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Home My WebLink AboutBuilding Permit #324 - 42 JAY ROAD 10/23/2006 TOWN OF NORTH ANDOVER NORTH APPLICATION FOR PLAN EXAMINATION O 0 p N' Permit NO: Date Received �,SSAUSE�� Date Issued: 013''�� r II y * IMPORTANT: Applicant must complete all items on this page LOCATION_� .Z �� '•t Print *PROPERTY OWNER V J Yf)LJ &�Qz ff- Ig Print MAP NO.: PARCEL: ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New.Building ❑ One family L" Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: Repair, replacement ❑ Assessory Bldg ❑Commercial Demolition Movin (relocation) ❑ Other ❑ Others: C' Foundation only t DESCRIPTION OF WORK TO BE PREFORMED s % Fi � ( Ah, �-mac Identification Please Type or Print Clearly) 'l OWNER: Name: �/ j� fi / �{1,t,�_ 1/Yj�� Phone- Address: ab CONTRACTOR Name C°L Phone:60 Address:—?> � r G Supervisor's Construction License: 7� Z Exp. Date: ..Z13 /Q� 11 sN'. Home Improvement License: Exp. Date: &e: "ARCHITECT/ENGINEER <<me: Phone: - ..'Address:address: Reg. No. FEE SCHEDULE.BULDING PERMIW$120 PER S'1000.00 OF THE TOT,4L EST/MATED COSEASED ON 5125.00 PER S.F. Total Project Cost :$ �6�(0, 57�) FEE:$ a _ Check No.: /P_q— Receipt No.: Page iof4 r N' Building Department The following is a list of the required forms to be filled out for the appropriate permit to be 0 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 Addition Or Decks ❑ Building Permit Application ❑ 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) 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 PlansOne To Be Returned)d) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report 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:I.NSPE(TIONAL SERVICES DErAARTNIEN'rMFORNI05 Page 4 of 4 TYPE OF SEWERAGE DISPOSAL Tanning/Massage/Body Art1-1 ❑ Swimming Pools Public Sewer �� Tobacco Sales Well Food Packaging/Sales 11i, i Permanent Dumpster on Site ❑ Private(septic tank,etc. ❑ Electric Meter location to project NOTE: Persons contracting with regi er /cont r ct s do not have access to the ,U ty I d" f Signature of Agent/Owner Signature of contra Plans Submitted ❑ Plans Waived Certified Plot Plan ❑ Stamped P ns ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF- U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ r COMMENTS / DATE REJECTED/ DATE APPROVED CONSERVATION ❑ ❑ COMMENTS j f 1 DATE REJECTED DATE APPROVED HEALTH _ ❑ , ❑ s COMMENTS FIRE DEPARTMENT - Tem Dum seer p p on site yes no Fire Department signature/date COMMENTS, Zoning Board of.Appeals: Varia tcce, Petition No: "Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water&Sewer connect"ion/Signature& Date Driveway Permit r . / I IT i Building Setback ( Front Yard Side Yard Rear Yard RequiredRequireLI Provided Require d- Provides Required Provided Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: I NOTES and DATA— For department use y i Page 3 of 4 Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORMOS Created JRIC Jnn.'_On6 1 1 k. t Location 'Z ell No. Date iEr � I� �oRTN TOWN OF NORTH ANDOVER 3?o�,t`,o <•,hO I C trtr1 A � + : • : Certificate of Occupancy $ ,SSACMUSEt('� Building/Frame Permit Fee $ /91. d Foundation Permit Fee $ �= Other Permit Fee $ r TOTAL $ I,. Check # 19723 F r f Building tnspectO Of 11 ORT Town of Andover 0 0% No. 37.� 0 over, Mass., 2j 0 LA COCHICHEWICK C IT 0'0�ATED WARD OF HEALTH Food/Kitchen PER IT Septic System THIS CERTIFIES THAT 41�............ BUILDING INSPECTOR ...... .... .... 401 .. .*............................ Foundation has permission to erect........ .................. ...... -buildings on ......YJX.....74J. ...... 4100e............................ Rough Chimney to be occupied as.... ..10-e ...ia& ........................................................ provided that the person acct -t-hpols—permit shall vi ry respect co'4%h 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 CONSTRU111IRTARTS Rough Service ................ Final Occupancy Permit Required to Ocatpy 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. IF-SEE REVERSE SIDE Smoke Det. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations „ 600 Washington Street U Boston, MA 02111 www.mass.g ov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual):C4LJ X74 � �, _�f R �"�(k(51 Address: z—V , City/State/Zip: � d �l.( �,/ Phone #: Are ygn an employer?Check the appropriate box: Type of project(required): 1. I am a employer with_C� 4. ❑ 1 am a general contractor and 1 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 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its officers have exercised their 10.❑ Electrical repairs or additions required.] 3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself [No workers' comp. c. 152, §1(4),and we have no 12ARoof repairs insurance required.]? employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#I 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 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. Insurance Company Name: ,A -1 Policy#or Self-ins. Lic.#: WC,Fq L4 a 3 IAPr/K+q Expiration Date: 0 / Job Site Address: 7 a ��"I ` City/State/Zip:�,;�dda,&- 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 n erg pl p is i of perjury that the information provided above is true and correct. Si-nature _ Date: ldole�� 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#: ACORD„ CERTIFICATE OF LIABILITY INSURANCE CorpLla D DATE 1DD cALLr-1 10/17/06 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTE OF INFORMATIO ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE DeSanctis Insurance Agcy, Inc. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 36 Cummings Park ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW Woburn MA 01801 Phone: 781-935-8480 Fax:781-933-5645 INSURERS AFFORDING COVERAGE NAIC 5 INSURED INSURER A Scottsdale Ineuranae Cmpanpl INSURER 8: Travelers Praparty Casualty 01899 Callistus Corp. MCL Contracting INSURER C: Americas Home Aasuranoe Co. 3 Sandpiper Lane INSURER D: Seabrook NH 03874 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REGUIREMENT,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 PATE 1DD1Y DATE MlOD1Y POLICY EFFECTIVE PCILICY EXPIKAT(M LIMITS GENERAL LIABILITY EACH OCCURRENCE S1,000,000 A CXNMERCIALGENMALUABILrIY CLS1139433 06/01/06 06/01/07 MEM As"(E'ocourenae) 5100,000 CLAIMS MADE ❑OCCUR MED EXP(Any one person) S5,000 PERSONAL&ADV INJURY S1,000,000 GENERAL AGGREGATE S2,000,000 CENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG s2,000,000 POLICY PR� LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT B ANY AUTO 81089878807 05/27/05 05/27/06 (Eamident) S ALL OWNED AUTOS 8108987BB07 05/27/06 05/27/07 BODILY INJURY S X SCHEDULED ALTOS (Par person) X HIRED AUTOS BODILY INJURY X NON-OWNED AUTOS (Per acdderlt) S PROPERTY DAMAGE S (Per ecdderd) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S ANY AUTO OILIER THAN EA ACC S AUTO ONLT. AGG S EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE S OCCUR F]CLAIMS MADE AGGREGATE S S DEDUCTIBLE S RETENTION S S WORKERS COMPENSATION AND X TORY Ul AfT3 I I ER C EMPLOYERS LIABILITY WC6702410 MA/NH 05/27/05 05/27/06 EL.EACH ACCIDENT S100000 ANY PROPRIETOR/PARTNER/EXECUTIVE — OFFICERMIEMBEREXCLUDED? WC8942223 MA/NH 05/27/06 05/27/07 EL.DISEASE-EAEMPLOYE 5100000 WeZabe VIunder PRO51ONS below EL.DISEASE•POLICYLIMIT S 500000 SPECIAL OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES)EXCLUSIONS ADDED BY ENDCRiSEMF_NT/SPECIAL PROVISIONS Evidence of coverage CERTIFICATE HOLDER CANCELLATION NOAND-1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER MALL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DD SO SHALL Town of North Andover IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR 384 Osgood Street North Andover MA 01845 REPRESENTArnES AUTHORIZED REPRESENTATIVE David A. 8outiatte ACORD 25(2001108) 0 ACORD CORPORATION 1 acoRv. CERTIFICATE OF LIABILITY INSURANCE OP 10 D DATE(MMmDIYYYY' CALLI-1 10/17/06 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTE OF INFORMATIO ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE DeSanctis Insurance Agcy, Inc. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 36 Cummings Park ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW Woburn bbl 01801 Phone: 781-935-8480 Fax:781-933-5645 INSURERS AFFORDING COVERAGE NAIC 0 INSURED INSURER k Soottedale Iasurame Caapamy INSURER B: Tranelera Property Casualty 01899 Calllstus Corp. MCL Contracting INSURER C: AIDeriam Hmne Assurame Co. 3 Sandpiper Lane INSURER D: Seabrook NH 03874 INSURER E.- COVERAGES :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. LTRTIVE POLICY EXPIRATION lm*m NSR TYPE OF INSURANCE POLICY NUMBER pAIE /DD1Y DATE MIDD/YY LIMITS GENERAL LIABILITY EACH OCCURRENCE S1,000,000 A 00MMERCIALGENERALLIABILITY CLS1139433 06/01/06 06/01/07 PREMISES(Es xwrenoe) $100,000 CLAIMS MADE F—]OCCUR MED EXP(Any one person) S5,000 PERSONAL&ADV INJURY S1,000,000 GENERAL AGGREGATE S 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG s$,OOO,0 00 OFFICE OF BUILDING DEPARTMENT 1600 Osgood Street Building 20 Suite 2-64 ��`' North Andover, Massachusetts 01345 cHu`•E Gerald A.Brown Telephone(978)683_95. T' Inspector of Buildings Fax 19?Q)68S-95. H0IIEOVU�iER LiCE,iSE EYE,),-iPTiON P!ease tn-int ,. DATE: s;. JOB LOCATION::, Number Street:address HOMEOWNE " *,1V1apLot__ , ame Home Phone Work Phone _ PRESENT �V[-AILENG' ADDRESS fflff� City Town, ` State Zip Code Thc'current exemption for"homeowners"was extended to include owner-occupied dwellings to two units or less and to allow such homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor). State Building (Code Section 108.3.5.1) DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two funily structures. A person who constructs more that one home in a two-year period shall not be considered a homeowner. The undersigned"homeowner"assumes responsibility for compliances with the State Building Code and other Applicable codes,by-laws,rules and regulations. The undfrsigned"homeowner,certifies that h e.ahe understands minimum inspection procedures and requirements and that he;"she will c mplvvo'th said proc rthAndovcrSuruilas and Department rt,quirements. HOlEO1�1iERS SIG `: 'URE APPROVAL OFA ILDUNG OFFICIAL n 20L --- r•:m H„tni., ,n��rs 1::,,t.tg7tirn 41 sy A ..- .1t.TH•. ..-.'.Iii > t,r�: MCL CONTRACTING Sandpiper Lane Seabrook,N.H., 03874 (603) 474-1440 N.H. (877) 345-6577 MA Specifications for Residence Of Mitchell Residence 42 Jay Road N. Andover, MA Roofing Demolition ovals All demolition required is included in this contract. All demolition materials will be disposed of by MCL at approved site Contractor will keep construction area,neat and organized.. Construction Roof—Approx 33 Squares - Strip existing roof 3 layers including back rubberized roof - Replace with 30 year architectural shingles - Ice and water all rakes and valleys (entire back roof) - Replace all pipe collars on roof and flashing - Install new drip edge - Install ridge vent and cap - Re-Frame roof between addition to blend w/lower roof - Remove existing skylight in Sun Room - Patch interior and exterior - Repair siding as necessary - Dump all demolition material in approved dumpster 2 New Velux Vented Skylights w/flashing kits and curbing(installed) The agreed upon price for this project allowances and the specifications containe here in is Total Cost $16,250.00 acoRvwCERTIFICATE 4F LIABILITY INSURANCE °A'��"�°°""Y'f' CA 1 06/27/06 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTE OF INFORMATIO ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE DeSanctis Insurance Agcy, Inc. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 36 Cummings Park ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW Woburn UA 01801 Phone: 781-935-8480 Fax:781-933-5645 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A soottsdale Insurance Caopaapf INSURER B: Travelers Property Casualty 01899 Callistus Corp. MCL Contracting INSURER C Ameriona some Aesnraaoe Co. 3 Sandpiper Lane SeabrookNH03874 INSURER D' 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 DATE M'I'DI 1f DTE 1DDJY LIMITS GENERAL LIABILITY EACH OCCURRENCE S1,000,000 A COMMERCIAL GENERAL LIABILITY CLS1139433 06/01/06 06/01/07 PREMISES(Eaoccurenoe) S100,000 CLAIMS MADE F—]OCCUR MED EXP(Any one person) S5,000 PERSONAL&ADV INJURY S1,000,000 GENERAL AGGREGATE S2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG S2,000,000 POLICY JE� LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S B ANY AUTO 8108987B807 05/27/05 05/27/06 (Eaaccideo ALL OWNED AUTOS 8108987$807 05/27/06 05/27/07 BODILY INJURY S X SCHEDULED AUTOS (Per Peson) X HIRED AUTOS BODILY INJURY X NON-OWNED AUTOS (Per scoide� S PROPERTY DAMAGE S (Per sodde t) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S ANY AUTO OTHER THAN EA ACC S AUTO ONLY: AGG S EXCESSIUMBRELLALIABILITY EACH OCCURRENCE S OCCUR FICLAWS MADE AGGREGATE S S DEDUCTIBLE S RETENTION S S WORKERS COMPENSATION AND X TTORY LIMBS ER C EMPLOYERS LIABILITY WC6702410 MA/NH 05/27/05 05/27/06 E.L.EACH ACCIDENT S100000 ANY PROPRIETOWPARTNERAD ECUTIVE OFFICEWMEMBEREXCLUDED? WC8942223 MA/NH 05/27/06 05/27/07 EL_DISEASE-EAEMPLOYEE S100000 IfUyy��desa,be under E_ ALPROVISIONSbelow E.L.DISEASE-POLICY LIMIT S500000 OTHER DESCRIPTION OF CPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Building Permit CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES 13E CANCELLED BEFORE THE EXPTRA DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Z3B;O �13 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES AUTHORIZED REPRESENTATIVE David A. Boutiette ACORD 25(2001108) 0 ACORD CORPORATION 1