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Home My WebLink AboutBuilding Permit #296 - 119 PENNI LANE 10/13/2009 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: 0 Date Received Date Issued: a IMPORTANT:Applicant must complete all items on this page LOCATION Print PROPERTY OWNER R/ i '+tI? ' Print NlAP.NOd PARCEL-6' 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,District Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identificat'on Please Type or Print Clearly) OWNER: Name: nq t* 9A1)U ,4 Phone: ' ?,'-6G-0/ < Address: UL? 1 NT, CONTRACTOR, Name: vyou, Phone: tip Address: C� ,lltt1l�•v� �A-r ru - . Supervisor's Construction License: 2 Exp. Dater LHomelmprovement'License: Exp._ Date: ,4L� 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. I � 2 Total Project Cost: $ *a2 FEE: $ JL T-�— Check No.: 7 /V- 3 Receipt No.: OqL4� NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund agnature of Agent/Owner ?, Signature of con#ractorT. Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, InteriorRehabilitation 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 ❑ Floor/Crossection/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: Doc.Building Permit Revised 2008 I 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 i 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 t 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 FIRE DEPARTMENT Temp Dumpster on site yes no °Locatedat 124 Main Street fire Department signature/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 ❑ Notified for pickup - Date Doc:.Building Permit Revised 2008 Location i't/Irt �G✓� No. Date MORTIy TOWN OF NORTH ANDOVER f? � • pw n 9 ` Certificate of Occupancy $ e►�s",^°'�t�' cMu9 Buildin /Frame Permit Fee $ s� sE Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 5T 2255 Building Inspector NORTH Town of _� 4Andover 0 ....�. No. a 4(,o CO, z- dover, Mass., T O LAKE COC MIC ME WICK y�. AD RA TED `s BOARD OF HEALTH • Food/Kitchen PERMIT T D Septic System 0--19 BUILDING INSPECTOR THIS CERTIFIES THAT........ .. .. .. . . ........... .h...V ..... ..................... ......../................................................ Foundation has permission to erect........................................ buildings on .. // /946.w ............................................................ /7I"'. ....... Rough ,,,rr to be occupied as..... .'ll1l.....G'o!!�,E .... �.r/l�..p��A..�....... ........................... Chimney provided that the person accepting this p rmit shall in every respect 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 a� PERMIT EXPIRES N .6 MONTHS Final ELECTRICAL INSPECTOR UNLESS CONSTR C ST TS Rough .................. Service BUILDING INSPECTOR 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. SEE REVERSE SIDE Smoke Det. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, AU 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: 1rSlt�k/97&Q - }� City/State/Zip: ! Phone#: � �j!� -:�7y� Are you an employer? Check the appropriate bog: Type of project(required): I.® I am a employer with j_ 4. ElI am a general contractor and I — * have hiredthesub-contractors 6. ❑New construction employees(full and/or part-time). 2.❑ I am a sole proprietor or partner- listed on the attached sheet. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5 We are a corporation and its 10.[1 Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL 1 l.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.] t employees. [No workers' 13.❑ Other comp. insurance required.] ' :.y applicant that checks box#1:mst also fi11 out the section below showing their workers'compensation policy information. t 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 the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: to Policy#or Self-ins. Lic.#: cof o a fm U a, Expiration Date: Job Site Address: 1`! ,!%jx City/State/Zip: c) 7,y dkr_ � Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date)., Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $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 certify under the pains andpenalties ofperjury that the information provided above is tr a and correct Signature: Date: Phone#: Official use only. Do not write in this area,to be completed by city or town official 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 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 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 havingnot more.tha.three apartments and-who resides therein, or the occupant of the dwelling house`' f another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto sha1not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local Iicensing 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 permittlicense 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 bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us`a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department.of Industrial Accidents. Office of Investigations 600 Washington Street Boston, MA.02111 Tel. # 617-7274900 ext 406 or 1-877-MASSAFE Fax# 617-72.7-7749 Revised 5-26-05 www.mass.govfdia wmimm ACORQ. CERTIFICATE OF LIABILITY INSURANCE ioios/ PRCDUm (781)449-6786 FAX (781)449-4269 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION BOYNTON INSURANCE AGENCY ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 72 RIVER PARK STREET ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. NEEDHAM, MA 02494 4 INSURERS AFFORDING COVERAGE MAIC# NNSURED Kyron Inc INSURER A: Max Specialty DBA Preserve Services INSURER& Hartford Insurance 203 Washington Street,#256 INSURER C: Sal em,MA 01970 INSURER D: INSURER E:- COVERAGES COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE POLICY NUMBER DATE IMMMDATE LIMITS GENERAL LIABILITY MAX01310000309 05/23/2009 O5/23/2010 EACH OCCURRENCE b 1 000 00 X COMMERCIAL GENERAL LIABILITY PREMISES(Ea o=ocurencw S SO 00 IM CLAS MADE XX OCCUR MED EXP(Arty are person) $ 500 A PERSONAL&ADV INJURY b 1,000 N GENERAL AGGREGATE S 2,000,000 GENAL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGO b 2,000,000 I X POLICY ECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Es eodderd) b __ ALL OWNED AUTOS BODILY INJURY b SCHEDULED AUTOS (Per Pin) HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per noddent) b PROPERTY DAMAGE S (Per acrid-d) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S ANY AUTO OTHER THAN EA ACC b AUTO ONLY: AGG S EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE b OCCUR CLAIMS MADE AGGREGATE $ b DEDUCTIBLE S RETENTION S 8 WORKERS COMPENSATION 0143M392 05/20/2009 05/20/2010 X AND EMPLOYERS'LIABILITY TORY LLMtT3 ER B ANY 0 CCE IMEMBEERR EXXCCLUDE�M ECUTIVF�� E.L.EACH ACCIDENT b lOO, NM In N YES E_L.DISEASE•EA EMPLOYE S 100,00 SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT i S S00,00 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS 1,000 Bodily Injury and /or Property Damage Deductible CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOP,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE.TO DO SO SHALL IMPOSE NO OBLIGATI OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR Eric Husgen REPRESENT 14 Conant St. AurxoRlzEO ATIVE Marblehead, MA ACORD 25(2009101) 0 lft&2009 ACORD CORPO TION. All rIghtB reserved. The ACORD name and logo are registered marks of ACORD �. fiemrtun' t nom' � "� SOI�RD OAF BUjt_t3tNG ION ISO, License:• GONSTFtUCT;ION SUV?ER ISOR Number*..`GS: fl3443 C � J t firth at I t3it196 s t Expues �213112i�G9 Tc nts. 8443 Restrscted . SEAN OGONNOR � 26 CHESTNUT'S { SA EM, ,MR o1976GpmFtiiss�aner' /ae-ot Qudao� EN CON �oaca., OVEN. a2g19 y OM \MOR . 123553 fit# 2 a, H E A �puat�'�e OOP t° �yNepa��t�n9 �.,0 tcAt°r z OCo �ONS'C Sear. ��1�tdG M�pA9�0 i 4 ## .v 203 WASHINGTON ST.#256 01970 Q R E 5 E R V E carpentry]painting]roofing I gutters SALEM,MA PHONE:978.74587. 5 E R r/ I C E S 874 FAX:978.745.34766 SALES@PRESERVESERVICES.COM &Mrs F'anuele ✓\✓ Date Bid:5/6/2009 119 Penni Ln Estimator:Sean O'Connor N vrth Andover,MA O l S 45 C86 686-0105 105 CIOMMENTS The below estima6i 74(re lace all the siding, including the sunroom on the house with pre-coated Hardie Plank Siding with a 5" exposure. The siding will have a 15 year warranty from The color will be Cobble Stone and the finish will be smooth siding . ster The dum �Iardie industries. p & materials should be placed on the lawn next to the driveway if possible. CARPENTRY* -We will pall a building Permit from the city. The permit is a non-inspectional permit. The fees for the permit are included in the below price. Remove the siding; dispose of the siding;install new flashing above doors and windows; install tyvek; install rubber membrane around windows and corners; install pre-painted Hardie Plank Siding using Stainless steel nails. Replace all the molding on the exterior of the house with Azek, accept the 3 front vertical corners, front door way- This includes the facia,nosing on the window sill, all band molding, and the lattice work below the deck. We will make the space below the deck accessable. On the front door frame replace the bottom 6" inches of flat facia at the bottom of both fluted facia. Will replace 3 windows in the house LABOR ONLY (The cost of the windows will be extra and we will need to be paid for these at the time of order.)The owner will paint inside. 11 Notes: Behind the electical meter install a flat Azek panel with flashing at the top. PRIOR PREPARATION GUTTERS /DOWNSPOUTS: Remove the downspouts and reinstall: MINOR MAINTENANCE CAULKING: Caulk all gaps and cracks. PREPARATION PREPARATION: Scrape all loose and peeling paint. AREAS TO BE PAINTED DOORS: Paint the front door and front door frame. Spot prime all bare areas. Apply 2 full coat of finish. WINDOWS: Paint 2 window sash on theara e g g Exclude: The rear deck and the window sash below the storms. PRICING Basic $ 32240 Sales Tax $ 0 Total Price $ 32240 including Labor&Material* � S Payment Terms: 20%deposit(day of start); 30%progress; 50%end of job McNis Annex Sean.01 onnor ustomer Signature ADDITIONAL TO ABOVE ESTIMATE:** BID 1: Replace the.3 front vertical corners with Azek and including building up the detail work with Azek. The new design will be less. Price$ 1750 Including Labor and Material *The cost of paint is included in the above price accept for the following: Benjamin Moore Aura (a new line of Benjamin Moore paint)exterior paint will cost an additional $3�2 per gallon;other , specialty products prices will be given on a per product basis. **Above additional prices includes all discounts. ***The carpentry portion of this estimate is valid for 60 days and the painting portion is valid for 365 days. Warranty: Craftsmanship: Kyron Inc. DBA Preserve Services warrantees all exterior painting against blistering and peeling for a period of 2 years. The only exclusions are: wooded gutters; walked on surfaces; and structural problems such as but not limited to"mill glazing." Should peeling or blistering occur we will fix the affected area including labor and materials. For the warranty to be valid the invoice that was presented at the time of completion must have been paid in full. Cps 47T-4 fiWC 66 6