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Home My WebLink AboutMiscellaneous - 135 APPLETON STREET 4/30/2018 (2) 135 APPLETON STREET 210!037.8-0059-0000. a BUILDING PERMIT oa ,yORTF/ TOWN OF NORTH ANDOVER F°3 09 APPLICATION FOR PLAN EXAMINATION Permit NO: 3� Date Received y n AC U Et�y Date Issued: 't 3 -0 SS IMPORTANT:Applicant must complete all items on this page LOCATION L CiC1 i PROPERTY OWNER PiY1 2Vf>�-St Print MAP NO: 7 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'Distdct Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: Identifi lease Type or Print Clearly) OWNER: Name: Phone:�l Address: 3 Wt ra i -CONTRACT OR 'dame: LSU YCp� Rhone: 5 Address A X_ A -7�77— ' Su ervisors Construction License: Supervisor's �:� �� Exp. Date: Home Improvement License: 1 '� c 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: $ 'Y.</CIG FEE: $ Check No.: I�� Receipt No.: or TE: Persons P,ersons contracting with unregistered contractors do not have access to the guaranty fund />- U Iv ■ 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 Li Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) L3 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) u 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: Doc.Building Permit Revised 2008 Location Isr �Ilyr1 / u No. 3�`,/ Date 11 NaRT� TOWN OF NORTH ANDOVER to • • OA Certificate of Occupancy $ ;,SSACMUSEt� Building/Frame Permit Fee $ r Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # -) 226 '19 _ Building Inspector Signature of Agent/Owner lgnature of contractor 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 CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decisionlreceipt 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: e2- 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 V4ORT!-� o o : tAndover . NoZ76 o A K E dover, Mass.,. 2COCKICKEWICK y1. 'd ADRAT E D `s E BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System THIS CERTIFIES THAT............e#46M.........16 1W.4.............. BUILDING INSPECTOR Foundation has permission to erect........................................ buildings on ...I.r.......... o ........4I. ....... .:.. Rough • to be occupied as.......... . . Chimney ..............�...... ............I' ..e... y provided that the persona opting this permit shall in every r pest 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 PENT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRU S TS Rough ........... Service BUILDING INSPECT O 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. IF SEE REVERSE SIDE Smoke Det. T1re Commonrpealth of Mmackusefts Department of industrial Accidents Offece of Investigations iii;'" 600 Nrashircgton Street Boston, MA 62111 wxrw_mas�gov/dia . Workers' Compensation Insitr"ce Affidavit: Builders/Con Applicant Information tractors/Eiectriciaas/Pinmbers Please Pratt La-rbly Nameamine , ®caval Roofin C Orgaoizafion/Individual); g' LLC Address: No. Reading, MA 01864 Cityzstatezip; _ Phone#:. Are yo _ac employer?Cheek.the appropriate box: 1• am a employer with 4. ❑ 1 am a gemeral contractor F7d oject(required): and I 2.�] employees(foil and/or part-time).* have hired the sub.eotrtractorsNew construction I am.aeole Proprietor or partner listed ort the attached sheet? odeling shy and have no employees' These soh-contractors have working for me 3n any capacity. workers, comp.insurance. olition [Alp woaicers'comp.iasruatce. 5. ❑ We arc a corporation and iLs ing addition Tequired] offict:rs have exercised their ical repairs oradditians 1 ain a homeowner doing ail work right of�atemption per MGL bin myself[Rto workers' gTepairsoradditions P' G 152, §I(4),�and we have no 12. f repairs insurance.re ]t .em*Ye es.[No woricors' comp. insurancerequired_] 13Z.Other 'Any appiicatsi tient checks ben#I muse also fill out the section beiow showing their;workets'bo' t Faomeown=who submit this atiiliavh indicating they arerioitt an mpensetkm Poiioy infntrnation - ICantraotora that chseok this box must g w'o'w and then hire onside contractors must submit a neiv affidavit indi su an rdditioaai ah*- showing.the name df the sub-conttactos and their wow'acs^^. vi:.• m* Ch. I(�T.r a fo erthatis;oro — v: Fes•issinnution. Y Mira war�erY corrpersalloa insurance for my eMMYEM Bdow is the Po&y oadjoh am iajornudioa. Insurance Company Name: t� Policy#or Self-ins.Lie,4: U 0;l'301A! / rT— cpiratiar Date: /CL �d Job Site Addms: Attach a copy of the workers''wmpe o City/StatelZip: .� Poi deciaratiiao page(showitzd the poiicy camber and expiration date). . Faihne to secttre coverage as required under Section 25A of M(3L C. 152 can lead to the imposition of criminal penaiti s of a fine up to$1,500,00 and/or one-year imprisonment;as well tis civil penalties in the form of a 57C)P WpRK QRDER 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. I do hereby c �.dr parry t:etd peftalti�s o lPe1lury twat the informv6on provided above is&ue and coat 5i Phone#: v Official use only. Do not write is this area,to be cn +np1��d by rimy or town officra( ZZ City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health !Building Department 3.City/Town Clerk 4 Electrics►Iaspestor 5.Plumbing Inspector 6 Other Contact Person• Phone#: Information a nd Iastructions Massachusetts Genual Laws chapter 152 requires all emp 30yers 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." I` 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 includirfgthc legal representatives of a deceased employer,or the receiver ortnrstx•of an individual,partnership,association►or other legal entity,employing employees."Howeverthe owner of a dwelling house having not more than three apa rune=and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair wcirk m such dwelling house or on the grounds of building appurtenant thereto shall not because of such empioyment be deemed to be an employer." MGL chapter 152,§25C(6)also states that."every state aa-local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct building in the commonwealth for any applicant who has not produced acceptable evidence.of compliance with the insurance coverage required." Addhtioml: ,WOL 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 evidence of compikinc a with the insrtrm iequiremert.of this chapter have been presented to the car&acting authority." Applicants Please fill out the workers'compensation,affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sul conh'actor(s)name(s),address(es):and phone number(s)along with their certifies)of insurance. LimitedLiability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required1to carry workers'on-Tnpensafion insurance. Van LLC orUP does have employees,a policy is required. Be advised that this a£rrcIELvit 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 6W the application for the permit or license is being requested,notthe Department of Industrial Accidents. Should you have any questions regal-ding the law or if you are required w obtain a workers' oompensation policy,please-call the Department at the nur.nber listed below. Self-insured companies should enwrtheir sel€�i:rsuaancc lhcensc rumbW can file appropriate ice. City or Town Offa iah; Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bots m of the affidavit for you to fill out in thee•event.the Office of investigations has to contact you regarding the appli:Mt Please be sura to HE in the permit/license number which W-ill be cased as a reference number. In addition,an applicant that must submit multiple permit/hc.-ase applications in any given year,need only submit one affidavit indice;ting-current policy information(if necessary)and und.-r"Job Site Address"the applicant should write"all locations in (city or town)."A copy of-the affidavit that has been offieiaily stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for fixture permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen i obtaining a license or permit not related to any business or commercial vesture (Le. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit The Office of Inves6pations would Ince to thank you in advance for your cooperation and should you have any questions, please do not.hesitate to give us a=11. The Department's address,telephone and fax number. The Commonwealth of Massachusetts Department of Lndastrial Accidents O•fke of Lnveaffgabons 600 Washington Street Bosom, MA 02111 TeL#617-7274900 6=406 or 1-8.77-MASSAFE R-vised 5-26-05 Fax#617-727-7749 www.mass.govldia Page No. of Pages Builders License # 58443 Home Construction Reg. # 109288 Q 0 aa� (781)944-1994 (978)664-2557 "The Areas Oldest Roofing Company" P.O. Box 637, North Reading,'MA 01864 PRO L ITi� �DACTEO1kdSk4l00 / L �d STREET I GA 4 n Zj CITY,STATEAN ZIP COD t JOB LOCATION We hereby submit specifications and estimates for: Recommended Optional E'r; li rr `'t,U F (Included in price) (Not included in price) s✓ Rip&Remove all shingle debris from roof&job site: La"1 layer ❑2 layers ❑3 layers or more Repair/or Replace any roof decking; not to exceed 50sq.ft. (additional at$1.70 per ft.) V/ Install 8"aluminum drip-edge/and rake-edge along entire perimeter.Choice of mill, lite r brown Install ICE&WATER underlayment along hdrizontal eaves,valleys,sidewalls,sky-lights and chimneys 64 Install premium base sheet underlayment between roof deck and roofing shingles Install 30yr CertainTeed/GAF/Tamko or IKO architectural roof shingles _ ❑40 year ❑50 year ❑60 year ❑Lifetime f `See manufacturer warranty policy for more details Y Install new aluminum vent-pipe flange(s) fi. Chimney(s)-counter-flash and re-step existing flashing ❑Cut&Install new lead flashing Ridge-vent/exhaust vent with,low profile design,hidden by shingle caps ❑Soffit-ventilation ; f ❑Roofrlouver-vents Seamless style aluminum gutters-custom fabricated at job site by our own gutter machine ❑Downspouts t `t ❑Leaf gutter guards • Other I 'Please Note:All items in roof attic should be removed or covered due to falling roof particles,at time of roof tear-off Price includes all items above that are checked only/others may be priced separately upon request. �e jUrepose hereby to furnish material and labor-complete in accordance with above specifications,for the sum of: 41/11'_500 rr Total price not including options. dollars($ 'If o ). Payment to be made as follows: 30%deposit required before ordering materials.Balance due in full upon day of completion. Please make all payments out to Kenneth Duval,mailed to: P.O. Box 637, No. Reading, MA 01864 Late charges of$50 per week for all outstanding bills due upon day of Authorized completion. Signature- 1)-,tl 2�,�J_ -Accepting proposal means agreeing to the terms of the enclosed binder Note:This proposal may be contract.Please sign contract&return top copy(whin)with deposit. withdrawn by us if not accepted within ~'� days I ' ,��7.11Q¢�6 I Board of Building Regulations and Standards { Construction Supervisor License LICe,f1Se: CS 58443 1 ExPiai —1/1,0/2009 Tr# 9949 m,l RestttcfiQn 00= KENNETH P DUWH PO BOX 190/72 NO43 N READING,MA 01864 ' Commissioner 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: Board of Building Regulations and Standards Registration: 109288 One Ashburton Place Rm 1301 ,Expiration =g/9!2010 Trtt 273490 Boston,Ma.02108 Type _DBA DUVAL ROOFING Kenneth Duval 72 NORTH ST N.READING,MA 01864 Administrator Not valid without signature NOTICE N W NOTICE TO = a TO EMPLOYEES ei EMPLOYEES � v The Commonwealth of Massachusetts DEPARTMENT OF INDUSTRIAL ACCIDENTS 600 Washington Street, Boston, Massachusetts 02111 617-727-4900 — http://www.mass.gov/dia As required by Massachusetts General Law,Chapter 152,Sections 21,22&30,this will give you notice that . I(we) have provided for payment to our injured employees under the above mentioned chapter by insuring with: THE TRAVELERS INSURANCE COMPANIES NAME OF INSURANCE COMPANY P.O. BOX 1450 MIDDLEBORO, MA 02344-1450 ADDRESS OF INSURANCE COMPANY (7PJUB-023ON91 -9-09) 03-11-09 TO 03-11-10 POLICY.NUMBER EFFECTIVE DATES GILBERT INS AGCY 137 MAIN ST READING MA 01867 NAME OF INSURANCE AGENT ADDRESS PHONE# o� DUVAL ROOFING LLC 184 PARK STREET NORTH READING MA 01864 EMPLOYER ADDRESS EMPLOYER'S WORKERS COMPENSATION OFFICER(IF ANY) DATE MEDICAL TREATMENT The above named insurer is required in cases of personal injuries arising out of and in the course of employment to furnish adequate and reasonable hospital and medical services in accordance with the provisions of the Workers' Compensation Act. A copy of the First Report of Injury must be given to the injured employee. The employee may select his or her own physician. The reasonable cost of the services provided by the treating physician will be paid by the insurer, if the treatment is necessary and reasonably connected to the work related injury. In cases requiring hospital attention, employees are hereby notified that the insurer has arranged for such attention at the NAME OF HOSPITAL ADDRESS 002624 W20PIG02 TO BE POSTED BY EMPLOYER