HomeMy WebLinkAboutBuilding Permit #395-15 - 68 BOSTON HILL ROAD 10/27/2014 t
f 00RT11
r O t�ao e H
BUILDING PERMIT � Q°`.•;,. ._ `'s
TOWN OF NORTH ANDOVER
.00e APPLICATION FOR PLAN EXAMINATION _w
w
Permit NO: I J Date Received
Area A
Date Issued:
— �4SSACHUS
IMPORTAN :Applicant must complete all items on this page
LOCATION P ��N Kt�L Qgo
Print
PROPERTY OWNER PAT
,,ll Print
MAP NO: /13"7 PARCEL: y��ZONING DISTRICT: Historic District yesine Shop Village yes nCo /
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building ' One family
❑Addition ❑ Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
;KRepair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
_= Septic Well Floodplain ❑Wetlands ❑ Watershed District
Water/Sewer
SSP►P� C- n<NIF 14t kNC Mo" eOk N,U 11CAe 9-k'ap"_ ((be N D)tiLy J
` U,4( Vj,v 4LL AiwuiN1) Vby,_c.W
Identification Please Type or Print Clearly)
OWNER: Name: r Phone: RIS- 2T
Address: �jp��-o� W. nn ,X./ ik (D I o
CONTRACTOR Name: Phone: $00-1-.1.t-31-_36
Address:
`J�k rMACsAc,wz T c. P\1G-wu16-i 8,ettmcT,JN AMA 0)q'46 r"
Supervisor's Construction License: Exp. Date:
0%tS6 a4-0�_ Pic
Home Improvement License: Exp. Date:
2-3547- 03 -e5 - 20t5
ARCHITECT/ENGINEER VJI,A 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: $ 5 .180 FEE: $ S(?Q
Check No.: Receipt No.:
NOTE: Persons c with unregistered contractors do not have ac ss o ranty fund
Signature of Agent/Owner t6--;g e.s.ywtd c .a� ignature of contractor
Location
No. 1 K Date
. • TOWN OF NORTH ANDOVER
. B' 6
Certificate of Occupancy $
f
Building/Frame Permit Fee $loa •lip
Foundation Permit Fee $
Other Permit Fee $
t
TOTAL $
! Check# M3
f �
`�' `� Building Inspector
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
PLANNING & DEVELOPMENT Reviewed On Signature_
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
7
' DPW Town Engineer: Signature:
Located 384 Osgood Street
FIRE DEPARTMENT - Temp Dumpster on site yes no
Located at 124 Main Street
Fire Department signature/date
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 Chapter 166 Section 21A—F and G min.$100-$1000 fine
NOTES and DATA— (For department use)
❑ Notified for pickup Call Email
Date Time Contact Name 3
- I
Doc.Building Permit Revised 2014
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
o Building Permit Application
o Workers Comp Affidavit
o Photo Copy Of H.I.C. And/Or C.S.L. Licenses
o 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
o Building Permit Application
❑ Certified Surveyed Plot Plan
Li Workers Comp Affidavit
o Photo Copy of H.I.C. And C.S.L. Licenses
❑ Copy Of Contract
o Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
o Mass check Energy Compliance Report (If Applicable)
o 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)
L3 Building Permit Application
o Certified Proposed Plot Plan
o Photo of H.I.C. And C.S.L. Licenses
❑ Workers Comp Affidavit
o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
❑ Copy of Contract
L3 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:Building Permit Revised 2014
BUILDING PERMIT0�"°oT"gtio
TOWN OF NORTH ANDOVER �2,y; �' 0�
APPLICATION FOR PLAN EXAMINATION
Permit No#: Date ReceivedrED
'
��SSACHUS����
Date Issued:
IMPORTANT: Applicant must complete all items on this page
LOCATION
Print
PROPERTY OWNER
Print 100 Year Structure yes no
MAP PARCEL- ZONING DISTRICT: Historic District yes no
Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building ❑ One 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:
Identification- Please Type or Print Clearly
OWNER: Name: Phone:
Address:
Contractor Name: Phone:
Address:
Supervisor's Construction License: Exp. Date:
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: $ FEE: $
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
gnature of AgenVf, _
kner Signature of contramu,
NORT1y
Town of n
C h ver, Mass,
O
w COG NIC M(WICM ��
oR'�TED I•P %��,�S
U BOARD OF HEALTH
Food/Kitchen
PER IT T LD Septic System
THIS CERTIFIES THAT ....... .. � .,. BUILDING INSPECTOR
..... .. .... ............ .... ................................... .............. .
has permission to erect .......................... buildings on .. .... ♦ Foundation
............. .... .......................
- --- Rough
to be occupied as .. . .. ....... .... ... . .....-...Q t�.. .... t ............................. Chimney
provided that the person accepting this permit shall in every respect conform to the terms of the application
p 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 6 MONIRS ELECTRICAL INSPECTOR
UNLESS CONSTRUCT /IT S Rough
4 —,�y�� Service
............. .. ...................................................... Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Required to Occupy Buildinz Rough
Display in a Conspicuous Place.on the Premises — Do Not Remove Fina'
No Lathing or Dry Wall To Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
Street No.
Smoke Det.
Proposal No. 11701 Date 8/26/2014
WN�C� F4 P.800-771-3938 F.800-771-1543
r` - 4 0 Lei!, • 1191 Mass. Ave., Arlington, MA 02476
. . . -.
Name Pat Carr Address 68 Boston Hill Rd
&
Address 68 Boston Hill Rd North Andover, Ma 01845
North Andover, Ma 01845
Phone Numbers
Main 978-210-9368 work
Email pjc1234@comcast.net cell Fax
F*brk Description (Page 1) Proposal No. 11701
We hereby propose to furnish and perform the labor necessary to:
Low Pitch/Flat Roof:
• Drape outer walls of building with tarp to prevent damage to building, and adjacent landscaping from
falling debris.
• Strip and dispose of all roofing material down to roof boards of which the first two layers are free, then
only 35 cents per square foot for each additional layer.
• Install .5" recovery-board on all sections of roof
• install .060" RPI 40-year rubber roofing on all sections of roof
• Remove siding where roof meets wall, install rubber up wall, minimum 12"
• Install 3" edge metal on all edges
when removing siding. siding is cracked. and may crack more
in stall gutters on rubber area'with 2 down spouts
WORK IS ONLY ON FRONT POURCH AREA
Ranch Renovations will obtain any permits and will be reimbursed by the customer for said permits and/or
any city fees incurred.
Client Initials Ranch Renovations Initials Ranch Renovations-Page 1 of 2
DescriptionWork ...
Conditions
If your roof is replaced during the winter or spring when there is snow on Ranch Renovations is not responsible for interior damage resulting from
the ground,expect to find some roofing debris after it is melted.If you call water penetration through a pre-existing skylight.
us once it is all melted,we will gladly come back and clean the lawn.
In the unlikely event of water infiltration resulting from snow and/or ice on
Any satellite dishes on the roof will have to be removed in order for the roof the roof,neither Ranch Renovations nor the product manufacturer is
to be installed correctly.We will do our best to install the dish in the same responsible for interior damage.
location as previous,and facing the same direction.You may still need to
call your satellite dish company,and have them realign the dish after the We at Ranch Renovations always relead chimneys and other stone brick
roof is completed.Fees are the responsibiliy of the customer. surfaces to ensure that where the brick/mortar meets the roofs surface is
water tight.Please be aware that brick,stone and mortar are porous and
Secure any loose or delicate objects on your walls or shelves before the can deteriorate over time.As such,rain,especially driving rain,can
work is begun.Roof work can shake the house,and walls.Take something penetrate above the area of the work we performed.
down if it is particularly important to you.
You may cancel this transaction,without penalty or obligation,within three
Ranch Renovations is not responsible for roofing debris that may fall into business days(excluding Sundays and Holidays)of the date of this
the attic.At Ranch Renovations,we always strip your roof to ensure the transaction.To cancel this transaction,mail or deliver written notice to
best possible installation.Small pieces of roofing debris and/or sawdust Ranch Renovations,7 Mystic Street,Arlington,MA 02474 no later than
may fall into your attic as a result of installation.We recommend that you midnight of the third day of this transaction(excluding Sundays and
cover your belongings. Holidays).After the third day there will be a service charge equal to 25%of
the total contract.
Roof Color Drip Edge/Edge Metal Color White
Price includes labor, materials and removal of debris. 15 Year Guarantee on Labor
Estimate $5,180.00 Deposit $500.00
Payment 1/2 of payment at start of job, balance upon completion.
Terms
Respectfully Submitted Robert O'Sullivan Per Ranch Renovations
Note:This proposal may be withdrawn by us if not accepted within 15 days.
�Acceptance of Proposal
By signing this contract, customer authorizes Ranch Renovations to obtain permits on their behalf.
The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work
as specified. ents will be made as outlined above. n
Datel(_2-3-1
t
Signature Signature 5� _
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)
V,J� h�t s� . .0� �i Oto —1th WC
❑ Notified for pickup Call Email
Date Time Contact Name
Doc.Building Permit Revised 2014
' The Commonwealth of Massachusetts
Department of Industt ial Accidents
` - Office of Investigations
r '
1 Congress.Street,Suite 100
t% s
Boston,MA 02114-20.17
'e
www.mass gov1dia
Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers
APPUcant Information Please Print I.e�iblr
Name {Business/Organization/individual): Oar J,-, �Le_1,10 fA D- V-,
Address: `�,f Mtf»f-C Vw5r :tom n:°. 16,'noAnn
i f
City/State/Zip: .Phone#:
Are you an employer?Check the appropriate box: Type of project(required):
II am a employer with Lt 4. E] I am a general contractor and I !
' employees(full and/or
* have hired the sub-contractors 6. New construction
pirt-time)_ Q
2.0 1 am a sole proprietor or partner- listed on the attached sheet. 7- Remodeling
ship and have no employees These sub-contractors have g_ Demolition
working forme in any capacity_ employees and have workers'
eom .insurance_± 9- Q Building addition
[I�r o workers comp.insurance p
required] 5. Q We are a corporation and its 10.❑Electrical repairs or additions
officers have exercised their 11_ Plumbing repairs airs or additions
1 ❑ 1 am a homeowner doing all work
myself. [No workers' comp- right of exemption per MGL 12. Roof repairs
insurance required_] � c_ 152, §1{4),and we have no
employees. [No workers' 13T'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 state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site
hiformadon.
insurance Company Name: 'R-t& C. 0n t!�CV1
Policy#or Self-ins.Lic.# �)(�' _� �� ' Expiration Date:0(11 L[ (—_
Job Site Address:(_ ort.1 -1411-t- 1),OAZ City/State/Zip: W6FvN4 ,�+v.►( nvc-R .r..�atoi$yS
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 cert±:fy under the pains and penalties ofperjury that the informadon provided above is true and correct
Signature- _ Date-V)—g— LOIS
Phone#• �-300 -441-S�YS
official use only. Do not write in this area,to be completed by city or town official.
City or Town, Perm itUcense#
issuing Authority(circle one):
i.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
b.Other
Contact Person: Phone#-
(
DATE(MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE
PIMPORTANT:
TE IS ISSUED�A 'A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
ES'
NOT AFFI ATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
I TE OF INSU CE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE
E AND THE CER FICATE HOLDER.
If the certificate ho der is an ADDITIONAL INSURED,the policy(ies)must be endorsed. ff SUBROGATION IS WAIVED,subject to the
n itions of the poli y,certain policies may require and endorsement A statement on this certificate does not confer rights to the
certificate hold r in lieu of such endorsement(s).
PRODUCER j CONTACT
II NAME:
FRED C. CH INC PHONE FAX
41 WELLM AN ST (A1C,No,Ext): (AIC,No):
E-MAIL
LOWELLJAA 01851-5134 ADDRESS:
229FJ S INSURERS)AFFORDING COVERAGE NAIC#
' INSURER A: AMERICAN ZURICH INSURANCE COMPANY
INSURED
O-SULLIV ,ROBERT 1 DB k RANCH RENOVATIONS INSURER B:
[INSURER C:
SURER D:
7 MYSTIC TREET SURER E:
ARLINGT N,MA 02474j SURER F:
COVERAGES ( , CERTIFICATE NUMBER REVISION NUMBER:
THIS IS TO CERTI THAT THE POUgIE OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING
ANY REQUIREM ,TERM OR CONDm N OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE
AFFORDED BYT E POLICIES DESCRIB HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY
PAID CLAIMS.
I
NSR i ADD SUB POLICY EFF DATE POLICY EXP DATE LIMITS
LTR TYPE OF INSURANC L R POLICY NUMBER (MMMDIYYYY) (MMIDDIYYYY)
GENERAL 1LITY CCI OCCURRENCE $
COMI AERMAL GENERAL JABILITY DAMAGE TO RENTED $
LAIMS MADE I OCCUR. REMSES(Es o=ffence)
W EV(Any one pewn) Is
RSON&S ADV INJURY $
i
GEN'L AGGREGATE LIMIT APP JES PER: ENEPAL AGGREGATE $
POLICYEl PROJECT LOC R CTS- 1CIPAGG $
i
AUTOMO TLE LIABILITY C INED SINGLE E $
LIMIT(Eae
ANY UTO
OD
ALL OWNED AUTOS P +t,) $
SCHEDULE AUTOS I 8ODIL.Y INJURY $
HIRE D AUTOS (Fera t)
NON OWNED AUTOS I DAMAGE $
I
EACH OCCURRENCE $
UMB ZELLA LIAR O CUR
EXCESS LIAB C MS-MADE AGGREGATE $
$
DED JCTIBLE i $
NTI
R ON $
WORKER' COMPENSATION D X WCSTAMORY OTHER
A EMPLO 'S LIABILITY 1 YIN UB 4210P87614 06112/2014 06/12/2015 LIMITS
ANY PROP RITORIPARTNER/EXE UTNE E L EACH ACCIDENT $ 100,000
OFFICERIM BER EXCLUDED? Y NIA EL DISEASE-EA EMPLOYEE $ 100,000
(Mandatory n NH)
If yes,des a under f E.L.DISEASE-POLICY LIMIT $ 500,000
DESCRIPTI N OF OPERATIONS be ow
DESCRIPTION F OPERATIONSILO CATIONSIVEHICLESIRESMCTIONSISPECIAL ITEMS
TIRSREPLACE.1 ANY PRIOR CER7 C.ATEISSUED TO THE CERTIFICATE HOIDER AFFECTING WORKERS COMP COVERAGE.
THE WORKERSCOMPENSATION i O CY DOES NOT PROVIDE COVERAGE FOR O'SULLTVAN,ROBERT.
f
1
I
CERTIFEA—T#HOLDER I CANCELLATION
__ 1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED
IN ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORRED REPR A�11E _
ACORD 25(2 10105) The A!C RD name and logo are registered marks of ACORD iSBB 2010 ACORD CORPORATION. All rights reserved.
I1
' 1 Massachusetts -Department of Public Safety
Board of Building Regulations and Standards
Construction Supen-isor
License: CS-098135 �'
-\--I 1
Robert J Osullivan-` '•;
1191 Mass Avenue
Arlington MA 02476
v,.�,.�� , Expiration
Commissioner 04/05/2015
\ ,
Jaeo�urrrarrroe�rll�a/Gi!�u;;uc�rr�ell;
Q Office of Consumer Affairs&Business Regulation
E IMPROCONTRACTOR
kUfflpVEMENT
gistration: -123542Type:
iration: .3/5/2015 DBA
Ranch Renovations
Robert O'Sullivan
42 BELLEVUE RD
ARLINGTON,MA 02476 Undersecretary