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HomeMy WebLinkAboutBuilding Permit #69 - 19 ROBINSON COURT 7/24/2009Permit NO: Date Issued: / LOCATI BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received " IMPORTANT: Applicant must complete all items on this pate u 4/U G - PROPERTY OWNER Y"f?U l D�1r�In', Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family JC[dition e PROPERTY OWNER Y"f?U l D�1r�In', Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family JC[dition Two or more family Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: OWNER: Name: Address: CONTRACTOR Address: ition Please Type o Pri t Clearly) ljG�N G �G Pr Phone: 763y Li Supervisor's Construction License: 6 ( Exp. Date: 3 �3 1 Home Improvement License: _? ��3 Exp. Date: L9 ARCHITECT/ENGINEER �^ t • C 6 V Phone: o64ol7,3 Address: t U X 63k?7 Reg. No. _Y 70, FEE SCHEDULE: BOLDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: �>Y FEE: $ Check No.: 3 ` Receipt No.:D* NOTE: Persons con racting with unregistered contractors do not have acct Signature of Agent/Owner _ Signature of contractor 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 Zo`iing Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes t Planning Board Decision: Conservation Decision, ` Comments Comments` ' Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: FIRE DEPARTMENT - Temp Dumpster on site Located at 124 Main Street Fire Department signature/date COMMENTS yes, t_ocatea 664 usgooa Street no 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-$1 000 fine NOTES and DATA — For department use ❑ Notified for pickup - Date . .............. . .. . . ........... . . . ... . .......... . . . . . . ............ . . . ... . . ... . ...... . . . . . . . ................. . . . . .................. . . . . . . . ............... . .................. — - — ------- . . . . .. . ..................... . . . ... . .... . ....... . .... . . . . ............. Doc.Building Permit Revised 2009 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 ❑ 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 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: Building Permit Revised 2008 Location/2 No. r Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ !� 41 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # ✓� 222+4 Building Inspector C14 cy Z (D CV Q 9L (D Ul0 C14 t: rn > CL O oll Z U (D Ud 0 Q ul LU 0) 0 LU 00 co U3 LU LU N ti Ui > LU 4WD co A#aL%�, AM ui > (9 Lu t> ;a www.mass.gov/dia . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers onlicant Information , Please Print Lezibl, Name (Business/Organization/Individual): Address: �- �rAV, ,� City/State/Zip: b Pt^, d/�%� Phone#:^ Are you an employer? Check the appropriate box: The Commonwealth of Massachusetts ^; 1 I t i Department of Industrial Accidents Office of Investigations iU.,- I 600 Washington Street .� Boston, MA 02111 t> ;a www.mass.gov/dia . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers onlicant Information , Please Print Lezibl, Name (Business/Organization/Individual): Address: �- �rAV, ,� City/State/Zip: b Pt^, d/�%� Phone#:^ Are you an employer? Check the appropriate box: 1.9'rel am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. x ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ 1 am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] t .employees. [No workers' comp. insurance required.] Type of project (required): b.❑ Ne construction 7. Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11. E] Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other *Any applicant that checks boz # l must also fill out the section below showing their workers' compensation policy information. I 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. l ^ , 1 insurance Company Name: Policy # or Self -ins. Lic. #:(� (i� �a7/ Expiration Date: Job Site Address: �t �(�lJG� C� ! City/State/Zip: 1l Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration d te . 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 may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under thins qn4 pepalties of perjury that the information provided above is true and correct. . ,77 �7 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 #: -T ACO CERTIFICATE OF LIABILITY INSURANCE NYYY) DATE(MM/D 200 PRODUCER THIS CERTIFICATE IS ISSUEDAS A MATTER OF INFORMATION Circle Business Insurance Agency Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 247 Newbury St. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. _ DATE (M,M/DD/YY)_.._......-...DATE (MMIDD/YYf_ ..... Danvers, MA 01923 ............._..__.. _ --9-7.8---7=--7-03Q_.................. INSURERS AFFORDING COVERAGE _............... ..... .__.._ NAIC# INSURED Build Tech Inc. ....... ....... _ _ INSURER A: Safety Insurance Company - INSURER B: Granite State Insurance CO. INSURER C: 5 Granite St INSURER D: Methuen, MA 01844 INSURER E: 1978-682-3503 COVERAGES 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, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INS DD L _.._ Of -INSURANCE GENERAL LIABILITY ...... .__.----_---_- ---- POLICY NUMBE. ........ _ DATE (M,M/DD/YY)_.._......-...DATE (MMIDD/YYf_ ..... LIMITS EACH OCCURRENCE $ 1,000,000 PREMISES (Ea occurence) $ 100 000 X COMMERCIAL GENERAL LIABILITY , CLAIMS MADE �I OCCUR MED EXP (Anyone person) $ 10,000 PERSONAL BADV INJURY $ 1 0000!000 A BP00006930 05/27/08 05/27/09 GENERAL AGGREGATE$ 2 Q 0U (0,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $— PRO- POLICY1­1 JECT LOC AUTOMOBILE LIABILITY ANYAUTO COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ ALLOWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ F1 GARAGE LIABILITY AUTO ONLY - EAACCIDENT $ OTHER THAN EAACC $ ANYAUTO F $ AUTO ONLY: AGG EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ AGGREGATE $ IOCCUR CI CLAIMS MADE DEDUCTIBLE $ $ RETENTION $ WORKERS COMPENSATION AND }( TORY LIMITS ER EMPLOYERS' LIABILITY--- E.L. EACH ACCIDENT ---"'—" $ ANY PROPRIETORlPARTNERIEXECUTIVE WC007-42-5951 03/25/09 03/25/10 E.L. DISEASE - EA EMPLOYEE $ B OFFICER/MEMBER EXCLUDED? Ifyes, describe under -- E.L. DISEASE- POLICY LIMIT --3,­0-0-0-,­0—UL $ 1�� Q0—rteO --OTHER SPECIAL PROVISIONS below -.................... .-.............- DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION Town of Andover 36 Bartlet Street SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Andover MA 01810 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. _.-.__..............----..............--- -................ _---- ...._ .._. -_.-......-- AUTHORIZED REPRESENTATIVE AI.VKU25 (LUUI/Utf) pGC�� & ` e © ACMCYCOKP"ORATI'ON 1988 t w O O FM4 �im 4 w � a w � w O a w aha w° acz cn r w° v U w a coG cu w v w W 'fou `�' co w x w v r� 0 2 cn Q o cn W � 5 0 ��m c 11 y V V y m r> E a W : m rtr z= O s v m JV _ CL Q y �ro ju * * a�0 CD v, r : PO `m a co I z (a z �f cm m y C m a y O C O E m WOO CD CLCJ L m - hmC:D,, = o CD :mor m .cc.32�z c H m ] y m C .O r0+ y as _ uiNJA A y AD .4 z � k O m .y O CLW cii O V ca 0 -0N3 d CD O . Z m�='� C f— t 0 a 0- CD ? I 2 O O ai • L �+ O v � Z fl. O h D � CO CM CosO ■� � 0 10 y O O 'E m m CL ~ Z O� �3 .a O G O cc O d Ma Co _ /c/am�� cY 0. O CD C Z CD V VD O C C� C cc a COD 0 W W U) Buildtech, Inc. Page 2 of 2 Page No. 1 of I Pages Price to install vaulted ceifin Jn bump out room. ion bf-61d-� �ccou§FZaTce7mF- r@ftgrs Provide and install new insulation. 56 1 is new ew t Price include.- Debris removal, Building permit, tabor and materials. — --- - ------ -material and labor- complete in accordance with above specifications, For the sUm of doAars ($ 9845.88 lo be made as 20% when job started 9 10 1 /1 1 /) 0 0 () CEC COLLOPY ENGINEERING CONSULTANTS FRANCIS H. COLLOPY REG. PROFFESIONAL �. P.O. Box 1684 ENGINEER Y:, Seabrook, NH 03874 ' Tel: 603 760-2273 Structural Engineering Services July 21, 2009 Mr Yves Nadeau Buildtech, Inc 5 Granite St Methuen, MA 01844 Dear Mr Nadeau: I am writing in regards to the recent site visit and inspection that I conducted at the residence at 19 Robinson Ct in North Andover, MA. at your request. The main purpose of my visit was to determine the necessary framing required in order to rery ;)ve the existing ceiling joists in the family room and to provide a cathedral room design. During my visit, I measured the size of the room and inspected the existing framing. It was decided that the pitch of the room was too low to design a vaulted'ceili%ig, and it was a better choice to provide a true cathedral design with the use of a structural ridge beam, and proper support beams/posts as required. After my visit, I was able to do an engineering analysis of the framing members under discussion. I am enclosing an engineering design sheet, Sheet D1, that shows the recommended ridge beam and support members that are necessary in order to make the framing comply with the intent of the State Building Code and good engineering practice. If you have any questions in this regard, please do not hesitate to call this Office, and we can discuss it further. Sincerely, COLLOPY ENGINEERING Francis H. Collopy, P.E. Structural Engineer Enclosed: Design Sheet D1 COLLOPY ENGINEERING CONSULTANTS 11-0. Box 1684 SEABROOK, NH 03874 Tel: 603 760-2273 JOB SHEET NO. CALCULATED BY CHECKEDBY SCALE NO. nl Vf>1el-I DATE Y DATE