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HomeMy WebLinkAboutBuilding Permit #13 - 524 MAIN STREET 8/23/2005 TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REP RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING geelir BUILDING PERMIT NUMBER DATE ISSUED: _ / M 11 q j34,0 ___ I SIGNATURE: Buildin Commissioner/1or of Buildings Date Z SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 0 52y _07/ Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Recpired, Provided red Provided v Zane 1.7 Water Supply M.G.L.C.40. 34) erega Disposal System: Public ❑ Private 0 Zone LS. blood Information: 1.8 SewOutside Flood Zone 0 Municipal 0 On Site Disposal System 0 SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT tIfstortc District: Yes No 2.1 Owner of Record #7 cp.C�Cn.e Pof C uS L K-y tame(Print) Address for Service Iff.-g—'algre Telephone 2.2 Owner of Record: Name Print Address for Service: O Z Signature Telephone M SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed -Constructioonn Supervisor: Not Applicable ❑ Licensed Construction Supervisor: 0601 ( 2 a 1 S' 7L License Number Address / r 1 Expiration Date = Signature Telephone '..� 3.2 r Registered Home Improvement Contractor Not Applicable ❑ 7%`%Jvr ( 4 S(J 1^ ( 0 xu'() )E Z / Company Name ) Z (.o Registration Number r Address ` r Expiration Date ^Z Signature Telephone V SECTION 4-WORKERS COMPENSATION(M.G.L.C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes.......0 No.......0 SECTION 5 Description of Proposed Work(check all applicable) New Construction ❑ Existing Building fes' Repair(s) 0 Alterations(s) ❑ Addition ❑ Accessory Bldg. 0 Demolition 0 Other 0 Specify " ''.` Brief Description of Proposed Work: S 94- e SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be 6MCIA.USE ONLY Completed by permit applicant 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a) x (b) 4 Mechanical HVAC p+' 5 Fire Protection 6 Total 1+2+3+4+5 7 Ute' Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN _T_ OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 77bb OWNER/AUTHORIZ(EED AGENT DECLARATION as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief X', b0 //— Print Name t), ze Z3 Signature of Owner/A ent Date NO.OF STORIES SIZE BASEMENT OR SLAB S17E OF FLOOR TIMBERS I 2 ND 3 RD SPAN DINIENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE NORTH Town of 0 No. 490 = W QMV o A dower, Mass.,—j ' �•� �� COCMICKEMCK y�t RATED P'P�\ '`� BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System ' • BUILDING INSPECTOR THIS CERTIFIES THATod A ........ ............ ................................................ ........... Foundation has permission to erect....................... ................ buildings on.... p�� .................. ... Rough to be occupied as.. chimney ... .... ....... ......................... ..................................................................... provided that the person accepti this permit shall m every respect conform to the terms of the application on file m Final this office, and to the provision 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 CONSTRUCTIONS ART 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. Propozat Page of Free Estimates 105 Haverhill Street Fully Insured Methuen, MA 01844 THOMPSON'S ROOFING (978) 691-1355 Shingles — Slate— Rubber Roof Single Ply — Copper Work PROPOSAL SUBMITTED TO PHONE DATE Maureen Cushing 7-18-05 STREET JOB NAME 524 Main Street CITY,STATE AND ZIP CODE JOB LOCATION North Andover MA 01845 ARCHITECT DATE OF PLANS JOB PHONE We hereby submit specifications and estimates for: Strip off all roof shingles on house Renail all loose boards Install aluminum drip edge around roof line -8��w��f� j6pply ice and water shield 6 ft. up all along edge Apply 151b. felt paper on rest of roof area ' Reshingle with a 30 year Architect shingle Install new flanges around soil pipe Install new ..ridge vent— ,A, � $o f"V�,ni 5" �o�/ c Waterproof chimney flashing R�/e77move Lall work related debris p (Z,0 S�}: V" CGm p�►�t � r o ll -, -� c i1 30 year warranty on material 5 year guarantee on labor construction lic . 3060112 improvement#128612 pc r C,� c."j o i�e�►-t ra r► cpOv r We PrOP09C hereby to furnish material and labor—complete in accordance with above specifications, for the sum of: Four thousand five hundred dollars($ 4 , 500 . 00 Payment to be made as follows: on completion 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 Aut riled extra costs will be executed only upon written orders,and will become an extra charge over and Sign above the estimate.All agreements contingent upon strikes,accidents or delays beyond our control. Owner to carry fire, tomado and other necessary insurance. Our workers are fully Note:This proposal may be covered by Workmen's Compensation Insurance, withdrawn by us if not accepted within days. racreptance Of propont—The above prices,specifications and conditions are satisfactory and are hereby accepted.You are authorized to do the Signatu work as specified.Payment wi a7asonod above. Date of Acceptance: Signature ACORD,, CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) PRODUCER 06/20/2005 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Pelham Insurance Services, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P.O. Box 960 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 122 Bridge Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Pelham NH 03076 INSURERS AFFORDING COVERAGE INSURED NAIL# INSURERA Nautilus Thomas Doyle dba INsuRERB Associated Industries Thompson's Construction & INSURER West St C Salem NH 03079 INSURER D. COVERAGES INSURER E: 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 DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TN—SR ADD-L LTR INSRD TYPE OF INSURANCE POLICY NUMBER PO!ICY EFFF.f'TIVE POLICY F.Y.PIRATION DATE(MM/DD/YY) DATE(MM/DD/YY) LIMITS A GENERAL LIABILITY NC 330578 04/15/2005 04/15%2006 EACH OCCURRENCE $ 1,000, 000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $ 50,000 CLAIMS MADE �OCCUR MED EXP(Any one person) $ 1,000 PERSONAL 8 ADV INJURY $ 11000, 000 GENERALAGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRO- PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY JECT LOC AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea accident) $ ALL OWNED AUTOS ' BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE (Per accident) $ GAR7AB AUTO ONLY-EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY EXCEABILITY AGG s EACH OCCURRENCE S u CLAIMS M11-.C� AGGREGATE s DEDUCTIBLE $ RETENTION $ s $ WORKERS COMPENSATION AND S EMPLOYERS'LIABILITY AWC7012214012005 04/21/2005 04/21/2006 x WC KIATUMIT ER TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E L EACH ACCIDENT $ 100,000 If yes,describe under E.L DISEASE-EA EMPLOYEE s 100,000 SPECIAL PROVISIONS below OTHER E.L.DISEASE-POLICY LIMIT S 500,000 DESCRIPTION OF OPERATION S/LOCATIONSNEHICL ES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Job: Various roofing and construction CERTIFICATE HOLDER CANCELLATION Wynwood Associates 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 CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. 19 Basswood Lane AUTHORIZE REPRESENTATIVE r Andover MA 01810 ��� /' �1 E C / , C !� P ACORD 25(2001/08)� ©ACORD CORPORATION 1988�INS025(0108)05 ELECTRONIC LASER FORMS.INC -(800)327-0545 Page t of 2 NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit at: is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, S150A. Also, note Permits are required under Fire Prevention laws Chapter 148 Section 10A. The debris will be disposed of in: � vL.4,-ell (Location of Facility) Signature of Permit Applicant Fire D artment Sign Sn off: DL Dumpster Permit Date f � _ ✓�1ce �amvneamusPalt�c oaaaaclu�Qelta4 4 .:BOARD Of BUILDING,REGULATIONS License: CONSTRUCTION SUPERVISOR Number• CS 060112 Birfl�date {f8tOM1956 Expires 08104/2006 Tr.no: 839.0 Restricted THOMAS T DOYLE 8 WEST ST SALEM, NH 03079 Corfimissiorier - _- Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR 1; ReglaVabpfi`_1,28612 { ExplteTtairr- 128/2067J15 6-- — 5 YP ag- THOMPSON S RCO:C�FING f` + i I• _ THOMAS DOYLE 8 WEST STtit SALEM,NH 03079 Adndnie#—#— 7 ffi Locations No. �� O Date NaRT�, TOWN OF NORTH ANDOVER � 9 ' Certificate of Occupancy $ Building/Frame Permit Fee $ s�CHus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ �� Check # 184J6 ABU Inspector