HomeMy WebLinkAboutBuilding Permit #434-15 - 74 ROCK ROAD 11/5/2014 BUILDING PERMIT t%ORT#1
.('tLED 16
TOWN OF NORTH ANDOVER F -
APPLICATION FOR PLAN EXAMINATION
Permit No#: Date Received "
S C uss��y
Date Is
sued:
MP R
O TANT: Applicant must complete all items on this page
LOCATION ,_
Print
PROPERTY OWNER 1-E`� (lis j=L�-M�`tJ G
Pnnt 100 Year Structurev yes
MAP _ PARCEL: - ZONING DISTRLCT. Historic District ye,
n..
Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
Reside tial 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 0 Well. ❑ Floodplain ❑Wetlands ❑; Watershed District
El Water/Sewer
DESCRIPTION OF WORK TO BE PERFORMED:
Identification- Please Type or Print Clearly
OWNER: Name: i I e-M nJ G Phone:
Address:
Contractor Name: Phone:- 7�
Address: . f` .,�t� 01Z _ P0,7 4 JY
Supervisor's Construction.License, _.-O6-I (Z`' Exp. Date: _-
- _
�7
Home Improvement License: I `�. S _ !_ _ Exp. Date:
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE.BULDING PERMIT.•$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST aASE ON$125.00 PER S.F.
Total Project Cost: $ U O ` FEE: $
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Signature of Agent/OWner ,. __ Signature of contractor.
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/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
❑ Mass check Energy Compliance Report (If Applicable)
f
❑ 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:Building Permit Revised 2014
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
i
CONSERVATION Reviewed on Signature
COMMENTS
is
iHEALTH 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 _ _ Ino
Located at 124 Main Street
Fire`Department signature/date ...
COMMENTS
Dimension
I
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 q pp 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
I
i Date Time Contact Name
-------—------------- ..—.....-..........
- ....—._ — ---...-------------
Doe.Building Permit Revised 2014
1
I
Location
dG
" No.
2 Date !i s- 14
s'- TOWN OF NORTH ANDOV9R
e y Certificate of Occupancy $
Building/Frame Permit Fee $
s Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check 651,)—
28224
Building Inspector
�yORTN
i� r
Town of �• : _ 1, ¢6Andover
45q,e
0 - h
6 h ver, Mass, I S
COC MICMl
'1TWICK 1•op a`..
7 RED
S V
BOARD OF HEALTH
Food/Kitchen
PERMIT T LD Septic System
•
THIS CERTIFIES THAT. �..I.l�, ............... c,.kl4.ft�c
.,,,,,,,,,,•,,,,,, BUILDING INSPECTOR
............... ...........
Foundation
has permission to erect ...........:.............. buildings on ..�............. . ,r.....� .............................
11 Rough
to be occupied as ......... ?..�.. .1 ......lf"... d ... ...........GX ........................................ Chimney
provided that the person accepting this permit shall in a res�pect confor 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 6 MONTHS ELECTRICAL INSPECTOR
UNLESS CONSTRUCTIO T S Rough
Service
..................... ........,............................................
BUILDING INSPECTOR Final
GAS INSPECTOR
Occupancy Permit Reguired 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.
City/Town [ � State � Zip i _
code
Search Registrants
Click on the registration number to view complaint history. You can also view arbitration and Guaranty Fund
history,
The list is current as of Wednesday, October 8, 2014.
Search Results
REGISTRANT RESPONSIBLE REGISTRATION ADDRESS EXPIRATION STATUS
NAME INDIVIDUAL NUMBER DATE
ALL UNDER ONE ROOF LANZAFAME, 137057 166 A MERRIMACK ST 10/02/2016 Current
JOHN METHEUN, MA 01844
®2012 Commonwealth of Massachusetts.
Mass.Gov®is a registered service mark of the Commonwealth of Massachusetts.
_ aC.�s titer
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C "a{f(y z 1'''_=` `"#r i.L" S 'r-• ., +LL4 ��u. `+.
Cy>` 'fry £.+.`+ �j •T` .. 3s.12
Residential & Comm-ercial Roofing �
Chnr ey All Types Of
CHIMNEYSP0tN�'EREnu1LT-CAP�*�o �l�
Siding Expert Masonry Work
d '
Mass Toif Free ��censed & Insured
1-800-w,4IT-4-US �:,;}���- cJ YT,P�r `�,�, �f�d s t r u7�, 11 c license#034200
(924-8481) C.t,Zff llazm or, vh-,v We 'Eltlork Year Round
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Proposal To: Phyllis Fleming ate 9/23/2014
Street: 74 Rock Rd* W
A G
N.Andover, M
Roof propos
IKO Cambridge
1. 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.) driveway.
2. Remove all shingles from entire house. 13. Building permit included.
3. Inspect and re-nail any loose or lifted roof 14. Contractor workmanship warranty: 10 years under
' boards or plywood.Any compromised roof normal wind and rain conditions.
boards will be replaced at an additional cost of
$2.75 per lineal foot of 1x8 spruce.Any com- Total roof cost: $ 7,800.00 --
'� promised plywood will be replaced at an addi-
tional cost of$60.00 per sheet of 112"CDXfir.
4. Install heavy gauge 8"white aluminum drip
edge to all rakes.
*Note*: Please be advised if applicable,valuables in
5. Install 6' of IKO Armourguard ice and water the attic should be moved or covered due to minor
shield along all eaves. ' debris,dust and asphalt particles that will accumulate
6. Install Rhino synthetic underlayment to during the stripping process.All Under One Roof not
'.responsible for any damage or clean up that.may
remaining sheathing up to ridge.
occur in attic.
7. Install all new pipe boots.
8. Install IKO Leading Edge starter shingles to all _Balance due upon completion
eaves.
9. Install IKO Cambridge Limited Lifetime _References available upon request
architectural shingles to entire house. 15 year –
non pro-rated warranty by mfg.All shingles will
_Highly rated member of the accredited BBB and
be installed and fastened according to mfg. ' - -
Angle's List
specs.
10.Counter flash chimney lead, all wall connections Thank you.
and roof protrusions with ice and water shield
and tie into new shingles and seal. W
11. Install new GAF Cobra ridge vent capped with
color matched IKO hip and ridge shingles.
Acceptance of Proposal—The above prices,speci -ations and conditiqqs are satisfactory an e herby
accepted. You are authorized to do the work as spec ed. Payment wi ma s outli above.
Date of Acceptance: 5 �r � ` Si ature.
P �
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na arvE: NO.92LL 11/08✓2013✓WBD O2tIEPM
The Commonwealth of Massachusetts07 -
Department of Industrial AccWd fs
Office of Investigations
600 Washington Street
Boston,MA.02111
www.mass.gov1dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electriciansfplumbers
Applicant Information Please Print Legibly
Name(Business/Organizatiordfndividual): _ A-i/ (1,q.1 c/ty
Address: T-c-- off_ 0/7
City/State/Zip: ✓w 4lPhone#:
Are you an employer?Chec e p priate b Type of project(required):
l. am a employer wi a general contractor and I 6. ❑New construction F
employees(full an orpa - ' have hired the sub-contractors
2.❑ I am a sole proprietor or partner- listed on the attached sheet. �• E]Remodeling
ship and'have no employees These sub-contractors have 8. ❑Demolition
working for me in any capacity. workers'comp.insurance. 9. ❑Building addition
[No workers' comp.insurance 5. ❑ We are a corporation and its
required.]
officers have exercised their ME]Electrical repairs or additions
3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions
myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑Roof repairs
insurance required.]t employees.[No workers' 134�10ther t2
comp.insurance required.]
*Any applicant that checks box#1 must also fill outthe section below showing their workers'compensation policy information.
t-Homeowners who submit this affidavit indicating they aie doing all work and then hire outside contractors must submit anew affidavit indicating such.
TContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information.
lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:. r1-
Policy#or Self-ins.Lie.#: A'LJC-e{o1- r7v v J z ^ 20/')Ixpiration Date: P/ a f' 2
Job Site Address: �� ��iGI �� . City/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 Section 25A of MGL 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 may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
X do Hereby cert under the pains nd penalties ofperjury that the information pro vided)above is true and correct
Sip-nature: �'" Date:
Phone#: 7 7 S�— `7 J
Official 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/Town Clerk 4.Electrical Inspector 5.PIumbing Inspector
6.Other - - -
Contact Person: Phone#:
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees,
s.
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 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 1\4-assa.,chusetts
Department of Jadustrial,Accidents
Office of Investigations
6.00 Washington Street
Boston,lA 021.11
TQL#61.7-727-4900 ext 406 or 1-877-MASSAFB
Revised 5-26-05 Fax#617-727-7749
www mass,govldia