HomeMy WebLinkAboutBuilding Permit #944-14 - 39 HAY MEADOW ROAD 6/30/2014Permit NO:—
Date lssued:-L
LOCATION
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATIO
Date Received!
"ORTANT: Applicant must
z,:
omplete all items on this pal
Print.
PROPERTY OWNER
Prinf_.�,, 1 00'Yeair Old Structure
MAP NO: PARCEL: ZONING DISTRICT: Historic District
Machine Shoo Villa
yes no
yes no
ie ves Cno
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
0 New Building
"ne family
0 Addition
El Two or more family
0 Industrial
0 Alteration
No. of units:
0 Assessory Bldg
El Commercial
fi2lRepair, replacement
0 Others:
El Demolition
0 Other
0 Septic 0 Well
0 Floodplain 0 Wetlands
0 Watershed District
0 Water/Sewer
DESCRIPTION OF WORK TO ESE PEK1-UKMEU:
&�q� -�Re_
Identification P11 ase Type or Print Clearly) C11y_( V17
OWNER: Name: Phone:
Address: 9 /h2L/MC40--�-LZ
CONTRACTOR Name: (i Phone:
Address: C -3't> Z-11(
Supervisor's Construction License: (y4p7/2-,D -Exp. Date:
Home Improvement License: Exp. Date. /",/2 &,,14
ARCH ITECT/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: $
o.: 2-7 -1 L
Check No.: to Receipt N
NOTE: Persons contracting with unregistered contractors do not have access tA the uarantyfund
$io-;if6re-of--A---q--e-n-t/--O---w-n-e-r i ilature of contracto
_)(Ig
Plans Submitted Pi Plans Waived El Certified Plot Plan El Stamped Plans El
Plans Submitted -El PlansWaived'El -Gertified Plot Plan El Stamped Plans El
.T-Y,PE-,OF�.SEW-ERAGEDISP-OSAL'-
Public Sewer El
Tanning/Massage/Body Art F]
Swimming Pools El
Well El
Tobacco.Sales El
Tood Packaging/Sales
Private (septic tank etc... El
permanent Dumpster on Site El
THE FOLLOWING SECTIONS FOR -OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
DATE REJECTED DATEAPPROVED
PLAN NI NG'&'DEVELOPMENt- El El
COMMENTS
,CONSERVATION
COMMENTS
HEALTH
COMMENTS
Reviewed on Si-qnature
Reviewed on Si-qnature
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes_..
Planning Board Decision:
Com
Conservation Decision: :Comments
Water & Sewer Connection/Signature & Date Driveway Permit
DPW Tow;2 Engineer: Signature:
LOcaTea M4 USgOOO zareei
E � D ART M �-;'N T T e m' D u- m'' pst e r' o n 's i t 6 -yes no
Located'bt 12*4 Mair, Str6ete-
Fire- 06pa"'ftifi6iit.�M'j irfAt-
J. ure/dsite""
COMMENTS
--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 21 A �F and G min.$10041000 fine
NOTES and DATA — (For department use
U Notified for pickup - Date
Doc.Building Pennit Revised 20 10
Location
No.
Check # '::� ( 4D 4�)
27718
TOWN OF NORTH ANDOVER
Certificate.of Occupancy $
Building/Frame Permit Fee 100 -
Foundation Permit Fee
Other Permit Fee
TOTAL
Building Inspector
Proposal To: Bill & Lisa Riedel
Date 4/28/2014
rStreet: 39 Haymeadow Rd.
978-687-1363
N. Andover, MA
Roof proposal
blcer@comcast.net
IKO Cam bridge/Certainteed Landmark
I . Extra caution will be taken to protect house
exterior and landscaping as best as possible.
(tarps etc.) Magnets run at final clean up.
2. Remove all shingles from entire house.
3. Inspect and re -nail any loose or lifted plywood.
Any compromised plywood will be replaced at
an additional cost of $55.00 per sheet of 1/2"
CDX fir.
4. Install heavy gauge 8" aluminum drip edge to all
rakes. Existing vented drip edge will remain as
part of the ventilation system.
5. Install 6' of IKO Armourguard or Certainteed
Winter Guard ice and water shield along all
eaves. Full coverage on rear dormer.
6. Install IKO roof guard or Certainteed Diamond
Deck synthetic underlayment to remaining
sheathing up to ridge.
7. Install all new pipe boots.
8. Install IKO or Certainteed Leading Edge starter
shingles to all eaves.
9. Install IKO Cambridge or Certainteed Landmark
Limited Lifetime architectural shingles to entire
house. 15 year non pro -rated warranty by mfg.
10 year if Certainteed is chosen. All shingles
will be installed and fastened according to mfg.
specs.
10. Counter flash existing lead chimney flashing and
all roof protrusions with ice and water shield and
tie into new shingles.
11. Install new GAF Cobra ridge vent capped with
color matched IKO or Certainteed hip and ridge
shingles.
12. Removal of all work related debris. Planks will be
placed under dumpster to prevent any damage to
driveway.
13. Building permit included. (MA state requirement)
14. Contractor workmanship warranty: 10 years under
norinal wind and rain conditions. -
OPW __�'
Total roof cost: $ 8,900.00 — %/'
Direct MFG. Extended warranties Fully
transferable, 100% coverage for a non pro
rated period of 20 years. Please see info packets
in material folder. Offered and included in this
proposal to our referrals at no additional cost.
Balance due upon completion
References available upon request
Highly rated member of the accredited BBB and
An2ie's List
Thank you!
Y17 -0
rl
A FCC %_U119yrs"Is wrUttis "J IrAuaa"L�fg&Cactta
47), Department of IndustrialAccidents
Office of Investigations
I Congress Street, Suite 100
Boston, MA 02114-2017
www.mass.gov1dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legib
Name (Business/Organization/Individual): , A Lc- U-' /2 -cz OA�<_ /Z 0
Address: 'J'zo 'T -C_�aj f- 479
Phone#:
Are you an employer? Check the appropriate box:
1. [21 am a employer with 5.'
4. E] I am a general contractor and I
employees (full and/or part-time).*
have hired the sub -contractors
2. 1 am a sole proprietor or partner-
[:]
listed on the attached sheet.
ship and have no employees
These sub -contractors have
working for me in any capacity.
employees and have workers'
[No workers' comp. insurance
comp. insurance.:
required.]
5. F� We are a corporation and its
3. E:] I am a homeowner doing all work
officers have exercised their
myself [No workers' comp.
right of exemption per MGL
insurance required.] t
c. 152, § 1(4), and we have no
employees. [No workers'
comp. insurance required.]
Type of project (required):
6. E] New construction
7. [:] Remodeling
8. F� Demolition
9. F] Building addition
10. El Electrical repairs or additions
I Q:1 Plumbing repairs or additions
12.[] Roof repairs
l3.ZJ-@ther_ 9 0, c�/-'
*Any applicant that checks box 4 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 insurancefor my employees. Below is the policy andjob site
information.
Insurance Company Name: (4 ^-""JT - fl, i
Policy # or Self -ins. Lic. #: /9(,j c - tl 9 . 5 4 ;- q — 2 ?0A _ Expiration Date: 1 s I I I Z- 14
Job Site Address: 32 �� 'M -42 `J 9 -"- - City/State/Zip:
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 cert�o under 11Wpains andpenaldes ofperjury that the information provided above is true and correct.
a
7 71 --9j—(3
Official use only. Do not write in this area, to be completed by city or town offi-cial.
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#:
S & Busmc:ss
' ROGUWOOn toHCAE041-
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Home ImPrOl'"" ny of the criteria belov'f-
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RESPONSIBLE REGISTRAT10" ADDRESS
REGISTRANT Nt)IVIDUAL NUTASER
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