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HomeMy WebLinkAboutBuilding Permit #691-16 - 160 CARLTON LANE 12/7/2015 (3) BUILDING PERMIT OF NORrh A TOWN OF NORTH ANDOVER z y ''` •_�.=6 o APPLICATION FOR PLAN EXAMINATION ' - b 14L �DR' Permit No#• Date Received "y^e ADRAreD^Pa 45 �SSACHUS�( Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION L GA-tzcTWn L/ Print PROPERTY OWNER i,J Amt etr� C3`Vy\ k,t1E. Print 100 Year Structure yesno MAP PARCEL: 192- ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building V171 One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other _ fl Septa❑Wellb F of odp rn Wetlantls �, ,D�Wat�_hed+D tact' DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly /�6 OWNER: Name: QAM<,-I1 Q h \ J e Phone: �g J 6 Address: I ��V �� f ,nom-M an,c Contractor Name: Tb k-i ) C� Phone: Email: Address: 'rl_ - Pt<_ r-rI�a Supervisor's Construction License: d 6q t Zw Exp. Date: Za/ Home Improvement License: /J 1 -a��,� Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.-$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BApp S1E(D�O^N$125.00 PER S.F. Total Project Cost: $ I 6" FEE: $ Check No.: � t j � Receipt No.: NOTE: Persons contracting -th unregistered contractors do not have access o 7arapihe nty fund - — - -1 d _ _ - -mm i Location bin No. Date-6A • - TOWN OF NORTH ANDOVER SLED . . Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ ' Other Permit Fee $ TOTAL $ Check#.5fi 13 2 .0e 77 7 uilding Inspector .. -.. - ti _ .. .. -..: ... .. _... ... u .. ,_ - - .. ... .... .. _. i .. .: ..^ ... �........ . :. .. ... :.. .. ....... .. .. .... - . ... .- .... ... ... .' .. ..-. .: I L Location i1� ���— J� G� No. Date . -- _^ <; ,.._. - _ • - TOWN OF NORTH ANDOVER I • 5isg6` - �;� �• ..0' -- Certificate of Occupancy $ - f Building/Frame Permit Fee $ � r � . Foundation Permit Fee $ Other Permit Fee $ ,�. TOTAL $ Check# -G r�' .- _._ 9 77 7 uilding Inspector s,_ - , ,,�. r 2 ,: .� k ,. r '. _:.,.. :. __ .. _ ... .. .,.. ... ,. ..... .._ .. .. ..... .. . . .. _:,, _.., _ .... , _r... .. n :. . .. . — ;_r .. .i - ...; ... . _. _.. � . ;.: ,,._ ,- - _. - __ _. . . -. `,� _ �'.," f 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 PackagineSales ❑ Private(septic tank,etc. ❑ Permanent:Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - 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& nate Driveway Permit DPW Town Engineer: Signature: _ Located 384 Osgood Street FIRE DEP�i4RTMENT "Temp Dumpster on=situ es° � �``��'b'} " 17_77— rf'. mss, _ _ a. kyr :a.3 'E�..0_. ..k-�Llst�S.i+•]!�� 3 1 Located at 1.24 Main Street s"kl' ....-`-.�...r� !;r . ,..- ' r� r ci4e'Rt..F ,a, ;. tFire Department sig t� Y om, -� natureldatet��,�� ,_,.. . ,.�,., ., ,max.. ii2«POO f€ � SS "°t Z - �±.•r +•xr'rS �r.r.l -,,ty�, ( yL e =y COMMENTS'. .� r• �, ty_` .�,.t�j � I.�y ,,,, .r,,_ ,� �� '•fi KP- 'T . ,c .NF_.t_ -..7..,«� +.......: ,d .- c,...r ..� .s .�. - t.-.n-..._r •� f,t�f _ _fa. 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.$10041000 fine NOTES and DATA-- (For department use) ® Notified for pickup Call Email Date Time Contact Name Doc.Building Pennit Revised 2014 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 4. 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 tAORTH own Of E �tAndover o � - so h ver, Mass, I. sop COCNICIOWICK ��• x.45 R'�TED V BOARD OF HEALTH Food/Kitchen PIERM T LD Septic System A r ... . h � BUILDING INSPECTOR .. THIS CERTIFIES THAT ..................I... 0....... .1..... ON. .r.......................................... has permission to erect .......................... buildings on .�.��.....IC. OVNA...... 1.011110� Foundation............. Rough tobe occupied as ......... .... ..... ..... ... #. .....400 ................................................ Chimney provided that the person accepting is permit shall in every res ct conform to the.terms of the application Final on file in this office, and to the provisions of the Codes and By-La s 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 CONSTRUCTI A. 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. ..i w ' f r Residential F C �° n rcial Roofing I Types Of LWH 1. N. o BUILT-GAFFED Expert Masonry Work Vias Toll r e Y Licensed & Insured 1-800-WAIT-4411tery Ovine l& t.Tpp a to .'!1 �.„<F> ".,V.26 �� = License#034200 (924-8487) KO �.ae? C”r.. e . d?���� We Work Year Round Proposal To: Darren Winnie Date 11/17/2015 Street: 160 Carlton Lane 978-906-5116 N. Andover, MA Roof proposal dswinnie@hotmail.com IKO Cambridge/Certainteed Landmark 1. Extra caution will be taken to protect house 12. Removal of all work related debris. Planks will be exterior and landscaping as best as possible. placed under dumpster to prevent any damage to (tarps etc.) Magnets run at final clean up. driveway. 2. Remove all shingles from entire house. 13. Building permit included. 3. Inspect and re-nail any loose or lifted plywood. 14. Contractor workmanship warranty: 10 years under Any compromised plywood will be replaced at normal wind and rain conditions. an additional cost of$55.00 per sheet of 1/2" Total roof cost: $ 12,350.00 CDX fir. 4. Install heavy gauge 8"white aluminum drip Both IKO and Certainteed direct extended non edge to all eaves and rakes. 5. Install 6' of IKO Armourguard or Certainteed Pro rated 20 year fully transferable warranties Winter guard ice and water shield along all included in this proposal. Please refer to eaves and top to bottom in all valleys. pamphlets in estimate package. Offered and 6. Install IKO roof guard or Certainteed Diamond included in this proposal to our exiting Deck synthetic underlayment to remaining customers at no additional cost. sheathing up to ridge. Rubber roof: Upon inspection we do not believe 7. Install all new pipe boots. Install extra ice and that you need to incur the expense of doing a water shield around any exhaust pipes and all new rubber roof. We will re seal all the seams roof protrusions. and connections with EPDM compatible seam 8. Install IKO Leading Edge or Certainteed Swift tape then apply a liquid EPDM rubber coating Start shingles to all eaves. over the entire area. $900.00 additional cost 9. Install IKO Cambridge Limited Lifetime *Note*: Please be advised if applicable, valuables in architectural shingles to entire house. 15 year the attic should be moved or covered due to minor non pro-rated warranty by mfg. 10 year if debris, dust and asphalt particles that will accumulate Certainteed is chosen. All shingles will be installed and fastened according to mfg. specs. during the stripping process. All Under One Roof not 10. Counter-flash existing chimney lead and wall responsible for any damage or clean up that may connections with ice and water shield, tie into occur in attic. new shingles and seal. Balance due upon completion 11. Install a new GAF Cobra ridge vent capped with References available upon request color matched IKO or Certainteed hip and ridge shingles. Highly rated member of the accredited BBB and Angie's List Thank you! The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street,Suite 100 Boston,MA 02114-2017 UV www mass gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electridans/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/OrpnizationlWividual): 4/1 U--naf4 a't"t.- ��'✓ Address: 3z;' 'G'Pl< 4211 City/State/Zip: kvk'0,-c^ /u-/4J Phone#: Are you as employer?(beck the approprlate box: Type of project(required): 1.[J I am a employer with employe=(full and/or pan-time).' 7. ❑New construction 2.E]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 homeowner doing all work myself.[No workers'comp.insurance required.]t 9. El Demolition 10 Q Building addition 4.O 1 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 arc sok I I.[]Electrical repairs Or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5011'am a general contractor and 1 have hived the subcontractors listed on the anacbed shod. These sub-contractors have employees and have workers'comp.insurance.t 13.E]Roof repairs �Othe I4. r 6.Orc We aa corporation and its officers have exercised their right of exemption per MGL c. 152,§l(41 and we have no employees.f No workers'comp.insurance required.] *Any applicant that checks box pl must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this afTrdavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 'Contractors dtat chock this box must attached an additional sbeet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Bdow is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: I ( J C412 LT", L4-l — City/State/Zip: 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 5250.00 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 under the pa' penalties of perjury that the information provided above is true and correct i a Date: /Z/)�/Za/�� Phone#: 11 -9 2 - ?S5 Ofikial use only. Do not write in this area,to be completed by city or town oJj`ieiaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.CityfTown Clerk 4.Electrical Inspector S.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),addresses)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 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 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 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. #617-7274900 ext. 7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia 11/18/2015 LVED 11:55 FAX 781 598 6430 DAVID ZELLER INSURANCE U001/001 AC RO 0® CERTIFICATE OF LIABILITY INSURANCEDATEIMMIDDNYYY) 11/18/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS 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 REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER, IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to St - 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(leu of such endorsement(s). PRODUCER CONTACT DAVID E. ZELLER INSURANCE AGENCY INC NAME: Maryellen Goodwin PHONE E (781)595-2071 FAX EMAIL INC.No): ADDRESS: mafyeilen davidzeller.com 370 LYNNWAY LYNN INSURERS AFFORDING COVERAGE NAICN MA 01901 INSURER A: ACE AMERICAN INSURANCE CO INSURED 22667 INSURBERRY FRANK&BERRY JAMES DBA FRANK&SONS INSURERC: INSURER 3: 45 WINBROOK DRIVE INSURER EPPING NH 03042 INSURERF: COVERAGES CERTIFICATE NUMBER: 13141 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED 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 THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. WSW TYPEOFINSURANCE ADDLSUB POLICYEFF POLICYEXP 2LMJMPOLICYNUMBER MMIDDIYYYY MMIOR LIMITS COMMERCIAL GENERAL LIABILITY EACHOCCURRENCE $ CLAIMS-MADE FIOCCUR pA :10 RENTED­- PREMISES Ea occurrence S N/A MED EXP(Any ona person) $ ' GEN'L AGGREGATE LIMIT APPLIES PER: PERSONAL dADV INJURY $ POLICY E]JET F LOC GENERAL AGGREGATE $ OTHER: PRODUCTS-COMP/OP AGO $ AUTOMOBILE LIABILITY $ ANY AUTO CMBINED Ee a utl SINGLE LIMB $ ALL OWNED SCHEDULED BODILY INJURY(Per person) $ AUTOS AUTOS N/A BODILY INJURY(P HIRED AUTOS E NON-OWNED AUTOS PRP E nDAMA E (Per E UMBRELLA LIAR $ OCCUR EXCESS LIAB EACH OCCURRENCE S CLAIMS-MADE NIA AGGREGATE $ DED RETENTIONS WORKERS COMPENSATION S AND EMPLOYERS'LIABILITY YIN X STATUTEANYPROPRIETOERH A OF ICER/MEM ER EXCLUEXCLUDED? D D7 wA N/A NIA E.L.EACH ACCIDENT E IOD,O�D (Mandatory in NH) 6S62U89998L43415 11105!2015 11105!2016 If yes,describe under E.L.DISEASE-EA EMPLOYEE S 100,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE POLICY LIMIT E 500,000 N/A DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,maybe anaehad if more space is re"Irod) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given 10 pay claims for benefits to employees in states other than Massachusetts if the Insured hires,or has hired those employees outside of Massachusetts. This CedifiCete Of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the Issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.govAwd/workers-CompensatiorJinvestigationst. No partners have elected coverage. CERTIFICATE HOLDER CANCELLATION D L�h [ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ALL UNDER ONE ROOF ACCORDANCE WITH THE POLICY PROVISIONS. 30 TEMPLE DRIVE AUTHORIZED REPRESENTATIVE METHUEN MA 01844 Daniel M.CrC609Y.CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD as Massachusetts-(Department of Public Safaty Board of Building Replatlons and Standards License: CS-%0120 y 7 `! 1iil�itiV.CLLl 6�ir! �Y47��y} �.17,.� ` � jqt\, .1{r 44L •Yr w" CI� � 1i'Itt t� i»J{ IIC3l'ii7ti t;a�mm3ssdaneY MSMOV • �- I I I.I Rl�1 i71.. tYi�A i V' I I �7G''iyft;Fl RL'�' te7UR11�J1 Click on tie registration number to view comP18111t history,You can also view arbitration and Guaranty fund history. The list i current as of Wednesday, October 8, 2014. Y Search Results RE LANT RESPONSIBLE REGISTRATION EX PER3RYti ON ' E INDiV;! UAL NULIBER ADDRESS DATESTATU ALL L'NMMF;ONE ROQr- LANZAFAME, 137057 166 A 114ERRIMACK 5T 10102/20le Curreni JOHN METHEUN, MA 01844 a 2012 Commonweatth of Massachusetts. Mass.GovO is a registered service mark of the Comnionweaith or Massachusetts. I. •