Loading...
HomeMy WebLinkAboutBuilding Permit #428 - 92 PRESCOTT STREET 11/28/2006 Ip TOWN OF NORTH ANDOVER ORTH I' APPLICATION FOR PLAN EXAMINATION G� -.o 1610 0.4 • •6 ►O- p PermitNO: Date Received // 'p,�o o Date Issued: 4SSACHUS�� IMPORTANT: Applicant must complete all items on this page LOCATIONZ nc s" (' , 5t",� 0 rint n PROPERTY OWNER---Do,-,Joh &, � e— �Ck ( Print MAP NO.: .�' PARCEL: ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑New Building ❑One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: Repair, replacement ❑Assessory Bldg ❑ Commercial Demolition ❑ Moving(relocation) ❑Other ❑ Others: ❑ Foundation only DESCRIPTION WORK TOB PRFF�O�RMED Icv Identification Please Type or Print Clearly) f7� OWNER: Name: cr--Ve,� � � k tf t?� Phone: Address: Z CONTRACTOR Name:-4d1L&11v% UJ' a/ r cSl �s� Phone: lr8 Z Jo(x p Address: loo t b,4✓ G �G �•� '-5 6( a 3 Supervisor's Construction License: Exp. Date: Home Improvement License: 1 Z �' l 7U Exp. Date: ?1a ARCHITECT/ENGINEER Name: Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.$12.0R$1000.00 OF THE TOTAL ESTIMATED OST BASED ON$125.00 PER S.F. Total Project Cost2L FEE:$ Check No.: d l Receipt No.: Page I of 4 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 Addition Or Decks ❑ Building Permit Application ❑ 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) 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 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:BPFORM04 Page 4 of 4 it TYPE OF SEWERAGE DISPOSAL Tanning/Massage/Body Art ❑ Swimming Pools ❑ Public Sewer ❑ Well F1 11 Sales 11Food Packaging/Sales El ❑ Permanent Dumpster on Site ❑ Private(septic tank,etc. Electric Meter location to project NOTE: Persons contracting,wit unregistered contractors do not have access to tAguaranundSignature of Agent/Owne Signature of contractPlans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ ans ❑ 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 FIRE DEPARTMENT - Temp Dumpster on site yes no Fire Department signature/date 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 Building Setback (ft.) Front Yard Side Yard Rear Yard Required Provided Required Provides Required Provided Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: NOTES and DATA— For department use Page 3 of 4 i Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 Created JMC.Jan.2006 r� 1 4Location p/ No. Date r•f MORTM TOWN OF NORTH ANDOVER 3: � •SOL ` Certificate of Occupancy $ • � a , s"CNUS<� Building/Frame Permit Fee $ ` Foundation Permit Fee $ IrJ Other Permit Fee $ TOTAL $ Check # _�( 19833 Building Inspector The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 s� www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl // II Name(Business/Organization/Individual): /"fie�c 1 ,, (— r 61 Gz-1 oMf �-- Address: /00 1.5 G,'Wty—) fD c06" 1� City/State/Zip: p 6i — Phone GZ - d.-Pd 910 ZZ d9Z� Are u 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. 1 7Remodeling 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 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.] t employees. [No workers' 13.0 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: S Policy#or Self-ins.Lic.#: C- — �� O c� — Expiration Date: Q Job Site Address: r-G 5C'a City/State/Zip: Attach a copy of the workerv,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 insurancecov rage verification. I do hereby certify u r the par a p alties of perjury that the information provided abo a is tr a and correct. Signature: Date: O G Phone#: 57 2)Z 02 zz 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 M Board of Building Regulations and Standards One Ashburton Place - Room 1301 �Y Boston. Massachusetts 02108 Home Improvement Contractor Registration Registration: 129170 Type: Private Corporation Gove Lumber Company, Inc. Expiration: 7/19/2007 Bruce Gove 80 Colon Street Beverly, MA 01915 Update Address and return card.Mark reason for change. )PS-CA1 0 5OM-04/05-PC8698 Address ❑ Renewal 0 Employment Q Lost Card ' ��ze {�anvynanraea`t� a�✓i'�,acfule�a Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 129170 Board of Building Regulations and Standards Expiration: 7/19/2007 One Ashburton Place Rm 1301 Type: Private Corporation Boston,Ma. 02108 Gove Lumber Company, Inc. —� Bruce Gove 80 Colon Street Beverly, MA 01915'"' — -- Administrator Not valid without signature 11-27-06; 1 :22PM;Production Control Gove Lumber ;978 762 0008 # I/ WI�(3 lO�(® S �J� syi ( FsP % Installation 1! Window & Door Shocase by GLC Quote iwbury Street Route 1 South v caeoe 978-762-0007 MA 01923 093 978-762-0008 fax OMER Don McDaniel & Carol Disney REVISION DATE 07/20/06 ,ODRESS 92 Prescott St. PROJECT NAME CITY,STATE,zip North Andover,MA ADDRESS DAY TIME TEL 978-794-1499 CITY,STATE,ZIP SALESPERSON Steve Miller DAY TIME TEL REV 02/06 LABEL QUANTITY DESCRIPTION PRICE TOTAL Marvin Clad Window Unit Stone white clad exterior Primed interior Low E 11 isul galss,tempered where noted 7/8"simulated divided lites,cut to match existing 5-3/16"jambs 5/4x5 Azek surround w/backband 4 CUDH 2620 649.80 2,599.20 RO=2'8-3/8"x 4'0-7/8" 4 Azek surrounds w/sill and backband 194.90 779.60 I 52 Harbor classic interior molding w/backband 2.20 114.40 16 1x4 Primelock(apron) 1.20 19.20 ,I 16 1268A Stool Cap(interior windowsill) 2.10 33,60 40 8104A Col stop 0.80 32.00 1 Building Permit Fee 135.00 135.00 1 Installation Flat Labor Charge 2,850.00 2,850.00 1 Miscellaneous Materials 232.00 232.00 1 Rubbish Removal Fee 79.00 79.00 All installations will be left broom clean at the end of the day. All painting is by others. Gove Lumber warrantees the installation labor only. All materials are covered under the Manufacturers warranty. Any rot found or extra work not specifically mentioned in this work order will be billed at an hourly rate plus the cost of materials. Customer will supply electrical power and water when necessary. Customer will prepare the work area by removing all furnishings and provide easy access to area. Massachusetts Home Improvement Contractor Registration#129170 TERMS DEPOSIT OF $2,189.23 REQUIRED PRIOR TO PLACING ORDER SUB TOTAL 6,874.00 $2,054.22 DUE WHEN MATERIALS TO BE INSTALLED ARE DELIVERED. DELV CHARGE 25.00 $2,850.00 FINAL BALANCE DUE ON THE LAST DAY OF INSTALLATION. 5%MA TAX 194.45 MAKE ALL CHECKS PAYABLE TO GOVE LUMBER COMPANY, INC. TOTAL $7,093.45 CUSTOMER HAS RIGHT TO CANCEL ORDER WITHIN 3 DAYS FROM DATE AT TOP ORDER ACCEPTED AS WRITTENXC I J �, NO RETURNS ARE ALLOWED ON WINDOWS,DOORS,A SPECIAL ORDER MILLWORK. IF YOU HAVE ANY OUESTIONS REGARDING YOUR INSTALLATION PLEASE CALL BARRY GOVE AT 978-922-0921 SELF INSURED LUMBER BUSINESSES ASSOCIATION NCCI CARRIER CODE NO. WC 00 00 01A WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY INFORMATION PAGE 1. The Insured: Gove Lumber Company Policy No. WC 000806-6 Renewal of: WC 000806-5 Individual - Partnership Mailing address: P. 0. Box 12 X Corporation or Beverly, MA 01915 04-1382050 Federal Employers I.D.# Inter/Intrastate Risk I.D. # 012217 Other I.D.# Other workplaces not shown above: See Schedule 2. The policy period is from 01/0 1/2 0 0 6 12:01 a.m_ to 01/0 1/2 00 7 12:01 a.m. standard time at the Insured's mailing address. 3. A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: MA B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident $ 500, 000 each accident Bodily Injury by Disease $ 500, 000 policy limit Bodily Injury by Disease $ 500, 000 each employee C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here: COVERAGE REPLACED BY ENDORSEMENT WC 20 03 06 A D. This policy includes these endorsements and schedules: See Schedule 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. Premium Basis Rate Per Code Total Estimated $100 of Estimated Classification No. Annual Remuneration Remuneration Annual Premium See Item 4 . Extension WC 00 00 01A Total Estimated Annual Premium $ 44, 362 Deposit Premium $ 11, 090 Minimum Premium $ 500 (MA) 5645 Expense Constant P $ 284 MA - DIA Assessment 0 . 011 352 . 00 Premium Adjustment Period: Annual Countersigned by: Servicing Office: SELF INSURED LUMBER BUSINESSES ASSOCIATION Date: 11/03/2005 i Producer: Copyright 1987 National Council on Compensation Insurance. Original And T f own o over No. �0 dover, Mass. - I.A COCHICHEWICK ORATED P\ BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT ..........A^o............. .............. ................ Foundation has permission to erect........................................ buildings on .. ... . .... . .. ..... ......... Rough . tobe occupied as...... ....... ..................................................................... Chimney provided that the person acting this permit shag in every respect 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 60P PERMIT EXPIRES IN 6 MONTHS 0 S S ELECTRICAL INSPECTOR UNLESS CONSTR TLf PE ......................... :UWIOL�DING INZ=� Final Rough ......................... Service 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.