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Home My WebLink AboutBuilding Permit #147 - 530 MAIN STREET 8/26/2004 TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING hirr bli WELDING PERMIT NUMBER: DATE ISSUED: Q Q / &7 C� 0 SIGNATURE: _ Building Commissioner/12gWor of Buildings Date SECTION 1-SITE INFORMATION I � 1.1 Property Address: 1.2 Assessors Map and Parcel Number: C S 3o f- Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use LA Area sf) Fratrta ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard ReqWred Provide Required Provided ReqWred Provided 1.7 water Supply M.G.L.C.400.1 34) 1.3. Flood Zone Information: 1.8 Sewerage Disposal system: �C Public ❑ Private ❑ ZOnQ Flood Zone ❑ Municipal ❑ tin site Disposal System ❑ WIN SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT :• ! i f t: __ n 2.1 Owner of Record nn Name(Print) Address for Service Signature Te phone O 2.2 Owner of Record. 4 �l 0—&)eS I'C t� (7 /O lite74- Name Pri Address for Service: r -Tjp(��- Signature Telephone SECTION 3-CONSTRUCTION SERVICES Q1 3.1 Licensed Construction Supervisor: Not Applicable ❑ NEW Licensed Construction Supervisor. 6 t C C !/f ( - !,/ !, License NumberX �� 0/-/ (in 35-1� Expiration Date 3 Signature Telephone r 3.i Registered Home Improvement Contractor Not Applicable ❑ v "Ap A-10 fi - Z� C mpany N" I ( Registration Number rn M Address MONS MONS Expuatlon Date Z Signature Tel hone SECTION 4-WORKERS COMPENSATION(N.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 it. Signed affidavit Attached Yes.......❑ No.......❑ SECTION 5 Description of Proposed Work(check aD■ ble New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: ,n SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant I. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost ofCrV �Construction 3 Plumbing Building Permit fee(a) x(b) 4 Mechanical(HVAC) 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, 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. c Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, 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 beli ' 3&iso l Print ame 2,-7 y Y' Si ature of Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 ST2ND3RD SPAN DIMENSIONS 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 i 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 Number 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. The debris will be disposed of in: / k 7l (Location of Facility) Signature of Per it Applicant T� 6Z7 Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector a The Commonwealth of Massachusetts d Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Name Please Print 1 Do Y/ Name: /� ,� Location: X30 m a-t w City A) A JC)J~e A Phone # 0 I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity F-1 I am an employer providing workers'compensation for my employees working on this job. Company name: S 0 X- Address 10 41-�( S City , / .I � Phone f #: Insurance Co. L-,n�el� wru Policv# a w C 4 Company name: Address City: Phone Insurance Co. __ __ __ Policy# Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of,a fine up to$1,500.00 and/or one years'imprisonment.as.welt_as_civil_penaltiesinThe form ofz_STOP.W.ORK_ORDER..and.a fine.d.($100.00.).a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify un the pains and penalties of perjury that the information provided above is true and correct. Signature \ / Date-,z ^2G Print name � Cf h� cis (�) O Y�� Phone# Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensino Building Dept ❑Check if immediate response is required 0 Licensing Board E] Selectman's Once Contact person: Phone#.• F-i Health Department Other t&ORTH Town of North Andover o� Building Department 27 Charles Street North Andover, MA. 01845 S��KUS� D. Robert Nicetta Building Commissioner (978) 688-9545 (978) 688-9542.Fax HOMEOWNER LICENSE EXEMPTION Please print. DATE JOB LOCATION Number Street Address Map/lot "HOMEOWNER Name Home Phone Work Phone PRESENT MAILING ADDRESS City Town State Zip Code The current exemption for"homedwners"was extended to include owner-occupied dwellings of two units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. (State Building Code Section 108.3.5.1) DEFINITION OF HOMEWOWNER: Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two family dwelling,attached or detached structures ac- cessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other Applicable codes, by-laws, rules and regulations, The undersigned"homeowner"certifies that he/she understands the Town of No. Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL 01 _ Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 128612 Ex p i ration: 4/28/2005 Type: DBA THOMPSON'S ROOFING THOMAS DOYLE 8 WEST ST SALEM,NH 03079 ? A.dministra.tbr. �t}"'~- '✓fze �a�r�nzovuuea� o�./�aQaac�ivaelta `� BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Rµ ,�� Numb614-t 060112 BI /156 011'(54"J'21606 Tr.no: 839,0 THOMAS T DOYiI 8 WEST ST /y SALEM, NH 03Commissioner CERTI F I CATE OF L IAB I L I TY I N S U R A N C E DATE 06-16.04 (MM/DD/YY) PRODULER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER PELHAM INSURANCE SERVICES INC THE COVERAGE AFFORDED BY THE POLICIES BELOW. 122 BRIDGE STREET 122 BRIDGE STREET I N S U R E R S A F F 0 R D I NG COVERAGE PELHAM NH 03076- INSURER A: Nautilus INSURED INSURER B: Associated Industries of MA Thomas Doyle DBA INSURER C: DBA Thompson's Construction & 8 West St. INSURER D: Salem NH 03079 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 DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR POLICY EFFECTIVE POLICY EXPIRATION LTR TYPE OF INSURANCE POLICY NUMBER DATE (MM/DD/YY) DATE (MM/DD/YY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $1,000,000 A [X] COMMERCIAL GENERAL LIABILITY NC330578 04-15-04 04-15.05 FIRE DAMAGE (Any one fire) $ 50,000 [ J [ ] CLAIMS MADE [ ] OCCUR MED EXP (Any one person) $ 1,000 [ J PERSONAL & ADV INJURY $1,000,000 [ ] GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG $1,000.000 [X]POLICY [ ]PROJECT [ ]LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT [ ] ANY AUTO (Each accident) $ [ ] ALL OWNED AUTOS BODILY INJURY [ I SCHEDULED AUTOS (Per person) $ [ ] HIRED AUTOS BODILY INJURY [ ] NON-OWNED AUTOS (Per accident) $ [ J PROPERTY DAMAGE [ ] (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ [ ] ANY AUTO OTHER THAN EA ACC $ L ] AUTO ONLY: AGG $ EXCESS LIABILITY EACH OCCURRENCE $ [ J OCCUR [ I CLAIMS MADE AGGREGATE $ [ ] DEDUCTIBLE $ [ ] RETENTION $ $ WORKER'S COMPENSATION AND [X] WC STATUTORY [ ] OTHER B EMPLOYER'S LIABILITY E.L. EACH ACCIDENT $ 100,000 AWC7012214012004 04-21-04 04.21-05 E.L. DISEASE-EA EMPLOYEE $ 100,000 E.L. DISEASE-POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Job: Roofing at 74 Somerset St., Methuen, MA for Nellie Montefusco CERTIFICATE HOLDER [X]ADDITIONAL INSURED: INSURED LETTER: CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR Methuen Housing TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED Rehabilitation Program TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION 41 Pleasant St. OR LIABILITY OF ANY KIND UPON THE INSURER. ITS AGENTS OR Methuen MA 01844 REPRESENTATIVES. V/ AUTHOR /L�ZED�EPRESENTATIVE Fax: Pat 978 681.9421 (7/97) Page 1 of 2 Free Estimates ��O�OlJ1ii Page of 105 Haverhill Street Fully.Insured Methuen, MA 01844 = HOMPSOl\ 'S ROOFING c978) 691-1355 Shingles = Slate — Rubber Roof Single Ply — Copper Work PROPOSAL SUBMITTED TO PHONE , DATE Charles Randone Sr. STREET JOB NAME 6-14-04 530 Main Street CIN,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 shignles on roof and remove old vents Renail all loose boards Install aluminum drip edge around roof line Apply ice and water shield 6 ft. up all along edge and in valleys Apply 151b. felt paper on rest of roof area Reshin le with a 30 year Architect shingle Instal new flange around soil pipe Cut in a ridge vent Cut in new lead flashing around chimney Remove ali work related debris 30 year warranty on material 5 year guarantee on labor construction lic . #060112 improvement #128612 e propat hereby to furnish material and labor—complete in accordance with above specifications, for the sum of: Seven thousand five hundred Payment to be made as follows: dollars($ 7 r 5 0 0 . 0 0 '2 , 500 . 00 down balance upon completion , ) All material is guaranteed to be as specked.All work to be completed in a workmanlike manner according to standard practices.Any alteration or deviation from above specifications involving Authorized extra costs will be executed only upon written orders,and will become an extra charge over and Signature above the estimate.All agreements contingent upon strikes,accidents or delays beyond our control. Owner to carry fire, tornado 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. acreptottre of Vroponl—The above prices,specifications and :onditions are satisfactory and are hereby accepted. You are authorized to do the Mork as specified.Payment will be made as outlined above. Signa �l )ate of Acceptance: Signature NORTH own of Andover 011 No. N7 ~ -- 11L 0 dover, Mass, ab? CO'Hjc�' �c 0 RATED PI?9, C) BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System . ivej THIS CERTIFIES THAT...4.r AAr,JOS ............ .....it a*j to B.UILDING INSPECTOR look# ................... Foundation has permission to erect.... ................................ buildings on jq tAO.....S� ............ ............................ ......................... Rough ,e avo & I to be occupied as ..........................................................RNIP &14040 r, Chimney ............................................... ............................................................. provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-jaws relating to the Ins action, Alteration and Construction of Buildings in the Town of North Andover. OP/Vr PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION START ELECTRICAL INSPECTOR Rough ......... ......00%ft 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 Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE= Smoke Det. ' Location `� 3� /`�A No. e Date o?(v Ofl r NORT1y TOWN OF NORTH ANDOVER � • LA ' Certificate of Occupancy $ 60, Building/Frame Permit Fee $ �cMus Foundation Permit Fee $ Other Permit Fee $ r� TOTAL $ V ' Check # 4M 7 17589 Building Inspector Inspector