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HomeMy WebLinkAboutBuilding Permit #604 - 121 RALEIGH TAVERN LANE 5/12/2009 pORTH BUILDING PERMIT o` TOWN OF NORTH ANDOVER c? APPLICATION FOR PLAN EXAMINATION h T Permit NO: Date Received 9SSACHUS Date Issued: J� IMPORTANT: Applicant must complete all items on this page LOCATION ; . Pram PROPERTY OWNER . Qat cJ 1��::,nie Gltn�aort � < Print (.A ) MAP NO: `PARCEL ZONING`DISTRICT: Historic District arcs °Machine Shop Village yes _ -- 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 n DESCRIPTION OF WORK TO PREFORMED: by < Qja�e wn4 e. Tc Im Maw f, d LJ oel Jogs Identification Please Type or Print Clearly) OWNER: Name: a e, Z�lenoon Phone: �' ,,,Identification O_A I`��rr�ti n Address: �� l 20\ er 6 CONTRACTOR Name: ; (-t Lia rise 'fir. Phone: ?5 7-6.7 2 7 i Address: t,t 4,e �.�we l� ssq (��. ()I Su ervisor s ' Construction License: CS -7S Exp. Date: 7 Z010 Horne Improvement License: 2 Z D Exp. Date: 3 l7 Z7.611 ARCHITECT/ENGINEER 01A 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: $ 07-j653 FEE: $27�;t('y Check No.: 7 �'/ Receipt No.: -ap�U 09 NOTE: Persons contracting.with unregistered contractors do not have access t he guaranty fund F signature of Agent/Owner � Signature of contractor gym. 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 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 r 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 FIRE DEPARTMENT Temp Dumpster on site yes ^ no .,, Located at 124 Main Street + , " Fire Department signature/date7 ,. -,_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.Euilding Permit Revised 200E i r 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 i ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses j ❑ 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 1 Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit G ❑ Photo Copy of H.I.C. And C.S.L. Licenses I. ❑ 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 I� ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit I ❑ 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 'I 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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 1 Location No. bV Date I MORTM TOWN OF NORTH ANDOVER F - 9 Certificate of Occupancy $ �_ �cMACH usE• cn Building/Frame Permit Fee s Foundation Permit Fee $ Other Permit Fee $ TOTAL Check # � l 220 9 Building Inspector F �ORT1y 0" , ® �. 4 over . 0 No. 4 _� _ __v­_PKi o = A K E i dover, Mass., • COCHICMEw.CK V �A0RATE D BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THISCERTIFIES THAT................... ......°.4........:.......................................... .................................................................... . Foundation has permission to erect... ........................... buildings on ..��i.�. ..�....... �.....4 Rough to be occupied as...... �I......�..✓. !✓ �i/rY � ...... •�0. '�....................... : Chimney . . . . .provided that the per on accepting this perm II in everyresponform 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 Final a JY I= PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONS TR SJJIRTS 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. Massachusetts- Department of Public Safet% Board of Buildin- Re!-ulations and Standards ' i Construction Supervisor License License: CS 75418 Restricted to: 00 - I ROBERT L LAGASSE JR 25 WHITE STREET , LOWELL, MA 01854 i Expiration: 9/7/2010 Commissioner Tr#: 3241 ✓fie Zoanameaozcaeaiacsuu�de6 Board of Building Regulatiods and Standards HOME IMPROVEMENT CONTRACTOR Registrations., 128280 Expiration: 3/22/2011 Tr# 281413 R.L.LAGASSE JR CONST ROBERT LAGASSE JR�0 tf 25 WHITE STt -� h LOWELL,MA 01854 Administrator The Commonwealth of Massachusetts kr ! Department of Industrial Accidents f Office of Investigations 600 *-ashington Street Boston, MA 02111 t t www mss gov1dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/individual); Address: ZS' ST. City/.State/Zig: �ow e,i it Phone#: . � S - G'7 Z 7 Fole employer?Check.the appropriate box: m to er with 4. Type of project(requires: P Y ❑ I am a general contractor and Iees(full and/or art-time .* have hi 6. ❑New constructionp ) red the sub-contractors proprietor or partner- listed on the attached sheet x 7• ❑ Remodeling ship and have no employees These sub-contractors have ' Q Demolitionworking for me.in any act ri• workers' comp.insurance. 9. Buildi [No workers'comp, insurance 5. ❑ We are a corporation and its ❑ addition required.] officers have exercised their 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 1 I.❑ Plumbing repairs or additions myself, [No•workers'comp. c. 152, §1(4),and we have no ran insuce_required.)t .employees. [No workers' 12.[] Roof repairs 13-R.Other i C1 tYl comp. insurance required.) `Any applicatn that checks lw�#I must also fill out the section hetow showing . t Homeowners who submit this affidavit indicating theyare lain all work their����cotirpensatiori policy information, =f iom a g rk and than hire outside contractors mu tors that check this box must rttE , submit a new affidavit indicating chi!an additional shoe show ndreating such. showing.Elte risme of the sub-contractors end their workers'co...1....t y r�•1.SitDrnatiOn. I am an employer that is providing:workers'compensation insurance for my aployeaBelow is&einformation. Policy 3and o b site Insurance Company Name: Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration dates). Failure to secure coverage as required.tinder 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 herely cern nder the pains and penalties of perlruY that the information provided above is true armor correct Si tore: ,Q - Phone 51' �o-7 'Z --------------- LBoardof useonly. Do not wri4 te in this area,to be completed by city or town official n: Permit/License# ority(circle ooe): ealth 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector son: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all emp I oyers-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 ormore of the'fore in engaged in a joint en rise and includiri the legal entatives of a deceased employer,or the g J Eo g � �'P g Sa repres 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 therein,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 Ito 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 t3he 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).a.nd 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 retuned 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 Meir self insuance'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 tinder"Job Site Address"the applicant shouldwrite"all locations in (city or town)."A copy oft he affidavit thathas 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 ftiture 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 1-8.77-MASSAFE Revised 5-26-05 Fax#617-727-7749 www.mass.gov/dia i CERTIFICATE OF LIABILITY INSURANCE OP ID Cl DATE(MM/DD/YYYY) RLLA GOl 05/09/09 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION CHARLES J COUGHLIN ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE INSURANCE AGENCY HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 14 DINLEY ST. P.O.BOR 10 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. DRACUT MA 01826-0010 Phone: 978-957-3588 Fax:978-957-6612 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: National Grange Ins Co 14788 R. L. Lagasse Jr Construction INSURER B: Rob La asse INSURER C: 25 White Street INSURER D: Lowell, MA 01854 INSURER E: 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. POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR NSR TYPE OF INSURANCE DATE MM/DD DATE MM/DD/YYW GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000. A R COMMERCIAL GENERAL LIABILITY PREMISES(EEaaEoccccurence) $500,000. CLAIMS MADE ®OCCUR MED EXP(Any one person) $ 10,000. MP072173 07/26/08 07/26/09 PERSONAL&ADV INJURY $1,000,000. GENERAL AGGREGATE $2,000,000, GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG s2,000,000. POLICY PRO LOC JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ I ANY AUTO EA ACC $ OTHER THAN AUTO ONLY: AGG $ f EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR EICLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN TTM I I ER ANY PROPRIETOR/PARTNER/EXECUTIVE[—] E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ OTHER RAN I DESCRIPTION F P !L A O OPERATIONS TOS LOCATIONS/VEHICLES!EXCLUSIONS ADDED BY ENDORSEMENT!SPECIAL 1 PR VI N 0 SO S Carpentry CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION NOAM01 DATE THEREOF,THE ISSUING U ER WILL ENDEAVOR TO MAIL 10 AYS WRITTEN NOTICE TO THE CERTIFIC H DER NAMED TO E LEFT UT FAILU TO DO SO SHALL IMPOSE NO OBLIGATIO OR BILIT ANY UPO E INSU ,ITS GENTS OR Town of North Andover 1600 Osgood Street REPRESENTATIVES. No. Andover MA 01845 AUTHORIZED REPR EN TIVE J/ ACORD 25(2009/01) ©19 - OR D CTI All fig—hits reserved. The ACORD name and logo are registered m sof ACORD HomeTech Cost Estimator Page 1 of 2 NO, R.L.LAGASSE JR. CONSTRUCTION 25 WHITE ST LOWELL, MA 01854 (978) 454-1799 Megan and-Damien Glennon 121 Raleigh Tavern Ln North Andover,Ma 01845 glennon siding 5/11/2009 Description Quantity Unit . BUILDING PERMIT(AVERAGE AMOUNT FOR U.S.): 21 PER Building permit fee, based on total amount of job $1000 PER$1,000 =Per$1,000 of total job cost(contractor's cost)or job price (price to customer) Building Permit Fee Based on $per 1,000 . EXTERIOR WALL COVERING: 3228 SF Remove siding from existing exterior wall Wood siding removal . . EXTERIOR TRIM: 200 LF Fascia board or soffit I" x 6" fascia removal . VINYL SIDING: 3228 SF o Solid horizontal PVC vinyl siding o 415 felt paper o All accessories, including starter strip, J-channel,utility or undersill trim,one piece inside and outside corner post o Not included are soffit fascia, rake and window and door trim 8" double 4 vinyl siding . HOUSE WRAP: 3228 SF Substitute house wrap for paper specified in siding installations House wrap, ADD per SF . FASCIA OR FRIEZE: 180 LF #2 pine, spruce,hemlock, fir 1" x 8" fascia . SOFFIT: 25 LF #2 pine, spruce,hemlock, fir 12" soffit http://www.costestimator.com/pmt_bid_sheet.asp 5/11/2009 HomeTech Cost Estimator Page 2 of 2 1-4 . ATTIC LOUVER: EA Redwood, including insect screen Rectangular 16" x 24" attic louver . VINYL SOFFIT: 85 LF Solid or perforated, including "F" or "J" channel Vinyl soffit 18" . Dumpster on site to remove all debris 1 EA from jobsite. Project Total: $22,693.21 I http://www.costestimator.com/pmt_bid_sheet.asp 5/11/2009 i '3 t R.L.Lagasse Jr. Construction Contractor Agreement MA Lic# CS075418 MA HIC# 128280 This Agreement is made on this 4th day of April, 2009 The parties to this agreement are as follows: Contractor: R.L.Lagasse Jr. Construction 25 White Street,Lowell, MA 01854 978-454-1799 Owner: Megan and Damien Glennon 1. Work Site: The work and services will be performed at the following location: 121 Raleigh Tavern Ln. North Andover,Ma. 01845 2. Scope of Work: SEE ATTACHED 3. Workmanship,Permits: All materials are guaranteed to be specified and warranted by the Manufacturer. All work shall be conducted, installed and completed in a workmanlike Manner. The materials and work will comply with applicable building codes and ordinances. The contractor will obtain the necessary permits and sanctions of the proper Authorities with respect to the work which will be performed. Owners who secure their own construction-related permits will be excluded from the guaranty fund provisions of M.G.L.c.142A. 4. Time of Completion: The work to be performed under this agreement shall be started by April 14th and shall be substantially completed by May 22°d,2009 except that the time of completion is contingent upon strikes, accidents,performance of subcontractors, availability of materials and other delays beyond the contractor's reasonable control. 5. Contract Price and P-ment: Owner will pay Contractor for satisfactory completion of the work in the s of $22,693.00 fcai the entire project. The payment refe ence herein sha"e paid in the following manner: First payment- Received upon 'fib1%3 the total cost, $7488.69. Next payment collected once the demolition, and half of siding is complete, $10,000 Third payment due once the job is complete,$5204.31. 6. Change Orders: Any alteration or deviation from the drawings and specifications Involving extra costs will be undertaken only upon written order of the owner, and will become an additional charge and may extend the time of completion. /y Initials i 7. Subcontractors: The contractor may engage subcontractors to perform work, provided that the contractor will continue to be responsible for the work performance of all work under agreement. This contract is binding on all parties who lawfully succeed to the rights or tale place of the owner or contractor. This contract may not be assigned by either party without the consent of the other. This contract will be interpreted under the laws of the state in which the work is to be performed. All Home Improvement Contractors shall be registered by the director and that any_inquiries about the Contractor relating to a registration should be directed to Director: Home Improvement Contractor Registration One Ashburton Place,Room 1301 Roston ,MA 02108 617-727-8598 Contractor's Registration #128280 The owner's three day cancellation rights under M.G.L.c.93 48; M.G.L.c.1400 10 07 M.G.L.c.2550 14; as may be applicable. Do Not sign this contract if there are any blank spaces. The parties have read the contract. They have received a completely filled-in copy and acknowledge receipt of copies of the drawings and specifications, if any. The parties have signed the contract as of the date written. OWNER: Date TRACTOR: Robert Laga e Jr. Date R.L.Lagasse Jr. Construction