The URL can be used to link to this page

Home My WebLink AboutBuilding Permit #552-14 - 287 FOREST STREET 1/15/2014 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION 2 \ Date Received Permit N0: Date Issued: k,5 IMPORTANT: Applicant must complete all items on this page LOCATION Pint. PROPERTY OWNER1'��c.�_-1 d- .� ��'� ... .f Pnnt 100 Year 01d Structure yes no MAP NO: L&2fARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no .TYPE OF IMPROVEMENT. PROPOSED USE Non- Residential 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 E Wetlands ❑ Watershed District ❑Water/Sewer ESCRI TION OF WO TO BE PE ORD: Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: FO NTRACTOR Name: Phone: jj�. �d/r_ Address: - f [% Exp. Date: LHomevlimplrovement 's Construction License:, License: 2— _ 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. 1 Total Project Cost: $ FEE: $ 1 (Sr Check No.: t� Receipt No.: x 0 NOTE: Persons contracting t u egistered ntract rs do not have access t guar fun Signafure of Agenti w0 he i ��ature of:contrac Plans S ❑ Plan aiv d ❑ Certified Plot Plan ❑ mped Plans ❑ Locatio �'S I `2 PSS ' No. (L} Date . - TOWN OF NORTH ANDOVER � o 7646. � 0 Certificate of Occupancy $ Building/Frame Permit Fee $ Ok Foundation Permit Fee $ Other Permit Fee $�_ TOTAL $ Check# 2 ,11 ® Building Inspector -Plans Submitted ❑ ' Plans Waived-0 -Certified Plot Plan ❑ Stamped Plans ❑ TYPE_OF-SEWERAGEDiSPDSAL Public Sewer ❑. Tanning/MassageBodyArt ❑--- Swimming Pools ❑ Well ❑ Tobacco-Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc... ❑ -_ - PermaneiA 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 . CU Planning Board Decision: Comments Conservation Decision: Comments Wates' & Sewer ConnectioniSignature& Date Driveway Permit DPW Tow;! Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMf NT_!'Temp Dumpster onsite yes no L.*FAoic.r•aete"Dd1 ea.wt.p:,1/la12TrJ4"t{ti/m^M,..Aafir�,.tS?streigent,a e' Zytu'r2��``�.+;_r`�it '`1i,.w At }i., '`.Iw' 3�y-,..e N. .L •,.s�*.n.aLT aSW- . +j,`t�'tiA,4- -.i- -rS% +•'.v f +.':,`t' COMM`; :.'. -..s y.[4.�-..a'^yf4 .iii .4#'a 4.yX�t'{.3� `".;r,�xtl.lr�r+.• �r,.. .�i .•. • .•1.., ti '4.. G. ,.., �, ENTS . ., .Fs . ..,. , ,r - ►. � ;� i �.. k Dimensloii 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-$1000fine NOTES and DATA — (For department use ® Notified for pickup - Date E Doe.Building Permit Revised 2010 +I Building Department The fol?wang is a list of the required forms to be filled out-for the appropriate permit to'be obtained. Roofivg, Siding, Interior Rehabilitation Permits ❑` 13.6ilding Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And 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 a 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) o 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 apt),al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm-tted with the building application Doc: Doc.Builj.ing Permit Revised 2012 . I I y The Commonwealth of Massachusetts Department o - De artIndustrialAccidents P .f . Office of Investigations 600 Washington Street Boston,MA.02111 Uf www.mass.gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le •bl Name(Business/Organizationftdividual): !3Ze L Address: P,� City/State/Zip: ti hone#• 23—� sS—'Z. . Are you an employer?Check th, appropriate box: Type of project(required): 1.V1 I am a employer with 4. ❑ I am a general contractor and 1 6..❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.El am a sole proprietor or partner- listed on the attached sheet. �• ❑Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working :forme in any capacity, workers'comp.insurance. 9. ❑Building addition [No workers'comp.insurance 5. ❑ We area corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ 1 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, o repairs . insurance re required.] employees.[No workers' q ] 1311 Other comp.insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. i-Homeowners who submit this affidavit indicating they 2te doing all work and then hire outside contractors must submit a new affidavit indicating such. TContractors 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 thepolicy and job site information. Insurance Company Name% Policy#or Self-ins.Lic.#: � Expiration Date: l l Job Site Address: �U S City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of o.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. fdozzerebycertryy, in r tl pains a e altie oFperjury that the information provided abovl is true nd correct. Signature: Date: l Phone#• / �F 2�� ( 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 ofhire,• express orimplied,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 or 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-contractors)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 maybe submitted to the Department of Industrial Accidents for confirmation of insurance coverage. AIso 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 aworkers' 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 pxinted 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 thatmust submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(ifnecessary)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 e provided rovided 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. 16 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: Tho Con aonwealth,ofM-assachvsPtts - Department ofIndustdal Accidents Offiee o£fuvestigaMns 600 Washbgtoa St7roet Boston MA 02111 TO,#617-7-27-4900 at 406 ox 1-877-MASSAFB Revised 5-26-05 Fax#617-727-7749 wwwaaago•vma t%O R TII Town t _ AndeveT . p �l c� No. 6a — - 5� zh ver, Mass o LAK II COC MICKl WICK �1, AERATE D 0' S U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT I VL(� I q� h �.... .... BUILDING INSPECTOR has permission to erect ...... buildings on f2sw. fts.". .ar �,-............. Foundation .................... .... .... ....... • � Rough g tobe occupied as ................ .. ............: W...004.... a ...................................................... Chimney provided that the person acceptin this permit shall in every respect c orm to the terms of the application Final on file in 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 MONT S ELECTRICAL INSPECTOR UNLESS CONSTRUC N T TS Rough Service ........... ...... ..................................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building 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. Smoke Det. SEE REVERSE SIDE Town of AnaoveT No. 6a . e 5 _ _ i h ver, Mass ' O "K � COCNIC"EMCK � �d AORATED I,*' s V BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT Vn . . ..... .................................................. BUILDING INSPECTOR has permission to erect ...... buildings on Foundation ....�. ..... .. . ............ ....... . Rough to be occupied as ................%V4.0 (W....!! 00 ...................................................... Chimney provided that the person acceptin this permit shall in every respect c orm to the terms of the application Final on file in 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final l PERMIT EXPIRES IN 6 M NNT S ELECTRICAL INSPECTOR UNLESS CONSTRUC N T TS Rough Service ........... ...... ..................................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building 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. Smoke Det. SEE REVERSE SIDE WOOSTER ROOFING PROPOSAL ALL TYPES OF ROOFS DATE: 1/13114 &ROOF RELATED SERVICES Always Hand Nailed �Y M License Numbers: Charlie and Steve Wooster Construction Supervisors 54268 One - at - M 1-888 ROOFIN-1(766-3461) Home Improvement Contractor Main:978 251-7181 Registration 100712 Serving MA&NH since 1984 Fag:978 251-0159 Call For Our References Proposal Submitted To Work To Be Performed At Name Paul&Sheri Marnoto Name Company Name Company Name Street 287 Forest St. Street City No.Andover Stated Zip Code 01845 City State Zip Code Home# 978 258-8175 Mobile#978 973-8586aul.mamoto k1 ates.com Sherimarnoto@comcast.net We hereby propose to furnish the materials and perform the labor necessary for the completion of the following job. Strip the entire roof to the roof deck excluding rear of right side addition. I. Renail any loose decking and replace any rotted at$2,00 per foot. 2. Install 8"mill finish aluminum dripedge. 3. Install 6' of Grace Ice and Water Shield on all eaves. 4. Paper remainder of roof with Grace Tri-Flex roofing underlayment. 5. Install Certainteed Landmark Lifetime Charcoal black shingles,hand nailed. 6. Install new vent pipe flange. 7. Install Shinglevent I1 ridge vent. 8. Clean and dispose of all debris. Workmanship guaranteed for 10 years. We are fully insured with workers'compensation as well as liability insurance. Please return copy of proposal-.- All roposal-All material is guaranteed to be as specified,and the above work to be performed in accordance with the specifications submitted.All work will be completed in a substantial workmanlike manner for the sum of Dollars($9,850.00), with payments to be made as follows:Job paid upon completion. Respectfully submitted_SfgA/L e w E. wov: �r Note-This proposal may be withdrawn by us if not accepted within 30 days. ACCEPTANCE OF PROPOSAL The above prices,specifications and conditions are satisfactory and are hereby accepted.You are authorized to do the work as specified. rPayment will be made as outlined above. Date �( � `1��3 Signature , � Mailina Address: P.O_ Box 8051 -Lowe!. M 1853 Location: 525 Woburn Street-Tewksbury. MA 01876 CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 10121/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY 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(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER, IMPORTANT: if the certificate holder is an ADDITIONAL INSURED,the policy(les)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 certificate holder In lieu of such endorsement(s). '0C1 Ger PRODUCER NAME: McSweeney& Ricci Insurance PHONE _ -8 00 A/c No: $ 843-8807 420 Washington Street E-MAIL P.O.Box 850984 ADDRESS: 'ri c�n�r�enevricci.com Braintree MA 02185 INSURER(SS)AFFORDING COVERAGE NA_IC8 INSURERA:A adla Insurance Company 1325 INSURED WOOST-1 iNSURERB:Star In, ranceCorripay Charles J Wooster dba Wooster INSURER C: Roofing INSURER D: PO Box 8051 Lowell MA 01853 INSURER E: „ . INSURERF: COVERAGES CERTIFICATE.NUMBER:12552gg �J .. 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 AEFORD50 BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE$EEN REDUCED BY PAID CLAIMS. INSRADDL SX OUCYEFF POLICYEXP LTR TYPEOFINSUNANCE S POUCYNUM8 R. MMIDDIYYYY MIDDIYYY LIMITS A GENERAL LIABILITY PA0083583 0/17/2013 0/17/2014 EACHOCCURRENCE $1,000,000 DAMAGE 10 BENI Eff- X COMMERCIAL GENERAL LIABILITY PREMISES ammaence $250,000 CLAIMS-MADE X]OCCUR MED EXP(Any one person) $5,000 _ PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GENt AGGREGATE LIMIT APPLIES PER: w PRODUCTS-COMP/OP AGG $2,000,000 fk1i.1�Y X PRO._ LOt $ A AUTONIO8ILE UA8IUTV MAlttl379734 0117/2Di3 0/17/2014 Ea aockbtll) $1,000,000 ___.. ANY AUTO ' , ..; BODILY INJURY(Pet person) $ ' ALL OWNED SCHNW1 ED BODR.Y INJURY(Per accklern) $ ---.-- _ AUTOS AUi135 0W;; it NOtd 0WNErJ 1 t „ PROPERTY DAMAGE . . HIAPOAUTUS x AU"it�5 - ( '+r° PeraecUent $ - • $ ! X UMBRELLA UAI3 X l ;CUh OIJA03ii3U67 i 0/17/2013 10/17/2014 EACH OCCURRENCE $1,000,000 EXC roe LIAB •� - ' � -- ��-, 41A�Atf-enAL4tr I ry�;1 AGGHtGAIt $1,000,000 I t x' 1tNtli 1 0 ` $ E31 /1720130/17/2014 TATTOTH- (gLERSCOMPENSATION WI • I ER AND EMPLOYE{W UA1.011TY 'f i N � •^+ f° ANY PRoPRiETdr{OAtilhiPnr=xt=CiHiVL ++ ` E.L.EACH ACCIDENT $2,000,000 *FPICFR,MEMW..REXCI_UDFb? (d WAj„ti jmandatory in NN) E.L.DISEASE-EA EMPLOYEE $2,000,000 11�yo desrjibe ofder DE3(.RIPT101 OEOPERATIONS l>ekYN - .. E.L.DISEASE-POLICY LIMIT $2,000,000 A prbpetiyPA008'.3583 0/17/2013 0/17/2014 Coht Fg0j3hier)1 DE9130iPTiON OF O40YIONfS t LOCATIONS I VEHICLES (Atiadh ACORD 1111,Addtilori#!Rii tdf)tE§6 dcite it rhore bpace is required) salfljsl� 1 r kI ... �G��l��'�ICAT�. ��C3�1`i....� :+.,..'^�z.�.',�+r.�. --•. ...� ^' ,t�AIrfGEI"LATI�N SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE INE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Sample ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORi2ED neORESENTATIVE Lr •� `'' r a -+ � t r' ' - 81988-2010 ACORD CORPORATION. All rights reserved. 'iL #Irl a{2 If3iti5 PtP(d ` f Acbkb r1bow 6f, it I f6&1 (`Marks of ACORD *� 14 I Office of Consumer Affairs d Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration o p g Registration: 100712 -Type: Supplement Card CHARLES J. WOOSTER ROOFING Expiration: 6/23/2014 STEPHEN WOOSTER 525 WOBURN ST TEWKSBURY, MA 01876 Update Address and return card.Mark reason for change. Address E] Renewal [] Employment ❑ Lost Card S 1 G 2OM-05111 .c- c��2�tz��lz�ecz�� _ - Z Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 021.16 Home Improvement Contractor Registration Registration: 100712 Type: DBA Expiration: 6/2312014 Tr# 227218 CHARLES J. WOOSTER ROOFING Charles Wooster -- -- P.O. BOX 8051 -- LOWELL, MA 01853 Update Address and return card.Mark reason for change. L Address ❑ Renewal ❑ Employment n Lost Card S1_ J/ idas^tSssai;lt@SE zS -Deper -men.: " '': 3i'C Safety Sc3a:C 0`_'R..Hdinq Reg J.atkc-as and Stanciards ;cense: CS-054268 CHARLES J WOOSTER PO BOX 8051 LOWELLMA 0853 ; C0' ,r:1iSSIOn 05/11/2014