HomeMy WebLinkAboutBuilding Permit #223-14 - 5 BUCKLIN ROAD 9/10/2013 .4 -
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TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO.. Date Received
Date Issued:
ORTANT:A licant must com fete all items on this age
LOCATION
Print
_PROPERTY OWNER e l?Ci5 ,) NG7 Unit#
Print
MAP NO: bZ5 PARCEL 10 ZONING DISTRICT: Historic District yes no
Machine Shop Village yes no
100 year-old structure yes no
TYPE-OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building lEr6ne family
❑Addition ❑Two or more family ❑ Industrial
❑Alteration No. of units: ❑Commercial
epair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
a::.❑ Septic t Well ❑Floodplain ❑ Wetlands` ❑ _Waters$edDistrict
,❑Water/Sewer>, r �'� a��r �-4, _,,��� _ ,�:����`_ �� fi, ,.w� 1���� r_ < �g F
DESCRIPTION OF WORK TO BE PERFORMED:
,/z A 4,,j -7-1,ems 291 Zr s- k1Z24 J E �(zr 1--.
y81J X21 yM)T, /v
(Identification Please Type or Print Clearly)
OWNER: Name:PAC, , A7?N6'-k' Phone: 9 S7-gn o Z' - Z 2 SC
Address:
CONTRACTOR Name: / Iz. '16�N Phone:
Address: K Z 9 l W1
Supervisor's Construction License: /_�O Exp. Date: _-;Z--G I��
Home Improvement License: /6 th 7 Exp. Date: 7 - 2- l
ARCHITECT/ENGINEER Phone:
Address: ~'' Reg. No.
FEE SCHEDULE:BULDING PERMIT:$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST13ASED ON$925.00 PER S.F.
Total Project Cost: $ ' /� FEE: $ �
�7 _
Check No.:
c J Receipt No..
NOTE: gp�r s contracting with unregistered contractors do not h ve ccess to the guaranty,fund
:.:� . X.
•ion�J(lieinor`,: afiiirP -r:ci RtC1r,: - �
Location
No. / 3-1 4. Date- 1
i
• ' TOWN OF NORTH ANDOVER
• �'Ce'fL"ED�6
` t Certificate of Occupancy $
Building/Frame Permit Fee $ (0
- Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check#,
` d Building Inspector
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑ Ta�g(MassageBody 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 - 11 FORM
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT ❑ ❑
COMMENTS
CONSERVATION Reviewed on Siqnature
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
i
DPW Town Engineer: Signature:
Located 384 Osgood Street
FIRE DEPARTMENT - Temp Dumpster on site yes no
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 Z®NE LITERATURE: Yes No
MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine
NOTES and DATA— For department use
L) Notified for pickup - Date
DomBuilding Permit Revised 2011 June/mi
I -
i
Building Department
The following is a fist 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 Pian Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
❑ Mass check Energy Compliance Report (If Applicable)
❑ Engineering Affidavits for Engineered products
MOTE: 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
Doe: Doc.Building Permit Revised 2008mi
tAORTH
Town Of 2 t EAndover
0
No. *
h Ma 3
h , ver, ss, V►Sj to Zo
o
Coc"ICHRWICK y1.
p°R.►TE o �P�',�.c5
S U
BOARD OF HEALTH
Food/Kitchen
PERMIT T LD Septic System
PM.A? S' NTHIS CERTIFIES THAT ..................... BUILDING INSPECTOR
........ ... .... .. .. ..... ..
has permission to erect buildings on .�.�.• ..W14 �(� Foundation
Rough
tobe occupied as ........ ...... .... ................................................................... Chimney
provided that the person accepting,this permit shall in every respect conform to the terms of the application Final
on file in 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 IN6JQNTHS ELECTRICAL INSPECTOR
UNLESS CONSTRU 0STA Rough
Service
.............. .. ....................................................... Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Required to Occupy Building 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.
Smoke Det.
SEE REVERSE SIDE
�; C-�,12e Cpo�noa2useaf,�i a�C%I/GaO�.cz��e�.
Office of Consumer Affairs&Business Regula.tioa
ME IMPROVEMENT CONTRACTOR
egistration: ,;1Q2467 Type:
expiration:;. 7/2.12014 Private Corpo dtio
.a
i NEW ENGLAND CUS M DESIGN;INC.
+ Val Lanza
226 LOWELL ST.
WILMINGTON, MA 01887 '
Undersecretary
Massachusetts - Department of Public Safiety,.
Board of Buii`ding Regulations and Standards •:
Construction Supervisor' ? � 7
License: CS-008828
VAL J LANZA l
34 BMY SV-'
REVERE•MX 02]!5 �s ^�
f14`�h Expiratio6
Commissioner 04/20/2014 .'
i
03/15/2013 14: 12 .9785319442 #3292 P. 001/001
0 PATE(MMiDIYYYYY)
ACORD CERTIFICATE OF LIABILITY-INSURANCE
3/18/1
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMA11ON ONLY AND CONFERS NO RIGHTS UPON THE CEF iFICATE HOLDER THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDEP BY THE POLICIES
BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BEIWEE-N THE ISSUING INSURER($), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIRCATE HOLDER.
IMPORTANT; If the co fit~ate halaer is a6,, D1110—NAL INSUREDI the policy(ies must pa endorsed. If SUSRD0ATION IS WANER, s0int to
the terms and conditions of the polis;l;Certain.policies may require an endorsement.A Statement onthis certificate does nottonfer rights to the
cartiflcate holder in lieu of such endorsement(s).
PRODUCER CO TACT
NAME: _
Kilgore Insurance Agency air t 9781 531-6550 Fw .Nc: (9�8) 531-9442
5 Centennial Dr:.ve E-MAIL
DDRE33•
Peabody, MA 01960 INSURER8IAFFORDING C
_ INsURERA'Wes-tern World Tzza_BraneE ,_,--
INSUR'EO•, ,•.1•-��•�•»,• INS RE B S tei; In Lz a ce ComtOal},V .._.._......�__
New England Custom Design INsuRERc•:Traya1grs Prop erty Ca ualt
Ron Weinberg tNsuJ?F-RA;
226 LOWe1:1: Street / Unit B4-A INSURER E:
Wilmington, NA 01887 • INSURER FI _.•_ ,
COVERAGES CERTIFICATE NUMB=R: REVISION NUMBER,
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE USTED BELOW HAVE BEEN ISSUED TO THE INSURE=D 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 ISSUE=D OR MAY PERTAIN, THE INSURANCE.AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OFSUCH POLICIES:LIMITS SHOWN MAY HAVE BEEN REDUCED t Y PAID CLAIMS.
...' -(A�DD�TSUBR( PpLTCY
TR� TYP60PIN$URANCE I' I I POLICY MBE M1DON MIDd I^^� LIMITS
A GENERALLIASILITY y , !NPP1340227 3/14/13 3/14/14 EACH OCCURRENCE S_1 .000,001
DAMTGGE TO RANTT, -
COMMERCIALQENE�LlIABILITY
-PREMLuE$..(ka Slzjeren.)
_ oviMs-NADE 1 X I OCCUR I MED EXP(AiHo�ersan?� 8 O(
PERSONAL&ADVtNJURY S 1,000,Op(
Ll ' i GENERAL AGGREGATE 5
GEN'LAGCRFGATE41MIr"APPCiE3PER PRODUCiS•006WlOPAtiG 3 21000••,40(
�. ..,.
POLICY.F7 PRO• F'"11 LOC I ( S
X S _N LELIMI
5054921 4/5/;3 4/5/14 .__ p
$
B AU70M081LELABIUTY BODILYINJURY(Pntion) S
2
ANYAUTO ,0
ALLOWNED X SCHEDULED I BODILY INJURY(Par w4idont) b b00 •QI
AUTOS AUTOS P P RiY PM1AdE'"
NON•OWNFD araccident) _� $ ADO,041
HIRLD AUTOS _AUTOS I "•
UMURELLALIAB EACH OCCURRENCE
�i EXCESS UAB -:• MS-MAI7E AGGREGATE
CLAI3
I DED RETENTION$
C ►nORKF.RSCOMPENSATION ) 3/14/13 3/14/18 WCSTATU• O7H• - _
7PJtJ>3-0239N23-2-13 X ORY.LIMI7
AND EMPLOYERS'LIABILITY Y I N H ACG oE� 5 100,00
MIYPROPRIETORMARTNEMEXECUTNE N!A
OFROF.RMEMSER EXCLUDED? F,„4 DIS EASE-EA EMPLOYEE,$,, 10 0,.0 O.
(MaPdaemry in NH)
Ii ypeu cltbe under E.L.DISEASE-POLICY LIMIT g O 00
DESCRIPTION OF 0 E RATIONS below
t I
DESCRIPTION OF OPERATIONS ILOCAIION$/VEHICLES (An4chAOORD101,Additional Rcr4lruGSohodu(e.ftorospace isregdeod)
CERTIFICATE HOLDER CANCEI_f-ATION
sHOULP ANY OF THE ABOVE DIESGIgISED POLIO IES Be CANCELLED 915hORi
THE EXPIRATION DATE THEREOF, NOTICE WILL SB DEUVERE`0`'1N
ACCQRQANCE WITH-THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATN
r�rrnq A. K.ilaor .
NEW ENGLAND CUSTOM DESIGN, INC.
226 LOWELL STREET
WILMINGTON,MA 01887
#978-658-0881
Home Improvement Contract Registration No. 102467
ROOFING AND SIDING AGREEMENT
s is a legally binding contract.Make sure you read this Agreement and understand it before signing it.Do not sign this contract if there are any blank spaces.
NOTICE:All home improvement contractors and subcontractors,unless specifically exempted by Massachusetts law,must be
registered with the Commonwealth of Massachusetts.All inquiries.about registration should be directed to:
DIRECTOR-HOME IMPROVEMENT CONTRACTOR REGISTRATION
One Ashburton Place,Room 1301
Boston,Massachusetts 02108
Telephone:#617 727-8598
lgreement isinade on 7, .20 1.3 ,by and between New England Custom Design,Inc.(hereinafter,"Contractor")
weer (hereinafter,"Ownee'),of
Town ! h I^-A A—67o V Lr,,2- " State Ii Vii— Zip UlMF( ?,H)Phone 7
-7-102'6'12 S 4
idress("The Premises") 6— ucell'A/ -1/� (W)Phone
Rngland Custom Design,Inc.Salesperson
Roofing will be applied only on slope roof surfaces below,over present roofing shingles unless specified under REMARKS.
z rl 1= I v31(.�Y1r/iit/ C
MATERIAL64 �7L� Color c- 14gZ-U 9�
O Main Roof_VC`.S Bay Windows /Ild/t/-e Extensions
Porches:Front 1r�Side A104/ Rear IZ, Other Roofs
NOTE:Roof board replacement cost 2-9-1- per foot OR DD per 4'x 8'sheet of inch CDX plywood.
i`
ARKS/EXTRAS:Missing or defective lumber is not included in any category of work unless specified here.
V�P►�iQl�t cex f�7 �'ivs S�n�clt �.�,.e/t e41 AS,P///14/`- sS�_'e��
f1�2/� fl��g L"oye.s rTG 11nvJ''2
3 / .�cc 7"Ql-(rn � -.A&Sf
dAR-9,YtL ll.<dr"l- 1L V /d<wiivyIn
/// G4, %Y/lam_ Gl
Q�f 4c' h'Lndi< 2�3 l CJJ We/C OVZ)ebeck e?
� .
I D PhYni� S i t Cam�Uirt� �o%/f1
Theactaragrees to perform in agoad and workmanlike mannerall work detailed above.
rc�
CASH PRICE$ � ,7 /1.�� dG
DOWN PAYMENT$ r41 Note 1-all—
Roofing Customers
PAYABLE ON START OF ORK$ d 6a 9.S Q u y New England Custom Design`Inc will noC be
held Cespatisible for dustatid'debns falLiig in uY`fly
PAYABLE $ amc azeas'dutrng rooiitig uisrallauon PleaseW tx4f
PAYABLE ON COMPLETION$ tA 1✓„ S + [L 7
remove of cover valuables t �� r,f f�z"'
DATE: l 20
RIGHT TO CANCEL
mer may cancel this agreement if it has been signed by the Owner at a place other than the address of the Contractor,which may be his main office or branch thereof,provided that the Owner
the Contractor in writing al his main office or branch by ordinary mail posted,by telegram sent or by delivery,not later than midnight of the third business day following the signing of this Agree-
.e attached Notice of Cancellation.A cancellation fee representing 30%of the contract price will be in effect if cancellation is requested after the legally alloned time has elapsed.
mer hereby certifies that he has read this Agreement,that the terms and conditions and the meaning thereof have bee ed to him,and that he fully understands them and that there is no
tndingbetween the parties,verbal or otherwise,than that which is contained in this Agreement,and agree stdte said Conttatt r is not responsible nor bound by any representations not con-
A Agreement, ade by ari of its agents,unless the same be reduced to writing and signed by the C/o� ctor.
VTI OSVNER O NOT SIGN THIS CONTRACT IF THERE ARE ANY Bel SPA t
's Sign a ate L Ne E nd usto Design,Inc. Date
's Signature Date