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HomeMy WebLinkAboutBuilding Permit #359 - 49 SUTTON HILL ROAD 11/4/2009 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: Date Received i Date Issued- IMPORTANT:Applicant must complete all items on this page LOCATION ! Pant 'PROPERTY OWNER 06 Print MAP NO: PARCEL. - ZONING DISTRICT: Historic District - yes. no Machine Shop Village yes -no TYPE OF IMPROVEMENT PROPOSED USE Resi Non- Residential New BuildingOne famil Addition Two or more family Industrial Alteration__----, No. of units: Commercial ,_e air, replaceme Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: lend m tion Plleease T e or Print Clearly) OWNER: Name: �e>bcF2� Phone: Address: 4 CONTRACTOR Name: OkAdIA Phone: Address: �'� Tlerr S`iMJ Supervisor's Construction License: <4,*-S _ Exp.- Date: 6,bC A61 L.. Home improvement License: l Yc ,k2,0 Exp. Date. l ARCHITECT/ENGINEER /� Phone: Address: Reg. No. FEE SCHEDULE:BULDING PE MIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 2�� 0900_ FEE: $ �.- Check No.: /7/;� �/' Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access t e uaran u d Signature of Agent/Owner'��" Signature of contracto r- Plans Submitted Plans Waived CertifiedAlot 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 I� 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 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 2008 h I 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: Doc.Building Permit Revised 2008 Location ''�`''� �` 4z No. � Dater! NpRT" TOWN OF NORTH ANDOVER f s P a y Certificate of Occupancy $ Building/Frame Permit Fee $ s�CHus Foundation Permit Fee $ { Other Permit Fee $ TOTAL $ �l Check # �7 2256 - Building Inspector NORT►1 ONNM of -� _ !' 4 Andover No. ,347 �{ o z= A K E dover, Mass., 9 COCHICHEWICK 1 RATEDPER .M .1T . T D `S BOARD OF HEALTH Food/Kitchen Septic System THIS CERTIFIES THAT................... .�A BUILDING INSPECTOR.......:.. .....................:: ..... Foundation has permission to erect. ............... buildings on ...... . ...... Rough t0 be Occupied as imn ey provided that the person accepting is permit shall in every-respect conform to the terms of the application on file in this office, and to the provisions of the Codes and.By-Laws relating to the Inspection, Alteration and Construction of Finat Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMEV ES IN 6 MONTHS Final IT UNLESS CONSTRUCTION ST ELECTRICAL INSPECTOR. Rough ...................................................................................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR. Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final No Lathing or Dry Wall To BeDone FIRE DEP Until Inspected and Approved -by the Building Inspector. ARTMENT Burner Street No. SEE REVERSE SIDE Smoke Det. Bolfri�f`1$`ffmaw-o961 an ar I { HOME IMPROVEMENT CONTRACTOR Registration:, 154068 Expiration 2/5/2011 Tr# 285716 i t yt k Type Pvate Corporation NORMANDIN ROOFING INC 1, =i JAMES BUCKLE Y ; „ i 96 PLEASANT ST.` DRACUT,MA 01826 �'� '" '"" {`�'�'- Administrator 11ta4s'a'rhusetts-Department of PdmicSaf.CA Via+ 11;oard of Building:Regulaitions anti St.tsiifaras �. •; .&nstruction Supervisor Specialty License i License: CS SL 99925 Restricted:to RF ; JAMES BUCKLEY 805 VARNUM AVE. LOWELL, MA 01854 Expiration: 6/26/2012 £'4wnri�issi�Meer Tr#: 99925 it ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 7M 10/28/2009 PRODUCER (603)382-4600 FAX (603)382-2034 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Insurance Solutions Corporation ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 60 Westville Rd HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Plaistow, NH 03865 Marialana D'Agata INSURERS AFFORDING COVERAGE NAIC# INSURED Normandin Roofing Inc. INSURER A: Atlantic Casualty Company — 8 Lexington Drive INSURER B: Sandown, NH 03873 INSURER C: INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING 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 BY THE POLICIES DESCRIBEn HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LTR NSR DATE MM/DD/YYYY DATE MM/DD/YYYY LIMITS GENERAL LIABILITY L143000479. 02/18/2009 02/18/2010 EACH OCCURRENCE _ $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DA A E 0� R�— PREMISES Ea occurrence) ccurrence $ 100,000 CLAIMS MADE FX] OCCUR MED EXP(Any one person) $ 5,000 A PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1,000,000 POLICY PRO LOC JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO EA ACC $ OTHER THAN AUTO ONLY: AGG $ EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR F-1 CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATIONITATI - AND EMPLOYERS'LIABILITY TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE Y *SEE BELOW E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS The insured has purchased Workers' Compensation coverage through the MA Worker's Compensation Assigned isk Pool . We have requested the servicing carrier issue a Certificate of Insurance on your behalf. gents are not permitted to issue Certificates of Insurance for Workers' Compensation coverage on olicies issued through the MA Worker's Compensation Assigned Risk Pool . CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICA HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Town of North Andover IMPOSE NO OBLIGATIO OR IABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR 1600 Osgood Street REPRESENTATIVES. 17 N Andover, MA 01845 AUTHORIZED REPRES NTA VE I I zi& —1 ACORD 25(2009101) ©198 0 ACORD CORP A5N All rights reserved. The ACORD name and logo are registered mark ACORD IMPORTANT If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER This Certificate of Insurance does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25(2009/01) MASSACHUSETTS ASSIGNED RISK POOL REQUEST FOR CERTIFICATE OF INSURANCE Use this form to request a Certificate of Insurance from an Assigned Risk Pool Carrier. Please provide all of the requested information, including the facsimile number(s) of the person or persons to whom the Certificate of Insurance should be issued. If this form is fully and accurately completed, the Certificate of Insurance will be issued and distributed by facsimile to each fax number provided below, within two(2) business days of the carrier's receipt. This Form may be mailed or faxed to the Assigned Risk Pool Carrier. To obtain each carrier's contact information refer to the Certificates of Insurance section located in the Producer Community section of the Bureau's website, (www.wcribma.orq). 1. Name, address, telephone number and facsimile number of the INSURED: Name: Normandin Roofing Inc Mailing Address: 8 Lexington Drive Sandown NH 03873 Physical Address: same Phone: 978-815-2114 Fax: 978-674-9981 2. Name, address, telephone number and facsimile number of the CERTIFICATE HOLDER: Name: Town of North Andover Mailing Address: 1600 Osgood Street N Andvoer MA 01845 Physical Address: same Phone: Fax: 3. Name, address, contact person, telephone number and facsimile number of the PRODUCER: Name: Insurance Solutions Corporation Mailing Address: PO Box 1079 -Atkinson NH 03811 Contact Person: Cindy St. Amand Phone: 603-382-4600 Fax: 603-382-2034 4. Policy Number, Policy Effective Date and Policy Expiration Date If a Certificate of Insurance is needed for more than one policy term, provide the Policy Number, Effective Date and Expiration Date for each policy term. If the policy has not yet been issued, you must attach a copy of the Notice of Assignment. Policy Number: WC006608332 Effective Date: 01/14/2009 Expiration Date: 01/14/2010 5. List any special requests for optional coverages/endorsements (see Page 2 for listing of coverages available in the pool and the conditions of availability)or additional information(including changes in exposure not yet reported to the carrier) that will assist the carrier in the issuance of the Certificate of Insurance. NOTE: An additional insured(s) shall not be listed on any Certificate of Insurance unless such additional insured(s)is a named insured on the policy. / I F R NORMANDIN ROOFING Page No. 805 VARNUM AVE M LOWELL,MA 01854 PROPOSAL M of Pages PROPOSAL SUBMITTED TO: DATE NAME JOB NAME DR.AND MRS.KELLAN STREET STREET 49 SUTTON HILL ROAD CITY CITY STATE NORTH ANDOVER STATE PHONE MA UPON INSPECTION OF ROOF NORMANDIN ROOFING RECCOMENDS THE FOLLOWING WORK TO BE PERFORMED: 1.REMOVE,FABRICATE,AND INSTALL NEW COPPER STEP FLASHINGS AND NEW LEAD FLASHING TO GRANITE CHIMNEY -CLEAN AND APPLY 2 COATS OF SEALER TO CHIMNEY -FABRICATE AND INSTALL COPPER CAP TO CHIMNEY -FABRICATE AND INSTALL STAINLESS STEEL CAP TO CHIMNEY TO COVER ENTIRE CHIMNEY 2.REMOVE(2 LAYERS)AND INSTALL 1 SQ.RUBBER ROOF SYSTEM TO FLAT ROOF RIGHT SIDE OF CHIMNEY 3. STRIP ENTIRE SHINGLE ROOF TO HOUSE AND GARAGE AND INSTALL THE FOLLOWING(56 SQ.): -6 FT. GRACE ICE AND WATER SHIELD TO BOTTOM EDGES OF ROOF 3 FT.TO VALLEYS AND CHIMNEY, 100%TO REAR SIDE OF HOUSE -15 LB.FELT PAPER TO ALL AREAS THAT DO NOT HAVE ICE AND WATER SHIELD -8 IN.WHITE ALUMINUM TO ALL EDGES OF ROOF -NEW VENT PIPE BOOT FLASHINGS(5) -NEW STEP FLASHINGS AS NEEDED -56 SQ. OF 30 YEAR ARCHITECH SHINGLES -CUT AND INSTALL 120 FT. COBRA RIDGE VENT TO MAIN RIDGES 4. CLEAN AND HAUL AWAY ALL DEBRIS EXCLUSIONS:BONDS,PERMITS,WOOD REPLACEMENT,PAINTING,AND MASONARY WORK. PRIG PRICE FOR FULL PROPOSAL: $28,800.00 We hereby propose to furnish labor and materials—complete in accordance with the above specifications,for the sum of Dollars ($ ) with payments to be made as follows: All material is guaranteed to be as specified.All work to be completed in a workmanlike manner according to standard practices.Any alteration or deviation from above specifications involving extra costs will be executed only upon written orders,and will become an ex",rgey� and above the estimate.,All agreements contingent upon strikes,accident or delays beyond our control.This proposal subject to acceptance within days and it is/void the jtheL pti of the undersigned. Authorized Signatu> �---/ ACCEPTANCE OF PROPOSAL The above prices,specifications and conditions are hereby accepted.You are authorized to do the7rasfied.Paymeased above. ACCEPTED: TV�7� Signatur DATESignature ©E-Z CONTRACTORS FORMS FORM NO.PROP23 Location t� No. 3 Date NORTH TOWN OF NORTH ANDOVER O? •_ a C� s ,. Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ GMUS -- ZT Other Permit FeeK54 $ Sewer Connection Fee V $ Water Connection Fee $ TOTAL $ � Building Inspector N _ o 1 . Div. Public Works PERMIT NO. APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. � PAGE 1 MAP 4-40. I LOT NO. 2 RECORD OF OWNERSHIP DATE BOOK ;PAGE - ZONE SUB DIV. LOT NO. yF LOCATION PURPOSE OF BUILDING OWNER'S NAME NO. OF STORIES Q� SIZE OWNER'S ADDRESS BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAMEowl SPAN -- DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES—SIDES REAR "' GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION APPADY, LAND COST SEE BOTH SIDES C'^C''� �� I/�y�,p -EST. BLDG. COSTPAGE 1 FILL OUT SECTIONS 1 - 3 J v (CS�d„�X�' {NN EST. BLDG. COST PER SQ. FT. V EST. BLDG. COST PER ROOM PAGE 2 FILL OUT SECTIONS 1 - 12 SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED�NP APP VED BY BUILDING INSPECTOR DATE FILED INO INSPRCTOR SI A URE OWN C- AUT ORI ED F E E ..�7 0 OWNER TEL.# �`�!O✓ PERMIT GRANTED CONTR.TEL. 04- 19 CONTR.LIC.# l7G✓ �'�� H.I.C.# yZ�v�D ORT TIC)'VM of �) 0 - over No.. 356 f yy rt yy cover, Mass., 2 19`��'�' 1` Q Z- LAKE - COCWICMEWICK '9 A ED BOARD OF HEALTH g Food/Kitchen Septic System :• •:* . 1 BUILDING INSPECTOR THIS CERTIFIES THAT...RIL......ea ......;.mL ...... .................................................................... Foundation �. �has permission to erect:...5*r�2........1:., .. buildings on.... .°�..... Rough to be occupied as�, � & .. .. 0Q.A?.... .j� .. .5' .... .. . l. ..S .ob Chimney t rms f thea Iication on f e in provided that the person accepting this permit shall in every respect conform to�he a pp 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 EXP 6 MONTHS ELECTRICAL INSPECTOR%.. •`— UNLESS CONS T S Rough Service BUILDING PECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Disolay in a Conspicuous Place on the Premises — Do Not Remove Final F. No Lathing or Dry Wall To Be Done •' ." FIRE DEPARTMENT 4 ' : until Inspected and Approved by the Building Inspector. f s Burner PLANNING' FINAL CONSERVATION FINAL Street No. Smoke Det. SEWER/WATER FINAL DRIVEWAY ENTRY PERMIT .. +d,iowry'h .r • OFFICES OF: 12� Town of 120 Main Street APPE-\Ls . .; NORTH ANDOVER North Andover, BUILDING �t,''�:::�,• Massachusetts o 1845 CONSERVATION •'"°"" DIVISION OF HEALTH PLANNING PLANNING & COMMUNITY DEVELOPMENT KAREN H.P. NELSON, DIRECTOR In accordance with the provisions of MGL c 4i0, S 5.4, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly liccriscd solid waste disposal facility as do:incl by MGL c lll, S 150A The debris will be disposed of in: f (Location of agility) Signature Of/permit Applicant #4D \ NOTE: Demolition permit from the Town of :forth Andover must be obtained for this project through the Office of the Building Inspector. I i s The Commonwealth of Massachusetts -- Department of Indusind Accidents �-- /lJJ�elllttll►�. 600 Washington Street Boston,Mass. 02111 Workers'Compensation Insurance Affidavit name: A, location* S S � — # �C?8�► I am a h&neowner performing all work myself. I am a sole proprietor and have no one working in any capacity AEr I am an employer providing workers' compensation for my employees working on this job. :co pan3t name,: . address: ci phone#. Lama nce coooticv# 0 I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: company name. -. :. ad-dress. .., city Rhone#. . :insuranceco. . ... Rolicp# .: company.name: ..... address. _ ::.:....:.. . ci _. =arance co. 124h4Y# - M, ona ace Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to 51,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of 5100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DU for coverage verification. !do hereby c under the pains and penalties ofZCVUFY that the information provided above is true and correct _ DateZip L Print name �1���2 L,I� .S17 Phone#_ (U —623 official use only do not write in this area to be completed by city or town official city or town: permittlicense it nBuilding Department _ [3Licensing Board C3 check if immediate response is required C]Seleetmeu's Ogee ` cHealth Department contact person: phone#; pother (mfsed 3M P1A) 'I ti