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HomeMy WebLinkAboutBuilding Permit #347 - 64 NORTH CROSS ROAD 11/18/2008 NORT14 BUILDING PERMIT 00 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: ( , Date Received 74woRwreo l Date Issued: /Ild-10;P- �SSAc►+us�� IMPORTANT:Applicant must complete all items on this page k,'•c.>:: r� +4" Y„",. ` ,> s• "ry "`.`"' ,'^. ".�„ z �- rte+ - z"'_ t s 'sY"=ti "+" .; _ �."'.a".f�n�aF '� -+s- i• � r s ?--�� ` - k �c..i x>� _:-� ���� �5 z s 1 y-'a� c z..�, •.Yfi �ss„�'��^�Y�..e4.� 'S�e'4 rs�. nY�" x r .�. F a '�`�=" ^•, "F a. y�3 :� �`� �U �' d rT<�"IlTs+JY'1�� i � .11:12`` aa' r TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration No. of units: Commercial e air, replaceme Assessory Bldg Others: Demolition Other y y:? "N aC'1 - }yrL Y//��`�"n F']i� b 't. }Vr�'}`�.�4, �+i' a� 'jam y� y,/}/1 4 +a �-S£ptaC `/ell} "y4" 3C , VIlar�ds +3.t.�A +•Ge3 SG ��i`ISILIt h DESCRIPTION OF WORK TO BE PREFORMED: Identification Please Type or Print Clearly) OWNER: Name: r �S Ill ijO/S4- Phone: O c� /J Address: �/Jo- louoav" 'HIPS, HIP ,.,.tax z—'�- J:irs"P� �,a s � � � „�, -....t � �z„�. �. is-��. F �� i t e� moi-s k '" 'r6-Ag ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT: $12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ `�� � _ ✓ FEE: $ Check No.: �4 r '� Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the uaranty fu PnRresof c qng- ignatur�hof contractor =` 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 DATE REJECTED DATE APPROVED CONSERVATION COMMENTS DATE REJECTED DATE APPROVED HEALTH COMMENTS 0 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 Located at 384 Osgood Street I 1RE 131EPA"�TM E-IT'� T-- p- p ter on JWzi Locatedt14�Mn Sre# F� t r x ,tz �s z . . ,.,� r s x€'tea �;�. r's q `'t "�, s- „' -.r �"' tst, .y �". r ° t C 1 i-a' �' J E✓ " 5 �,? L fi- e. }— e 7 9' �F�re��iepart��:n����na�re��date �. z 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) ❑ Notified for pickup - Date Doc.Building Permit Revised 2007 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 2.2007 Location / vy� r No. Datei. F 1 — �oRTh TOWN OF NORTH ANDOVER Of� • e , 1'10 Certificate of Occupancy $ ,ss,�ClsEt� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ �y Check # - 217L 'I � Building Inspector NORTH 0 of , s 4 over No. a Y - - dover, Mass., 1 IF'��' COCKICMEwICK V 7 AOOATED BOARD OF HEALTH i Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR r THIS CERTIFIES THAT.T.O..V91�J:....A..C�`' ?`{. Q.C............................................................................................... Foundation has permission to erect........................................ buildings on..a.v.....Ivact-'A.... ros.�A ................................. Rough t0 be Occupied aS /'l �,f✓`�.....1..r� �r Chimney ..... . ... .... v. ..... ......i.. .:.............................:..................,.............................:........ provided that the person accepting this permit shall in every respect conform to the terms of the application on file.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 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO TARTS Rough .............. ............ . . ......... . . Service BUILDING CTOR 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. 0R44er PROPOSAL Doug&Kris Alexander 64 North Cross North Andover, MA 01845 978-683-9330 krisa@479@aol.com November 17, 2008 Work to be completed: • Remove remaining roof structure over front entry. • Finish siding and transition between clapboards and panel section. • Install new corner boards on both sides of front entry. • Finish trim at base of paneled section of front entry. • Remove and replace water table trim along front of house and garage. • Replace corner boards on front corner of garage. • Dispose of all debris. TOTAL LABOR AND MATERIAL $ 4150.00 Terms: $ 1350.00 To start $2800.00 when complete Submitted By: Chris Rivet MA Lic#CS072173 HIC #139962 207 Winter Street (C) 508-265-3115 (H)978-794-1165 North Andover, MA 01845 ACCEPTANCE OF PROPOSAL The above prices, specifications and conditions are satisfactory and are hereby accepted. You are a Otho i ed to do the work as specifiedAft �;�rs wi be mad aw'outlined a ove. Date Signatur Date / a Signatur ACORD,. CERTIFICATE OF LIABILITY INSURANCEDATE(MM/DD/YYYY) 11/17/2008 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION MacDonald & Pangione Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P.O. BOX 428 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 104 Main Street North Andover, MA 01845 INSURERS AFFORDING COVERAGE NAIC# INSURED Christopher Rivet INSURER A: PREFERRED MUTUAL INS CO 15024 207 Winter St. INSURER B: N Andover, MA 01845 INSURER C: INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION 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. INSR ADD'L POLICY EFFECTIVE POLICY EXPIRATION TRI POLICY NUMBER ry p /p LIMITS A GENERAL LIABILITY CPP 0150 57 01 05 09/26/08 09/26/09 EACH OCCURRENCE $ 1,000,000 COMMERCIAL GENERAL LIABILITY DAMAGE ( RENTED PREMISESS Ea occurence) $ 100,000 CLAIMS MADE Fx_]OCCUR MED EXP(Any one person) $ 5,000 _PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1,000,000 X POLICY JECPR2i ED LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO EA ACC $ OTHER THAN AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR FICLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ STATU- OTH- WORKERS COMPENSATION AND TORWC Y IMITS ER EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Certificate holder as listed below CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Town of North Andover DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN'; 120 Main Street NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR No Andover, MA 01845 REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2001/08) ©ACORD CORPORATION 1988 \ ire a.m mnaun"WASAM VJ Massacausew ni Dept of IndrLct W Accents Office of Invesfigadons 600 W4ddngton Street .Boston,MA 02111 www mass gov/dia Workers' Compensation Insurance Affidavit: Ba*lders/ContractorsJEtectricians/Plumbers Applicant Information Please Print UAW Name(Business/Organizationandividual): Address: 121,=i - city/stata zip:NO, 4i 19041d1Z /W ViJ-is Phone.#: S-A?;F-e96-- T//S Are,you an employer?Check the ttippropnate box: Type of project(ragnired ` 1.❑ I an a employes wig :; 4• Q I sin a general contractor and I , —�: have hied the 6. Q New construction PWloyees(fan and/or part tone). 2['I am a sole piop�or partner- on t ahs sheet 7: �R cmodeliag . ship and have no employees These sub-cxomiracboa have & Q Demolition working for me in any capacity. employees and have workers' [No workers'comp.insurance CO'mP.insurance.$. 9. E]Buirldingaddition ) 5. Q Weare a corporation and its ME-1 Electrical repairs or additions officers have exercised \ 3.❑ I am a homeowner doing all work 11.Q Phmlbing repairs of additions myself[No workers' Cam, right 6f exemption,per MGL 12.Q Roof repairs insurance required.]t c.12,§1(4), and we have no 13.Q Other employees.[No workers' comp.insurance required.) !Any applicant that dheeks box#1 most also fill out the section below showing dmir workers,coition policy inforaradon. t llomxovmers who submit Ibis affidavit indicating they are doing all work and thea live outside conv2dors must submit anew affidmt indicating such. tContractws that check this box must attached an additional shed showing the name of the su"oaoactams and state whedher or not those entities have employees. U the subconharaors.have eammployees,tdhey must provide their wvrksas'comp•policy number. I am an employer that ispnowidnrg workers'compensation irrsnMUM for my a mp/oyem $elow is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: / ©�3;0'0 Y O/ Expiration Date: Job Site Address: e<�I'V02/7`6 ZZpS� ' CitY/State/ZiP: /(/Q /Y/V�oU 5 2_ Attach a co of the workers'compensation policy dedara6on sh ^� i�9`/ . Py nP Po cY Page( owing the policy number and ezpirafion 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of luvestisations of the DIA for insurance coveraee verification. I do herrby certify the penokkw of perjury drat the information provided above is true and corm Si e• ate: Phone 0,07datuse only. Do not-write of this area to be completed by city or town q,$rciaL City or Town.-- PermiNL'c ense# Issuing Authority(curie one): :L Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Phunbing 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 employm is defined as"...every person in the service of another ander any contract of hire, express or implied,oral or written." r An employgr 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 incheding flie legal representatives of a deceased employer,br 9ie receiver or trustee-of an individual,partnership,association or other legal entity,employing employees. However flue owner of a dwelling house having not more than three apartinents and who resides therein,or the.o 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 bf such employment be deemed to be an employer." MOL chapter 152,§25C(6)also states that"every state or local licensing agency shalt withhold the issuance or renewal of a license or permit to bpel U.-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 1-52,§25C(I)states"`Neither the canomomweahh 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 tins 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 sub­cont!$ctm s)name(s),address(es)and phone mumber(s)along witir their certificates)of insurance. Limited Liability Companies(LI,C)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to cavy workers'compensation insurance. If LLC or LLP does have employees,a policy is required. Be advised that this affidavit maybe s&mMed to the Departrnent of Industrial Accidents for confirmation of insurance coverage: Aim be sure to sign and date the affidavit. The affidavit should be ieturned to the city or town.trust fire application for the pemait or 1icense is being negnested,not the Departinent of Industrial Accidents. Should you have any questions regarding the low.or if you are required to obtain a workers'- compensation policy,please call1he Department at the number listed below. Self-insured companies should enter their self-insurance license member on the appropriate Iine. 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 permittlicense number which will be used as a reference member. 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 wider"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit tient-has been-officially stunqmd or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for Amire permis.or licenses. A new affidavit must be filled out each year.Where a ho mie,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 brim leaves etc.)said person is NOT required to comps to 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 add&,telephone-and fax number: The Commonwealth of Massaebusetts Depart6ent of lhduAdd l Accidents Office of Inve a"m 600 Washington Street Boston,MA 02111 Tel.#617-727-4900 ext.406 car 1-$77 MASSAFE Fax# 6177-727-774.9 Revised 1122-06 t www.mass.gavfdia Massachusetts- Department of Public Safety Board of Buiadin­ Re-,u and Standards Construction Supervisor License License: CS 72173 Restricted to: 00 CHRISTOPHER F RIVET 207 WINTER ST N ANDOVER, MA 01845: t � c-- �''�psi Expiration: 6/2/2010 ('ummissiuncr Tr#: 25403: 4 / Board of Buildit►g Rtgutations and Standarifs., HOME IMPROVEMENT CONTRAC iOR - Registration 139962 Exp�cF@ . 9f8/2009 Tr#' 132286.1 - T��: Indp4duni CHRISTOPHER F RIVET ` CHRISTOPHER RIVET t 20tIhKER SY. `�'""' N, 1NDOVE9-MA 01845 "AdifiinistCaf��