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HomeMy WebLinkAboutBuilding Permit #173-15 - 42 PROSPECT STREET 8/18/2014 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: �� Date Received Date Issued: v t i, IMPORTANT:Applicant must complete all items on this page - r'Fa,:.��„,'-_ •' ".o ..,a.: � oma �--- - ,� - � �' - - �r..`.R : 1PROPERT�Y OWNERS ,, A � Pring 1'OONYear Old St�ucture� yes no < F MAF NOS`� z PARCEL Z Z®NI:NG QI;STRICT _ — istonc'Dlstrlct ,yes #n--d) in -!k! Village, yes ono _ _ TYPE OF IMPROVEMENT. PROPOSED USE Residential Non- Residential ❑ New Building ne family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: 0-Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septicy ❑Wellt '❑Floodp IaI n O'lNetlantls ❑ �UVatershedt®IstrIct 'A _ } Fri- a ❑ 'W ater/ewer. _ J _ DESCRIPTION OF WORK TO BE PERFORMED: p Identification Please Type or Print Clearly) OWNER: Name: J,IS4 d Ji21Z Phone: Address: 4S /?a s c ' /M J e✓� �, - ------- � CONTRACTOR' Name � G'� _ Rho-nee 7 .. �� f Address '' '�lz- om • meq, P e Date: Gf( S.0 ervlsor's.�.ConstructiQ kens` _ ,- ar u - - `/ Hone Improvement-License '%�,5.� ti .. ._ ;Exp =Date ) ?� ARCHITECT/ENGINEER Phone: I 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: $ S ��� o FEE: $ (0 G U Check No.: Receipt No.: 21 oil . NOTE: Persons contracting with unreg' tered contractors do not have access to the guaranty fund r,at �A ent%Owne�`� 9�� . .9 - SI In ture.,oTo, .contract_©r�'. f Y' Plans Submitted LJ ans Ived ❑ Certified Plot Plan ❑ tamped Plans ❑ : Plans Submitted ❑ " :. ;Plans Vi/aived E].,: -_.Certified Plot Plan ❑ Stamped Plans ❑ :TYP1✓O){`:S) WERAGEDISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑. Swimming Pools ❑ Well ❑ Tobacco.Sales ❑ .,Tood Packagin S -Private:(Septic-tank,etc._ . ❑. " g� ales El Perrriarient-Diimpster ori.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 . r 4 _ COMMENTS i Zoning Board of Appeals: Variance, Petition No: Zoning Decisionfreceipt submitted yes . Planning Board Decision: Comments I Conservation Decision: Com _.. ments Water & Sewer ConnectionlSDate Driveway Permit DPW Toiv.. Engineer: Signature: Located 384 Osgood Street SIRE'DEPARTM. IvT Temp Dumpster on site . yes no Located at�124Mair Street _ t.{< Fire-Departme'ItSlgll�tlll`e/dslte COMM.E NTS } r 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 U Notified for pickup - Date Doc.Building Permit Revised 2010 t I Building Department -< The fohpwing is'a list of he required:forms to be filled outfor:the appropriate.permit to.be obtained. Roofing, Siding, Interior Rehabilitation Permits - Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And-/O'r C.S.L: Licenses 7 ❑ 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 i 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 o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o 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 apu•?al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submAted with the building application Doc: Doc.Bui!ding permit Revised 2012 Location 42— No. t� 1 Date 0 � l e - TOWN OF NORTH ANDOVER e Certificate of Occupancy $ j Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee TOTAL $ Check# � j IN� 11 27910 Building Inspector t%OrHR' Town of _ Andover M, ......... .... to A- No. It - zy th ver, Mass, COCHICHII""CK 1- A- 7,�AERATE O J'PP�,`'�5 S V BOARD OF HEALTH Food/Kitchen PER IT T LD Septic System THIS CERTIFIES THAT • V�`�'� BUILDING INSPECTOR ...................... ....... ..... ....... .................................. ................... ..... ....... ..1.. ...{/f�4. ......ssfle,w,� Foundation has permission to erect .......�................: buildings on ... �1 ��. ••• �rwr� �l . ... Rough tobe occupied as ... 1. .......... ..... ...................................................................... Chimney provided that the person acce in this permit shall in eve respect conform to the terms of the application p 9 p every p pp Final 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 CONSTRUC N QRTRough Service ..........( ...... ........................ Final BUILDING INSPECTOR 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. i i 140"� NV Yl INK31l Commercial R ofi A l Types Of Expert Masonry Work !fuss Toll Frei � � ��� Licensed � Insured s t'x t fx !i s n(rJ'<§c-C)�rt aax•t! 4r .c !J'I`(i 3 1..800-L AIT-44 . , License#034200 (924-848?) a .< ? � � , . '4'Z Work. Year k exaa.md $ask `�'a� wy �.i^ �2^t° fix, 'ei " L - � � p i-5 � � ,.������ qar�d isa �Kf u:a y .�n i _ �p�-� ami• i R Proposal To: Lisa Burke Date 5/14/2014 Steve Levesque Street: 42 Prospect St. 978-702-7095 N.Andover, MA Roof proposal levesqueconstruction@comcast.net Certainteed Landmark 1. Extra caution will be taken to protect house 1.2. Removal of all work related debris. Planks will be exterior and landscaping as best as possible. placed under dumpster to prevent any damage to (tarps etc.)Magnets run at final clean up. driveway. 2. Remove all shingles from entire house except 13. Building permit included. rear dormer. 14. Contractor workmanship warranty: 10 years under 3. Inspect and re-nail any loose or lifted plywood. normal wind and rain conditions. Any compromised plywood will be replaced at an additional cost of$55.00 per sheet of 1/2" CDx fir. Total roof cost: $ 5,500.00 4. Install heavy gauge 8" aluminum drip edge to all Total Gutter Cost: $ 900.00 eaves and rakes. White, brown or mill finish. Install all new white.032 aluminum seamless 5. Install 6' of Certainteed Winter guard ice and gutter and downspouts. water shield along all eaves. Full coverage on' Wings: right side low slope roof. Install new'white composite PVC freeze boards. 6. Install Certainteed Diamond Deck synthetic Wall connection will be flashed with ice and underlayment to remaining sheathing up to water shield and all new aluminum step ridge. flashing. 7. Install all new pipe boots. *Note*: Please be advised if applicable, valuables in Pp 8. Install Certainteed Swift Start starter shingles to the attic should be moved or covered due to minor all eaves. debris, dust and asphalt particles that will accumulate 9. Install Certainteed Landmark Limited Lifetime during the stripping process. All Under One Roof not architectural shingles to entire house except rear responsible for any damage or clean up that may dormer. 10 year MFG shingle warranty. All occur in attic. shingles will be installed and fastened according to mfg. specs. Balance due upon completion 10. Counter-flash existing chimney lead and wall connections with ice and water shield, tie into References available upon request new shingles and seal. 11. Install a new GAF Cobra ridge vent capped with Highly rated member of the accredited BBB and color matched Certainteed Shadow hip and ridge Angie's List shingles. - --A / Thank you! y The Commonwealth of Massachusetts , - Deparbuento,flndustrialAccide is Office of Investigations 600 Washington Street Boston,MA 02111 www.mass gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors Electriclans/Pli mbexq Apulieant Information Please Print Le2lbk Name(Business/Organizatiowbdividuai): Owe- 2pJ/::� Address: <1-> -02 City/State/Zip: Phone It: Are you an employer?Checke appropriate box: Type of project(required): .1.�am a employer with�S 4. ❑I am a general contractor and I 6, []New c6nstruction employees(full and/or part-time).* have Hired the sub-contractors 2.El am a sole proprietor or partner listed on the attached sheet: 7� Remodeling ship and'haveno.employees. These sub-contractors have S. ❑Demolition working forme 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.[] I am a homeowner doing all work right of exemption per MGL 1I.❑Plumbing.repairs or additions myself.Iwo workers'comp. c.152,§I(4),and we have no 12,0 Roofxepairs insuraucerequired.]i employees.[No workers' 13 comp.insurance required.] xAny applicant that checks box#1 must also fiat out the section bel6w showing their workers'compensation policy information. 'Homeowners who submitthis affidavit indicatngthe f tie doing allwork and then hire outside contractors must submit anew affidavit indicating such. tContractors that checktbis box must attached au additional sheet showing the name ofthe 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 ani'job site information. Insurance Company Name;- /,A-1 fiw UTw� Policy#or Self-ins.UG.#: Expiration Data: lob Site Address: CZ 5�-P c./' S% /� City/State/Zip: Attach,a copy of the workers'compensation-polley declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A ofMGL o. 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 inn,the form of a STOP WORK ORDER.and a fine of up to$250.00 a day against the woktor. 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 Izereby cert&uridep the ins d pena les ofperjury that the information provided above is true and correct. Si ature: Date: l �( Phone#: `7 Oficial use Drily. 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#: Information. and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an eraployee is defined as"...every person hi the service of another under any contract ofh1ra,- express orimpHA oral orwAtten." An employei is defiu.ed as"an individual,partnership,association,corporation or other legal entity,or any two ox more of the foregoing engaged in a joint enterprise,and including the legal representatives of a-deceased employq,.Or the xedeiver 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 1.52,§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,MOL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance ofpublic work until acceptable evidence of compliance with the insurance requirements of this chapter have beenpresented to the contracting authority." Applicants Please fill,out the workers'compensation affidavit completely,by checking the boxes that apply to yoursituation 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 ox partners,are not required to cant'workers'compensation insurance. If an LLC or LLP does have employees,apolicy is required. Be advised thatthis affidavitmay 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 thepern it 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 poficy,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 thatthe affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit fox 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 pemsit/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(ifnecessary)and under"lob 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 ox permit not related to any business or commercial venture (i.e.a dog license orpermit 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.anal fax number: • Tho CQ1WA01M1a6OFMIQ acAu. Ptt, Department ofladmidal.A,ccidwits Of ace ofTuVesugationa 6bG WasbiugtM&Ceet Boston, 02111 TOL#61M-2'_4900 at 406 ox T-8,77:Wi A Revised 5-26-05 Fax#617-727-7749 lair." BU."wess Kcgu IdI1011 OCABIR) Aft0s 4&Bus of Con-o"01 Consumer AffajTs and Susi"ess R094kom n LookuP Home ImPrOverwitent COntrOctor ReOsl"tlo PQu can seardii-flitf- the reglStXt'ltton jig by any 01,he cme", below searchi Search by RegiStwat"D""U"'beIr F3-7057---'-% Search by Registrao� Name S i Zip Code I Searcii UY City ,earch RegiStfalls vie, comp history You can a'so view g number to Sday, September 20, 2012. The IiSt is curre it of Thur Search Results EXPIRATION STATUS REGISTRANT T RESPC AISLE RlE6*T"T'0" ADDRESS DATE NAME IpdD ,UALI t4UMBEER 01()Z 2 166 A FWACHARO e)l 4 .ME �37057 1 INCIE R ONE i~CKJ ANZ� BUILDING METHEUK MA 01844 all aSsachusells Department of Public Sately Board of Building Rj'gulatioas and Stanoards r,% License: CS-W9120 JOHN W LANZA 30 TEMPLE DR METHUEN NA Qa�oa 1 J 1612013 a . 38 : k3 PM ,Z3 33'� 8618 atruelw YY� ' CERT114CATE OF L IA131LITY INSURANCE smuft"mIWV=1 awmick'T Of WMAN2 OM an p"OUM AM TO bOWWATS ���� . 1co�ll a u Ra/AitOi'{v A dosf nal eottfer aQBtts puff. RRnRy t�tlPtt hears �14�lRR0�!>OW�te��' MI. � $ arares LLC. 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