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HomeMy WebLinkAboutBuilding Permit #24 - 280 MARBLERIDGE ROAD 7/8/2009 BUILDING PERMITof "ORT" q b,�t Ll D.tib• �� TOWN OF NORTH ANDOVER c� °�, APPLICATION FOR PLAN EXAMINATION 70 Permit NO: Date Received > ZA) �SSACHUSF� Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION pl IL.X1� Print PROPERTY ONER_. � �� 7 �.�(� Print MAP NO. . PARCEL. ZONING DISTRICT: Historic:District yes no Machine-Shop Village yes no 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 Septic Well - Floodplain WetlandsWatershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: a Identification Please T e or Print Clearly) OWNER: Name: VEAI Z-(J�W Phone: Address: CONTRACTOR ala n me C1VCst, .. ;Phone: Address: 3`7 / / i6 Supervisor's Construction License:5A/y/Y3 Exp. Date: Home Improvementlicense: 1 Exp. Date ARCHITECT/ENGINEER 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: $ "e-15-0 0 FEE: $ � Check No.: I I ��� Receipt No.: n1\ C43 NOTE: Persons contracting cth unre ' tere ontractors do not have access to the guaranty fund Signature of Agent/Ow Si _ of contract =—% ,. 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 g Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C: And/Or C.S.L. Licenses sr/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 Li 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) ❑ 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 _ o Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract o 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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 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 i CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature C6MMENTS 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 Dumpsteron: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 2008 Location AIL-1 n�(e_ r No. "�- Date NORTH TOWN OF NORTH ANDOVER Of ,••o , 1h0 3? i • O AL F 9 Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 22196 � Building Inspector �AORTH 0" 'o 4Andover No. a tr dover, Mass.,- 0C T LAK COMICHEWICK 7,p ADRATE D P'P�` �Cl `S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT..........3�......... .1 ....... .................................................. ...... ...................... .. Foundation 'has perMission to erect................:....................... b dings n�...... . • Rough tobe occupied as......... .a...... V'�!!�............. .........a. ................................................................................................ chimney provided that the pers accepting this permit shall in ev respect 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 PERMIT EXPIRES IN 6 MONTHS S y I ELECTRICAL INSPECTOR UNLESS CONSTRUO. N STARTS 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 bathing or Dry Wall To BeDone FIRE DEPARTMENT' Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. , chusetts �qm.mvnw alth of :wi - The,> .. In -ia A cede `j• " tiiient of dos ns = e ar _ lee:of Investiga. o. _ f on street 600JVashin Boston,NSA 02111 le s'_ sov/dia - www.m .g ders/ onte:. Workers'. COM-W safion InstiYance Affidavit:Buil. C . - - Yicant: nfbrarriation. ®oval ioofiirl (gusin�org�ation/lndividual): PQ 130x 637 Name -7�-�o C�Gr-2 SS Address: phone#: roject.(req�eO Type of p . - 6. �New construction City/State/Zip: ropriate box: to er? Check the pP 1 am a general contractor and 7 Remodeling Ar- u an eYnP yer 4' have hired the sub-contractors 1 I am a e-rnplo�l and/or part-time)•# listed on the attached sheet. 8 0 Demolition employees( These sub-contractors have addition or partner- 9 Building tions 2 1 an a sole proprietor to ees employeeS and have workers' airs or adds ship and have no emP ca capacity- comp.insurance-110.�glectiical rep or additions for me in any P oration and its Plun1b�g repay working 5 We are a corp 11.❑ ' comp-instance [No workers officers have exercisedMGL 12. oof repairs required.] all work right of exemption p er doing p(4), an 13.0 Other a homeowner C. 152, d we have no 3.❑ I am o workers' compo workers' myself. [1`l t employees.[N insurance required.] comp.insurance required.] ensation policy infl. on.affidavit indicating such_ workers'comp must submit a new have all work and then hire outsidectorss m ands tate whether or not those entices they are doing wing the name of the su - number. ant that checks box#t tnus it i'o fit ou the section below showing their' tic b site *[wy aPPlrc who submit this aft comp-Po Y and JO t Homeowners ust attached an additional streets workers is the policy at cbeck this box m must provide their plo ees. Below i ctors that to ees.they for my em y Coma . employees. If the sub-contractors have emp wOY1CCYS'compensation insurance that is providing I am an employer information. 6/ UExpiration Date: e 30 /J Insurance Company Nam ' �- Lie.#: City/StatelZip: ' iration date Policy#or Self-ins- policy number and exp amities of (showing the P alp Policy eclaration page lead to the imposition of criminal, and a Job Site-Address: ensatiou P of MGL c• 152 can of a STOP WORK ce- a copy of the workers comp der section 25A civil penalties in the form forwarded to the Oft Attach e as required un well� be forty and/or one-year urtprisomntnt, of this statement may Failure to secure coverag $e advised that a copy fine up to$1,500.00 anviolator. against the verification. of up to$250.00 a day g for insurance coverageprovided above is true and correct- of Investigations of the DIA er ury that the information P / and r the ains and penalties of P J Date: I do her certify Si afore: official. Phone#: to be completed by city or town official use only. Do not write in this area, PernvrlLicense# cal Inspector 5.Plumbing xnspectc City or Town: Authority (circle one): Department 3_City/Town CJerk 4.Electri Issuing 2.Building vtnard of Real"' vhnne#: Inforrhatioll Massachusetts General Laws and Inst_rU c tl o ll s chapter e r P 152 Pursuant to this statute, an employee is defined as "...eve requires all employers to provide workers' com e express or implied, oral or written.- "...every Person in the service ofanot P nsation for their employe( her under any contract of hire, o f employeris defined-as"an individual of the foregoing engaged in a joint enterprise.Pnershi F,association,corporation or other IegaI enti receiver or trustee of an individual partnership, and including the legal representatives of a deceasedeor m owner of a dwelling >parttiershiY two or mor< house having P>association.or other legal enti employer, or the dwelling house of another who em Io more than three apartments ty,employing employees. and who resides therein However the Or on the grounds or buildinga P �` Persons to do maintenance,constriction or re air Vor the occupant appurtenant thereto shall not because Of such e Pant of the P work on such dwelling MGL chapter 152 mployrnent be deemed to be g house p > §25C(u7 also states that"eve employer." renewal of a license or permit to operate a bus- agencyto conslocal t licensing a aPPlicant who has not produced acceptable evidence of compliance g gency shall withhold the issuance or- Additionally, AICL chapter 152, tact with he in the commonwealth for any §25C(7)states ` p with the insurance covera e enter' any contract for the perf orniance of either the co requirements of this chapter have been present��toe contras ?nmonwealth nor any of its g required." public work anti]acceptable evidence of co Phan e subdivisionsishall Applicants ting authority." the insurance Please fill out the workers'compensation affidavit completely,necessary,supply sub-contractor(s)name(s), P ( ), address es Y' by checking the boxes that apply to your situation and,if insurance. Limited Liabili ss(es) Pone number(s)along with their certif tate s members or tY Companies(LLC)or Limited Liabili P partners, are not required to c �'Partnerships(I,I•p ( ) of employees,a policy is re �'workers compensation insurance. )with no employees other.than the Accidents for con qua ed. Be advised that this a ffdavit may be submitted t 'he Department C or LLP does.have be re fi'Triation of insurance coverage.turned to the city or town that thea g Also be sure to sign and date the affidavit.ent of Industrial Industrial Accidents. Should you have an lication for the Permit or license is beim The affidavit should compensation policy,please call the De Y questions regarding the law or if you are r gaited to of P�nent at then the Department of self-insurance license number o umber listed below, btain a workers' n the a pro Ziate line. Self-insured co City or Town Officials MPanies should enter their Please be sure that the affidavit is complete and Of the affidavit for you to p Printed legibly. " fill Out � Th t Y The e P the a Please be event th P rtment b .. e sure O as to fill in the e ffice of Investigations has to contaProo and a space at the bottom..., .. P niiit/license number which will be used as that rqust submit multiple pemvt/license a Y regarding the a p°li�X uifonnation applications in a reference number. Papplica. (if n an r. ( necessary) given In addition,' Y g n year,need only sub tin ic applicant town _". azY) and under"Job Site Address"the Y mit one affidavit indicating current ­ any 'PPY-ofthe affidavit that has been o applicants should write " aPPicanisas prool.�at,.a'valid stamped or marked b all locations in g davit is on file for future e Y the city or to —(city or: -: year_-.Whew a-home;.owner or.ci u'r'may be ti2en is obtainin a Permits or licenses. A new Y Provided.to.the - (i.e.a.dog,license.oz•pernit to b g license.Orpermit not to an davit must be filled Out each. tun leaves etc.)said y business or co The-Office of Investigations would like.to thank Person is NOT require to tom Iete mrrierc-al venture q P this affidavit.. please do not he to You in advance for your give us a tali. cooperation and should The.Departrnent's address teIeph You have..any questions; ::: .._ .> .. one and fax number: The Commonwealth of Massa chu t:o setts f Industz�a1 Accidents - Office QfInvestigations: . 600 Washin gton Street - . - Boston, MA 02111 l :TeL 1577- R #'617-727-4900 ext�06 or =evised.4-24-07SS E Fax 617-727-7749 , . -'' N... � ✓1LG VQ7J"UIYEO�JL[l1P2LL� ��/(/(,CjdQ�Lll4G000 e Board of Building Regulations and Standards Construction Supervisor License License: CS 58443 ' Expiration 1*110/2009 Tr# 9949 r :Restribtsbn Q' KENNETH P DUVAL PO BOX 190/72 NORTH ST ' :�7 - q N READING,MA 01864 "" Commissioner 3 ,fes T� Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Board of Building Regulations and Standards Registration: 109288 One Ashburton Place Rm 1301 Expiration :g/g/2010 Tr# 273490 Boston,Ma.02108 F ._ -7ype DBA r DUVAL ROOFING Kenneth Duval t 72 NORTH ST N. READING,MA 01864" Administrator Not valid without signature Page No. of Pages tt Builders License # 58443 � Home Construction Reg. # 109288 - -�A 2GGU'fl'M_ mo (781)944-1994 (978)664-2557 "The Areas Oldest Roofing Company" P.O. Box 637, North Reading, MA 01864 PROPO SUB E TO STREET © (!��n CI r I JOB NAME CITY,STATE AND ZI C DE I J05 LOCATION ,+ A r r We hereb submit specifications and estimates for: Recommended Optional 1r � PV rljlj ,� (Included in price) (Not included in price) Rip& Remove all shingle debris from roof&job ite: U' 1 layer ❑2 layers ❑3 layers or more Repair/or Replace any roof decking; not to exceed 50sq.ft. (additional at$1.7g.Kr ft.) Install 8"aluminum drip-edge/and rake edge along entire perimeter. Choicemill ite or brown Install ICE&WATER underlayment along horizontal eaves,valleys, sidewallss y- , lights and chimneys Install premium base sheet underlayment between roof deck and roofing shingles Install 30yr CertainTeed/GAF/Tamko or IKO architectural roof shingles ❑40 year ❑50 year ❑60 year ❑Lifetime `See manufacturer warranty policy fo"r more details Install new aluminum vent-pipe flange(s) V/ Chimney(s)-counter-flash and re-step existing flashing ❑Cut& Install new lead flashing Ridge-vent/exhaust vent with low profile design, hidden by shingle caps4 b C. of r °(/ V c„�r ❑Soffit-ventilation ❑Roof louver-vents • Seamless style aluminum gu'tte'rs-custom fabricated at job site by our own gutter machine ❑ Downspouts ❑Leaf gutter guards Other t1 P /r i "s 4 C-1(f M 3 i P ci l r ` _�3 C) ,i -Please Note:All items in roof attic should be removed or covered due to falling roof particles, at time of roof tear-off Price includes all items above that are checked only/others may be priced separately upon request. �)` e Prapase hereby to furnish material and labor-complete in accordance with above speci ications,for the sum of: V Total price not including options. dollars �$ J. Payment to be made as follows: / 30%deposit required before ordering materials.Balance due in full upon day of completion. J Please make all payments out to Kenneth Duval, mailed to: P.O. Box 637, No. Reading, MA 01864 _-V Late charges of$50 per week for all outstanding bills due upon day of Authorized completion. Signature -71 -Accepting proposal means agreeing to the terms of the enclosed binder Note:This proposal may be contract.Please sign contract&return top copy(white)with deposit. withdrawn by us if not accepted withindays