HomeMy WebLinkAboutBuilding Permit #690-2016 - 127 KARA DRIVE 12/7/2015 BUILDING PERMIT OF,tLED NORTy,6 qti
TOWN OF NORTH ANDOVER a�
APPLICATION FOR PLAN EXAMINATION
T Z y
Permit No#: �/ �V Date Received
�RgDR^tED I.PP� 5
�SSACHUS��
Date Issued: 1
IMPORTANT:Applicant must complete all items on this page
LOCATION 1 Z ' IRA O��� �
_ Print
PROPERTY OWNER
Print 100 Year Structure yes no
MAP PARCEL: ZONING DISTRICT: Historic District yes no
Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building P�TOne family
El Addition ❑Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
Septic ❑Well ❑ Flood plain ❑Wetlands ❑ Wateished.Distiict.
El Water/Sewer .. ... y. s
w
DESCRIPTION OF WORK TO BE PERFORMED:
Identification- Please Type or Print Clearly
OWNER: Name:_ Phone:
Address: /02 /cam/� /�� Am'2/J�Jc-"�'l
Contractor Name: Phone:
Email: T ;1 o.VAli
Address: 3 i> TT-e-Pkt C-1 x4K4-f-
Supervisor's Construction License: C�G�! Exp. Date: �4 3 2
Home Improvement License: 112 Exp. Date: 2�/
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE:BULDING PERMIT:$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ ��` b0° ` ° FEE: $ <z2�
Check No.: \ Receipt No.: 2--cl- 1
NOTE: Persons contracting w'h unregistered contractors do not have access to the uaran fund
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL f
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 m U FORM
PLANNING & DEVELOPMENT Reviewed On Signature_
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
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 DEP
__ ��AR�TtMENT ;T;�em ® er, gntsite. yes,
. _ . - P k.
um st
s LocatedLat 12
� 4(Mam�Street
i F e 1 e _ ,
_,..apartmentdsignature/date:
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 Permit Revised 2014
J
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
4, Building Permit Application
,4. 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
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)
24. 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
Doc:Building Permit Revised 2014
Location 2-
No. Q —Zoe Date 2 9
• - TOWN OF NORTH ANDOVER'
S
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check#G
/– .., 775 Building Inspector
NORTH
own of ndover
0
No.
h ver, >
Mass •� ��
o
cocNicMew1cK 1'
'lsi9s RATED I.PP��,�S
U BOARD OF HEALTH
Food/Kitchen
Septic System
THIS CERTIFIES THAT
PE -RM ,IT
�m, ,. BUILDING INSPECTOR
... lG.......... 111�.11�. . ................ ............................... . ... .....
Foundation
has permission to erect .......................... buildings on ..�+r...�..... { .... �............
Rough,
tobe occupied as ....... ... ....�i ....... ... .................................................................. 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
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
Final
PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
UNLESS CONSTRUCT1 ST S Rough
Service
................ ........ ... .. ..................................... 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.
C
.....................
�o - Types
�c��r�i�G L�cra�anc�
�1�^'r )�t=,�9Y�.t Of
CAP ED All
CExpert Masonry Work
Mass Toll Free - Licensed& Insured
1-800-WAIT-4-U.S n Locally ilp O+tr+ed&Operate I .
License#034200(924-8487)
3 d2�� � 2 QG rJ l We Work 'Year
Round i
iV ..
Proposal 10: Pete & .Kathleen Bennet Date .1.1/19/2015
Street: 127 ]Kara Dr. 978-273-7859
N. Andover
Roof proposal kathleenbennettl?7 cr gniail.com.
Certainteed Landmark
1- Extra caution will be taken to protect Douse and 12. Removal of all work related debris.Planks will be
landscaping as best as possible. (tarps etc.) placed under dumpster to prevent any damage to
Magnets run at final clean up. driveway.
2. Remove all shingles from entire house. 13- Building permit included.
s\ 3. Inspect and re-nail any loose or lifted plywood. .14.Contractor workmanship warranty: 1.0 years under
Any compromised plywood will be replaced at an normal wind and rain conditions.
additional cost of$70.00 per sheet of 1/2" CDX.
i\ 4. Install heavy gauge 8"aluminum drip edge to all roof ®Sly' S 19,000.00
eaves and rakes. White, brown or mill finish
5. Install 6' of Certainteed Winter Guard ice and
water shield along all eaves and top to bottom in Certainteed 3Star extended direct Ml FrG warranty
all valleys. A fully transferable 1.00% coverage against
6. Install Certainteed Diamond.Deck synthetic material defects for a fully non pro rated period of
underlayment to remaining sheathing up to ridge. 20 years, Please refer to pamphlet left in estimate
7. Install all new pipe boots. folder. Offered to our local referrals and included
8. Install Certainteed Swift Start starter shingles to in this proposal at no additional cost.
all eaves.
9. Install Certainteed Landmark PRO Limited Balance due upon completion
Lifetime architectural shingles to entire house. l0
year material MFG. warranty. (See extended R.cferences available upon re(jue4t
warranty)All shingles will be installed and fas-
tened according to r ,fg. specs. Hiehly rated member of the accredited BBB and
10. Install new GAF Cobra ridge vent and cap Augie's List
color matched Certainteed Shadow hip and ridge
shingles. (I\4A code) Thank youI
1.1. Counter flash existing chimney lead and all roof
protrusions with ice and water shield,tie into new
shingles and seal with clear Geo-Cel sealant.
Acceptance of Proposal—'I'h.e above prices, specifications and conditions are satisfactory and are 4erby
accepted. You are authorized to do the work as speci ted. Payment will be made as outlined abov"t
- __–
--
Date of Acceptance: 'I €, -— Signature: ` f
�r
Z'\ The Commonwealth of Massachusetts
Department of Industrial Accidents
I Congress Street,Suite 100
Boston,MA 02114-2017
kvi www.mas&gov/dia
Workers'Compensation insurance Affidavit:Builders/Contractors/Electricians/Plombers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Le-ibly
Name(Business/Organization/Wividual): All 41
Address:_ 3" —
City/State/Zip: " ---\ r"`` j Phone#:
Are you as employer?Check the appropriate box: Type of project(required):
I.Q I am a employer with employom(full and/or Part-time).* 7. ❑New construction
2.[]1 am a sole proprietor or partnership and have no employees working for me in 8. E]Remodeling
any capacity.(No workers'comp.insurance required.]
3.01 am a ho.doing all work myself.[No workers'comp.insurance required.)t 1 Demolition
10 Q Building addition
4111 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 sok 11.0 Electrical repairs or additions
propridors with no employees.
12.D Plumbing repairs or additions
S I am a general contractor and I have hired the sub-contractors listed on the attached shod. 13.DRoof repairs
These sub-contractors have employees and have workers'comp.insurance.I
6.E]We are a corporation and its officers have cxcmisod their right of ex MGL c. 14.�Otlter
exemption Pn
152,§1(41 and we have no employees.[No workers'comp.insurance required.]
*Any applicant that checks box#1 must also 611 out the section below showing tbeir 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 chock this box mast attached an additional sheet showing the name of the subcontractors and state whether or not those entities have
employees. If the subcontractors 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:
Policy#or Self-ins.Lic.#: Expiration Date:
Job Site Address: a rl �Z�� ��,�'� City/StatetZip:
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 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 unpains and penalties of perjury that the information provided above is true and correct
Signature: Date:
Phone#•
Oflw- al use only. Do not write in this area,to be completed by city or town of)`ieiaL
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-contractors)name(s),address(es)and phone number(s)along with their 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 or license is being requested,not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you arc 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 permitAicense number which will be used as a reference number. In addition,an applicant
that must submit multiple permitAicense 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 Department's address,telephone and fax number.
The Commonwealth of Massachusetts
Departrnent of Industrial Accidents
I Congress Street, Suite 100
Boston,MA 02114-2017
Tel. #617-72741900 ext.7406 or l-877-MASSAFE
Fax#617-727-7749
Revised 02-23-15 www.mass.gov/dia
Gn CERTIFICATE OF LIABILITY INSURANCE DA'fE(t1M1DDNYYY)
�y " 5/2812016
I4I5 CERTIFICATE IS IS5UED AS A MATTER OF INFORMATION ONLY AND CONFF I
ERS rap RIGHTS UPON THE CERTIFICATE HO?DER. THIS
.ERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
tiLOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT $ETWEEN THE ISSUING INSURER(), AUTHORIZED
:CPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER.
IMPORTANT: Ir the certtficate holder Is art ADDITIONAL INSURED,the poky(les) must be endorsed. If SUBROGATION IS WAIVED,subject to the
rens and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not Confer rights to the
*$I,icate holder In lieu of such endaisement(s).
%iTuR �'- ,I"cT Berkley Assigned Risk Services
ikilvemai Insurance Agency Incr .'r5 $DD 634-4589 FA
7�' Belmont St 856 215-$118
�oII�: PoF.cy�sen,'.ses�5erkt2yTisls.eom
Voyooster, MA 016.04
_]N3IJXERM AFOR NO COVERAGE NAIC11
IF LR h Acadia Insurance-Go- 31325
'v��IncD
MIG Construction Inc LesrAER e:
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Z�`+dr71�7I'SS St 0:
INSURER 42
Cif60rd, PY1A 01757
rsUREst E
It�SLRER F.
4VJiRASES CERTIFICATE rwr-aBER: _ _ _ _ F VtStOr1 iiU`.it3EFt:
I4iS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LIST[=3BELOLE HAVE i31 N[SSIJEA TOTHEI SUREEMrED ABOVE FOR THE POLICY PERIOD
NDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
"ERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
XCLUStOfdS A.ND CONDITiTt4$of SiiCH pCUCW..l-MITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
TYPE OF INSURANCE INSR TELLU D POLICYHUGI6=R OLwT° POLICY EX Lltlrr5
JU(DDIYYY L JIDDIYYYY
GG ENERAL LIABILITY
AUTOCDBILE LIABILITY I $
WORKERS COMPENSATION Q.\YC STATU• 0TH•
AVD EMPLOYERS'LIABILITY YfFr � TORY MATS ER
ANY PROPRIETOR/PAFRTUePh x-0UT(VL' C1
OFFICMEMBEREL EACH ACCIDENT E 1,D00,000
rc. E EXCLUO£QT NIA WC-2Q-2MG565MI) 05/2af1015 Q51201201&
IMandrioryto NN)
If yet•detthbe Vader L DISEASE•EA EMP OYES 1,000,000
OSGCRIPTON0F,OP6RATIONSbelov _ E.t ❑ts AS _AOLICY N.tT 1,000,000
�'?.CR,p TaV N OF OaERktIOgS t LCCk7IOW6 t VEH[ZLE5 CACI- b ACCORD 101.Addiftnal Rar-arks Bched_6.Q rre agc:c,sreau'stdp
Coverage.
I to Category Elect.Status Naine state(s)� ) All)^t1tiL+t?s Lntatiarts
Officer Include Maria Guaman MA MGG Construction Inc
83 congress St Milford,MA 01757
dERTIFIGATE HOLDER CA4iCELLAT-15M
SHOULD ANYOF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED I N
VIII Under One Roofing ACCORDANCE WITN.THE POLICY PRO.VISiONs.
U HD t•!t TIV
12 Temple St
V�thuen, MA 01844
Signatures / !J .� -'"' L,
:ORO 25(2010/05)
at
MM8801oh-Usefts-Department of Public SafttV
Board of Building Reguleflons and Stmdarft
Cow. ruedart
License: C&M120
40
30 TEMP DU
MZTfWMMM-A' a184
Expiration
comyrrissioner 001201?
OUENUFf M--gIbLI 61 It,,,
Click on tie registration niumber to view comPl8int history,You Dan' also view a
)nand Guara
history. taMI!2 ��Fund
The list i4urrent as of Wednesday, October 8, 2014,
Search Results
RI 1_'MMT RESPONS113LE RIE-GISTRATION
"0
JM INDJVWUAL NUMBER STATU
DATE
A"UNnEIROKU 8000 LANZAFAME, 137057 166 A ME"iMACK ST 10=120-t6 Current
JOHN METHEON, MA 01844
02012 Commonwealth of Massachusetts.
registered Service mark of the C(5mmonweaith or Massachusetts.
——----—--------........