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HomeMy WebLinkAboutBuilding Permit #584-14 - 201 CARLTON LANE 2/11/2014 (3) TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: f Date Received I Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION 2PA Print. PROPERTY OWNER. e—r--t- T,:, Print 100 Year.Old St,�ucture' yes no MAP NO': _ ,PARCEL: ZONING DISTRICT Historic District yes, . Machine $f qp Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building 160ne family ❑Addition ❑Two or more family ❑ Industrial Iteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Septic; .❑Well ❑ Floodplain 01Netlands ❑ W.atershedlDistrict an -?/sewer DESCRIPTION OF WORK TO BE PERFORMED: a.r-e� �bv� �e�rc. , 40 u - biCC' -1/7 11r, Identification Please Type or Print Clearly) OWNER: Name: Phone: ,:��Y) 691 -1 1603 Address: Cw.lz4-7-�I•i �-Q.ti-A. Iyvv�- ��.�t� v-tf\, . - i j .QNjTRACTQ.R Name LC. = -� _.- Phone Address;.- ._��' _. 1ro.r�.S � S�-,I•� -� --; Nt�_»�:.:�..���. .,Rte..-- © «Ll;� - 4 Supervlsq(js,Qn$truetion License: y 3 U`i _.____ Exp (Date: ��,1,�.�.L E _ Home�lmprovement'SLicense : _ t-o_LtL-i Ex Date, ARCHITECT/ENGINEER Phone: s, ,, bpi .S`''ly-7 Address: \-crty h.,y, 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: $ 1"1 .3 ID O FEE: $ ?73 Check No.: Z� Receipt No.: J.al o NOTE: Persons contra tin with unregistered contractors do not have access to the guaranty fund g 51 nature of A ent/OvVner -_ . .. �tSi.gnatta�re of contractor g_ _. _ _ . _ _ Plans Submitted-S Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans 4 _:: _ _ .. ... ... _ _ _ .... _ .. _'::j f iV I - _ Location 2D t i�o U�,e rL I -' I— . 11 I —.1 -1-- — . -1 — - I — — - I-- — - No. « Date �-� << 1 i - ,� .1-1 � -,. ;, - ..�.. � —, ;-I .I — I I . I ,,;:... — ��::.- — — " — -- .1 , ..1 �— . I. .. . I . ,—'. i � . � . — . I =I —: :*I- ::-- —, --- - 7— , . ., . .,-,.- - . -�� — , — - , --- — I � — F— - � .b�—..—7 �.. �'. — - �. -- — ... .. — ,".----'—.- . -.-—- --. : ----::�, . r"'1--�,—--—-:-:-,-., ..-,—.-. . I., I . —.. ,:. � � ,-.— — --1--.— I , . � .. .....� . - , '' — .. ...'.... m:—... ...6�. I i'�.:::::::-.::.:--.— - — . . 1: ..- — w:,:. - ... . .I 1. . — —... 11 -Y, ....�'�.�:.-.. . :..—..-.""...". • • TOWN OF NORTH ANDOVER • _. - _ ,. - l - Certificate of Occupancy $ -. -. Building/Frame Permit Fee $—g� G Foundation Permit Fee $ Other Permit Fee $ TOTAL $ _ Check# c��i �" Ir 7fl I41A - iLII1 = Building Inspector - _. . - _- _ - - > -_ - . _. . .. . - . .- , ; _. . - <. . ..: - _;., , Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE-OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/MassageBodyArt ❑. . 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 A ~ Water & Sewer Connection/Signature& Date Driveway Permit `j DPW'I owo Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Mair'Street Fire De pa signaturetdate' 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 DANCER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A-F and G min.$100-$1000 fine NOTES and DATA— (For department use B Notified for pickup - Date s E - Doe.Building Permit Revised 2010 Building Department The fol?yawing 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 app%-al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm.tted with the building application Doc: Doc.Building Permit Revised 2012 Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost 27,300.00 m $ - $ 327.60 Plumbing Fee $ 40.95 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 40.95 Total fees collected $ 509.50 201 Carleton Lane 584-14 on 2/11/2014 Storage Space off Master Bedroom NORTiiy q Town o ndover No. g o h ver, Mass, c1 t COC NICNl WICK �1• A�RgTEG S IJ BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT ao.h. jig Y ..................... BUILDING INSPECTOR has permission to erect ........... ......10.00W.............. buildings on .ab.k......... "'� .......... Foundation ........ ........... Rough =A . he... ms....to be occupied as ..... .%s.......ST . ....�.....04 ....m .. r(� Chimney provided that the person accepting this permit shall in euryres respect conforotothea plicati n 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 Z�• UNLESS CONSTRUCTIO A Rough 3 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. SEE REVERSE SIDE 1 I II • . 98 Forest Street K� . North Andover,MA 01845 PH:978-688-6335 Building Contractor FAX:978-688-7207 Proposal To: Rob&Michelle Doherty 201 Carleton Lane All Hone improvement Contractors and Subcontractors engaged in hone improvement contracting,unless North Andover, Ma 01845 specifically exempt from registration by Provisions of Chapter 142A of the general laws,must be registered with the Commonwealth of Massachusetts.Inquiries about registration and Status should be made to the Director,Home Improvement Contract Registration,One Ashburton Place, Froin: Kevin Murphy Room 1301,Boston,MA02108.(617}727 8598 CC: Date: 2/11/2014 Job: Office Date of plans: None to date Architect: None to date Location: Same Section I-Work Schedule Contractor will begin the work or order the materials before the third day following the signing of this agreement, unless specified here in writing contractor will begin work on or about 2/1/14. Barring Delay caused by circumstances beyond Contactors control,the work will be completed by 3/30/14.The owner hereby acknowledges and agrees that the scheduling dates are approximate and that such delays that are not avoidable by the Contractor shall no be considered as violations of this agreement. Section II-Warranty The Contractor warrants that the work furnished hereunder shall be free from defects in materials and workmanship for a period of 1 year following completion and shall comply with the requirements of this Agreement. In the event any defect in workmanship or materials, or damage caused by the Contractor, his subcontractors, employees or agents, is discovered within one year after completion of any job, including cleanup,the Contractor shall,at his own expense,forthwith remedy,repair correct, replace,or cause to be remedied,repaired,or replaced, such damage or such defect in materials or workmanship. The foregoing warranties shall survive any inspection performed in connection with the agreed-upon work. Section III—Scope of Work Page 1 of 4 The Commonwealth of Massachusetts Department of IndustriqlAccidints Office of Investigations kvi 600 Washington Street Boston,MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information PIease Print Legibly Name(Business/Organization/Individual): Address: S -- City/State/Zip: tw. �..,_ k -, a t_yyC— Phone#: 53 3 Y', Are you an employer?Check the appropriate box: Type of project(required): LV I am a employer with_ 1 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet.1 7. 13 Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. 13 Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑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.]t employees.[No workers' 13.❑Other comp.insurance required.] `Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. T Homeowners who submit this affidavit indicating they Sire doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors 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. / Insurance Company Name:. G—A Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: 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 requiredunder 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereh cert fy under the pains and penalties of perjury that the information provided above is true and correct. Simature: Date: (J_ LL Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.PIumbing Inspector 6.Other - - - Contact Person: Phone#: ACORD® DATE(MMIDDiY CERTIFICATE OF LIABILITY INSURANCE 7/17/2013VYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER., AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder In lieu of such endomement(s). PRODUCER CONTACT NAME: M P ROBERTS INS AGCY INC PHONEg']g) 683-8073 978)683-3147 North Andover, MA 01845 aC No Ext: aC,No 1060 Osgood Street ADoeS$:sandi@mprobertsinsurance.com INSURER(Sl AFFORDING COVERAGE P!AICB INSURER A:PROVIDENCE MUTUAL INSURED KEVIN MURPHY BUILDING & REMODELING INSURER B:MERCHANTS INSURANCE 169 BOXFORD STREET INSURER C:GUAM INSURANCE NORTH ANDOVER, MA 01845 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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. MSSR TYPE OF INSURANCE ADDL sUBR LACY EFF POLICY EXP INSD WVD POLICY NUMBER MM/DD MMIDD/YYYY LIMITS X I COMMERCIAL GENERAL 11ABILITY EACH OCCURRENCE S 1,000,000 CLAIMS-MADE ®OCCUR PREMISES Fa occurrence $ 500,000 MED EXP(Any one person) $ 15,000 A BOPI068945 11/22/12 11/22/13 PERSONAL&ADV INJURY $ 1,000,000 GEWL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICYPRO �, CT LOC PRODUCTS-COMP/OP AGG S 2,000,000 OTHER: $ AUTOMOBILE LIABILITY Ea accident) $ 1,000,000 ANYAUTO IM-CAL701311118 01/23/13 01/23/14 BODILY INJURY(Per person) $ ALL OWidED SCHEDULEDB AUTOS X AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident $ I UMBRELLA LIAR OCCUR $ I EXCESS LM EACH OCCURRENCE t$ 1,000,000 1,000,000 CLAIMS-MADE CUP9145304 11/22/12 11/22/13 AGGREGATE DED RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERT LIABILITY YIN I X STATUTE _ ER C ANY PRIMEM ORI PARLUDED?ECtmVE ❑ E.L.EACH ACCIDENT $ 500 000 Ma dater Ind EXCLUDED? NIA KENC422467 07/01/13 07/01/14 � E.L.If yes,describe under DISEASE-EA EMPLOYE4$ 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE BUILDING DEPT. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN NORTH ANDOVER. NA 018845 ACCORDANCE WITH THE POLICY PP,OVISIONS. AUTHORIZED REPRES A I C 1988-2013 ACORD CORPORATION. All rights reserved. ACORD25(2013/04) The ACORD name and logo are registered marks of ACORD RIDGE VENT INTO maunNG tem NEW DOOR R-88 INIKILATION TYPICAL CROSS SECTION (PROPMED) 1'AIR GAP NEW SKYWKM 3W TW PLYWOOD. NAILED a OWED TO FRAMING 2X4011f'O.C. FAS704 TO FLOOR JO1SM 'SISTER'NEW 2 X 10 ONTO d ROOF RAFTER EXISTING 2 X 6 AT 10'O.C. R921 T1ON STUDY 12 IQ� FINISH IST FLOOR R�0 INSULATIONIF JLL DEPTH OF FRAMING MEMBER RIGID INSL ATM BLOCK 5w TYPE X am GARAGE FINISH I ST FLOOR W.F.EXISTING GWB RATING. + — — MODIFY AS REGIARED. FWW DRAW PLAM e �CONCRETE SLM DOHERTY RESIDENCE 201 CARLETON LANE u'-0' NORTH ANDOVER, MA RIDGE VENT OUSTING 2ND FFLOODOOR SPACE PAW INIK"TION TYPICAL CROSS SECTION (PROPOSED) V NR GAP NEW SKYLIGHTS 8144'T&G PLYWOOD. NAILED A OWED TO FRAMING 2X4016.O.C. FASTEN TO FLOOR JOISTS 'SISTER'NEW 2 X 10 ONTO &ROOF RAFTER EXISTING 2 X 6 AT 16'O.C. R-1 INSW ATION STUDY r12 101 FINISH IST FLOOR R30 NSL LATXX67LILL DEPTH OF FPAMINO MEMBER RIGID INSULATION BLOCK &w TYPE X GWS. GARAGE FINISH IST FLOOR V.I.F.EXISTING GWB RATING. + — — MODIFY AS REMARED. F�CFI ORAOE wwweo� SLAB DOHERTY RESIDENCE 201 CARLETON LANE u'-0' NORTH ANDOVER, MA RIDGE VENT TYPICAL CROSS SECTION 5V CDX PLYWOOD---_ (E)OSTING) ROOF SHEATHMO 2XSAT18'O.Q ASPHALT SHIOGLES 12 1� ATTIC FINISH IST FLOOR -ji 2X8AT18.0.C, GWB WALLS A CEILNG WOOD STUD FRAWM 2.2 XS WOOD SILL GARAGE FINISH IST FLOOR CMU FOUNDATION wNwpm �OONCRETESLAB DOHERTY RESIDENCE 201 CARLETON LANE NORTH ANDOVER, MA __- 2 17 v�