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HomeMy WebLinkAboutBuilding Permit #394 - 295 FOREST STREET 11/4/2011 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: Date Received Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION �� r � Print PROPERTY OWNER Fl-(•( CCi Unit# Print MAP NO ,�rARCEL:�ZONING DISTRICT: Historic District yes no Machine Shop Village ye no 100 year-old structure ye 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 _ VS - �® ell �' '®Food 'lain '®�?Jetlands 0 VWaters; �d +istridt ' R SS r� p �Water/Sewers ¢„ DESCRIPTION OF WORK TO BE PERFORMED: 0 It-e- aoa42 j� �dentificatio Please Type or Print Clearly) OWNER: Name: < �ct Phone: Address: CONTRACTOR Name: t 116Phone: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ! ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST B SED ON$925.00 PER S.F. Total Project Cost: —FEE: Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to th ra I _-ignature ofAgent%Owner ,__,. :, ° . _ *'=Sign_atureoficont�actort. _ Location No. Date kv-11 NORTH TOWN OF NORTH ANDOVER F? •. . ow s Certificate of Occupancy $ ti CMUs Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 24769 Building Inspector Plans Submitted ❑ Certified Plot Plan ❑ Stamped Plans ❑ Plans Waived ❑ C p TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/MassageBody Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ i THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature I COMMENTS HEALTH Reviewed on Signature COMMENTS 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 Dumpster on site yes no Located at 124 Main Street Fire Department i p s gnature/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.$10041000 fine NOTES and DATA— For department use I i l ❑ Notified for pickup - Date _J Doc:.Building Permit Revised 2011 June/mi 1 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 o Building Permit Application a Workers Comp Affidavit ❑ Photo Copy of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work o 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 o Certified Surveyed Plot Plan L3 Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) o Engineering Affidavits for Engineered products YOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) o 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 ❑ Mass check Energy Compliance Report o Engineering Affidavits for Engineered products COTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg .Permit a all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals iat the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording lust be submitted with the building application Doc: Doc.Building Permit Revised 2008mi The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information ''ll Please Print Le ibl Name (Business/Organization/Individual): WAS Address: City/State/Zip: S Phone#: �-2�h 7 � Are you an employer?Check the appropriate box: Type of project(required): 1. LIKam a employer with 4. ❑ I am a general contractor and I 6. ❑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.t 7. ❑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.❑Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 1 Roof 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. f 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: \a Policy#or Self-ins.Lic.#: �C/>� _ Expiration Date: Job Site Address: A��dne City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration cute). 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 ami 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 DI r insurance coverage verification. I do hereby certify n th ins and ena ie fperju that the information provided above ' true n correct. Sign re: 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#: NORTH Town of ? Andover, 0 No. o , clover, Mass., COCHICHE WICK �� ADRATED G'P�,S�� S BOARD OF HEALTH s Food/Kitchen .PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT........... .... ...�.�/M!R....... ................. &`......... ...................................................... Foundation has permission to erect........................................ buildings on ....a.... ... .......... ..... ......... Rough to be Occupied as �j�jl.P..�W... Chimney ........ provided that the per, a eptmg this permif shall in every respect confo 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 nspection, 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 THS ELECTRICAL INSPECTOR a UNLESS CONSTRUC N TS 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 Lathing or Dry Wall To Be Done FIR_E-DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner, Street No. SEE REVERSE SIDE Smoke Det. 2011-Nov-03 09:41 AM Wyeth (978) 247-2130 1(2 WOOSTER ROOFING PROPOSAL ALL TYPES OF ROOFS DATE: 10/27/11 &ROOF RELATED SERVICES 0 (� Always Hand Nailed jUl � License Numbers: One Charlie and Steve Wooster Construction Supervisors 54268 - - - 1-888 ROOFIN-1(766-3461) Home Improvement Contractor Main:978 251-7181 Registration 100712 Serving MA&NH since 1984 Fax:978 251-0159 Call For Our References Proposal Submitted To Work To Be Performed At Name Virtliam Fcmicci Name Company Name Company Name Street 295 Forest St. Street City No.Andover Staled -Zip Code 01845 City_ State Zip Code gome#970-Mg-etaU )5j Mobile# 978 247-2351 Wort* Fax# y�57Qper.31 P We hereb LTLose to furnish the materials and perform the labor necessary for the completion of the foil awing job. Strip the entire roof to the roof deck. 1. Renail any.loose decking and replace any rotted at$2.00 per foot. 2. Install 8"white aluminum dripedge. 3. Install 9' of Grace ice and water barrier on all eaves and valleys,running up sidewall under siding. 4. Paper remainder of roof with Grace Tri--Flex roofing underlayment. S. Install Certainteed Landmark Lifetime shingles,hand nailed. 6. Install two vents to receive bathroom exhaust. 7 Install new vent pipe flange. 8. Install Shinglevent 11 ridge vent: 9. Clean and dispose of all debris. OPTION To install new vent pipe flange,install two vents to receive bathroom exhaust and remove satellite dish would be $675.00. Workmanship guaranteed for 10 years.We are.fully insured with workers'compensation as well as liability insurance. Please returiLconv of nranmmni-, submitted.All work will be completed in a.substantial workmanlike manner for the sum of Dollars($11,850.00), with payments to be made as f'l ow :Job paid upon completion. Respectfully submitted 7V A�Yi'I t_'; Note-This ro osal may be wiffidta b us if not C=p ted within 30 da ACCEPTANCE OF PROPOSAL The move prices,specifications and conditions are satisfactory and are hereby accepted.You are authorized to do the work as specified. Paymcntwill be made as outlined above. Date 3 AAAl ZO1.( Signature _j4A4 Mailing Address:-12.0. Box 8051 -Lowell, MA 01853 Location:525 Wobum Street-Tewksbury, MA 01876 E-Wil:I Wooster-Roofin .com Website:www.Wooster-Roofinq.com .:r J67 X e O ice o � onsumer f air and Business egulation 10 Park Plaza - Suite 5170 • Boston Massachusetts 02116 Home Improvement Contractor Registration Reqistration: 100712 Type: Supplement Card Expiration: 6/23/2012 CHARLES J. WOOSTER ROOFING:_ STEPHEN WOOSTER 525 WOBURN ST TEWKSBURY, MA 01876 Update Address and return card.Mark reason for change. Address Renewal F] Employment Lost Card DPS-CA1 ea 50Mr04/04-G101216 a Office of Consumer Affairs andusiness Regulation E_ 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Reqistration: 100712 Type: DBA Expiration: 6/23/2012 Tr# 299388 CHARLES J. WOOSTER ROOFING ._ Charles Wooster P.O. BOX 8051 - LOWELL, MA 01853 Update Address return card.Mark reason for change.e. Address Renewal -Employment E] Lost Card DPS-CA1 is SOM-04/04•GlOI216 a� Massachusetts- Department of Public SJON Board of Building Regmiations and St.tntlarAS Construction supervisor License License: CS 54268 CHARLES J WOOSTER PO BOX 8051 LOWELL, MA 01853 Expiration: 5/11/2012 ('ononissi„ncr Tr#: 28341 WOOST-1 OP ID: DN ACORO" DATE(MMIDDNYYY) �. CERTIFICATE OF LIABILITY INSURANCE 11/02111 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERT151CATE 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(ies)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). CONTACT PRODUCER 781-848-8600 NAME: McSweeney&Ricci Ins Ag Inc PHONE FAX 420 Washington Street 781-843-8807 A/c No Ext): (AC,No): P.O. BOX 850984 F-MAIL Braintree, MA02185 ADDRESS: PMarks mkt INSURERS)AFFORDING COVERAGE NAIC# INSURERA:Acadla Insurance Company 31325 INSURED Charles J Wooster dba Wooster INSURER B:Travelers 18674 Roofing PO Box 8051 INSURERC: Lowell, MA 01853 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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 AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMrrS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUB POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MMIDDNYYY MMIDDNYYY GENERAL LIABILITY - EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY CPA0083583 10/17/11 10/17/12 PREM DAMAGETI ENTED 25O�0O PREMISES Ea occurrence $ CLAIMS-MADE FX_1 OCCUR MED EXP(Anyone person) $ 5,00 PERSONAL&ADV INJURY $ 1,000,00 X Per Project Aggre GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $ 2,000,00 POLICY PE LOC $ AUTOMOBILE LIABILITY COEe aBINEDtSINGLE LIMIT $ 1,000,00 A ANY AUTO MAA0379734 10/17/11 10/17/12 BODILY INJURY(Per person) $ ALL NED OWX SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,00 A EXCESS LIAB CLAIMS-MADE CUA0383967 10/17111 10/17/12 AGGREGATE $ 1,000,00 DED I X I RETENTION$ 0 $ WORKERS COMPENSATION X WC STATU- OTH- AND EMPLOYERS'LIABILITY TORY R B ANY PROPRIETORfPARTNER/EXECUTIVE Y❑ N/A 879P222 UB 10117/11 10/17/12 E.L.EACH ACCIDENT $ 1,000,00 OFFICERIMEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,00 If yes,describe under 1 000 00 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ , , DESCRIPTION OF OPERATIONS/LOCATIONS!VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required) CERTIFICATE HOLDER CANCELLATION EVIDEN1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Evidence Of Coverage ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD