HomeMy WebLinkAboutBuilding Permit #503 - 428 PLEASANT STREET 3/6/2008Permit NO: 6
BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
n s
Date Received �a p�Aw7[o PP.�
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
New Building
One family
Addition
Two or more family
Industrial
Alteration
No. of units:
Commercial
Re it re laceme
Assessory Bldg
Others:
Demolition
Other
Septic Well
Floodplain Wetlands .
._ Watershed flistrict
Water/Sewer -
OWNER: Name:
CONTRACTOR Na
PTION OF WORK TO BE PREFORMED:
Type or Print Clearly)
Phone:
t i
Supervisor's Construction :License: ! Exp. Date:
Home Improvement'Licerse: ! Exp. Date:
ARCHITECT/ENGINE
Phone:
Address: \ Reg. No.
FEE SCHEDULE: BOLDING PERMIT: $1.2.00 PE $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
r
Total Project Cost: $ FEE: $ 63 r
Check No.: ��D%` Receipt No.: c,9 c7J _-_�d—
NOTE: Persons contrapdag with unre�tered contractors do not have access to4the guaranty fund
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 2.2007
BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
`� 0
Permit NO: `� Date Received
o St�aD �6�•ND\
16.
7a pDAATED I.PP �•(�/
ZS CH
Date Issued: ' J , d
IMPORTANT: Applicant must complete all items on this page
LOCATION
PROPERT`
MAP NO: PARCEL:. ZONING DISTRICT: Historic District yes
Machine Shop Village yes.
no
no.
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
New Building
One family
Addition
Two or more family
Industrial
Alteration
No. of units:
Commercial
Reit re laceme
Assessory Bldg
Others:
Demolition
Other
Septic Wel
Floodplain Wetlands :
Watershed District
Water/Sewer.
DESro2IPTION OF WORK TO BE PREFORMED:
OWNER: Name:
Address:
CONTRACTOR
►,
Address:
,Type or Print Clearly)
Supervisor's Construction License: L Exp. Date:_
Home Improvement License: \ J S _ Exp. Date:__
ARCHITECT/ENGIN
Phone:
ARIME
Address: \ Reg. No.
FEE SCHEDULE: BULDING PERMIT: $12.00 PE $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
r 22
Total Project Cost: $ FEE: $ 63 r
Check No.: //o s%` Receipt No.: cge-1
NOTE: Persons contrapting with unregstered contractors do not have access tollhe guaranty fund
of
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 2.2007
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 2007
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
DATE REJECTED DATE APPROVED
CONSERVATION
COMMENTS
DATE REJECTED DATE APPROVED
HEALTH
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
Located at 384 Osgood Street
FIRE DEPARTMENT - Temp Dumpster on site yes no
Located at 124 Main Street
Fire Department signature/date
COMMENTS
Location 1,�i ,Z -s�-
No. 503 Date
40RTN TOWN OF NORTH ANDOVER
Certificate of Occupancy $
s�c►+us t� Building/Frame Permit Fee $ s �f
Foundation Permit Fee $
Other Permit Fee $
TOTAL
Check #�/ �/ t
f
20972
W. -
Building Inspector
✓fie -Pomvnwozurea� o�.,/�/iaarsac�ivael�a
-
- Board of Building Regulations and Standards
License or registration valid for individul use only
HOME IMPROVEMENT CONTRACTOR
before the expiration date. If found return to:
Registration: 133895
Board of Building Regulations and Standards
Expiration 8/22/2009 Tr# 133005
One Ashburton Place Rm 1301
Type: Public Corporation
Boston, Ma. 02108
MC CONTRACTING INC.
LEONARD MARTELL JR.
62 CONSTANTINE DR.�,��„`
TYNGSBORO, MA 01879 Administrator
Not valid without signature
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The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
a
600 Washington Street
.Boston, MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricans/Plumbers
Name
Address:
City/State/Zip:
: M
.#: -1s --��
Type of project (requiredy`
6. ❑ New construction
7. Remodeling
8. Demolition
9. Building. addition
10.❑ Electrical repairs or additions
11.0 Plumbing repairs or additions
12XRoof repairs
13.❑ Other
*Any applicant that checks box #1 must also fill out the section below showing their workers' compensation poiicy 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-contractorshave employees, they must provide 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.
Insurance Company
40
Policy # or Self -ins. Lic. #:' l ,�;�� _ (� -� a Expiration Date:
Joh Site Address:, L(11-�' 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 $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
T....ens:,...s.:___ _rat_ TIT A
I do hereby cerofy under the
not write in this area, to
City or Town:
Of
provided'above. is true and correct
or town official,
Permit/License
Issuinb Authority (circle one):
1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
ct Person• Phone #:
Are you an employer? Check the appropriate box:
1. I am a employer with' 4. Q I am a general contractor and I
employees (full and/orPart -time) .*
have hired the sub -contractors
2. ❑ I am a sole proprietor or partner-
listed on the attached sheet.
ship and have no employees
These sub -contractors have
working for me in any capacity.
employees and have workers'
[No workers' comp, insurance
comp. insurance.$
required.]5.
We are a corporation and its
3. ElI 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 reauired_1
Type of project (requiredy`
6. ❑ New construction
7. Remodeling
8. Demolition
9. Building. addition
10.❑ Electrical repairs or additions
11.0 Plumbing repairs or additions
12XRoof repairs
13.❑ Other
*Any applicant that checks box #1 must also fill out the section below showing their workers' compensation poiicy 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-contractorshave employees, they must provide 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.
Insurance Company
40
Policy # or Self -ins. Lic. #:' l ,�;�� _ (� -� a Expiration Date:
Joh Site Address:, L(11-�' 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
T....ens:,...s.:___ _rat_ TIT A
I do hereby cerofy under the
not write in this area, to
City or Town:
Of
provided'above. is true and correct
or town official,
Permit/License
Issuinb Authority (circle one):
1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
ct 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 employee is defined as "...every person in the service of another under any contract of hire,
express or implied, oral or written."
i
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 -"ever state or local licensing agency shall withhold the issuance or
renewal of a Iicense or permit to,opera'te�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, §25CO) 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 maybe 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 laworif 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
pplicantPlease be sure to fill in the pemiit/hrense 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. A new 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 bum 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 Commonwealth of Massachusetts
Department Qf Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
Tel. # 617-7274900 ext 40,6 or 1-877-MASSAFE
`
Revised 11-.22-06 Fax # 617-727-7749
www.mas&govldia
ISSUED BY THE STOCK INSURANCE COMPANY HEREIN CALLED THE COMPANY
COMPANYTHE INSURANCE OF THE STATE OF PENNSYLVANIA
e..e
AGENT NUMBERPOLICY NUMBER
7199 1-0000 WC 671-78-38
013-82-1207-00
62 CONSTANT I NE DRIVE04MMember
Companies of
TYNGSBORO, MA 01879-0000
American International Group
EXECUTIVE OFFICES:
70 PINE STREET, NEW YORK, N.Y. 10270
SEE NAME AND ADDRESS SCHEDULE - WC990610
I.D# MA UI#:
CLUETT COMMERCIAL INSURANCE AGENCY INC
WORKERS COMPENSATION AND EMPLOYERS
8 PEMBROKE ST
LIABILITY POLICY INFORMATION PAGE
KINGSTON, MA 02364-1109
INSURED IS
PREVIOUS POLICY NUMBER
CORPORATION
RENEWAL 0089 282
OTHER WORKPLACES NOT SHOWN ABOVE:SEE NAME AND ADDRESS SCHEDULE - WC 0610
ITEM 2
POLICY PERIOD 12:01 A.M. standard time at the insured's
mailing address FROM 12/27/07 TO 12/27/08
ITEM 3
A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed
here:
MA
B. Employers Liability Insurance: Part Two of the policy applies to the work in each state listed in item 3.A.
The limits of our liability under Part Two are:
Bodily Injury by Accident $ 100, 000 each accident
Bodily Injury by Disease $ 500,000 policy limit
Bodily Injury by Disease $ 100.000 each employee
C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here:
AK AL AR AZ CO CT DC DE FL GA HI IA ID IL IN KS KY LA MD ME MI MN MO MS MT NC NE NH NJ
NM NV NY OK OR PA RI SC SD TN TX UT VA VT 141
ITEM
The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans.
All information required below is subject to verification and change by audit.
aassifications
Code Number
Estimated Total
Remuneration
Rate Per I
$too OF Re-
Estimated
Premium
Annual ❑ 3 Year
muneration i
0 Annual ❑ 3 Year
SEE EXTENSION OF INFORMATION PAGE - WC7754
TAXES/ASSESSMENTS/SURCHARGES
EXPENSE CONSTANT (EXCEPT WHERE APPLICABLE BY STATE) $318 MA
ItInfantine
Insurance Inc.
P.O. Box 5125
Manchester, NH 03108
(603)669-0704 FAX: (603) 669-6831
$853
MINIMUM PREMIUM $500 MA TOTAL ESTIMATED PREMIUM $19,039
If ndicated below, interim adjustments of premium shall be made:
❑ Semi -Annually ❑ Quarterly ❑ Monthly DEPOSIT PREMIUM
ENDORSEMENTS (FORM NUMBER) SEE ATTACHED FORM SCHEDULE - WC990612
11/01/07 PARSIPPANY
Issue Date
39967
Issuing Office
Authorized Representhtive WC OO 00 01
of
M.C. Contracting, Im 62 Constantine Drive
Tyngsboro, MA 10879
(978) 649-2073
Fax- (978) 649-1471
Page 1 of 2
March 5, 2008
Mr. David Gulezian Tel:
DG Contracting, Inc Fax:
428 Pleasant St email:
North Andover, MA 01845
Re: Roofing Proposal
Project: 428 Pleasant Street
Dear David,
978-815-7745
978-686-6337
dgbuilding@aol.com
We propose to provide and install roofing to the above-mentioned project according to the
following scope of work by sections.
Shingle work
• Remove and properly dispose the existing roof shingles on the front and back of the
house.
• Furnish and install Bithuthene Ice & Water shield 6' wide at eaves and valleys.
• Furnish and install 15Lb. felt paper on balance of roof deck.
• Furnish and install Aluminum drip edge at rakes and eaves.
• Properly flash all roof penetrations.
• Furnish and install Ridge vent on all ridges, where required.
• Furnish and install 30 year Architectural shingles.
• Keep jobsite clean on a daily basis.
• Shingles warranted by the manufacturer for a period of 30 years.
• MC Contracting workmanship is guaranteed for a period of 2 years.
Exclusions: Winter Conditions, Snow Shoveling, Weather Delays,
Prevailing Wages, Union Labor,
Please note the following qualification: Any additional work beyond the above scope
of work will be done at a rate of $70.00 per man per hour for roofing plus materials,
portal to portal and $.445 per mile travel expense and any per diem charges. These
labor rates are subject to change without notice. Phasing of project is excluded.
Page 2 of 2 428 Pleasant Street
Note: This price is contingent upon existing roof deck meeting manufacturer's fasteners pull
requirements to issue warranty. And access next to building for trucks, dumpsters, and crane.
We propose hereby to furnish material and labor — complete in accordance with the above
specifications, for the sum of:
Base bid: Four thousand four hundred dollars $4,400.00
Payments to be made as follows: Upon completion. All legal and or collection fees will be paid
by the binding holder of t ' ontract.
Authorized signature;
Peter J Corti Estimator
Note: We may withdraw this proposal if not accepted within (30) days.
Acceptance of proposal ---The above prices, specifications and conditions are satisfactory and are
hereby accepted. You are authorized to do the work as specified. Payments will be made as
outlinrm-
This proposal will become p o the cont unle stricken by the owner.
Date; -25 Signatur