Loading...
HomeMy WebLinkAboutBuilding Permit #770 - 39 ELMCREST ROAD 5/23/2007Permit NO: �v Date Issued: BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received TYPE OF IMPROVEMENT PROPOSED USE Reside I Non- Residential ❑ New Building ne family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Altera ' n No. of units: ❑ Commercial CRe'pair, replacement ❑ Assessory Bldg I-O'fhers: ❑ Demolition ❑ Other Smf �. DESCRIPTION OF WORK TO BE PREFORMED: Z141*776t/�q/-L_ OLf-� 2a,JFZI1 Cr-Z-H1',4LL H'J'(Z"`t, (�` -(- a i C.£t- - W 3^ L 1�i�o —30 /2 n or ,SGL-U,aL ,2-C, e' S";,-4 G LZ o �v�?�JL 1 f�E r ,�( t✓ V �� , �� r3o,p rL�il: �� S -r /�.r^1 a.✓z � Identification Please Type or Print Clearly) OWNER: Name: ArS' O Phone: 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: $ Sy a FEE: $ Check No.:' '71 -� Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund Location 39 C-T&I &-ir-0 I- No. t i Date 5 N�RTh TOWN OF NORTH ANDOVER � 9 Certificate of Occupancy $ 1Ss�MUSEt Building/Frame Permit Fee �} $ Z Foundation Permit Fee $ Other Permit Fee $ TOTAL $ d- / Check # 2+0267 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 ❑ COMMENTS CONSERVATION COMMENTS HEALTH COMMENTS IN El DATE REJECTED DATE REJECTED DATE REJECTED DATE APPROVED 11 DATE APPROVED DATE APPROVED 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 Located at 384 Osgood Street Dimension 3a�� sy 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 MGL Chapter 166 Section 2 1 A —F and G min.$100-$1000 fine No 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 ❑ 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) ❑ 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 2.2007 c c c� o � c N O C CL C m W m c 2 w `o 9 Ea w C dELIM : d NSEE E C cm t me E 4N O m O �' NJ H m; r zoo m O C 4- E� h W COD CLU m m 0 ac c :I c 0cc Q _ :y' ct •O mZ o ev � c 2.6 co S Q L 'Gonc c = m m=3 WO M .O m_.. ti •io; _ = m c Z o •� O _ a c�� O CIO CL 10 H z ..0. a..zm 5 w w P-4 v r•�r w cii a w cw U w a � u: x x W x w ir. a x w w � w rA cn 0 o cn c c c� o � c N O C CL C m W m c 2 w `o 9 Ea w C dELIM : d NSEE E C cm t me E 4N O m O �' NJ H m; r zoo m O C 4- E� h W COD CLU m m 0 ac c :I c 0cc Q _ :y' ct •O mZ o ev � c 2.6 co S Q L 'Gonc c = m m=3 WO M .O m_.. ti •io; _ = m c Z o •� O _ a c�� O CIO CL 10 H z ..0. a..zm 5 w w P-4 v r•�r RAYMOND E. DAMPROUSSE, JR. AND SONS ROOFING CO., INC. MA. CONSTRUCTION SUPERVISOR LIC. #0636 HOME IMPROVEMENT REG. #101862 BOX 431 LAWRENCE P.O. LAWRENCE, MA 01844 TEL: (978) 683-4588 ROOFING — SIDING — INSULATION _ Date /l%/-� / 1 j7 - © � From (Name) C,r^(Address) TO: MATHMM E DAM$ISSE, A AMS SEMS I1NEi CI., MC., BOX 431 LAWRENCE P.O., LAWRENCE, MASSACHUSETTS 01842 I (we) hereby authorize the Contractor to furnish all materials and labor necessary to install, construct and place the Improvements described below in -on building located at No. -1c i�r �~ Street, City L State /22 1 C in accordance with the following specifications: r`7 U /3 f {_ S 1•-1 e V Vic- L Y— r.—�-7r' �4 k.1,1 C. r t < <� J ' S ' A 1— e rJe✓t r1 ";Y''t t�,� %�•�G-�};';L_ A l x.4,1 "� ,•-"�. i J /- / r ' , d.. .1 C... r e J"� s , i `. C.J ''"�. �� F' `'1 ( -+- A r / f%'y) G / I (i [r• /f"! t 7 l�. 1 / �C'� `U _ c3- .=') r' - ( i l ,tet / ! Crc rs r=te ..S l n I �r C �' t / / j ! ; `1 L i • , r • j —A All of the above work to be done in a good and workman -like manner. All men and equipment InsuredefO smixes to" left cleanupon-4ornpletion of work. For the total sum of --� Entire Sum to be paid immediately dollars. In accordance with plan as shown below. TOTAL CASH SELLING PRICE .......... S DOWN PAYMENT IN CASH ............. DEFERRED BALANCE . UPON COMPLETION .................. The undersigned agrees to keep property mentioned In this agreement properly insured against loss by fire including the Contractor's interest therein. This agreement shall become binding only upon the written acceptance hereof by said Contractor, and upon such acceptance this shall constitute the entire contract and be binding upon the parties hereto, there being no covenants, promises or agreements, written or oral except as herein set forth. It Is the intention of the parties hereto that this contract shall be binding upon their respective heirs, executors, administrators, successors and assigns. Customer agrees to pay a reasonable sum as attorney's fees and Court Costs if placed in hands of attorney for collection. The owner further agrees that In event of cancellation of this contract after acceptance by tbil contractor and before the work is commenced the OWNER agrees to pay 20% of the total consideration herein named as liquidated damages for breach of contract. ..,Said contractor shall not be responsible for damage or delay due to strikes, fires, accidents, or other causes beyond his reasonable control. 1We, the undersigned, certify that we are the sole owners of the property herein described on which said work or repairs are to be performed. IN WITNESS WHEREOF, the undersigned has (have) hereunto set his (their) hand(s) and seal(s) the day and year written above. Accepted By 9A1fMOND E. DAMPHOUSSE, JR. AND SONS i! ROOFING CO., INC. ( ignstvrf<and Title of Off l) Husband Mail Address (If different from above) I -- ��rvisor License i License: CS 46636 Blrttu�ate fi/2/1948 i expiration:.. 6[2/2009 Tr# 14024 I Restriction 1 r! rr �f RAYMOND E DAMPHOUSSEJR' 1 75 BUTTERNUT METHUEN, MA 01844 Commissioner •1 r APO ' ✓lie �omvnaoouuee. MaeA Board of Building Regulations and Stands t ` ^ ` HOME IMPROVEMENT CONTRACTOR' € ` ;= Registration: 101862 Expiration: 6/29/2008 s Type: Private Corporatidn ftAYMONb E. DAMPHOUSSE, JR. & SONS F Rayn pond Damphousse, Jr. 75 Butternut Lane ;aalhuen, MA 01844 Dcpu!. A(4nim r.:ti` TRAVELERS INSURER: THE TRAVELERS INDEMNITY COMPANY 1. INSURED: RAYMOND DAMPHOUSSE & SONS +ROOFING CO INC 75 BUTTERNUT LANE METHUEN MA 01844 WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY TYPE AR INFORMATION PAGE WC 00 00 O1 ( A) POLICY NUMBER: (6KUS-663X466-A-06 ) RENEWAL OF (6KUF-663X466-A-05) NCCI CO CODE: 1 1 347 PRODUCER; INTERNET INSURANCE AGCY 522 CHICKERING RD NORTH ANDOVER MA 01845 Insured is A CORPORATION Cth,64* work places and identification numbers are shown in the scheduie(s) attached. 2 Tne lrroilcy perloc+ is from 08-22-06 to 8-22-07 :Gt A.M. at tha insured's maii!ng address. 3. A WORKERS COMPENSAfIdN INSURANC : K One of the policy applies to the Workers Compensation Law of the stats(s) listed here: MA B• EMPLOYERS LIABILITY INSURANCE: Part Two of the policy applies to work in each state !isted in Item 3.A. The limits of aur liability under Part Two are: 8061y Injury by Accident: $ 100000 Each Accident Bodily Injury by Disease. $ 500000 Bodily Injury by iDissase: $ Policy Limit 100000 Each Employee C. OTHER STATES INSURANCE: Part Three of the Polley applies to the states, If any. listed here: COVERAGE REPLACED BY ENDORSEMENT WC 20 03 06A D. This policy inciudes these endorsements and schedules: SEE LISTING OF ENDORSEMENTS - EXTENSION OF INFO PAGE 4. The premium for this Polley will be determined by our Manuals of Ruigs,C! asslficati0 Plans. All required informationns, Is subject to verification and change by audits be I ns, Ratter and Rating DINE OF ISSUE: 08-16-06 ML OFFICE: ORLANDO INDUS AFF 161 a0600e PRODUCER: INTERNET INSURANCE AGCY 753XF ST ASSIGN: M4 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Wdshiitgton Street Boston, MA 02111 l Workers' Compensation Insurance Atiidavtt Builders/Contractors/Electricians/Plumbers dicant Information Name (Business/Organization/Individual): Address: City/State/Zip: V",5 -� a TJX tt G G e. -Z,( Phone #: 9'ZL `&- '? ix,,—� ff – Are you a ployer? Check the appropriate box: 1 • am�a emplo with 2. ❑employe (full rid/ r p time).* I am 4. ❑ I am a general contractor and I have hired the sub -contractors a sole proprietor or partner- ship and have no employees listed on the attached sheet. I These sub -contractors have working for me in any capacity. [No workers' comp. insurance workers' comp. insurance. 5. ❑ We are a corporation and its 3. ❑required.] I am a homeowner doing officers have exercised their all work myself. [No workers' comp. right of exemption per MGL C. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp ins— Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.❑ =frepairs repairs or additions 12•4 ce required.] 13 ❑ Otherl(% *Any applicant that checks box # I must also fill out the section below showing theirworkers' 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 I- must attached an additional sheet showing the name of the sub -contractors and their workers' P.— _n_ 7 -- �-�••� employer that is providing workers' compensation insurance for my employee& Below is the policy and job site information. Insurance Company Lr2P Policy # or Self -ins. Lie. #: �t!y /� _ �(' y Expiration Date: �-�� - 7 Job Site Address:7 G 2€ P City/State/Zip: Afo fj A1w9. Tz A,9 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 impositionof 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. - �� ..c�coy cern naer the pains and naltie�ofperjj�ury that the information provided above is true and correct. Si nature: C Date: - -o Phone #: Official use only. Do not write in this area, to be completed by city or town oJficiaL 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 #: