The URL can be used to link to this page

Home My WebLink AboutBuilding Permit #332 - 59 WAVERLY ROAD 10/25/2006 TOWN OF NORTH ANDOVER NORT1i APPLICATION FOR PLAN EXAMINATION 0 "tAD 06t9tio L 0 � 3 Iz A 3� Date Received Permit NO: rap Date Issued: 114-C;2s-06 �9SV CHUS�� IMPORTANT: Applicant must complete all items on this page LOCATION 6�J,,4 vc 44 Y 4uc Print PROPERTY PROPERTY OWNER C: A A Al Print MAP NO.: PARCEL: ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non-Residential ❑New Building ❑One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑Repair,replacement ❑ Assessory Bldg ❑ Commercial ❑Demolition ❑Moving(relocation) ❑Other ❑ Others: ❑Foundation only DESCRIPTION OF WORK TO BE PREFORMED e /too Identification Please Type or Print Clearly) OWNER: Name: C'141°'y Phone: Address: 5 �" gl-vc- CONTRACTOR Name: Q4 FiW 119f a��✓� Phone: Address: L v.v sL— Supervisor's Construction License: O 9 5-02- 2 Exp. Date: L '7 Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Name: Phone: Address: Reg. No. FEE SCHEDULE.BULDING PE IT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost :$ C/ FEE:$ Check No.: 115�7 2 Receipt No.: Page I of 4 TYPE OF SEWERAGE DISPOSAL Swimming Pools ❑ F1Tanning/Massage/Body Art E]Public Sewer Well Tobacco Sales El Food Packaging/Sales 11❑ ❑ Permanent Dumpster on Site Private(septic tank,etc. ❑ Electric Meter location to project NOTE: Persons contract' with unre red co actors do not have access to th ara ty fund Signature of Agent/Owner Signature of contract Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF-U FORM DATE REJECTED DATE APPROVED PLANNING& DEVELOPMENT ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS FIRE DEPARTMENT - Tem Dum ster on si a es no Temp p Y Fire Department signature/date COMMENTS Zoning Board of Appeals: Variance,Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Signature&Date Driveway Permit Building Setback(ft.) Front Yard Side Yard Rear Yard Required Provided Required Provides Required Provided Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: NOTES and DATA—(For department use Page 3 of 4 Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 Created JMC.Jan.2006 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 Addition Or Decks ❑ Building Permit Application ❑ 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) New 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 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:BPFORM05 Page 4 of 4 Location f� No. .�.�'�- V Date Z2 NORTH TOWN OF NORTH ANDOVER O?O°t,`•O ,•,hO w 1 9 i Certificate of Occupancy $ • ��s'•^°''�� 9 Buildin /Frame Permit Fee $ _ s�cMust Foundation Permit Fee $ t Other Permit Fee $ /n TOTAL Check # ' 19733 "- Building Insp`actor FORTH Town of 4 L Over dover, Mass., ��•Z�� O�/ T Q C-- l A OC NIC NEE WICK V x,95 RATED BOARD OF HEALTH PERMIT T Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT......... D............1151INW.A./Z,000. . .................................................................................. Foundation has permission to erect........................................ buildings on ... . ... ab `i.1. ..... Rough to be occupied as..............� ..... i! l! .. �...rfit6e Chimney ........... .. . . ................ provided that the person accepting t s permit shall in every respe form to the termsication onfile in Final 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final l O GOP PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTT Rough ...... Service . .. . ... .. .. ................................................ BUILDING INSPECTOR Final Occupancy Permit Required to OmVy 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 R Smoke Det. i ✓fae vi a»vma�uuea�t a�✓�faaaac`u�aelta. Board of Building Regulations and Standards ' "= HOME IMPROVEMENT CONTRACTOR Registration: 142339 ! Expiration: 3/26/2008 Type: Individual { John Ashton Jr. John Ashton Jr. 2 Lunt Street Byfield,ma 01922 Administrator f I , � ✓lie V�amirrco�uaea�i o�✓�aaaac%uaelta *: BOARD OF BUILDING REGULATIONS i License: CONSTRUCTION SUPERVISOR t; Number:,CS 085822 Birthdate:',05/2511937 Expires: 05/25/2007 Tr.no: 85822 Restricted 00' JOHN ASHTON 2 LUNT STS } BYFIELD, MA 01922' Administrator f 09/12/2006 11:58 19787743581 TARPEY INS DANVERS PAGE 02 ..., .,, on IM111Do1TYrrf CERTIFICATE OF LIABILITY INSURANCE o9 1t/:ooe 7i 74. p (971 76-3581 ONL AND CONp! RICO U'�YTMEP CI N OR Tarpay Insurance Group Inc A� � eN, y�MOR'All ORD% eROM 401We St (Rt g)-suits 304 PO Box III INSURIN APPORDING COVIRRAO! NAIL 0 Danverel NA 01933-0!113 AOF Iw IIIA Warnr 113 High Road Eu raw ONE dawn Z3 5/ Nawbury, MA 01951 I � cove 0111 NDIN THE IS1 IEG OF u LISTED OF11=144W IN Q W �N U TH ICY P ANY REQUIREMENT,TERM OR CONDITION OR ANY CONTRACT of OTMIA DOCUMENT VWTM RE/PECT To WHICH TH18 CRATIRICATI uu►v BE IBaueG OR MAY P1,;THIN,THE INIUFIIWCE AFFORD Q SY WE POLICIE6 RISEp HEREIN Ia SUOJECT TO ALL THE TIRMS,PxCLUSIONS AND CONDITIONS OF SUCH POLICI ,AOOREQATB LIMITS SHOWN Y NAVA 19EN RED{lCR'D 9Y PND CLAIMS. TTPE OF IN8u11Am POLW WJNM LIINTI oINwAL 6IAI1Lm N P099io Z 0 -W/1111/20" wg4i OCCUN1fiNCE 1 1000 x DCMMCRCULL GRAL eNELRALRY 1 50.0001 CLAN MADE CE OCCUR Mea � A p1mmum I RYURY 1 O99,0001 ; ON= OATN 3 000 G&LAMMGAT!LIMITAPPLICC PLR PRODUCTI.COINPIEPAGO 1 2,000.00 POLIOY 71 J M LOO AUTD11dNILE LIAEIUTY COI�aIO IN°Ll LIMIT ANY AUTO �r�� ALL OWNED AUTO$ LY INJURY 1 8OWIDULND AUTON HIRED AUTON NOD LY�INJURY 1 NON-WMID AUTOI ME4AMAOI GARAGE LwiLm► AUTO ONLY•G AOCIDW 1 ANY AUTO AU1'° p � CAACG I Ole �p 8 EXCU UMCRCLLA LIAIIUTY IACH OCCURRNNOB 1 OCCUR OLAIMI MASE AOORIOATi 1 1 DEDUCTIELE I PATENnON Is WORNOM000PCNEATIONAND KU 03B40A05-AR 03/31/2M 08/31/200f ' EMPLOYERS UANINTT B ANY PROgP_R_impiPMTHowwCUTive l,L LAOHACCIPEW 1 OFFICIRIMEMERR IXCLUDEDT 1/01828/•IA IMMY14 1 100. eMM" RP"OVII"81361 duow 111 D118AM•POLICY LIMIT 1 500 oofinq Operation C! !MCAT!HOLDIR CANCELLATION EHOYLO ANY 01 THE AWN oNNDNNNO MAN N=MUD BEFORE TNN EEFIRVION DATE TNWOP,?MR INUINO INWREII WILL IN1WVW TO MAIL —10,_m"WINTIIN Mme TO-ml GlImp 6ATE HOLM NAMED TO TNN LAFT, Brian Leehey BUT PAWN TO MAA IUGH NOreO WALL 1111100 NO OLIOATION OR LWILITY 21 %pl ewood Rd OF ANY NO UPON TNN INlURE4 ITE AGWTI OR REPRESENTATIVE& Seabrook, MA 03174, AUTIroR®1112111111SWAM 31101111 TAMIX, CICE V pas ACORD 24(2001101) GACORD CORPORATION 1985 William Ayer Jr Ayer Brothers Roofing 113 High Road Newbury,Ma 01951 978462-1084 John Ashton Jr 978-223-8816 October 24, 2006 Proposal#2095 Ed Garner 59-61 Waverly Ave No.Andover,Ma We hereby propose to furnish the materials and perform the labor necessary to • Strip roof&haul to dump • Install 3 ft of ice&water shield on lower edge and valleys • Install 15 lb felt paper and new aluminum drip edge • Install 30 yr architectural shingles • Install ridge vent Total: $9000 Options: • Replacing rotted wood if needed: '/z ply,$1.75 per sq ft 5/8 ply$2.25 per sq ft boards $2.90 per lineal ft All material is guaranteed to be as specified,and the above workmanship is guaranteed for 10 years. A certificate of liability ins.and workmans compensation insurance will be provided before work begins. Deposit: $3000 Completion:$6000 Respectfiilly submitted by William Ayer,Jr. NOTES—Arty alteration from the above specifications involving extra costs will be executed only upon written order,and will become an extra charge over and above the estimate. All agreements are contingent upon strikes,accidents,or delays beyond our control. This proposal may be withdrawn by us if not accepted within 45 days. At present we are scheduling the week of October 30,2006 ACCEPTANCE OF PROPOSAL The above prices,specifications,and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payments will be made as outlined above. Date Signature Please return one signed copy to the address shown above,and keep the other for your records. Thank you. Hyl \ The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.g ov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Address: //3 /-�/G/-1 �e .0. City/State/Zip: 106-7e),Bv e >/ m . Phone #: Are you an employer?Check a appropriate box: Type of project(required): 1.En I am a employer with � 4. ❑ 1 am a general contractor and I 6. ❑ New construction employees(full and/or part-time).* have hired the sub-contractors 2.El am a sole proprietor or partner- listed on the attached sheet. + ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its officers have exercised their 10.❑ Electrical repairs or additions required.] 3.❑ 1 am a homeowner doing all work right of exemption per MGL I I.❑ Plumbing repairs or additions myself [No workers' comp. c. 152, §](4),and we have no 12. Roof repairs insurance required.] r employees. [No workers' 13. Other comp. insurance required.] *Any applicant that checks box#1 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 a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. /am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. _ Insurance Company Name: C)Dc /7- Y Policy#or Self-ins. Lic.#:_6,-'0-6 7 536 Expiration Date: Job Site Address: SG ' /l/Jc -y A0,� City/State/Zip: l �S 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 Tine 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 may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. /do herebrtlfy un er tl:e pc ns and e i 'es of perjuty that the information provided above is true and c rrecl. Si nature: Date: 0'1 Phone4/ 974' ,--2,23_ (�� 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 Person: Phone#: