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Home My WebLink AboutMiscellaneous - 44 MARIAN DRIVE 4/30/2018 (3) BUIE IN GF I-LE BUILDING PERMIT of NORTy ED F L TOWN OF NORTH ANDOVER o� w: =6 APPLICATION FOR PLAN EXAMINATION '-- PPermit No#: �� Date Received 1 d�7 RSTED,ea SSACHUS�t pate Issued: LVRORTANT:Applicant must complete all items on this page � n0, PROPERTY - �Pnnt '1 D0 ear 111111-c-Ite- yes no `yr '�ZONINne ryes ono s vim: -Mae me�,Sh 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 O�.Well;. y z� [] Floodplain t Wetlands Watershed®isfhet ❑Water/Sewer' - �.. � '� _ _ -- .or��r:dvaA+ _ r.wig -»:... ._K-�„�..•�r.�-.2i.,...�.._ a DESJGR,IPTIO F RK TO E PERFORMED: i Identification- PIease T e or Print Clearly' 1� OWNER: Name: ��y c� ►�� -�- / Phone: Address: m `Contractor Name Phone:T r r •rr x^^ ..,.4, s n y-t7�'rr��y � t ,.ew _^+'�tyM �•� J Adtlress � �� ,' J+t� at:.f'r_s'Y,wa..,,: r'"r�i _.,F S Supe isor�s ,_n �uctfoil icense -��" �� o f' Exp Date '�� }•� ,tw-'��%.fiR'^�-{�*"' ^+Kt...i`�'F.�'`3.7 � Y....P `",�;�z;;m _. }�.i J�1. i. �''�-'�f �. . >-.f� al ARCHITECT/ENGINEE Phone: Address: Reg. leo. FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. 1-__,Total Project Cost: $ /0540 FEE: $ 0-k(,o Check No.: `7 rr Receipt No.. S NOTE: Persons contracting witli unregistered contractors do not have:a e s the guara Signatu�e_of_AgeritLOwner" Signature of contr ctoT 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 o 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 i ❑ Building Permit Application o Certified Surveyed Plot Plan j ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (if Applicable) o Mass check Energy Compliance Report (If Applicable) o Engineering Affidavits for Engineered products i NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ 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) ❑ Copy o CContract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products 40TE: 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 j 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 Plans Submitted ❑ Plans Waived 0 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 PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Siqnature COMMENTS I HEALTH Reviewed on Signature c� COMMENTS Z:-)ning 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 limension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, roast or service drop_,requires approval of Electrical Inspector Yes No ®ANGER 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 Call Email _ N Time Contact Name ate - Doc.Building Permit Revised 2014 Location L/L/ j/)'J)q/LI r1N ,flOL, No. S Lr ' ;�01 7 Date i ?-- - 1 I • - TOWN OF NORTH ANDOVER • " Certificate of Occupancy $ Building/Frame Permit Fee $� $� Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# 7 # r L` Building Inspector NORTIy Town of o :'ifi. 1 mal.9 No. h ver, Mass, I 2L - 1 0 01 Coc t"4lWICK '�• �9S RATED JkfF U BOARD OF HEALTH PERMIT T Food/Kitchen LD Septic System THIS CERTIFIES THAT ... .RO .......�r:-Is.t-d—e.. ,!r.................................................. BUILDING INSPECTOR has permission to erect buildings on ...... Foundation Rough to be occupied asxi�r ........'3Ta..... ...... .........stc.......................................................................... Chimney provided that the person accepting this permit shall in every respect conform to the terms of 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 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION -�STS Rough Service .................. . .... ...... ....... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz 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. Smoke Det. 44 Marian Dr, North Andover Ma, �I November 29, 2016 OVERVIEW 1. Project Background and Description Strip and Replace roof 2. Project.Scope i I will strip and re-roof entire roof including garage&side porch with 25 year CertainTeed three tab Black roofing shingles. I will install 9'of ice and water shield on the upper roof(because it has small pitch)also will ice&water all valleys,and 3' on garage area. I will strip siding over the small kitchen window and ice&water over that area to prevent any leaks that may come from water behind the siding. I will also remove and install new lead around the chimney. 77 3. Deliverables John Brouillette will obtain all state and local building permits for job. I will also supply dumpster for removal of all roofing materials. 4. Affected Parties We will put the dumpster in the driveway on the left side of the garage so not to block your car.All materials will be delivered to job on the day of start. The total amount for the job will be$10,500.00 with 50%paid for materials, and the Balance paid at the time of completion ...._ .... ..... 5. Specific Exclusions from Scope There will be an extra charge if the plywood under the singles is rotted and needs to be replaced @$100.00 per sheet installed.To my professional opinion, it does not look like any plywood is rotted at this time. In the event we do find any wood needing replacement I will take pictures to show the home owner and discuss all materials immediately as to not slow down or stop the job. 1 6. Implementation Plan Providing weather permitting and any unforeseen circumstances-This job will start on Monday the 5"', Of December 2016,the job should only take one day. All roofing materials will be picked up and cleaned and put in dumpster on the same day.We will remove the dumpster the following day. All work and workmanship will be done in a professional manner. APPROVAL AND AUTHORITY TO PROCEED We approve the project as described above, and authorize the team to proceed. -Name, . Title Date .__......_ . I�I 1 i i 6 _ AoSproved By Dae A o Date 2 De commonwealth of Massaohmsetls - _ F Department of..1ndustrialAcelldents I co ng-ress Street,xS`rlite 100 d Boston, 02114--2017 •� • �4�` www mass.go-v/die QOM Syyti ypoikexs'Compensationxnsuraued Affidavit:Builders/Contxactoxs/Electricians/Z'lt�m exs. TO BE PILED WITH THE RERNIfI'MG.A.UTi(OI ltT r. Please Paint Le ' 1 A '•licant Information �� ation/Individual): �G /1 c'v�^ (-e 7t Name(Business/Oigaf& Address: City/State/Zip: Phone Are you an employez?CJiecktlie appropriate box: Type of project(x'equired); 1 R f Mr,a employer with employees(fun and/or partime)• �' El NdVd6ustriiCtlOn d 2.❑lam.a sole proprietororpartnersbiPandhavenoemployeeswoAdygfor mein $. ElRemoe-9 any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.E]I am ahomeowner doing allworkmy"e [No workers'comp.insurancerequired.]t 10 Building addition 4.❑I am a homeowner and will be hiring matractois to conduct all work on my property. I will 11.❑Electrical repairs or additions emstuet,at all contractbts eitherhave,workers'compensation in=ane or are sole j proprietors withno employees. 12.��Plumbing repairs or additions 5.❑I am a general contractor and Ihave hiredthe sub-contractors listed onthe attached sheet. 11 E]Roof repairs These sub-contractors have employees and have workers'comp.insurance.T 14 n Other 6.❑We are a corporation.and its,officers have exercisedtheir lig bf of exemreq=C er MGL c. 152,§1(4),and we hav6 no employees-[No workers'comp.insurance required] *Any applicantfihat checks Vol,#1 must also fill outthe swtionbelow showingtheir workers'compensaflonpolicytnformation i Homeowners who submit tb:s affidavit mdtcatmg they are doing all work audthcnhrre outside contractors must submit a new affidavit indicatuag v eh }Contractors that checkthis bok must attached an additional sh cat vihde thesworkersI name oome.pooli number and state whether or not(hose entiftes aye emplcyees. Ifthe sub-contractors have employees,they m istp p p jam an employer that is providingivorkers'compensation insurance for my employees Below is tliepoliey arzdjo7r site information. Insurancem Coany Name: -- xP ate: ' ationD E ar Policy#or Self ins.Lic.#- g - y� City/State/Zip: Job Site Address:---4+--(-f-- e)- v�✓L�Zi9- /J 7'l9c ti-e Z'Gt 1� Attach a copy of the workers' compensation policy declaration page(shownng the policy number and expiratio-n dat Failure to secure coverage as required uuderMGL c.152,§25A is a criminal violation ��1��a fi� ofup to $250.00 a F penalties in the form of a STOP WORK as civil en as well P ante onm incur and/or one-year impx�s ce of Tnvesti 'Mons of the DTA.fox day against the violator.A copy oftbis statement may be forwarded to the Ofd tdo rage un the airs and enalties ofperjury that the information provided above is true and correct. Here ytt p �_-- Date:e. Phony Official rise only. Do not write in this area,to be completed by City or town off tial City or Tovvn- • Permit/License# Issuing A.iathoxity(circle one): Z.Board ofRealth 2.BuildingDepaxtment 3.CitylTown Clerk d•.Electrical fuspector 5.PlumbingIMPector 6.Other Phone#: Contact PeXSOu- 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 d'efti bd 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 receivefor rust6e of an individual,partnership,association or other legal entity,employing emplbyees:-However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant ofthe' 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 to cal 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 applica&wlio has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MOIL 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=contractors)name(s),address(es)and phone numbers)along with their certificates)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 ox LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation ofinsurance 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:Accidenis. 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 thatthe affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to El out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to M1 in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple pennit/license applications in any given year,need only submit one affidavit indicating current PORGY information(if necessary)and under"fob Site Address"the applicant should write•"all locations in (city or town):'A copy of the affidavit that has b een officially stamp ed 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. Anew affidavit must be filled out each year.Where a homeowner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to buns leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Depattnient of Industrial Accidents 1 Congress Street, Suite MO Boston,MA 02114-2017 Tel.# 617-727-4900 ext.7406 or 1-877•-NaSSAFE Fax#617-•727-7749 Revised 02-23-15 wwwmass.gov/dia Massachusetts Department of Public Safety 3 Board of Building Regulations and Standards License: CS-064081 Construction Supervisor r•• JOHN J 13ROUILLETTE .r • 2 HARMONY LN ANDOVER MA 01810 .ten lJ� • Expiration: (� 06/2812018 Co mmissioner v la 0 (� �C6ddCIl fbCldG - T„in,a7Za7ana9•Ccnit, n f COn r fairs&Business Regulation � ice of Cons umer Affairs Off HOME IMPROVEMENT CONTRACTOR pe 1 Registration 122514 C Expiration:--911112018 DBA JJB`PROPERTY MAINTENANCE JOHN BROUILLETTE L� 90 Westford Street dersecretary Lowell,MA 01851 •.i