HomeMy WebLinkAboutBuilding Permit #1066-15 - 37 ROCK ROAD 5/1/2018 1� , F OORTIM 1
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� _2 . � �- BUILDING PERMIT 3� 4�<:._ .•_�.`6 °oma
TOWN OF WNRTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: -/ Date Received
rep
Date Issued:
9SSAc►+us��
IMPORTANT:Applicant must complete all items on this page
LOCATION 3'7 lock-, Zc o- F Q , A,�c�wee-;, � Ot B 1`S
Print
PROPERTY OWNER , Wd 1(am Coo aec
;�-� Pant
MAP NO: _PARCEL:AW ZONING DISTRICT:Historic District
yes. no
Machine Shop:Villa a yes no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building ❑ One family
❑ Addition ❑ Two or more family ❑ Industrial
❑ A ration No. of units: ❑ Commercial
epair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
❑ Septic ❑Well ❑ Flood lain I Wetlands a ❑ Watershed District
p P
❑Water/Sewer.
Identification Please Type or Print Clearly)
OWNER: Name: hlil�l'n,M �rx��er Phone: bx-1-939 3�>2_6
Address:
CONTRACTOR Name: Phone: 't$j-3�i 3~ ` t(
y 9-k
Address: W;".
41�'J d,t-n, A0 o 2(q FJ
Supervisor's Construction License Exp. Date.
� 6Is ?tet(
Home Improvement License: Exp. Date: �
l` (5 3 2, d
ARCHITECT/ENGINEER Phone: r
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: $ .`J 7 0 y FEE: $ elo 3 100,
Check No.: /�-,� Receipt No.: srgyn
NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund
ignature of Agent/Owner Signature of contractor, -y
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NORTH
BUILDING PERMIT `
o`,-fLED 16
TOWN Or NORTH ANDOVER �? 5 y:,. •a
APPLICATION FOR PLAN EXAMINATION
Permit No#: Date Received qSs Argo S
Date Issued:
IMPORTANT: Applicant must complete all items on this page
LOCATION
Print
PROPERTY OWNER
Print 100 Year Structure yes no
MAP PARCEL: ZONING DISTRICT: Historic District yes . no
Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential y�
❑ New Building ❑ One family r
❑Addition ❑Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
0 Septic p Well ❑ Floodplain ❑Wetlands .[>,'Watershed District
D Water/Sewer -__ .- - ---
DESCRIPTION OF WORK TO BE PERFORMED:
I
Identification- Please Type or Print Clearly
OWNER: Name: Phone:
Address:
Contractor Name: Phone:
Email:
Address:
Supervisor's Construction License: Exp. Date:
r
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: $ FEE: $
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
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
4, Building Permit Application
4. 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
IS OTE: 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/Cross Section/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
i
46 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
2012 IECC Energy code
Engineering Affidavits for Engineered products
OTE: 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:Building Permit Revised 2014 i
i
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑ Tanning/MassageMody 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 Reviewed On Signature_
j , COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on Signature
COMMENTS
I
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
r Planning Board Decision: Comments
P
-Gionservation Decision: Comments
'4r,water& Sewer Connection/Signature& Date Driveway Permit
DPW Town Engineer: Signature:
Ft RIE DEARg�TMErtY� °` ''w= tick
eLocated
s tt384 Osgood Street
�N � ro onsieY
-ate, aMaiS ee
t�
'
i
j Fire Departs entsg
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
DANCER ZONE LITERATURE: lyes No
MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine
NOTES and DATA.— (For department ease)
i
❑ Notified for pickup Call Email
Date Time Contact Name
Doc.Building Pennit Revised 2014
r
Location -07
No. -- Date
. - TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $ ;O�
Foundation Permit Fee $
Other Permit Fee $
TOTAL $ .�
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Check# ` /Y
r Building Inspector
NORTH
own of M EAndover
o
No. I t '�
ver, Mass, 7
COC
Hic„ewIcw
BOARD OF HEALTH
Food/Kitchen
PERMIT T LD Septic System
THIS CERTIFIES THAT ... Z�yl�.0: .............. ............................................. BUILDING INSPECTOR
has permission to erect .......................... buildings on .-�... :�� ., Foundation
��
Rough
to be occupied as ......................11.�:........5.!�l(.!u .............Ae-
: . R ...y /.+��.71�............ Chimney
provided that the person accepting this permit shall;'; eve respect conform to of the application
p p p g prY pFinal
on file in 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 CONSTRUCTIOS RTS Rough
Service
E-C.-
OR......
"...
.............. .... ... .. .. . . IL .I.........INSPE..
�r'�'�y BUDNG CTFina
GAS INSPECTOR
Occupancy Permit Required to Occupy Building 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.
Smoke Det.
ICS Inc.
Registration#139495
Construction License#80815
Federal I.D#270431848
Customer:
8111 Cooper
37 Rock Rd
North Andover,MA 01845
CONTRA
Siding*pre painted Hardie plank-smooth
Replacement of the following:
All siding including ali window/sills.and door trim
Remove and replace existing sidingwith*James Hardie Plank
Removal of existing siding.including under lament and nails as required
Installation of James Hardie wrap and tape to complete exterior of hom
Installation 5,25 or 6.25 with 4 or 5 inch exposure*Hardie Plank
All siding will be fastened using 2 Inch galvanized ring nails
All trim boards will be 5/4 x 6 Hardie boards fastened with ahidden fast ning system(pre-painted)
Installation of composite window sill nosing(solid vinyl composite)
All municipal permits and fees included
All Dumpster fees and disposal included
Total cost of project including all materials'and labor:.,.::... ........ ...... ..:.. . :....... ....................................$27,430:00°
'A ngi"%#,i+f cttstaiinE�tspiled
*Sheathing per 48 sheet$85.00
*NOTE:Electrical permit,including removal and reattachment of the electrical service meter,Is included in total cost.Any and all
subsurface electrical Issues or code violations will be presented to the homeowner by a licensed electrician,if any.The homeowner
Is responsible for any and all work plus cost related to any and all poten lal code violations.
Roollifte
III
Fascia boards/Soffits/Rake Boards
Remove and replace all fascia boards with composite boards composite aterials approximately 11M......... $1465.00
Remove and replace soffits with Y.inch hardle panel board solid approxii nkely 115ft:.....:......... .. ..... I........ ..........$1465.00
Remove and replace rakes with 1x6 hardie trim.or composite approxima ely 110ft..................:...........................: .................$1290.00
Gutters
Remove and replace 5"K style white aluminum seamless gutters with 16 if guard-115ft
Total cost of project including all materials and labor......... .............................. ........... ...: ... $2,929.00
Siding color„_5.25 Artic White
Trim color Artic Whit,
Total cost of project Including all materials and labor.:..... ... $34,579A0
Hardie Credit.. ...... ........ ... ... ..... ...............................1,000.00
Total cost of project Including'all..materials and labor..:...:... ».................................................. .........$33,579.00
,
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Payment schedule:
Deposit for siding order:$8,000.00 (�
Start date:$5,000.00 3
Upon stripping of complete home:$4,000.00
Upon completion of 25%of siding install:$4,000.00
Upon completion of 50%of siding Install:$4,000.00
Upon completion of 75%of siding:$4,000.00
Upon completion of 100%of siding:$4,579.00
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105 Bi i aper
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The Commonwealth of Massachusetts
Department of IndustrialAccidents
R d
Office of Investigations
I Congress Street, Suite 100
W
Boston,MA 02114-2017
www.mass gov%dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual):
Innovative Contracting Services Inc
Address: 339 Pleasant Street, Second Floor
City/State/Zip: Malden, MA 02148 Phone #: 781-393-4427
Are you an employer? Check the appropriate box: Type of project(required):
1.0 I am a employer with 8 4. ❑ I am a general contractor and I
employees (full and/or part-time).* have hired the sub-contractors 6. E]New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees These sub-contractors have g.. ❑.Demolition.
working for me in any capacity. employees and have workers'
[No workers' comp. insurance comp. insurance.$ 9. ❑ Building addition
required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their I LF❑ Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs
insurance required.],t c. 152, §1(4),and we have no 13.� Other Renovation
employees. [No workers'
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 state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: John M. Costello Insurance Agency (Travelers)
Policy#or Self-ins. Lic. #: 7PJUB-471 OP86A Expiration Date: 7/1/2015
Job Site Address: �� �o City/State/Zip: �� Rv`,l�yerI Nle 01 0`15
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 a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify unde5rfAefiWa a aloes of perjury that the information provided above is true and correct
Signature: f Date:5
Phone#: 781-393-4427
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: Permit/License #
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6. Other
Contact Person: Phone#:
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Massachusetts - Department of Public Saetq
Board of Building Regulations and Standards
C>n:truction Super-,is,r
License. CS-080815
EMANUEL F COF-LHO_ ,
51 HAWTHORNY S 7 t
Malden MA 021,4$
expiration
Commis>i o n r 03/30/2016
y. Office of Consumer Affairs& Business Regulation
`iiMWM�PME IMPROVEMENT CONTRACTOR
"registration: 171578 Type:
expiration- 3/29/2010 Private Corporatior
INNOVATIVE CONTRACTING SERVICES INC.
EMANUEL COELHO
43 THORNDIKE ST / g —
CAMBRIDGE, MA 02139 Undersecretary
The' Commbnwealthof Massachusetts
Department of Fire Services -
Oftice' of the State'Fire Marshal '
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R.O.Box.I025 St<ztcRoad,Stoic;NIA 0I775
'APPLICATION FOR PERMIT
Date:
N. Andover �'ermzt:No
(City or Town.) . (HApplicable) Dig Safe Numb
In accordance-with theprovisions ofMGl. Chapter ' 10 as
provided in Scctiaa 527 CMR 34 application is•hereby made _ Start Date '
by Z M n...i v C_or_ -(11��
Full name ofperson,Finn OF Corporation)
'State clearly Address
purpose for - (Street arP.O.Box City arTown)
'chpe� Forpcmvssianto locate dumpster' far constr on/ nnvat;nn f rlamnl ; t-jnn
isreqursted '
of b u i l d i n p•-
Commcutr: dumpster must be 25 ' from structure or "covered' when n'ot in ,ig,e
at
(Give location by street and no,or dcscri a in suchmanncr as to-proyied adequate ideatifrcadcn of location)
Name of competeat'aperator Cert-No.• ,
(If Applicable)
DatcIssucd-rejected 3(14-- 15—
o- S_ By
(Signatnrn of-Applicant)
Date of ezpiratian Aug r�� �5;�o( $— Fee$ 5 0 .0 0 Pard �� Due
The -Commonwealth of lWassachusetts :.
vo
Department-of Fire Services Q
Office of the State Fie
r Marshal
P.0.Bax 1025 Statc-Road,.Stow,MA 01775 '
PERMIT Date:
North Andover )Permit No
Ci of Town Dig Safe Num er
• - ( t7'• ) (I.f'Applicable) .
In accordance.with the provisions of P2.G-L_ 4.8 Chapter T 0 asprovided in section i 7 7 CXR 34
Start Date
ThisPcrmitis granted to:.
Full name of person,Firm or Corporation
Pcrmissionto locate dumpster - for construct3-on/renovation/demolition
.
of building,
CO e 1:' dumpster. must be, 25f from structu.re if unable to place with re uired
Restrictions:
clearance dumps-ter must be coveted with plywood or tarp end of 'work -day
at
(Give location by street and no.,or describe in such manner as to provied adequate identification of location)
FeePaids 50.00 Fire Chief
This Permit will expire- C.� 5 (Signature ofoffical (Title)