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Home My WebLink AboutBuilding Permit #515 - 421 MASSACHUSETTS AVENUE 4/2/2009Permit NO: r, I I Date Issued: J 0 10 d BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received y 1• IMPOV.TANT: Applicant must complete all items on this page LOCATION Pri t PROPERTY OWNER t�C�,P.�� WOO Print MAP"NO: PARCEL: ZONING DISTRICT: Historic`Districtyes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration No. of units: Commercial epair, replacement Assessory Bldg Others: Demo i ion Other Septic Well Floodplain Wetlands Watershed District Water/Sewer . 5CRIPTION OF WORK TQ BE PREFORMED:. Identification Please Type or Print Clearly) OWNER: Name: ��QQ,1,.� YIliC {.jc��. Phone: Address:Jyr CONTRACTOR Name. N Phone: Address. Supervisor's Construction License: ° Exp. Date: Home; improvement :License;Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE: SULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ ��(� 00 '"' FEE: $ 0 � Check No.: It, Receipt No.:_OR Clod"" NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund /lA . - - I/1 _ re or contractor -'{ " 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 2.2008 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 T1 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 5 COMMENTS i Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: Com Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer:<§i,►ature: LOcatea J64 US OOa Street FIRE DEPARTTorn p Durnpster on site yes no • Located at 124 Ma' _ Fire Department signature/date COMMENTS Dimension Number of Stories Total land area, sq. ft.: Total square feet of floor area, based on Exterior dimensions. ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No .DANGER ZONE LITERATURE: Yes MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine No NOTES and DATA — (For department use ❑ Notified for pickup - Date . ......................... ..................................................................... _... .............. ............. --........ ---............. _............ _.................. ...................................................................... _.._.... ................... ................. _... _.......... _... _........................................................................................._............... ........................... Doc.Building Permit Revised 2008 Location No. Date &ORTH TOWN. OF NORTH ANDOVER O't..•o .•.�hO. F S 4L I Certificate of Occupancy $ cHus `� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # U� 21902 Building Inspector s j Page No. of Pages proposalBuilders License # 58443 Home Construction Reg. # 109288 1 t � _ �D e QOOU,fl,L 0 0aac� (781) 944-1994 (978) 664-2557 "The Areas Oldest Roofing Company" P.O. Box 637, North Reading, MA 01864 7 PRO AL B 4ellV- ��r_ 412b71 DATE / V ( V S ET' d i'' iL� ,i I • P ve f"j° tt � 00 , Oa CITY, STATE A D IP CODE A V JOB LOCATION We hereby submit specifications and estimates for: Recommended — Aq Ii r. k0of (Included in price) Optional (Not included in price) jf Rip & Remove all shingle debris from roof & job site: ❑ 1 layer d2 layers ❑ 3 layers or more (t` Repair/or Replace any roof decking; not to exceed 50sq. ft. (additional at $1.70 per ft.) :<• Install 8"61uminum drip-edge/and rake -edge along entire perimeter. Choice of miI6 =whiteLpr brown Install ICE & WATER underlayment along horizontal eaves, valleys, sidewalls, sky -lights and chimneys Install premium base sheet underlayment between roof deck and roofing shingles Install 30yr CertainTeed/GAF/Tamko or IKO architectural roof shingles ❑ 40 year\ ❑ 50 year ❑ 60 year ❑ Lifetime " See manufacturer warranty policy for more details e t Install new aluminum vent -pipe flange (s) Chimney (s) -counter-flash and re -step existing flashing ❑ Cut & Install new lead flashing ` Ridge-vent/exhaust vent with low profile design, hidden by'shingle4SPS� ❑ Soffit -ventilation I ,. Roof louver -vents 0Q • Seamless style aluminum gutters - custom fabricated at job,site by our own gutter machine ❑ Downspouts t �� ❑ Leaf gutter guards i OtherVa1�C'1 S �t �� v1"�s e d lr/Ch �� I�rrr �F �rr�� % ubPr�t jd*0-N, f. � f Cl' UAJef G m el d �Q 12ef 0 l� 3.5 I to s e 'Please Note: All items in roof attic should be removed or covered due to falling roof particles, at time of roof tear -off Price includes all items above that are checked only / others may be priced separately upon request. We ]Jrapase hereby to furnish material and labor - complete in accordance with above specifications, forthesum of: ado�� Total price not including options. dollars ($ S � � ). Payment to be made as follows: 30% deposit required before ordering materials. Balance due in full upon day of completion. Please make all payments out to Kenneth Duval, mailed to: P.O. Box 637, No. Reading, MA 01864 V' Late charges of $50 per week for all outstanding bills due upon day of Authorized completion. Signature - Accepting proposal means agreeing to the terms of the enclosed binder Note: This proposal may be(� contract- Please Sinn cnntract R roti inn Mn ennv twhital with rianncit withrfralnrn by i ie if not nnrontnrf —ithin � 4J rlo„, r RightFax N3-2 3/30/2009 7:19:59 AM PAGE 2/002 Fax Server ACORD. CERTIFICATE OF INSURANCE DATE (MMIWYY) 03••30-09 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE GILBERT INS AGCY HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 137 MAW ST ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE READING, MA 01867 73MCG INSURED DUVAL ROOFING LLC P O BOX 637 NORTH READING, MA 01864 COMPANY A TRAVELERS DIRECT ASSIGNMENT COMPANY B COMPANY C COMPANY D COVERAGE THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NMIED ABOVE FOR THE POLICY PERIOD INDICATED, NOiWITHSTANDM ANY REQUMEMEbNT, 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. LIMIT'S SHOWN MAY HAVE BEEN REDUCED BY PARD CLAIMS. CO POLICY EFF POLICY EXP AGGREGATE LTR TYPE OF INSURANCE POLICY NUMBER DATE (MMOMYY) DATE LIMITS GENERAL LIABR.ITY GENERAL AGGREGATE $ COMMERCIAL GENERAL PRODUCTS-COMP/OP AGO. $ CLAIMS MADE OCCUR. PERSONAL && ADV. INJURY $ OWNER'S && CONTRACTOR'S PROT. EACH OCCURRENCE $ FIRE DAMAGE (Any one fire) $ MED. EXPENSE (Any one person) $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULE AUTOS HIRED AUTOS NON -OWNED AUTOS GARAGE LIABILITY ANY AUTOS COMBINED SINGLE LIMIT $ BODILY INJURY (Per Person) $ BODILY INJURY (Per Accident) $ PROPERTY DAMAGE $ AUTO ONLY - EA ACCIDENT $ OTHER THAN AUTO ONLY: EACH ACCIDENT $ AGREGATE $ EXCESS LIABILITY UMBRELLA FORM EACH OCCURRENCE $ OTHER THAN UMBRELLA FORM AGGREGATE $ WORKER'S COMPENSATION AND A EMPOLYER'S LIABILITY UB-MON919-09 03-11-09 03-11-10 STATUTORY LIMITS X THE PROPRIETOR/ EACH ACCIDENT $ 100,000 PARTNERSIEXECUTNE X INCL DISEASE - POLICY LIMIT $ 500,000 OFFICERS ARE: EXCL DISEASE - EACH EMPLOYEE $ 100,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLESIRESTRICTK)NSISPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE TOWN OF NORTH ANDOVER EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT 120 MAW STREET FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY HIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. NORTH ANDOVER, MA 01845 AUTHORIZED REPRESENTATIVE ACORD 25-5 (3/93) Charles J Clark CA m m m CO) m CO) F) C2 y C � � d CO) CO) CD Z y G.O n• r � � o CL y aUM -0 o p CD . CDCL O cr CD CD CD mm C O N�• • CD CL. O CO) �Q CD . CO) � Z CD .Ort O CD ' O CCD 0 �0 W �I cn cn n 0 cn C O O O O O to 0 00 C _ co CD coC cF O a a N co ? a c m _= z Q N S m N y ama m n 0 H0 06 C 40 O N T � CL o CO) N IE 94' St Z�.n l =r ' N CL 0 =r O m 71 a m .� CDff: N d N . cr CL gyCD: C m N M N to CIO& o t o �o: o � � O = m CD CD H = CD m m Z a� C-) 0 = o CD B z n ='- o( �i o 0 b 5 0 t" M Ix w n C :T, o CL O C d I O a x H 0 ✓fie -Uan�inw�zcuea`� o�✓%�aaaczctivaeka Board of Building Regulations and Standards Construction Supervisor License Lic n'se: CS 58443 �E{{x'-piration 1 /10/2009 Tr# 9949 �y1L S t lti rResfi% ip :00t KENNETH P DUVL� PO BOX 190/72 NORTH N READING, MA 01864 Commissioner 0 ✓fie i�am�nanulec� a�aeaciiuGetld Board of Building Regulations and Standards HOME, IMPROVEMENT CONTRACTOR Registration: 109288 j, DUVAL ROOFING'--_' Kenneth Duval 72 NORTH ST N. READING, MA 01 License or registration valid for individul use only before the expiration date. If found return to: - �- � Board of Building Regulations and Standards One Ashburton Place Rm 1301 Boston, Ma. 02108 Not valid without signature The Commonwealth of Massachusetts FDepartment of Industrial Accidents Office of Inva4adons 600 washingion Street Boston, MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information_ , Please Print Legibly Name (Business/OrganizationtlndMduel): Duval Rog inn- Li C PO Box 637 Address: Nn Beading, Aea &Im Phone M 9 Are you n employer? Check the appropriate box: 1. Ularn a employer with 1, 4. [ ] I am a general contractor and I employees (full and/or part-time).* 2,E] t am a safe proprietor or partner- ship and have no employees working for tree in any capacity. (No workers' comp. insurance required.) 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t have hired the sub -contractors listed on the aftched sheet. These sub -contractors have employees and have workers' comp, insurance.; 5. ❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. ileo workers' comp. insurance required.] 66 Type of project (required): 6. ❑ New construction ?. p Remodeling 8. [] Demolition 9. ❑ Building addition 10.0 Electrical repairs or additions 11.0 Plumbing repairs or additions 12.G54MR repairs 13.❑ Other *Any nVilewt that dmks box At mtrat alar 511 out the section below showing their workers' eomperamion polity infammion. t Hornwwners who submit this affidavit indicting they ate doing all work and then hire outside coatnetaas must submit a new allidatil ind'uZing sueh. tContrwtois that cheep this box mast suackd art s ddidonai Sheet dtowing the name of the sub ewttntetnrs and Mme whether or not those anitfes lim ernployom If the sttb-conunetots hays mWkyees they must provide their workers' comp. poficy nwaber. I oun an employer that is providhtg warkers' campowa fan lnsur=ce fnrmy aWayeim Below is the policy and/oh site information. Insurance Company Policy # or Self -ins. Lic. #: —7 9-,T o,6 01 � 0 /Lf 9 / X61 %` Expiration Date: ( 11 / Job Site Address; Y.2 / �a4-✓ City/StatelZip: 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. t52 can lead to the imposition of criminal penalties of a fine up to 51,500.00 and/or one-year imprisotunent, as well as civil penalties in the farm of a STOP WORK ORDER and a fine of up to $250.00 a Clay against the violator. Be advisedthat a copy of this statemem may be forwarded to the Office of Investigations of the DIA for insurance coverage verifica ion. I do hereby eertff y Under the paints and penahies of perjary that the injormetibn provider! above is true and wrrmr. Ofjlcial ase only[ Do not write in this area, to be conWicted by city or town ofciuL City or Town: permit/License # Issuing Anthotity (circle one): L Board of Health 2. Building nepartment 3. Cityfrown Clerk 4. Electrical Inspector S. Plumbing Inspector 6.Odher Contact Person: Phone M