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Home My WebLink AboutBuilding Permit #130 - 280 SALEM STREET 8/18/2006 ,tORTH Of,��te e'9hA ~ - a TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION 9,TSNCNU`�E< Permit NO: 0 Date Received: Date Issued: IMPORTANT: Applicant must compl"ette.all items on this page LOCATION Print Co PROPERTY OWNER Print MAP NO.:037 -D—PARCEL: ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Reside tial Non-Residential ❑New Building One family ❑Addition ❑Two or more family ❑Industrial ZAI�teration No. of units: ❑Repair, replacement ❑Assessory Bldg ❑Commercial ❑Demolition ❑Moving(relocation) ❑ Other ❑ Others: ❑Foundation only DESCRIPTION OF WORK TO BE PREFORMED Identification Please Type or Print Clearly) - OWNER: Name: ( G�OLZIA43 Phone: 5° Signature �t Address: 0720 & x Y1lo, Ne CONTRACTOR Name�V y Phone: �'? 6(-,Y c SS� Address: '2� G 3 Supervisor's Construction License: /� ,� Exp. I ate: Home Improvement License: Exp. Date: 41,1 ARCHITECT/ENGINEER Name: Phone: Address: Reg.No. FEE SCHEDULE:BULDING PERMIT:$10.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Cost :$ rS Total Project -®B=FEE.$ J 7,50 x18 2 Check No:: .� Receipt No.:/ Z, Page 1 of 4 i TYPE OF SEWARGE DISPOSAL Public Sewer Tanning/Massage/Body Art El Swimming Pools ❑ ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ l h NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund A Signature of Agent/Owner��,y,_ � Signature of Contractor � 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 ❑ ❑ ❑Water Shed Special Permit ❑ Site Plan Special Permit ❑ Other COMMENTS DATE-REJECTED DATE APPROVED s CONSERVATION � � F1 ❑ • COMMENTS I 't DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS Zoning Board of Appeals:Variance,Petition No: 'r Zoning Decision/receipt submitted yes ' Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer connection signature&date Tem Dum ster on site es_noI` P P y ,� Fire Department signature/date r Building Permit Approved and Issued by: Page 2 of 4 Building Setback (ft.) Front Yard Side Yard Rear Yard Required Provided Required Provides Required Provided � � I I DIMENSION E Number of Stories: Total square feet of floor area,based on Exterior dimensions. Total land area, sq. ft.: NOTES and DATA—(For department use i E Page 3 of 4 Doe:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 Created JMC.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 li ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract j ❑ Floor Plan Or Proposed Interior Work a 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 ❑ Workersom C Affidavit p ❑ 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 DEPARTMENTMITORM05 Page 4 of 4 Location 1�" `'`" " S f No. Date 1 o i i MART" TOWN OF NORTH ANDOVER - F p -� Certificate of Occupancy $ Building/Frame Permit Fee $ ACI Foundation Permit Fee $ — Other Permit Fee $ ;�— TOTAL $ �~ _ Check # 4 9372 Building Inspector RUG-17-2006 20:10 FROM: 70:19786899542 P.1 1 Hoard of Building Regulations and Stamiards HOME IM? License or registration valid for ie�dividnl use only ROI-EMENT CONTRACTOR before the expiration date. if found return to: Ragistcation: 109289 Board-of Building Regulations and Standards Expi.'a*on: One Ashburton Place Rm 1301 Type: DBA tiocton,518.02108 DUVAL ROOFING Kenneth Du%-j! 72 NORTH ST N.READING,MA 01e64 Administrator Not valid without sigoature NORTH 0 0 t 4Andover No. 130F: � r Mass. o �A o dove , , COCHICHEWICK I �ADRATED P'Q�y\ -`45 BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT..............CO!!!*... ......................4 ��...5......................................................... Foundation has permission to erect........................................ buildings on ..040....5.04.14i.0......&C.�......................... Rough to be occupied as....... ... .!o.... `,�� Chimney . . ................................................................................... provided that the person accepti this permit shall in eve respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-La elating 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 CONSTRUCT ONSTRU ARTS- Rough Service BUILDING I CTOR 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. •+- �. �L,. y,.<.� r -r:- ..;;a,r..ai>H r„ titt, .,sr”-"'..;tli` ,(�• ,� Y�, t 'A cs� j7 Page No. of Pages r r[5a Builders License # 58443 Home Construction Reg. # 109288 OOU0067, aac� (781) 944-1994 (978) 664.2557 w The Areas Oldest Roofing Company" P.O. Box 637, North Reading, MA 01864 P POSALSUB DTO PHO E F / JOB NAME f CITY,STATE AND IIP CODE ``r, Opt` JOB LOCATION Al",C16 pV We hereby submit specificatins and estimates for: i f Recommended Optional Ftp ,t °�ron' ; 4 fn:jr ( {t /Nf s'tE,< Alot i i &.,,, ncluded in price) (Not included in price) 0" Rip& Remove all shingle debris from roof&job site: ❑ 1 layer ❑2 layers 0�layers or more tf Repair/or Replace any roof decking; not to exceed 50sq.ft. Install 8"aluminum drip-edge/and rake-edge along entire perimeter. Choice of mill,white or brown Install ICE&WATER underlayment along horizontal eaves, valleys, sidewalls and sky-lights&chimneys s Install premium base sheet underlayment between roof deck and roofing shingles iri Install 25yr CertainTeed/GAF/Tamko or Owens&Corning traditional 3-tab roof shingles ❑30 year Install 30yr CertainTeed/GAF/Tamko or Owens&Corning architectural roof shingles L 40 year ❑50 year ❑Lifetime See manufacturer warranty policy for more details Install new aluminum vent-pipe flange(s) • 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 caps ❑Soffit-ventilation ❑ Roof louver-vents • Seamless style aluminum gutters-custom fabricated at job site ❑downspouts t r Other ;c1 t� S l S s ;, t r f c,c. i , cr r rot e { 1 11 �, e"cj X' } r��t1 d r of r c? of a jt +v , 6,V , > *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. »»� Pe Propose hereby to furnish material and labor-complete in accordance with above specifications,for the)sum of: Poo0 Total price not including options. dollars($ Payment to be made as follows: 30%deposit required before ordering materials. Balance due in full upon day of completion. Please make all payments out to Kenneth Duval, mailed to: P.O. Box 637, No. Reading, MA 01864 Late charges of$50 per week for all outstanding bills due upon day of Authorized � completion. Signature f�+r• ; lry -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 within fl days i The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street ' Boston, MA 02111 `« s� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Duval Roofing, LLC PO Box 637 Address: No. Reading, MA 01664 City/State/Zip: Phone#: '79/ 9V*/ / �9' y A;�Iam employer?Check the appropriate box: Type of project(required): 1. a employer with ��-- 4. [1I am a general contractor and I — 6. E]New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. EJ 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.❑Pl repairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no 12. oof repairs insurance required.] t employees. [No workers' 13.❑ Other comp. insurance required.] *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 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:_ /��–C.(�cam f Policy#or Self-ins.Lic. #: y e t-G /4 a b Expiration Date: 3 77 Job Site Address:�� VC�1.JC.J1iYV►. City/State/Zip: AM' a,0-x cul d 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 under the pains and penalties of perjury that the information provided above is true a correct. Si nature: 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#: I I 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 il, S 150 A. Also, note Permits are required under Fire Prevention laws Chapter 148 Section I OA. The debris will be disposed of in: (L cation of Facil' ) Signature of Permit Applicant Fire Department Sign off: Dumpster Permit 9--// 7 Date