The URL can be used to link to this page

Home My WebLink AboutBuilding Permit #354 - 796 WINTER STREET 10/24/2011 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: Date Received Date Issued: IP- 1/// MPORTANT:Applicant must complete all items on this page LOCATION A TI,(e y) kiA-4 v 5XI-Q q, Print PROPERTY OWNER �crCo.^��E, �� Q `cl•� Unit# Print MAP NO:/!AARCEL: ZONING DISTRICT: Historic District yes6no Machine Shop Village yes100 year-old structure yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ne family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ® Septic D,Well! q,Floodplain �Wetl'andsl tai WatershedDistrct �'W.ater/Sewer•_ .. E _ 4 DESCRIPTION OF WORK TO BE PERFORMED: \\ RQ NX\aJ L- Q_ iL SA 1v�k S`n\v\,r_\et, Sz"aAm, o,\\ cex& ase c,S 0.il, <.� en�� C �� ice .a .�ic . ,` 1J It" \Ck (Identification Please Type or Print Clearly) OWNER: Name: F`Cc,.� Phone: '�- Address: Sew. CONTRACTOR Name: rk� � Phone: Address: 0 C13 Supervisor's Construction License: a-��-°l Ex-P. Date: r � Home Improvement License: lulu a.a'� Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.•$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BA ED ON 125.00 PER S.F.1i�0;Z-Y 2-q Total Project Cost. $ FEE: Check No.: Receipt No.: T T7 7 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund ;Signature of Agent/Owner,� .. ,..: Signatureof contractor:..: I i Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plarls,D TYPE OF SEWERAGE DISPOSAL I 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 F 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 i i 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 I i ❑ Notified for pickup - Date Doc:.Building Permit Revised 20117une/mi I 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 o 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 (VOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg .Permit I 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: Doc.Building Permit Revised 2008mi Location A),n�4z , No. Date ZIP! ~�! °0 TOWN OF NORTH ANDOVER iR 3 • - pL 9 Z Certificate of Occupancy $ E<� Building/Frame Permit Fee $ s�cMus Foundation Permit Fee $ r Other Permit Fee $ f TOTAL $ Check # Building Inspector 24744 NpRTIy Town of _ oAndover- 0 No. =_ 410,� o , lover, Mass., •e�. < < - "" I, -Ay COCHICHEWICK ��RATEO A'Pa,�'C� S BOARD OF HEALTH Food/Kitchen PERM .. IT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT........ ....1!' /!r..Vmm.............. .. ........................ ..................................... Foundation has permission to erect...........:............................ buildings on ..... ........ .I. . ................. .�....... Rough Chimney to be occupied as....... Aid 0. 1. ch' ey provided that the person accep ing this permit shall in every r ct conform to the terms 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 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR It UNLESS CONSTRUC O C�S Rough Service ........... .............................................................................................. BUILDING INSPECTOR 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. USI New England 5 Bedford Farms Drive Suite 200 ® Bedford,NH 03110 www.usi.biz Phone: 603.625.1100 Toll-free: 800.639.4671 Fax: 603.625.1107 November. 3, 2010 Gregory S. Green d/b/a G & G Roofing Company 8 Four Acre Drive, Burlington, MA 01803 RE: Policy Number: WC7003489012010 Coverage: Workers' Compensation-A/R Policy Dates: 10/25/2010 to 10/25/2011 Insurer: AIM Mutual Insurance Company Dear Greg: We are enclosing the renewal of your Workers' Compensation-A/R policy. Please read your renewal policy carefully and let us know if any changes or corrections are necessary. In the event of a loss, your rights to insurance coverage will be controlled by the terms, conditions and exclusions set forth by this policy. Higher limits and additional coverages may be available. Please contact us if you would like to discuss these options. We appreciate your confidence in USI and look forward to serving you again soon.. Sin erely, Account Manager 32085900!GGROOFIN encl i i The Commonwealth ofMassachusetts Department oflndustrialAccidents Office of Investigations 600 Washington Street Boston,MA 021.1.1 www mass go-pldia Workers' Compensation Insurance Affidavit:Builders/Contractorsxectricians/Plumbers Applicant Information n Please Print Legibly Name(Business/Organizationdndividual): �' 1�G�� C_ 9 �� r S • �reev\ Address: ov.� �c� City/State/Zip: (3 utK\ � �`� o 01 o Phone A re youan employer?Check the appropriate box: _ a employer with � 4. ❑ I am a general contractor and I 'pe of project(required): loyees(full and/or part-time). have hired the sub-contractors6 ❑New construction a sole proprietor orpartner- listed on the attached sheet. t 7• ❑Remodeling and have no employees These sub-contractors have 8. ❑Demolition king for me in any capacity. workers'comp.insurance. workers' comp.insurance 5. ❑ We are a corporation and its9 ❑Building addition ired.] .officers have exercised their 10.❑Electrical repairs or additions a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions lf. [No workers'comp. c. 152,§1(4),and we have no ance required.]t employees. 12.❑Roofrepairs [No workers' comp,insurance required.] 13.❑Other *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. tContractors that check this box must attached an additional sheet showing the name of the sub_contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy anti job site information. Insurance Company Name: kZ'M\ , Policy#or Self-ins.Lic.#: W�C- cA r Expiration Date: 10 Job Site Address:_ �of� `J ,��tc S'i City/State/Zip: �,Q��, _ n ov< Attach a copy of the workers'compensation policy declaration page(showing the policy M 01 rj 4 5 y 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. fP J r1' r do hereby cei•tif under flzepains and enalties o ei•'u that the infornzationprovided above is true and correct. li nature: -�A t Date: C•- `.hone# '1 8 1 '� "t 1 - -13 1 G 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): L Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector. 6. Other Contact Person: r, Information and Instructions coons 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-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 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/licease 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 off cially 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: T e C0-`M-uoAwvea— of Massac'o setts Department of Industrial Accidents Office of]In e i �� aMons _ 600 Washington Street Boston;MA,02111 TO.#617-727-4900 ext 406 ox 1.-877-MA.SSAFE Revised 5_9.6-ns Fax#617^727-7749 til.lssachusetts - Department of Public Satcty Board of Building Regulations and St<tn • Co day ds Construction ion Supervisor License License: Cs 26698 Restricted to: 00 IIii GREGORY S GREEN 8 FOUR ACRE DR BURLINGTON, MA 01803 Expiration: 5/25/2012 ('ununissiuncr Tr#: 25626 —> e -Comwwwaiva" Office of Consumer Affairs and 8usiness Regulation . c 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement tato e vement Con r c r Registration Registration: 106222 r — — Type: DBA (� Expiration: 7/22/2012 Tr# 201586 G & G ROOFING CO. Gregory Green m � `. 8 Four Acre Dr Burlington, MA 01.803 'fij - c 4 Update Address and return card.Mark reason for change. Address ❑ Renewal ❑ Employment F-] Lost Card JPS-CA1 0 50M-04/04-G10011Q216 ��jJ,, I Office of'Con m'er airs ine"sslt gu a� License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: - 06M Type: Office of Consumer Affairs and Business Regulation Expiration: .7/27J2012 DBA 10 Park Plaza-Suite 5170 Boston,MA 02116 G ROOFING Gregory Green 8 Four Acre Dr Burlington,MA 01803':-;,, :, Undersecretary Not v lid wil6out signature Y 0 U X01/111 . Licensedand Fully Insured DATE: / 10/7/2011 In business since 1982 PROPOSAL SUBMITTED TO: JOB ADDRESS IF DIFFERENT: 8 Four Acre Drive Frank Drake Burlington,MA 01803 796 Winter Street (781)272-7310 North Andover, MA 01845 617-379-1236 We hereby submit specifications and estimates for.- We will remove existing shingles from all roof areas. New roof will be installed as follows: • 18"strip of W.R.Grace ice shield applied to roof edge extending down onto facia 3". 12"aluminum to extend from facia up onto roof to prevent ice/water from pushing back through facia. • W.R. Grace ice and water shield applied over aluminum on first six feet. • GAF shinglemate applied to remaining roof surface. • 8"white aluminum drip edge installed along all eaves and rakes. • We will use 30 yr. Laminated shingles.GAF or Certainteed brand. • Install new copper hi-hat sleeves to vent pipes. • Shingle-over ridge vent will be installed to main house areas that fall wiithin manufacturers specs. • Protective tarpaulins to be hung around house. • Legally dispose of all construction related debris. Authorized Signature:9 � We Propose hereby to furnish material and labor-complete in accordance with above specifications,for the sum of: $13,500.00 PAYMENT TO BE MADE AS FOLLOWS: DEPOSIT: One third when contract is accepted,one third when half done,final third BALANCE: when job completed. The above prices,specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above. Signature: