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HomeMy WebLinkAboutBuilding Permit #280-16 - 15 MIFFLIN DRIVE 9/3/2015 NORTH BUILDING PERMIT o`.11 E° .e "o 2 y get ;a TOWN OF NORTH ANDOVER � APPLICATION FOR PLAN EXAMINATION w !! ///1111/1/1/////// Permit N�JMrr Date Received 0R�,.Eo SSACHUS� Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION l S �rLi Print PROPERTY OWNER ��L"n' W'4-xC'CABGs Print 100 Year Structure yes n MAP PARCEL: ZONING DISTRICT: Historic District yes n ii ''"" Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ane family 11 Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: El Commercial epair ,replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other it Septic. ❑1NeIV ��Floodplair5 ❑Wetlands " ❑ VVatershedb®i tract D WaterlSewer - DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: C, C44 4:- Phone: Address: AV'�Y�G'� l"V14• Contractor Name: dAe? Z474, &-s Phone: Email: Address: c3 —Exp. Date: Z'� s Construction License: p Supervisor � Home improvement License: Exp. Date: q-)7 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 Project Cost: $ y v FEE: $ Check No.: Receipt No.: oc l 0L-'%`S NOTE: Persons contracting with "fregisterd contractors do not have access to the guaranty fund 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 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) 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 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL, Public Sewer ❑ Tan„ing/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 d COMMENTS a 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 S ee E �-E�� n}�, T'emp Dempster}onosi e6a ,6s .� i :.' n `F t 4,LtFdtfi124 MainiStreetFirepartment sig date , •, ti . ; ,�, rA r,,;.. 4 i e # "s r n . . r 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.$1oo-$1000 fine NOTES and DATA-- (For department use) i ❑ Notified for pickup Call Email Date Time Contact Name t ..___.. _ Doc.Building Permit Revised 2014 j Location 7) No. � Date q/�)/15� a . - TOWN OF NORTH ANDOVER j ` 4 Certificate of Occupancy $ Building/Frame Permit Fee $ � C. Foundation.Permit Fee $ Other Permit Fee $ TM TOTALS Check r',_ 292 9G J 9 Building Inspector OORTH own of E . I� Andover o �. _ Y � 0 No. - _ b soh , ver, Mass, COCNICMIWIC44 1' Arlo ON S V BOARD OF HEALTH Food/Kitchen PER T LD Septic System THIS CERTIFIES THAT ......... ...... „ � BUILDING INSPECTOR ..L.40M................ .... ................................... .......... has permission to erect .......................... buildings on ....IS..........M................... ................. Foundation.. Rough to be occupied as ...... ... .. ............ ................... ... .................................................................:. Chimney provided that the person accep ng this permit shall in eve 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 CONSTRUCTIO 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 Street No. Smoke Det. � .. 9, I r c Resilden.UaI & tc?trmn it errcia� Roofing t Types �f '1 C O.N�"l�®-...... i�T- Expert Masonry Work Mass Toll Free '° ` -. Licensed & Insured 1-800-WAIT'-4-tJs 1.ur z/I) C.hvnrd tt: CJpfl l'.d l <tr "976 "`"`'"'° License#034200 (924-8487) I E)`, az wvzm cc 901-W We gook Year Rota ned OWN x .. �- n � Proposal To: Roberta & Vinnie McBlae Date 7/21/2015 Street: 15 Mifflin Dr. 978-609-4982 NN.Andover, MA �. Roof proposal Certainteed Landmark 1. Extra caution will be taken to protect house and 12. Removal of all work related debris. Flanks 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. 3. Inspect and re-nail any P loose or lifted roof boards. 14.Contractor workmanship warranty: 10 years under Any compromised roof boards will be replaced at normal wind and rain conditions. an additional cost of$3.00 per lineal foot of 1x8 Spruce. 1st 16' at no additional cost. Total roof cost: $ $79400.00 4. Install heavy gauge 8"brown aluminum drip edge to all eaves and rakes. Angie;s List discount applied and 5. Install 6' of Certainteed Winter Guard ice and included water shield along all eaves. v \/ 6. Install Certainteed Diamond Deck synthetic' underlayment to remaining sheathing up to ridge Certainteed 3Star extended direct MFG warranty 7. Install all new pipe boots. A fully transferable 100% coverage against 8. Install Certainteed Swift Start starter shingles to material defects for a fully non pro rated period of all eaves. - , 2d,,years. Please refer to pamphlet left in estimate 9. Install Certainteed Landmark Limited Lifetime folder. Offered to our Angie's List referrals and architectural shinglesktojentire house. 10 year included in this proposal at no additional cost. material MFG. warranty. (See extended warranty) All shingles will be-installed and Balance due upon completion, no deposit required fastened according to mfg-specs. 10. Install new GAF Cobra ridge vent where References available upon request applicable and cap with color matched Certainteed Shadow hip and ridge shingles. Histhly rated member of the accredited BBB and 11. Counter flash existing chimney lead with ice and Angie's List water shield,tied into new shingles and seal with clear sealant. Thank you! 12. Top dormer: Existing rubber membrane is an good condition an will remain. All compromised seams + around chimney area will be repaired and sealed. The Commonwealth of Massc ehasetts . Department of Iiiadzcs�lalAccade�ets� 1 Congress Street,Suite 100 R � G Boston,MA 02114-2017 www mass.gov/dia Sy. %rkers'Compensation insurance Affidavit:Builders/Contractors/ElectricianslPlumbe)rs. TO BE PILED WITH THE PERMITTING AUTHORITY. A licaut Information. Please Print Le ibly Name(Business/Organization&dividual): a 124 J .Address: city/state/zip: F'l W /,�J Phone##: Areyon an employer?Checkthe appropriate box: Type of project(xecluired): 1„aI am a employerwith__employees(full and/orpart time).* 7. ❑New construction 2.❑I ama sole proprietor or partnership and have no ernPtoYees working for me in &. ❑Remodelig 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 ❑Building addition 4. lam a homeowner and will be hiring contractors to conduct all work on my property. I will ❑ 11. Electrical repairs or additions are sole p ensure that all contractors either have workers'compensation insurance or r ❑ o em'Io ees. or additions rietors with n p y 12..[]Plumbing repairs 2idi, a general contractor and I have hired the sub-coutractors listed on the attached sheet. 13.❑Roof repairs o ees and have workers'coin .insuraace.� e sub contractors have empl y P ' 14.LjOther 6.F1 We are a corporation and its officers have exercised their right of exemptioa per MGL c. 152,§1(4),and wehave ria employees.[No workers'comp.insurance required.] *Any applicant that checks box 41 must also fill out the section below showingtheirworkers'compensation policy information. T mit'his affidavit indicating they are doing all work andthen hire outside contractors must submit a new affidavit indicating such. Homeowners who sub t H ?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 . e to ees the must roNide their workers'comp.policy number. ha e employees. If the sub-contractors v m p y Y P , I am an employer that is providing workers'compensation insurance for rrcy ernplayees'Below is the policy aftd,lob site information. Insurance Company Name: J � Policy##or Self-ins.Lic.#: Expiration Data: Job Site Address: )� l �L�"� /l vt City/State/Zip: Attach a copy of the workers'coxnpensation'policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL o.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 this statement may be forwarded to the Office of Investigations of the DIA for insurance 'o ator.A co of y day against the violator. copy coverage verification. X do hereby certify unft tree pains andpenaldes ofperjury that the information provided above is true and correct. Si nature: Data: Phone#: / Official use only. Do not write in this area,to he 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#: Inf®rmation 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 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 number(s)along with their certificates)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLQ)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 fox 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' compensatioii 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 permi�iJlicense 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 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 Dan fmsD"Yyyy) 4 ii IN MM I c; . r yk&ta i`a the fla ts > t:r.S-,�)aAO:wA. 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I� ct Massachusetts-Department of Public Safety Board of Building Regulations and Standards COMITUELSOn SUPertiVi- Licensw C3-0 120 S61 i r TF" DR► ! biffirm AA. 1 1 � u i . .�..11r • ,�;�i��` Expiration Cor�emtssioner 041032017 Rl�. IIS� �/■ ■111 � Aeer�vr�r�c�iauarw� Click on the registration number to view complaint hi 9 p story. You can also view arbitration and Guaranty Fund histo[y. The list icurrent as of Wednesday, October 8, 2014. Search Results REG 7 INT RESPONSIBLE REGISTRATION EXPIRA77ON .. INDIViDUAL NUMBER A►iE� bRES DATE 57A7U: ALL UNUR OHE Root- LANZAFAME, 137057 16 A MERRIMACK ST 10102/2016 Current JOHN METHEUN. MA,01844 ©2012 Commonweeltn of Massachusetts. Mass.Gov®is a registered service mark of the Commonweaith of Massachusetts. i. I I l