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HomeMy WebLinkAboutBuilding Permit #212-15 - 10 WALKER ROAD 8/27/2015 TOWN OF NORTH ANDOVER w pf NpRTM APPLICATION FOR PLAN EXAMINATION 3r b•�'.`` a"opL 0 Permit NO: Date Received ` / ss.S C �cause Date Issued: 2:3r I 13 IMPORTANT: Applicant must complete all items on this page LOCATION ® �Q I I I�U1 . AWT 1 MQ(A' AMOUR jJ� Pr W ArA PROPERTY OWNER&�AW Print MAP NO.: PARCEL: lZONING DISTRICT: TYPE AND USE OF BUILDING (,t/4fT 4Vf HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non-Residential ❑New Building ❑One family ❑Addition ❑Two or more family ❑Industrial ❑Alteration No. of units: Repair,replacement ❑Assessory Bldg ❑Commercial ❑Demolition ❑Moving relocation ❑Other ❑ Others: ❑Foundation only D SCRIPTION OF WORK TO BE PREFO v ` - inhere, ,bfA 1 V& a kA S 6b( 4 e4, CA6 h,06virA Identification fliase Type or Print Clearly) OWNER: Name: 6P1." QJ aM Phone: Address: iD V atkee- CONTRACTOR Name:--JPA Phone: Address: fzI LPA W(II 1fr?Jd1- M 11QML(o Supervisor's Construction License: C6 ag� !2 Exp. Date: /0/1�o 1;L0 15- Home Improvement License: t'I 1C 13gg30 Exp. Date: a Ic ARCHITECT/ENGINEER Name: Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.•$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost :$ zo Do x12.00=FEE:$ Check No.: Receipt No.: Page 1 of 4 J I 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 o Building Permit Application o Certified Surveyed Plot Plan ❑ 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) ❑ 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) ❑- 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:Building Permit Revised 2014 i ❑� Plans Waived ❑ Certified Plot Plan ❑ Stam Plans Submitteded Plans ❑p 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 Signature COMMENTS HEALTH Reviewed on Signature COMMENTS 'r 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 I DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department so igna' ure/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 DATA— (For department use) 0 Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 i 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 —4Building Permit Application o Workers Comp Affidavit 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 ❑ Certified Surveyed Plot Plan o Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses o 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 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 Li Workers Comp Affidavit ❑ 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 10 L Lx, UMT 1 No. Datet _� —`6 +It4 . = TOWN OF NORTH ANDOVER Certificate of Occupancy $ . Building/Frame Permit Fee � Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# v l �} Building Inspector � NORTly Town of ndover No. t oh ver, Mass, tol C OC MIC"l WIC« �ol• x,95 q�rE0 P'P�,`'�5 U BOARD OF HEALTH Food/Kitchen PERMI-T T D Septic System 9 THIS CERTIFIES THAT ,. ���,t ,,,,,,...... BUILDING INSPECTOR ��,[ Foundation ' has permission to erect .......................... buildings on ....... .t�....wG.� .. ^................. Rough to be occupied as ... �..?.���...... ... ........W....... !�. .. .......F�I'l�, .or% Chimney provided that the person accepting this permi all 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 CONSTRUCTIO T S 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. IFA Services LLC "It's not how you start, it's how you finish" August 12, 2014 Adam &Kendall Allard 10 Walker Road#2 North Andover, MA 01845 Contract Complete rebuild of existing residential space located at 10 Walker Road, Unit#2,North Andover MA Scope of work: Kitchen Area Supply and install all kitchen cabinets and counters(Approved by owner) Supply and install all kitchen cabinet hardware(Approved by Owner) Supply and install all kitchen flooring(Approved by Owner) Living room/Bedrooms and Common Areas Supply and install all Blueboard and Plaster Supply and install all baseboard and trim Supply and install all doors and hardware Supply and apply all prime and paint(1 coat of primer and 2 coats of finish) Supply and install all flooring(Approved by Owner) Total Investment for the above scope of work$30,000.00 All work to be done in accordance with the building code and the sign offs from the North Andover building department. All materials and fixtures to be approved by Owner prior to installation. Price is inclusive of a demanding work schedule of 4 weeks to finish/Occupancy certificate. Accepted By: Kendall Allard Owners Acceptance—Kendall Allard 3 Heritage Lane, Lynnfield, MA 01940 Office.781.2 14.62 20 Fax.781.371.0505 I yhe Commonvedb of tVlassachuse'th Department oftnduSjW 1Accrc&f9 • , 0f,flee of Invesaigafeons 640 Washington S`tireet Boston,MA 02111 Vww MussgovIdliz Worlkexo'Comp exisation)(usuxanceAffidavit:BuflderelContractor$)Electriciansl�l*bero Applicant 7n brma#on Please.PAMUAly Namo(3usiness10rganiza6onlln&!du4}: U V C C CL Address: '7d AN Amey anex�nplaper?,cheek therappropxiatebox-. 'Typeofproject(required): 1. ` 1 am.a employer with�S�) 4. [x=a general contractor and S �. New constz`actzon f employees(-JuRancl(oxparEti-me).T have Y&adthosub-conixactors ��� 2.[� 1 am a sole proVxzetor or Vaztnez listed ontha attached sheet 7. remodeling ship and have no.employees These sub-contxactorshave 8. ❑Demolition workiaag forma in any capacity. workers'comp.insurance. S. Building addition rN'o workers' comp.insurance 5. ❑We are a corporation and its 101]Blectricalxepairs oradditions requixed.] officers have exerelsed.their 3.[l z am a homeowner doing all work right of exemption perMOL 11=[[Tlumbingxepairs or additions myseL 110workers'comp. c.152,§1(4),andwehaveno 12.PRoofJVP airs insurancerequired.� employees.[No workors' 13.0 Other comp.insuranceregaired.] A applzcanttbat checks box#Z must also futduithesection bel6wsho-wingtheirworkers'compensAn.Volieyinfozmation. ►Homeowners-rho mbmitbig affidaYitindicatingihey2redoing Aworgaadthenhire outside contractors musLsubmit anow affidavit indicatingsuch. xContractoxsthat chCektbhbolmust attached anadditionalsheet showingihenameofthe4u contractors andtheirworkers'comp.poRcyinfomiation. Iar2exnproyePtrt[ttispoviriit2glokers'compe�asationinsttraftcefoxrrzyemroyees�, Beroi�theorteyaratja ,�zte infoxxmadon. Insurance Company Name; o c # or Sall iw.Lic.#: ObSbl �1 01 Expiratzon Data: P � � Tob bite ddxess 11) W.1I6y Pty/state/zip: f I Affach a copy aft ewoxlters'compensationpolxcycleclaratioupage(showing•the Volley mmuher and explratZoa date). Failum to secure covexage as xequixed.uuder Section 25.x,ofMCrL o.152 can lead to the imVositian Of frne up to$1,500.00and/or one�y ear xmVxisoznnextt,as well as chApenaltles in the foam of a STOP-•GV ORIS ORDS.and a flue ofup to$250.()o a.day against the violator Be advised that a copy of thig statementmay be forwarded to the Office of Investigations of the DIA for insurance coverage verification. .ado Hereby eeruricXet�triegains a�tcl�aenalties of perjury ilial tree in,for�natior��roviriec�aiFioye is due anr�eorzee� - 81 re: Data: Phone 0.- Official :Oficial use oBly. .Do not wiife in this area,to be conwleted ray city or town official. City or Town: Pern�itlLicense f8suing.Auth.ar4(circle()Re)'- 1.Board of Health 2.BuilclingDepa�rtmem, 3.CztyHowu Clark �&. lectricaX>nspector 5.1"lurubangJfusVector f.Other .s Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provideworke'rs'compensation for tlteix employees. Pursuant to this statute,an e�2proyee is defined as",.,every person the service of another under any contract ohixe,• express ox•implied,oral orwritten:' Auer raye is defined as"an izzdividual,partnership,association,corporation or other legal entity,or anytwo oxmoxe, of the Foregoing engaged in a joint enterprise,and lucludingthe legal representatives ofa•deceased emplQyex,. t xecezver oitrustee of au iudMduat partnership,assooiation or other legal entity,employing employhe ees, PSowa or r t the owner of a dwelhghousehavfugnotmore thmtbxee apartments audwho resides fherek,orthe occupant ofthe dwelling house of another who employs poisons to do maintenance,construction ox repair work on such dwelling house or onthe grounds orbadiag appurtenant thereto shallnot because of such employment be,doomed to bean employer.,, MQL chapter 152,§25C(6)also states that"every state or local Ruensiug agency shall withhold the issuance or renewal of a license or Pamit to operate a business or to construct buildings iu the coxnxnonwealth for any applicant who has not pro duced.acceptable evidence of compliance with the insurance coverage required."Additionally;MGL chapter 152,§25C(7)states`�7eithex the commonwealth nor any of its p olitica,subdivisions sha11 entex into any contract for the performance,ofpAllo work until acceptable evidence of'coxnpliance with the insurance requirements oz flus chaptexhave b eenpxesented to the contracting authority," Applicants please fill out the workers'comp ensaiion affidavit completely,by checking the boxes that apply to your situation and,if 9f ecessary,supply sub_contractor(S)Mme(s),address(es)and phone numbers)along with.their cez tifxcate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability partnerships(LLP)with no employees outer thatz the members or partners,are,notrequired to=7 workers,compensationiasurance. Ss an LL C or Up dousWe employees,apolicyxs mquized. Be,advisedthattbis affxdavitmay be submittedto the,Department of Tndusirial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit The affidavit should b e xetum ed to the city or town that the application for thepennit or license is being xequoAQq,xtot the Dqa dment of kdustrial Acoldenfs, Shouldyon have,any questions regarding the law or if you axe xequixed to Obtain•a*oikexs' CDmVcnsatlonpolfqy,please call tha Department at thq number listed below. Saifiusuredcompanies shouldenter hair self-insurance license number on the appropriate line. City or Tom Officials , Pkasebesuxethat theafitdavitiscomplete audpxiatedlegibly. The Department has provided a space at the bottom ofthe aMdavztfbxyouto fill out in tTie avant the 0fce of:favestigationshas to contact youxegardingthe agRcant. Please be-luxe to f LU iu the pemait/license number Whichwill be used as a rezexence number, 7n,addition,m applicant thatmust submitmulftle,permit/license apphoations is any givenyear,need only submit one,aft tdavit indicating current PORGY information(if'necessmy)and under"Job Site Address"the applicant shouldwxite"all locations in (city or town)°'A copyoF'theaffidavitthat has beenoff clay stainpadormarkedbyt ocityortow nmaybepxovidedtothe appHcantaspxaofthatavalidaffidavit•isonfilei'oxfaturopexmitsorlicenses, Anew affldavitmustba,Medbut each year.Where altome owner or citizen is obtainiugalicDDS a orb ezmitnotrelatedto any bminass orcomraoto al venture (i.e.a Clog license orpermit to burn leaves eta.)said parson is NOT xegalred to complete this affidavit, The Office of luvost gatloni would like to thank you in advance fox your cooperation and should you have any questions, " please do nothesitate to give us a call. The Depaxtm.ent's address,telephone and faxnumber. 6.00 Waghfi.%tQa TO 617.7-2'-4900 Qxt 406 Qr-1-877h���� Revised 5-26-OS AA CQRO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDrYYYY) 82614 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 CONTACT Lemire Insurance Agency, LLC PHONE Jeff Hoisington FAX 213 Main St. , Suite 1 IA N E-0/IAIL - (978 568-8700 / N (978) 568-8702 PO Box 445 ADDRESS: INSURERS)AFFORDING COVERAGE NAIC# Hudson, MA 01749 INSURERA:Atain Specialty INSURED INSURER B:AE IC JFA Consulting, LLC INSURER C: 3 Heritage Lane INSURER D Lynnfield, MA 01940 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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. ILTR TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP N WVD POLICY NUMBER M/DDIY MM/DD/YYYY LIMITS A GENERAL LIABILITY NPP1375707 6/11/14 6/11/15 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY I Eaoccu ce $ 100 000 CLAIMS41ADE 1XI OCCUR MED EXP(Anyone person) $ 5,000 PERSONAL&ADV INJURY $ 1 000 000 GENERAL AGGREGATE $ 1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER PRODUCTS-COMP/OPAGG $ 2,000,000 X POLICY PR � LOC $ AUTOMOBILE LIABILITY COMB INED SINGLE LIMIT a acciderx $ ANYAUTO BODILY INJURY(Per person) $ ALLOWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE HIRED AUTOS _ AUTOS (par. $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ _ EXCESS LIAB CLAIMS-MADE AGGREGATE $ _ DED RETENTION$ $ B WORKERS COMPENSATIONWCC50050135712014 6/16/14 6/16/15 OR I[MIT- X OTH- AND EMPLOYERS'LIABILITY Y/NS Fp ANY PROPRIETOR/PARTNER/EXECUTIVE 7 E.L.EACH ACCIDENT $ 500,000 OFFICERMIEMBER EXCLUDED? N/A — (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DYSCRIPTIONOFOPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Job Location: 10 Walker Rd Apt 1 North Andover, MA 01845 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood St North Andover, MA 01845 AUTHORIZED REPRES E 988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registeredarks of ACORD Phone: Fax: E-Mail: Office of Consumer Affairs & Business Regulation-Mass.Gov Page 1 of 1 The Official Website of the Office of Consumer Affairs&Business Regulation(OCABR) Consumer Affairs and Business Regulation Home Consumer Rights and Resources Home Improvement Contracting Home Improvement Contractor Registration Lookup To search by registration number, enter the registration number in the textbox below and click the 'Search' button. Search by Registration Number' Search To search by other fields, enter the search criteria in the fields below and click the 'Search Registrants' button. For the State field use the two character state abbreviation such as MA for Massachusetts and "RI" for Rhode Island. All search fields allow partial text so the search will look for any values that begin with what was entered. 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Search Results REGISTRANT RESPONSIBLE REGISTRATION EXPIRATION NAME INDIVIDUAL NUMBER ADDRESS DATE STATUS SEAN COHANE 174430 15 ALLSTON TERR 02/11/2015 Current MEDFORD, MA 02155 Sean E.cohane 164629 15 Allston Terrace 10/27/2011 Expired Medford, MA 02155 ©2012 Commonwealth of Massachusetts. Mass.Gov®is a registered service mark of the Commonwealth of Massachusetts. http://services.oca.state.ma.us/hic/licenseelist.aspx 7/29/2014 Sean Cohane 9784471650 p.2 MMONWFt�TH OF MiA;SSJlGli(S MINK ul,1.1e +IOU. e . f`'ff-SSUES THE-FOLLOWING E AS. g.... I .5 41) "AST, Ep1ECTRIC F ::= COHANE _ 4 PEARL- W,Ft 11"I dPGTOt: 5887-376d O 1 ;.. _ 887-370 ' ?2©4 A=t 'off{ ��6. ,;f:q.: o 47 _ � �7assaci;�se�ts-�epari;t�ento��Lh:i^SG;et; oaid Oi Suitciing Repulations and Standards C<1n4truction Sullervislir kn.ceisse: CS-085533 SEAN COHANE - 15 AUSTON TER MEDFORD MA 02155 10f1512014 �Ci 1l I'tl1 tis%loo-1.Lit 01• SS-001938 Sean Cohane - 4 Pearl Ct Wilmington MA DIM l