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Home My WebLink AboutBuilding Permit #438 - 395 BEAR HILL ROAD 11/28/2011 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: Date Received Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION r - Print PROPERTY OWNER /-k q4f/-� Unit# Print MAP NO: PARCEL: -� ZONING DISTRICT: Historic District ye n Machine Shop Village ye no 100 year-old structure yes o TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building �'6ne family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial A?Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other q;Septic ❑Well' i7 Floodplain .Wetland's D Watershed+District, Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: (Identification Please Type or Print Clearly) OWNER: Name: CA/1 /M 00 2 Phone: Address: 9 CONTRACTOR Name:-77_�A n ��Mrd L' Phone: 1 r Address: b Teln ►2 aL QK - -ems M41,15 Supervisor's Construction License: ��( 2 Exp. Date: Home Improvement License: 1,11 6-5`? Exp. Date: - ARCHITECT/ENGINEER Phone: 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: $ /o 0/ 0 0 FEE: $ '� Check No.: � - I r� Receipt No.: 4TFo NOTE: Persons contracting with u egiste ed contractors do not have access to the gu anty and �Signature,of,AgeritlOwner Signature�of�contiactor, `^'` Location___3qr L� �i A/� ao No. Date No�T„ TOWN OF NORTH ANDOVER !ja Certificate of Occupancy $ �,SSACHUSE�� Building/Frame Permit Fee $ ..-- Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check #` -+qS--- Q 2 4 tCi 4 0 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 DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dempster on site yes no Located at 124 Main Street Fire Department signature/date 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 21A—F and G min.$100-$1000 fine NOTES and DATA— For department use ❑ Notified for pickup - Date Doc:.Building Permit Revised 2011 June/mi Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits o Building Permit Application o Workers Comp Affidavit ❑ Photo Copy of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract o Floor Plan Or Proposed Interior Work Li Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition or Decks o Building Permit Application ❑ Certified Surveyed Plot Plan o Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family ❑ Building Permit Application o Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract o Mass check Energy Compliance Report o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg .Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc: Doc.Building Permit Revised 2008mi n3k EL E. U e Residential && Commercial RoofingtGlh�iila�>ma�grs All,Types 4f S$ad[utrn� CHIMNEYS POINTED-RESUIILT-CAPPED Expert Masonry Work k Mass Toll Free r'` Roof j eafss E.�A ert`` � Licensed& Insured i_800-WAIT-4-US rV76 License#034200 3 1924 $4137) l � azleE '1'zae'sz o co in -`" We Work Year Found x Proposal To» 1VJ[egan Mohr Aate 14/20/2011 Street: 395 Rear Hill Rd. 508-816-6329 N.Andover, MA Roof proposal mccmohr@comcast.net 1. Protect house exterior and landscaping as best as possible. (tarps etc.) 2. Strip all shingles from entire main roof Total roof cost: $ 15,100.00 3. Inspect and re—nail any loose or lifted plywood or boards, Any compromised plywood will be re- Note* Existibg Hix vent drip edge on eaves will re- placed at an additional cost of$50.00 per sheet of main as part of the ventilation system. 1I2"cdx fir. 4. Install heavy gauge aluminum drip edge to all Balance due upon completion eaves and rakes. 5. Install 6' of IKO Armourguard ice and water Referrals available upon request shield along all eaves,wall connections and top to bottom in all valleys. Highly rated member of the accredited BBB and 6. Install all new pipe boots. Andes' List 7. Above the ice and water shield, install IKO syn- thetic underlayment to the remaining sheathing up Thank you! to the ridge. 8. Install IKO starter shingles to all eaves. ; 9. Install IKO Cambridge 30 AR Limited Lifetime architectural shingles to entire main roof 10. Install new GAF Cobra ridge vents. U 11. Counter-flash chimney with ice and water shield, seal and tie into new roof 12. Shingles are covered by mfg. warranty 13. Building permit included. 14. Removal of all work related debris. 15. Contractor workmanship warranty=10 years un- der normal wind and rain conditions. Acceptance of Proposal--The above prices, specil ications and conditions are satisfactory and are herby ac,.. cepted. You are authorized to do the work as specif ed.Payment will be trade as outlined above, Date of Acceptance: Signature: Portland 40 Warren Avenue,Portland, ME 04104 207-797-7950 Fax 207.797-5$46 �„�, Bangor 35 Godsoe Road,B gar,ME 04401 207-947-8112 Fax 207-947-4366 ACU CERTIFICATE OF LIABILITY INSURANCE DATVW% timyr; ►+waac> TMS CERTWCATE IS IMMD AS A MATTER OF WORMATION Perry Insurance Agency ONLY AMD CONMRS 0#0 RN,'fT8 UPON THE CERTIFICATE Road NOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND Oft 522 Chickerin 9 ALTER THE COVERAGE AFFORDW BY THE POLICIES WLOW. North Andover.MA 01846 _a_ 103MRS AFFORM6 COVERAGE MAIC Ir Mi$UFtER& ATLANTIC CASUALTY INSWiANCE JOHN lANZAFAME IAB AIM DRA ALL UNDER ONE ROOF C. � 30 TEMPLE OR aR D. METHUEN. FAA 01844 e COVERAGE3 TIE POLsMS OF NQUI%ANCE.LISTED BELOW HAVE BEEN ISSUED TOTHE tM)RED NAND ABOVE FOR THE POLCY PERIOD MDICATED.NO7WrtHSTANDiNG ANY REOt REMENT,TERRA OR CONDITRIM OF ANY CONTRACT OR OTHER DOCUMEW WITH RESPECT TO WHICH THE CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE UIVSURANCE AI MIDIED BY THE POLIOS DESKRED HOtM LR SLISUFCT TO ALL THE TO".EXCLUSIOUS ARID CONDITIONS OF SUCH POL ISS.AGGREGATE LOUTS SHOWN MAY HAVE BEEN REDUCED BY PAR)CLA64. "TRM I I TYPEOFINSURANCE POLICY A GEMEYtAL L mmm-Y L I 15000227 9/11/2011 9111/2M 2 f,,o4 ooctmterxx S 3w,900 00 J C01WERCIAL GENt RAL t ca Wrtr ROM t 1500 CLAWS&OM 0 OCCUR MED Exp ft ww ors) S 2.500 00 { PERSONAL t AOV IkAWY S w om ea T GENERAL AGGREGATE S 660.00000 IGENi AGGREGATE S S6,AP4+UES PEft PRODUCTS•cow/OP AGO S 600-0000 Policy PRO45-CT Fj LOC FTS AUTOWNBILl U^IKtTY COMIBINfD 57NCi.E Uf UY s ANY AUTO I +t tti+c•-++i} t .....___......._�.._.._.. ALL OWED AknO$ 1 BODILY INJURY 11 S .. SCHEOUIt_DAUTitiS f �+x-*.rt? HIREDAUTOS BDO4Y 1"tJUR`°_. ...�..-.. f 4014OWWDAVTOS (Per acc =snti, 1 PROPEArf OAIAGE I fPt•awu±�+ls GARAG[UADILrTY AU70 OF$Y.EA ACCIDENT S. ANY AUTOQTt� �1hN EAACC i AUTO Qk<1 AGG $ EXC 1$*ANMREI.LA LisRftl'i.1TV EACH DCLURR£tor-t I OCCURCL^mSAWDE AGGREC ITE I � T OEOa/CTIBLE S _ ....w..._ 1R(REpTeffit"ON S A �OMFR$`LtA�lil'YIDiIAMb AWC7009464012010 11/09/2041 11/09/2012 TORYLtM11T3 ER ANY PROPRIEjOR7PAiTW-PJEXCC0T" EL,EAQvAMGtNf I :00'XJOAi OFFICERRAEMBER EXCLUOE'.Tr tet.°2 ffOU 0('r H dourbe WWtr ElAt5EA3E•EA£M�'iOYEE 1 ..._.. SPECIAL PROVtSK MS Do-a. E L DW.ASE•POLICY LINT I OTEtEIt CERTIFICATE HOLDER CAMCELLATION TOWN OF WEST NEWBURY Utl10ULDANYbFtNEA QU:OCRIsmit0! MtCe1NCELL!ODtFORLTfl!tx!IlRA' DATE TKIWAo«."9 IRSMW4*4UkElt WILL EMDCA1VOR TO MAX 10 DAYD ImfT TI %AfrQT A19Z1NQ1 UAV ROA MORC NOTICE tO THE CEIRTOXATE64OLMRNAMED TO THE LEFT.BUT F"tMF Y0&D SO SNA ,kW Ganatruebop SuperASW Lu:ense: CS ('3120 Reat,-Cted W W jOHNI W LANZAFAW 30 TEMPLE OR ME-rHUEN.MA 01"4 44K tsplratl p 413=111 Trx 1340 A, .. 4`' Office of Consumer Affairs and usiness Regulation ;. 10 Park. plaza- Suite 5170 Boston, Massachusetts 02116 Home improvement Cg °r Registration R+sr,+mSu00 ,3rW TV6e. 08A Tre 261 scfz l EXPW8 i0n' ,012n. )12 ALL UNDER ,3NE ROOF JOHN L.ANZ•AFAME 166 A MERRI A 0844 METHEUN, 0 tiQdste Addtteas aad return card.Mark reason for 1cu��sre� Address : Aewewal , , t'rnpley+�i L4cmw Or fvOgmtien Vaud w ipdiridal wt oat+ A1�inM+� dsee. if 6orsdd ratotn ea: tT}1}rr p p105t#Mpr 1MEftli^a EAe flt1161! {pttita iMtPROVEle NT CONTRACT OM"of Car+stf3ver Affairs and Bosineas ltegv R. owz 1371157 Typo: 16 pot @'tsps-safte-5'179 } Ia>iFtratian 1tIt2lZU77 06A Scow.MA 62116 411.Atit.ii�;¢C1tvE ROOF ,t1'>4N t.ANZAFAME t(6,t+MEwRIMACK Sri U Niot VA9d.r3tl10at s sAoirHELN MA 01944 1'adersee*�tan The Commonwealth of Massachusetts _Prnt•Forn_�_� Department of Industrial Accidents Office of Investigations e y 600 Washington Street - Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/individual): Al J V n,�I CA OK-C 0�4` Address: 1,211 City/State/Zip: (A/Kj Phone#: 9/1,(' 7,) -171-3� Are you an employer?Check the appropriate box: Type of project(required): 1.L7 1 am a employer with 4• ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 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 forme in any capacity. employees and have workers' 9 ❑Building addition [No workers' comp.insurance comp.insurance required.] 5. n We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.E]Plumbing repairs or additions right of exemption per MGL myself. [No workers comp. 12.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no 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. lContractors 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 mustprovide 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. n Insurance Company Name: /1;. .N Policy#or Self-ins.Lie.#: ,� C ° 9 q L 4 V( . Expiration Date: Job Site Address: [� t L L n 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. Ido hereby certify under t pains a penalties of pefjury that the information provided above is true and correct. Signature: Phone#: 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#: IInf®rmati®n and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in_(city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. Anew affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and:fax number: - -- --- The,Cozx MOjawean of MaBsachusetts Departneut of Industrial Acoidents Offiee of Investigations 600 Washington Street Boston,MA 02111 Tel. #617-727-4900 ext 406,or: 1-977-M. ASSAFE Revised 4-24-07 Fax#617.727-7749 www,rMa5s,govfdia NORTH Town of _: Andov* er . 0 v 4 r No ........... . d over, 1Vlass., ` •a' • LAKE COC MICHE:WICK V 7� � ADRATED P � S BOARD OF HEALTH Food/Kitchen Septic System PERMI T D BUILDING INSPECTOR THIS CERTIFIES THAT...................... ...... .�. !1�..... ..�i►.�. ... ....... ........ .. ............................... Foundation has permission to erect............ Apo ............................ buildings on .. ....... -for �. .. .......�i�.1e.......... Rough to be occupied as....... )to, pi� ........` ........ .. . ................................................................... .. Fi al- y h' eprovided that the person athis permit shall in every respect form to the terms of the application on 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 PERMIT EXPIRES IN 6 MONTHS ' ELECTRICAL INSPECTOR UNLESS CONSTRUTS Rough ..... .......................................................4�........ Service f BUILDING INSPECTOR ' 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 SBDE Smoke Det.