HomeMy WebLinkAboutBuilding Permit #508-15 - 984 TURNPIKE STREET 12/1/2014BUILDING PERMIT
TOWN OF NORTH ANDOVER
Permit NO: APPLICATION FOR PLAN EXAMINATION
Date Received
ANT: Applicant must complete all items on this
,a Identification Please Type or Print Clearly)
OWNER: Name:
Phone: 72 --
Address: nrlot'le. o 1P L(C.--)
ARCHITECTIENGINEER Phone:
Address: Reg. No,
FEE SCHEDULE: SULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON V25.00 PER S.F.
Total Project Cost: $ FEE: $
Check No.: —Receipt No.:
NOTE; ti
t
Persons contracting P/Y� unre##ered tractors do not have acc
Z- * y" the guarantyfutnt
L.
Plansi,Submitted ❑ Plans Waived 0 Certified Plot Plan ❑ Stamped P.aans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑
Tanning/Massage/Body Art ❑
Swiimning 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
PLANNING & DEVELOPMENT Reviewed On
COMMENTS
Signature_
CONSERVATION Reviewed on Sianature
COMMENTS
HEALTH
COMMENTS
Reviewed on
nature
Zonirsg Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planding Board Decision: Comments
Conservation Decision:
Commen
Water & Sewer Connection/Signature & Date Driveway Permit
DPW Town Engineer: Signature:
Located 384 Usgood 5treet,
FIRE DEPARTMENT' - Temp Bu'mpster on site ,yes no,
Located,at 124. Main Street
Fire'L'partment 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 DA I A — Wor department use
❑ Notified for pickup Call Email
Date Time Contact Name
Doc.Building Pennit Revised 2014
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
L3 Building Permit Application
o Workers Comp Affidavit
o Photo Copy Of H.I.C. And/Or C.S.L. Licenses
o Copy of Contract
o Floor Plan Or Proposed Interior Work
o Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
Addition Or Decks
o Building Permit Application
La Certified Surveyed Plot Plan
o Workers Comp Affidavit
o Photo Copy of H.I.C. And C.S.L. Licenses
o Copy Of Contract
o Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
o Mass check Energy Compliance Report (If Applicable)
Li 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
o Workers Comp Affidavit
o 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: Building Permit Revised 2014
Location
No. .-- Date ' }
40
t
Check #
2%309
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Building Inspec or
Professional Building Services
9 Olde Woode Rd Salem NH 03079
«nvnv.professionalbuildingservi ces. corn
info@professionalbuildingservices.com
781-995-2335 / 603-898-2977
David Dockham
984 Turnpike St
North, Andover 01845
Estimate
Description
Qty
Rate
Total
Building Permit - Administration Fee
1
100.00
100.00
Home owner can pull building permit themselves.
If customer wishes Professional Building Services to pull permit,
please add
$375.
** Customer to reimburse Professional Building Services cost of
permit fee paid to Town/City. **
Building Permit Fee paid to Town/City - TBD
0.00
0.00
This fee to be reimbursed to Professional Building Services or
customer can pay directly to municipality
Estimate Valid for 14 days of Issue
Total
Page 1
Professional Building Services
9 Olde Woode Rd Salem NH 03079
www.profession albuildingservices. com
info@professionalbuildingscrvices.com
xV 781-995-2335 / 603-898-2977
David Dockham
984 Turnpike St
North, Andover 01845
Estimate
Description
Qty
Rate
Total
Roof:
19
435.00
8,265.00
Strip 1 layer of roofing down to sheathing level and dispose in
dumpster
Synthetic felt paper to be supplied and installed.
Install 6' of Ice and Water shield in all valleys and edges - ice and
water to be
extended to be rolled over roof sheathing.
install aluminum drip edge and metal where applicable. Will seal ice
and
water shield with drip edge.
Replace all vent pipe boots,
Replace Ridge vent - expend vent size if determined undersized
upon removal
Install Owens Corning Duration architectural shingles. Color - TBD
Cap and starter strip included
20 yard dumpster with 3 tons. If additional dumpster needed,
1
550.00
550.00
customer agrees to pay for additional dumpster or dumping fee.
ROT REPAIR - remove, dispose, purchase and install 4x8 plywood
0.00
0.00
- $100/sheet
Structure/frame repair rates:
$75/hr for Master Carpenter
$48/hr for Carpenter Apprentice
$30/hr for Laborer
Estimate Valid for 14 days of Issue
Total
Page 2
k Professional Building Services Estimate
" 9 Olde Woode Rd Salem NH 03079
www. professionalbuildingservices.com pate' ' ; Estimate # -
info@professionalbuildingservices.com � '
781-995-2335 / 603-898-2977 10/18/2014 2348
12/6/2014
David Dockham
984 Turnpike St
North, Andover 01845
Description
Qty
Rate
Total
CONCEALED CONDITIONS: This Agreement is based solely on
0.00
0.00
the observations Contractor was able to make with the structure in
its current condition at the time this Agreement was bid. If
additional concealed conditions are discovered once work has
commenced which were not visible at the time the proposal was bid,
Contractor will stop work and point out these unforeseen concealed
conditions to Owner so that Owner and Contractor can execute a
Change Order for any Additional Work.
DORMER REPAIR:
64
11.00
704.00
Includes all materials and labor to install 1x4 PVC trim around
dormers by scribing and cutting siding back and flashing properly
up the walls before PVC install.
Estimate Valid for 14 days of Issue
Tota
$9,619.00
Page 3
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ik O CERTIFICATE OF LIABILITY INSURANCE
`�
ATE
11/26/2014
D1/26/DD014
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER
Financial Insurance Services Inc
PO Box 950
Derry NH 03038
CONTACT Patricia Blais
NAME:
PHONE , (603)432-6414 A/CA/C No): (603)432-3852
E-MAIL
ADDRESS:Pblais@fisins.com
INSURERS AFFORDING COVERAGE NAIC #
INSURERA:National Grange Insurance Co
INSURED
Professional Building Services, LLC
9 Olde Woode Road
Salem NH 03079
INSURER B:Hartford Insurance Company
INSURER C:
INSURER D:
INSURER E
INSURER F:
COVERAGES CERTIFICATE NUMBER:14-15 REVISION NUMRER-
THIS IS TO CERTIFY THAT 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 ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR
TYPE OF INSURANCE
AD
POLICY NUMBER
POLICY EFF
MM/DD/YYY
POLICY EXP
MM/DD/YYY
LIMITS
A
GENERAL LIABILITY
PCOM MERCIAL GENERAL LIABILITY
CLAIMS -MADE ®OCCUR
T1630H
/5/2014
/5/2015
EACH OCCURRENCE $ 1,000,000
DAMAGE TO RENTED
PREMISES Ea occurrence $ 500,000
MED EXP (Any one person) $ 10,000
PERSONAL & ADV INJURY $ 1,000,000
GENERAL AGGREGATE $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
X POLICY PRO LOC
PRODUCTS - COMP/OP AGG $ 2,000,000
$
A
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
NON -OWNED
HIRED AUTOS x AUTOS
1T1630H
/5/2014
/5/2015
Ea aBINEDISINGLE LIMIT 1,000,000
BODILY INJURY (Per person) $
BODILY INJURY (Per $
( )
PRODAMAGE
PER D
Per accident $
Medical payments $ 5,000
UMBRELLA LIAB
EXCESS LIAB
HOCCUR
CLAIMS -MADE
EACH OCCURRENCE $
AGGREGATE $
DED I I RETENTION $
$
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? ❑
(Mandatory In NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
N/A
D4WECLB1809
/5/2014
/5/2015
I WC STATU- OTH-
CRY LIMITS I I ER
E.L. EACH ACCIDENT $ 100,000
E.L. DISEASE - EA EMPLOYE $ 100,000
E.L. DISEASE - POLICY LIMIT $ 500,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
I IVIY
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
David Dockhatn
ACCORDANCE WITH THE POLICY PROVISIONS.
984 Turnpike St.
North Andover, MA 01845 AUTHORIZED REPRESENTATIVE
Al.vnu La tzU I WUO)
I N 5025 not nnss m
Sam Fragala/PAT
U 1988-2010 ACORD CORPORATION. All rights reserved.
The annnn namo anri Innn aro ro iatcrM marlea of annni1
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