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HomeMy WebLinkAboutBuilding Permit #881-2016 - 111 GLENNCREST DRIVE 2/23/2016 4 LI' BUILDING PERMIT NORT}1 q `( O �t`eo ,6a TOWN OF NORTH ANDOVER �'? y . . ., o APPLICATION FOR PLAN EXAMINATION � Z Permit No#: �i� Date Received 7q ^TED SPP�(y SSACHUS� Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION U / 0/2" 7- 1,�W Print PROPERTY OWNER Print 100 Year Structure yes no MAP 6 'C 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 p(Zepair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other _ _ ❑ Septic 0 Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: dentification- Please Type or Print Clearly OWNER: Name: Qy Lc.' �/4I'L Phone: �'�d' G��I- 29d1 Address: /� r' CrLe%� G'2��T O� A11 Contractor Name: a�n )_A4 A4rK rZs Phone: '9°7�' Email: Address J e­x PW/I-q-5 I Supervisor's Construction License: Q(bi(Z,-o Exp. Date: 141.3 f Zil' Home Improvement License: 6 S Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ ��, Ste°1 °" FEE: $ �d A Check No.: a5/ Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access tothe guaranty fund Location No. -Q� Dater '� f . . TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ t Foundation Permit Fee $ t f Other Permit Fee $ w TOTAL $_ \ Check#. � i 1 Building Inspector I Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOS. 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 Sig nature COMMENTS 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 DPW Town Engineer: Signature: _ Located 384 Osgood Street RE E: JT ,Temp:),Dump§ter on site yes nog 4,1 yt .r �.tXS- ! ./ �._.�. - 1 ��....� __.R .tea--s:�,. tLocated P4124 F4ire Depart mentsignature/date ?J COMMENT �S.' 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) i ® 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 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 OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit ` I 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 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 OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) + Building Permit Application 4 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 2012 IECC Energy code 4 Engineering Affidavits for Engineered products OTE: 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 Doe:Building Permit Revised 2014 I Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 22,500.00 m $ - $ 270.00 Plumbing Fee $ 33.75 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 33.75 Total fees collected $ 437.50 111 Glenncrest 881-2016 on 2/11/2016 Baement Remodel NORT#1 Town 2 ndove'r O - 0 No. - ,� oh ver, Mass, COCNICNIWICK y1. 7,95 RATED U BOARD OF HEALTH Food/Kitchen . PERMIT T LD Septic System THIS CERTIFIES THAT .��................... BUILDING INSPECTOR �Y/� �^ .. Foundation has permission to erect .......................... buildings on .//,/.... ...........G:..��5: ....��::........................... /� Rough to be occupied as ��..� �Q /' / ':r ...................... . ....................................................................................... 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES. IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough Service ..... ll :.... i:s....................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Fingl No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. Y v f : r - 4 iN All_ N,1F-JUNE � P%F, �I r-� U9LT- PPE Types . Expert Masonry Clark Mass Toll Free Licensed & Insured 1-8004VAIT-4-ESS G t._. ztr�•Own e. sa. aj>f,<r,.« �, << J V:,.F; e License#034200 ( 2�d-84$P} IF T ' Cexe� ` e'e-oz a;�e �S e Work 'ileac Round 1 -s Proposal To: Phil and Marilyn Doyle Date 1/3/16 Street: 111 Glenerest 978-687-2989 N. Andover, MA 978-948-7383 Basement Remodel Finished area 1. Remove existing flooring 14. Install (4)new vinyl Paradigm Energy Star rated 2. Remove existing wall around boiler insulated glass gliding basement windows. 3. Seal all foundation walls 15. Install all new electrical plugs, switches and 4. Insulate all foundation walls with rigid insulation recessed lighting cod g g g to e. board to code. Insulate all interior walls and 16. Sink area: Remove existingsink. Install n - new cus ceiling to code. tomer supplied sink and cabinet. Alllumbin P g 5. Frame new perimeter and interior walls to all areas included. discussed during estimate meeting. Frame in new 17. Laundry area: Install all new drywall, tape, sand, closet. prime and paint. 6. Install new walls and ceiling: Blueboard,plaster 18. Stairs: Remove one wall on one side. Install new and paint. wood railing and balusters to code. 7. Install all new finish trim 19. All permits included 8. Re-locate hot water tank. 20. Removal of all work related debris. 9. Install all new baseboard heating 21. contractor workmanship warranty: 10 years 10. Remove existing support column. 11. Per structural engineer report: Install whatever Total Cost: $22, 500.00 needed to existing house support beam to comply with code and maintain structural integrity to remove support column. 12. Install all new customer supplied tile flooring to entire area. 13. Remove (1) existing basement window on front foundation wall. Frame in. Acceptance of Proposal—The above rices specifications and conditions are satisfactory and are herby accepted. You are authorized to do the work as specifi d. Payment will be made as outlined above. Date of Acceptance: , i 4 Signatur . Signature: �605� tit G��rJ «�sr pv4kve (Vo(ZTH powooce..- 7-tdib FOR �04t4 LRAjZAF'/ NC_ 978-6( 5 - Zoos L1h40 PROJEcr �►��p� ; •:?REL0CA-rr 2 LA1.LK Gac��:M rv5 �N S n nab" AND REIrvFOI'GE Ex�STrNG (�-t($p�tz 1A) FRSEME&u7- NOTE CAREFULLY: 14L Z, 1 �— 9�_�, SHOULD CONDITIONS OR DIMENSIONS AS DEPICTED ON DRAWINGS BE DIFFERENT THAN SHOWN OR F@O M SHOULD ANY UNFORSEEN LATENT CONDITIONS BE UNCOVERED DURING THE COURSE OF CONSTRUCTION THAT o APPEAR QUESTIONABLE OR ARE NOT IN COMPLIANCE WITH THE BUILDING CODE,OR DRAWINGS +` f THE CONTRACTOR IS TO NOTIFY THE }— �q ENGINEER FOR REMEDIAL CORRECTION DETAILS � � Ag APPs�� art o STEL nD N e w t 'tQ E AC 4 LRe.t.rt CQ�v��S � GtRtJ�.� r• W trH e I . .. 4N - 1F��� $KreE �� � � € ou �fit STEML�¢T� (.Zk1OF +' a rr.A. H SIDE oma' u IL tL � �E( i a 7v twiora A307 $oLT p LV I Tt{ N VT Aw 0 N $TE!L P4.4,T ft OvEX (2xT-rex" LAWRENCE H.OGDEN.P.E. 198 EAST MAIN STREET GEORGETOWN,MA.01833 978-352-8318,cell 978-502-5921 The Commonwealth of Massachusetts (� Department of Industrial Accidents I Congress Street,Suite 100 Boston,MA 02114-2017 www mass gov/dia Workers'Compensation insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Leeibly Name (Business/Organization/Individual): (/k-�7-1 6 ° Address: � � T'G" r" " ���✓L� City/State/Zip: t-"n C-1 1AI-1,1J Phone M X1,9 Are you as employer?Check the appropriate box: Type of project(required): 1 a employer with employees(full and/or part-time).* 7. []New construction 2.E]1 am a sole proprietor or partnership and have no employees working for me in 8. ORemodeling any capacity.[No workers'comp.insurance required] 9. ❑Demolition 3.01 am a homeowner doing all work myself.[No workers'comp.insurance roquired.]r 10[] Building addition 401 am a homeowner and will be hiring contractors to conduct all work on my property. 1 will ensure that all contractors either have workers'compensation insurance or are sole 11.[]Electrical repairs or additions proprietors with no employees. 12.Q Plumbing repairs or additions 5-Q 1 am a general contractor and I have hired the subcontractors listed on the attached sbect. 13.❑Roof repairs These subcontractors have employees and have workers'comp-insu raocc.t 6.O We are a corporation and its officers have exercised their right of exemption per MGL c. 14.[:]Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box fel must also fill out the section below showing their workers cornpensation policy information- s 'Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing dee name of the subcontractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers comp.policy number. I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: pw✓ jT '1 ur Policy#or Self-ins.Lic.#: /fie' 41a— / 00 yyc�—Z6IS-4 Expiration Date: /( Job Site Address: N I C1zZ51 City/State/Zip: /j/l''7f"r Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to51,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to 5250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify undertins and penalties ofperjury that the information provided above is but and correct SignatureA Date: Phone#: - 9 7 S—17 57,31 O,fcial use only. Do not write in this area,to be completed by city or town officio[ City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant tE 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 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 including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides merein,or the occupant of the 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 local 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 applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL 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 number(s)along with their certificate(s)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 or LLP does have employees,a policy is required. Be advised that this affidavit 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 that the application for the permit or license is being requested,not the Department of Industrial Accidents_ 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 that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped 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. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 Tel. #617-7274900 ext. 7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia WORKERS COMPENSATION AND EMPLOY RS LIABILITY INSURANCE POLICY INFORMATION,PAGE A.I.M. Mutual Insurance Company 54 Third Avenue, Burlington, Massachusetts 01803-0970 (800) 876-2765 NCCI NO 26158 POLICY NO. A1/IJC-400-70094_84-2015A PRIOR NO, 'AWC-400-77009464-2014A ITEM _ 1. The Insured: All Under One Roof DBA: Mailing address: C/O John Lenzafame FEIN:i•-•6251 30 Temple Drive Methuen,MA 01844 Legal Entity Type: Sole Proprietor Other workplaces not shown above: See Location 2. The policy period is from 11/09/2015 to 11/09/2016 12:01 a.m.standard time at the insured's mailing address. 3. A. Workers Compensation Insurance: Part One of the policy Ipplies to the Workers Compensation Law of the states listed here: MA B. Employers'Liability Insurance: Part Two of the policy appri s to work in each state listed in item 3.A. The limits of liability under Part Two are: Bodily Injury by Accident $ 100,000 each accident Bodily Injury by Disease $ 500,000 policy limit Bodily Injur by Disease $ 100,000 each employee C Other States Insurance: Coverage Replaced by Enclorserr ent WC 20 03 06 B_ D. This Policy Includes these Endorsements and Schedules: bEE SCHEDULE 4. The premium for this policy will be determined by our Manuals f Rules Classifications, All information required below is subject to verification and chatge by audit. tons,Rakes and Rating Plans. Classifications Pre .._ • _• miu Basis ;_ .Rat : es "�"-'•- `-" •••- Code Estimat d Per$100 •Estimated No. Total Anqual of Annual ___- _,•,_,• _ - _� Remuneration Remuneration Premium INTRA 174355 INTER SEE:CLASS CODE SCHEDULE Minimum Premium OW Nal Estimated Annual Premium - - GOV GOV Deposit Premium STATE CLASS MA 5474 S#LAssessments/Surcharges $1500% $1 This policy,Including all endorsements, is hereby countersigned by ~- --'� t__lG- !�' -� 10/05/2015 � Auihorir�d Signature ""` ' Oate Service Office: 54 Third Avenue P Irry Insurance Agency LLC Burlington MA 01803 5t2 Chickering Rd, Rt 125 N rth Andover,MA 01845 WC 00 00 01 A(7-11) 1 Includes copyrighted material of the National council on compensation Insurance, used with Its permission, Massachusetts -Department of public Saf=*a1,- Board of Butin;ng Regulations anc �tat,dar ,.uu„i cunni .�utrcn i„i, , License: CS-069120 JOHN W LANZAFAME--__. 30 TEMPLE DR METHUEN MA 01844'\ Commissioner 04/03/2017 Click on the registration numt�r to view complaint history. You can also vie��arbittata©n and C,uarant Fund histoa. The list is current as of Wednesday, October 8, 2014, Search Results REGISTRANT RESPONSIBLE REGISTRATtON EXPIRATION S'TA'TUS NAME INDIVIDUAL NLMER ADDRESS KATIE ALL UNDER ONE ROOF t ANZAFAME. _137057 166 A MERRils ACK ST 10102/2016 Current JOHN METHEtlN, to 01844 Q 2012 Commonwealth of Massachusetts. Mass.Gove is a registered service mark of the commonwealth'of Massachusetts. W011 AI n I I