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Home My WebLink AboutBuilding Permit #145 - 29 MAPLE AVENUE 9/10/2001 f I � TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING� PERMIT NUMBER: / �� DATE ISSUED. < SIGNATURE: < <l2 Building Commissioner/I for of Buildings Date SECTION 1-SITE INFORMATION 2 1.1 Property Address: 1.2 Assessors Map and Parcel Number: do /�/// n Ij Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area "1" Fronta e ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required ,Provide R red Provided Required Provided 1.7 Water S M.GL.C.40. 54 1.5. Flood Zone Information: rTPP� Zone Outside Flood Zone ❑ Municipal Sewerage Disposal System: al ❑ Public ❑ Private ❑ p On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record M Gt,n t�e �Ck LA.) 2 CA,�1 civ `Q Name(Print) Address for Service Signature Telephone 2.2 Owner of Record: Name Print Address for Service: C Signature Telephone SECTION 3-CONSTRUCTION SERVICES Q� 3.1 Licensed Construction Supervisor: Not Applicable ❑ a� V l+°` (7 I /.I- Licensed Construction Supervisor: 060 (� �O 0S- blaVPA,�41 SJw u License Number Om OT Address ZW --� Expiration Date Sig6ature Telephone l r 3.2 Registered Home Improvement Contractor Not Applicable ❑ 1� rd—.1 f Company Name /2-ep4 ( ( 2. �d r /��( �E ,� Registration Number Address /7� �1 r Q Expiration Date Signature Telephone SECTION 4-WORKERS COMPENSATION(NLG.L. C 152 § 25c(6) ` Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes.......❑ No.......❑ SECTION 5 Description of Proposed Work check all applicable) New Construction 0 Existing Building 9-*' Repair(s) ❑ Alterations(s) Addition 0 Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: a 00 ` SECTION 6-ESTIMATED CONSTRUCTION COSTS qOV Item Estimated Cost(Dollar)to be < �� OFICIAL>(ISE UNIrY Completed by permit applicant 1. Building (a) Building Permit Fee ®� Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)X (b) 4 Mechanical HVAC 5 Fire Protection t 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUH.DING PERMIT 1, b as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf,in all matters relative to work authorized by this building permit application. Y Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief Print Si at u•e of Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIlVIBERS1 2 3RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHI10NEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE Building Department o� 5.`�_ '. Ya oG 27 Charles Street North Andover, Massachusetts 01845 n (978) 688-9545 Fax (978) 688-9542 �Q Eo SS�1CD-lU'S�'C i DEBRIS DISPOSAL FORM In accordance with the provisio s of MGL c 40 s 54, and.a condition of Building permit # the debris resulting&ani the work shall.be-disposed of in a properly license so id waste disposal facility as defined by11i1GI; ell, sISO sposed a. The debris will be disposed of in/at: Facility location ` Signature of Applicant Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. R, The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 k� Workers'Compensation Insurance Affidavit Please Print Name: 7a Location: cr City / 4-,—,f Phone I U am a homeowner performing all work myself. �I am a sole proprietor and have no one working in any capacity 0 I am an employer providing workers'compensation for my employees working on this job. Company name: i'/y`,swt A t Address City: Phone#: Insurance Co. Policy# (,AoC Z Companv name: Address City: Phone#: Insurance Co. Policy# Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fined($100.00)a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. ` I do herby certify under thp pains arid penalties of peduQry that the information provided above is true and correct. Signature "2 Date Print name Phone# Official use only do not write in this area to be completed by city or town official' ❑ Building Dept ❑Check/f immediate response is required Building Dept ❑ Licensing Board ❑ Selectman's Office Contact person: Phone#: ❑ Health Department ❑ Other FORM WORKMAN'S COMPENSATION Propont Page of ty Free Estimates 105 Haverhill Street Fully Insured Methuen, MA 01844 THOMPSON'S ROOFING (978) 691-1355 Shingles —Slate— Rubber Roof Single Ply— Copper Work PROPOSAL SUBMITTED TO PHONE DATE Marie Daw 1 5- 1_ STREET JOB NAME �� ^� �O 79 Maple Avenue CITY,STATE AND ZIP CODE JOB LOCATION North Andover IMA 0 !_8,115 (l/ 27q— 3100 ARCHITECT DATE OF PLANS JOB PHONE We hereby,submit specifications and estimates for: S--ci p off all roof shingles on entire house non por::hes Renail all loose boards .and i"F any nee:; repl.-�ice;ftent it will cost $3 . 0;) a ft. ( lx8 ) :Install aluminum drip edge ;",round roof 1. ine Apvly ice .end water shield 3 ft . up all _aIonq ec:iges •-inc' in v L--ys Apply 151h. felt paper on rest of roof erea Resh.ingle with a 25 ye�at 3 tab shingle Tnstall new flanaes around soil p .aes Waterproof chimney flashing Cut in a ridge vent on troth pe.ikz Remove all work related debris 25 year wa.rranty on maVtr i:a i L01 yn vr gurantee on labor construction lic. #0601_ 12 intprovemnebt#1286.12 Option: If you decide to have a 25 yer .ir Archi.tf�t.t siainy.l.e it wi. L1 cost: 0650 . 00 more*** CrOpD�e hereby to furnish material and labor—complete in accordance with above specifications,for the sum of: Nine thousand -------------------- dollars($ 2 OO 0 - 22 ) Payment to be made as follows: $3 .000 . 00 sta ct of job S6 , e?i10 . 00 on c.,mpl_ oc� All material is guaranteed to be as specified.All work to be completed in a workmanlike manner according to standard practices.Any alteration or deviation from above specifications involving Authorized extra costs will be executed only upon written orders,and will become an extra charge over and Signature ' /% l above the estimate.All agreements contingent upon strikes,accidents or delays beyond our control. Owner to carry fire,tornado and other necessary insurance. Our workers are fully Note:This proposal may be covered by Workmen's Compensation Insurance. withdrawn by us if not accepted within days. ZUeptance of proposal—The above prices,specifications and conditions are satisfactory and are hereby accepted.You are authorized to do the Signature work as specified.Payment will be made as outlined above. Date of Acceptance: Signature Y r C E R T I F I C A T E OF L I A B I L I T Y I N S U R A N C E DATE 05-01.01 (MM/DD/YY) ` PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER PELHAM INSURANCE SERVICES INC THE COVERAGE AFFORDED BY THE POLICIES BELOW. 122 BRIDGE STREET INSURERS AFFORDING COVERAGE PELHAM NH 03076- INSURER A: Liberty Mutual INSURED INSURER B: The Maryland Thomas Doyle DBA INSURER C: Thompsons Construction & Roofi 8 West St. INSURER D: Salem NH 03079 INSURER E: COVERAGES 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, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR POLICY EFFECTIVE POLICY EXPIRATION LTR ` TYPE OF INSURANCE POLICY NUMBER DATE (MM/DD/YY) DATE (MM/DD/YY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $1,000,000 B [x] COMMERCIAL GENERAL LIABILITY SCP 34865353 04.17-01 04-15-02 FIRE DAMAGE (Any one fire) $ 300,000 C ] [ ] CLAIMS MADE [x] OCCUR MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $1,000,000 [ ] GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG $2,000,000 [ ]POLICY [ ]PROJECT [ ]LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT [ ] ANY AUTO (Each accident) $ [ ] ALL OWNED AUTOS BODILY INJURY [ ] SCHEDULED AUTOS (Per person) $ [ ] HIRED AUTOS BODILY INJURY [ ] NON-OWNED AUTOS (Per accident) $ [ ] PROPERTY DAMAGE [ ] (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ [ ] ANY AUTO OTHER THAN EA ACC $ C ] AUTO ONLY: AGG $ EXCESS LIABILITY EACH OCCURRENCE $ [ ] OCCUR [ ] CLAIMS MADE AGGREGATE $ [ ] DEDUCTIBLE $ [ ] RETENTION $ $ WORKER'S COMPENSATION AND [X] WC STATUTORY [ ] OTHER A EMPLOYER'S LIABILITY WC2-31S-314995-019 04-21-01 04-21-02 E.L. EACH ACCIDENT $ 100,000 A E.L. DISEASE-EA EMPLOYEE $ 100,000 E.L. DISEASE-POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Job: Roofing @ 35 CAMPUS RD, METHUEN CERTIFICATE HOLDER [ ]ADDITIONAL INSURED; INSURED LETTER: CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR LUCY CUTULI TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED 35 CAMPUS ROAD TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR METHUEN MA 01844 REPRESENTATIVES. AU RIZED REPRESENTATIVE (7/97) Page 1 of 2 IAORTH Town of ,..^ Andover No. Jam' x h D _o7ao 0�A Co�H;CIP dover, Mass., ORATE D P*? Cl S H E BOARD OF HEALTH PERMIT T D . Food/Kitchen Septic System '7 �+ B.UILDING INSPECTOR THISCERTIFIES THAT............./�. . ...e..�.4...............A-k/ .. .. ..................................................................... Foundation has permission to erect...L5'�f2....�..�...... buildings on ....0?.9'.....-In ply v .......... Rough .............................. to be occupied as R ,r m O 0 l��S<��/��C 4t- Chimney p' �'�'.... ..................................... ............................................................................... provided that the person accepting this permit shall in every 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 o the Inspection, Alteration and Construction of Buildings in the Town of North Andover. / q PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. / V� Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR Rough ........................................................................................ Service BUILDING INSPECTOR Final Occupancy Permit Required t0 Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. IFSEE REVERSE SIDE Smoke Det. Location I AgPIE P � �- No. Date qw -U NORTIy TOWN OF NORTH ANDOVER Ofi . o ,•'�ti0 3? _ OL ' 9 ` Certificate of Occupancy $ �'�S'••°•E<� Building/Frame Permit Fee $ s�CHus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 4 Check # �f 5 15001 Building Inspector