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HomeMy WebLinkAboutBuilding Permit #757-11 - 360 ANDOVER STREET 5/10/2011BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building &Tne family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other 111Se00c "Well ❑ Floodplain. ❑ Wetlands ❑: WateishedDistricf �WaterLSewe� ; DESCRIPTION OF WORK TO BE PREFORMED: entification Please T e or Print Clearly) OWNER: Name: Phone: Address: J2�r� '4 L�-V-r 10a, fC.ONTRACTOR Name: :Phone: - 0 -4 - Su" ervisor s Construction License: 5_ �5q24� <Z� Exa. r®ate:- . 'Homeflmp'rovementlLice'nse ._._.lob -/ _ Ezn..Dafe- � 12311 ARCHITECT/ENGINEER Phone: 2 Address: Reg. No. FEE SCHEDULE. BULDING PERMIT. $92.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $925.00 PER S.F. ��`'� 6d Total Project Cost: $ %®/ � , FEE: $ 1AF Check No.: 3� Receipt No.: ;� 5'/ NOTE: Persons contracting �*fh unregistered cRntractors do not have access o _he-agarar�iy fund , 0® { r Location No. Date /r TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $T Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check #Q 24142 "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 PLANNING & DEVELOPMENT DATE REJECTED 101 DATE APPROVED I COMMENTS CONSERVATION Reviewed on Signature COMMENTS. HEALTH COMMENTS Reviewed on' I Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comme Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood,�reet ;FIRE DEPARTMENT = Temp Dumpster on site Locafedat,124 Main.,Street CQMMENT51 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 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 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 (If Applicable) ❑ Engineering Affidavits for Engineered products 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 ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Cdpy 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 til V W R.7; O w �v cn a) 0 v zqa Gp L O CCZcaa vu oo F U � 0. c pG O w cn w p w �o w :.c co O ua o cn Qv o cn O w a V 6 O co C) . CD L O as c Z � 0. c y C O CM G i G — O O CO m :.c co O 0 CD r C 3 -a CD 0 C.3 U •d'O o M a M: ca Ca p• C C cc wca CC t0 ts C CD CL V y c � LC O O R co C � o a yr CO) o m C s ® m If J O !e L !J N y to 3 O1 m N (�\ _ m •� 'fl N G CO) A O E N m CD fl•C� � m G� CD C CCD O� m MZ o = o. c Q vLO' m C o = m ~' ~ m yam•, cc.,* m O CD r •gooC r.+ 16 m � •m a C � 'r m •N Z O V .9 cm H CO2 _ CL m o a ` y•� O �=4-CL4-m� cc O w a V 6 O co O CD L O Z � 0. O O y C O CM C G — O O CO m CL. 0 CD CD 3 -a CD o M a M: ca Ca O C cc wca ts C CD CL V y c � C d CA LLI 0 uj U) W W 19 LUW Mailing Address: P.O. Box 8051 - Lowell, MA 01853 Location: 525 Woburn Street - Tewksbury, MA 01876 E-Mail: InfoWooster-Roofin .com Website: www.Wooster-Roofing.com WOOSTER ROOFING PROPOSAL ALL TYPES OF ROOFS DATE: 3/15/11 &ROOF RELATED SERVICES Always Hand Nailed (} �J License Numbers: L,1 L,I l� Charlnail ie and Steve Wooster � - - 1-553 i(OV1+11V -1 /66 Construction Supervisors 54268 17V111G IllP •rV VGIIICnt %..V�l tr Altol ("- 3461) Main: 978 251-7181 Registration 100712 Serving MA 81 NH since 1984 Fax: 978 251-0159 Call For Our References Proposal Submitted To Work To Be Performed At Name Eleanor George Name Company Name - Company Name Street 360 Andover St. Street City No. Andover State MA Zip Code 01845 City State Zip Code Home# 978 682-6820 Mobile# Work# Fax# We hereby propose to furnish the materials and perform the labor necessary for the completion of the following job. Strip the main shingle roof to the roof deck 1. Renail any loose decking and replace any rotted at $2.00 per foot. 2. Install 9' of Grace ice and water barrier on all eaves. 3. Install Grace Tri-Flexon remainder of roof. 4. Install 8" brown aluminum dripedge. 5. Install Certainteed Landmark Lifetime Burnt Sienna colored shingles, hand nailed. 6. Flash chimney and vent pipe to roof. 7. Install rubber membrane roof on low pitched rear dormer roof. 8. Install Shinglevent II ridge vent. 9. Clean and dispose of all debris. OPTION strip a roof g �wo d e a ad itt 1 2,4 Workmanship guaranteed for 10 years. We are fully insured with workers' compensation as well as liability insurance. Please return copy of proposal: All materia] is guaranteed to be as specified, and the above work to be performed in accordance with the specificationssubmitted. All work will be completed in a substantial workmanlike manner for the sum of Dollars ($10,640.00), with payments to be made as ows: Job paid on com letion. Respectfully submitted Note -This proposal ma be wit ra by us if of acce ted within 30 da ACCEPTANCE OF PROPOSAL The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above. Daie � G — 7 /17- �_ / Mailing Address: P.O. Box 8051 - Lowell, MA 01853 Location: 525 Woburn Street - Tewksbury, MA 01876 E-Mail: InfoWooster-Roofin .com Website: www.Wooster-Roofing.com WOOSTER ROOFING PROPOSAL ALL TYPES OF ROOFS DATE: 3/15/11 &ROOF RELATED SERVICES Always Hand Nailed (} �J License Numbers: L,1 L,I l� Charlnail ie and Steve Wooster � - - 1-553 i(OV1+11V -1 /66 Construction Supervisors 54268 17V111G IllP •rV VGIIICnt %..V�l tr Altol ("- 3461) Main: 978 251-7181 Registration 100712 Serving MA 81 NH since 1984 Fax: 978 251-0159 Call For Our References Proposal Submitted To Work To Be Performed At Name Eleanor George Name Company Name - Company Name Street 360 Andover St. Street City No. Andover State MA Zip Code 01845 City State Zip Code Home# 978 682-6820 Mobile# Work# Fax# We hereby propose to furnish the materials and perform the labor necessary for the completion of the following job. Strip the main shingle roof to the roof deck 1. Renail any loose decking and replace any rotted at $2.00 per foot. 2. Install 9' of Grace ice and water barrier on all eaves. 3. Install Grace Tri-Flexon remainder of roof. 4. Install 8" brown aluminum dripedge. 5. Install Certainteed Landmark Lifetime Burnt Sienna colored shingles, hand nailed. 6. Flash chimney and vent pipe to roof. 7. Install rubber membrane roof on low pitched rear dormer roof. 8. Install Shinglevent II ridge vent. 9. Clean and dispose of all debris. OPTION strip a roof g �wo d e a ad itt 1 2,4 Workmanship guaranteed for 10 years. We are fully insured with workers' compensation as well as liability insurance. Please return copy of proposal: All materia] is guaranteed to be as specified, and the above work to be performed in accordance with the specificationssubmitted. All work will be completed in a substantial workmanlike manner for the sum of Dollars ($10,640.00), with payments to be made as ows: Job paid on com letion. Respectfully submitted Note -This proposal ma be wit ra by us if of acce ted within 30 da ACCEPTANCE OF PROPOSAL The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above. Daie � G — 7 /17- �_ -roIrmoiana Saniackas FaxID:McSweeriy Ricci puge'2 of 3 Date:3/18/2011 03:55 PM Page:2 of CERTIFICATE OF LIABILITYDATE(MMlDD1YYYY) INSURANCE OF' 1 03/21/11 PRODUCER THIS CE TIFICATE IS ISSUED AS A MATTER OF INFORMATION McSweeney & Ricci Iris Ag Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 420 Washington Street HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P.O. Box 850984 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Braintree MA 02185 Phone:781-848-8600 Fax:781-843-8807 INSURERS AFFORD INGCOVERAGE NAIC# INsuREo .W .iRr=rtA INS13: v�bion�i;wnt'. rfix. rr>suri+�b• Charles J Wooster dba Wooster Roofing �, INSUKtRQ: PO Bax 8651. ItaSJRCRL� Lowell MA 01853 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 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. LTR NSR TYPE OF INSURANCE POLICY NUMBER FULILoYEFFECIIVE DATE (MM/DDIYYYY) DATE (MM/DD/YYYY)LIMITS GENERAL LIABILITY EACH OCCURRENCE $1,000,000 A X COMMERCIAL GENERAI.LIABILITY CPA 0083583 10/17/10 10/17/11 PREMISES(Eaoccurence) 5250,000 CLAIMS MADE M OCCUR MED EXP (Any one person) $5,000 PERSONAL & ADV INJURY $1,000,000 X Worksite Poll 200 GENERAL AGGREGATE $2,000,000 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000 POLICY X JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000 A ANY AUTO MAA 0379134 03/21/11 10/17/11 (Ea accident) BODILY INJURY 5 ALL OWNED AUTOS X SCHEDULED AUTOS (Per person) s { HIREDO• c} .- ;Y }� � T . 1 ,1 BODILY INJURY. 5 X IiLSt1 OWktilY4??IrtR' (P ace td•itl� PF?O1-tRTV f5 GE 5 (Per et;citlent} @R34 YE' LIAf?ILriY ' AUTO C#k EA ACeltt I ANY AUI+RTFtIJsAhF ., / AUl'O tShAY. e ±yCi s ? tiraESAtELLA 14A)SILI "Y EA(5k6t JAeRIw�LI ; X 1 ,1300 1.000 A k J rr:ruR �u. f i/k)W31'itAJ7E CUA 038.3987 02/1,7/ii .10/11/1l A06RE6A S ":`{ , 000 I 000 I � . �� � « � i,» srYF,�4-• � ie RC'1�I�TtK1P� S AND tMPLI, s' L4Afrt." qf ti n u+v Ftsatmlt inPt�iJcrtr� xe�t rtyt e ay�-FI:E"ttfi+k"ktrJCii i�:�v�:t �SUEr.Y7, � � y 93SCii 9 r 1f3/' yr 10/17/'1 F l C, w 3CNt " d i�t30 , Q00 � - E L t31b J ° •FFA 'A�LOYC8 t" 000 . (AietttAalory In NH1 jCiA I'$?i3V131t}t(itfl+W I: LMl71ei!'_Mt,r'>ivi riIA+IIf 1{3{:((300 OTHER. - - DESCRIPTIOhI Or OPERATIONS ? LOCATION;? ! VEHICLES I ?(CLUPZO ADDED BY E DOR E N71 SPECIAL PROVISIO S C•ERTINCA TE HOLDr-R , , CANCELLATION. . SHOULD ANY OF THE AAovE DESCRIBED PdLiCfES Bt- CANCELLED A&ORE Tkt tkPIRATAON Evv*k) DATE THEREOF, THE ISSUING INSURER WILL EN15EAVEIi7 td MAIL 10 DAYS WRMT'EN NdT)CE TY) tHE L'Ef.iIFItAiG HOLDER NAM5D.*0 THE trlft1 )AUT kAiLUAt 'b 06Ob §HALL, • - MPOSE W) OBUGATIOPi OR LIABILITY OF AWAIND LIP(W 114E INSUREfd, 41'8 AdbmTS OR BVitl+�li�'•+�! Off" L°�strer�ge - . 12.EPitE'SEIJTATtVES. AUn o 6FtEPRESENI'ATIVE �•,,'. Who ORO I1hi * W)d Izrgo �t+6 T a), !a0f o n1 04t of AOORL4- ' v% in�� elation J/teO ice o=nsu=er�fair and us ess g 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration a / CHARLES J. WOOSTER ROOFING' - STEPHEN WOOSTER 525 WOBURN ST TEWKSBURY, MA 01876 DPS -CAI u 50M-04/04-6101216 Registration: 100712 Type: Supplement Card Expiration: 6/23/2012 Update Address and return card. Mark reason for chane. F-] Address E] Renewal n Employment [j Lost Card Office of Consumer Affairs and Efusiness Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration -- - Registration: 100712 i Type: DBA Expiration: 6/23/2012 Tr# 299388 CHARLES J. WOOSTER ROOFING F Charles Wooster it; 7�f =! P.O. BOX 8051 \,� `ti= y -; b� --D LOWELL MA 01853 DPS-CA1 Co 50M -04/04-G101216 Update Address and return card. Mark reason for change. ❑ Address n Renewal F] Employment ❑ Lost Card Massachusetts - Department of Public Safet% Board of Building Regulations and Standards Construction Supervisor License License: CS 54268 CHARLES J WOOSTER PO BOX 8051 LOWELL, MA 01853 �T--� - _:__' Expiration: 5/11/2012 ('ummissitile r Tr#: 28341 The Commonwealth of Massachusetts r i Department oflndustrialAccidents Ii Office of Investigations C 600 Washington Street a Boston, MA ozzzr mass.wwwg `f ov/dia �. Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Name (Business/Organization/Individual): Address City/State/Zip: Phone #: Are you li, employer? Check th appropriate box: 4. ❑ I an a contractor I 1 am a employer with _ general and employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I ain. a sole proprietor or partner- listed on the attached sheet. I ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ I atn a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] i 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 11.0 Plumbing repairs or additions 12. oo repairs " 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. $Contractors that check this box must attached an additional sheet showing the name of the sub -contractors acid 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. J N_ Insurance Company Name: ZfT Policy # or Self -ins. Lie. #: 4 -`� Expiration Date: l© �( 1,4� Job Site Address: City/State/Zip:"r� Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Sedtion 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 maybe forwarded to the Office of Investigations of the DIA for insurance' coverage verification. I do hereby information provided above is trite and correct Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License Itl 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