HomeMy WebLinkAboutBuilding Permit #196-15 - 58 ROCK ROAD 8/25/2014 NORTH
BUILDING PERMIT
TOWN OF NORTH ANDOVER o�
APPLICATION FOR PLAN EXAMINATION ~ 00
j 7°
Permit No#: Date Received
�SSAC HUS�'t
Date Issued: `� I
IMPORTANT: Applicant must complete all items on this page
LOCATION
Pnnt
PROPERTY OWNER °,I �""t. rJ-� 1- �. -
Pnnt 100 Year Structure yes no
MAP _'PARCEL' ZONING QISTRICT _ Historic District yes no
- T Machine Shop Village yes g_ no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building p ne family
❑Addition ❑ Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
Septic 0 Well D Floodplain Ell Wtlaflds- ❑ Watershed District
❑Water/.Sewer-_
DESCRIPTION OF WORK TO BE PERFORMED:
Is7p,ro 4 /<?c /E7. 110T
Identification- Please Type or Print Clearly
OWNER: Name: 'Jt4IrT.�_'- c-/� Phone:c�l�'�3-
Address: yy IVA
Contractor Name:2MZ4A"IF7Phone
Address: m zez^ at
Supervisor's Construction License Exp. 'late: t'- qc�l Sr.
Home Improvement •License �_� _` ,�". Expo Date:,_ -
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE.BULDING PERMIT.$r1Z00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $� -o FEE:
Check No.: Receipt No.: 2_19 qD
NOTE: Persons contraeti g with unregistered contractors do not have access to the guaranty fund
Signature of Agent/Owner Signature of contractor c.
_�
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 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/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
❑ Mass check Energy Compliance Report (If Applicable) i
❑ 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
a 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:Building Permit Revised 2014
I
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 Dumpster on Site ❑
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
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
r Water & Sewer Connection/Signature& Date Driveway Permit
s 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
k
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)
I
! ❑ Notified for pickup Call Email
i I Date Time Contact Name
Doc.Building Permit Revised 2014
CA_C
ICU Ct(.. kyi
No. -1 Date O
s
. - TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $ �
Foundation Permit Fee $
Other Permit Fee $
•����`�cs a}' TOTAL $
Check#
Building Inspector
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tiOT1 (lumber;
t%ORTi�
Town of ndover
No. * -
h ti ver, Mass, A,
coc«�cMew�cw �
S u
BOARD OF HEALTH
Food/Kitchen
PERMIT T LD Septic System
73qTHIS CERTIFIES THAT ..............w ............... BUILDING INSPECTOR
Foundation
has permission to erect buildings on ��.... ....................
.......................... .... ... ...................................
t Rough
tobe occupied as ........� ............ ...! i.T�................................................................ Chimney
provided that the person accepting this permit shall in every respect conform 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
Rough
VIOLATION of the Zoning or Building Regulations Voids this Permit.
Final
PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
UNLESS CONSTRUCTI T S Rough
Service
w ... ...... ...............................
.................. .. Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Required to Occupy Building 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.
public Safety
Massa
ah�a d Standards
n'rs -•
. . Boarder=� t3j �11�
Const
License: CS-00120 9
�;c i ti Oji
JOHN W LANZAFXME
30 TEMPLE DR
METHUEN MA '0044
Expiration
04/03/2015
Commissioner
i
Oq
Nip,
>.:� sfl
Com^ � � �� � 0
�R
im m Residential & Commercial Roafirig Y Types Of ..
gSiding CH01MNEYS POE NTED-REBUILT-CAPPED
Expert Masonry Work
Mass Toll Free �� � -° � �'.. Licensed & Insured
1.,c e 115 O vn€d& f J'rx r�xttrl St a r^ I4?fi '�� License#034200
1-800-WAIT-4-4JS
{924 X48�} a AC_, J7V � We. Work YearkZarntrsa&
3�« �., �F.tee .\ � i S' W✓-'j, 3'n? ' � Y�' y � .�
Proposal To: John & Christine Whitlock Date 6/24/2014
Street: 58 Rock Rd. 978-683-9279
N.Andover, MA
Roof proposal J.whitlock@verizon.net
IKO Cambridge/Certainteed Landmark
1. Extra caution will be taken to protect house I I.Install new GAF Cobra ridge vent capped with
exterior and landscaping as best as possible. color matched IKO or Certainteed hip and ridge
(tarps etc.) Magnets run at final clean up: shingles. (See option)
1 j 2. Remove all shingles from entire house. 12. Removal of all work related debris. Planks will be
3. Inspect and re-nail any loose or lifted plywood placed under dumpster to prevent any damage to
Any compromised plywood will be replaced at driveway.
�\ an additional cost of$65.00 per sheet of 1/2" 13. Building permit included. (MA state requirement)
CDX fir. 14. Contractor workmanship warranty: 10 years under
j --J 4. Install heavy gauge 8" white aluminum drip normal wind and rain conditions.
edge to all eaves and rakes. 4L
5. Install 6' of IKO Armourguard or Certainteed
Winter guard ice and water shield along all Total roof cos . 8,700.00
eaves and top to bottom in all valleys. Option: Install (1) Lam 1 temp/
6. Install IKO roof guard or Certainteed Diamond humidistat control. Connected by licensed electric'
Deck synthetic underlayment to remaining $500.00 additional cost.
sheathing up to ridge. Direct MFG. Extended warranties:
7. Install all new pipe boots. Fully transferable, 100% coverage for a non
8. Install IKO or Certainteed Leading Edge starter pro rated period of 20 years. Please refer to
shingles to all eaves. pamphlets in material folder. Offered and
9. Install IKO Cambridge or Certainteed Landmark included in this proposal to our local referrals
Limited Lifetime architectural shingles to entire at no additional cost.
house. 15 year non pro-rated warranty by IKO.
10 year if Certainteed is chosen. All shingles and
materials will be installed and fastened Balance due upon completion
7ZS according to mfg. specs. All valleys will be
References available upon request
woven.
10. Counter flash chimney lead with ice and water Highly rated member of the accredited BBB and
shield, tie into new shingles and seal with clear Angie's List
sealant. Integrity of existing lead will be
inspected. Option on cutting new lead flashing
will be offered at that time. Thankyou.
The Commonwealth ofMassachuseits
Uw
• . Q.fflee o, laves igafeons '
600 Washington StreetBosto .,.MA 02111
-wwi mast's go-plciia '
Wgrkexc0'CompewaflonbsuranceAffidavit:BugdergICod.tractors)Electre cians�'I*bexs
AMY eaxnt Info naflo77 Please,P t[n e lily
�I
� v
Hama(Businessiorganizationlfnwdad):, A(I �JnQ Gll oft-<-
-�.ddress• �� 7���� �2.
vert l+sj Phony :
Are you all.employer?Cheek the appropriate box: Type of project(reg irecl):
1.01 am a employer with 4 4. ❑I am a general contractor and I 6. []New constraction
employe,es ullaucl(oxpax tune)T have likedthesuh-contractors e oclelin
7. R.m
� g
the.attached sheet� ❑
., listed on h a
2.❑ I am.a sola proprietor or partner
ship and`haveno.employees These salt-contxaetorshave 8. ❑Demolition
workers'comp.insurance. 9. Building working l'or me in.any capacity. ❑ g addition
pTo workus'comp.,nuance 5. El We area corporation and its 10.r]Electricalxepairs ox additions
xequixed.] officershave,exerelsed.their
3.❑ Z am a homeowner doing all woxk light of exemption per MOL 11.[]Plumbingxepairs or additions
j c.152,§1(4),andwehaveno 12.❑R:oofxepairs
myseL:coworkers'comp.
' insurance;xequixed.�? em-ployees.[.L�I'o workers' O
comp,insmancexequired.]
I .
Any applicantthai checks box#Z musfalso fdl ouithe section bel6wshowingtheirwbrkers'compensatzortpolicy information.
1 Iromeowners who subnntthis affidavit indicatijfftey 22e doing allworlVand then hire outside contracfors mus'subm t a nevi a. dayit indicating such.
xContractorsthatcbeckthisbo mvstaftachedan.additionalsheetshow1hgthenameofthesub-contractorsandtheirvtorkers'comp,policyinformation.
arra are ernproyei t,iai is providing workers'comyeiasation insuran fov�r�y ernproyees Be10 is t ie oticy anciro site
information.
Insurance Companylrlamo%
Policy#ox SeXz ins.llic. 2-Jj Expiratiol Date: al
lob bite A ddxessi �� pw D Pity/Statelz p: G�? / .
Attach a copy of 1hawoxkers'compensation-policy i(eclaratiou page(showing•the policy number and expiration crate).
Failure to secure covexage as xequixedunder,Section 25A.ofMOL o.152 can lead to the imposition,of Orha alpenalties of
fuze up to$1,500.00 andiox ow-year imprisounent�as well as civil penalties im the foxra of a STOP WORD ORDER and a fn e
of-up to$250.00 a day against the violator. Da advised that a copy ofthis statement maybe foxwarded to the Office-,of-
f ations ofthe DIA.for ihsuxance coverage vexifeation.
,av
g
-'•do liereby cerci uric, tried ns and vaB. of perjary&at tit information provided above is tr ae and eorree�
Si atute:
Date•
Phone# "'��
Offy-eiaX use on,y. Do not virile fry this area,to be eonTfeted by city or toren official.
City or Town: Perini-Mcemse#
lssningA.uthority(circle 631e):
1.Board.of Health 2.Budding Department 3.Gt Mown Clerk 4.ElectylealInspector S.BlunmbingInspector
6.Other
bfOrmation and -Insir
Uctions
Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees.
Pursuant to this sta e =_
tiff an e��t to eels de
p y fined as ,„evexStpexson intlie service of auoth under any coniraet oXhir%.
express orlm�liact oral orwxitten."
After loye�is defined as"an.individual,partnership,association,corporation or other legal entity,or anytwa oxmoxe.
ofthe foregoing engaged in a joint enterprise,and includingthe legal representatives ofa'deceased emplgyex,.or tTte
xeceivexortnisteeofaninchvzdua�partnership,associationorotherlegalentity,employingempXoyees, Howevexih'e
owner of a dwellinghousehavingxiotxaore thamthree aparfmants andwho xesides therein,orthe occupant ofthe
dwelling'Louse of another who employs persons to do maintenance,construction ox repair work on such dwelling house
or on,the grounds or building appurtenant thereto shall not because of such employment ba doomed to be an amployar2,
MOL chapter 152,§25C(6)also states that"every state or local liaenslug agency shah'withhold the issuance or
renewal of a license or p ermit to operate a business or to construct buildings in the:commonwealth for any
applicant who flag not produced-acceptable evidence of compliance with the insurance coverage required."
Additionally,M L chapptex 152,§25C(7)states Weitherthe commonwealthnor any of it's political subdivisions shall
enter into any contract for the p erformaace ofpublic work until acceptable evidence of compliance with the insurance
xecluixements of Us chapter have beertpresented to the coptracting authority."
.Applicants
Please fill out the workers'compensation affidavit completely,by chadldng the boxes that apply to your situation and,if
necessary,supplysub-contractors)naina(s),addresses)and honenumber(s)alongwiththeircattiftcate(s)of
insurance, Limited Liability Companies(LLC)or Limited Liability Partnerships(M)with no employees other than the
members orpartnexs,awnotreeluiredto carryworkers'compensationinsurance. I•f anLLC orLLP doeshave
employees,apolicylstaquized. BeadvhedthattbisafddavitmaybesubmittedtotheDepartmentofIudustdal
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The of-davit should
be retained to the city or town that the application for the pemlit or license is being requested,not the D e�arim.ent of
Industrial Accidents. Shouldyou have any questions regarding the law or if you are required to obtain,a Workers'
comp ensationpolioy,please call the Department atthenumbarlistadbelow. ScIf-InSwedcompanies should enter their
self-insurance license number on the appropriate lice.
City or Town Officials
Pleasebesurethattheaftitdavitiscomple,teandpxintedlegibly. T$aDepartmenthasprovidedaspaceatthebotLom
ofthe alfidavitfoxyoutofal out in the event the Office of Investigations has to contactyouxegardingthe applicant.
Please be-sure to fill inthe peimit/Iicense numbex Which-will be used as a reference number, In addition,an applicant
thatniust submitmultiple peimit/lIceme applications is any givenyear,need only submit one affidavit indicating current
PORGY infoxr ation(if necessary)and under"lob Site Address"the applicant should wxite"all locations in (city or
towo):'A:6 opy o the affidavit that has bei officially stainp ed ox marred by the city or town may be provided to the
applicantaspzoofthatavalidai davitrsonfile oxfutuxepemsitsorlicenses, •A.newafgdavitmustbeflledouteacli
year.Where aIlomo owner orcitizen is obtaining a license orb eamitnot related to any business or commercial venture
Q.e.a dog license orpermit to burn leaves eta.)said person is NOT xegahad to complete this affidavit.
The Office of Investigations would like to thank you in advance fox your cooperation and should you have any questions,
please do not hesitd a to give us a call.
The Department's address,telephone and fax number:
TIM Ca o w�aIth Of A4 a rhv._. Pt
604 asgo �"xe
PA40.6 or 1-877-M
Revised 5-26-OS Fax 617"727"7749 I
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