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HomeMy WebLinkAboutBuilding Permit #290-13 - 88 MIFFLIN DRIVE 10/11/2012 BUILDING PERMIT °F NORT#j TyrD;°s �O TOWN OF NORTH ANDOVER 3? � ..'`•- r; ° APPLICATION FOR PLAN EXAMINATION Permit NO: `' ` Date Receivedc Ar I / R /' ��SSACHUs���y Date Issued: I ✓V/ IMPORTANT:Applicant must complete all items on this page LOCATION ► e�- Print PROPERTY OWNER , d 1 Print MAP N0ARCEL ZONING DISTRICT: Historic &trict yesnno Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residenti I Non- Residential New BuildingOne family Addition Two or more family Industrial Alteration No. of units: Commercial epair, replacemen Assessory Bldg Others: Demo i ion Other Septic Well_ Floodplain Wetlands_ _ Watershed District Water/Sewer DESCRIPTION F WORK TO BE PREFORMED: c7 k •. J — 02aJSP ti, c, ple JJ CAE1 ;m1�x}✓ t ice_ Avc-�(1--ck-.,.l C>k J.r 1e v►, Identification Please Type or Print Clearly) OWNER: Name: ch v Phone: 9--78 Address: 09 CONTRACTOR Name: ` .o, ,K, Phone: + t ) SAS 395Y Address: yy C�� I SL 'fed �� 1A C�atSS Supervisor's Construction License: Q&95ct .Exp. Date: Home Improvement License--- _13S-?YS Exp. Date: 5 3 -lq ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ '9I-A&I FEE: $_t-,2)< Check No.: 2(�),-J y Receipt No.: NOTE: Persons contracting with unregistered Tactors do not have access to the guaranty fund Signature of Agent/Owner ature 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 e/1 uilding Permit Application orkers Comp Affidavit hoto 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 Ail* 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 DEPARTMENT:BPFORM07 Revised 2.2008 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 - Date Doc.Building Permit Revised 2008 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 Siqnature 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 signatureldate COMMENTS Location If I, — T>,/ No. Zq U— Date i t I 11- TOWN yTOWN OF NORTH ANDOVER • ��,j11,N:I)�hy�� e • Certificate of Occupancy $ Building/Frame Permit Fee $ u #. � Foundation Permit Fee $ ' Other Permit Fee $ TOTAL $ Check# -�26 90 25813 Building Inspector NORT1y Town of 6 ndover O - No. = - �- �AK.90h ver, Mass, COCMICHEWICK y1. S U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT r BUILDING INSPECTOR Yhas permission to erect buildings on 8� . Foundation �* Rough to be occupied as ..........................S.. ..................6 �O... ....................................................................... Chimney .. provided that the person accepting this permit shall in every respect conform 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 STARTS Rough Service ........ti... .. + ...................:.::.................... 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. SEE REVERSE SIDE .a ore C RTI ICATE OF LIAS't ` > � C E a�1 (I-`�;;-m— THIS 0/121201 CEflTIFACIATI!?19 I$ D,AS A:#NAT" OF INFORMATION ONLY AND Cai�f NQ #t3#ITS I#F�4N 7WE CI*[aT#F10A1'(r Hb ,aw THIS CERTIFICA7t= I T Aa=F FIMATIVRLY'OR NEGATIVELY AMEND,_. EXE OR AL O Tf(E CQVgftA' E.AFFORDISO •BY THE :POLICIES BELOW:. 7HIS;OEIt7'ilr# i 0 INSLI tANCI;DOES NOT Co.NST#1'IITE A CE�NYIt�14�'BI SEM 'Tup ISSIONG 41OU IER(S), AUTHORIZED REPtES)rN�Jt1K F�iR �{l3Jiwt=R,AND THE CERTIFIC7MTE I#C�1D:ER: IMPORTANT ` . i itrs<tlol r is an 155moNAL INSUR 1,the.polI*W- "ll"st I*i Iwo.6 BRpC�kT1AN:#g yy##V ,subject to the terrhs arld teond#§fttlof the poIIcy,certain,pclicles may requfre an endorses hrL A st lerneht'an this eerthlaats etoes not eortler rights to the certiflca. h ilT#e14I mof m>:endoreement s PRODUCERDR- Eastern:Insurance:Gmap:.LLC Main fiHDNE- 233 West.Cetltrel.streset G N Natick MA 01760` AIL s IMSUI, FOfiO1NGCOVERAGE' NAIGrF INSUHfRA INSURED _. 31298pAny aNsuaaR:a� Joseph S.SavIni, Inc. INsuRAR e 40 Canal Street Medford MA 02155 INSURER D INBU"'KE INSURER'F: EL COVERAGIzS CERTIFICATE NUMBER 1304472191 RVI>;IOIV.,NUMB THIS IST C It✓Y T: E POLI IES OF INSURANCE LISTED BELOW'HA E BEENISSUE O7HE.`INSttRE. N =A V F R T'E LILY>PERIOD INDICATED. NOTIWTHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY C©NTRACT OR OTHER DCSGUhAi=T#T WITH RE1.SPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY,T.14I POLICIES btSORtSED HEREIN IS.SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE E BEEN REDUCEIS'SY PAID CLAIMS. INSR LTR 7j'PEOP�N8UIiANCf POLICYNUMBER r uPOLIDYJ3FF 'DD/ P"YYm LIUMM A GENERALUA91UTY MAX013100005261 0/21/20#1 0/21/2012 EACH06CWFIRENCE 51;000;000 X COMMERCIAL GENERAVUABILITY MI $50 000 CLAIMS-MADE t' i OCCUR MED EXP(An.one; .eo $5000 PERSONAL 3 ADV INJURY -1000 000 GENIENERALAGGREGATE . ASZ0100.000 nXGEN'L AGGRE0ATE LIMIT APpms PIER: POLICY. : PRO LOC PRODUCT$�.00kIPK1PAGG .$kacklded s 8 AUTOMOBILE UABILITY 12MMBDNCVK 5/2012 1,3 u'oc 6. u00,000 ANY AUTO BODILY INJURY(Fier person) .$ ALLOWNED: X EDULED $..CH AUTO$ AUTO$ BOD.LY INJURY(Pier acelck", $ X HFlEDAUTOS X NQN?WNED AUTOS rft gERTY.DA GE S .... Iddaarn�ll $ -d UMBRELCAlJs43OCCUR EACt1000UFIRENCE. $ EXCESS LIAS HcLAmsmAm AGGREGATE D S. C WORKERSC MPENBAnON C0690570 /12120T2 x2/201.3 X AND EMPLOYERS'LIABILITY Y/N. ANY PRQPRIO OPIPAf fNER+EXECUTFVE: OFRCf3�lEMKpf6XCLUWW M NIA E:L.EACH ACCIDENT 950Q X00 (Mandatory In NH) g �,�a , J 019EASE-EA EMPLOYE :SWO 000 01 D RIPTIONOF'CIPEPAT1JNSbel6w .:. l.-DI,SEASE.-POLICY.LItiIIr :S50Q000 DESCRIPTION OF OPER4TION8/LOMON8.I VEHICLES (Attach ACORD aOa,.Adtlltlonal'Rertsika:Schtldula,'It ijioYl epKne:latogrjiruel) v CERTIFICATE HOLDER CANCIrtll'I. SHOULD AFIV�OF`WABbVE pESCR1BED'POLICIES`SE CANCELLED BEFORE THE EXd�IRATI 1 .t)ATE THEAtw, NOTIC: WILL :BE DELIVERED IN AC00FfD9►N61E'll ItH THE POLICY PAOVI„SIONS AUTHORIA REPRE8EM�ITIYE m tSii90 2O AC0 D CtTFIPOR TION AI#:rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks Of ACORD Massachusetts- Department of`Puhlic Safety Board of Building Regulations and Standards Construction Supervisor License License: C$ 36954 1k JOSEPH S SAVINl ` h 84 RAVINE=R1 MEDFORD, MA 02155 . . ��` Expiration: 7!22/2013 ( unmissiiroer Tr#: 18435 Office of Consumer Affairs&Business Regulation License or registration valid for.individul use only HOME IMPROVEMENT CONTRACTOR before the expiration.date. If found return to: Registration: ,41,35743 Type: Office of Consumer Affairs and Business Regulation Expiration: "4 DBA 10 Park Plata-Suite 5170 Y The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 1 Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: -CityBtate/Zip: ORVS-S Phone#: $ X15— 9 Are'yo n employer? Check the appropriate box: Type of project'(required): L.UNK am a employer with -B 4• E] I am a general contractor and I 6 ❑New construction employees'(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no.employees These sub-contractors have g, ❑ Demolition employees and have workers' working for me in any capacity. 9. [].Building addition [No workers'comp.insurance comp.insurance? • 5. [] We are a corporation and its 10.❑ Electrical repairs or additions required.] 3.❑ I required.] a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself, [No workers' comp. right of exemption per MGL 12.❑Roof repairs ]t c.1152,§1(4),and we have no insurance required.] 13.�ther��'� � -►� 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. t 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 state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Q l Insurance.Company Name: zri- Y' v,`���ov�t Q f Policy#or Self-ins.Lic.4: `)e o 6°10 5'7 c, __ Expiration Date: Job Site Address: l� � �A /101, VP City/State/Zip: �vv 1•� c]cke� Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requited 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereb cerci un the ains and enalties o er'u that the in ormation provided above is true and correct Si ature: - Date: Phone#: Official use only. Do not write in this area,to be completed by city or town officiaL - City or Town: PermiMicense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other• Oct 11 12 03:47a Mark Sullivan 9786575132 p.5 - r opozr�� as a Joseph S.Savini k 6rporated DIWA Joseph S.'Sateini Roofing&Gutter Contactors. - MASS WL.DiMIS 40 Canal Stteet,Medford,MA 92155 CONTRAMRS LICENSE 40369" (781)395.3954 • Fax(M),393.4926 no® REG.13S743 nc.o.K .e107 ove l,'am.VAX ARM= n1l nolo int VapoEll:`here!ty.10.itmtisA_ rii>!. taiwr - complete to etordttrtoe wilts.sp�a7lcaEiorts.tielorr .; the sum of �prO•Yb rlolwr. / ,/ - fIRJ3�.atUiGLtII�IdEUJ"t,+r'3UHda�ltTii , NQIIC�AImrYMsw•rrcrm�msa0aim�•r�snbqiYpAr A�t>14� *P10r�Imm44t�Yr�CNoMl•�M�lawraOyPorh� •l G1rgY,r7•SldWt3adlara�amrtb•gy„dM4M�welA .. dMaoamtm.YgtArYr�baRn�u�kd'e,d�aYe�lb��d�bb �+oasY�,as tmgo..ae.e comoa ngptins tar�,emw .akrdrawn� ,tri�n L�O days. goal -,so,,aoeo�.to eerrn. WOWWtV o�1 NW0000ftfW. ROOF WORK i$ STRIP ROOF OF !AVERS OF ASPHALTSMNIGLM COVER EXTERIOR WALLS AND /MUAGE VM71 TARPS TO HELP PREVENT DAMAGE'-.ADDITIONAL LAYERS WII:L BE EXTRA,SEE BELOW (� R DEGK.WTrH UNDERLAYMENT FELT. WrNSTALL ICE&WATER SHIELD AT LEADING EDGE,VALLEYS AND IFit=PiETRATI jSTANIDARD APPLICATION AT EAVES IS S FEET.ALL LOWER SLOPS=O F TO REC I ALL PERIMETERS WIFH S iNCH ALWANUM DRIP EOGE-C :,: SILVER f _ ALL 1 = A =LDATnc Odf ER LATKIN.- N9TALi.SOFFrr-VENTS V#'HE RE NWESSARY.SOFFIT SIZE TO DETWINIME SIZE OF VENT. SOIL PIPES WETH NEW RUBBER FLASHING SOOT'S. FLASH CHIMNEYS)WITH ALUMINUM FLASHING AS NEEDED. aFi EAD cmiMNE Y. CUT ALL t3-ms AND LEAD FROM • l CHIW4EY(S),-C UT 1V REGLET CEMENT NEW LEAD IN PLACE WITH MORTAR.IF NEEDED FOR A WATERTIGHT.IOB.APOr � ftURD CHIMNEY FROM ROOF DECK LIP WtTH NEW OR USED,BRECK ADD TO ABOVE PRICE. REPLACEDEF£CTiVEROOFOECKINGWHERE. ARYATCONTRACTORSDISCREnm DEFECTIVE ALOOF DEMNG REPLACED WITI-1 SPRUCE,FIRST. _j0'_FEET FREE AND-THEN��PM FOOT THEREAFTEFIL PLYWO0Q_DECKS.R LACE_ �SHEET(SiFR>=ETHEN ¢O.ae U SHEET.BY.AND INSTALL, THICKNESS , rW COVER ROOP-SURFACE WTI H STORM NFSiL'ALL SHINGLES WHEN APFMJCAsm(sm&*;& ONS). INSTALL SKYLIGHTS PROVE BY CONTRACTOR DR CUSTDMEi;-FRAMR-ROOF DECK AS NEED, PROPERLY FLASH UNITS WfTH FLASHING ICIT PROVIDED,ADD TO PMCC-- MMMMOR 70 00 IF MORE I.AYi=13&AAF.FOUL T)•iAN iNDr—ATEDA®OVE.AN ADDmoNAL CFUIRGE.OF' _:WELL S£AD PEfI�1YER:IN THE EVB�ET OF.i m-nPLE LAYERS 1N.lif W DOM AREAS OF ROOF,COST.13 °O"'PER'.SQVARE(1IY X"10 AREA)TO RE�M1fE AiJD.D OF ApDR1ONAL LAYERS. CLEAN ALL.LOB'Fi tk D Dawns FROM OUTSm wow AREA..OBT mi ALL PE3RNBT$AND CARRY ALL NEC6$SARY MURAN=AS REQUIRED 13Y LAW. 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