HomeMy WebLinkAboutBuilding Permit #1000-15 - 50 COBBLESTONE CIRCLE 6/2/2015 NORTFI
BUILDING PERMIToF�tLe° '6,6 6 0
TOWN OF NORTH ANDOVER y.. ,-
APPLICATION FOR PLAN EXAMINATION
i✓VDI f � A�°A `yea
Permit No#: Date Received qp oq""ED
'"PP ^5
gSSACHUs���
Date Issued: Iva, Z` ZO
IMPORTANT: Applicant must complete all items on this page
LOCATION 5-0 rr�b h�a s t7Ile C Y
Print
�
PROPERTY OWNER ✓�r h,
Print 100 Year Structure yes
MAP�PARCEL:��ZONING DISTRICT: Historic District yeszo
Machine Shop Village yes
TYPE OF IMPROVEMENT PROPOSED USE
Reside ial Non- Residential
❑ New Building 206ne family
❑ Addition ❑Two or more family ❑ Industrial
eration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition _ ❑ Other _
❑ Septic; ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District
p_Water/Sewer
DESCRIPT ON OF WORK TO BE PERFO�W!E // /1✓
Identification- Please Type or Print Clearly
OWNER: Name: r-fj;� Sd d 9r1.e.L-- Phone:
—JI
Address: 0
Contractor Name: K) Phone: -78-1 -0.6 y-�'�v
Email: bok-t ,Y3
Address: aL; G tom,,w �. ✓ �
Supervisor's Construction License: 24 3 Exp. Date:
Home Improvement License: -7 1"' Exp. Date: �)
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: $ FEE: $ i�
Check No.: ���� Receipt No.: c)ss
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Location
No. /�Uy— Date �✓
• - TOWN OF NORTH ANDOVER
. Certificate of Occupancy $ '
Building/Frame Permit Fee $
r..
Foundation Permit Fee $ "
Other Permit Fee $------7
TOTAL $
Check#
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 Dump ster on Site ❑
i
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING!& DEVELOPMENT Reviewed On Signature_
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on Signature
COMMENTS
f
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
r FIREDEP,��ARTMENIT fernp -®urnpsster,nl�site° Syes nogg �����'
t ocated
Fire De
artmen ri date,
^I p,�.�.�.:.� _t��gnature/�.,�
�CO,MMEN�T °
i
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 Call Email
Date Time Contact Name 3
Doc.Building Permit Revised 2014
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
OTE: All
dum stet permits require sign off from Fire Department prior to issuance of Bldg Permit
p
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/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
Mass check Energy Compliance Report (If Applicable)
4. Engineering Affidavits for Engineered products
OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
New Construction (Single and Two Family)
i
Building Permit Application
4 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
2012 IECC Energy code
Engineering Affidavits for Engineered products
OTE: 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
i recorded at the Registry of Deeds. One co and roof of recording
that the appeal period is over. The applicant must then get this g rY PY P
must be submitted with the building application
Doe:Building Permit Revised 2014
NORTH
own of E 1�' Andover
No. 115
h ver, Mass, 2 26115
LAKG
coc"Ic"IWICK
A04ATED IPP�,�y
S U -
BOARD OF HEALTH
Food/Kitchen
RMI Septic System E
_T - - - ---
THIS CERTIFIES THAT .............. ......... ............O.W1.4000%olsm.............:............................................
BUILDING INSPECTOR
� � .. C.,/ Foundation
has permission to erect .......................... buildings on ._W.......... .... ..... 1
Rough
tobe occupied as .......... .. .. ........ ............................ .� ......... ............................................ Chimney
provided that the person accepting is permit shall in every respect c nform 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 IN 6 MONTHS ELECTRICAL INSPECTOR
UNLESS CONSTRU3 I ARTS Rough
Service
.......... ...... ........... .................................... Final
" G INSPECTOR
GAS INSPECTOR
Occupancy Permit Required to Occupy Buildinz 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.
VID A
- -- ,L --- -
Roofing- & Contracting
Off ce 781-925-9596/Mobile 781-267-0253
Fax 781-925-9597
Po Box 43 Hull, Ma 02045
Job Location:
50 Cobblestone Circle
North Andover, MA
Price: Roof: $14,450
Color:
Payment Schedule:
1/3 DOWN'(deposit)
1/3 HALFWAY POINT
1/3 UPON COMPLETION
GAF CERTIFIED WARRANTY: Lifetime Shingle/Siding
IOyr Workmanship
130 MPH Wind Coverage
1. Homeowner agrees to make all payments as scheduled.
2. Contractor agrees to provide all labor and materials to complete job description.
3. Contractor agrees to work consecutive days weather permitting.
4. Contractor agrees to install all materials to manufacturer's specifications.
5. Workmanship is warranted for 10 years from date of completion. Option for GAF 25yr
Golden Pledge warranty can be purchased for additional $850.
6. Homeowner is responsible for covering any storage items in attic and removing any
pictures from wall.
Page 1 of 2
Description of job to be performed and material to be used includes the following_
1. Remove existing roofs and all debris from properly into dumpster provided by contractor.
Includes all roof areas.
2. Replace any rotted boards/plywood. Up to 100 sq./ft. is included additional will be $50
per sheet. Re-nail all loose roof boards as needed.
3. Install GAF WeatherWatch ice and water shield on bottom 6 ft. of roof and in all valleys
and flashing areas. Rear low slope roof area will receive 100%ice and water shield
coverage. Area over front door will receive 9 ft. of ice and water shield coverage.
4. Replace missing piece of step flashing at roof/wall intersection over front door.
5. Install GAF ShingleMate synthetic underlayment on all remaining roof areas.
6. Install 8-inch white aluminum drip edge and GAF Pro starter strips along the entire
perimeter of house. Starter strips will be hand sealed to drip edge.
7. Install GAF Timberline HD Lifetime shingles using hurricane-nailing system on all areas.
6 nails per shingle.
8. Install GAF Cobra ridge vent and ridge caps using GAF TimberTex heavy weight caps.
9. Install new pipe flanges on all vent pipes.
10. Install new lead flashing and step flashing on chimney.
11. Protect all siding, windows, and landscaping using tarpaulins.
12. Perform magnetic sweep over driveway and lawn.
13. Clean out all gutters.
I
Expected work schedule to begin:
NOTES: this job will take approximately 1-2 working days to complete. Job cost covers permit
fees. Please call me with any questions that you may have.
CONTRACTOR X DATE:
HOME OWNERX DATE: -1:
I
Page 2 of 2
CERTIFICATE OF LIABILITY INSURANCE
5/27/15 i
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r The Commonwealth of Massachusetts
F' Department of IndustrialAccidents
1 Congress Street,Suite 100
y Boston,MA 02114-2017
ow` www.mass.gov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
A licant Information Please Print Le 'bl
Name(Business/Organization/In/dividual): g
Address: �d �o {• lsl��
City/State/Zip: LAIA 6 20 Phone 4:
Are you an employer?Check the appropriate box: Type of project(required):
1. I am a employer wrth�_-employees(f`11 and/or part-time).* 7. ❑New
'construction
2.F1 I ain a sole proprietor or partnership and have no employees Working for me in 8• ElRemodeling
any capacity.[No workers'comp.insurance required.] 9• ElDemolition
3.❑I am a homeowner doing all work myself[No workers'comp.insurance required.]t 10❑Building addition
4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will
1LFI Electrical repays or additions
ensure that all contractors either have workers'compensation insurance or are sole
proprietors with no employees. 12.0 Plumbing repairs or additions
S.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13•❑Roof repairs
These sub-contractors have employees and have workers'comp.insurance? r(7,
• 14. Other
6.❑We area corporation and its,officers have exercised their right of exemption per MGL c.
152,§1(4),and we haveno employees.[No workers'comp.insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
i Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
tCo Homeowners
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-contractors have 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. /f/��•
Insurance Company Name: '1
iration Date: S lei
Policy#or Self-ins.Lic.#: 1�/���/�����'� 12--' E� J
Job Site Address:
(�15 !i<���,; �� iN 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 MGL c. 152,§25A is a criminal violation punishable by 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.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 and penalties of perjury that the information provided above is true correct.
Sign tur �� Date:
Phone#: ? '`-7 G
Official use only. Do not write in this area,to be completed by city or town offrciaL
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 Person: Phone#:
Office of Consumer Affairs and Business Regulation
10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
ti
Home Improvement Contractor Registration'
Registration: 178475 I
Type: Individual
Expiration: 4/16/2016 Tr# 251161
BRIAN F. O'NEILL w
w
BRIAN O'NEILL a �
6 LANDMARK DR. =
METHUEN, MA 01844
o a �
�.l y
Update Address and return card.Mark reason for change.
Address Renewal F� Employment Lost Card
41 Q 20M-05/11
_ __ - • ---- -.._...+--_...-.,...- �.�,--.a _3.rr_..„_,,. --;r-�.-:.un�s.�awr�+.c�a.m..rv+�,s�.c'.�.__�.,.- .---- --------..._. _.
��e rpo�nir�w��nuecc�a�C%vlrzaaa�c�eL�- '
Office of Consumer Affairs&Business Regulation License or.registration valid for individul use only
ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
a egistration: 178475' Type: Office of Consumer Affairs and Business Regulation
xpiration: 4/16%201:6,. Individual 10 Park Plaza-Suite 5170
Boston,MA 02116
;IAN F.'O'NEILL 'fi 'r
tIAN O'NEILL ` r.
ANDMARK DR. N =r g
THUEN,MA 01844
Undersecretary g Not valid without signature,-
! Massachusetts,-D67partment'of Public Safety
Board of SOIdi6 Re "ulat'on `
.. 9'., � tions and'"Standarcts,
iConstruc'tiuri.Supen.isor R
+.r License,CS=107638
BRIAN 'N ILL
6 LANDMARKDtIVE
' Methuen MA 01944
'Ex
pigation
• Commissionero
. 10/23/2017