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HomeMy WebLinkAboutBuilding Permit #881 - 136 RALEIGH TAVERN LANE 5/31/2012 gUILDINC PERMIT of "°oT" qti o TOWN OF NORTH ANDOVER �`h: APPLICATION FOR PLAN EXAMINATION 41 Permit NO: �qz Date Received 4i Rgop eo JI pa`` y wr �SSACHUS�� 1 " Date Issued: S" 3 1 Z" IMPORTANT:Applicant must complete all items on this page r`•:pC1TION. � F ' ' 'k`T �a y�'��=� -rAri,� •'��r�? �G't��*'� �°}�iw r ®xA 4rt1 � . �_T i4+ •�M b S� MY "'c: h�'Qw YI`b a3 F '� R• �r��� �Y,.. N P R 0 Q E R NER��-CsK+u��T � ' *�ir"'d'��'�4,�"�-,Stint t,� P�'��,jer"t.����+����y .S.M1�L "t������•,� t y}Y^4 � z VY OWE �f-L�� ®ISTRIC�T . '� �Histon'd Distract yes, ono_.: TYPE OF IMPROVEMENT PROPOSED USE Re ' Non- Residential New Building �familYAdditio ily Industrial teration ' No. of units: Commercial air, replacement Assessory Bldg Others: Demolition Other r; 5ep �Well � kFlootlplavn yWetlands f # , f f 'VI/atershetl Districti,� �, at �. ater/Sewer"� ;°�' /y DESCRIPTION OF WORK TO BE PREFORMED: 1)170 ve Identification Please Type or Print Clearly) OWNER: Name:— fW// S ��„c.�/ Phone: Address: 136 f''`"�C.4a+..'''FF� 4 rf i-„ {, �� �;...`. f * �at# i•COVIM- ACT4®R Namez.�c �+ .� �.� c�� i p,m- ". _3'`? k1'*:� cam.kF•a,y-7'' '�"" 56 x,,' b,, - - t r"' �mgg'13� S`� 4 t/� � .�dre �/: r u� 1i i7 � � } 4 ^ 4ssaY' �No 7F W7 t« u n USC/� / f x� ; a -,'" - '• 4S > :�Y S w Aff ' Kr CM ,F; # c`* ,,,*� � Supervisor s Construcfion License � ��� '�( -4l��' � ��,� ,.� � �,y{,�.a� :,._.� �,- �►�� Exp Date 5�• y * ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925,00 PER S.F. 00 Total Project Cost: $ FEE: $ (� Check No.: Y�� Receipt No.: �j?� NOTE: Persons contracting with unregistered contractors do not have access to!45 h guaranty fun it- Signature of A'gent/Owher . .. Signature ' c6 -r 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 I PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature COMMENTS i HEALTH Reviewed on Siqnature 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 Streetyyyy Fire Departmentsignatureldate GOMMENT:S 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 - Date i I i — Doc.Building Permit Revised 2008 I 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 ❑ 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 o 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 I NJOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New ConstructionSin le and Two Family) � 9 Y) � ❑ .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 10TE: 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:INSPECTIONAL SERVICES DEPARTMENTMFORM07 Revised 2.2008 Location Y&A 71 No. 9471 Date-- i • ' TOWN OF NORTH ANDOVER Certificate of Occupancy XS 4 ° -t Building/Frame Permit Fee --�" Foundation Permit Fee "$ Other Permit Fee $ TOTAL Check#kk 25391 Building Inspector CX The Commonwealth of Massachusetts • - Departmentoflndustr aUccidents Office oflnvestigations ' 600 Washington Street .Boston,MA 02111 www.massgov/dia Workers'Compensation Insurance Affidavit:Builders/ContractorsfFIectricians/rlwmbers Applicant Information Please Print Legibly Name(Business/Organizationllndividual): SIL21 � ( C, 6"AnU Q S �,Minr1Ve S�'Iv4 p / Address. y U Cj r d� /{�'l UC' . City/State/Zip:_ /0!/t'r AV a/�f'yaone#: cl 79- 6 06- s1/(V Are you employer?Check the appropriate box: Type ofproject(required): 1.. am as employer with4. ❑ I'am a general contractor and I 6. ElNew coon employees(full and/ -time).* have liiredthe sub-contractors 2.❑ I am a sole proprietor or - listed on the attached sheet.z 7• emodeling ship and'have no employees These sub-contractors have S. ❑Demolition working forme in any capacity. workers'comp.insurance. g, Building addition [No workers'comp.insurance 5. El We area corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself.[No workers'comp. c.152,§1(4),and wehave no 12.❑Roofrepairs insurancerequired.] employees.[No workers' 13.❑Other comp,insurance required.] 'Any applicant that checks box#I must also fill outthe section bel6w showingtheir workers'compensation policy information. Homeowners who submit this affidavit indicating they fire doing all work and then hire outside contractors must submit anew affidavit indicating such. tContractors 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:. A S S UC ch�ed EM Plo�(Ct S .3-'n vlG�i C.Q Cd m P n Lj Policy#or S elf ins.LIG.#: S� U S d d 12 O I t Expiration Date: 2' 4q Z Job Site Address: 13(l Tti V(h LOA eCity/State/Zip:_ l�a�-i, Ari dGyrl- A O/$ys Attach a copy of the workers'compensation p olicy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL c.152 can lead to the imposition of criminal penalties of a flue up to$1,500.00 and/or one=yearimprisonment,as wellas civilpenalties in the form of a STOP'WORK ORDER and a fine of up to$250.00 a day against the violator. Do advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA.for insurance cove age verification. X do hereby cer unileY fl pai a penalties ofperjury that the information provided above is true and correct - i ature Date: �� •3 I� Z Phone 0: 7 [[0fjfJ":c!a7se only. Do not write in this area,to be completedby city or town official.ityown: Permit/License# ssuuthority(circle one): 1.Bof Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector [.OConerson: Phone#: i I - 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"...everyperson in the,service of another under any contract ofhire,- 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 tmstee 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 shallirot 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 ofpublic work until acceptable evidence of compliance with the insurance requirements of this chapter have b eon 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 numbers)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 maybe submitted to the Depart mentofIndustrial Accidents for confirmation ofinsurance 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 dire 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. fn 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"an locations in (city or town)"A copy of the affidavit that has been officially stamped or marked by the city or town maybe 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.More a homeowner or citizen is obtaining a license or permit not related to any business or commercial venture i.e,a dog g lice nse or permit to burn leaves etc)said person is NOTxequired to complete this affidavit. The Office of Investigations would like to thank you in advancefor 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. Tho CQmmonweall ofM-0machv..soffig Dep.aftcut QMdustdal,A..celdwts Office ofInvesfigat ions 604Washio0a Stxcet BOSWU,MA,02111 Toll#617-72,7-4900 QYd 406 or 1-877,MA.SSAFB Revised 5-26-05 Fay,#617,4727-7749 SILVA LIGHTNING BUILDERS 48 LINDEN AVENUE NORTH ANDOVER,MA 01845 (978)688-5464 O/F (617)799-4585 C CONTRACT AGREEMENT I,Emanuel A. Silva of Silva Lightning Builders will perform work on 136 Raleigh Tavern Lane, North Andover,Massachusetts 01845 for the sum of One Thousand Three Hundred and Five Dollars and 00/100 cents($1,305.00). WORK TO BE COMPLETED: Exterior&Interior Work Door Installation (front door) • Remove existing storm door unit. • Remove existing exterior trim. (head and side casing/save pediment if possible) • Remove existing interior trim. (head and side casings) • Remove existing siding along sides of door trim. (in order to apply self-adhering flashing) • Remove existing door unit from opening. • Cut and apply self-adhering flashing to existing opening. (helps protect structure from water infiltration) • Prep opening for door unit. (level,plumb, and square with pitched sill) • Prep new door unit for opening. (contractor supplies/Masonite products%homeowner agrees with door selected) • Cut and assemble exterior trim as trim package unit. (Kleer pvc products/same design as existing/using existing pediment if possible) • Remove new door from jamb. • Install exterior trim package to jamb. (pvc glue and pocket screw together) • Apply self-adhesive flashings to back of exterior trim package. (helps keep out water and moisture) • Install door unit to opening and secure to sheathing. • Seal self-adhering flashings to house wrap. • Install door into jamb unit. • Spray insulation around door unit. (low foam expansion) • Cut and assemble interior trim as package unit. (same as existing) • Install interior trim. • Re-install existing siding. • Install new locket. (supplied with door unit/homeowner agrees with lockset selected) • Caulk interior and exterior weather tight. Contractor will supply permit. Contractor will supply materials listed. Contractor will dispose of debris. Contractor will not paint or stain. Construction Supervisor License No. 65791 Northland Insurance Company Home Improvement Contractor No. 120334 (Liability Insurance)Policy#WS098714 FULLY INSURED Associated Employers Insurance Company (Workers Comp)Policy#5010510012011 Any other work that needs to be done that is not explained on this Contract Agreement will be executed only upon written order from the Contractor and signed by both parties becoming an extra charge over the agreed amount. CARPENTRY WORK Labor: $ 1,125.00 Stock: $ 50.00 P/D $ 130.00 Total: $ 1,305.00 PAYMENTS Deposit on signing. (05/30/12) $ 400.00 When job is completed $ 905.00 (Job will take about 3 to 4 days, subject to change depending on weather or additional work) (Approximate start date of June 11,2012,subject to change) I, Perry Sparrow,have had the opportunity ity to read the above and understand the terms contained therein and by signing this Contract Agreement I agree on paying Emanuel A. Silva of Silva Lightning Builders for the work itemized above on this Contract Agreement. SILVA LIGHTNING ILDERS By: Emanuel A. Silva, Contractor Pe parrow, eowner PAGE 3 OF 3 DATED: MAY 30,2012 tAORTF1 TO" Of 2 ``_., Andover . . . No. ' 'LAKE o , lover, Mass., �O COCHICHEMCK ATED BOARD OF HEALTH Food/Kitchen PER Septic System -BUILDING IT T D A.......o...n........ fIL2INSPECTOR r/nr� THIS CERTIFIES THAT............ .... ..,..... Foundation has permission to erect.... ................ buildings on . ......... ... ...... .' � Rough to be occupied as............ ..........:... ............... ......... .. ....:.:....................... ......................:.......:................... Chimney provided that the pers.-o--n-.11 erson accepting this permit 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 Final PERMIT EXPIRES IN 6 NTHS 30 * T STT ELECTRICAL INSPECTOR UNLESS r LESS CONSTR V C ST � 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. I,Perry Sparrow,have had the opportunity to read the above and understand the terms contained therein and by signing this Contract Agreement I agree on paying Emanuel A. Silva of Silva Lightning Builders for the work itemized above on this Contract Agreement. SILVA LIGHTNING ILDERS By: Emanuel A. Silva, Contractor Pe parrow,116M eowner PAGE 3 OF 3 DATED: MAY 30,2012 • Install door into jamb unit. • Spray insulation around door unit. (low foam expansion) • Cut and assemble interior trim as package unit. (same as existing) • Install interior trim. • Re-install existing siding. • Install new locket. (supplied with door unit/homeowner agrees with lockset selected) • Caulk interior and exterior weather tight. Contractor will supply permit. Contractor will supply materials listed. Contractor will dispose of debris. Contractor will not paint or stain. Construction Supervisor License No. 65791 Northland Insurance Company Home Improvement Contractor No. 120334 (Liability Insurance)Policy#WS098714 FULLY INSURED Associated Employers Insurance Company (Workers Comp)Policy#5010510012011 Any other work that needs to be done that is not explained on this Contract Agreement will be executed only upon written order from the Contractor and signed by both parties becoming an extra charge over the agreed amount. CARPENTRY WORK Labor: $ 1,125.00 Stock: $ 50.00 P/D $ 130.00 Total: $ 1,305.00 PAYMENTS Deposit on signing. (05/30/12) $ 400.00 When job is completed $ 905.00 (Job will take about 3 to 4 days,subject to change depending on weather or additional work) (Approximate start date of June 11,2012,subject to change) t SILVA LIGHTNING BUILDERS 48 LINDEN AVENUE NORTH ANDOVER,MA 01845 (978)688-5464 O/F (617)799-4585 C CONTRACT AGREEMENT I,Emanuel A. Silva of Silva Lightning Builders will perform work on 136 Raleigh Tavern Lane, North Andover,Massachusetts 01845 for the sum of One Thousand Three Hundred and Five Dollars and 00/100 cents($1,305.00). WORK TO BE COMPLETED: Exterior& Interior Work Door Installation (front door) • Remove existing storm door unit. • Remove existing exterior trim. (head and side casing/save pediment ifpossible) • Remove existing interior trim. (head and side casings) • Remove existing siding along sides of door trim. (in order to apply self-adhering flashing) • Remove existing door unit from opening. • Cut and apply self-adhering flashing to existing opening. (helps protect structure from water infiltration) • Prep opening for door unit. (level,plumb, and square with pitched sill) • Prep new door unit for opening. (contractor supplies/Masonite products/homeowner agrees with door selected) • Cut and assemble exterior trim as trim package unit. (Kleer pvc products/same design as existing/using existing pediment if possible) • Remove new door from jamb. • Install exterior trim package to jamb. (pvc glue and pocket screw together) • Apply self-adhesive flashings to back of exterior trim package. (helps keep out water and moisture) • Install door unit to opening and secure to sheathing. • Seal self-adhering flashings to house wrap.