HomeMy WebLinkAboutBuilding Permit #462-11 - 565 OSGOOD STREET 12/2/2010TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION,
Permit NO. 7 L/l Date Received
Date Issued /d, Z --j(()
EMORTAINT: Applicant must complete all items on this page
LOCATION 565 Os 6�i>
Print ri
-- - — � - % • Print
MAP NO: 3Je_PARCEL--__:9f_ ZONWGI DISTRICT: Historic District yes
Machine Shop Village yes no
r,-PerRmTmN OF WORK TO BE PERFORNMAD: n
-g- tAI iS
Identification Please Type orgrint Clearly)
L
�i"l �'
Address:
CONTRACTOR Name: -CML.&11QAaMCY1 JjA Phone.6M -_?,t -69
Address: If71 1�^�'-n�i 'c1�Cs-.a �PA �3
Supervisor's Construction License: Exp. Date: 3—!qJ 2C'r 1 '2
Home Improvement License: 101 a- a 0 ____gxp. Date: 20
ARCHITECT/ENGINEER Phone:
Address: Reg. N
FEE SCHEDULE: BULDING PERMIT: $92.00 PER $9000.00 OF THE TOTAL ESTIMATED COSTBASED ON $925.00 PER S.F.
Total Project Cost: $ �� FEE: $_j ®G -00
Check No.: aa Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the
11
Plans Submitted ❑ - Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑
Well ❑
Private (septic tank, etc. ❑
Tanning/Massage/Body Art ❑ I Swimming Pools . ❑
Tobacco Sales ❑ Food Packaging/Sales ❑
Permanent Dumpster on Site ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
DATE REJECTED
PLANNING & DEVELOPMENTEl
DATE APPROVED
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on Signature
COMMENTS
Zoning',Board of Appeals: Variance, Petition No: Zoning Decision/receiptsubmitted yes
1
a
Planning Board Decision: Comments
Conservation Decision:
Comm
Water & Sewer COnnectl6n/Signature & Date Driveway Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street
FIRE DEPARTMENT - Temp Dumpster on site yes 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 ZONE LITERATURE: Yes No
MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine
Doc:.Building Permit Revised 2008
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
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permi
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)
❑ 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
Ideal 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
10TE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
1 all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals
to t the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
It st be submitted with the building application
Doc: Doc.BuUding permit Revised 2008mi
Location6�
No. Z Date
MORTh TOWN OF NORTH ANDOVER
O',.s°
to
Certificate of Occupancy $
^° Building/Frame Permit Fee $
04USE
Foundation Permit Fee $ —r
Other Permit Fee $
TOTAL $
Check # 4�103
2.3759
Building Inspector
The Commonwealth of Massachusetts
Department of IndustrialAccidents
Office of Investigations
600 Washington Street
Boston, MA 0211'
www.mass.gov1dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/FIectricians/Plum hers
Applicant Information Please Print Legibly
Name (B.usiness/Organization/Individual): ibp
Address:_ 4 C
City/State/Zip: o a Q -Phone #: q lt3 7-12-6r>
Are y an employer? Check the appropriate box:
1. WI am a employer with Z
4. ❑ I am a general contractor and I
employees (full and/or part-time).*
have hired the sub -contractors
2. ❑ I am a sole proprietor or partner-
listed on the attached sheet.
ship and have no employees
These sub -contractors have
working for me in any capacity.
workers' comp. insurance.
[No workers' comp. insurance
5. ❑ We are a corporation and its
required.] .
officers have exercised their
3. ❑ I am a homeowner doing all work
right of exemption per MGL
myself. [No workers' comp.
c. 152, § 1(4), and we have no
insurance required.]
employees. [No workers'
comp. insurance required.]
Type of project (required):
6. ❑ New construction
7. ❑ Remodeling .
8. ❑ Demolition
9. ❑ Building addition
10.❑ Electrical repairs or additions
11. ❑ Plumbing repairs or additions
12.❑ Roof repairs
13. VOther W L1V vt-R) Z*na A
*Any applicant that checks box 41 must also fill out the section below showing their workers' compensation policy information.
T Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such.
lContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information.
I am an employer that is providing workers' compensation insurance for• my employees. Below is the policy and job site
information. _
Insurance Company Name: j'A i2f-� RIO I
Policy # or SeIf-ins. Lie. kz� 6S2a— Expiration Date:
Job Site Address: S bs �i.�C- _C City/State/Zip:��� hq& 0)84A-
Attach
j84 --Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as required under 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 STOP WORK ORDER and a fine
of up to $250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certifl ur der k4#?s and'penalties ofperjury that the information provided above is true and correct.
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. EIectrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: Phone #:
CONSTRUCTION INC.
Scope Of Work
November 28th, 2010
Co-operative Preschool, 565 Osgood St. North Andover.
Install 3 new gable end vents, painted to match existing siding.
Remove and dispose of all existing Fiberglass insulation from attic area.
Air seal all Top plates and ceiling penetrations with 2 -part foam.
Seal and insulate all heating ducts in attic area with 2 -part foam.
Fabricate and install a rigid foam attic hatch cover.
Replace existing bath fan ducts with new insulated duct.
Replace existing bath fan wall boots with new.
Install 12 inches (R-38) of loose blown cellulose insulation in attic area.
Total Price, labor and materials: $8825.00
Dave Hope:
President, HRH Construction, Inc.
Julia Ross:
Board Member.
P i
1
HRH Construction, Inc.
57 Chase St, Methuen, Ma. 01844.
978-314-7263 www.hncconstruction.net dave@hncconstruction.net
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mY."v*gQyWYon COPY Of q
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�be`made according to the following
cataC ; — ')
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mpletiomschednla{••j to be paid for
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Additioaad Ytdarmation ... • .: .
If yon leave smaai.gnestiona oraeed addifimd iaSosmafm abort the Room Impm msm Contactor t aw or other
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,For am stemm wdh is mud mediation-ofdispnft a r to ngmtwsaimal complaints against a business, call:
ComumerCampisimt Serous
Offcca of the Attomey 0amarat
(617) 7274400
__
on valid: for individul use only
HQMF- IMPROVEMENT CONTRACMR
before the expiration date. If found return to:
Registration: �,�101730. Type:
9HONSTRUOTIQ
Office of Consume r Affairs and Busi . ness R I egulation
Expiration: 12 Private Corporation
10 Park Plaza - Suite 5170
Boston, MA.02116
William Hope
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