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Home My WebLink AboutBuilding Permit #307-11 - 80 PROSPECT STREET 10/11/2011 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: -1/ Date Received Date Issued: -/l I/ IMPORTANT:Anplicant must complete all items on this p4ge LOCATION �,b ??,b S P (''T ST Print PROPERTY OWNER I l i�•.n M e (�n n� }SAT ftr n N Umt# Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes Machine Shop Village yes 100 year-old structure yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: 0 Commercial Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other EJ Septic ❑Well ❑Floodplain ❑Wetlands ❑ Watershed District 0-Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: T M by E: A Nib Rt A i b (Identification Pleas Type or Print Clearly) OWNER: Name: L ti N P i fl Phone: 17$' 6 9 8--7 yp�. Address: W - -1- CONTRACTOR Name: A N ( Im I Phone: 9-1 g y-7 Address: 11 \A g V E9: L Y ,R tys,1 to P Y 9 70 V K Supervisor's Construction License: Q L-11-4 $ Exp. Date: 1 Home Improvement License: 16 ? 51 eQ Exp. Date: ARCH ITECT/ENGINEER_ N llzh., 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: $ f'";l r FEE: $ � Check No.: -�- � = Receipt-No.: NOTE: Persons contracting with unregistered contractors do notch ve acces' to the uaran g nd Signature:of AgentLOwner - .. ty u x - Signature f corit(actor•' ' 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 HEALTH Reviewed on Signature COMMENTS Zoning Bdard of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes r Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - ernV Dump` r on site yes f no Located at 124 Main Stre t Fire Department signa /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 I i I I i Notified for pickup - Date Doc:.Building Permit Revised 2011 June/mi 1 -- 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: Doc-Building Permit Revised 2008mi t Location 6V No. Date / "I J1 NORT1y TOWN OF NORTH ANDOVER 10. s a Certificate of Occupancy $ Mu14U Building/Frame Permit Fee $ s�csE Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # ,s 2 4 6 b 5 Building Inspector t N0RTH Tovm Of V" 04 o , lover, Mass., T 0 = LAKE COCHICHEWICK 7�ADRATED PC� S BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR • THIS CERTIFIES THAT................ .. . ...�� ....... �.r.................................................................................................... Foundation has permission to erect.................. .................... buildings on .ft. ........ .... .. ....... ............� Rough to be occupied as.........1. S �..... Chimney ...... ........... . . . .. . ....................................................... provided that the person accep g this permit all in every respect conform t 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 4 PERMIT EXPIRES IN 6 NTHS _ ELECTRICAL INSPECTOR.` UNLESS CONS TRLJ STARTS 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. TBurner Street No. SEE REVERSE SIDE _ Smoke Det. 1600 ros�o�� The Commonwealth ofMassachusetts Department oflndustrialAccidents Office of Investigations 600 Washington Street Boston,MA. 02111 www.mass govldia Workers' Compensation Insurance Affidavit:Builders/Contractors/EIectricians/Plumbers Applicant Information Please Print Les=ibly Name(Business/Organization/Individual) Ni Pt- Moo,f C, Li r I AbkM SRl) Address: I? W NV E V i y b City/State/Zip:, . ti M Phone#: g7$ . y'7 . 15 Are ou an employer?Check the appropriate box: 1.�I am a employer with__�___ 4. Type of project(required): ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.01 am a sole proprietor or partner- listed on the attached sheget.t 7. Remodeling ship and have no employees These sub-contractors have working for me in any capacity. workers'comp.insurance. . ❑Demolition [No workers comp.insurance 5. 9. El Building addition ' P ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.El Plumbing repairs or additions myself. [No workers'comp. C. 152,§1(4),and we have no insurance required.]t employees. 12�Roof repairs [No workers comp,insurance required.] 13.0 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. Contractors 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 and job site information. Insurance Company Name: AN C �Rpt�W o� S� �A Air 6Policy#or Self-ins.Lic.#:��U Expiration Date:_ 9 19 .12 Job Site Address-ID OS Plr C.t rt e, N,p YUt�ny�, MA City/State/Zip OVI:IZ �•►iD 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 Df up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DI&for insurance coverage verification. do hereby certif under the pains and penalties ofperjury thattI e information provided above is true and correct. di nature: . Date: :none#_� 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): I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electric 6. Other al Inspector 5.Plumbing Inspector Contact Person: Phone#: Information and Instructions ructions 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, ever the employing employees. How owner of a dwelling house having not more than three apartinents and who resides therein, e 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 any for 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 th self-insurance license number on the appropriate line. eir 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 perm t/liceirise 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 for 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 cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: Tl1e CQ'ni7,i.ormealtl-L of Massae4uisetts Department of Industrial Accidents Officeof Inv s$igations 600 Washington Street Boston;MA 02111 Tel.#617-727-4900 ext 4406 ox 1.-877-MA.SS.AFE Revised 5-26-05 Fax#617-727-7749 �= Massachusetts- Departinent of Public S:Ifeth Board-of Building Regulations and Standards Construction Supervisor License License: CS 104428 ADAM BRIEN 417 WAVERLY ROAD NORTH ANDOVER, MA 01845 c— �"C—-�— Expiration: 5!12/2014 ( nnmi��ioncr Trtt: 104428 ,,pper� �� \ Office of Consumer Affairs&B mess Regulation 1 HOME IMPROVEMENT CONTRACTOR Registration: ,168512 Type: Expiration: 3/1/2013 LLC F BRI O BUILDING AND REMODELING LLC ADAM BRIEN .417 WAVERLY RD NORTH ANDOVER,MA 01845. Undersecretary 0 i CC. Building&Rcmoddin T Adam Brien CSL 104428 978-479-1526 HIC 168512 adambricoCgmail LLC 10/7/11 CONTRACT Pat McCann 80 Prospect St. North Andover, MA 01845 This agreement is between BriCo Building and Remodeling and Pat McCann for the stripping and re-roofing of the house at 80 Prospect St in North Andover , Ma. Details are listed below. • Entire roof to be stripped of existing shingles, underlayment, flashing and drip edge. • Due to the current conditions of the roof any wood roof sheathing that has split, rotted or necessary to be replace will be removed and sheathed using the appropriate plywood material, along with any nailing that is necessary. • A 15yd dumpster will be placed in the driveway for all debris and removed at the completion of the project. • Ice and water shield will be installed 3' up around the perimeter of the house, in all valleys and wherever any flashing is necessary. Remainder of the roof will be covered with black felt paper as underlayment. • 5" white aluminum drip edge will be installed around the perimeter • Lead flashing will be installed around chimney • At dormer side walls will be step flashed in with aluminum flashing • Approximately 30' of Cobra ridge vent installed on the ridge for proper venting • 30yr architectural asphalt shingles, color dual grey to be installed on roof • Property to be cleaned of all debris with as little disruption to the grounds as possible The contractor agrees to perform this work in a competent and skillful manner according to standard industry practices and all work performed shall be subject to final approval by owner. All work to be done incompliance with the Massachusetts building code. The owner agrees to pay BriCo Building and Remodeling $6115.00, for doing the work outlined above. A$3000.00 deposit is required for materials to begin this project. The remaining balance will be done at the completion of the project. Due to the nature of this project unforeseen work or necessary repairs found during this project to be brought to the owners attention as soon as possible. Any work resulting from unforeseen problems will be priced accordingly on site and be done with written approval. Contractor is not responsible for any unforeseen damages that may occur to the property grounds during construction. All sub-contractors contracted to perform work must carry appropriate licensing and insurance to work in Massachusetts. BriCo is a fully licensed and insured company in the state of Massachusetts. Dated: Signature of Owner: J Signature of Contractor: