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HomeMy WebLinkAboutBuilding Permit #758 - 56 BAY STATE ROAD 4/23/2012O� �1.E0 '• `l� BUILDING PERMIT tt 6= a TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Dermit N(1 Date Received /9k, qArlo P -el TYPE OF IMPROVEMENT PROPOSED USE Resid tial Non- Residential ❑ New Building ® ne family El Addition ❑ Two or more family _ ❑Industrial Q Commercial 11 Alteration No. of units: epair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other fl Set�c �j1�1(elt�' plai Floodn�, Watershed"b�strict F� ,❑Wetlands :❑ n�croiDrinnl nG W(1RK Tn BE PREFORMED. arc.p ��►..���� c©v S�,�Y.c,\es R ��s�� neva Co�`c Q 3 C2 .D ��� No Se-L \e, �v^a-AJ\ �Z,24Mc1J4 �02 0\'�s I OWNER: Name: Please Type or Print Clearly) .o Phone: gly- t s _ i .4 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. .ate rJQ Total Project Cost: $�� FEE: $ Check No.:—) 4 Yd Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund t. 1 Location No. Dat Check #'-)Wd 25218 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Qo Foundation Permit Fee Other Permit Fee $ Y TOTAL $ Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Seng 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 PLANNING & DEVELOPMENT ❑ COMMENTS CONSERVATION COMMENTS Q DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED t DATE REJECTED DATE APPROVED HEALTH COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: Comments Comments Water & Sewer Connection/Signature & Date Driveway Permit Located at 384 Osgood Street 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 Nu i t, -i ana UA I A — (For department use ❑ Notified for pickup - Date Doe.Building Permit Revised 2007 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 o Building Permit Application ❑ Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses o 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) o 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 o 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: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 9Z9SZ µj1 ZLOZ/SZ/S :UO1lPjidx3 £08L0 `dW 'NOiEft-i the 80 380`d 8no3 9 N33iJD S MA00360 00 :01 palculsaa 86992 SC :asua3i-1 asuao11 JoSiAJadng uoi;ona;suo0 sll.iehuclS Pur. suuilrin,`aB ".ulplm8 jo 1).1ro8 �1,01r��iiynd.1111u�w1.ir.d,�a - �lt,�sntl.�rs`'1�11 Office of Consumer Affairs and usiness Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 106222 Type: DBA G & G ROOFING CO. 1r,' µ r '' Expiration: 7/22/2012 Tr# 201586 Gregory Green 8 Four Acre Dr w' Burlington, MA 01803 �r Update Address and return card. Mark reason for change. UPS-CA1 5oM-04/04-G101216 - Address E] Renewal [] Employment [] Lost Card Office of�ons mer rs - u�iness egu anon — _ HOME IMPROVEMENT CONTRACTOR Registration::, 106222 VGV"ROOFING Type: Expiration: 7/22/2012DBA CO x: Gregory Green } 8 Four Acre Dr Burlington, MA 01803 Undersecretary License or registration valid for individul use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, MA 02116 Not v lid wi out signature m m m m m v m c C � N Cl) CD n Z y CD O � .• r C d�• y o CD CD O CL Q CD CD 0 C O N• CD =0 y = O I t� CD = oH 'C Z O SZ O a O CD O C CD g C ?� O m N 2 QN ` O m 0, m CO) N !9 'i7 [7 m _d n rn ' p CL .+ d am O � Is,N O CD H ?o: G ea 2 x �o zs:� N � ' a m m N � w • CDCD N CA .� d N cr gym: e � CD N N m O oma: Ta �o off: tea: CD Wim: W N . CD � co C/) m () o off: d rfl c'o g, C-)Cl) 'i7 rt 'J7 n rn ' p G O O O � C) rD O CD 0 C/) m () o t d rfl R7 g, 'i7 W) 'J7 n rn ' p JJ ] 7o C) rD 0 x H .lEq YOU Copy In business since 1982 8 Four Acre Drive Burlington, MA 01803 (781) 272-7310 licensed and fulty /nsured DATE: 2/29/2012 PROPOSAL SUBMITTED TO: JOB ADDRESS IF DIFFERENT: Phil Petto 56 Baystate Road North Andover, MA 01845 978-375-0718 We berebysubmitspedfica&onsandes&mates for. We will remove existing shingles from all roof areas. New roof will be installed as follows: • GAF Weatherwatch alongfirst six feet to prevent ice dam. • GAF Shinglemate applied to remaining roof surface. • 8" white aluminum drip edge installed along all eaves and rakes. • New step flashing installed to chimney and flashing to vent pipes. • We will use GAF 30 yr. Timberline fiberglass shingles. • Shingle -over ridge vent installed along entire length of main roof and garage. • Install two bathroom vents as discussed. • Protective tarpaulins to be hung around house. • Legally dispose of all construction related debris. Fastening of all materials will be hand nailed, no pneumatic nailers will be used. Cost: $8,300.00 Authorized Signature: We Propose hereby to furnish material and labor -complete in accordance with above specifications, for the sum of: ........ . ................. . „ - , , , , , - , , , , ...... . PAYMENT TO BE MADE AS FOLLOWS: DEPOSIT: One third when job is started, one third when half done, balance due upon BALANCE: completion. The above prices, specifications and conditions are satisfactorywork as spec and Pya (1are hereby accepted. You are authorized to do the work as specified. FIS Payment will be made as outlined above. Signature: The Commonwealth of Massachusetts - Department of IndusidglAccitlents Office of Investigations 600 Washington Street .Boston, MA 02111 www.mass gov1d1a Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Nam(Business/Organization&dividual): e G ' (-s em�k nc� , Address:_8 Fc,�M- .Rcce �D C wA_ City/State/Zip:_ Mor Phone M '4 91 - ---Z l o Are you an employer? Check the appropriate box: 1. L=! l am a employer with d• ❑ 1 am a general contractor and I Type of project (required): 6. ❑ New construction employees (full and/orpart-time).* 2. ❑ I am a sole proprietor or partner- have hired the sub -contractors listed on the attached sheet. 3 7• ❑ Remodeling ship and'have no employees These sub -contractors have 8. ❑ Demolition working forme in any capacity. workers' comp. insurance.g ❑Building addition [No workers' comp, insurance 5. F1 We are a corporation and its 10.❑ Electrical repairs or additions required.] officers have exercised their 3111 am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, § 1(4), and we have no 12. ❑ Roof repairs insurance required.] i employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box #1 must also fill cutthe section below showing their workers' compensation policy information. T Homeowners who submit this affidavit indicating they ere doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp, policy information. lam an employer that is providing workers' compensation insurance for my employees Below is thepolicy and job site information. Insurance Company Name:. k11A Policy # or Self -ins. Lic. #: AA C.,1 a 0 3 `i �. 4 Expiration Date: 10 �a S 6 201. a Job Site Address: ,City/State/Zip:_ 1 ('C�h � MLQI-f, `y► Pt. Cil g l[_, Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL c.152 can lead to the imposition of criminal penalties of 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. De advised that a copy of this statement maybe forwarded to the Office of Investigations of the DTA for insurance coverage verification. I do hereby certify under the pains andpp.enalties ofperjury that the in provided above is true and correct. Signature: �J'1r�r,�--�� ✓ Date: I�3 Phoneg: Official use only. Do not write in this area, to be completed by city or town official 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 Phone #: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract ofhire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant ofthe dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced.acceptable evidence of compliance with the insurance coverage required" Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance ofpublic work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. B e advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. AIso be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple pennitllicense applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. Anew affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license orpermit to burn leaves etc.) said person is NOTrequired to complete this affidavit. The Office of Investigations would like to thank you in advance. for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: Tho GomrgonwealthofMassacl,usotts DUartrnent of Industrial Accidents Office ofjuvestigatlons 6.00 Wash ptpa Street Boston, MA. 02111 Tel, ## 617-727,4900 ew.t406 or 1-877 MA.SS,AkE Revised 5-26-05 Fay,## 617"727-7749 wwwmass,govldia