HomeMy WebLinkAboutBuilding Permit #571 - 76 MOODY STREET 4/29/2009 BUILDING PERMITO� pGRT#1 q
Std tG #6
TOWN OF NORTH ANDOVER Fes`'` ''- _ o�
APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received 3 .0gATED
Date Issued: f
IMPORTANT: Applicant must complete all items on this page
LOCATION. lldl�tl
PROPERTY OWNER ,
Print
MAP NO: 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
rD�e
air, replaceme Assessory Bldg Others:
oIition—�_,_ Other
Septic Well Floodplain Wetlands Watershed District
Water/Sewer
DESCRIPTION OF WORK TO BE PREFORMED:
Identificationlease T,yB�9�Tint Clearly)
OWNER: Name: f / f �/� ! Phone:
Address: 76. ,pada NA
CONTRACTOR Name:40 CX L Phone: 1 'Z!�7'7�43
Address: r.
Supervisor's Construction License: r , Exp. Date: )'' 1z_
Home Improvement License: Exp. Date: ' Z wO
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: $ 7t dW` FEE: $ ��
Check No.: �/ Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access d t e uaranty fund
signature of Agent/Owner Signature of contractor
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!SFC,T4QNS FgRrPFFIGE',.USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on �,_ �s :.�` �P,, gnature •,�
'rl
COMMENTS
v - ftp ' �•�t� `�..1��, .� �►t'', � ,... µ��i .� n
Zoning Board 6TApPeaig: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 21 A—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 j
❑ 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 DEPARTMENTMFORM07
Revised 2.2008
Location
No. � � Date
�oR,M TOWN OF NORTH ANDOVER
�� • O0
isimailft
• ; ; Certificate of Occupancy $ a
' ", ._ter.:... +' • ��
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check # 70
2 _----
Building Inspector
V%ORT11
Town ofdoverx
O �_ V
No.%,�/
LAKE dover, Mass., f ' f
COC MICNEWICK
RATED O'Pp\ �y
`s BOARD OF HEALTH
PERMIT T D Food/Kitchen
Septic System
BUILDING INSPECTOR
THISCERTIFIES THAT...................... . . .... ............. ........................................................................................................... Foundation
has permission to erect...................................... buildings on ....�..0........M.06..d.%.......4�.......... Rough
to be occupied as........S.. ...... ....p...... ... .... .. ... �� Chimney
provided that the person acce ng this permit shat in eve respect conform to the ter s of the application on file in Final
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
• PERMITI EXPIRES IN 6 MONTHS
ELECTRICAL INSPECTOR
UNLESS CONSTRU STARTS Rough
.................... .................................... Service
BUILDING INSPEE
Final
Occupancy Permit Required to Occupy Building GAS INSPECTOR
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.
SEE REVERSE SIDE Smoke Det.
DATE(VAVUtxyv T
ACORD, CERTIFICATE OF LIABILITY INSURANCE I 12/11/2008
5p—IIDUCER"-(978)459-4647 THIS CER MICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
ilpha insurance Agency HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
I ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Mill Street
1 ewe 1, MA 01852 INSURERS AFFORDING COVERAGE MAIC#
It 3UREDI INSURER A,HT BA I LEY INS
OLD SCHOOL GROUP INC
6 ADAMS ST INSURERB-111" SPECIALTY INS CO
NORTH CHELMSFORD, MA 01863 1!NSURFP c:SAFETY INS CO
1 INSURER D:AGAD I A I NS GO
IL
L,NSU�111E
C )VERAGES7
HE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHISTANDS THIS CERTIFICATE MAY BE ISSUED OR
ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITHR, E PECT TO WHICH
bAAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUC
POLICIES,AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
T ICY EFFECTIVE i POLICY 71-N 4R DO' POLICY NUMBER I POLICY
(MMMMY) —EyEAPI LIMITS(MMMC-V"YY
UR
04T—
OUCY N
I NSR TYPE OF INSIMMANQ EACH OCCURRENCET$ 1 000,
GENERAL LIABILITY DAMAGE
50".
1 y
NPP11
I X COM MF:RCIAL GENERAL LIABILITY NPP1143791 11116/2008 II/W2009 PREMISES fEe occurencel
MED EXP(A'-Y One person)
CLAIMS MAI 5-1 $ 1,000,;
CIE OCCUR
pERS(?!��__8 ADV INJURY
GENERAL AGGREGATE 2,000, ) 1
1
PRODUCTS-COMPIOP AGG $ -0
000,; -
GEN'L AGGREGATE LIMIT APPLIES PER:
jl�lcy =ip R O� 7 L
(Ea BINFO SINGLE
4-�� i-LIMIT
C��'m
AUTOMOBILE LIABILITY
X ANY AUTO 62011181 io/17/2008 10/17/2009 —+den"
i t-:� 21D,_
BODILY IN.rURY
ALL OWNED AUTOS
(Per person)
AUTOS SCHEDULED A
E
BODILY INJURY 40, 0
HIRED AUTOS Ter accidon!)
NON-OWNED AUTOS
PROPERTY DAMAGE
is 100'.
i.Per acckiontl,
YI
I AUTO ONLY-EA ACCIDENT
GARAGE LIABILITY—
OTHER THAN
ANY AUTO il AUTO
_A
EACH OCCURRENCE
GARAGE
- f 7
ExcESStUMERELLA LIABILITY I
r------ A!GGREGAT�__ --J
OCCUR
i I- $
$
DEDUCTIBLE
$
RETENTIONWC STATU- 10TH-
TO Y I
EMPLOYERS'LIABILITY E-L.EACH ACCID 90
WORKERS COMPENSATION AND ENT
1W0202000132700 11/27/2008 11/27/2009
ANY PP.OP'RIE'rORIPARi-NEPVEXECLM',IE E.L.DISEASE-EA EMPLOYEE 110-0-0-, }0-
0'�FICERWEMBER EXCLUDED?No
If
E-L,OfSE.kSE-POLICY LIMIT,$ 1 000 )0
s
I SPECIAL describe under PaOVISIONS below—_
_T;THER
SCR4PTION OF OPERATIONS LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
7
C ERTIFICATE HOLDER CANCEI-LATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIF-S BE CANCELLED BEFORE THE EXPIRA, N
DATE THEREOF,'HE ISSUING INSURER WILL ENDEAVOR TO MAIL Iq_ DAYS WRrr-
No-nCE TO THE CfN-rIMATE HOLDER NAMED TO THE LEC svT
T, 'pK(LURE TO M. SO SHA
OF ANY KIND Uj�%�T--.;N(INSUREIR,ITS AGENTS OR
IMPOSE NO OBLIG ION OR ABILI
REPRESENTA
AUTHORIZED
fvORD 25(2001108)
The Commonwealth of Massachusetts
kj ! Department of Industrial Accidents
OJNee of Investigations
600 Nrashington Street
Boston, MA 02111
Workers' Cwww_nzass.gov/dia .
ompensation Insitrance Affidavit: Builders/Contractors/Electricians/Plumbers
A licant Information
T fes, Please Print(Legibl
Nannie (Business/Organization/individual):_
Address: tl► S �� J
City/State/Zig: C Gtl hufS Phone#: . �l7�ZS"�- Wj�'
Are you an employer?Check.the appropriate box:
1•EA-Kam a employer with 51" 4. ❑ I am a general contractor and IF�E�]
J�(required):
employees(full and/or part-time).* have hired the sub-contractors construction .
2.
Iam.
❑ a.sole proprietor or partner_ listed an the attached sheet,t deling
ship and have no employees These subcontractors have 8. ❑Demolition
working for me.in anyaci , workers'
cap , ty comp.insurance.
[No workers'comp, insurance 5. El We Building We are a corporation and its ❑ addition
required.) officers have exercised their 10.0 Electrical repairs or additions
3.❑ I am a homeowner doing all work right of exemption per MGL 1 I.❑ Plumbing repairs or additions
myself.[No-workers'comp. C. 152, §1(4),and we have no 12. Roof
insurance required.)t ..employees. ❑ repairs
[No Woticers
COMP. insurance require&] 13.❑.Other
'Any epp(icant that checks bob#l must also fit[out the section below showing their workers'bompensation policy information.
r homeowners who submit this affidavit indicafing they are doing an work end then him outside contractors must submit a new affidavit indicating such•
tConftctors that check this box must niched an additionai sheet shoving.the name of the sub-conttURctc and their workers'cef;p.avit i infoms tion.
I am an employer that is p>nwdurg:warkers'compensadan insurance for my.employeaL Below is the policy and job ante
information. I
Insurance Company Name:
LAM
"
Policy#or Self-ins.Lie.#: C ZIP00 I Zjz �(�(�
Expiration Date:
Job Site Address: City/State/Zip: `
�itla /L1
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration dafe�
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 agaithe violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA r insurance coverage verification.
E
I do hereby certify r>th, p i and penalties of perjury th the ' ar+na?ion provided Or is true and correct
Si tune: t�.�•�•�' �j I�.�- �/J
i11 L" ��S Dater
Phone#: q 7 4
0ffwial 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. Plumbing Inspector
6.Other peer
Contact Person: Phone#:
Information and Instructions
Massachusetts General Laws chapter 152 requires all emp Ioyers 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 ihe'foregaing 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
oyrner-of a'dwelUng house having not more than three apa 1anents.and who resides therein,or the occupant of the
,}rd v'eil§itgho`use of anot}fer wtio'•emjsloys persons w`.3o maimtenance,construction or repair work on such dwelling house
` or on the grounds or building appurtenant thereto shall not because of such empioymgnt be deemed to be an employer."
MGL chapter 1,52,•§25C(6,)*e,strttes thax"every state"oirJocsl licensingagen shall withhold the issuance or
renewal of a'license of lie`rttiit to operate a business or tto con uct`balidings 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 subdivisigns 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 certificates)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners,are not required to =ry 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 numberlisted 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 pr nied,ie�ibly., 7h*Department has provided a space at the bottom
of-the affil vit for you to fill out in the event the Office of,Irivesti tions has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be,u��sted as a ` , pce°n(unber.;in addition,an applicant
t` that n tSubttlit`mulitiple permit/license applications in any•gi4nNyear,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 bum leaves etc.)said person is NOT required to complete this affidavit
The Office of Investigations would like to thank you in advance for your coopbration-and should you have any questions,
please do not hesitate to give us a=11.
The Department's addres;,tel9phone and.4k nrim8ch
The Commonwealth of Malsacliusietts
Department of Industrial Accidents
Officeof Investigations
600 Washington Street
Boston, MA 02111
TeL# 617-727-4900 ext 406 or 1-8.77-MASSAFE
Fax#617-727-7749
Revised 5-26-Q5 VAVw_mass.gov/dia
NT a ssaic 11 usetts- Dcpartmew nf Puhlic$;ik-tN
13,aird trof Suilding Regul;jti(j*s and St;ndar('Is
Construction Supervisor SpecialTy 1-icenso
license; C5 SL 99669
Restricted to:.FF,'Y'VS
ANTHONY wajvo
13 WILLOW DRIVE
TOWNSEND, MA 01489
Tr#-, 99549
T&
Board of Building Regulatiom an�SlAddards
HOME IMPROVEMENT CONT60TOR
Registration: 167.-,47
Exr,'Tation: iosi2ang
Type: Supplement Cird
OLD SCHOOL GROUP.INC.
1.
ANTHONY DC)tjD
6 ADAMS STREET
N,tHELMSFORO,MA 01863
14
XI. A ridge vent will be installed to allow for proper ventilation,and is the most effective method for ventilating a roof.
XII. Old School will furnish a factory enhanced 15 year non pro-rated warranty from Certainteed that includes;labor,material,tear-
off,and disposal costs.
XIII. Work site shall be cleaned on a daily basis. This is our BIGGEST priority during and at tue end sof every job is keep
the property clean.We pass magnetic rakes over the entire job to pick up the nails paying close attention to the
driveway and children's play areas. We will treat your home tike our home throughout the entire project.
XIV. Old School Roofing will be responsible for obtaining any and all necessary permits to insure the work is performed legally.
XV. Upon completion of the project and full payment,Old School will warranty all work,which includes coverage of labor,
materials,workmanship errors and disposal.
Ple gse tale the foilovOng precautions:
X Check and remove paintings,antiques,photos,mirrors,etc.frown walls,as these may incur damage if they
fall due to vibrations during roofing.
*Cover any and all items in the attic that may get dirty or damaged during the roofing project as some debris
may fail on thein during roofing.
*Old School Rooting is not responsible for attic clean-up.
Insurance Information. Workers Compensation Polrei, 0001-35119: $2,000,000.00
General I.iahilittl Policy'PPI 143 79 1: 51.000,000.00
General Information: Better Business Bureau 508-755-2548 is j:►r°.hbh.ter
Tamko Building Products 800-641-4691 wiviv.€tunko.com
Certainteed Corporation 800-782-8777 ►4 wul.certain teed.cont
Roof Tcax,800.00
Contract Terms and.Payments: Owner agrees to pay Old School Roofing the sura of Seven Thousand eight
hundred dollars.
Payments shall be made as follows: 113 deposit due before scheduling work, balance due upon completion of the work.
QUOTE GOOD FOR 30 DAYS ONLY! PRICE INCLUDES ALL AVAILABLE DISCOUNTS.
SIGNING BELONN, 1NI;1CATES ACCE MANCE OF THL PRICES .AND SPECIFIC.ATIONS 'SFT FOR T lI HEREIN AND
ACCEPTANCL OF T1-11'TERMS AND CONDITIONS OF THIS CONTRACT.
Old School Roofing. Home Owner.•
mo=t �, �L.---.~.r-----_ B - L
By. y:
r�
Authorized ent Date Date
Please call me with any questions you may have, thatik you very much for your time.
Ryan Dolan
(978)551-7484
A- c
- I
i
00
Massachusetts Contractor License#157447
CONTINUALLY T INED AND CERTIFIED BY A FSI It A'S LARGEST R00FINUMANUFACTURERS
Thank you for considering Old School Roofing and giving us the opportunity to provide you with a no worry,
quality roofing system. At Old School Roofing, we are committed to customer service and satisfaction and
prompt response to your needs or concerns. We would be honored to welcome you to the Old School Roofing
family.
.Tay and Erin Phelan April 15,2009
76 Moody St
North Andover, Ma
ESTIMATE FOR ENTIRE HOME AND GARAGE
I. Prepare home for removal of shingles. Tarp all necessary areas to ensure protection of precious landscaping,shrubbery and
siding and paint.
II. Remove existing I/2 layers of asphalt shingles.Completely de-nail roof and re-nail roofing boards and advise homeowner of
any needed repairs.
III. Replace any rotted or broken.roofing boards at no cost up to 100 linear feet of deck board and plywood up to 100 square feet.
Additional boards will cot$3.00 per lineal foot and$2.00 per square foot for plywood.
IV. Install six feet of ice alyd water ship lfl to the eaves Iice and %iter shield *4 ill be installed both under ind over the dr'sn
ed��three feet uta the rales three feet in all N alleys and three feet around anN roof obtrusions. Back shed dormer 4vill
be covered 100`/o.
V. Install a fiber€lass felt to the remainder of exposed roofing area to ensure proper deck protection prior to installing the roofing
shingles. We use a high quality felt paper,which exceeds the standard for a proper vapor harrier.
a
VI. All wall flashing will be inspected an.,replaced as needed. Our workmanship is guaranteed and we take all the necessary
g P p P b
precaution to make your new roof watertight.
"tl�cate: IJsictirtg needsto be rectae,>rC4!Iu propel-11,flush is ul/or is br-itt,c or rot,et"u«cl Is darnrrge 1�n•rrornarrl instaliu!io:l it
is not the responsihihi.v q1 01C1.>chuol to Pc:phwe, but ccUP be done Cat and Additional(U1't.
VII. New eight-incl aluminum drip edge will be applied to all rakes and eaves.
VIII. New pipe flanges will be installed.
IX. Install a,rhirty-dear Architectural Type:Shingle.T "'G.�GS -30 Color: �✓(C'L`°C v
g
X. Chimney will be re-leaded. Back gutter will be re-attached to the fascia.
6 Adams;Street
N.Clrelzn-Nforcl. NTA 41IS63
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