Loading...
HomeMy WebLinkAboutBuilding Permit #244-16 - 73 FOREST STREET 8/27/2015 A�w-" � NORTH VVii BUILDING PERMIT o� qw- ��ZlEO 16T 'IO TOWN OF NORTH ANDOVER c� APPLICATION FOR PLAN EXAMINATIONOK- ~ ~ i Permit No#. Date Received �pq°Nreo�Pp` gSSACH's Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION Abq Pri PROPERTY OWNER Print 100 Year Structure yes no MAP/i PARCEL: ZONING DISTRICT: Historic District ye n Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building R'One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well El Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: J ATT t/Jo1S72ovwN ert Phone: 9lP_6Y3 .- Address: �3 J�D���' NR- Contractor Name: '12A� Phone: , `/`)) " �' 17j'3 f Address: c> -r— Uv-A Supervisor's Construction License: f 2 ` Exp. Date: Home Improvement License: 13� Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BAS ON$125.00 PER S.F. Total Project Cost: $ ! 60D o D FEE: $ Check No.: Receipt No.: a9240 NOTE: Persons contracting with rregistered contractors do not have access to tl guaranty fund Signature of AgenVCQwner Signature of contract Location No. Date . - TOWN OF NORTH ANDOVER Certificate of Occupancy � r Building/Frame Permit Fee $ Foundation Permit Fee �— ° w�^ ' Other Permit Fee $ TOTAL $ � Check Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE'bF 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 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 3 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. f 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/Cross Section/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 m ust be submitted with the building application Doc:Building Permit Revised 2014 NORTH Town of ? E �. Andover O - 0 • h ver, Mass 2J�H -io i o IAH. > > - ifCOCHICHl WICK �1• S U BOARD OF HEALTH Food/Kitchen PERMIT T LD III Septic System THIS CERTIFIES THAT ................, 'ti��i,,... . .............� BUILDING INSPECTOR Foundation has permission to erect .......................... buildings o ... ...... T � Rough to be occupied as ............. ... .. .......... . . ..r.................................................. Chimney provided that the person accepting thM permit shall In every respecnfomto 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 6 MON ELECTRICAL INSPECTOR UNLESS CONSTRUC IMS S 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. 7 f -A� 3 11 $ } Residential & Commercial Roofing All Types Of . i n HiirJi 1E�'B. C II�iT DREBUILT-oA o yl� Expert Masonry Work Mass Toll Free Licensed & Insired f..ar z!!,i C)vncd c <33�r rrrtnrl S <.xs ./ ;lfi "�. 1-800-1AiAlT-4-€J,�, tt, � � License#034200 (924-8487) '"VeAfr seer %==O We Work Year Round Proposal To: Matt Wolstromer Date 5/26/2014 Street: 73 forest St. 978-683-5113 North Andover, MA Roof proposal jimwolstromer@verizon.net Certainteed Landmark 1. Extra caution will be taken to protect house and 11. Removal of all work related debris. Planks will be landscaping as best as possible. (tarps etc.) placed under dumpster to prevent any damage to `- Magnets run at final clean up. driveway. 2. Remove all shingles from entire house. 12. Building permit included. 3. Inspect and re-nail any loose or lifted plywood. 13.Contractor workmanship warranty: 10 years under Any compromised plywood will be replaced at an normal wind and rain conditions. additional cost of$70.00 per sheet of 1/2" CDX 4. Install heavy gauge 8"white aluminum drip edge Total roof cost: $ 89800.00 f to all eaves and rakes. 5. Install 6' of WR Grace ice and water shield along Certainteed Pro upgrade: 700.00 all eaves. Opti n: nstall 1) omenl 2 OHT ' mo 6. Install Certainteed Diamond Deck synthetic humi ' tat cont 1 ed Powe ent. $3 .00 underlayment to remaining sheathing up to ridge. addi ' al cost. ( electric ok u i luded) 7. Install all new pipe boots. i 6 a 00 8. Install Certainteed Swift Start starter shingles to all eaves. Certainteed 3Star extended direct MFG warranty 9. Install Certainteed Landmark Limited Lifetime A fully transferable 100% coverage against architectural shingles to entire house. 10 year material defects for a fully non pro rated period of material MFG. warranty. (See extended 20 years. Please refer to pamphlet left in estimate warranty) All shingles will be installed and folder. Offered to our local referrals and included fastened according to mfg. specs. in this proposal at no additional cost. 10. Cut and install new GAF Cobra ridge vent and cap Balance due upon enT�2nlct ��rt with color matched Certainteed Shadow hip and - ridge shingles. (MA code) References available ul)on reapiest L4 Highly rated meini-r cI*0-c accredited BBB and Angie's List Thank you! Acceptance of Proposal—The above prices, specific a 'ons and conditions a :'isfictory and are herby accepted. You are authorized to do the work as specified. Payment will be r::: -s ou 11u,;d above. Date of Acceptance: Signature: - -- �\ The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street,Suite 100 Boston,MA 02114-2017 www mass gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Lepjbtv Name(Business/Organization/Individual): /1 (3"u Address: 3 T'<"V9j` aA City/State/Zip: ik -ti'` Phone#: 9n8"11,7S-. ?s 3 t Are you an employer?Check theappropriate box: � Type of project(required): 1.r1am employer with _employees(full and/or part-time).* 7. New construction 2. sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers comp.insurance required.] 9. ❑Demolition 3.[:]l am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 Q Building addition 4.0 1 am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sok 1 I.Q Electrical repairs or additions proprietors with no employees. 12.[:]Plumbing repairs or additions 5.1 am a general contractor and I have hired the subcontractors listed on the attached sheet. 13.E]ROOf repairs EE These subcontractors have employees and have workers'comp.insurance.' b.O We are a corporation and its officers have exercised their right of exemption per MGL c. 14. er pOf% 152,§1(4),and we have no employees.[No workers comp.insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their workers compensation policy information. 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 subcontractors and state whether or not those entities have employees. if the sub-contractors have employees,they must provide their workers'comp.policy number. 1 am an employer that isproviding workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: AVM Policy#or Self-ins.Lic.#: AL-)C.-q6O - 90(9 -Z4 V4 Expiration Date: I° q241) Job Site Address: )I /�'an-e S T 57- IJCity/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 MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 do hereby certify under thepa' and penalties of perjury that the information provided above is due and correct Si ature: ��_ Date: I I y 12-/I— Phone#: 22y S 3 / Oficial use only. Do not write in this area,to be completed by city or town o ieiaL 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 carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be 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 Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 Tel. #617-727-4900 ext. 7406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 02-23-15 www.mass.gov/dia `�� � CERTIFICATE F A 6U nil{f,;.(ilJIY,(•: 62t2'3/�?i 5 �..�+i•aR�,wl�ti.,w.w:urww ...•d+•_,.oy�::'A9:•.n!t.. o&1 TtB C lT M IMCD AS A VAMR Of MF=GYM CMY ARD AFM go-MMCR F. G9ita tt�"3 THE CERy4FECATE HOLDER. 'Etit4', CM-OW�CTMS comm-ATE�OFF in lAnce toes m. T f(AM.W T>:A�C{ l d�tAL IM COZ iS E AT i�3 �iS).THE LICHEE aw„ 'E�git�47W9 Oft PRC�UM,A90 nM CERtiAMye flet Ct PTANT,tf fk&toa#.'Jemla teedit fist cite Ad7iTI DXU if.,�.L"Ftl MMCI -- fe lrts�Tsf9r ttnats�Bf6�ts s# y,r iftat*Pt pD�{ g oe�:3ni � m rd%ccjjG� dittos fS mal c canter rights mi 4;7 cats ti oor in ow at he r s►_ OZO51-cat 3tvrse LLQ .._..__.._ -..__._. .____ ��1 •011YY�i� �Q � ? 1 �9?II�ti& -iki4D _ id rta d97$)6R7-O:.d� Andomr,OA 91W wal5 PUM i!uturl tnsumci'company thtde�r osTe Moor :�T S:eTSF3 sa"ti+ ,Te.).r: 1Tc—pla Ora" MA 01244 MUP GRu C�3TIC�r�AT�C3t;�uR'TIJS�f: igEi/f�3OCd dJu*7&��Ft: IS IS TO CERTIFY THAT THE 'C11t R_Z OF IAMRWME LTSTM flEICU41 RAVE i1+ 941 LSWED TO THE M'SU 2ED Ni%MW AAUP FOR T}iF F�ILICY Pl f t'is �i},iCAT[p. hYOTWrTH5TAN33ld�LTJ A)d1! R€t7tRaEbtRT TERR! QY 6Cl�tB)TGDt3 fkF Any Cd23TRmCT ClR OTHER QSSCitll7 t�siTir i4ESPFC7 td Ws•llr;. CERTIFICATE MAY BE tS�itEQ JR ltlsY TTR�t TME C+J$4illfiL:Ct��ttBED DY' TtNlk R�iICiFS t?ESCatt�lEi7 HEREM FS Si+4JEGi t0 ALL THE rTlT T: L`74C)1Pv4t 5�pty} S3TlL1Ri5 OF StDr>FT Ht7L1CisE.4i.LC=5 SiiD4'Y7 MAY HAVE 8W*MEOUMD DY P&D T;jAb,S. !'8 4 TYPE or n0ju atia — •"w> •« ....._... __—._ ._ _.. .__ _.� -I.__� iOEL{LYf�1'"3. Cxt _. _ '~3C13 ?i Lt.A(T5 �£tiE'1QA1 Ll1t$dLTTY ••----'..••..••—•.-�« .._.._._...._.. �` �Ai(TI:IxSOE`LE LtABS,RY r -i•• g- _ _ T� t&tSMLA LL4TILL- ; t• . _.. 1 Y•'Yu'Tf.'"iNT..+Tf4#.iT--Ch�(�l°!",:' YtN �-.;X•>• __A.�.._..... ._p . . •aww -KM '-Y• v_.j �� 1'INYn1.it$I€f�`c'(i�-C(.i/ryW,i/►/�,�• ■3.3:JGfY'�41 i��� L� •- _ ,� tV1!,4�{� j__•,._.a::'`rtt_��_-_...�I�F�t.t:rn* ,-�'•.. ..... ...._....,. .. 1�61J l"2"17'x'( `.',+:.r:'� �.;, .......: —� .._..... �9CS�.�SS:: i .+ Tto31 QS OPfCtAtSLllp,"J JY.13 ATic i ..-••.••_. ..�..•..__....__. _._....._.. _ CLE9C> lct:CT7:7tiTJi,��t3�.Y ."-a"iRra�rk3SCatG•4r.c7c�icrn[x�aace�sn9C,Wa3S_ ,....... _. rho +armors componsigion palmy does not&MVWa cowrsgo Far'atm lLarm 3 mo n WMATE HOLDER CA M- ELLAMOM i P L:`3uy'M AM QF 7-r-A-?*w4E Ge=c-4*"20 paUCMS it G616.CELL!c3 R 1T tkTt?t7�c �'r"' €_oltm TALL, 6t R�LtVrTQ 1F; Y 1it-PA+, y 3aLtGfitSIMS. tr as Massachusetts-Department of Public Safety Board of Building Regulations and Standards ' �`iill�YD'Sic'i31Pt�iil3f:i-i7C63€ - License:CS-069120 30 TEMP>E.E IDR S M6?HUEN MA. 81 �c S µ NW �r 952..�,�►..��- wit't` Expiration comrWssioner 041031''1017 �ea��r�ncs��aiiarsoi Click on the registration number to view complaint history. You can also view arbitration and Guaranty Fund history. The list i current as of Wednesday, October 8, 2014, Search Results REG ENTRANT RESPONSIBLE REGISTRATION EXPIRATION IME INDIVIDUAL NUMBER ADDRESS STAT U" DATE ALL tlMIIER ONE ROOF LANZAFAME, 137057 166 A MERRIMACK ST 10/02/2016 Current JOHN METHEUN. MA 01844 m 2012 Commonweam of Massachusetts. MasS.GovO is a registered service mark of the Commonweaith of Massachusetts. i.