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Home My WebLink AboutBuilding Permit #243 - 6 KATHLEEN DRIVE 9/29/2006 i TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATIONof"O RT b qti . o i 3r 4.... ._ •: a o� Permit NO: Date Received /' 7J� ey Date Issued: 7' �9 °a^*•�'°Pty SSAcmU`+� IMPORTANT: Applicant must complete all items on this page LOCATION A+ 0, /Vl PROPERTY O f_ Y P ER Le r --� trint / �.�. Print MAP NO.. c5 PARCEL: cO ZONING DISTRICT. TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non-Residential ❑New Building AOne 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 VPS, r� Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: CONTRACTOR Name: Phone: 60370"'ya35— Address: 9- Supervisor's Supervisor's Construction License: Exp. Date: Home Improvement License: t' 3�6 Exp. Date: ARCHITECT/ENGINEER Name: Phone: Address: Reg. No. FEE SCHEDULE:BULDING ERMIT.•$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BA DON$125.00 PER S.F. Total Project Cost : c2 x12.00=FEE:$ f Check No.: Receipt No.:—/ 16el Page Iot'4 TYPE OF SEWERAGE DISPOSAL r Swimming Pools Tanning,TZassage!Body Art J Public Sewer ❑ i Well ❑Tobacco Sales Food Packaging./Sales C Permanent Dumpster on Site Private(septic tank,etc. ❑ Electric Meter location to project NOTE: Persons contractin with unregistered contractors do not have access to the guara I fund Signature of Agent/Owner Gn- Signature of contractor 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 ❑ ❑ ❑Water Shed Special Permit ❑ Site Plan Special Permit ❑ Other COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS Zoning Board of Appeals: Variance,Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Coniments Water& Sewer connection/Si naturJ&Date Driveway Permit Temp Dumpster on site yes_no Fire Department signature/date Building Setback (ft.) Front Yard Side Yard Rear Yard Required Provided Required Provides Required Provided / r 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 DEPARTM ENT:BPFORM05 Created 1MC..Ian'006 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 i ❑ 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) j 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:1311FORM115 Pana 4 of'4 `AORTH Town of 4Andover No. Z. - o A E r dover, Mass., COCMICKEWICK ORATED P'P�` "♦y S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THISCERTIFIES THAT.............................................9....................................................................................... Foundation . ..... ... . has permission to erect........................................ buildinis on . .... +.......... Rough #o be occupied as Chimney .. .ff ... . ................................ ................................................. provided that the person accep ' is permit shall in every res conform to the terms of the application on file in Final this office, and to the provisio the Codes and By-Laws rel ' g 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 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUC START Rough ..... ........... ......................... Service BUI R Final Occupancy Permit Required to Occupy 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 Smoke Det. Roger Dussault General contractor P.O. Box 356 Gilmanton NH. 03237 603-267-1786 603-770-4035 Mobile September 26, 2006 Leverett&Anita Zompa 6 Kathleen Dr Andover Ma 01810 978 475 5722 Contract Project address: Same as above The following specifications are provided for removing existing siding and replace with new vinyl siding. Remove existing hardboard siding. Inspect for wood rot. No provisions for rot repair are included in this quote. Bring any problems to owners attention and continue when satisfactory resolution is achieved. (repair or cover over) Install new aluminum step flashing on roof and wall over garage. Install new housewrap Install new Greengaurd Insulation Install new vinyl siding Cedar Impressions(Herringbone) Supply and install new vinyl soffit. (white) Supply new aluminum flat stock and form to apply to all trim and soffits.(white) Windows will also be covered with aluminum flat stock formed to fit. Remove existing shutters and save for possible reinstallation. Remove rotted fascia trim on front of home (aprox. 60') and replace with new primed pine and cover with aluminum coil. Remove wood trim around garage door and replace with AZEK trim boards. Remove all debris from site. All work stated above is based upon specifications of homeowner. Any and all parts can be changed to the satisfaction of homeowner. Anything not stated in this proposal is not included. The total cost or work described above is$23.750.00 Payments are to be made as follows: 113 upon acceptance$7916.00 113 when existing siding is removed $7916.00 Balance upon completion$7918.00 Roger Dussault Thank you for your business i Authorized Signature Date fd �Q to �a%;z-rr.•r:�7U!'l/,�1� t�.. r�Cl�:iCll:�.Ct..1s.'/�3 BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 046532 Birthdate: 08/10/1960 Expires: 08/10/2007 Tr.no: 27241 Restricted: 00 ROGER C DUSSAULT 86 OAKCREST LN GILMANTON, NH 03237 Commissioner `� ✓jie �a-nz»zarau�eal� o��,ljar,.;.;cac�uae�Cd ` Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 113566 Expiration: 6/28/2007 Type: Individual 3 ROGER C.DUSSAULT ROGER DUSSAULT 86 OAKCREST LN GILMANTON,NH 03237 Deputy Administrator The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 UV, www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information j� Please Print Legibly Name(Business/Organization/Individual): �o Sm_ Address: '5C oA1CC1eS f Ziy City/State/Zip: �� ,4A../ ti� Phone#: X 0 3 770 - YY 3 Are you an employer?Check the appropriate box: Type of project(required): 1.E:1 I am a employer with 4. ❑ I am a general contractor and I 6. E]New construction employees(full and/or part-time).* have hired the sub-contractors 2. I am a sole proprietor or partner- listed on the attached sheet. t EJ 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 required.] officers have exercised their 10.[] Electrical repairs or additions 3.❑ I 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.] t employees. [No workers' 13.El 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. TContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy infonnation. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: 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 a 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. I do hereby certify und r#pains andpenalties ofperjury that the information provided above eeiis true and correct. Si nature: Date: d G Phone#: 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#: 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 of hire, 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 of the 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 of public 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-contractor(s)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. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also 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 permit/license 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. A new 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 or permit to burn leaves etc.)said person is NOT required 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: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax#617-727-7749 www.mass.gov/dia I Location /t,eq� No. 61Y Date ,.oRTM TOWN OF NORTH ANDOVER O 9 t � Certificate of Occupancy $ Building/Frame Permit Fee $ s�CMus Foundation Permit Fee $ E Other Permit Fee $ TOTAL $ ` Check # 19631 Building6r 4pector