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Home My WebLink AboutBuilding Permit #021-15 - 66 CHADWICK STREET 7/7/2014 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: v / I� Date Received Date Issued: i IMPORTANT:Applicant must complete all items on this page LOCATION C(iq0 � I� �1 > Print. PROPERTY OWNERMR l` VMe- Print 100 Year Old Structure yes n0 MAP NO: PARCEL:bA� ZONING DISTRICT: Historic District yes no Machine ShopVillage es no g Y .TYPE OF IMPROVEMENT. PROPOSED USE Residential Non- Residential ❑ New Building ne family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: STPe Z� e%Z -eA Ym Identification Please Type or Print Clearly) OWNER: Name: i Vwl Lei c-C Phone: Address: 6 &41-0r-J%'C( ( S% CONTRACTOR Name: h ✓1 � +c-- Phone: Address: "J-r�r►►��(t /�2 Nl �lkJ e�-� //�Z/�J� Supervisor's Construction License: Exp. Date: 3 2 y / J Home Improvement License: �3`�Js Exp. Date: 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. c/� 00 $ Total Project Cost: $ � d FEE: Check No.: Receipt No.: a � NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contractor xf Plans Submitted Lans W ved ❑ Certified Plot Plan ❑ tam � ed Plans ❑ TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: I� Date Received Date Issued: IMPORTANT:Applicant must complete all items on this page -..:.. LOCATION-. - b [' 4 U� V' -)� ?1, Print PROPERTY OWN ERM9 Print x.00 Year Old Structure yes no MSP NO: PARCEL: _ ZONING DISTRICT _ _ Historic District yes no _ Machine Shop Village yes no .TYPE OF IMPROVEMENT. PROPOSED USE Residential Non- Residential ❑ New Building ne family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other. ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District _0.Wate._r.'(Sewer__ DESCRIPTION OF WORK TO BE PERFORMED: STP�04 rn'► Identification Please Type or Print Clearly) OWNER: Name:_1 Yr✓i e'7'GC Phone: Address: �, Ci- �c.J t'C f 5-T CONTRACTOR Name: _ T_'4%�_,JuA 11W _-_ :Phone: AddnE ss: o { _, �t►�. �,-! 1/1'yl/. j V Supervisor's Construction License: 6cl tz 3Lg Dl s Home Improvement License: _ L3s _ Exp Date: 2 ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT., $112.00 PER$1000.00 OF THE TOTAL ESTIMATED COSTBASEDON$125.00 PER S.F. Total Project Cost: $ ` d FEE: $ ' 1 Check No.: Receipt No.: 1� � NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund .Signaturegof Agent/Ovvner " Sigattare of contractor '' Plans Submitted FJ ans W ved ❑ Certified Plot Plan ❑ tam ed Plans ❑ Location No. O� l 5 Date . • TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ � p Foundation Permit Fee $ A Other Permit Fee $ TOTAL $ Check# �1U d ' Building Inspector Location . TOWN OF NORTH ANDOVER 1 • Certificate of Occupancy Building/Frame Permit Fee AA-,-W I Foundation Permit Fee �-- mit Fee �- Other Per h-- TOTAL Check#�_�— 7749 Building Inspector _ - k W. G�4 - Plans Submitted ❑ Plans--Waived ❑ ".:Certified Plot Plan ❑ Stamped Plans ❑ - �TI'PE-OF'S)JWERAGE_DiSPO.SAL . Public Sewer ❑ Tanning/Massage/Body Art ❑. . Swimming Pools ❑ Well ❑ Tobacco.Sales Food Packaging/Sales ❑ Private(septic tank,etc._ ❑ = _ .-Perinaneint Dtimpster on Site ❑ THE.FOLLOWING SECTIONS FOR 0FFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM _:,. DATE. REJECTED DATE.APPROVED PLANNING & DEVELOPMENT' ❑ ❑ 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 Water & Sewer Connection/signature& Date Driveway Permit DPW Tow;! Engineer: Signature: Located 384 Osgood Street FIRE DEPi4RTME T Temp Dumpster on site eyes no Located-at 124 Mair Street Fire Departure►it signature/date-_ COMMENTS - -: Plans-Submitted ❑ " Plans Waived..❑. -Certified Plot Plan ❑ Stamped Plans- 'T lans ❑ TI'PE DY-,SEWERAGE DISPOSAL" Public Sewer ❑ Tanning/Massage/Body Art F] Swimming Pools ❑ Well ❑ Tobacco.Sales ToodPackaging/Sales ❑ :. Privat -(septic tank,etc__ . ❑--_: perriianent Mimpster on Site ❑ _. THE.FOLLOWING SECTIONS FOR OFFICE.USE.ONLY INTERDEPARTMENTAL SIGN OFF'- U FORM DATE.REJECTED DATEAPPROVED PLANNING-& DEVELOPMENT ❑ ❑ 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 Water& Sewer Connection/Signature& Date -Driveway Permit ,DPW To`v:: /Engineer: Signature:: Located 384 Osgood Street -T-11RE DE PAR�'M:F�iVT., .Temp Dumpsfer on site :yes no Locatedat:124 Mair, Street _ Fire Departmeif signature/date "Y .COMMENTS 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-.Chapter166.Section 21A=F and G min.$100-$1000.fine NOTES and DATA— (For department use U Notified for pickup - Date Doc.Building Permit Revised 2010 Dimenstan Number of Stories: Total square feet of floor area, based on Exterior dimensions._ Total land-area; sq. ft.: -ELECTRICAL: Movement of.Meter l.o.catfon, wiast-or service drop requires approval of Electrical Inspector Yes No DANGER Z®NE LITERATURE: . =Yes No MGL-.Chapter166.Sectlon21A=F and G min.$1004100.0.:fine NOTES and DATA— (For department use ® Notified for pickup - Date Doc.Building Permit Revised 2010 Building Department The fol'ipwing is'a=list of he required forms to be filled ouffor the appropriate.permit to be obtained. Roofivg, Siding, Interior Rehabilitation Permits Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/GrC.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) o 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 cans if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the apw•al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submAted with the building application Doc: Doc.Building Permit Revised 2012 Building Department -rhe fol-)vying i"s- 1i'st of:the req uired:forms to be filled out'for:the appropriate.permit to.be obtained. Roofirag, Siding, Interior Rehabilitation Permits o' Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H-.I.C. And1O'(C.S.L Licenses ❑ Copy of Contract o 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 apuaal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm-tted with the building application Doc: Doc.Building Permit Revised 2012 . NORTfy Town of s E : I� Andover No. , ver, Mass, COCNIC MI WICK 1_ �•9 A�R�rEo �Pa��S S U BOARD OF HEALTH Food/Kitchen PERMIT - LD Septic System THIS CERTIFIES THAT ....... GCIA.pf . .... ° C' BUILDING INSPECTOR has permission to erect buildings on (P(* l�.. UR Foundation .. ...................... ........` � .......... .......................... Rough ®u� to be occupied as ..... .. .. ... ........... ..... ............................................................................. 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN NT ELECTRICAL INSPECTOR UNLESS CONSTRUC I S TS Rough Service ............. ........................................................ 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. C Residential & Conamercial Roofing All Types Of CHIMNEYS POPI TED-REBUILT-LAPP ; Expert Masonry Work Mass-Coll Free Licensed & Insured 1-8004VA J-4-US 'Owned Operated License#034200 (924-8487) co %=r4 We Work Year ]Round Proposal To: Margaret Shaheen Date 5/1/2014 Kmeic residence Street: 66 Chadwick St. N.Andover, MA Roof proposal IKO Cambridge I. Extra caution will be taken to protect house 12. Removal of all work related debris. Planks will be exterior and landscaping as best as possible. placed under dumpster to prevent any damage to + (tarps etc.)Magnets run at final clean up. driveway. 2. Remove all shingles from entire house. 13. Building permit included. (2 Layers) 14. Contractor workmanship warrant : rs under 3. Inspect and re-nail any loose or lifted roof normal wind and rain conditions. boards or plywood. Any compromised roof boards will be replaced at an additional coast of Total roof cost: 9,20 art $2.75 per lineal foot of 1x8 spruce. Any compromised plywood will be replaced at an Option: Cut all new lead flashing into existing additional cost of$55.00 per sheet of 1/2"CDX chimney, counter flash with ice and water shield and fir. seal with clear sealant. $600.00 additional cost.Note: 4. Install heavy gauge 8"white aluminum drip Existing tar is very high. Newle will be cut in to edge to all eaves and rakes. hide as much as possible. 5. Install 6' of IKO Armourguard ice and water Z_z;4 shield along all eaves. � 0/) Y 6. Install 1K0 roof guard synthetic underlayment to *Note*: Please be advised if applicable,valuables in remaining sheathing up to ridge. the attic should be moved or covered due to minor 7. Install all new pipe boots. debris, dust and asphalt particles that will accumulate 8. Install IKO Leading Edge starter shingles to all during the stripping process. All Under One Roof not eaves. responsible for any damage or clean up that may 9. Install IKO Cambridge Limited Lifetime architectural shingles to entire house. 15 year occur in attic. non pro-rated warranty by mfg. All shingles will Balance due upon completion be installed and fastened according to mfg. specs. 10. Counter-flash existing chimney lead with ice References available upon request and water shield, tie into new shingles and seal Highly rated member of the accredited BBB and with black rubberized cement. (See Option) 11. Install a new GAF Cobra ridge vent capped with Annie's List color matched IKO hip and ridge shingles. Thank you! .' / ''- /,/) �!%f '/-7 A V T mil �li/ �,' ,- , /2 011-1ce of,Consumer !k0airs Lt. Business Regulati The Commonwealth o,f MassachuseUs - _ Department oflndustrialAccielenk Of lee of Investigations 600 Washington Street .Boston,.lV.rA 02111 -www.mass govIdla Workers'Compensation bsurance Affidavit:Builders/Conti°actors)Electrxcians)Plumber,q Applicant 1hformation Please Print Ledbh 'Name(Business/Oxganizationftdividual): 0 o L .Address: City/State/Zip: M c-�J-" vim ASS S Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.Vam a employer with 4-1- - 4• ❑ Z am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have liiredthe sub-contractors 2.[] I am a sole proprietor or partner listed on the attached sheet. 7• E]Remodeling ship and'havo no.employees These sub-contractors have S. ❑Demolition woxlsing forme in any capacity. workers'comp.insurance. 9. ElBuilding addition [No workers' comp.insurance 5, ❑�rVe area a corporation and 10.[]Electrical repairs or additions required.] officers have exercisad.their 3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.[(Plumbing repairs or additions myself.[Foworkers'comp. c.152,§1(4),and we have no 12.❑Roofrepairs insurancere edi employees.[No workers' �' .� 13.0 Other comp.insurance required.] xAny applicant that checks box0f must also fill out the section below showingtheir workers'compensation policy information. t-Homeowners who submit Phis affidavit indicatingthey tie doing all workand then hire outside contractors must submit a new affidavit indicating such. l'Contractors that chdkthis box must attached an additional sheet showingthe 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:. ` M41 Ln—U) , Policy#ox Bel£ins.Lic.#: I�► 0 9 — 9 O y� Expiration Data: /t g " Job Site Address: �� t.J►HCl C S City/State/Zip: J t/I Attach a copy of the workers'compensation-polley declaration page(showing the policy number and expiration date). Failure to secure ooverage as requiredunder Section 25.A,.ofMGL o.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 maybe forwarded to the Office of investigations of the DIA.for insurance coverage verification. I do hereby cert under the pain and penalties ofperlwy tliat the information provided above is true and correct. - Signature:. Date: Phone#• Oficial 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/Towa 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. Parsuaz t to this statute,an employee is defined as"...every person in the service of another under any contract of bira,- 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 f'orego'ing engaged in a joint enterprise,and including the legal representatives of a•deceased employer,or the receiver or trustee of an individual,partnership,association.ox 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 bean employer." MGL chapter 152,§25C(6)also states that"every state or local lieensing 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 ofpublic work until acceptable evidence of compliance with the insurance requirements of this chapterhave beenpresented 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),addresses)and phone numbers)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,apolicy is required. De advised thattbis affidavit maybe 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 applicatipn 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 xequired 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 andprinted 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 whichwill be used as a reference number. In addition,an applicant thatmust 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):' 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.'Wh.ere a home owner or citizen is obtaining a license ox permit not related to any business or commercial venture (i.e.a dog license orpermit 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 ctuestions, please do not hesitate to give us a call. The Department's address,telephone anal fax number: Tho CQMM0JjWeaItbL ofMassa� Deparbent of TmduMa•1.Aceldouta Office ofTimstig'Wong. - 600 WakiU&tm Street Boston,U.. 0.21.11. T01, 6IM-2'x,4900 W406 or-1-877.WASS E Revised 5-26-05 Fax#617-727-7749 CER-n��aO E OF LIABHAY INSURANCE,a 3 Mai mss,-oa+ Nn�1 Affls�wf» o,sss A,,1l,1kAw lam• 33151 1r► om moo 4 {410 3 C85YfINMTlE i1 �� PER10D Two sow w 2mr"c+ a AYO s�(W r �r�rtsw►r "'"° � . itiwrar NUMAWO I null,fiutseu EAEGiACDUAAQf�>; � LWAVr + e god"&4~v Mf�D#le�4Aq�tom) � r� &fiDVWOXW ppd1UGIS.COF~Ago f , •'I'LWAPPtAMPO OWLY any re AMt Wt0 W)CKY OM X f €A04 t?C f toWJMILA WAW An0lart"It # goo +�P I16itS1AAC@ fNAA !A 11!lRs43 1t�.o�lse•�Ao�aree 3A et ess •roacrsrwrf ♦W J{00.400.ao tis oreu ►A +► Ne:vo, t '"'"QO�e�'t�+rf�s fw.�rr wr+r..r.»w ww►w Tlfs atA oafaaE'A r�1��e)o!pfen4t#e oav+ri0e for iatfa Lansds�� FORM oil* ! s.a _i ' ACOOD 15(MGJ" 7Ms ACRO aMrM tiwd ltgo as►al0tatafd f)tMl[M et/tCOR4 i xstsays: ao.sail s)ios/Zolsixav o=: ierw 9 a