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HomeMy WebLinkAboutBuilding Permit #628-12 - 122 LANCASTER ROAD 2/29/2012 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: o� '/ 2— Date Received Date Issued: , ' L-- IMPORTANT:Applicant must complete all items on this page LOCATION I ) �-L-% CA S4t-e._ l&rk Print PROPERTY OWNER 120 & ti Unit# Print MAP Nob PARCEL: ZONING DISTRICT: Historic District yes o Machine Shop Village yes no 100 year-old structure yes o TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑New Buildingne family 11 Addition ❑Two or more family ❑ Industrial ❑Alteration S+tki No. of units: ❑Commercial ❑ Repair, replacemehl ❑Assessory Bldg ❑ Others: ❑ Demolition ❑Other ❑��ptio We ll � 'sx$ oodplain111 ®W�etlands . 0 7,a ershed,y:g c '.'+ mss':a � ' ''�" �'.��x.r-1pl 4'x` .' �Ct= __s£sr�._ . DESCRIPTION OF WORK TO BE PERFORMED: (Identification Please Type or Print Clearly) OWNER: Name: Lf�ix,Ir -t K'A-? Cie, Phone: o19 G 3 Address: L a C.a c�S � ✓L � �„�c.-� m CONTRACTOR Name: V��•, Phone: Address: L /-e� s`-� �i►�,ta�f( t� lr �f _ �o� / a Supervisor's Construction License: /0!7�k4 S Exp. Date: ,/y Home Improvement License: / S 3 Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASE ON$125.00 PER S.F. Total Project Cost: $ / 3 FEE: $ Check No.: Receipt No.: S so �D NOTE: Persons contracting with un re ' ontractors do not have access to the guaranty fund ,Sign:ature_ ent/©wne ., .. Signatureof;c:_nt�actorF:. -- _ Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer El' Tanning/MassageBody 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 I HEALTH Reviewed on Signature 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/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 servicedroprequires approval of Electrical Inspector Yes 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 2011 June/mi 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 f ❑ 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 j i ❑ Building Permit Application ❑ Certified Surveyed,Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract j ❑ 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 N.I.C. And C.S.L. Licenses o 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 roust be submitted with the building application Doe: Doc.Building Permit Revised 2008mi NORTH ® o over .. No. o dover, Mass., • O COC IC EWICK � I. S RATED P'P `'\� • �l ` BOARD OF HEALTH Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.......... �. �. .� ............. ................... ...................... ............... Foundation has permission to erect........................................ buildings on ....tllala ......`,�ill�. .S ........... �... Rough �r�1 Chimney to be occupied as.............5.... ..• ......T......... ........................... ................................. ..... ........................... provided that the person accepting his permit shall in every respe onform to the terms of the app 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 PERMIT EXPIRES IN 6 MONTHS � b ELECTRICAL INSPECTOR UNLESS CONSTRUC ARTS 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 FIR_E-DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. p Proposal A 93 New Salem Street.Wakefield MA 01880 Tei:617-571-9056 Email:RyanAndSrrn4(i Mc.conr www.RvanAndSonRoofing.com Submitted To: lob location: Robert&Karen Barnett 122 Lancaster Road 122 Lancaster Road North Andover MA North Andover MA Phonep. 978-686-2963 Mail: LBamett580a aol.com Proposal date: February 23,2012 Revised: February 27,2012 We are pleased to hereby submit this proposal to furnish materials and labor,completely in accordance with the below specifications: (Additional charges may apply for any change's not included below in proposal either by request of owner,or if Ryan and Son Roofing finds unforeseen circumstances that will affect the performance,quality or integrity of thisjob).In the event legal action is taken to enforce any provision of this agreement, the prevailing party shall be entitled to all its reasonable costs, including reasonable in-house or outside attorney's fees.Not responsible for debris in attic. THIS PROPOSAL IS T0: Strip roof to bare wood and re-shingle a reaead chimneys:$13,925.00 • Strip existing shingles down to bare wood • Check for rotted wood and replace as needed • Nail down any loose wood • Install ice&water shield to entire sunroom • Install ice&water shield to first 6',which is 2-rows and in all valleys • Check and ensure ice&water shield goes up under the clap-board • Install 301b felt paper to remainder of roof • Install all new 8"white drip edge on perimeter and step flashing,where needed • Install GAF Lifetime/30-year architectural shingles in color of your choice • Properly re-install heating cables on roof • Install ridge vent and hip&ridge cap,to match • Properly flash any protrusions and all new pipe flanges,if any on roof • Re-lead chimneys Clean Up: • Will cover area with tarps to minimize debris • Remove debris related to work • NOTE: Please cover any belongings in the attic,as they will get dusty,if applicable Payment Terns made as follows: (This includes labor, dump&materials) Strip a shingle roof price: $13,925.00 Kindly remit payment to Total Cost-Xf no changes] $13,925.00 "Peter Ryan" In payment due upon signing: $5,000.00 Thank you! Balance due upon completion: $8,925.00 1 ZAthe Respectfully Submitted bp: - _� Accepted by: All work is 100%guaranteed 0- ears on all craftsmans ' r wanantee are through the manu a turer.All w an es will e nu void if job is not paid in full.Thank you for letting us serve you!!!Ryan And Son Roofing,Inc.is fully licensed( 591§7)&insured. The Commonwealth ofMassachusetts Department of1nd'ustrialAccidents Office of-Investigations, 600 WashingtQn,S'treet 5� Boston,MA 0211.1 www massagov/d'ia Workers' Compensation Xnsurg..neeAffidavit:Builders/Contvactors/FIectricians/.Plumbers A licant Infoxxnation please Print Legibly Name(Business/Organization/Individual): Address: t9 3 oV .City/State/Zip:—&1 M4 Ol& Phone#: l FE10 an employer?Check the appropriate box: _ a employer with 4. [12 project(required):� ❑T am a general contractor and Tloyees(full and/orpart-time).* have hiredthe sub-contractorsew construction a sole proprietor or partner listed on the attached sheet.1modeling and have no employees These sub-contractorshaveing for me in any capacity. workers'comp,insurance. molitionorkers'comp.insurance 5. ❑ We aie a corporation and its ilding additionred.] officers have exercised their ctrical repairs or additionsa homeowner doing all work right of exemption per 1V�GL mbing repairs or additionslf.[Noworkers' comp, c.152,§1(4),andwehaveno nce required.]i employees. ofrepah[No workers'mpmsurancerequired] er �` =Any applicant that checks box#1 must also fill out the section below showing their workers'compo ationpolicyinfo rmation. Homeowners who submitthis affidavit indicating they are doing all work and then hire outside contractors must submit anew 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 flzat isproviding workers'compensation znsuYance for my employees Below is flae policy taytrZ job site information. Insurance Company Name: Policy#orSelfins.Lie.#:_ �'��'ta Lib& -t(s7 /Ylr 6- /n-y v Expiration Date;-1h � lob Site Address City/State/Zip: �- /Ao 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 ofMGL c.152 can lead to the imposition of criminal penalties of a ine up to . d 00 a d00 and/or one-year imprisonment .f up to$25050. ,as well as civil penalties in the form of a STOP WORK ORDER and a fine ay against the violator. Be' dvised that a copy of this statement may be forwarded to the Office of nvestigations of the DTA.for insurance coverage verification. do hereby certI Y u r in Fidpenalite perjury that the information provided above is true and correct. '. nature: Date: / !one#: offrcial use On4l D0 riot write in tl2is area,to be completed by city or town official. City or Town: Permit/li,icense# [ss;uingAuthority(circle one): 1.13oard of Health 2.Building Department 3.Cityff9wa Cl 'eric4.Eleetiri i Other calInspector 5.Plumbing Inspector Information and st.�uc��Iin • • ®ns 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 ofhire, express or implied,oral or written:' An em ployer•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 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 issua renewal of a license or permit to operate a business or to connce or struct 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 ofpublic work until acceptable evidence of compliance with the insurance requirements of this chapterhave beenpresented to the contracting authority." Applicants Please fill out the workeW,compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(os)andphonenumber(s)along with certificates)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 ox license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the.law or ifyou are required to obtain a workers' compensation policy,;please call the Department at the number listed below. Self-insured companies should enter ,self-insurance license number on the appropriate line. their City or Town Officials Please be sure that the affidavit is complete and printed legibly. The D apartment 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. PIease 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 pernvt/license applications in any given year,need only submit one affidavit indicating current Policy information(ifnecessary)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 pro of 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 notrelated toF any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOTrequired to complete this affidavit. The Office of Investigations would like to thank yo-din 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. eC01MAOMWOa-Uh,of S �ssac'oses ;Depaft"L-t of Zudustridl A_eddeats Office of InVeMig_atIoxRs 600 Washfiigton Steet Bostona;M-A,02111 T01.#617-727-4900 ext 406 ox 1-$77MM4SSM + CERTIFICATE OF LIABILITY INSURANCE (JA Tr-,(MMIDD/YYYY} THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFgRDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTtTUTF_. A CONTRACT BETWEEN THE ISSUING FORDED BY HE POLICES REPRESENTATIVE OR PRODUCER.AND THE CERTIFICATE HOLDER. iMPgRT"ANI': if the certificate holder Es an ADDITIONAL. PNSURED. the pot(cy(ies) must be endorsed. the terms and conditions of the policy.certain o ed. If SUBROGATION ({cies 15 W p may require an endorsement, A statement on this certificate does n AIVED,subject to certificate Milder in lieu of such endorsements. of confer i o --'-•---• —. er ri h t f) rights o the r ONTAc ;MassPay Insurance 5atrvices,LLC 978-998-6896 NAM(. ---- __.. 27 Garden Street Unit 1B 978-998-6897 '1?c)nci _.. FAX Beverly, MA 01915 (A/ No,t XII Sharlene Hilda WullemarT t:.-MAIL (Art:,No): Arn)RFSS PRODIl(:f R - - cusrgMEEp ID a RYANSON N,uREsrJ, Ryan gr Son Roofing,Inc ' MSURER(S)AFFORDINGCOVERAGE . ... NAIL a 93 New Salem St j INSURER A Ace American Insurance Co Wakefield.MA 01880NsuRV'R H. ( ItJSURC.R C - j IN$UREeIi E COVERAGES --------.._—___...._....... ._ INsLL,eL.r �---, _..___CERTIFICATE NUMBER: •_....._-_._,_, i(t15 Ib 'It:J("ft?t tFY T{-IA( 7 r_r( pOL.(C:(FS OF INSLI!?ANCk l.IS7T:C;f3F,i_c')Lni HAVE E3EFN ISt,uEt� T o REVISION NUMBER: 1NI)1(;AIEI7 N(�T/y1I'FI I/1N()INC„4NY F2F'()IJIRF.MFNt TI.RM ()F IHL INSUREf. NAMED ABOVE FOR rHE POLICY P[RIOD4 FRA,1S1OTE MAY NE ISSUE-0 OR MAY F'EPTAIN 1111. IN SURANCF AFPI)RNF,() BY THfOF ANY �)N�)LI(IEtS I)E':SCR OR f?hCUMENT itnT( RESPECT TO VV XC:r..tJti10NS AND CONDITIONS OF SE1CI+hOi 1C'IF_S !.IMtI'.,..;fin WHICH THIS rNsh )IDN MAY HAVE:BET:.V REIIU(F I1 E3Y PAI(.)C(.AIMS' IiLRl-,1N IS SURJE�C I TO ALL IP•(E:: Tfi.FZMS. I1 TK- TyP'Or/NSURANf.r. Anri! SUE#f2 __...._. .___...._rN.�f3..YYyIL,__..____.. POLICYVFF POLICY[XP _.___ 4 C)t.ICY NUMD[R rit3NE.Rfii.I,1AHi1 IrY ,. -„_.(MMlOO/YYYY� (_MMlDDNYYY ._—. ........._._. _ IR f``✓ (°r f•:i:r Tr. un; 4GVNJURY r E. f ... .t IAHu.I rY ._.... ..:_. r rc. s JM01Nt1 .. ._.. r i rl pn'r S .. - Irl;r;f'E R'Y DAMA(i[ii ... . N",',C?'A'^JE-i)':Il.•.+c � _._ __._..__- s _ UMHRELLA i IAN ........... ..._..___._-_—..._..�.._.___..__._.._..„_...._ ..---------------__. _.._ LIAR ON WORKERS COMPF_—.—_.___„__...__..........__...._...._.--._..—i_._— NSA rio ANP EMPI OYFRS IAHIt IrY _ A w IrrThR, t rKr.i, tn ); �N:A6S62US-4571 P66-9-11 t/ tJ �� !? � Wawa forg n NH! 03116/1103/16/12 , I y< ru cxlhr nvr t/ r r)FaJ < 1,000,00 1,000,0 1,aom0 _...1.._:......__,...___... DESCRIP TKJN OF OPERA I fr)NS LOi:A rTON;;t, . Evidence of Insurancerr(i.?:s (An,-r,At;ORr Tc, iia 1 C> of cERrlFrca rE HOLDER LANCELLAT!ON `` -----_-_. l�nfle of I�surence SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ! !i� THE EXPIRATION DATE THEREOF- NOTICE WILL BE DELIVERED IN I , ACCORDANCE_WITH THE POLICY PROVISIONS. Forbidding purposes oniV All ftK>RIT,EIJ Rfir RFSFN I'A�TIVf,' /� — - �-W�”--"' ------_-• . ... .._....__._.._......... (5)1986-2009 ACORD CORPORATION- All rights reserved. ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD PDF created with pdfFac.tory trial version wv+rw_�ff�ctcar�,com J '+I,iti�.ti•i,u..iEt�- )z•Ircrf•rnreirt orf Ptt.iriit• �;I+',(� Birart! of Bttiltii7tf,)� Rellulations and Standards Vie, :sor ?.censa License: CS 104865 CLINTON GALVIN 102 DELMONT AVE APT 2 LOWELL, MA 01852 Expiration: 7/1/2014 f unu�i �i•;x''' Tri: ## - P sa_ �� C�TOvrz�tnfvrecrlc:rse`�� of✓I�rz�.l<irf«Jel�ct 1 Office of Consumer Affairs&Business Regntation t E HOME IMPROVEMENT CONTRACTOR E �! Registration: 169538 Type:. r i Expiration: 7/112013 . Private Corporatioi' Rl�AV AND SON ROOFING:INC.`' CLINTON GALVIN, 93 NEW SALEM ST' WAKEFIELD,MA 01880 -- Undersecretary n LocationI_ 2- -1- 14 h 4AIJ, No. Z� L.'" Date �-- r - TOWN OF NORTH ANDOVER �-a o , Certificate of Occupancy $ Building/Frame Permit Fee $-/t o Foundation Permit Fee $, Other Permit Fee $ TOTAL $ Check# 25060 Building Inspector