/Sewer on ES RiPTIQN 0 WORK TO BE PE R M (Identificatio Please Type or Print Clearly) OWNER: Name: ��u� Sc��rv,1 4 Phone: Address: 9,9 D-wcQm CONTRACTOR Name: PO W H v 1110t"1w (7�cx/ Phone: gg g Address: S6 S���o✓t �� Cl/JPS PV T� Supervisor's Construction License: �/70� Exp. Date: l a —•� �� Home Improvement License: Q 0Exp. Date: 3 /0 ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT:$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: E FEE: $� Check No.: �/' Receipt No.: �� NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund y - �G ------• ., x.," ° "t 1 i-. Si" nature.of�g/lgent/®wner ���_ "` ._ _ .._ _�. ,Signature_of�contractorx . Location CUA C-A'kq T L� No. Date NORTH TOWN OF NORTH ANDOVER ' Certificate of Occupancy $ t i # Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # I�9 2 4 t I 8 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 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 yes no Located at 124 Main Street Fire Department signature/date COMMENTS 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 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 ❑ 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 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 FAMILY FIRST ROOFING AND MO ; LC 1'197 103 DUTCHER ST (781)654-5568 HOPEDALE,MA 01747 53-13/110 MA DATE ff �� Al 68513 PAY TO THE ��� O Nvv� r1 ,/P ORDER OF_ kd v i e $ Oprv Q 1 ✓O CL�fit/� DOLLARS B 5ecui1j Banko America ACH Rfr 011000j13388 FOR IBJ(g C fj 11100 i97111 11:0 1 1000 1 381: 0046 27 2 2354 1u1 Check # 2 44C) ! Building Inspector tilas.�acl)uutts - UC);tP ltn)er]t of Public Safct� 1 �r Board of Buildin!f, Rc� ati ulons and Standards ,.;;,�r<•. :.. Construction Supervisor License License: CS 97225 TED DOW 74 LUCAS DRIVE , STOUGHTONr MA 02072 y Expiration: 12/3/2012 Tr#: 8049 -_ Office,of Consume Affai B s�s Regu latio OME IMPROVEMENT CONTRACTOR r , Re is 3 -_ 9 tration:` 16.8616 Expiratio---_:3/18/20;1 3 Type: POWER HOME F� DELINGGROUP INC. Supplement C 1� - } TED DOW - 2501 SEAPORT DR.I,VE_STE.•B:1.10 CHESTER, PA 1901.: - i Undersecretary NORTH 9 0 of over 0 No. low =_ o , dover, Mass., co CMIC ME WICK AORATED P`PS S U BOARD OF HEALTH Food/Kitchen Septic System IT T D BUILDING INSPECTOR PER THIS CERTIFIES THAT...............P�V.L............ .... .�►.w�.f... ....... ..................... ...... ..�..................... Foundation has permission to erect........................................ buildings on .. .. ,........ Von, Afteration ....... 11�............... Rough to be occupied as........... X-'Pti%-t--h=sper-m- it ............... ....................................... chimney . . . . ..provided that the er shall in every res t conform he application on file in Final this office, and tohe provisions of the Codes and By-Laws relating to the Insand 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 CONSTRUC 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. i j tt TtC!°wAt RE i AR TF Rs PoWtandOaui:Schmtv t:l P(Xtl Cm, zn� G T?M RE 00 L,N AND t�MOVEMENT AGREEMENT Sv1a tsYaiattoi S tt�eaa r?�i�b�u t�Chmitt F'ioJz�t l�tUn?t�ir'- rdiw+�tn�►-pS,24#1 3 iit$Chtbii€!: {9Y8j;77 E-5itZ3(flebblcr's.Colo .. eb�sut,(pmo:nyir 28.t9unran Mm$$� (lffat�j. iVodhAnd.oW.10A,0180 tO iQwnshtp;. t►yejsj ii#tfti eti :hy j�i�xtiyttr seveirai •Pure>xa grr +cisttdlr sgrvit +�f ilriOro r r idei s €3ra�tp(" rEEt at4r":in s ref i c�Withtha:p arF firs+iressCani�:i �iy�al+�ii�.l�ur 1 is gc rte Mitisrr+ent art sp caHr sheets[cr iiective*-tito?ensn�9art").T-hi r nl ra tt y a c n .a� s i seruiresr sj agr s to pey fixe cc:sir v f the Baia a a sd' �i�s purcr�x+eer� sem iii. i x, e��fress bf#irdittg:or.appaC�ie��►!`any trnai+r����s}rnuy+srti�e#r; r�aB�. lo 3'utclx se t tit $ iiti1spsc ibr i3 ws: - poWrx P=syixnf. _ �0;00 ed prtxja�Gt art:. ; 3 to 4 weeks ub tar agl. 33eatce3xico 328.U0 mtd.Pfojea Compiafion t-tO26ys Cd?T7tptBfiOt}° 'lRetxxc+p4eHtst.d�lXr ts;npi of the assenoe.-.6►etays trayariif Csmt�acta�'s control riot NietiC()d crf ft enf Chsd4 tnAidet¢Fa catoiil;3iCncf L frame&Sea t)eta ll3tytt�txutt:S�o�dEt+oris tit r raess� i r3uyer{s)it8rebif ack�svpEetrges tflC@Ip�Df 2E�c of fixe par�rphrelK"the r.�. 4yfi GartrBsd GWife to R8fl4iF&ta�iEt", jnffermia$l tty�ar(s;or tr►e pntetst r si lk of ie rte r 'expSurettra>�x te�aystiort ecrivit<y ro rig perr�arf i din yens hptYie,at - the �xrs.iv�rel{sjnecei #this parxiet t:h the otthts: rent, e:orrine>isent ct word. {bite #(rtf3fs31&} 1t is iagn 3 arstt d acid by and bsb400ii,the partt$s 4ttM osis A r+ er:t nsir t s e entire irnrtars`atsdln ixelKcee�r tit+a. s ,. > ti :rre ntt v�rligderer+ttttix b# tgirs sxr tify� al<xy 4a tsfma gf#ht�A�jra�emept3styerf sj ilia re3 ay� +xied a that riiuyer s� n s rai d the entire nt olre+s ria+ race vee a eokripreteci.srg t>end fad ottiris agreement,Incluxita tib t ..ta ©tr�panytn esticxs of.Gancsii tioiitn,ane,sera tt a riatia'i!t$tai�+ri €r er afire an t +mss fir _.tnfcs x04.. h S"r ri is to C.�tti i fiats t� otx. d A iC ITi`1i :fiG#t iK 4liENT ipTiNY .8 NK # IrtLetTx+ti► ts P4icshl+r. _.... !raa�rea8 arssr re�eix�idT ea£h'p�e s�bra�.page agr�en:ent owv fitii Gnuy �s) OY;. nig atu�s it Saies'Repressntathr Aire ixYi�atoFtsrottti �ichm3ttlslhtxrltk Y,?.00 OIE 90 R{SjrMIRY EA4NGEL'#Hi F#Attl A Tf©N At PrV?t i«i`'iPS}R73�i 1D1�1t H c�i`rr� ril ti I ERfi 9 zr Y AFT '.'t`oe f►R1tE o'F'fE#1S TpfirSp�(19Ct}� �i kkTFii~N��li;i:s�GA,NCr=LaE�itOi�r�0i�}Ftp�f�tv:CE�i AkrA7�C'tRf QF;fr trS itis#T i CIS� NATIONAL HEADQUARTERS Debbie and Paul Schmitt 2501 Seaport Drive Chester .- PA 19.013'. 30 33680 November 05,2011 8$8-REMODEL. - t Project Specifications PdAiitCN 158616 Roofing: whole house 1 750.01x1.0" :.• Roofing:whole house 1 750.0x1.0" ROOFING:Models GAF Styles Architechiural Shingles Types None Configs None OPTIONS:Color Shakewood/Removal Standard Shingle/Installation Details None CORPORATION Roofing: ridge t 15.0"X1.0" Roofing:ridge 1 116.0"0.0" ROOFING:Models GAF Sayles Cobra Ridge Vent Types None Confrgs None OPTIONS:Color Shakewood/Installation Details None E i f f November 05,2011 14:37 I Page 2 of 2 �. I POWER-1 OP ID:AC CERTIFICATE OF LIABILITY INSURANCE °ATE`"M'°°N"""' 11!14!11 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATNELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(SJ AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the j certificate holder in lieu of such endorsement(sl { Lacher Associates Ins Agency 215-723-4378 DUCER cONTa� Chad Lacher Lacher Insurance Group 215-723-8604 ""O Nft FA: AX No. 632 E Broad St P O Bok 6439$ MAIL Souderton,PA 18964 ADDRESS: Chad Lacher INSURER(S)AFFORDING COVERAGE NAM 0 INSYIRERA:Pennsylvania Manufacturers 41424 INSURED Power Home Remodeling INSURER a-Pennsylvania Manufacturers 12262 Group,Inc. INSURERC:lronshore Specialty Ins.Co. 25445 2501 Seaport Drive Ste B110 i Chester,PA 19013 INSURER D: j INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT 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, II EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. { TYPE OF INSURANCE POLICY EFF POLICY EXP -li I POLICY NUMBER MMAD MMfDDIYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 t AX COMMERCIAL GENERAL LIABILITY 821100-M-20-M-7 09/22111 09=12 PREMISES Ea oa'xrence $ 30-D7NVZt"" S 0,00 `! CLAIMMpDE �OCCUR MED EXP(Any one person) S 10,0 PERSONAL&ADV INJURY $ 1,000,0 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/01? $ 2,000,00 X POLICY PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT(Es wadent) 1,000,0 00 A X ANY AUTO 151100-6640.96-7A 09122!11 0912212 BODILY IN,URY(Perperson) $ I ALL OWNEDSCHEDULED I( AUTOS AUTOS BODILY IN (Per acddent) $ HIREDAUTOS NON-OWNED OWURI AUTOS Peracddent $ S UMBRELLA LIAR HX OCCUR EACH OCCURRENCE ¢ 5,000,00 X X EXCESS LIAR CLAIMS-MADE 1158200 09122111 0912212 AGGREGATE $ 5,000,0 —DEDTX RETENTION 10000 $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY X W'C STATUS TORYLIMITS OTH- A ANY PROPMETORPARTNERIEXECUTIVE YIN 1100-68-20-W7A 09/22/11 09/2212 E.L.EACH ACCIDENT $ 1000,00C OFFICERMIEMBEREXCLUDED9 Fi] NIA r r0 B (Mandatory in NH) 107-66-20 86-7B(MASS) 09/22/11 0912212 E.L DISEASE-EA EMPLOYEE $ 1,000, Ilyes,describe under f DESCRIPTIONOFOPERATIONSbelor+ E.L.DISEASE-POLICY LIMIT $ 1,000,00 A MASS AUTO 151107-66-20-96-78 09/221110 9/2212 LIABILITY 1,100,0 I I DESCRIPTION OF OPERATIONS I LOCATIONS I VE-MCLES(ACach ACORD 101,Additional Remarks Schedule,It more space Is r"Wnd) i CERTIFICATE HOLDER CANCELLATION NANDOVE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEWERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 120 Main Street North Andover,MA 01845 AUrHORIZEDREPRESENTATNE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD c The Commonwealth ofmassachusetts Department oflndustrialAccidents Office oflnvestigationg 600 Washington Street 5� Boston,MA 02111 www.mass,gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumlbers Applicant Information please Print Legibly Name(Businessiorganization/Individual): POLAJPV 6 Address: S ea,00 b .City/State/Zip:C`r-am ter 'Pol /10 7� — Phone Are yo n employer?Check the appropriate box: _ 1. am a employer with 1OG. 4 Type of project(required): ❑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 shget.3 7. ❑Rem.odeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. [No workers'comp.insurance 5. ❑ We aie.a corporation and its 9. ❑Building addition 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 insurance required.]r 12. oofrepairs 9. ]� employees.[No workers comp,insurance required.] 1311 Other ------------- *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. T Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name ofthe sub-contractors and their workers'comp,policy information. information, . Elam an employer thatisproviding workers'compensation insuranceformy employees Below is thepolicy and job site • Insurance Company Name: Pei)/'S VGv�/u �t/ft fav / QC �vPkS Policy#or Self-ins.Lic.#: 0'� -C?6-do_ 7 Expiration Date:_ Job Site Address: oc g 'pV tI C O h L- . , City/State/Zip: �t94'I�, � fddi/p " 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 ofMGL 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. r do hereby certify under the ains and en o .p P fperjury tliat the information provided above is true and correct. 3i nature: Date: -l `hone#: R8 Official use 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): . I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electric 6. Other al Inspector S.Plumbing Inspector Contact Person: Phone#: