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Home My WebLink AboutBuilding Permit #437 - 136 RALEIGH TAVERN LANE 11/30/2012 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION r . Permit NO: / Date Received Date Issued: IMPORTANT:Applicant must complete all items on this page L®CATION, .__(o. - rmt f PROPERTY OWNER-_ _ l�__ /: .rint 100 Yeas Old Structure, yes' t MAF NO? PARCEL ZONIN&�.ISTRICT Histone District y„es, n t - :Machine Shop Village y_ese iio TYPE OF IMPROVEMENT PROPOSED USE Reside I Non- Residential ❑ New Building ne family ❑Addition ❑Two or more family ❑ Industrial ❑AI ion No. of units: ❑ Commercial &fRepair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑Septics ❑�V1/ell� Floodplain” Wetlands ❑ Vl/atershedt®stncV , Oly.V /Sewer -- / DESCRIPTION OF WORK T BE PERFORMED: / 1 /1,201/e Z&/4::�/g � �/liS7✓�/ �C'� !/�/%�G r./S G1/J(� 00'- !4,16 eve e:�rns 9 Identification Please Type or Print Clearly) OWNER: Name: f Phone: �y6 a Address: CQNTRACTOR` Name �°�_�� sito� Phone: Supervisor''s'Gonstruction`License -(aS��( 1Exp Date I " Home'ImprovemenfLicense, ARCHITECT/ENGINEER hone: 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: $ 7,0, � �� - O J FEE: $ Check No.: `� Receipt No.:CPS qqs NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fu ISI•. *' ,r..x"y, �'�""�}i-p.a_3r'z'_"" - +'S?Z4an `-'.`CM°i;;'.�-�-[.�,�•�i^.�a x-� .,y. , ^ '�"x.�"..""'.,i^.=_"—».,,":'L�'f"'"�"'k`� "t,;..� � .e�� n. ,��- -' Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ I _ 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 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 Depaitmenf.sigriature/date COMMENTS I I Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. i Total land area, sq. ft.: i \ 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 I NOTES and DATA— For department use I i i EJ Notified for pickup - Date II I I Doc.Building Permit Revised 2010 Building Department The fofiowing 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 ❑ 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 ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract i ❑ 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 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 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 must be submitted with the building application Doc: Doc.Building Permit Revised 2012 . Location N . Date 0 ` � . } . 3 wv TOWN OF NORTH ANDOVER «\ .• ` � . , . : » w2 > : , Ce$!� b*eofOcupny � $ % a � 6s . y § 2« Building/Frame » � �\ Foundation P r|! F e $ / . . . f . # « Other Permit Fe $ . v TOTAL $ 6 Ch m§ 25999 Building Inspector « » </ NORTH 'Tlown of 6 ndover O - �- N► No. 3 SAN, h ver, Mass, • A_ COC NIC Nl WICK �� 7�AD��TED S U BOARD OF HEALTH -PE R I Food/Kitchen Septic System THIS CERTIFIES THAT........ ..... .........�. .....frpme .. ..... BUILDING INSPECTOR .... 1. � dation has permission to erect .......................... buildings on ............... ......... ....... .44 . .......: ugh to be occupied as .. &......lia. .. ...........I....... 11 ........ .��..... .. 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 • T T VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES M TH ELECTRICAL INSPECTOR UNLESS CONSTRU I TA Rough Service ........... .......... ........................................................ Final BUILDING INSPECTOR GAS INSPECTOR • � i 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. SEE REVERSE SIDE NORTH own Of E ., 6 ndover j 0 1.- ver, Mass, • coc...c..ew.c. S U . BOARD OF HEALTH PER I T Food/Kitchen Septic System T D THIS CERTIFIES THAT , ,,�� ......,,,,, BUILDING INSPECTOR . . . .. ........... dation /ziZ�S has permission to erect .......................... buildings on ...............�. �......... .. ....... ....... .... ; �� / � � - ��t to be occupied as .. �A � '. .��. �� ne ��...... .......... ...... ........... .... y provided that the person accepting this permit shall in every respect conform to the terms of the application nal on file in this office, and to the provisions of the.Codes and By-Laws relf"ting 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 TH ELECTRICAL INSPECTOR UNLESS CONSTRU I TA 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 j Street No. Smoke Det. SEE RE)MRSE SIDE Ma,�•,tiachuse Bu �Ccnpt'gu l7Vp8i9 �Structi 'D, Rutcr';t;�ulatpi�n nl tps`t uSda1CLiense. CS Supertt 65sorCicneardc l I 48 AI A SIL VA N AIVpOVER MA 01845 ^� coli oA — jam Expiration. Tr>#: 4278/2012 5 Office of Consumes erg"" � ' HOME IMP Affairs&Bus Hess RR`'egaucl mon Registration,�VEMENTCONT gulation ,%120334 CONTRACTOR \ Expiration: 11/26/2013. TYpe: _ SILVA LIGHTNIN DBA EMANUEL SIL48 Vgi LINDEN AVE N.ANDOVER, MA 0184:5`,` "`` Undersecretary ti 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 Twenty Thousand Five Hundred Eighty Dollars and 00/100 cents($20,580.00). WORK TO BE COMPLETED:. Exterior& Interior Work Window Installation (16 units) • Remove existing window shutters. o Remove existing storm units. • Remove existing exterior trims. (head and side casings) • Remove existing interior trims. (head and side casings/stools and aprons) • Remove existing siding along sides of windows. (in order to apply self-adhering flashing) (as best as possible/may require new siding, depending on condition of existing siding, resulting an additional cost to the job) • Remove existing window units from openings. • Prep openings for window units. (self-adhesive flashings with pitched sill) • Install new window units. . (homeowner supplies) • Apply self-adhesive flashing to exterior of window flange. (helps keep out water and moisture) • Spray insulation around window units. (low expansion foam) • Cut and assemble exterior window trim packages. (Kleer pvc products/same design as existing/glue and pocket screw together) • Install exterior window trim packages to windows. • Re-install existing siding. • Cut and assemble interior window trim packages. (same as existing/glue and pocket screw together) • Install interior window trim packages to windows. • Caulk interior and exterior weather tight. Door Installation (1) • Remove existing storm door unit. • Remove existing exterior door trim. (head and side casings) • Remove existing interior door trim. (head and side casings) • Remove existing siding along sides of door trim.(in order to apply self-adhering flashing) (as best as possible/may require new siding, depending on condition of existing siding, resulting an additional cost to the job) • Remove existing door unit from opening. j • Cut and apply self-adhesive flashing to existing opening. (helps protect structure from water infiltration) • Prep opening for door unit. (level,plumb and square with pitched sill) • Install door unit into opening. (homeowner supplies) • Cut and assemble exterior door trim package. (Kleer pvc products/same design as existing/glue and pocket screw together) • Install exterior door trim package to door. • Reinstall existing siding. • Spray insulation around door unit. (low expansion foam) • Cut and assemble interior door trim package. (same as existing/glue and pocket screw together) • Install interior door trim package to door. • Install new lockset. (homeowner supplies) • Caulk all trim weather tight. Family Room (walls only/767f) • Remove existing base board and door trim in room. • Remove existing wall paneling. • Remove existing wall board. • Remove existing insulation in walls. I �E • Install new insulation to walls. (fiber glass) • Install vapor barrier to walls. • Install new wall board. (blueboard) • Apply plaster to board. (smooth finish) • Cut and install new baseboard and door trim. (same as existing) Contractor will supply permit. (price to be determined) Contractor will supply materials listed. Homeowner 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: $ 15,350.00 Stock: $ 4,505.00 Debris: $ 725.00 Total: $ 20,580.00 PAYMENTS Deposit on signing. (11/30/12) $ 200.00 On start of job. $ 6,800.00 Half way through job. $ 7,000.00 When job is completed. $ 6,580.00 (Job will take about 6 to 7 weeks,subject to change depending on weather or additional work) (Approximate start date of December 4,2012, subject to change) 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 BUILDERS By: Emanuel A. Silva, Contractor Pe Sparro , Ho eowner PAGE 4 OF 4 DATED: NOVEMBER 30,2012 THE COMMONWEALTH OF MASSACHUSETTS Department of Public Safety I One Ashburton Place, Room 1301 Boston, MA 02108-1618 APPLICATIONFOR RENEWAL OF CONSTRUCTION SUPERVISOR LICENSE Er nanoet A , S,-Jur, VAME $ G('nden Aue ADDRESS vr4-k CITY OLD ADDRESS E'S; iyA �70 � Mfr 2on,ne -� -CS � � �� E-Mail Address Licenses not renewed by the expiration date become void, and shall after a two-year period, be reinstated only by examination of the licensee(780 CMR 110.R5.2.4 All). 1_ tttttlTE renewa! ].t tnC�S 'Fill L�2 52n;�3t47 n ;g I rs si ? ^at-oLi t s t f OSS i7 «I�iz1i ,ni3 ::P_3 tixic'S, ?i-ider -pains, an-a penalties of y)erj .'F tljc:t t�.Ck5ilt' 3S iii ctlis'e t.3 ' n2tSCa it?Lt. f` cl{4lr'tt ,5 ; - (PIease refer to the certification line at the bottom of this form.) E � b AUTHORIZATION FOR RELEASE OF RMV INFORMATION: My signature below.aut >rizes the Department of Public.Safety to electronically access my photogra h om the Massachusetts Registry of Motor Vehicles i ( ` i fl-) data e soi f u on this license/registration. 1 .:; l MA- RMV photo Blease signature w i v Otherwise please submit a color Passport Photo 2x2 inches in size taken within j .g,45!P the past 6 months showing current appearance. Tape photo on edges to the bot 4�Cp" Attach photo on the left with clear tape. Tape photo edges to this bn�. Please enclose a check or money order made payable to the Commonwealth of Massachusetts for the required renewal fee of $100.00. DO NOT MAIL CASH. Please include your license number on the front of the check or money order. Mail the completed renewal form with payment and photograph to: Department of Public Safety- CSL Renewal P.O. Box 414376-Boston,MA 02241-4376 Also, Y`1Casc j-F1C fl �[2 LE'33tt71E'i1L Di pt1i711C car ih' E�SiiE' tCi? www.mass.gov/dps r, r.,�';t' F. C Ctitti•Ii to Vt3ircl.;..lta�C`r COnstruction.9"'(supervisor_'-iC TSCe F t`"' I hereby certify under the pains and penalties of perjury that to the best of my knowledge and belief the information above is correct and that I have filed all state tax returns and paid all state taxes required by law,and complied with all laws of Commonwealth relative to th ithholding and payment of child support. Signature of Applicant Date I hereby certify,under the pains and penalties of perjury,that I Si ature am unable to access e-mail notifications and therefore request U.S.mail notifications of renewals. Date s:\admin\current forms\bbrs\app]_csI_renewal_8 2011.docx The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 UT. www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): / (/tn C. i hTn i it t 1��s Emo%A0C Address: �6 &,ide/, Ae City/State/Zip: V. A(I(3V(,0' MA 0 SY.�Phone#: q 76- 6 9g Are y an employer?Check the appropriate box: Type of project(required): 1. I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/ r part-tai have hired the sub-contractors 2.❑ 1 am a sole proprietor o artner- listed on the attached sheet.$ emodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9. ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.F1 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 we have no 12.❑Roof repairs insurance required.]i employees. [No workers' 13.❑ Other comp.insurance required.] *Any applicant that checks box#I 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 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. e ( n Insurance Company Name: A 5 s �t�Aepr M�i9 yj Cf 1 r1.5ura li c P Policy#or Self-ins.Lic.#: S o 1 oS ( ()U 12c) I'L Expiration Date: IZ_ q'l IF, Job Site Address:_ 13 C e iPn h I oiye.-n JagCity/State/Zip: �! A/t dOdfi MA 0��,� 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 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cert' trader th ains a alties ofperjury that the information provided above is true and correct. Si nature• / Date: j' P Phone#: 91 TJ�J 6 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 otrustee of an individual,partner ship,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 v 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'complAe 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 suretofill.dii the permit/liceinse'number which will be used as a reference number: In addition,an applicant r 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 any 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 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: j The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 5-26-05 www,mass.gov/dia