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HomeMy WebLinkAboutBuilding Permit #84 - 625 GREAT POND ROAD 8/1/2008BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: OQ Date Received Date Issued: -9' 1 — IMPORTANT: Applicant must complete all items on this page LOCATION 6I"y not PROPERTY OWNER t CYL O i .- Pant - MAP NO: (0 �) PARCEL: ZONING DISTRICT: 'Historic District Machine Shop Village y �ttsv 161 ryO O p q 1• yes no ves no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial _AJIetEgion No. of units: Commercial (;Re:,Jair'i,,,replacement Assessory Bldg Others: on Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: OWNER: Name: Address: WS tion Please Type or Print Clearly) i IBJ 10 04 qm� 0, Phone: � �1 - (094- oo)..-3 F n� CONTRACTOR Name: �1��-�� .� Phone: Address: JII l IPS'" j Supervisor's Construction License: Exp. iDate:i� t ` Home .Improvement License Exp. 'Date: 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. Total Project Cost: $ 000 FEE: $ Check No.: 7- 3 k Receipt No.: l 3 NOTE: Persons contracting with unregistered contractors do not have access to thgguaray4fund 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/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 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 ❑ 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 2.2008 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 DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature COMMENTS IHEALTH , Reviewed on Signature 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 DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT Temp Dumpster on site yes' no Located,at 124 Main Street Fire Department signatureldate COMMENTS Dimension Number of Stories: Total land area, sq. ft.: Total square feet of floor area, based on Exterior dimensions. ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No, DANGER ZONE LITERATURE: Yes MGL Chapter 166 Section 21A --F and G min.$100-$1000 fine IM NOTES and DATA — (For department use ❑ Notified for pickup - Date . ........... . . . ........... . . ......... . . . . . ........ . ...... . ......... . ..... . ........... . .. . .. . ....... . ............... . . ................... . ..................... . . . .................. . ............. . ..... . . . . .............. . ............ . . . . .. . .......... . ............. Doc.Building Permit Revised 2008 Location zoec-?r 44e-pt7— A4W 7,11" No. Date e-) -z n - Check # 1�14T TOWN OF NORTH ANDOVER Certificate of Occupancy $ Buildi ng/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee TOTAL 2 1 380 �CBuilding �Inspector a W O u o w2 > U) O w w° � ao' U w O U � r� w' O w V w o u: cn c w O o w w W A m O cn Q E cn • A 0611 .1.1 P U O 4-J •nJ CD O C L O C s Z C. O y C C ICD � C co 'C co m m Co O.a }i Rom W CD O C O c O a a. CM< c"0 o Cc v J .O coFL C Z CD 0 CL V h C C C. CO2 C LLI U) W uj LLI �/� Y/ c o m c c � i p.= cL - O N C V V Q c to O m p L 0 y � EQ L C DCD vC., C A V! •.s o n y EE :.o m .cow Co :mom Q 4d L \^] L � y H O : 3 L •• y y c CD ca m ♦ O y Vj A c p :gym cm J ;eoy m m CD Li ' s oi o o" CM'S Q 'D C = m tJOy O L , . ;Z O .V c Q COD = m :ago N uu co 4; c 5 •y +• O o .® C.= Ce p r m Z LU. V N4 a CD H- z C. a.m • A 0611 .1.1 P U O 4-J •nJ CD O C L O C s Z C. O y C C ICD � C co 'C co m m Co O.a }i Rom W CD O C O c O a a. CM< c"0 o Cc v J .O coFL C Z CD 0 CL V h C C C. CO2 C LLI U) W uj LLI �/� Y/ Mr Vince Rubin 625 Great Pond Rd North Andover MA, 01845 (978) 697-2023 ROOFING ESTIMATE carpentry I painting; roofing igutters 203 WASHINGTON ST. #256 a SALEM, MA 01970 PHONE: 978.745.8745 FAx: 978.745.3476 SALES@ PRESERVESERVICES.COM Date Bid: 5/6/2008 Estimator: Sean O'Connor Keep the existing copper valley if possible. PRIOR PREPARATION PERMITTING: All permits will be obtained in accordance with the law as required. DISPOSAL: A dumpster will be placed in a area designated by the homeowner. ROOFING PREPARATION COVERING: Tarp the exterior of the house so as not to damage the siding. SHINGLE REMOVAL: Remove all layer(s) of old shingles NAILING: Re -nail roof decking as necessary. CARPENTRY* Replace 1 board butting up against the roof on the rear of the home. On the front of the house on the wall to the right of the front door. Install 1 wall length hard at the base of the stucco. Replace 3 vertical boards off this pieces. Pine/spruce 2 x 8. Patch stucco in the front of the house with a patch. It is not a long term solution. Paint the effected areas. Replace upto 6 pieces of plywood Re -attach gutter on the rear of the house that fell down. The crease will be notieiable when it is done. UNDERLAYMENT FELT: Install 15 lb felt on all areas not covered by ice and water shield. n ICE AND WATER SHIELD: Install 3 feet of ice and water shield on eves and valleys. Install as necessary on other areas. DRIP EDGE: Install drip edge on all perimeters. WALL JUNCTION: Install or rework flashing where the roof meets the wall. VENT PIPES: Install new boot or flange around vent pipes. CBDO NEY(S): Install or rework the flashing around all chimney(s). VENTILATION RIDGE VENT: Install ridge vents. ROOFING MATERIALS ASPHAULT SHINGLES: Install architectural shingle. PRICE $10000 including Labor & Material Payment Terms: 20% deposit (day of start); 30% progress; 50% end of job McNisa/Amex Sean O'Connor r Customer Signature Additional to above estimate: Patch all the stucco not specified above. Bondo rotten wood. Prime patched areas. Paint the stucco and all brown boards butting up against the stucco 1 full coat. Price $2600 Price including Labor & Materials 0 6*1 £6 I al���l�?J _ y _, :� F's'� The Commonwealth of Massachusetts Department of Industrial Accidents �a``" ;• ! Office. of Investigations 600 Washington Street Boston, MA 02111 c_' www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers pplicant Information dl_*� Please Print Legibl, Naive (Business/Organization/Individual): 11 � Address: 02x) 2) W 041�N City/State/Zip 0 -�- ',J J-YICI � Phone #: 4 l _ -AAS_ — P -4S Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4/1?;—Lam 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. I ship and have no employees These sub -contractors have working for me in any capacity. [No workers' comp. insurance required,] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t workers' comp. insurance. 5. ❑ We are a corporation and its officers have exercised their right of exemption per MGL C. 152, § 1(4), and we have no employees. [No workers' comp. 'insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. [1 Electrical repairs or additions 11.❑ Plumbing repairs or additions 1 Roof repairs 13.❑ Other 'Any applicant that checks box # 1 must also fill out the section below showing their workers' compensation policy information. + Homeowners who submit !'his aiidavii indicaiing they are duiug ail work aiid 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. 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 �^ / Policy # or Self -ins. Lie. #: 3 10'000 301 Expiration Date: � 0 az I �� Job Site Address: 6a-� 1 Ld 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. Ido hereby certify u er the pains pe !ties of perjury that the information provided above is true and correct. Signature: _ Date: P v" 6 6 0 1` 0 0 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 -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 cavy workers' compensation insurance. If an LLC .or LLP does have employees, a policy is required. Be advised that this affidavit may 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. # 617-7274900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 5-26-05 www.mass.gov/dia t7J/ J1/ Lt3ut1 LL: t7ts bl /J54U4b11 t'UNIL 1N5URANUL PAGE 02 4/1/2008 9:11:50 AM 876a ® 03/03 ISSUS DATE 04/012008 70DU PICATE 1S SSUEDAS A MATTER OF INFORMATION ONLY AND umnce kmey Inc CONFERS NO RIGHTS UPON TILE CERTIFICATE HOLDER. TM CERTIFICATE DOES NOT AMEND. EXTEND OR ALTER THE COVERAGE AFFORDED BY THE Street POLICIES BELOW. ` a nWdge, MA 02141 COWAIUZFS AFFORDIIvCx COVERAGE SURER lose DeMornis. 6a Action RoDSng cowANY A A.I.M. Mutual Insurance Co 3 Centemiat Ave LETTER evClc, MA 02151 THISB IS TO CERTIFY TRAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PBRIoD INDICATED. NOTWITHSTANDING ANX REQUIRFMEW. TERM OR CONDITION OF ANY CONTRACT OR OM ERDOCUKM WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BM REDUCED By PAM CLAIMS. Co LIR TVPEOTBRURANCa POLICY NONBCR POLXYBFPRCTTYE OATS (MMlDO POLICY FXVIRATH)N OATE(MMIDM VMTTI CENRRAL LIABILITY CCHERALACURaGATE t PRommCompw GO. PUMMALA: ADV. INJURY COMMERGAL GENERAL LUBIU:Y =�LAfhT: MADE=OCCUR aACn0ccuR0.EY46 =OWNER'S k CONTRACTORT PROT. FIRE DAMAcA (Arybe GM) MR0. ETPEMSZ(Akwo-pniu) AUTOMOOILa VANILITV COMBINED SIM= LIWRT AMYAU M Boons tN1UR V ALLOWHEDAUTOS Ofwnv) 1 BCRWULED AVTOD soar Y i"NRT HTREe ARTOS NON-0WNED MRD."• (pN,� GARAC.P. UABILRY PRorRRTY DAMADa RICERR WAPIILITV BACH OCCURREMCa AGGRCCATS UMBRELLA TORN OnIMTHAN UMBRELLA FORM STATVMY LU4= VVORMMS COWENSATEON RM lb.OYEn LEABILTIY x $L EACHACCM744T100,001) PReMUF.7DIU A ARNEMpEEECInw T CIen^. ARE' 6011669012008 03/15/:.'008 03/15/2009 EL 11M Ass-POLICY UMT 500.000 INCL 9EW.L LL DISEASE«EACR 100,000 EIr�LOYEE COMMENTS/ DESCRIPTION OF OPERATIONS OR I,OCAITONS: OSE DEMORAIS 13 NOT COVERED BV THE WORKER.CCOMPLNSATION POLICY. He; Y OF THE ABOVE DBBCMW Paums BECANCELLEDBEFORE Ti KXMRA7MNDATB REQERVE PAINTING� ISSUUM ro1IF"MMTowm kaNNoz>xETOTMCbRTrPtc+►AM W TO TRR LEFT. BUT FAMP, TO MAD. SUCH NUMIr AHALL DOOSE NO ORUGATON 73, TY OF MY UPM TIM CObWtafY. M AOXM OR PJYK EMTATtVBP. O7 WASIIIhGTON ST. 4256 IS ALEM. MA 01970 IkuTuawaDRRP r !hTA-nvE 4928 DO/ IV/ ZVOU 14. CIL f0144J4ZbJ bUYIVIUIN lIVS AALTLMY I kuL 03/ U4 ACO CERTIFICATE OF LIABILITY INSURANCE oAT>6 M '1 06/10/2008 PROBER (781)449-6786 FAX (781)"9-4269 BOYNTON INSURANCE AGENCY 72 RIVER PARK STREET NEEDHAR, NA 02494 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLIC BELOW. INSURERS AFFORDING COVERAGE NAIL I *mURw Kyron Inc DBA Preserve Services Z03 Washington Street,PZS6 Salem,MiA 01970 INSURER A; Max Specialty INSURER& Hartford Insurance INSURER C; INSURER D: INSURER E: OVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR COMMON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. t115R TYPE OF INSURANCE POLICY NUMBER T'D41CY E P0I)CY BItPIRATION UNITS 68NERALUAlUTY m"01310000309 OS/23/2008 05/23/2009 EAcIIo=uRwmF. I 1.000. X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED S SO, 7 CLAIMS MADE � OCCUR MED EXP iAny ane owm) $ S A PERSONAL 6 ADV INJURY 8 1.000,0001 GENERAL AGGREGATE S 2 000 GEN'L AGGREGATE LIMIT APPLIES PER; PRODUCTS • COMPmP AGG S 2,000t X PoLICY T F J LOC AUTOMOR" LIABILITY INOLE LIMIT ANY AUTO (EMi�S ALR OWNED AUTOS BODILY INJURY 80HEDULEDAUTOS (Perpww) : HIREDAUTOS BODILY INJURY S NONaWKEDAUTO6 (ParaaldeMq PROPERTY DAMAGE S (Peraafdem) GARAGEUABILRY AUTO ONLY -EA ACCIDENT I ANY AUTO OTHER THAN EA ACC f AUrOONLY: AGG I EKCESMMBRELLA UASIUTY EACH OCCURRENCE I OCCUR CLAW MADE AGGREGATE S / f DEDUCTIBLE RETENTION S I VIORIUM COMPENSATION AND 0143M392 05/20/2008 05/20/2009 X IWe STAT U. oT►ti B EMPLOYERS UIUi1LITY ANY PROPRETORIPARnMRWMCUTNE E.L EACH ACCIDENT f 1130. DO E.L. DISEASE • EA EMPLOYE I 100, OFFMERN MBER EXCLUDED? if ea. d.txaiho andel s�ECIAL PaovesDNs W. EL 016FMI E • POLICY umrT I f 500000 OTHER DESCRIPTION OF OPM71010ALOCATRMIS/VENTOWIIO(CLUBIONSAWED BY£t1ooRSBNBJt/SPECIAL PROVISIONS 1,000 Bods y Injury and /or Property Damw Deductible OR INFORMATIONAL PURPOSES ONLY. IF ADDITIONAL INFORMATION 15 NEEDED PLEASE CONTACT THE AGENT. TO WHOM! IT MAY CONCERN ACORO 25 (2001!06) SHOULD AMI OFTHE ABOVE DESCRIBED POLICIES HE CAHCEUED BEFORE THE EJtmk-IDN DATE THEREOF, THE MUINO INSURER WILL ENDEAVOR TO MAL 10 DAYS N mmw N0710E TO THE CERTIFICATE HOLDER NAMED ThTM M LOT. HUT FAIL((U�R�E_T/Q�MA0. SUCH NOTICE SHALL IMFKW NO OBLIGATION OR LIABILITY OF A11Y KIND 2: THE IN91AtER. ft'9/1.&*APREBENTAT7I.S n CORPORATION 1966