HomeMy WebLinkAboutBuilding Permit #811 - 149 BRIDGES LANE 6/2/2011 TOWN OF NORTtJI ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: Z l IMPORTANT:Applicant must complete all items on this page LOCATION IHg Fs L—PJ 01rd!AS, Print PROPERTY OWNER 2 t M SCA i LL 1 S Print MAP NO:1PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes C TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building One family El Addition ❑Two or more family ❑ Industrial ❑ fetation No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other - ��h � ;�: ��'�s-la,... aa - : +sx•�r-���;x��< sr OEM �3-�'' q Seytic'3 DiFloodptlam Wetlands .�F , D,WatershedIDistr�ict�ks ; ,��0 Water'/Sewer_ 4 � � ���" .. i - r�.�*� _ :��5� lo r DESCRIPTION OF WORK TO BE PERFORMED: E t W (Zoo s�R � r�Fn/ti sT � � Pryer—tom A N Identification Please Type or Print Clearly) OWNER: Name: KaTIJ Lfli►-I WIL-1-I S Phone: 97,9 to154-1 qq 11 Address: m9 RV,1VL-4E5 Inc N A,yJ,0 \Jf(z I MA CONTRACTOR Name: � I(��oN Phone: 6(7 33,1 38&e> 4. Address: Jz. koy4 i- SA AFM ,.n1 o3o-7! Supervisor's Construction License: 91,2�,IC Exp. Date: 0jpJiy)2oiz_ Home Improvement License: 19879(o Exp. Date: tv/20�zo I 1 ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COSTBASED ON$925.00 PER S.F. Total Project Cost: $ 214K, FEE: $ f Check No.: 2$1�J Receipt No.: c9,q�), ok— NOTE: Persons contracting with unregistered contractors do not have access to the guaranty f nd Signature of'Agerifl0whie Signature_of_contractor 1 _'-,ys'°y-s.a -.:wz w'�.;�r .sv�s yY�- �•a�s-i:. Location No. Date TOWN OF NORTH ANDOVER p L F � �, ; + Certificate of Occupancy $ - cMuse< Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check #. 24t� U � Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art r] Swimming Pools El 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: FIRE DEPARTMENTLocated384 Osgood Street -Temp Dempster on site yes no Located at 124 Main Street Fixe 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 service drop requires approval of No 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 2009 Building Department artment 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 o 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 Permi Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract o Flo or/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 Permii New Construction (Single and Two Family) o Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ CopyContract of - ❑ 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 Permii 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 2008mi Licensed E Insured Member of Boston Better Business BureauPro p o5al Page No of Pages BROOKLINE MALDEN, (617) 734-9100 , COH N (781) 322-0822 ANDOVER I. TOLL FREE (978) 475.1145 888.646-9'111 FULLY LICENSED HOME IMPROVEMENT SPECIALISTS FULLY INSURED 405 WALTHAM,ST.#336,LEXINGTON,MA 02421 PROPOSAL SUBMITTED TO: PHONE DATE KA1r4 l•c�t t�tLi� '?_744- lt�s.�i 1`1`111 )1-113JI1 STREET JOB NAME CIT,Y,`STATE AND ZIP CODE JOB LOCATION f'•17� Ott rLl ! ()M111' ARCHITECT DATE OF PLANS JOB PHONE ' Cohen Construction,Inc.hereby submits specifications and estimates. 6,01e[ +; c t v:�t s R LL l..rat,. f r'Z tea r S) -All Permits&Fees Included -All work to be completed by Cohen Construction,Inc will comply with Certainte.ed's strict Standards for roof practices -Strip roofing materials down to the roof decking. -Replace up to 75ft of Boards and up to 3 sheets of plywood at no additional charge. - ►1- `G A� -An additional charge of �,� per sheet of plywood will be added to price if exceeds allowance. GoL -An additional charge of ' ?_ per board will be added to price if exceeds allowance. -._.__.a--------=--~— � -Install six feet(two rows)of Certainteed'Weather Watch'Ice and Water Shield to all eaves of roof. : -Install Certainteed's'Diamond Deck'Synthetic Roofing Underlayment on remaining of roof. -Install-eight inch aluminum drip edge( U,;t?I i 1P color)to all edges of roof. Install new aluminum pipe.flanges to all plumbing exhaust pipes. N)_Install new lead counter flashing to base of Chimney(s) -Install a _Lrt3"1�J`year Certainteed Shingle of roof. -Shingles will be fastened with appropriate sized nails to meet Certainteed's Warrant minimum. 9 _ Y Y/ N for roof to be hand nailed. Cohen Construction,Inc.recommends all Boarded Roof Decks to be hand nailed. (_Y/_N)_hurricane nailing. -Install an'Air Vent'baffled ridge vent f t to all ridges es of hausproper _ ...._ e to allow for g a exf.aust ventiia ion. -_ g ALL DEBRIS WILL BE REMOVED BY COHEN CONSTRUCTION INC CONSTRUCTION, -Cohen Construction,Inc.practices proper techniques while removing old shingles from roof. -A magnetic sweep of premises will be completed. -All gutters and.down spouts will be cleaned 12 YEAR GUARANTEE ON WORKMANSHIP _5a 0 YEAR GUARANTEE ON MATERIALS Designingthe Balance System for Attic Ventilation Research has shown that the best way to ventilate an attic is with a system that provides continuous airflow along the / entire underside of the roof sheathing.Achieving this desired airflow requires a balanced system of intake ventilation low at the /! roof's edge or in the soffit/eaves and exhaust ventilation at the ridge.Cohen Construction,Inc.herebysubmits additional work to be performed to the soffit area of the house,to meet/exceed necessary warranties by Certainteed. r Acceptance ( Y N)> cIj v Cohen Construction.will perform such work to soffit area: Me AhOPWSC hereby to furnish materia�andrlabor-complete in accordance with above'specifications for the siim of rot I 1 I't�yS(3TVQ.�P_c.t.F {tom q���;<[� l Circ! t�11 r4'il dollars Payment to be e s ollo s:, f �� . � (�F. f G t i( .R'. .rawer ,t 0/,j �' fa, i A�,S 4�n X'-IfS of (cmPLr:1 rot✓ §'r _ All material Is guaranteed to be as specified:All work to be completed In a workmanlike manner - •_, accordmg to standard practices.Any alteration or deviation from above specifications involving. Authorized extra costs will be executed only upon written orders,and will become an extra charge over and i ."; .=- ¢ Signature f f ` above the estimate.All agreements contingent upon strikes accidents or delays beyond our control C-�- r-. Y Y - _ Ownertocarryfire,tornadoand other necessaryinsurance.Our workers are fully covered by - Note Thisproposal�e --t Workmans Compensation insurance. - _ withdrawn by us if riot accepted within - 1 � days. .. - t>Leta>tce.ofroo�aY The above prices'specifications and conditions are satisfactory and are hereby accepted.You are authorizes to do thewo_rk as specified Payment will.be made as outlined above. sign u , Date of Acce tance Signature - f, ORTH Tovm o Andover No. o ,. .VW �4; 11"x, �• � ' oil 0tL- LAK _o dover, Mass., ^� COC HIC HE wIGK 4 \� ORATED Cl S U BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System • — BUILDING INSPECTOR THIS CERTIFIES THAT ............... ................. ...... ...Q. ...................................�................................................... Foundation has permission to erect........ buildings on ........I. I .. ... I .................................... Rough to be occupied as........5.. .......f-e-. ...-"" .............................................................................. Chimney provided that the person accepting this permit shall In eve 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 MONTHS UNLESS CONSTRUC STARTS ELECTRICAL INSPECTOR Rough ............. ...... ..........................................:................................. Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in Conspicuous Place on the Premises — Do Not Remove p y a P Final No Lathing or Dry Wall Ti Be Done 3 FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner, ' Street No. SEE REVERSE S8®E Smoke Det. c]�u�ctt� i BOartl.ti1..B �l�ur trrtetat of P u.etiin r unlit Ss`lct� j Construction.SRE ta1�ti��ns.and St,p , i`c(s pet, isor License CSI 95405 License . CRAIG COHEN. : 42 ROYAL CIRC:E SAL�M''NH 03079 ' C"„ramrissiuner EXporation: 6/1 4/2012. rr#: 29005 . f f h . Office of Consunmr rlffarrs&-$use e s Regul h nom': a .. HOME IMPRO�YEMENT CO.NTRACT,QR� " Registration: 148746 + Expi►atian 10/20%20 1 �- Trht 289727 ! Type; - indruidual QW1." • < , mk .CRAIG COHEN` $ CRAIG:COHEIV' 4: r" _,8JANAROAD.. . �' /Ir'. . SALEM,NH a 030.791\ ` T``�• l 4' °' IIndersecretary "` Tlie Commonwealth of Massachusetts Department of Indlustrial.Accidents Office of Investigations , k 6001 Washington Street Boston,MA 02111 �. www.Inass govldia Workers' Compensation insurance Affidavit:Builders/Contlracfo:rs/Liectricians[ lumbers Applicant Information . Please PlrinKL.!J � Name(Business/Organization/Individual): c t-4 C;�,,J TV,V t"T l O.fJ .t, N7 Address: tjoS 1,.1,MA1,ta.M ST UWState/Zip: l- �n�N 02-&12-1 Phone##: b i 7 334 38&n FE] an employer?Check the appropriate box: Type of project(required): m a employer with� 4. ❑ I am a general contractor and Iployees(full and/or part-time)* have hired the sub-contractors6• ❑New construction rs a sole proprietor or partner- listed on the attached sheet 1 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity, workers'comp.insurance. o workers'comp.insurance 5. 9. E]Building addition [N' p. ❑ We are a corporation and its ME]Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all work right of-exemption per MGL - 1 l.❑Plumbing repairs or additions inyself.[No workers'comp, c. 1.52,§1(4),and we have no 12.p�:Roofrepaairs " insurance required.] ' employees.[No workers' comp.insurance required.] 13.❑Other *Any applicant that checks box#I must also fill out the sectiorl below showing their workers'compensation policy information. homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such.lContractorsthatcheck this box must attached an additional on 1 sheetshowin the name o thesub-contractors azid their vworkers 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: ofte o-I1 N"Ja'`SCt Policy#or Self-ins.Lie.#: (o22U(�-[��32N 12 Expiration Date: 0-711011 1 Job Site Address: 1 lit g�R vt)/�L�, U�1 City/State/Zip:A,q,,l`c ft l MA 01�Hs 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$1,500.00 and/or one-year imprisonment,as well as civil penalties in the forth of a STO$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 or insurance coverage verification. Investigations of the DIA f Ido hereby certr' rider tlae pa' sane fpetjury that the information provided above is true and correct.' Si ature: Date: 2- Phone Phone#: 12 . EEOther only. Do not write in.this area,to be completed by city or town offlcaal. n: Permit/License# hority(circle one): Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector ector 5.Plumbing Inspector p g p r son• Phone#: Information and Instruefi®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 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 ofthe foregoing engaged in a joint enterprise,and including the legal representatives of 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 beAcerned 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 itspolitical subdivisions shall enter into any contract for the performance ofpublic 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)narne(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 maybe 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 ifyou 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 permWlieense number which will be used as a reference number. In addition,an applicant that must submit multiple permitllicense 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 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: The CQmmonwe,41th of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel.#617-727-4900 eA406 or 1-87.-MASSAFE Revised 5-26-05 Fax#617-727 7749- www.mass.govldia 06/02/2011 08:55 19786859460 HASBANY INSURANCE PAGE 01/01 CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIWW) 6/2111 HIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS I 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 REPRESENTA71VE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL 1O-RED, the policy(les) 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 endorsemen s. PRODUCER CONTACT NAME: F.iXZ C Jansen Hasbany Insurance Agency PHONE 978 685-319$ (978) 685-9460 236 Pleasant Street ADDRLE.SS: eric@hasbana .com Methuen, MA 01844 PRODUCER Dus,T.OMERLD ' 2490 INSURE R(S)AFFORDIi9 COVERAGE INSURED INSURERA:Western World Cohen Construction INsuRERB:American Zurich Insurance ~� 405 Waltham St. INSURERC:Natio>zal Grande Mutual Lexington, MA 02420 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE N UMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE USTED 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 TFE POLICIES DESCRIBED HEREIN I$SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONUITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE IN= UBR �7(p POucY NUMBER M LINTS GENERAL LIABILITY EACH OCCURRENCE $ ,opo-'00P A X COMMERCIAL 917 OAmAGET0,NERALLIABILITY NPP1119654 6/26/10 6/28/11 RENTED 100,000 CLAIM84nADe ❑X OCCUR MED EXP aneperson) S 10,000 PERSONALE ADVINJURY $ 1, �00 GENERAL AGGREGATE GEN'LAGGREGATELRATAPPLIESPER PRODUCTS-OOMPIOP AGO $ 2,000,000 X POLICY PR LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT C ANYAUTO B101769LT 8/1/10 8/1/11-(Easdd)daed) $ 500,000 BODILY INJURY(Per petaon) $ ALLOWNEDAUTOS BODILY INJURY(Per scoldent) S X SCHEDULEDALrros PROPERTYOAMAGE $ HIRED AUTOS (Per aedldenl) NON-OWNED AUTOS 3 UMBRELLA LIAROCCUR EACH OCCURRENCE $ EXCESSLIAB CLAIMS-MADE AGGREGATE $ DEDUCTIS LE S RETENTION S $ WOREMPLOYER COMPENSATION ILIT 6ZZUB-0732N12 7/10/10 7/10/11 WC BTATU- X OTH- � AND EMPLOYERS'LIAeRITY V I N ANY PROPRIETDRIPARTNERlEXECUTIVE OFFICE PJK MBER EXCLUDID7 " '� N I A EL,EACHACCIDENT $ 1 OOO OOO (Mandatory In NM)ibEL.DIS EASE•F-A EMPLOYE $ 1,000,000 DyESaRIIPPTIOUOPERATIONS Wow E.L,DISEASR-POI.ICYLIMIT $ 1 000 000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD i01,Addlaonal Reeerks Sebmwe,If more space Is raqured) locatino: 149 Bridges Lane North Andover Maas CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Torun of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. FAX # 978-688-9542 AUTHORIZED REPRESENTATIVE Eric Jansen ID 1938-2003AMRO CORPORATION. All rights reserved. ACORD 25(2009109) The AC ORD name and logo are registered marks of ORD