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HomeMy WebLinkAboutBuilding Permit #070-2016 - 124 BLUEBERRY HILL LANE 7/15/2015 BUILDING PERMIT o` N°or 6 6ti TOWN OF NORTH ANDOVER 02 5 - ` ° 16 I�vy,C, �,,���4x'APPLICATION FOR PLAN EXAMINATION � _ y Permit No#: U7 C) ?, -6, {\yam/ Date ReceivedA�� " I 'J RAORATEO �SSgCHu5�� Date Issued: , Ji5 p IMPORTANT:Applicant must complete all items on this page LOCATION / , ffluth n, 14'1) Ayt //// Print PROPERTY OWNER To D O' )/ Ywu e- �p �y Print 100 Year Structure yes no MAP I o PARCEL:ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building KOne family ❑Addition ❑ Two or more family ❑ Industrial Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other _ ,Septic ❑V1CeII ❑'Floodplain': �nWetlalib s, 1Natersh,edi'®�stnct 1Nato-Sewer DESCRIPTION OF WORK TO BE PERFORMED: ruai IV + YXLI h1xl Ij,)y Identifi ation- Please Type or Print Clearly OWNER: Name: �U b i�,s V-005 y- Phone: 6 Address: L=� 01w&gg 14J1 Ave Contracto Name: 'Grad 4Vir kil Phone: q 7 F-Y 3 q'd 3y Email: L C UN?C N400 M Address: C14 JJr10(6U '}- eW1% O)T I (a Supervisor's Construction License: C5 -- 10�'ht+ Exp. Date: 11 "I3 JS- Home sHome Improvement License: pL)U Exp. Date: '��'1 / 7 T 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. Total ProjJect Cost: "P'/S� ' FEE: $ �0 Check No.: Receipt No.: c-2- 91)(Pe NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund rg , Location No. D U"o2�I Date �J10 � TOWN OF NORTH ANDOVER r . Certificate of Occupancy $ e Building/Frame Permit Fee $W-0— Foundation Permit Fee $ -', ;ewb, Other Permit Fee $ • Ev TOTAL $ l M Check#1 � fj Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art ❑ Swiiauning 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 (o ) Si nature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes ;tanning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Signature Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street F, E DEPAR_+T�_MEMT)�� Temp Dumpster -- -- .� _ YaeS nog . jLoeated at 1, Ma nEstree- ,, � f Y x, -` t t x } ten. .s^r.�" r'a.-s-,. f"!".�^ i i Kz r {_ }'. ' •� + 4 a' Fi�r�e Department�sgriature/dates 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.$10o-$1000 fine NOTES and DATA— (For department use) ® Notified for pickup Call Email Date Time Contact Name =_ Doc.Building Permit 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 i6 Workers Comp Affidavit 4- Photo Copy Of H.I.C. And/Or C.S.L. Licenses 4, Copy of Contract 4. Floor Plan Or Proposed Interior Work 4. Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit c i Addition Or Decks Building Permit Application Certified Surveyed Plot Plan Workers Comp Affidavit 4- 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) 4. 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 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 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 i i Doe:Building Permit Revised 2014 i _ill NORTIi Town of t 71 ndover No. bJ6-,Ib(� h y o KI ver Mass A- COCMICHIWICK y1• 7�A�R�TED P4a,��y S �t V BOARD OF HEALTH Food/Kitchen PERFAIT D Septic System { THIS CERTIFIES THAT �. .. .�ABUILDING INSPECTOR .. ......... ..... ....... . has permission 1.44. �"60. q 11 �t1. Foundation p ion to erect .......................... buildings on ... .. ...... .......�A. �. I V ..... . ...� .. ..a ��� Rough to be occupied as ..... .... ..... �"+..... .... .. Chimney provided that the person accepting this permit shall in every respect conform to th terms of the applicatPbn 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 CONSTRUCTION STARTS Rough Service .............�..... `..L:—T.......................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building 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. ESTIMATE Tobias And Andrea Krause 124 Blueberry Hills { North Andover, Ma ' 617-852-9954 4 i Estimate # 000096 Date 06/06/2015 B.L. Contracting 92 Pringle Street Tewksbury, Ma 01876 Phone: 978-815-9884 Email: blcontract@yahoo.com Web: blcontract.com Description 24x12 deck with 4x4 landing Slate grey azek decking with hidden fasteners White azek trim 12 stairs Titan vinyl rail system Demoted disposal, permits Subtotal $15,000.00 Total $15,000.00 Notes: Back deck Page 1 of 2 "Zlh Signed on: 07/16/2015 Signed on: 07/16/2015 Bradley Lawrenson Tobias And Andrea Krause r Page 2 of 2 North Andover MIMAP July 16, 2015 T On f 3M �1 � raw p x ti»r • J P 5� e y ov�(�yYM1 y. J 141 t II �f 41 f T r 1 ' tee �. r� �tfi. fix.. Interstates —I —SR Horizontal Datum:MA Stateplane Coordinate System,Datum Ni Roads Meters Data Sources:The data for this map was produced by Merrimack r401111 1 Valley Planning Commission(MVPC)using data provided by the Town of Easements Ot�tia a qa North Andover.Additional data provided by the Executive Office of 0 MVPC Boundary r 9t +6*6 Oa Environmental Affairs/MassGIS.The information depicted on this map is ]Parcels •; L for planning purposes only.It may not be adequate for legal boundary F •—• a definition or regulatory interpretation.THE TOWN OF NORTH ANDOVER MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING {t i THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT �F o9q f� i ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF THIS INFORMATION �,SSACNUS t 1"=81 ft w�° North Andover MIMAP July 14, 2015 5-9-8-. 09.8:C=.0013 435 CHE!5 991BLUEBERRY HILLEN Ci 10�4�i#t Ift-RRYINICLIN. 445-CHE ST I MPT'S T' . 098 C-0095 �q 008X-0093 09�BLUEBERRYrHILL LN; as -1-4,iWOI-t t RYI(MIL-4 09.8.4-'0094 319 Hk -1 �1,24BLUEBERRY tikLVIN 108.C-00108' -61 WK EV. (S--Tl 46 -# 5, NUk- nST T T--� SN _42"WESLEYST t�Al 098 �93-6 ADRIAN $T t 34 1NESLEX"S:T �Z. Vito 098:0=0042' 0 1 '�14 09 "C-6 �-(90 0031; 68.61 Rail Line Wetlands Zoning Interstates 13 Exempt Lands Busi—a 1 District I B.sine!:2 Di:: rs District Datum:MA Stateplane Coordinate System,Datum NAD83, SR ts sine! 3 District MeteData Sources The data for this map was produced by Merrimack O B sine! 4 District "ORT'll Valley Planning Commission(MVPC)using data provided by the Town of Roads m Gere ,Business District It.0 North Andover.Additional data provided by the Executive Office of Easements Planne, Commercial DevEnvironmental Affairs/MassGIS.The information depicted on this map is E3 MVPC Boundary r Comido Development Dist, for planning purposes only.It may not be adequate for legal boundary 13 Corrido Development Dist definition or regulatory interpretation.THE TOWN OF NORTH ANDOVER 0 Municipal Boundary U Corrid,Development Dist MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING Zoning 0 eday Ind. THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY 13 Adult Ente Entertainment . hxlZ�i:�2'DD�:�nc: OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT DowntownOverlayDistrict 0 Industri'1 3 District • ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF C3 Historic District IN Industri il S District THIS INFORMATION *Water Protection Reside�ce I District Cr Reside ce 2 Di *Parcels 0 R—idence 3 District C Hydrographic Features deAce 4 District Sl—rna 1"=81 ft de I5District de 6DisN't ageesidntil District =�j The Commonwealth ofMassa chusetts Department of IndustrialAccidents 1 Congress Street,Suite 100 Boston,MA 02114--2017 www nass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Lezibly Name(Business/Organization/ludividual): ,C �t� 7�111)0. Address: Cid, Prwok, S p Tebutt AA 7( City/State/Zip: 14uq (4007 Phone#: 9 7d-Y/>) - ©10Y Are you an employer?Check the appropriate box: Type of project(required): QN I am.a.employer with �. : employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in g. 01'emodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3..❑I am a homeowner doing all work myself[No workers'comp.insurance required.]t 10 0 Building addition 4-Ell am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. - 12.F-1 Plumbing repairs or additions 5. I am a general contractor and I have hired the sub-contractors listed on the attached sheet. ❑ 13.E]Roof repairs These sub-contractors have employees and have workers'comp.insurance,; 6.F1We 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 41 must also fill 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 state whether or not those entities have employees. If the sub-contractors have employees,'tYiey must provide their workeis'comp.policy number. I am an employer that is ppoviding workers'compensation insurance for my employees.'Below is the policy and job site information. '�` + 1 Insurance Company Name: f I'Q VG b n li � — Policy#or Self-ins.Lic.#: J(D-1 U tB `, V 14 Expiration Date: /Q"I'1 'r5 Job Site Address: OLI luL p-i34 City/State/Zip: d yS Attach a copy of t e workers'compe• •ation 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 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify un r the pain andpenalties ofperjury that the information provided above is true and correct. signature• - r Date: — 'L� Phone#• 6171415--9M 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 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 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=contractor(s)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 ahy 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.# 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia a DATE(MMIDDIYYYY) �►�o CERTIFICATE OF LIABILITY INSURANCEF 7/16/15 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 NAME: American Insurance Agency PHONErm, 978) 657-0209 FAX No: (978) 657-5551 404 MAIN STREET E-MAIL ADDRESS: Wilmington, MA 018$7 INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:SAFETY INSURANCE INSURED -INSURER B:SAFETY INSURANCE Bradley Lawrenson INSURERC:Ace Group 92 PRINGLE STREET INSURER D: TEWKSBURY, MA 01876 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. INSR AML SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MIDDY MMIDDIYYYY LIMITS GENERAL LIABILITY CP0001782 9/10/14 9/10/15 EACHOCCURRENCE $ 1,000,000 }( COMMERCIAL GENERAL LIABILITY DEREMISa AMAGE TOE(Ea $ CLAIMS-MADE Fx—]OCCUR MED EXP(Anyone person) $ PERSONAL&ADV INJURY $ GENERAL AG GREGATE $ 2,000,000 GENTAGGREGATELIMITAPPLIESPER PRODUCTS-COMP/OPAGG $ 1,000,000 1-1 POLICY PRO- LOC $ AUTOMOBILE LIABILITY 6208114 11/16/14 11/16/15 COMBWMSINGLELIMIT $ ANYAUTO BODIL Y INJUR Y(Per person) $ 100,000 ALLOWNED X SCHEDULED BODIL Y INJUR Y(Per accident) $ 300,000 AUTOS AUTOS NON-OHIREDAUTOS _AUUTOSWNED PerracaidenDAMAGE $ 100,000 UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESSLIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION 6S62UB-5B66665-0-12 10/19/14 10/19/15 TWO CSTATU- OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER IXCL LDED? N I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 Ms,describe under CRIPTIONOFOPERATIONS below E.L.DISEASE-POLICYLIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is regui red) WORKERS COMP CERTIFICATE TO FOLLOW DIRECT FROM COMPANY CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN North Andover ACCORDANCE WITH THE POLICY PROVISIONS. 124 Blueberry Hill ave North Andover MA AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement C_:ntr.'actor Registration Registration: 182440 Type: DBA ' r Expiration: 6/19/2017 Tr/f 267600 B.C. CONTRACTING BRADLEY LAWRENSON Y 92 PRINGLE ST TEWKSBURY, MA 01876 Jr.�At 4` Update Address and return card.Mark reason for change. >CA 1 0 20M-05/11 Address [-] Renewal [] Employment E] Lost Card ��e�oon��adncaecc�Gf a�C�/l/�cc��a�euae� Office of Consumer Affairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration ;A1k440 Type: Office of Consumer Affairs and Business Regulation „7 Expiratio n:= 6/19!20.17DBA 10 Park Plaza-Suite 5170 Boston,MA 02116 B.C.CONTRACTING- ir } BRADLEY LAWRENSON"-t^-,.- i 92 PRINGLE ST TEWKSBURY,MA 01876Vii;,, Undersecretary Not valid without signature # 'Mas sachusetfs _ .BOard Of Bulldira- Department Of.Public Safety L f g Regulationsand Standards:. ,.: Comtruction Supers icor License: CS-106494 . BRADIEy LAWRtNSON- 17.LAWRENCE 66 takT Wilmington MA 6188'7 j 1 • y tY Cti� , T' ExpirafiOn Po+ missioner.. ' . .'11/13i2015`=