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Home My WebLink AboutBuilding Permit #242 - 30 HEATH ROAD 9/29/2006 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION p� IUILD q At�ati ,+ p A Pennit NO: ! Date Received IVA% z .^ � o e � 4p�gATE Date Issued: 2�l - 9SSACHU`-+�� IMPORTANT: Applicant must complete all items on this page LOCATION 30 d1 A Road mt /J PROPERTY OWNER �1�1/ �� cl1'19 2 w �J� -17 Gll Print MAP NO.: 0,4 PARCEL: ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non-Residential ❑New Building ❑One family ❑Addition ❑Two or more family ❑ Industrial ❑ teration No. of units: Et, Repair, replacement ❑Assessory Bldg ❑ Commercial ❑ Demolition ❑Moving(relocation) ❑ Other ❑ Others: ❑ Foundation only DESCRIPTION OF WORK fTO BE PREFORMED Identification Please Type or Print Clearly) '/ OWNER: Name: / k i WLi'1C��YY1C'!1" /43^h di- Phone: Address: 3 C>�9`� �a/,� 1�lt A de) vee CONTRACTOR Name: If'10 17 C, Phone: iW 71a Address: el D Pc>A 9- 31& Z6f 0 1,) >A �V a Supervisor's Construction License: 0 � 70 Exp. Date: 0//__50 'Z00 7 Home Improvement License: /001, 53—/ Exp. Date: O 7%%o 0 ARCHITECT/ENGINEER Name: Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$11.00 PER$1000.00 OF THE TOTAL ESTIMATED COST B ON$115.00 PER S.F. Total Project CostS�do0D x12.00=FEE:$ ' Check No.: �� r Receipt No.: Page I of 4 TYPE OF SEWERAGE DISPOSAL Tanning/Massage/Body Art ❑ Swimming Pools U Public Sewer ❑ Tobacco Sales ❑ Food Packaging./Sales ❑ Well ❑ Permanent Dumpster on Site ❑ Private(septic tank,etc. ❑ Electric Meter location to project NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/OwnerSignature of contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF-U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ ❑Water Shed Special Permit ❑ Site Plan Special Permit ❑ Other COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS Zoning Board of Appeals: Variance,Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Continents Water& Sewer connection/Si n ture&Date Drivewav Permit / Temp Dumpster on site yes no_ Fire Department signature/date Building Setback(ft.) Front Yard Side Yard Rear Yard Required Provided Required Provides Required Provided Dimension Number of Stories: Total square feet of floor area,based on Exterior dimensions. Total land area,sq. ft.: NOTES and DATA—(For department use) Page 3 of'4 Doc:INSPECTIONAL SERVICES DEPARTME-NT:BPFORM05 C're:ued.IMC..lan_'000 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 Addition Or Decks ❑ Building Permit Application ❑ 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) 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 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:BPPORM05 Pape 4#)f4 Location-40 Xlra,!t� No. �/z Date -E TOWN OF NORTH ANDOVER • ; ; Certificate of Occupancy $ Building/Frame Permit Fee $ Y'9 s�CHus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 7=3� 19630 Auilding Inspector F NpRT1y Town of over 0 No. Zi - - 1 _- dover, Mass., i 9 O = LAKE 1 COC NIC ME WICK �oRATED PPG �5 vv 4 BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System N� BUILDING INSPECTOR THIS CERTIFIES THAT...` .... ................ ..................Anfio.. ................ ...:. . .. Foundation has permission to erect........................................ buildings on ... .. . /1 ................................. Rough • to be occupied as.................... Chimney ..../..l ,�. . .thev--e--4jre _frt .. ................................................ provided that the persona pting thisRfflfrshall c-. t� rms of the application 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 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCT*..' TARTS Rough 00e..... . .. Service ... . .. .. ... BUILDING 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 of Massachusetts � nH13W ��^+ b4810`dW N3 Department of Fire Services 'iR)NVO'dOW sL ja)WAA PEO Office of the State Fire Marshal ' iNlt N6S'8 13�30M�BVO P.O.Bos 1025 State Road,Stow,MA 01775 `. North Andover PERMIT 1Date: lFi§Lp�� io ldX3 Permit NO uol7eJlslBa2! (City of Town) .% In accordance with the provisions of A G.L.1 4 8 Chap.ter�_as provided in section-522--CMR 3 4 0(If Applicable) Dig Safe Num er 12 d W 13 W OH This Permit is granted to: A �� Start Date / awling)o paeog Full nameof person,Firm or Corporation Permissionto locate dumpster for construction/renovation/demolition of building Comments: dumpster must be Restrictions: . 25 ' from structure if unable to Place with re uired clearance dumpster must be covered with I wood or tar end of at !� l work -day (Give location by street and no.,or describe in such manner as to ovied adequate identification of location) ! Fee Paid$ 50.00 1 f V8L0 HW 'N3f1H13W This Permit will expire , Fire Chief 96Cz X08 Od (Signature of offical granting permit) Offical granting permit13>i30M M'121V0 (Title) saga • ;ep43a!9 agwnN ` I asueo!l SN011.`d1nQ—:21-JN!dllflff k`d�v� ACORD CERTIFICATE OF LIABILITY INSURANCE 7%28%2006 'RODUCER (603)293-2791 FAX (603)293-7188 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 9 & S Insurance Services LLC HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 21 Meadowbrook Lane ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P 0 Box 7425 3ilford NH 03247-7425 INSURERS AFFORDING COVERAGE NAIC# NSURED INSURERA Western World Insurance Carl Woekel 6 Son, Inc. INSURER B 18 Woekel Circle INSURER INSURER 0 Pelham NH 03076-2846 INSURER 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 D'L POLICY EFFECTIVE POUCY EXPIRATION UNITS LTR NSR TYPE OF INSURANCE POLICY HUMBER DATE(M MIDDIYY) DATE(MMIDDIYY) GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE ( RENTED S 50,000 PREMISESS RENTrre++ce A CLAIMS MADE aOCCUR NPP94D500 41('2006 4/1/2007 MED EXP Ony one S 5,000 PERSONAL 8 ADV INJURY S 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATELIMITAPPLIESPER PRODUCTS-COMPIOPAGG $ 1,000,000 X POLICY JECOT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S (Ea acc4em) ANY AUTO ALL OWNED AUTOS 9001LY INJURY S (Per person) SCHEDULED AUTOS HIRED AUTOS BODILY INJURY S (Par acdident) NON•04N1ED AUTOS PROPERTY DAMAGE S (Per accident) GARAGELIABIUTY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC S 0 AUTO ONLY AGG 5 EXCESSIUMBRELLA LIABILITY EACH OC URREN E S OCCUR CLAIMS MADE AGGREGATE S S DEDUCTIBLE $ RETENTION 5 $ $ WORKERS COMPENSATION AND TO Y Ll,. S ER EMPLOYERS'LIABILITY E L.EACH ACCIDENT ANY PROPRIETORIPARTNERrrr-XECUTTVE S OFFICER/MEMBER EXCLUDED? E L DISEASE•EA EMPLOYEE S If yes,desu,be under SPECIAL PROVISIONS below E.L DISEASE-POLICY LIMIT S OTHER DESCRIPTION OF OPERAnONSILOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE File Copy EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENT 1 8 OR REPRESENfATWES, AUTHO!mm rs_rv�_ i ACORD 25{2001108) m ORD CORPORATION 1988 INS025 miom n6 AMS VMP Mortnage Solulcns,Inc,(8 00)32 7-0545 Pepe I of 2 Mai 02 06 08: 55a John Horan (603) 329-6209 p. l 05/02/2006 08;51 FAX 6036656004 OSI NEW ENGLAND tQ003 Clivntd:19227 JOHN RA A C ORD, DATE IIAMmaYYTh CERTIFICATE U>r LIABILITY INSURANCE os10,106 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION USI Now England ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR PO Box 15360 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Manchester, NH 03108.6360 603 625-1100 INSURERS AFFORDING COV9RAGE NAIC 0 INSURED INauaR A: Hartford Insurance Company 29424 John Horan Construction LLC INSURCk0: Eaztguard Insurance Company 14702 21 EVERGREEN DR INSURER C: Hampstead,NH 03841 IN5VRERv, 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 OT14ER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED By T}I@ POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.EXCLUSIONS AND CONDITIONS OF SUCH POLICICS.AGGREGATE LIMITS SHOWN MAY HAVE SEEN REDUCED BY PAID CLAIMS. LTR NLR TYPE OF INsuRANtCE rouGY NUMBER A r LUDO P T LIM178 A GENERAL LIABILITY 04SBAGO8654 04101106 04/01107 EACHOCCURRENCE $1,000,000 ppA, NYE° COMMERCIAL GENERAL L1A81UTY PR DQ STO"aS30D000 c CLANS MADE FX OCCUR MED EXP OM M1) SIO OOO PERSONAL A ADV INJURY S1 000 000 GENERAL AGO4(0A'N s2,000,000 GEN%AGGRiGAYE LIMIT APPLIES PER: PRODUCTS•COMPgP AGC s2,000,000 POLICY[71 jIRIIT LOC A A00MOOILELIABILITY 04UECTU4440 12/30/05 12/30106 COMBINED>rNGLeLIMNT X ANY AUTO (EA&c6dsNI =500,000 ALL OWNCO ALICA BOORY WJURY SCHEDULED AUTOS X HIRED AUTOS BODILY IWURY T X NON-OWNED AUTOS (wu�anq PROPERTYONdAGE a j Iry Accdcnkl GARAGE LIABILITY AUTO ONLY•EA ACCIDENT 3 ANY AUTO OTHER THAN EA ACC i AUTO ONLY: AGG S rXCBSHUMbAELLA UAStUTY EACs OCCURRENCE S _ OCCUR � M CLAIMS MADE AGGREGATE S OGOUCTIQLE S RETENTION S S B WORNER3COMPENSATIONAND JOWC701908 04107!06 04/01/07 X 5TATy IH• EMPLOYERr LIABILITY ANY PROPRETOIIPARTNERENLECUnVE EI.EACH ACCIDENT $100 D00 OFFICERIMEM9Ek IUCLUU011 EL DIMkABE•EA EMPLOYE E 1100,000 Is, Ilculix waa �C UI PROVLi10N5 E.L.DISEASE.aoLICYIIfwT S500000 OTHER DESCIUPTION OF OnRADO00 N LOCATIONS I VEHICLES I FXCLUNfONS ADDED BY ENDORSEMENT 1 SPECIAL.PROVISIONS CERTIFICATE HOIJSER CANCELLATION SHOULD ANY OF THE ABOVE OCSCRISED POL=rL6 of cANCELLEG SLFORE THE EAPIRATION Carl Woekel$Son Inc. DATE THEREOF,TNS R"LNNG M3URER WILL ENDEAVOR 70 MAIL In� DAYS WRITTEN PO BOX 2316 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO 00 SO$HALL Mothuon,MA D 1844 IMPOSE NOOBLRFAT1ON OR UABILRYOF ANY KIND UPON IKE INSURER.ITS AGENTS OR RDPRILSE14YAYIVEE. AUTHO la'.YD PAPRCSENTATiVi Q ACORD 25(2001109) 1 Of 2 0130946 JMLCA 0 ACORD CORPORATION 1988 Ca Wo,k�f z7 �Of2 �f2c, A Name of Service Since 1897 CONTRACTORS AND BUILDERS P.O. Box 2316 Methuen, Massachusetts 01844 (978) 682-7901 September 20, 2006 Mr. Waldemar Arndt 30 Heath Road North Andover, MA 01845 I Dear Waldi: I am pleased to submit the following price on work as outlined below. Remove 2 layers of asphalt shingles from roof. Renail roof boards. Apply W.R. Grace underlayment along roof edge for 3'-o" and in valleys. Asphalt , 151b felt, on remainder of roof. 5" white aluminum drip edge at edges and along rakes. Shingles to be IKO architectural, 30 year, Harvard slate. Install 2 new exhaust vent caps and 2 roof vents. Remove and install new aluminum white gutters and adding 3 additional down spouts and conductor pipe to existing layout. 2 new Andersen white storm doors with self- storing paneis and screen and brass hardware. Replace oak door sill at entrance, add metal threshold pieces to 2 doors. New weather strip to 3 doors. Total Price-----$16,580.00 Debris will be picked up and disposed by dumpster. Very truly yours, Carl Woekel �l \ The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street 1.,; •i , :6= .` Boston, MA 02.111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): �C" �^ ��k�, qts Soy( Zn C, Address: / ` 0° b,)cC 2 3 e Z7� V(26 City/State/Zip: QI If 44 Phone #: ?7,P 4�o? c'9, 7110/ Are you an employer?Check the appropriate bo Type of project(required): 1.El am a employer with 4. ' 1 am a general contractor and 1 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 7. 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 for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its officers have exercised their 10.El Electrical repairs or additions required.] 3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.EJ 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. t 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. am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic.#: Expiration Date: Job Site Address: 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 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 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. do hereby certify under the pains and penalties o1perjarJthat the information provided above is true and correct. Signature: Date: CIAA q/2G Phone#: 97d P__7q0 / Official use only. Do not write in this area,to be completed by city or town of ficial. 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#: