The URL can be used to link to this page

Home My WebLink AboutBuilding Permit #21-12 - 45 ROCK ROAD 7/11/2011 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: IMPORTANT:Applicant,,m�ust co m Tete all items on this age LOCATION �l /1O� R N�� 14 i Print PROPERTY OWNER f / (��? C' Unit# Print MAP NO:A-?r—PARCEL: ZONING DISTRICT: Historic District yes o Machine Shop Village yes no 100 year-old structure yes no TYPE OF IMPROVEMENT PROPOSED USE Resi ntial Non- Residential ❑ New Building Vbne family ❑Addition ❑Two or more family ❑ Industrial Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic El Well ❑Floodplain 0 Wetlands ❑ Watershed District ❑ Water/Sewer DES RIPTIO F WORK TO BE PERFORMED: , e�D �-, (Iden i cation Please Type or Print Clearly) OWNER: Name: ioq 4o Y1 Phone: Address: T� ��C�c �� /�•�, � ��/ CONTRACTOR Name: L°S` Jebl^eCeO r Phone: lK�� l / Address: L � 01,4C��1�1 Supervisor's Construction License: ST�1� Exp. Date: Home Improvement License: � 5'�� Exp. Date: ,lf-'A?� ARCHITECT/ENGINEER Phone: 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: $ �ryoz FEE: $ Check No.:. J ( CIO Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund 5ighature of_Agent/Ownr Sgnatureaof contracto 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 o Building Permit Application a 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 o Building Permit Application ❑ Certified Surveyed Plot Plan o 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) ❑ 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 Li Certified Proposed Plot Plan L3 Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit o 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 o 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: Doc.Building Permit Revised 2008mi Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools t ❑ ,` 1 Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ permanent Dumpster on Site ❑ i THE FOLLOWING SECTIONS FOR OFFICErUSrf'ONLY - ` INTERDEPARTMENTAL SIGN OFF - U FORM 3 } DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS . � I 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: F { Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no )j Located at 124 Mai ntree Fire Department signature/date COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: I 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 2011 June/mi Location No. Date �ORTh TOWN OF NORTH ANDOVER s � s • ; . Certificate of Occupancy $ Building/Frame Permit Fee $ �J►: Foundation Permit Fee $ Y Other Permit Fee $ TOTAL $ Check # 1T 2455 $' Building Inspector H18 CERTIFICATE IS 188UED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE ERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED Y THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN HE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER. IMPORTANT: If the Certificate holder is an ADDITIONAL INSURED,the policy(iss)must be endorsed. If SUBROGATION I8 WAIVED, subject to the terms and conditions of the policy,certain policies may require and endorsement. A statement On this certificate does not confer rights to the certificate holder in lieu of such endorsement. PRODUCER Dognan Insurance Agency 65 Salem St Lawrence,MA 01843 COMPANIES AFFORDING INSURANCE COMPANY A GRANITE STATE INSURANCE COMPANY INSURED Jamas Debrecenl Dba Famlly Roofing And Palnting 2 Tanager Way Londonderry,NH 03053-0000 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOT WITHSTANDING 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 THE POLICIES DESCRIBED HEREIN 18 SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, 00 LTR TYPI or INI URANOE POLICY NUMBER FOUCYEPFICTM DATE POLICYE7Q9MTM DATE A WORKERS NvfWN— ANDHMPLO ERSELIABLrrY LIMITS E PROPRIETOR) PARTNERS/EXECUTIVE OFFICERS ARE; �a❑EXCL n 2453365 5/11/2011 5/11/2012STATUTORY LIMILS OTHER, —��-- CoreaQaApplies loMAOperallonaONy. CH ACCIDENT $ 100100 ISEASEPOLICY LNIT $ 500100 ISEASE•EACH EMPLOYEE 10000 DESCRIPTION OF OPERATION&VEHICLIWOPECIAL ITEMS RE:THE WORKERS COMPENSATION POLICY DOES NOT PROVIDE COVERAGE FOR JAMES DEBRECENI. i CERTIFICATE HOLDER CANCELLATION COTE&FOSTER SHOULD ANYOF THEABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE 21 AEGEAN DR WINTETHE POLICY PROVISION S. METHUEN,MA 01844 AUTHORIZED REPRESENTATIVE i The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information )) Please Print Legibly Name(Business/Organization/Individual): Address: Av)a, f CA �f, City/State/Zip: L&/ l7 cl err I �� Phone#: Are you an employer?Check the appropriate box: Type of project(required): '1.L1 l am a employer with_ 4• ❑ I am a general contractor and I 6. ❑New construction employees(full and/of part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. E]Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition workingfor me in an capacity, workers' comp.insurance. Y9. ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions required.] officers have exercised their 3.❑ I 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 12.❑Roof repairs insurance required.]t employees.[No workers' comp.insurance required.] 131-1 Other *Any applicant that checks box 41 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. lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. a Insurance Company Name: Gro, Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: /V1 40J . 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 5aL ify under thy andpenalties of perjury that the information provided above is true and correct. s Signature: Date: Phone#: )gnor 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 Persoin: Phone#: ORTH TO" of And 0 Qgk = -o dower, Mass., COCHICHEWICK y�. '?A-rED P'P��"`y `s BOARD OF HEALTH Food/Kitchen PERMIT . T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT........ !! ....... „llti/'L ' .C7............................................................................................ Foundation has permission to erect......................................... buildings on ....4.q.......D-e'.1;........ .. . ...!................................... Rough to be occupied as......... ........ .. ....*........ .......... 7.. ............................................................................................. Chimney provided that the person accepts g this permit shall in eve respect conform to the 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 UNLESS CONSTRUCTIO � ELECTRICAL INSPECTOR Rough ................................................:.......................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy 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. SEE REVERSE SIDE smoke Det. i8 Maple Street James Debreceni ethuen, MA 01844 LIC#99685 78) 683-5127 ® FAMILY HIC#122385 RAF ERS & PAINTERS ill To: ✓cJ Jdress: �`� ✓v `ciY��` �z hone: f 12 Plq� te ' f1r- xrc 1/0 54 E;�Ac leldeca vr/17 - ALL WORKMANSHIP GUARANTEED 10 YEARS ESTIMATE �y ko INITIAL DEPOSIT 1ST PAYMENT.- .3� Vo® 7- 1/- 2ND PAYMENT Q FINAL PAYMENT - -•--• ••� -ticcruco strove for the total sum of: a Payments will be Inde according to the following schedule: S upon signing cmltrnr.t(riot to exceed I/3 of thelotsl contract price or lire cost of special order items,whichever is greater) S t V by. /__/_ or upon completion-of S Y __-__— ur upon completion of upon completion of the contract. (Lew forbids dere;ndmg full payment.until contract is completed to botb Party"; io �—, p ty s antisfection) 7be following materiel/equipment must he special $ • ordered before the couhacled wort•begins in order S - =to Ue paid for to meet the completion schedule.(*4) -- to be paid for f NOTES:(')Including all finance charges(")Law requires(hat any deposit or down-payment required by the contractor before work begins may not exceed the greater of(a)one-third of the total contract price or(b)the actual cost of any special equipment or custom made material. which must be special ordered in advance to meet(he completion schedule. Cxnress}yarranh If an c9preir warraniyheluenavidedhv-tttacontractnrT No vK (pit. Snbcontraclars- f1'te->rontractor agrees to be solely responsible for completion of therms offliewitrrB e work described regardlessmattached to lite of llbe actions orally third•ctl party/subcontractor utilized by 1116 contractor. The contractor fitrther agrees to be solely responsible for all payments to all suhcontractors for InftLed&h3 a dry Igh-fes tde his Agreement Contract Acceptance-Upon signing,this document becomes a binding contract under law. (Unless otherwise noted withi contract shell not imply Ills(any licit or other security interest has been placed on the residence. Review the follon this ducumenl,the wing cautions and notices carefully before signing this coulrneL : Doe'(be pressured into signing the contract.Take time to read and fully Understand it. Ask questions if some0ling is mtclear. vllakc sure II co clot lid ItgS n v i[ome m rovemeu[Contrec(or e ( a 'ot. The law requires most homc im rovement contractors sect subcontractors to be registered with the Director of Nome llnprovetn�Con clot Registration. You may inquire about contractor registration by writing to the Director at One Ashburton Place,Room 1301,Brac ort,MA 021 io . by calling quire x7-3200 contractor 1-800-223-0933. • or Does lite contractor have insurance? Check to see That your contractor is properly insured. Krtowyour rights and re possibilities. Read the Important Information on lie reverse side of tl i. form and gel a copy of file Consumer Guide(o the home Improvement Contractor law. 'i may Cancel this agreement if it has been signed at a place o1116r titan the contmclot's normal place of business,provided you notify the conlroclon in writing et his/ltcr main office or branch office by ordinary moil posted,by telegram sent or by delivery,not later than midnight of the Third business day fallowing.Ih;Signing of this agrcernenL See tire attached notice of cancellation form for an explanation of(his right. DO NOT, ;�;N THIS CONTRACT IFTHERE ARE ANY BL/�NI{SPACCS!!! Tr o idcmic pr:a of c "tract est a cm hied and signed. One copy should go to lilt homcowncr. The olhv c pyshould be kept by the CEP nhactor. r `• i Flomeowner's Signa re Con actor's Signature f)atc -- 7-9.— /- Dole