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HomeMy WebLinkAboutBuilding Permit #536 - 43 ELMWOOD STREET 4/13/2009BUILDING PERMIT TOWN OF NORTH ANDOVER 02 APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received S Ic 4DAA �tP` �9 - �SSACHus�� Date Issued: -01 IMPO TANT: Applicant must complete all items on this page LOCATION Pain PROPERTY OWNER `PAUL > a' Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alters No. of units: Commercial Repair, replacement Assessory Bldg Others: Demo Jr_ icon Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: iv 5 t✓f I J`f ? �'F S 1 (U 5 Gt / �y l� G� T "' c e �,�►c�cv �`edJLi'e c1 �- Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: CONTRACTOR Name: .11,12 42 r" t , -11.e t-, � p -hone: Address:���-� Supervisor's Construction License: �r— , e ` Exp. Date:.I2' Home Improvement License: Exp. Date ' C /2 oil, ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE: BULDING PERMIT: $12.000 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ �J FEE: $ I Check No.:—Lo �� Receipt No.:� NOTE: Persons contracting with unregistered contractors do not have�access to the guaranty fund ature Location 7 �'//'!?LcJd 0 i No. ✓ 3 Dateaf Of NORTh TOWN OF NORTH ANDOVER L Certificate of Occupancy $ '7s'•"°' E<'�' Building/Frame Permit Fee $ s�CHus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # —IA y —2--- 2 19 4 . 21943 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 Dumpster on site yes no Located at 124 Main .Street 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 No MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine NU I t5 ana UA I A — (tor cie ❑ Notified for pickup - Date Doc.Building Permit Revised 2008 nt use 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 43 W Cd ,..� w W4 A v e 0 w GO z A o a as a o w x O w a H z w O � o o w v cn w or. o w o a U G xc� o q w" o w U) w" ¢ no o cs; C w w wo o cit Q �e o C G : ® C O cy ; O C vv ACL C C ev � m C 3� ®a CO .. c 0 C *-a E c z om O • :oma �� os �� c :y oCC* MA E :mo a m3 cn y tm m N m � N O O Em _� W o o 5 CL. cmO . o vi c�Q c O .a w iA 5 ^ � CL== CO = m 1-4 V y O O Z cm .oC c ar Qo i 0 C .o m m:m�3 N CL O o COD c cv = o u� .O .o P go � � � Z H_ C.3 CD a ozip � O� !O 0 L -H f- r saMm C2 I� w a fil O � L O V Z � d O ca o c I CCM C* p -p co M E m m OO O Z O.a 3� 0 CD m Cl CL CMa y E c Ccc v .5.0 O G Z CD �..± co � C C C c CIO 0 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 S" www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): V U S-, ✓r `;p /I, t ? 4 ti Address: /3-7 ')�J,�-✓a VIA A- V7 5 % . City/State/Zip: Wt ✓>L. Gib 3 b Phone #:—'F-2 �_ 3 7 Q ( -S y -? Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and 1 employees (full and/or part-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. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] 3. ❑ I am a homeowner doing all work thyself. [No workers' comp. insurance required.] t officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.0 Electrical repairs or additions 1 l.❑ Plumbing repairs or additions 12 -El -Roof repairs 13.0 Other 12 f2ool -Any appucant tnat cnecxs box # t must also till 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 workerscompensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy # or Self -ins. Lic. #: Job Site Address: Expiration Date: 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. I do hereby certify under the pains andpenalties ofperjury that the information provided above is true and correct. ����-�c_ Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License # e_1—r 3—v,1- 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 #: 'y.0 )zZ�. 70 \Ul) - \ #cm» \ -!\ X070 \ D? . � \ S >r 2 _}§ zn c > Lo �.' : a . D\ «1Sw:©d'>\. «zo3 . o « 0 r ƒ (D9 2 'y.0 )zZ�. \ \ �� } / \ \�> \ D? . � \ S 0.0 ! ( \ �: < � -- --- « Home Improvements by Bob Date: 03-27-09 157 Boardman Street home # 978-686-5296 Haverhill, Ma 01830 cell # 978-374-6397 work # Proposal submitted to: Paul Anderson Address: 43 Elmwood City, State, Zip code: N Andover MA. 01845 I hereby submit specifications and estimates for: roof Strip roof of two layers of shingle. Install Bin. Drip edge around entire roof line. Put ice and water shield on the first six feet of roof and tar paper on the remanding. One chimney, 2 vents, and 2 stacks will all be re flashed and sealed. New ridge will be installed at peak of roof. Install a 25yr. I.K.O. three tab shingle to customers choice of color. Yard will be protected from roof debris and cleaned up as we go. Warranty on workmanship will be 5yrs. Under normal conditions All waste will be removed by contractor by a 30 yard dumpster. Permits will be supplied by contractor. I hereby propose to furnish material and labor complete in accordance with the specifications for seven thousand five hundred and eighty two $7,582.00 Payment to be made as follows: 1st payment of $500 is due prior to starting to pull permits. 2' payment of $5,582 is due on day of construction. Last payment of $1,500 is due on day of completion. All matter is guaranteed to be as specified. All work to be completed in a workman like manner according to standard practices. Any alteration or deviation from specifications involving extra work will become an extra charge over and above the estimate. All agreements contingent upon accidents, or delays beyond my company. I carry all necessary liability insurance. Authorized signature: X Note: This proposal may be withdrawn by my company if not accepted within 30 days. Acceptance of proposal. The above prices and specifications are satisfactory and hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above. X X Signature Signature