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HomeMy WebLinkAboutMiscellaneous - 844 SALEM STREET 4/30/20181IN n CO m m m m O Q r C:, o m o M O TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING �":�„`§ BUILDING PERMIT NUMBER: DATE ISSUED: w 00 SIGNATURE: Buil ' mmissioner/I f Buildings Date SECTION 1- SITE ORMATION 1.1 Propert Addr 1.2 Assessors Map and Parcel Number: mac. o /, O(Os s Map Number Parcel Number 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide ReqWred Provided ReqWred Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: Public 0 Private ❑ Zone Outside Flood Zone 0 1.8 Sewerage Disposal System: Municipal ❑ On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record Name (P6 > Address for Service S �tuu<ef/ Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction r`/\ Con\cstructir,6urVCs-0r,-,-- LicensedConstructi Supervisor: Addr Si al re Telephone Not Applicable ❑ te)`/` 4 l S License Number l Expiration Date 3.2 Registeereed a Improvement _Contractor ^ 6 QGG lJ6"tZ�V� Not Applicable ❑ J l 70 Registration Number .7— Company Name r Ad s Expiration Date Expiration i nature Telephone P n RM W7;" SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 § 2506) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes .......❑ No ....... 0 SECTION 5 Description of Proposed Work(check all applicable) New Construction ❑ Existing ``Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ ''emolit ❑ Other ❑ Specify 4- • I'..; f 4 Brief Description of Proposed Work: 7W '"W. -4_4 ak, " V ` C16n V W� Q SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant OFFICIAL USE bNLY. x '" 1. Building (� a r () Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) X (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS(A EENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, `MU �- C as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building pen -nit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, KE as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Pr' ame ` e of Owner/ NO. OF STORIES Date SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS IST 2ND 3FD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE k Contractor will: PROPOSAL FOR: 01 JOYCE COOPER 844 SALEM STREET N. ANDOVER, MA NEW ROOF FOR 844 SALEM STREET • Install all drip edge for complete edge of house, studio and garage • Install ice and water starting from roof edge up 3 feet • Tar paper remaining areas of main roof of house, studio and garage • All flat areas of roof will be laid over with insulation board and will be rubber roofed • Install 25 year shingles • Building permit included • All materials included • All waste materials cleaned and disposed of • Will do flashing on chimney if necessary for additional cost Accepted by: Cost = $230.00/square Total roof area = 50 square 39tal cost = $11.500.OQ Date: c fn ROOFING SERVICES PROVIDED BY CIARAN MORGAN & OLIVER MCCAFFREY (781) 340-9858 ft M Q. r `� w* m D 0 0 m z n a y oo co o® n Q d v -c rn -�rn iitt o cfl e C p n' c O o N V O 0 � rrnoz '-r - t7 •'j D t�D .O Gn 3 C m CD, . 0 m C a Mz C3 N I GRANITE STATE -INSURANCE COMPANY 13102 PENNSYLVANIA EVIN FOLEY DBA FnLFY IIMITFn rnMTRarTnPC 70289-000o WC 125-01-52 --------------------------------------------- SEND CORRESPONDENCE TO: 013-66-0799-00 AMERICAN INTERNATIONAL CO. P.O. BOX 409 PARSIPPANY, NJ 07054-0409 PHONE: 1-800-645-2259 6 FRANKL IN PLACE- - - �M Member Companies of QU I NCY, MA 02169-0000 American International'Group EXECUTIVE OFFICES: 70 PINE STREET, NEW YORK, N.Y. 10270 SEE NAME AND ADDRESS SCHEDULE - WC990610 I.D# MA UI#: •. AGNITTI INSURANCE AGE © N- y S� V C WORKERS COMPENSATION AND EMPLOYERS 21 FRANKLIN STREET LIABILITY POLICY INFORMATION PAGE QU I NCY, MA 02169-0000 JUL i n mg INSURED IS INDIVIDUAL PREVIOUS POLICY NUMBE RENEWAL 003 49MTTIINSURANC OTHER WORKPLACES NOT SHOWN ABOVE: SEE NAME AND ADDRESS SCHEDULE - WC (617) 770=0123 - ITEM 2 POLICY PERIOD 12:01 A.M. standard time at the insured'slt��� mailing address FROM 07/18/99 TO 07/18/00 CU`s- OG''t— ITEM 3 A., Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the istatis listed here: MA B. Employers Liability Insurance: Part Two of the policy applies to the work in each state listed in item 3.A. The limits of our liability under Part Two are: Solily 'f?;, h,r .Accident $ 100,000 each accident Viii!-- by Ul .atse $ 500.000 policy limit i7v:-, by nisease $ 100.000 each employee C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here: SEE ENDORSEMENT - WC200306A ITEM 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. Estimated Total Rate Per Estimated ' Classifications Code Number Remuneration 0 El $100 OF Re• 2re:rium Annual 3 Year muneratinn I I Arnual 3 Year SEE EXTENSION OF INFORMATION PAGE - WC7754 i TAXES/ASSESSMENTS/SURCHARGES $16 EXPENSE CONSTANT (EXCEPT WHERE APPLICABLE BY STATE) $100 MA MINIMUM PREMIUM $ 500 MA TOTAL ESTIMATED PREMIUM $ 500 If indicated below, interim adjustments of premium shall be made: 11 Semi -Annually 11 Quarterly Monthly DEPOSIT PREMIUM ENDORSEMENTS (FORM NUMBER) SEE ATTACHED FORM SCHEDULE - WC990612 07/22/99 ASSIGNED RISK 66 Issue Date Issuing Office Authorized Representative I WC 00 00 Of 39967 PRODUCER'S COPY - Town of North Andover Building Department 27 Charles Street North Andover, Massachusetts 01845 (978) 688-9545 Fax (978) 688-9542 DEBRIS DISPOSAL FORM F t%ORTy O t�eo � �4 t ti 0 TA O•Q COMM 7. T 7a Teo rPp -45/ In accordance with the provisions of MGL c 40 s 54, and a condition of Building permit # the debris resulting from the work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, s150a. The debris will be disposed of in /at: Facility lgnature of Ap Vidaint Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. I I .r r cz W A o c° a U z GQ w° °�° 4:4 U _ ro w �' wm w a W '6. W ::s �191 CO w a n°' ro w z W A q rA cn o C/) P CO) _W LL F -- C: W C.3 _y 0 CO c o � c ` O N O vw c'o C. c :oo co r o o c H Z.'' Ect Co ... cD o H O � r C* _~ :VO j OI W C 1 CD C" Cc •O O � � = c N O : ft! N m ' E� cc aw CLO Q Cl -t Ci C O 0 '� Z co a o 0 O N ® C m d O r t C O .y 'dL O C E C0.1w ce CD C C.3 O C. � C_ co 0 y �O r0+ C.�... QD ti C! MI V! 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