Loading...
HomeMy WebLinkAboutBuilding Permit #1064-15 - 98 PLEASANT STREET 6/17/2015 J" �1ORTH BUILDING PERMIT ?o°`'`10 ;°•�oG TOWN OF NORTH ANDOVER ° ` APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received 4q �•9 "14 Date TEo�PP`y�y Date Issued: SSACHU5 IMPORTANT: Applicant must complete all items on this page Nly IIII G > MAP4NO`'rPARCELa �ZQNIGD STRI�TI�stor�c D strict yesno`� Mach«e5ho Vil1108 TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential =1 New Building YOne family E Addition E Two or more family ❑ Industrial 'Alteration No. of units: Ll Com rcial I Repair, replacement I:: Assessory B g-1 ­I O ers: E Demolition E Other I Septic I Wella 1 Flbodplaira ` b I Wetlands VV atershed district P ,# WN ... ,_ . . . _. W Zn 1 ( Vinyl ' '1 ,n �s an C1 1nQ le- Ea m ' 1n Identification Please Type or Print Clearly) OWNER: Name: As= mm Phone:9_18o 47G -4 1')o Address: QC2 � MA CQiN3 RANO �IV�a=Nem 3 gip ► hon . eye Address r 33 u aa'tys . ��' ,: +.,.z fi, _ z; :. d,'y";, s: �`x „3.. •a ii.�' x' ,..a ' �Superusor's Con'strtct�onLicense ' -Exp Date m Home lrnproement Ucense .. A ,.. ARCHITECT/ENGINEER NA 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: $ /D 000 FEE. $ 12,0 Check No.- Receipt No.. NOTE: Persons contra ting with unregister d contractors do not have access to the uaranty and Signature of Agent%Owrie° <, Sigr"W re� of contras#o Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOS Public Sewer ❑ Tanning/Massage/B Art ❑ Swimming Pools Well ❑ Tobacco Sal ❑ Food P aging/Sales ❑ Priva septic tank,etc. ❑ Perma nt Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR*OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMENTS CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ CONWENTS 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 FIDE EP,1RM� � �eim�p ®' � ps�t a� safe R yews \ � r.c %, 14Cs � •' • C©t'.YIM�rNTS '3 Yk»�». Z:. » C sW ...u4 -c �Y���—ga. d�5 Z `� G� \ d�krs��T+ �. Location`d R No. U.. , Date J _ • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $- . Al Other Permit Fee $ r '_ r}l) TOTAL $ y Check# y Building Inspector P'War AMERICAN CONSTRUCTION :ICA ROOFING SIDING WINDOWS, Commercial and Recidential, Lucia Or Milford RIA 01757 American Construction,Inc.is committed to excellence and quality craftsmanship at an affordable price Our success has been achieved by our values we are professional,detail-oriented, neat,honest,caring, and dependable Professional Craftsmen.Top Quality Products&Best-in class Service On it Customer,Name� Y `� ' Dat [ i Address: tt' l 1 Town n Phone: I° E-mail THIS PROPOSAL IS FOR SIDING REPLACEMENT (over) Install new insulation board. -Wrap all windows with aluminum. -Install vinyl soffit and aluminum fascia. -install all new electrical boxes and water -Install 18 Scl Main St Vinyl siding the color oft . t. + V"= ) IS-Year Craftsmanship warranty on installation CLEAN LIP Cover all sidewails&landscape with tarps to protect your property including using magnets to pick up all nails Covered your grass with tarps and protect piants MATERIAL&LABOR Total:(10.000.00), Includes dumpster and permit. PAYMENT TERMS: Payments:Deposit $1.000.00 of agreed amount,when half done with balance due on completion& your satisfaction. The above prices,specifications and conditions are satisfactory and constitute the entire agreement and are hereby. Accepted.You are authorized to perform the work as specified above.Payments will be made as outlined herein"p I Please sign and date.Please make checks payable to AMERICAN CONSTRUCTION ROOFING INC.&mail to 4 Lucia Dr Milford MA 01757 On behalf of AMERICAN CONSTRUCTION ROOFING.,thank you for the opportunity to quote on this project,we look forward to serving you.,please contact us with any question.At your service REPRESENTATIVE OF AMERICAN CONSTRUCTION ROOFING INC.508-3710367 Email luisroofing@hotmail.com NORTH � t e own of , 00% I - h ver, Mass, 00+ A- coc c»l WICK y1. '7�Q�R�ITEO ►'Pa,��y S U BOARD OF HEALTH Food/Kitchen PERMIT LD Septic System ^ THIS CERTIFIES THAT ............ V .r/.Cl$ BUILDING INSPECTOR . .1�li .............................................. .. Q 11 . ........... Foundation has permission to erect .......................... buildings on ........1.1a...... .....I dito�l�►�... Rough V to be occupied as ................ ..... ........... .� .. .��. ................................. Chimney provided that the person accepting thi permit shall in eespect conform to a to sof 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 MO HS ELECTRICAL INSPECTOR UNLESS CONSTRUCT S Rough Service ............ ... ........ ....... .................................... 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 Inspectors Burner Street No. Smoke Det. a� The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington.Street Boston, MA 02111 wmv.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/orgaruzation/lndividiW): American Team Construction Inc Address: 4 Lucia Street City/State/Zip: Milford, MA 01757 Phone #: 860-753-0452 Are you an employer?Check the appropriate box: Type of project(required): 1.9 I am a employer with 1? 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. $ E] Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working forme 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 10: 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.❑ Roof rct,airs insurance required.] t employees. [No workers' `� comp. insurance required.] 1.3.K Other Vin h Any applicant that checks box#1 must.also fill out the section below showing their workers'compensation policy inforrnation. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new ariidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors anti their workers'comp.policy information. I am an employer tliat is proi,iding ii,orkers'compensation insurance for my efnployees. Below is the policy and fob site information. Insurance Company Name: Ace American Insurance Company _ Policy##or Self-:ins. Lic. #: 8D851692 Expiration Date: 12/07/2015 n Sim Norfi 6)846- Job Site Address: �� �nso rt e City/State/Zi,& Ver 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.-yeas 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cerhf Inde he pains a penalties ofperjury that the information provid d above is true and correct. Signature'. {Authorized Agent} Date: pho e—Fax : 860-315- 66 / Cell: 860-753-0452 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. (Xher Contact Person: Phone#: ' s ' acarzv� CERTIFICATE OF LIABILITY INSURANCE ,Zo 2d"v5 _ E ' THIS C R (-!GATE IS ISSd_D AS A MATTER OF IN=ORMOtiFER ATiOY ONLY AND CS NO RIGHTS UPON';HF.CERTIFICAi -' r1OLO2.. THIS e4TMcA .OES NUI AF..itMA,i�'ELY OR NEOATtV_LY AMEND, E%TEND OR ALTER THE COVERACe.l A ORDED 3Y THE POLICIES BELOW ''IS CERTI ICATE OF INSURANCE DOES NOT CONSTTUTE A CONTRACT SETYV'E`N' THE ISSUING hSURER(S)AUTHORIZED RC?p SEliTATIV_0"R>AODUCER,ANiD THE CERTIFICATE HOLDER .... IMPOR[ANTt It,he cer#fitea!e holder=s ar.ADDITIONAL INSURED,the Pcfty{ies,mus,be endorsed. U Sv3ROGATICN ISY AiVM_ suhjacttothe terms and conditions of the policy."ra!,p icies may require an endorsement.Astatement on this Cr4tsatsx3Das no!confer rights to the certificate holder in lieu of SL-h ondarsarcen,{at, t FfADb.tCi:R L ITR - J=`t+! 4�S wSA ctJCY ;Fax 37482LMONIT S ReET 4L : WORCESTER MA'_iEG< i .,,.. .....__._ JFE T'r� >•3'y: ;, E tinrCe F (t- AMERICAN .........__.... _.......... +;LUCIA ORCJG ......q v.Ego: , MA077.57 - ....._ .....� ........_, j GOvsRA� CERTI`iCATE UM9 R; ,NUM. 'HIS S O C�;,T A E"C C� -le 4;t - e 3.tGV H.Ati i3. 'FN SSU:£.' A"Vr ^ORSTHE-POLICY ? R= ',0 ATr_C. .N '.S?.•NO;NG ANY ��w�IR.>,_tr„ £ER„s OR CONC;TION OF.A,& .. 4 R/t OR'3 �tFR 00 h +qty EC iCo i F RTIF AT CLAY C tFS e P �_ r,v AS AeC:. A= 7-;DtO - P-01 1-C ES 3_5 Ro D HER It IS b-`BC H'. TE iS. 'CUtiDI.I;NS 0. 5,.,.N PO ....a..I!dpi'a o:_Cyv:Sr L'qY Kt \ FD.:C-D SY aAtu C A S yrSR Ty? DF I4SURl4CE '<L`oLSUap ithdtY EFF Ct-CYES;P TR �YSR.YNC' PoucC Huva R (r'aK+2orc.wivw^'+rwr uN`TS j "! £L Ct. 4n nCc - I QC BAol ill'J'2Y i S 3EA 6R QA (. i � o ��DMo i etY �,..._ - ..• of EJ-n EEJ/iT - i AllC ter` I I;M:gI3E;y„1,AE , .5.1340-. er cl �uR u-f Y-RS WoftCOLO"NPe.YbA LIT : +ICS s,J !tf k Etrttltj+'<r5S UA,.E�Ty j y I r^gY-tmits� ��N I IAV CtF CE E kCE"M';Jl -NY / 't��cr r p�` 5 2.?2D,- :2•;r7-'[03$r-----� v� FC8 092 � z� cars :z�AfvII o_[•£�A,7"gyr Q F� 4$ - € ' !(}9_F.,,; .F.Y�lel. Jl(��3;:J I c E 'r i ' I 1'JEatRI°iid?;G OPERA.tDVS%i.LCATiC�`S:YEBICLES!Aax>£ACORh SCI,A3Rrx:as lteecarkx 4ahc n.,,sc.a sP>annca?real " arF QAM HDLD_R CAµCHI ATIOM, ..........._. SH OU LD ANY v' THE AFCVE D SC216EU POLICIES a-i CANCELLED $ FORE HE EXPIRATION DATA' T.4.REO6'l NOTICE VALL DE DELIVERED tN ACCORDANCE rvn 'HE) ?OLICY PROVISIOVS. I r-rw�Rtz:oaersE Ek-nTa�E 998.2Ct0 ACORD CO2PORa„ON,kit r gfi5 rese ved. ACORD 25(20ins) The ACQRD name and Toga are r@�s creel marks,a'ACORD frf{'j, {'' Pr 0!lice of Cunsmucr,\1L,u, and Hu:siness Re u1atku, f.0 ;'ark Plaza- Suite 5170 Boston. MassachuseUs 021 !!,i I 10111 I17),r)"o emcnt Cont acteir JZ ,�iStrltiora F2cq/strati car 18126 Tvpe: Cr>rp j, )ttcn AMIwRICAN TFAM CONSTRUCTION INC. T,# zCt:`)u:'.; LOJA LUIS 4 LUCIA ST MILFORD. MA 01757 ISpd.ne A�Idr�a arrd€cinrn card.Alark r .;t rrn for chartge. wo r r .err, l Address 1 ILcrier+srl F,niFtiucuu�nt 3.uyt t�:rrd tltlitf 4Cmnsnut AM v Sr Ikr5u51;.§a RW W", 1 itenxf 7;H'EC 1,54"fl 6iOn utrlid f(U'Indlklihrl USQ fjpll++ -- W0ME IMPROVEMENT CONTRACTOR b"I"re tha A�xariratirrri d;u��. 7!"Errand return fu: ,. If o��istrpm 'f312��` Typr.. <ltliee'A'01u1ernret Affair-tmi 11usinessgm lie$nitrti�u 5 Cbsp rpt-x, Inl'arl:'Ptaru-4uFu• 1K Roston,ndA U2k Ib A!,tEN :-fEAc41 Cc5R15i�tlr7ir'fh.NC, t J.i LULL, !' CIAMA.,T , M... NIA 1757 i - t ndrrccur bi,y Not a rli�l wif6 tut sii;nrt i'u re 7 r f J /* assachusetts -DePartment of Public Safety 'Board of Basitding Regulations and Standards License CS--097,319 LUwS SVEC 827 THOMPSON 1tOA�t ' fig„' Thompson CT 0677 ✓,.�..- 1 + �` fps F< Expiration Cot tm s tura r 08/31'/2016