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Home My WebLink AboutBuilding Permit #684 - 707 WAVERLY ROAD 5/21/2008Location O -2 No. Date a NORTq TOWN OF NORTH ANDOVER O. �"ao ,•',•yG • OL 9 Certificate of Occupancy $ ��s'•^�''t�' Building/Frame /Frame Permit Fee $ 3 s �cNust 9 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 2 ( f 68 Building Inspector BUILDING PERMIT TOWN OF NORTH ANDOVER c, APPLICATION FOR PLAN EXAMINATION Permit NO: 7 Date Received Date Issued: `J' �� 0? IMPORTANT: Applicant must complete all items on this page LOCATION 70 t? ld- > Rfit 1L)Ay) t 'I PROPERTY OWNER /YJr.5 (d n6,(/ fJcS" Print MAP NO: v PARCEL: OZ ZONING DISTRICT: Historic District Machine Shop Village jrORTFi \ O Stereo ;6• tiA AL ea r �* o � *� yes no ves no TYPE OF IMPROVEMENT PROPOSED USE Reside Non- Residential New Building One famil i Addition wo or more family Industrial No. of units: Commercial ,.-Repair , re lace Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION F WORK TO BE PREFORMED: Identification Please Type or Print Clearly) OWNER: Name: %nvs Ano � �' 1 Address: 70 7 CONTRACTORName: Address: 'y AJh, 70_ Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: —Sb Illo 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: $ Q , ��e FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund signature of AgenUOwner Signature ofcontractor 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 EEL T H COMMENTS Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: Comm Comm Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: FIRE DEPARTMENT Temp Dumpster on site Located at 124 Main Street Fire Department signature/date COMMENTS uocatea X364 usgooa Street yes no 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 2008 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 N, The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations a d 600 K'ashington Street eW� Boston, MA 02111 ,a S V www.mass.gov/dia ' Workers' Compensation Insurance Affidavit: Builders/Contractors/Eleetricians/Plumbers Name (Business/Organization/Individual): Address: City/State/Zip: -6) f W V, V0 01_bL S - Is Oi 1 Phone.#: D! % � (0 % 6 - i q O q Type of project (required):, 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.. ❑ Electrical repairs or additions 1l.❑ Plumbing repairs or additions 12. E] Roof repairs 13. ❑ Other *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. lContrctors that Check'is 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 information. l I0Insurance Company Name:�t� __, i, a S u O] l �UV�a10 Policy # or Self -ins. Lic. #:(/S -03,)-7 L ny�� c-1 — 67 Expiration Date: -[ Job Site Address:30--7 WaV-e zi � City/State/Zip: l�< h400 _er 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 $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coveraee verification. I do hereby certifyxun0��ains andpenalties ofperjury that the information provided above is true and correct one Official. use only. Do not City or Town: area, to d vs h or town official Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other -G 70 - Contact .Person: Phone Areyou an employer? Check the appropriate box: 1A I am a employer with _ ' 4. ❑ I am a general contractor and I employees (full an part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub -contractors have working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its 3. 111 am a homeowner doing all work officers have exercised their myself. [No workers' comp. right of exemption per MGL insurance required.] t 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.. ❑ Electrical repairs or additions 1l.❑ Plumbing repairs or additions 12. E] Roof repairs 13. ❑ Other *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. lContrctors that Check'is 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 information. l I0Insurance Company Name:�t� __, i, a S u O] l �UV�a10 Policy # or Self -ins. Lic. #:(/S -03,)-7 L ny�� c-1 — 67 Expiration Date: -[ Job Site Address:30--7 WaV-e zi � City/State/Zip: l�< h400 _er 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 coveraee verification. I do hereby certifyxun0��ains andpenalties ofperjury that the information provided above is true and correct one Official. use only. Do not City or Town: area, to d vs h or town official 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 -G 70 - Contact .Person: Phone Information and Instructions Massachusetts General Laws chapter 152 requires all employ6rs 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 ortrustee 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,opera'te.-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 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 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 permivlicense 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 Fax # 617-727-7749 Revised 11-22-06 www.mass.gov/dia 3-i �/:eaninwmsuea�i Board of Building Regulations and'Standlirds . I U1HOME IMPROVEMENT CONTRACTOR Registrtioir, 150272 }—�t�?� X121/2010 Tr# 265638 DEMPS.EY CONS{ �30OF, 1NG I ERIC DEMPSEY sr :f 7 RICHARbSON S; `r BILLERICA, MA 01821 Administrator.. License or registration valid for individul use only before the expiration date. If found return to: Board of Building Regulations and Standards One Ashburton Place Rm 1301 Boston, Ma. 02108 Not valid,,Without signature FROM :DEMPSEY ROOFING FAX NO. :19783623102 May. 15 2008 12:38PM P1 Dempsey Construction S Roofing Specialists Proposal 7 Richardson Street Billerica, Me 01821 978-670-8904 ,--. customer - Name Ann Webster Address 701 Waverly Road City ` North Andover State Ma ZIP Phone 978-376-9625/Fax 888-872-5033 Qty Main House Roof over(ony if there are no existing leaks) Install 30 YR Architect Roofing shingle over existing. Install new pipes and ridges. "The cheek wall siding may be an issue as discussed on 5.14. We can remove siding & install new Ice & water, and flashing or remove siding & use existing flashing at an additional cost. Install 2-2" and one 4" pipe flanges. Install shingle over ridge vent. This is a labor, materials, and permit proposal. Five year warrantee on all workmanship --� FlIm posal — Date 5115108 Order No. Rep FOB Unit Price TOTAL ` Com, --wick ,1V5tew -'� �lr�l �4� f-ir�in� �'�a..�""t'`'t�r i ►'1 Ir�2'�`.� � C�''1,/ a.�-� �1.� Please make all checks payable to Eric Dempsey rayment ueaansr C) () Check C) Pa►able to ERIC DEMPSEY $1,000.00 down. for materia/s remainder due upon completion. SubTotal Shipping & Handling, Taxes State TOTAL Office Use Only $2,890.00 p IZ w O N M x a c a 0 w° cn o z cc w° OD a�' G U w a a�G Cd w x ugn w cz w O U w a 1:4 w F w � A w w� Z cn - o 0 cn I O as • �• L O Z CD CL O h D O � c cm 03 Q y O O •E m CO CD C2 CD �3 O � � CD 0 0 cc o a CL vmQ co Cc Cc CL O CD c Z CD CLCO2 c C C cc CL LLI CA LU U) ce W lu 19 ujW N cz 5 0 :�m c � C V : C H O V V : •C.Cc p, C ev m C CDam s� O Cc N ja �, : EQ V 0 CL N 10 aF * * 'O o c mo a C N N m � �+ N C C O E N A &-'0 C CLC.% r: cm m N m > �v coQc N acz cc � :mom m a O > Z C v W O •� G cm Q � i m C •O W C10 ui I L L CLIS m •N O ca 0 CM O n m 'm o Z y = v ��y� O = q- a�m� I O as • �• L O Z CD CL O h D O � c cm 03 Q y O O •E m CO CD C2 CD �3 O � � CD 0 0 cc o a CL vmQ co Cc Cc CL O CD c Z CD CLCO2 c C C cc CL LLI CA LU U) ce W lu 19 ujW N