HomeMy WebLinkAboutBuilding Permit #199 - 35 WALNUT AVENUE 9/12/2007 TOWN OF NORTH ANDOVER 0A a
APPLICATION FOR PLAN EXAMINATION
Permit N0: Date Received
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Date Issued:
IMPORTANT Applicant must complete all items on this page
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TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building ❑ One family
[I Addition ❑ Two or more family ❑ Industrial
0 Alteration No. of units: Commercial
Repair, replacement ❑ Assessory Bldg ❑` Others:
❑ Demolition 0 Other
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� /� DESCRIPTION OF WORK TO BE PREFORMED:
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entification P e Type or Print Clearly)
OWNER: Name: o n �4 7 C .4 e e Phone: j)
Address �,aVe
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ARCHITECT/ENGINEER e:
Address: <- Reg. No.
FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ �� 00' go FEE:
�/ �'��- Receipt No.: �D
Check No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Sr nature nget/�a�a/tez F9 Signature of�c ca ;
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
i
DATE REJECTED DATE APPROVED
CONSERVATION ❑ .
D
COMMENTS
DATE REJECTED DATE APPROVED
HEALTH ❑ ❑
!.
COMMENTS
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Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Water & Sewer Con nection/S9nature & Date Driveway Permit
Located at 384 Osgood Street
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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
i
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 2007
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
o Workers Comp Affidavit
❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses
❑ Copy of Contract
o 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
❑ Building Permit Application
❑ Certified Surveyed Plot Plan
❑ Workers Comp Affidavit
❑ 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)
❑ Engineering Affidavits for Engineered products
g g
g
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
o 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
o 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 2.2007
Location/5-
No.
ocationsNo. d Date �-12-'
N°^TM TOWN OF NORTH ANDOVER ;
0
9
} ° Certificate of Occupancy $
Building/Frame/Frame Permit Fee $
s,KMusE 9
Foundation Permit Fee $ F
Other Permit Fee $
TOTAL $
Check #15d
05u9
Building Inspector
The Commonwealth of Massachusetts
Department of Industrial Accidents
i
Office of Investigations
600 Washington Street
Boston, MA 02111
s� www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): G a , IlVev •e/', -?,5,
Address: 7?2 /(d 6 4 f 2
City/State/Zip: /,— �p-e o Phone #:
Are you an employer? Check the appropriate box: Type of project(required):
].'VQ I am a employer with 4. ❑ I am a general contractor and 1 6. ❑ New construction
employees(full and/or part-time).* have hired the sub-contractors
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. E] 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 l 1.❑ Plumbing repairs or additions
myself. [No workers' comp. c. 152, §1(4),and we have no 12 Roof repairs
insurance required.] t employees. [No workers' 13.0 Other
comp. insurance required.]
*Any applicant that checks box#I 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.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: GHQ } P f44,
e..
Policy#or Self-ins. Lic. #: C �" T — ��- �' 3 Expiration Date:
Job Site Address: G W Q e City/State/Zip: . vP
Attach a copy of the workers' compensation polic declaration page(showing the policy number and e� a on ate.
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 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.
l
I do hereby certify and n r ce f perjury that the information provided above is true and correct.
Si nature: Date:
07
(7
Phone#: l 10 (
i
Official use only. Do not write in this area, to be completed by city or town official
I
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#:
IAORTH
Town of over
And
No. 9 -_
0 0 over, Mass.,
0 LAK E
COCHICHEVOCK
0RA T E D C:)
BOARD OF HEALTH
Food/Kitchen
PERMIT T D Septic System
'? 11 BUILDING INSPECTOR
THISCERTIFIES THAT............. .................AY�A ........................................................................ Foundation
has permission to erect........................................ buildings on ....15........ !.........,......... ......ITZ-40k................. Rough
t.....D_A.J� Chimney
to be occupied as.................45I.......", . P.—A.-I-4.6 .0........................5
provided that the person accepting tills permit shall in every-*-eicl -conform to the term-S%-e0;-p-1_1ication_-o-n--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
3 ` . PERMIT EXPIRES IN, 6 MONTHS ELECTRICAL INSPECTOR
UNLESS CONSTR%,7N AR S Rough
TAR ..I..Nq IS,;%Etv-.0...R. 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.
Lice BARD p BUejl�l ✓�
nse; CO L01 G RE
Number^ NSTRUCTI S EULATIONS
CS ON Up RVISOR
B
e: lyll/1964irthdat72475
Expires 12/1
R 1/2007
estricted..90 no: 9924.0
CARL NEVETr.
37 Ret) �ANS
I TMNGBOR0 RD
AM 01879'
, j
i;oa: �°'rvnz°num
d or Building Regul �►'�
HOME IMPROVE a°(I Stand.:A
MENT
Registration^ CONTRACTO
,. R
Expiration; ,150288
3/23/2008
TYpb: DBA. i.
-P{EVERJAMS CONSTRUCTIO
CARL \IE VN
ERJAMS
37-R
D GATE.RD
SEP.12.2007 09:20 19784590488 WILSONI14S 06823 P.001 /001
UA t(MMluuttl 111►
ACORDTM; CERTIFICATE OF LIABILITY( INSURANCE 09/12/2007
PRODUCER (978)459-7744 FAX (978)459-0488 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Wilson Insurance Agency Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
6 Courthouse lane Ste 14 —ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Chelmsford MA 01824
INSURERS AFFORDING COVERAGE MAIC M
INsuaeD Carl M. Nevejans dba+Nevejans Construction INSIIRCRA: Granite State Ins Co.
37 Red Gate Rd hcx A: - ---_—
Tyngsboro MA 01879 INSuktK E
INSURFR n:
THE POLICItS OF INSURANCE LISTED 00 OW HAVE BEEN ISSUED 10 iHF INSURED NAMED ABOVE FOR THF.POLICY PERIOD INDICATCD.NO I WITHSTANDINC
ANY RFQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS(;CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, FHE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL'I ItE TERMS.EXCLUSIONS AND CONDI I IONS OF SIKH
POLICIES.AGGREGATL LIMITS SHOWN MAY HAVE 13EEN RFr)UCED BY PAID CLAIMS.
... _
LNSR D TYPE OF IN6URAMCE POLICY NUMBER POU Y FFECTIVE 2611(MMIDD=POLICY EXPIRATION LIMITS
GENERAL LIABILITY pCCAIRRCNCE 3
COMMERCIAL GtNtkA1 1 IARIIJTY DAMAGE TO RENTED S
jILMI.
CLAIMS MAGE 4GCI.IR MED EXP(AnY ora P!-1r^) S
PCRSONAL6ADVINJOHY :I
CCNCRALAGGREGATE i
GEML AGGREGAI t LIIM PC
I APPI IRR R: mOLR)�1 S-c,c)MP n Are, _
POLICY DCCT LEC
AUTOMOBILE LIABILITY CUMVINH'I$INRLf LIMIT y
ANY AUTO (Eta(Iqc IClret}
Al I OWNED AUTOS BODILY INJURY E
SCHhUULED ALITnS
I TIRED AU'I US !!UINI Y IN.II IrY
(Persomenq t
NUM()WNFnA11Tn.S _. •...........
.,.. i'K(WtMtY nAMARC:.
... (DLI act�aent)
GARAGE LIABILITY At]To nNLV•CAACCIDENI' R
ANY AtITO OTHeK1MAN ACC S
AUTO ONLY: AGG S
EXCESSIUMBRELLA LIABILITY EACH 0CCIIRRCNCE
OCCUk ED CLAIMS MADE AUCKtCAIF ="
S _
DCDUCTIBLt _ 5
Ht I FNTION S S
WC STATU OTH-
WORKERS COMPENSATION AND I TORY LIRATS UL
EMPLOYERS'LIABILITY MIC 984-83-93 02/18/2007 02/18/2008 F 1,!`ACI I ACCIDENT :F 100 OO
A ANY PROPRIETORMAH I NERIEXECUTWE F.L DISEASE•EA EMI I.i IVFF S lOO O
OFFICLRMEMBEK t JGCI!. n? -
1Iye3,de3errA UnArr I.i.nI.StASE•POUCY LIMr1 Soo,
SPECIAL PROVISIONS hrkwr
OYNER
ot$CRIPTION OF OPERATtOM61 LOCATIONS I VEHICLES I EXCLUSIONS ADDED By ENDORSEMENT I SPECIAL,PROVISIONS
For informational purposes for proof of insurance
HNCELLATION
SHOULD ANY OR THE ABOVE DESCRIBED POLICIES BE CANCEI.LFO BEFORE THE
EXPIRATION DATE THEREOF,THE ISSUIMO INSURER WILL ENDEAVOR TO MAIL
10 DAYS wRrTTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
Don Blanchette
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMP0 ND OBLIGATION OR U ITY
1S Waverly OF ANY KIND UPON THE IN ,7 NTS E ATMES;
NTAT
AUTHORItr_o RHPRESEI
North Andover, MA 01845
Clark N. Lindley
c�jACORO CORPORATIO 988
ACORD 25(2001108) FAX: (978)688-9542
i
I
I
I
I
Nevejans Construction Proposal/Acceptance
37 Red Gate Road MA LICENSE 012475
Tyngsboro, MA 01879
H.I.0 130144
Phone# Fax# E-mail
978-649-1111' 978-649-1116 CNevejans@comcast.net
Proposal Submitted To Job Location
Don Blanchette Don Blanchette
15 Waverly Rd. 15 Waverly Rd.
North Andover,MA 01845 North Andover,MA 01845
dbbrewer@aol.com 978-808-8314
Date of Plans Customer Phone Customer Alt.Phone Terms Estimate#
8/23/2007 978-682-5232 978-808-8314-cell 1/2 upon start 1/2 u 349
Item Description Total
New Roof Rip Rip and remove off property existing roofing materials 2,600.00
Fasten 8"drip edge on perimeter
Fasten 6'of ice and water shield on eaves,valleys,and"Shinglemate"tarpaper on
remainder
Install 30 year arch.shingle(fox hollow blend)
Install Cobra ridge vent
Install all near flashing devices on pipes
Re-flash entire chimney,install new aluminum step flashing,and install new lead
counter flashing if needed
Install snow guards on edge of rubber roof to prevent large sheets of ice from
forming
10 year no leak guarantee
Plywood option:
If 1/2"CDX plywood is to be installed on entire roof surface,there will be an
additional charge of$600.00,includes labor and materials.
Gutter option:
Install 60'of seamless aluminum gutter and properly down spout;there will be an
additional charge of$800.00,includes labor and materials
Thank you for your business. Tota
$2,600.00
All material is guaranteed to be specified. All work to be completed in a worlanart-like manner
according to standard practices. Any alteration or deviation from above will become an extra charge r'
over and above estimate. All agreements contingent upon strikes,accidents or delays beyond our Signature 1 yf�
control. Owner to carry fire,tomado and other necessary insurance. Our workers are fully covered by
Workman's Compensation insurance. ,-
The above prices,specifications and conditions are satisfactory and are hereby accepted. You are Signatu
authorized to do the work as specified. Payment will be made as outline.