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Home My WebLink AboutBuilding Permit #348 - 30 EAST WATER STREET 10/21/2011 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION f161- Permit NO: -5 V Date Received Date Issued: i r IMPORTANT: Applicant must coEllete all items on this age LOCATION 3Q wx / Print PROPERTY OWNER �-44J ��('// TT-.t# Print MAP NO: kq,,O PARCEL: ZONING DISTRICT: Historic District yes Machine Shop Village yes no 100 year-old structure yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building 09 ne family ❑Addition Y`Two or more family ❑ Industrial 0 Alteration No. of units: ❑ Commercial Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other U$ P ptFloodplam (] Wetlands r M! Watershedlbistrict U Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: (Identification Please Type or Print Clearly) OWNER: Name:_ �1✓1/ T11ri�,it ( 7P''' �935� Phone: � Address: d -- ---- ---- - CONTRACTOR Name: Phone: Address: 7 J� Supervisors Construction Licenser Exp. Date: Home Improvement License: 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. Total Project Cost: $ -5 3� � ;� 7 FEE: $ Q -- Check No.:-.3Rece �3 (i NOTE: Persons contracting with unregistered contractors do no't have access to the guaran fu d signature of A ent/Ovvner. - Signatiare_of,contracto Location,�30 eFIx— No. Date �`�/� NpRTh TOWN OF NORTH ANDOVER ' p:� .•e :•,tip F w % r Certificate of Occupancy $ s�CMus<�' Building/Frame Permit Fee $ '�- Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # Building Inspector 2478 Plans Submitted F1Plans Waived F1Certified Plot Plan ElStamped Plans El TYPE OF SEWERAGE DISPOSAL Swimming pools I Public Sewer ❑ Tanning/MassageBody Art ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ I I THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED li PLANNING & DEVELOPMENT ❑ ❑ i COMMENTS i CONSERVATION Reviewed on Signature I i COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes r Planning Board Decision: Comments I� Conservation Decision: Comment- 0 Driveway Permit m Water & Sewer Connection/Signature& Date DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT -Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS L Dimension Number of Stories:_Total square feet of floor area, based on Exterior dimensions. I Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or servicedroprequires approval of Electrical Inspector Yes DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— For department use I I ❑ Notified for pickup - Date Doc:.Building Permit Revised 2011 June/mi J 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 ❑ Engineering Affidavits for Engineered products Applicable) N TE: 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 NO"i E: 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 t k e 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: Doc.Building permit Revised 2008mi COMMENTS NORTH ToVM '9 _ 0 No. �p _ _ �o/� i _ I ��al• l � p� o }� dover, IVMass., Y O - LAKE �, T .� COCHICHEWICK RATED PPS\ �� BOARD OF HEALTH Food/Kitchen PER.. M .IT T D Septic System • ( BUILDING INSPECTOR THIS CERTIFIES THAT...........D.*4.0 s 0........fi... Ir .... . M..I........................................... .................... . Foundation has permission to erect........................................ buildings on .........&........ �T.....�/�ii. ............5.. • Rough to be occupied as..........�.. ........... .... ..........Pas ......13. .1 ...... Chimney ' e provided that the person accepting this permit shall in eve respect conform to the terms of the applic tion on file in Final' 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 40 PERMIT EXPIRES IN d MONTHS ELECTRICAL INSPECTOR UN - - LESS CONS 1 R V TS Rough Service BUILD G 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 FIRE-DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE :smoke Det. The Commonwealth ofMassachusetts 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 please Print Leg><bly Name(Business/organization/individual). J Address:_ tip^ City/State/Zip: jC� U e,,l ' Oak Phone#: fJ26 A rean employer?Check the appropriate box: _ a em to er with TyPe of project(required): p y _/• 4. ❑ I am a general contractor and Iloyees(full and/or part-time)•' have hired the sub-contractors6 ❑New construction a sole proprietor or partner- listed on the attached sheaet. t 7• ❑Remodeling and have no employees These sub-contractors have 8. []Demblition king for me in any capacity, workers'comp,insurance.workers' comp.insurance 5. ❑ We are a corporation and its9 ❑Building addition ired.] officers have exercised their 10.❑Electrical repairs or additions a homeowner doing all work right of exemption per MGL 11.❑ lumbingrepairs or additions lf. [No workers'comp. c. 152,§1(4),and we have no ance required.]f 12. Roof repairs q ] employees.[No workers' comp,insurance required.) 13.❑Other *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. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. Iam an employer that is providing workers' information. compensation insurance for my employees. Below is the policy and job site Insurance Company Name: ,�/ � Policy#or Self-ins.Lie.#: (��v�L�kq � � Qj Expiration Date: Job Site Address:_ �J0jgsR/l� J�G/ 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 required uhder 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 nd pena ies o perjury that the information provided above is true and orrect. Si nature: •Q �Q D/ Date: Phone#: �S F/ 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): I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Numbing Inspector 6.Other Contact Person: Phone#• Information and Instructions Massachusetts General Laws chapter 1,52 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 of hire, express or implied,orad.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 apartinents 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 nor 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-contractor(s)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 may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also 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 a workers' 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. . Q✓ity or Town Officials ' Please be sure that the affidavit is complete and printed 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 that must submit multiple permit/licerise applications in any given year,need only submit one affidavit indicating current Policy information(if necessary)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 be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. Anew 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 bum leaves etc.)said person is NOT required to complete this affidavit. 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: The Conumonwealth 0f10'assachusetts Department of Industrial Accidents O.Vice of Investigations 600 Washington Street Boston;MA 02111 Tol.#617-727-4900 ext 406 ox 1.877-MA.SSAFE Revised 5-26-05 Fax#61.7-727.7749 www.mass.gov/dia �. .,. --- DATE_(MM/00/1'1'1'1') -- ILL-- CERTIFICATE OF LIABILITY INSURANCE 5/17/2011 THIS CERTIFICATE IS ISSUED AS A MAFTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.- 11-IIS - — CERTIFICATE DOES NOT AFFIRrAATIVELY OR NEGATIVELY AMEND, EXTEND OR AL-'ER THE COVERAGE ,AFFORDED BY THE POLICIES BELOW. T141S CC-R-IFICAIE 0= INSURANCE DOES NOT CONSTITUTI= A CONTRA.C'r BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, IMPORTANT: If(he 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. Astatement on this certl(icate does not confer rights to the certificate P:olcrer in lieu of such en(lorsement(s). PRODUCER -- :' FIT/TC1-------V------- —'------------ NAME: Circle Business Insurance Agency Inc F'HGNE � r_ FAX (A/C.No,Ex�)78-777_5619 — (A/G,NW 978-777-4898 247 Newbury S t. _. ,sir-- — -- ------— - ------- --- — A.ocREss: Paul51halas@c.il-.Cle;insurance, nE't. Danvers , MA 01923 ------------------ ------ -------- -' - ---------------- INSURER(S) AFFORDING COVERAGE: NAIC 1t 1781639 ----------- -------------- -- ----'-----------.._...._... INSURER A: Satfety_Tn UrF3nCE: Ccs. -------- ----- INSURED Build Tech Inc . INSURER Ef Granite! State In.s . Cc). INSURER C 5 Granite St INSLRER D Methuen, MA. 01844 INSLRER fE 978-682--3503 —__ INSLRER F COVERAGES CERT11=1CATENUNIBER: --- ------REVISION NUMBER: --v--- ------ CBIS IS TO CL=RI IFY IHA.' TAF P01_ICIf=S OF INSURANCE LISTED BELCW HAVE BEEN ISSUED TO Tt1E INSURED NAMED ABOVE [--OR -HE POLICY PERIOD INDICAI ED NO VhlII SI ANDING ANY REOUIRFME=N 1, TERM OR COND:TION OF ANY CONTRACT' OF: OTHER DOCUMENT VVIII-I RESPECT 10 1NI-IICII THIS CERTIFICATE MAY I3L Iti5l)lED CR MAY PERTAIN TIME INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUIiIJECr TD AL_ FINE. u_RMS, I_XCLUSIONS A1,11) CONDITIONS OF SIJ(>I POLICIES. LIMITS SINOWN MA"HAVE= BE-N REDUCED BY PAID CLAIMS, 1YP[QF INSU.9ANCi'_ FrtSLTCS'EFF---P'Of.rQYEXfT-- -----"-"------------------'----------'-' LTR_.-__._-_________.-_.-_.-_____.__.___-___ INSR POLICY(NUMBER (MM/DD/`"{YV) (PAM/OC/YYYY) iJMIT6 GI=NERAL LIAra LITv -_—_-____---___--____-___._-.._.___-__--_-_-_.__._-__._._._-_.__._- -- EACH OCCURRENCI'- t, 1 000 000 X COMMERCIAL GENERAL LIA1711.7l -FYAMAGE?T0-RENTED----`"-------r-------r------�1-- PREMISE'S(Ea occurrenr:o) J 1.0 o o V CI lUMS-MADE X OCCUR MED EX'(Any one person) a -- - I--I _ 10 '_00.0 PERSONAL&ADV INJUFY '_--1 , 000 000 -, GENERAL AOGREc-,\7T v,. 2 ,000,000 --- '— ------ ------ -------.... L, N( A(;i;r.E_nTr unnlrAr-Putar-=R PRODUCTS -COMPIXAGG s 2 X000 , 000 --- --=-- - ---— - -.__.. r-OLICY � I IEC]-- I Oc �. l-_.�I._----- -- -- - ------ --- -------- ------------ _ •;;>uioMonn.E I_InniLlr'rNYA1 - -- - (Ea accirlenl) Al-L.0 HO BODILY INJURY(Pe'person) e __- -. f AI.�.OvVIJEI\ SCI-I f_DULEH AUTOS AUTQ)5 HODILYINJURY (Pe occldenl) NON{I'NPIED -_ I-IIRF-D Al-110S -- AUT03 I P.MIC------------- (Per ccdo"t) UMHRELLA IIr03 OCJUR 'ACI-I (JCCIIRReN(;i3 EXCESS LIAR CLnIMS PvinDE AGGIRL=GA'rE 5 ........... vvorl<r_rs -- W('S IMA I P IIL1 EMPLOYE-:R2;L.AB!LrrY YIN _ TORY LIfJ�ITS _ - - __r-4:- - — ------ib'b __. nrar F'Rorlal:x;nll>nual:r,!exe:.lnve N/A i:.L.f_nCI I ACCIDENT y .L 000 Ung B GFFICER/,>,I[n1I'Ffi LXl'.LIIDE O'. I N� 11 yos,descl'Io andNil11 WC 00250:489 3/25/:113/25/12 E.L.DISf_Asf_-LA EMP-LO)I-:E :; 1 , 000, 000 II yes,rlescriba antler DE>CRIPTHIN OF OPERATIONS ..__ bnloL_.D-IS_I_=A._i-E_P_l-J_1__L.I._I_._ 1 , 000 , 000_._._._ ._-_________- ------------ .. ULSCRIPrIUN Or .. , .---.,-.-101.nr6:IilinalRl Re.-rna-rks S_-c_P._e.r_lu..le_,il_n-,n_n_a_spa_c-e_is req.iired) CfERIIFICATE HOLI.:)I`R------- ---------- CAfJCELLATIONl ----— ------- ---------- SHOULD ANY OF IIIE ABOVE DESCRIBIFO POLICIES 13E CANCELLU B[EORE THE EXPIRATION DATE THEREOF, NO-1 ICL= WILL BE DEUVFR[:D IN L�ladte �aC�I4� ACCORDANCE Wllll II IE PCLICY PITOVACCORDANCE 13 g 0 ,) s o}�a t�StC('e ------------------- — ------ t � r a r4 Pe n edkb g t - �--�------., ;;1t� f7 Al1ThIORILED R=PRESENTA'-PI L +v5r f �a 1 sF M6 North Anno�ie,rz;N - 11 Co 1968-2010 ACORD CORIDORATION.All right:, rnsowecl. ACORD225(20 1 O/C5) The ACORD na'ne and logo are register ed rnarks of ACORD Buildtech,inc. 5 Granite ST,Methuen,MA 01844 978-375-3967;Fax:978-682-3453 buildtechl @verizon.net www.buildtechl.com Page No. 1 of 1 Pages aNOP06A16UB TEO TO PNONE DATE Dean & Mona Thornhill 10/19/2011 6TNEET JOB NAME 30 East water Strip rear of main house with t Re-shingles roof at rear of house. CT',6TATE AMO VP COOE JOB LOCATION North Andover, MA 01845 Same AMCMRECT GATE OF"6 ___E Strip roof and dispose. Re-nail all roof surfaces. In.stall onelayer at bottom edge of Grace Ice and water shield. - °roJ�o�o^d i^tea" 36 Of iee arld water shield over drip edge Install ice and water shield around skylite. Provide and install new Tamko Heritage arch shingles 30 years color Rustic Slate. Remove siding at one chike wall to install ice and water shield at lease 16" high, then re-install siding. Remove-eme-Zoarse on Vinyle entry and install flashingco r white, re-install Rrnvide and install one new pipeflange for 2"119 pur Provide and install new cobra vent at ridge top. rice include: Labor , materials, permi , debris disposal tee. We A9ropoor hereby to furnish material and labor-complete in accordance with.above specifications, for the sum of: dollars($ 3360.27 Payment to be made as - follows: Mab:TMi,OAV,„I mY G 10 vmd.xw by u.w re1,«w,a..m� d ZIcseptance of Vropo"I UME OATE OFACDEPLAMCE_ BpNATUBE w 10 f-Zolll