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HomeMy WebLinkAboutBuilding Permit #445-14 - 291 MASSACHUSETTS AVENUE 11/18/2013 NORTH q BUILDING PERMIT o 0.1C , ti 6 TOWN OF NORTH ANDOVER o � APPLICATION FOR PLAN EXAMINATION Permit NO: �"' Date Received Sys qArm'�t�y gACHU`-+E Date Issued: 1� IMPORTANT: Applicant must complete all items on this page LOCATION a -9-5 5 AyU.. Print PROPERTY OWNER CJ4 K 8 RcJ<M tqN "Print MAI:' NO �J PARCELO .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: 1 Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed Distract Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: Sr2ip (4ND P.Oor Jwyp M/9-" Identification Please Type or Print Clearly) OWNER: Name: ��r-.4< m/o,N Phone: 92,F- ,6-ori k�� Address: all mr�5s ►4 U h'o&-r-H CONTRACTOR Name: JRt4l1)h_: 2K Phone: /1 t /1t0 Address: 5q 10(4 D VdCk' At4/YE o ar ynA Q bra Supervisor's Construction license: 9 / 'Exp. Dater Home Improvement License: a Exp: Date: eARCHITECT/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: $ 7,50j, °—�- FEE: $ 00 l �— Check No.: - Receipt No.: 7 fl .i Il NOTE: Persons contractingwith unre istere ontrractorrs do not have access to a uar rind g g . f igna#ure of Agent/Owner Signature of contractor ; 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 y ❑ Workers Comp Affidavit ❑ Two Sets of BuildingPlans One To Be Returned to Include Sprinkler Plan An ( ) P d 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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL t Public Sewer Tanning/Massage/Body Art Swimming Pk5 , Well Tobacco Sales Food Packaging/Sales Private(septic tank,etc. Permanent Dumpster on Site i C3�rZxF RGY:�=rMG r/Z�ck THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature COMMENTS i HEALTH Reviewed on Signature .,h COMMENTS Zoning Board of Appeals: Variance Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments R Y Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit .DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENTTemp Dumpster on site yes no Y' Located.at 1 24.,Main Street Fire Department signature/date I _ i COMMENTS_ Qtj rZKa. iia F I N6 T7ZU-cam 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 i ❑ Notified for pickup - Date .......__....._._..............._.......................___..................................._.._..--.........................._..___..............._._..._.....................--...._.._..........__..._......_........._........................._................._...__..............._.......__ Doc.Building Permit Revised 2008 Location 2 / No. rAv Date 1 �� • • TOWN OF NORTH ANDOVER Certificate of Occupancy $ .� Building/Frame Permit Fee $ , Foundation Permit Fee $ Other Permit Fee $ TOTAL $ .. Check#. d 27116 Building Inspector � NORTIi E �� 0 Town of ver J_As�l _nNo. T h , it ver, Mass, 2a)3 0 COCMIC"t Wick y1' S U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System 11 i BUILDING INSPECTOR THIS CERTIFIES THAT ............ .l......... !L ..... .has permission to erect ... g 1 � IJ 1/�SL. Foundation ....................... buildin s on .. ......\..... .............. .......................... Rough Q to be occupied as ...."accepting ........ ... . afR. ............................................................... Chimney provided that the persthis permit shall in every respect conform 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 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUM T RTS 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 Date: �10V. JG: � /S l91j, : 80)027/ f-i-/y RALPH J. BURKE A Family Business Since 1941 Roofing - Gutters Rubber Roofing DANIEL M. BURKE RALPH J.BURKE,JR. TELEPHONE 781-245-1110 FULLY INSURED -LICENSED 27 BYRON STREETMAKEFIELD,MA 01880 Estimated price for labor and material to: Remove all roof shingles Replace rotted/broken roof boards up to 100 square feet Re-nail loose boards Install aluminum drip edge 6 feet of ice and water barrier " heavyweight felt paper or CERTAINTEED Synthetic roof underlayment CERTAINTEED LANDMARK ARCHITECTURAL shingles, hand nailed Reflash all vent pipes and chimney Remove all roofing debris from the yard 00 Total cost / Q All workmanship guaranteed twenty years. ' Please remove or cover all items in attic,as dust and roof particles may settle on attic floor. Thank you ACORD� CERTIFICATE OF LIABILITY INSURANCE 11/15/20 3 PRODUCER (781) 245-3954 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Wakefield Insurance A enc Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE g Y r HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P.O.Box 557 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 63 Albion St Wakefield, MA 01880- INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Ralph Burke Roofing INSURERB:Safety Indemnit 27 Byron Street INSURER C:ZURICH INSURER D: Wakefield MA 01880— 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 ADD-LI POLICY EFFECTIVE POLICY EXPIRATION LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE(MM/DD/YY) DATE(MM/DD/YY) LIMITS GENERAL LIABILITY / / / / EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE ( RENTED $ PREMISESS Ea occurrence CLAIMS MADE F—] OCCUR / / / / MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY JECOT LOC AUTOMOBILE LIABILITY / / / / COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ B ALL OWNED AUTOS 1614563 01/01/2013 01/01/2014 BODILY INJURY Ix SCHEDULED AUTOS (Per person) $ 250,000 HIRED AUTOS / / / / BODILY INJURY NON-OWNED AUTOS (Per accident) $ 500,000 / / / / PROPERTY DAMAGE I F (Per accident) $ 100,000 GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ _ ANY AUTO / / / / OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY / / / / EACH OCCURRENCE $ OCCUR FICLAIMSMADE AGGREGATE $ DEDUCTIBLE / / / / $ RETENTION $ $ WORKERS COMPENSATION AND / / / / TORY LIIMITS OER EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBEREXCLUDED? 6ZZUB-1325082-3-09 03/01/2013 03/01/2014 E.L.DISEASE-EA EMPLOYEE$ 100,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Building Department EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 20 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT Town of North Andover FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE RER AGENTS OR REPRESENTATIVES. TH I D EPRESENTATIVE ACORD 25(2001108) ©ACORD CORPORATION 1988 Pae 1 of 2 INS025(oloe).os e b The Commonwealth of Massachusetts d Department of Industrial Accidents a Office of Investigations ,CWF Boston, Mass. 02111 't 5�a4 Workers'Compensation Insurance Affidavit Name Please Print Name: RAI ?� 8a(ZxE �120of'flYl ) Location: 54 F/3 DJoGK �f3N F City JQ a_"r m fa tof R, r'. Phone # 61 t,c/o j// O aI am a homeowner performing all work myself. �j I am a sale proprietor and have no one working in any capacity I am an employer providing workers! co mpensaton for my employees working on this job. Company name: 21410 h /3 Id 2fc i- Roo 7�/ 7�G Address 427 6 UI2 tj 6YaJF_P_ 2y: i sr.use_Fl F I cl- M n_ to I 9?-0 Phone Insurance Co. (Q 2/Q4 l*We fz (°d-?/`/ .1-fvS. Policy# 6 Z 2 U 13" 0/Q,P/y 'S-=/3 Company name: Address Ci#y: 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.civii.pena ties in She form d a.STOP WORK ORDER..and.a fine of.(.$100.00)_a stay against-me. I understand that a copy of this statem t maybe forwarded to the Office of Investigations of the DIA for coverage verification. /do hereby cer4unre rn ' d nalties of perjury that the information provided above is true and correct. Signature _ Date NOV, /� . 6�3 Print name U LK - Phone#L). L 1/0 Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensing O Building Dept ❑Check if immediate response is required 0 licensing Board E] Selectman's Office Contact person: Phone#: ❑ Health Department D Other O ce of Consumer A Eaars aad usimess Reg ila don 10 Park Plaia- Suite 5170 Boston,Massae 02116 Rome�IQVemeIlt or __-- giBtra#i031 R6 ift8ffGn_ -107146 !r.' TYpe: 'DBA Expirafion• 7!2912014 Tri. =890" RALPH J. BURKE ROOFING ;mss Ranh Burke 27n St �� Wakefield, MA 01880 �� lSfj UgdaftAddress aad return card Mark reason for ebange- oFs cw, sox�oamw,o z,6 + Q Address Q Reneerai 0 Employment 0 Last Carta _0Ma fC r"fdm&� Bfm!Rm 0n ~_~—License er reffis[raiion vam fo"ihnuvidal ase an HOME 1MPROVEMEW CONtRACTOR bdomiiampiration data If1hand return#o: Region: 116 Type: Off of Consamer�iis and Business RQgaiat4on cgira . SOM 4Wm&W D8A 10 bwkPh=-So t 517o Boston,MA07- I6 Ralph Stake 27 Bymn St Wak+eiieK MA 0188[1 ved ------------- Suilding, ;—Reguiat'Ons cl, Corl%tri'vtjon Supervim;r Spe-i'lltv Ldense CSSL-099814 RALPH J ate= 54 PADDOCK LANE DRACUT MA OIS26 I S 0-n e r 07103/2015 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 c 11, S 150 A. Also, note Permits are required under Fire Prevention laws Chapter 148 Section 10A. The debris will be disposed of in: (Location of Facility) ` ignature of Permit Applicant NU V; 15- d 13 Date