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Home My WebLink AboutBuilding Permit #132 - 89 WOODSTOCK STREET 8/20/2007 BUILDING PERMITO� N0 pTh qti TOWN OF NORTH ANDOVER F? APPLICATION FOR PLAN EXAMINATION � �� Permit NO: Date Received �rE .c� Date Issued: r '' 0 �SSACHUS�t IMPORTANT:Applicant must complete all items on this page LOCATION_V &C w °C. Q S C-. Off, S/ W '5a k Print f PROPERTY OWNER Cuff 5 AcGk 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 Repair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: (-A-4n R-r J1j,-.j F Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: CONTRACTOR Name: 73h', /to Phone: Address: ICS J-PA, Supervisor's Construction License: Cb 0 c t 2 Exp. Date: Home Improvement License: 12 $ f Exp. Date: a 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: $ �> �.5 l� FEE: $ '70 Check No.: L� l Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund ,signature of Agent/Owner Signature of contracto I 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 DATE REJECTED DATE APPROVED CONSERVATION COMMENTS DATE REJECTED DATE APPROVED HEALTH COMMENTS 3 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 Located at 384 Osgood Street FIRE DEPARTMENT -Temp Dempster on site yes no Located at 124.Main Street Fire Department signatureldate 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 ❑ Notified for pickup - Date Doc.Building Permit Revised 2007 I 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 ❑ 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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 Location 6r / 40U S/P No. �"" Date 01 NORTN TOWN OF NORTH ANDOVER F p + ; Certificate of Occupancy $ �'�s'•°•Eta' Building/Frame Permit Fee $ . 0 .-- sACNUs Foundation Permit Fee $ ' Other Permit Fee $ TOTAL $ Check # 20567 ``� Building Inspector NORTH 0 0 _ over 0 No. 13 & LAKE _O1. dover, Mass., COC HICHEMCK \1 �ADRATED C2 �S V BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System / BUILDING INSPECTOR THIS CERTIFIES THAT.........................V.'.^. .......... �i (/,�cr �r. ........................................... Foundation has permission to erect........................................ buildings on .......... ..................... Rough t0be occupied as......... ........... ...... ...... ........................................................................... Chimney provided that the person accepting this permit shall in every res 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 70ELECTRICAL INSPECTOR UNLESS CONSTRUC T TS 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. LSEE REVERSE SIDE Smoke Det. Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR License or-registration valid for individul Registration before•the expiration date. use only If found return Use 128612 Board of Building Regulations and Standards Expiration 4/28/2009 Tr# 129477 One Ashburton Place Rm 1301 r Type DBA Bt#stoq,Ala.02108 THOMPSON S ROOFING THOMAS DOYLE, %t 8 WEST ST SALEM, NH 03079 '�CI�"'` ZL of Administrator Not valid without sign�e �— F°g° of I Free Estimates 105 Haverhill Street Fully Insured Methuen, MA 01844 THOMPSON'S ROOFING (978) 691-1355 Shingles - Slate - Rubber Roof Single Ply - Copper Work PROPOSAL SUBMITTED TO PHONE DATE Vincent h 7-20-07 STREET JOB NAME 89 k Street CITY,STATE AND ZIP CODE JOB LOCATION North Andover Ma 01845 ARCHMECT DATE OF PLANS JOB PHONE We hereby submit specifications and estimates for. Strip off all roof shingles on house Rena-1.1 al_' loose dao.=.r(,s _ Install .024 aluminum drip edge around roof line Apply ice and water shield 6 ft up all along edges Apply 15 lb. fetl paper on rest of roof area Reshingle with a GAF timberline 30 shingle Install new flanges around soil pipe Install ridge vent , Remove all work related debris 30 year warranty on material 5 year guarantee on labor construction lic. #060112 improvement #128612 eroOge hereby to furnish material and labor—complete in accordance with above specifications,for the sum of Five thousand eight hundred and fifty-- dollars($ 5 ,850 . 00 Payment to be made as follows: 1, 950 . 00 down balance upon corn letion ce, ail material is guaranteed to be as speafied.Ab work to be compbted in a wormwilike manner according to standard practices.Any afteratim or deviation from above apeollfcabbrts hVolWng extra costs wr11 be executed only upon written orders,and wN become an extra charge over and above the estimate.An agreemertts oontlngerd upon strikes,accidwits or delays beyond our conttro. Owner to carry fire,tomado and other necessary inarxenoe.Our workers are fully Note:This propose!may be covered by Workmen's Compensation Insurance. wrfCMrawm by us H not accepted wift gaeptante of Propogat—The above prices,specifications and conditions are satisfactory and are hereby accepted.You are authorized to do the Signaturwork as specified.Payrnent will be made as outlined above. ° Date of Acceptance: �� Z,/ The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): ' DSo� t�'iT/Nit Address: a City/State/Zip: ol,. ��U -c,(._ Phone #: Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ 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 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.❑ 1 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 12,0,R—oof repairs insurance required.] t employees. [No workers' 13.❑ Other 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 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: a4 ;5'A,& -P5- Policy 5'A, ,r -PSPolicy#or Self-ins. Lic.#: Cli AC08&�D CERTfFICATE�OFLIABILITY INSURANCE DATE(MM/DD/YYYY) PRODUCER THIS CERTIFICATE IS ISSUED ASA MATTER OF IONFORM 200 Pelham Insurance Services, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P.O. Box 960 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 122 Bridge Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, Pelham NH 03076 INSURED INSURERS AFFORDING COVERAGE NAIC# Thomas Doyle dba INSURERA Nautilus Thompson,s Construction S INSURER B Associated Ind of MA 8 West St INSURER Salem NH 03079 INSURER COVERAGES INSURER E THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHIC1i7HtS�ESTIFp,TE*yjy.-g�; _OR 14TAYTAIN, THE INSURANCE AFFORDED 8Y THE POu.CJFs-. Etc£ft{BED-IIEREIN IS SDE TU ALL THE TERPrS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. h-CiliREGAI E LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. NSR ADD'L LTR INSRD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION DATE(MM/DD/YY) DATE(MM/DD/YY) A GENERAL LIABILITY NC 644138 O9�1S�2OO7 04/15/2008 LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS MAGE OCCUR PREMISES(ETO a oc-.cur occurrence $ 50,000 � MED EXP(Any one person) $ 1,00() I PERSONAL&ADV INJURY S 1,OOQ,O0Q GEN'LAGGREGATE LIMIT APPLIES PPR GENERAL AGGREGATE $ 2,000,000 POLICY jE LOC PRODUCTS-COMP/OP AGG $ 1,000,000 AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT $ ALL OWNED AUTOS (Ea accident) SCHEDULED AUTOS BODILY INJURY MIRED AUTOS (Per person) $ NON-OWNEU AUTOS I BODILY INJURY I (Pef accident) $ I PROPERTY DAMAGE ( GARAGE LIABILITY Per accident) $ ANY AUTO I AUTO ONLY-EA ACCIDENT $ OTHER THAN EAACC $ EXCESS/UMBRELLA AUTO ONLY LIABILITY AGG $ OCCUR ID CLAI%1S MADE EACH OCCURRENCE $ AGGREGATE $ DEDUCT.BLE $ I RETENTION S I $ B WORKERS COMPENSATION AND AWC 7012214012007 04/21/2007 04/21/2008 X T0TH• $ EMPLOYERS'LIABILITY TORY LIMITS ANY PROPRIETOR/PARTNER/EXECUTIVE ER OFFICER/MEMBER EXCLUDED? E.L.EACH ACCIDENT $ 100,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-EA EMPLOYEE$ 100,000 ..- OTHER I E.L.DISEASE•POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS roofing La 17 Knollcrest Dr. , Andover, MA for. Judith Brasseur CERTIFICATE HOLDER CANCELLATION 978 623-8320 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Town of Andover EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 1 O DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT 36 Bartlett St FAILURE TO Do SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR REPRESENTATIVES TIV ES. AUTHORIZED REPRESENTATIVE /,p j /�A n NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit at: is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150 A. Also, note Permits are required under Fire Prevention laws Chapter 148 Section 10A. The debris will be disposed of in: a, Pei (Location of Facility) Signature of Permit Applicant Fire Department Sign off: Dumpster Permit Date