HomeMy WebLinkAboutBuilding Permit #48 - 34 EAST WATER STREET 7/21/2008BUILDING PERMIT
TOWN OF NORTH ANDOVER
f� APPLICATION FOR PLAN EXAMINATION
Permit NO: a Date Received
Date Issued:
IMPORTANT: Applicant must complete all items on this pale
LOCATIO
PROPER'
Print
MAP NO: { PARCEL: ZONING DISTRICT: Historic District yes [
Machine Shoo Villaae ves no
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
New Building
One family
Addition
Two or more fat�a ,
Industrial
tion
No. of units:
Commercial
Qi—epair, replacement
Assessory Bldg
Others:
Demolition
Other
Septic Well
Floodplain Wetlands
Watershed District
Water/Sewer
Please Type or Print Clearly)
OWNER: Name:
Address:
CONTRACTOR Name: Phone: 9l ' 9� .
Address: .z.►7 cay
Supervisor's Construction License: CS t�B' 6 Exp. Date: 5�^ 4
Home Improvement License: 7.ZZ Exp. Date: l'
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
-- q.9F.4
FEE SCHEDULE. BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Total Project Cost: $ /Ji 5Z> FEE: $
1
Check No.: �2-3 3 Receipt No.: � � �'I O
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Signature of Agent/Owne� r Signature of contract(r!/r C
Location
Lam-
No.
Date
HORT#, TOWN OF NORTH ANDOVER
� OL
2
Certificate of Occupancy $
cMu
�� BuildinglFrame Permit Fee $
s�s
Foundation Permit Fee $ to
Other Permit Fee $
TOTAL $
Check # dd— �') 72
2 J 40 Building Inspector
Plans Submitted Plans Waived Certified Plot Plan Stamped Plans
TYPE OF SEWERAGE DISPOSAL
Public Sewer
Tanning/Massage/Body Art
Swimming Pools
Well
Tobacco Sales
Food Packaging/Sales
Private (septic tank, etc.
Permanent Dumpster on Site
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH
COMMENTS
Reviewed on Signature
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision:
Conservation Decision:
Comments
Comments
Water & Sewer Connection/Signature & Date Driveway Permit
DPW Town Engineer: Signature:
Locatea J64 USgood Street
FIRE DEPARTMENT - Temp Dumpster on site yes no
Located at 124 Main Street
Fire Department signature/date
CO
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
❑ Notified for pickup - Date
Doc.Building Permit Revised 2008
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
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
OTE: 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
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
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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: i . G114,A�s -,- Si-. 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
I OA:
The debris will be disposed of in:
(Location 6f Facility)
Signature of Perm' Applicant
17 — ';�1 0 8�
Date
Department of Industrial Accidents
OfJIee of Investigations
600 Washington Street
kvi Boston, MA 02111
www, mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Name (Busings/Organiz"on/Individual):
Address:
City/State/Zip:4Z.—I t ��` Phone #: q% � � %� '��`��
. T�
Are you as employer? Check the appy
>�am a employer with Z -
employees (full andlo pi' art.'
2. ❑ I am a sole proprietor or partner.
ship and have no employees
working for me in any capacity.
[No workers' comp. insurance
required.)
3. ❑ 1 am a homeowner doing all work
myself. [No workers' comp,
insurance required.] t
riate box:
4. ❑ 1 am a general contractor and I
have hired the subcontractors
listed on the attached sheet. t
These sub -contractors have
workers' comp, insurance.
S. ❑ We are a corporation and its
officers have exercised their
right of exemption per MOL
c. 152, 31(4), and we have no
employees. [No workers'
comp. insurance required.)
Type of project (required):
6. ❑ New construction
7. ❑ Remodeling
8. ❑ Demolition
9. ❑ Building addition
10.0 Electrical repairs or additions
I LCD Plumbing repairs or additions
12.gRoot repairs
13.C3 Other
'Any applicant that chairs box / 1 must also till out du section below showing tbeir workers' oompeasation policy iatormatba.
' Homeowun who submit this atthdavit Mlcadag shy aw going all work nae thea hire outside soatraaton must submit s arw attldavit IrAkAdag such.
{oayacton dug chap this box must anwlwl as aktditloaal sheet showing the suns of the su"ontnctom aced thek workers' ooakp. Polloy <alb oAdoa.
I ant am employer that is providing workers' compensation insurance for my employees. Below is the polky and Job site
information.
Insurance Company Name: G1i oK
&,
Policy Y or Self -ince, Lic. M: Z "`�-� l C� •mac' '� Expiration Date: ly
Job Site Address:_ Kt; :ata ,t �%rrTu2 0<=�- City/State/zip:.Jez. ,
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Failure to secure coverage u required under Section 25A of MOL c. 152 can lead to the imposition of criminal pwalties of a
fine up to $1,500.00 and/or on*-yeu imprisonment, u 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 DU for insurance coverage verification.
I do hereby cert(& under tkepatns and penalties perjury that the ihformodon provided above is true and correct
Phone k:
Official use only. Do not write In gids ata, to be eomplcitd by city or town ofj'Iclal
City or Town: Permit/Liccnsc M
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 0:
1�
Page No. / of Pages
pxay-asal Supervisor CS 068461
t p
Fully Licensed &Insured Home Construction Reg. # 146722
i( •
=. ; O'Iteetle
Roof In
North Reading, MA
978-276-3043
PROPOSAL SUBMITTEDfO
PHONE '
DATE
STREET/ .� /
��/J"'
JOB NAME
CITY, STATE AND ZIP CODE �../ �.
JOB LOCATION
We hereby submit specifications and estimates for: Recommended
(Included in price)
Optional
(Not included in price)
Rip & Remove all shingle debris from roof & job site: ❑ 1 layer2 layers ❑ 3 layers or more
Repair/or Replace any roof decking; not to exceed 50sq. ft.
Install 8" aluminum drip-edge/and rake -edge along entire perimeter. Choice of mill, white or brown
Install ICE & WATER underlayment along horizontal eaves, valleys, sidewalls and sky -lights & chimneys
Install premium base sheet underlayment between roof deck and roofing shingles ❑ 15 Ib. felt ❑ 30 #. felt
• Install 25yr CertainTeed/GAF/IKO traditional 3 -tab roof shingles ❑ 30 year
Install 30yr CertainTeed/GAF/IKO architectural roof shingles
❑ 40 year ❑ 50 year
❑ Lifetime
* See manufacturer warranty policy for more details
Install new aluminum vent -pipe flange (s)
Chimney (s) -counter-flash and re -step existing flashing
❑ Cut & Install new lead flashing
Ridge-vent/exhaust vent with low profile design, hidden by shingle caps
❑ Soffit -ventilation ❑ Roof louver -vents
• Seamless style aluminum gutters - custom fabricated at job site
❑ downspouts
• Other
01
//
eeV
O'Keefe roofers will properly dispose of all roof debris in our own dump truck.
*Please Note: All items in roof attic should be removed or covered due to falling roof particles, at time of roof tear -off
Price includes all items above that are checked only / others may be priced separately upon request.
We Propose hereby to furnish material and labor - complete in accordance with above specifications, for the sum of:
Total price not including options. dollars ($ ).
Payment to be made as follows:
30% deposit required upon delivery of materials. Balance due in full upon day of completion.
Please make all payments out to Michael O'Keefe, 21 Francis St., No. Reading, MA 01864
Late charges of $50 per week for all outstanding bills due upon day of Authorized -y�/9� /p.1
completion. Signature
- Accepting proposal means agreeing to the terms of the enclosed binder Note: This proposal may be ,e
contract. Please sign contract & return ton rnnv (whitel withdrawn by i is if not nrrontari within c