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HomeMy WebLinkAboutBuilding Permit #184 - 90 AUTRAN AVENUE 9/11/2008 BUILDING PERMIT of"°oT"qti TOWN OF NORTH ANDOVER or APPLICATION FOR PLAN EXAMINATION b Permit NO: Date Received AT.o,•P �5 �SSACHUS�� Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION 90 ga*fr*%,n AV Ald- h Print PROPERTY OWNER__(3 d /Ot V 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: S fir' P I0 0-� Identification Please Type or Print Clearly) OWNER: Name: Bob C 1 ►/ Phone: Address: ` CONTRACTOR Name:_-_ J&r,,g 1-h4. in LtiT- PhoneOP5`0-60/91 Address: 3 rtla mo t h dr V. y Sc, Ie ett off 0 30 79 Supervisor's Construction License: Exp. Date: Home Improvement License: JCo Exp. Date: / " 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: $ �- FEE: $ -*5U Check No.: Receipt No.: Q NOTE: Persons contracting with unregistered contractors do not have access to the gu ranty fund §Signature of Agent/Owner Signature of contracto Location / 0 No. Date 9d' MORTM TOWN OF NORTH ANDOVER 3? ' O 0 s Certificate of Occupancy $ �ssACHUSEt� Building/Frame Permit Fee $ U Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # /Ij o ` 1144- 2 1 5 6 Ci. --�--- \—'Building Inspector Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public SewerSwimming Pools Tanning/MassageBody Art I 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 r 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 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 Building Department artment 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 o Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract Li 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 L3 Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses Li 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) o 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) o Building Permit Application o Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses a Workers Comp Affidavit Li Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract o Mass check Energy Compliance Report o 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 vx®RT ti Town of 0 - ..�. . No. rw = A o �` dover, Mass., - • COCKIC MEWICK �'k ADRATED `s BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT .................40.. ..............:..'"c 1k.... .............................................................................................. Foundation has permission to erect.................... buildings ........ , ..v. ,.I!►...... ,,.,.,,,,, Rough to be occupied as ! ............... 041 Chimney provided that the person acceptiZhi permit shall in every resp ct confor 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 3b PERMIT EXPIRES IN 6 MONTHS Final ELECTRICAL INSPECTOR UNLESS CONSTRUCTION-5, T TS Rough ...:. Service ........ . ......... ......... ............................... BUILDING INSPECTOR �- Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal No Lathing or' Dry Wall To BeDone FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID DN DATE(MM/DD/YYYY) PREMI-3 07/31/08 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Santo Insurance - Salem HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 224 Main Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Salem NH 03079 Phone: 603-890-6439 Fax:603-890-0315 INSURERS AFFORDING COVERAGE MAIC INSURED INSURER A. Western World Insurance Co INSURER St Paul Travelers Premier Roofing & Painting Jonathan N Lee PBA INSURER C: American International Group 334 N Broadway #307 INSURER D: Salem NH 03078 INSURER E: COVERAGES 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 WHICH THIS CERTIFICATE MAY BE IS, IED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS.AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS LTR INSRE TYPE OF INSURANCE POLICY NUMBER DATE(MM/DD/YY) ,DATE(MM/DD/YY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY NPPI036706 05/24/08 05/24/09 PREMGETO-RENTEience) $50,000 CLAIMS MADE � OCCUR MED EXP(Any one person) $ 5,000 NPP1036706 05/24/07 05/24/08 PERSONAL&,ADV INJURY $ 1,000,000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AC,,,- $ 1 Q Q Q Q Q Q POLICY PRO- JECT LOC AUTOMOBILE LIABILITY COIVIEINED SINGLE LIMIT ANY AUTOEa aocioen', $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per person) $ HIRED AUTOS ----- BODILY INJURY NON-OWNED AUTOS (Per accident) $ PROPERTY D.AiViAGE (Per accident) $ GARAGE LIABILffY AUTO ONLY-EA ACCIDENT $ ANY AUTO ---- --- OTHER THAN EA ACC $ AJJTO ONLY AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR ❑ CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE RETENTION $ WORKERS COMPENSATION AND B EMPLOYERS'LIABILITY ' ANY PROPRIETOR/PARTNER/EXECUTi''JE WC6966897 05/25/08 05/25/09 E.L EA(H��.",DErrr C OFFICERIMEMBEREXCLUDEW $ 100000 WC6872240 05/25/07 05/25/08 EL.DISEASE- $ 100000 S es, L PRO under _ _— — S ECIAL PROVISIONS below OTHER E.L.DISEASE-POLICYLIMIT $500000 DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Bob Clay IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR 90 Autran Avenue REPRESENTATIVES. North Andover MA 01845 AUTHORIZED REPRESENTATIVE James A Santo ACORD 25(2001/08) ©ACORD CORPORATION 1988 --� rvr- PREMIER ROOFING & PAINTING By Jonathan N. Lee 215 South Broadway,#145,Salem,NH 03079 603-235-5731 603-890-9019 wN►w.premierroofingnh.com Proposal Submitted to: ,Bob Clays Date: 5=12=08 90 Autran Avenue North Andover, MA 01845 Phone : ,978-688-6047 : Job Location: :90,Autran.Avenue, North Andover, MA t We hereby submitsnecifications and estimate for the following.- Strip and Reroof: 1. Strip roof of 2 layers of shingles. 2. Renail all sheathing. 3. Replace one sheet of plywood(if needed). Any additional sheets of plywood will be and additional charge of$65.00 per sheet. Includes removal of damaged plywood and installation of new sheet of plywood. 4. Apply GRACE Ice and Water shield 3'up from edges of roof. 5. Apply 301b felt paper to remaining roof surfaces up to ridge. 6. Install 8"aluminum drip edge around perimeter of roof surfaces. 7. Install 2 bathroom vents. 8. Reroof with IKO Cambridge 30 yr shingle.Color:Brown. 9. Install TAMKO Ridge Ventilation. 10. Replace 2 pipe collars.Size:3" 11. Clean up and removal of waste and roofing debris. 12. Walkways and driveways cleaned of debris. 13. Magnetic sweep of property. 14. Dumpster provided and included in job price. We Propose hereby propose to furnish materials and labor -complete in accordance with the above specifications,for the sum of: Two thousand,four hundred seventy five dollars _($2;475:00) Payment in full to be made upon completion of job. (make checks payable to Premier Roofing&Painting.) All material is guaranteed to be as specified.. All work to be completed in a workmanlike manner Authorized according to standard practices. All agreements contingent Signature upon accidents or delays beyond our control. Owner to carry fire,tomado and other necessary insurance. This company Is covered by General Liability and Worker's Compensation insurance. Certificate of insurances will be sent directly from insurance agent to ensure validity. (Note:This proposal may be withdrawn if not accepted within 90 days) Acceptance of Proposal-The above price,Specifications and conditions are satisfactory and.hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above. Signature Date of Acceptance c Board of Buildin g g Re ulations and Standards HOME IMPROVEMENT N CONTRACTOR Registration: 5586.1 8 -5/15/2009 TrJt 255421 Tme. 3)BA PREMIER ROOFING&PAHVTING'i JONATHAN LEE t 334 N.BROADWAy'4307 SALEM,NH 03079 •..` ���� Admigistr The Commonwealth of Massachusetts Department of Industrial Accidents (k Office of Investigations .1 U ;;11; ►° 600 Washington Street Boston, IIIA 02111 i www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): ,041'G Yet t ti r/' f00�iot~C Quit r1 fiMK Address: -33q AVo r+k (3rodwc l _707 City/State/Zip: M AIH 03078 Phone#: Are you an employer?Check the appropriate box: Type of project(required): -/ 1. t am a employer with ._ 4. ❑ 1 am a general contractor and 1 6. ❑ New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ 1 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.❑ I am a homeowner doing all work right of exemption per MGL I I.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no 12.E] Roof repairs insurance required.] t employees. [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 subniit.this a���davit indicating they are doing all work and tiler,mire outside contraciors 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. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: S a►kj ta- 17 N(i Policy#or Self-ins. Lie.#: Expiration Date: Job Site Address: City/State/Zip: 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 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. 1 do hereby certify under the pains andpenalties ofperjury that the information provided above is true and correct Simature: `xu� Date: Phone#: 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): 1. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions 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/license 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 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 cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-7274900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax#617-727-7749 www.mass.gov/dia