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HomeMy WebLinkAboutBuilding Permit #882 - 201 CARLTON LANE 6/18/2013 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: b 4—�( 3 IMPO TANT:Applicant must complete all items on this page LOCATION n_ , _ int PROPERTY OWNER OQ �G1�1 Print 100 Year Old Structure yesno MAP N(/QPARCE v NING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building One family ❑Addition ❑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 PERFORMED: Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: ,, I CONTRACTOR Name: `�^ �i -- Phone: Address: . G 1 Supervisor's Construction License: off- 1 Exp. Date: I �� Home Improvement License: � Exp. Date: �0 2 ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ �, %b FEE: $ z , J Check No.: `7 �I� Receipt No.: (G NOTE: Persons contracting with unregistered contractors do not have ecce tgua my fund Signature of Agent/Owner Signature of contract Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan Ll tamped Plans ❑ ---- __ �ti .w ti, . . I .. . ...-,.- . ,, . . .. _ .- - .. .-. .-- - : _ _ .. - . .. - . . ... .: .. ... .. .... ...-....'�.-.:- ._. % .. ... .. .. ._. - `. ... ... - ..... .. .. _ - I. .. t : - J f _, l - - - .. _ -. : T :`• -1 7 Location/ ( a"I'(74 .I No. '� 1 2 Date `� f ' / 3 • - TOWN OF NORTH ANDOVER • s� � F6 '�; • a~ . Certificate of Occupancy &$ 4 TM Building/Frame Permit Fee $ Foundation Permit Fee $ -� Other Permit Fee $ TOTAL $ I K . - . _ _ r. .. Check# 1. _- ,; I 7--- �'.; -- �:.%-.� . 9 'n-':�2� . �11..I- . � 1� 2 6 5 2'9 Building Inspector _ I -- .x _ "- ,.. `>; m_. ..._ .w ... .- -- �-. .. -.. .' - -.,. .. . :: :: _ _ at Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPEOFSEWERAGE DISPOSAL Public Sewer ❑ Pools ) 0 Tanning/MassageBSwimminody Art ❑... g Well ❑ Tobacco Sales El Food Packaging/Sales El (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 ❑ El 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 u Water & Sevier Connection/Signature& Date Driveway Permit DPW To`vo ]Engineer: Signature: ' Located 384 Osgood Street FIRE'DtPARTM,ENT - Temp Dumpster on site yes no Located at'124 Main Street Fire Departniert signature/date 1's COMMENTS 7 The Commonwealth of Massachusetts FOR t f Board of Building Regulations and Standards MUNICIPALITY Massachusetts State Building Code,780 CMR, 7''edition USE Building Permit Application Revised August, 2012 s This Section ForOffictal Use Only Building Pemi�t Number ' Date Applied: Building Inspector Date SECTION 1 SITE INFORMATION . . Residential ❑ Commercial ❑ Other Description: 1.1 Pro rty Add ess: 1.2 Assessors Ma fir. Parcel Numbers Teo CA0 QTL L-tJ P l.la Is this an accepted street? yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private❑ Zone: Outside Flood Zone? Municipal ❑ On site disposal system ❑ Commercial- Service Size Check if yes❑ SEC d TO 2 . PRO.PER$Y'OWNERSIIIPI 2.1 Ower'of Reco d— �0 Name(Prin Address for Service: Si re Telephone E-Mail Address SECTION 3 DESCRIPTION OF PROPOSE])WORKZ(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units Other ❑ Specify: Brief Description of Proposed Work: ,SEC, TION 4 ESTIMATEI2.CONSTRUC Y ION COSTS; Item Estimated Costs (Labor and Materials) Official Use Only 1.Building $ 1. Building Permit Fee: $ 2.Electrical $ :2.% IndiCate how fee.is determined ❑'Standard City/Town Application Pee 3.Plumbing $ 0 Total Project Cost (Item 6)x multiplier x 4.Mechanical (HVAC) $ 3: .Other Fees: $ 5.Mechanical -is,t: (Fire Suppression) Totai.All Fees:$ [6.Total Project Cost: $ / 7 Q Check No Cheek Amount Cash Amount SECTION 5: CONSTRUCTION SERVICES i 5.1 Licensed Construction Supervisor(CSL) �2 t� 2.sJ> 2 License Number Expiration 6 to Name of CSL-Holder `� y,q y�, cJ / � ffimMasonry pe(see below) � ��� �� r,,` �.e� Descri tion Address Unrestricted u to 35,000 Cu.Ft. Restricted 1&2 Family Dwellin Signature Only MD Residential Roofing Covering el ephone Q J- /� s�3 f WSResidential Window and Siding Residential Solid Fuel Burning A liance Installation E-mail Address Residential Demolition 5.2 Registered home I provement Contractor(HIC) / Ail U4✓--."2 �t �'��� l HIC Compan Name or HIC Registrant N t� Registration Number �� 0 Address �?_pelf'Jj'� xpirationDate Signature Telephone E-mail Address SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§ 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached? Yes ..........H"- No...........❑ SECTION 7a:OWNER AUTHORIZATION TO RE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I bl'2, as Owner of the subject property hereby authorize �'/� r� G to act on my behalf,in all matters relative to work authorized by this building permit application. s.1-2-,1 Signature of Owner Date SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION &v-1 p`�� G� �yG� ,as Owner or Authorized Agent hereby declare that the statements and informa' on the foregoing application are true and accurate,to,the best of my knowledge and behalf. Signature o er or Autho` ed Age Date (Signed un er a pains and penalties o e ' ry) NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program and Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations 110.R6 and 110.R5,respectively. 2. When substantial work is planned,provide the information below: Total floors area(Sq.Ft.) (including garage,finished basement/attics,decks or porch) Gross living area(Sq.Ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open i I1 is t ut C'c�nstiar�er A t Lairs o auare.�•� .-.a___. The Offic+81 Vlteasde rat ttia`vrtice of Conwime r Affairs&Bunte"R,agulaWn(OC"R) Consumer Affairs and Susitness Regu Worne Gonsurner -iarnFs ,,,,G Crmfd Coottacon9 Home Improvement Contractor ReQistrutiOn i.,00kup You can search/fitter the regisWat on lit by any of the criteria bel"w- R istra Nu nber 37057 '' Search Search by e9 Search by Registrant Nstne Search by City Zlp Cade Search Registrants! Click on the registration number to view comptaint his". You can also »� ^ft�ttfattofl acrd [� ��It�anh' Fupd 1199 t The list is current as of Thursday, September 20, 2012' Search Results EXPIRATION REGISTRANT RESPONSIBLE REGISTRATION ADDRESS GATE STATUS NAME INDIVIDUAL NUMBER ALLur,otrR owRoaF LANZRFRME, 137057 166 A FINACHARO 1 0/0 212 01 4 Current JOHN BUILDING METHEUN, MA 01844 }�10»GQ(ll(IMgnWpa,th ui Massachusetts `i `�t mass Gov®is a recisterro service mark o1 the Carr1t110NA31t11 of i�aUgtllll"H'. 110 Massachosetts - Departt7rent Of PL'U"C Safely Baarrl of Suitding Reyuiations and Standards Construction 1111wril.1sr License' CS,4369'�2tI JOHN W LANZA 30 TEMPLE DR i iE4 ETNUEN MA 0184 Expiration na gnif9nl S Y S K Residential & Commeircaal Raefna f_'himneys All � �'�1l � � �r� r r- A Siding ...... ExpertMasonry ` x "` - CInsured tcr19Mass Toll Free vnrcl CLicensed #034Lac !/ 200 1-800-WAIT-4-U,S (924-84$7) IKO C_--aee o 1z cm-' L70.l'e We Work Year Round _. .. y� J'41,!�*�.d�'\ i �i+� ;4 ?�� a ..i�'y` } � }�/"����`"�a'JI IBJ• � ' _ 'a'�''� �;n,: :✓�,. '!; ?s,7 r LY ! � 3g'.:r., ,-K.. e:a�t�.. „.err ......... I Proposal To: Robert Doherty Date 5/1/2013 Street: 201 Carlton Lane 978-886-9055 N.Andover, MA Roof proposal rob@doherty.net 1. Extra caution will be taken to protect house 13. 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. (2 layers) 14. Building permit included. 3. Inspect and re-nail any loose or lifted plywood. 15. Contractor workmanship warranty: 10 years under 4. Any compromised plywood will be replaced at an normal wind and rain conditions. additional cost of$5500 per sheet of 1/2” CDx. Total IKO cost: $119900.00 5. Install heavy gauge 8 aluminum drip edge to all eaves and rakes. Total Certainteed cost: $1 . 6. Install 6' of IKO Atmourguard ice and water • If Certainteed is chosen by homeowner, all shield along all eaves and top to bottom in all accessory materials will be by Certainteed valleys. MFG. 7. Install all new pipe boots. • IKO Shield Pro Plus extended MFG,warranty: 8. Above the ice and water shield, install IKO Fully transferable. 100% full coverage against mfg. synthetic underlayment to the remaining defects for material, tear off labor, install labor sheathing up to the ridge. and debris removal for a full non pro rated period 9. Install IKO starter shingles to all eaves and rakes. of 20 years. Offered in this proposal at no addi- 10. Install IKO Cambridge AR Limited Lifetime tional cost. architectural shingles to entire roof. 15 year non pro-rated warranty by IKO mfg. All shingles will *Note*: Please be advised, valuables in the attic be installed and fastened according to mfg.specs. should be moved or covered due to minor debris, dust 6 nails per shingle 1-2-2-1 pattern for wind rat- and asphalt particles that will accumulate during the ings and mfg. warranty. stripping process. All Under One Roof not responsible 11. Counter flash existing chimney lead with ice and for any damage or clean up that may occur in attic. water shield,tie into new shingles and seal with clear sealant. Balance due upon completion 12. Install a new GAF Cobra ridge vent capped with References available upon request color matched IKO hip and ridge shingles. Highly rated member of the accredited BBB and Angie's List Thank you! cceptance of Proposal—The above prices, specificaons and conditions are satisfactory and are herby ccepted. You are authorized to do the work as specif1 . Payment will be made as outlined above. % - CERTIFICATE OF LIABILITY INSURANCE II1010412012 � THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ttCER ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATERTIFICATE DOES u- �,y EXTEND OR Insurance Agency S CE ALTER E�CQVERAGE At FORDED B THEEAMENDIIJC ES OBEW. i22 Chickering Road ' ,40dh Andover, MA 01845 NAIL u INSURERS AFFORDING COVERAGE k@n INSURER- ATLANTIC CASUALTY INSURANCE JOHN tANZAFAME INSURERS AIM DBA ALL UNDER ONE ROOF INSURER C 30 TEMPLE DR INSURER 0: METHUEN,MA 01844 INSURER E. t 40VERAGES To THE THE THE POLICIES OF INSURANCE TERM OR LISTED BELOW OF ANY CBEEN ONTRACT OR OTHER DOCUMENT RED WUEDITITHH RESPED ABOVECT TO HITCH THIS CERTIFICATE MAY BE 1650�}OR MAY ANY REQUIREMENT, PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALLTHE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,AGGREGATE LIMITS SHO`NN MAY HAVE BEEN REDUCED BY PAID CLAM- UMITS t k tpr>FRD` TYPE OF INSURANCE POLICY NUTTER DA OA A GENERAL UABIUTY L 118000227 9111/2012 9111/2013 EACH OCCURRENCE PREs 50,000-00 MtlSES Ea etxauer>ce '1,/l COMMERCIAL GENERAL L"ILITY MED EXP(Any erre Persona S 23W IID y E]Cl-AIMS MADE ® OCCUR 300.00000 PERSONAL 8 ADV INJURY $ h AGC3REGATE S600-00000 PRODUCTS-COMPtOP AGG S R 0w0 o 00 C,EN•L AGGREGATE LIWT APPLIES PER POLICY PROJECT LOC COMBINED SINGLE LIMIT § AVTONOBILE LtAINLITY (Ea accadent) ANY AUTO BODILY INJUPY § ALL OWNED AUTOS (Per person) SCHEouLEO AUTOS BODILY INJURY S HIRED AUTOS (,Per accident) I NON-OWNED AUTOS PROPERTY DAMAGE S (Per accident) AUTO ONLY-EA ACCIDENT S E)LABILITY A C § GARAG EAACC OTHER THAt4 ANY AUTO AUTO ONLY AGG S HEACH OCCURRENCE $ EXCIESSIUMBRELLA LtABLUTY AGGREGATE § OCCUR CLAIMS MADE § S a DEDUCTIBLE S RETENTION S p RK MPENSALTION AND AWC7009464012010 1110912012 11/09/2013 J TORY L n ' ER L7 E.L EACHACCjDENT S _ANY PROPRIETORtPARTNER(EXEt;UTIVE _� 400 00OFMERtMEMBER EXCLUDED ... EL p1yEk5E EA F IPL'�Y`[ 5 _ I( as,describe caner El OISEASE-POLICY LIMIT S '�O�q 00SPECIAL PROVISIONS CMcw OTHER CANCELLATION CERTIFICATE HOLDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE ExPtRATs DATE THEREOf.THE ISSUING ENSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEI NOTICE TD THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SKM "IMPOSE NO OBLIGATION OR LMMUTY OF ANY KIND UPON THE INSU R,ITS AGENTS OR [—�ATrS.AUTHORQED RESBtTArtVE i�..s:�S..�c2�•:st,%„�.f.� ...�.1�Y� -^..��:bi���z:.-,^��`�.�.�--�e:.�e2;a�tiE.,ir:::, a.,Y-..,.,.,_. _ .:. .. .;:,:: � ,,,.., ,sem - NORTH own of No. a - -_ - �]`( 2h ver, Mass 6 1 T O LAN• COCNIC N�WKK ��� RATED J0a�,�S V BOARD OF HEALTH Food/Kitchen PERMIT LD Septic System THIS CERTIFIES THAT ..............42-.410--0—T................0 BUILDING INSPECTOR ............ ... ........:..:..............:.......... has permission to erect buildings on�1. Foundation l Rough to be occupied as 'x.................... -�� Chimney provided that the pers n acc pting this permit shall in every resp 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 M NTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIqkrSTA 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. SEE REVERSE SIDE The Commonwealth of Massachusetts Board of Building Regulations and Standards Massachusetts State Building Code,780 CMR,7"'Edition Building Permit Application To Construct,Repair,Renovate Or Demolish a. One-or Two-Family Dwelling SECTION S: ADDITIONAL.APPROVALS 1. Ballardvale Historic District Commission: Date: Comments: Application# (s) 2. Board of Health: Date: Comments: 3. Conservation Commission: Date: Corn_ments: Application# (s) 4. Design Review Board: Date: Comments: Application# (s) 5. Electrical Permit Number: Date: Comments: 6. Fire Prevention: Date: Comments: 7. Planning Board Date: Lot Release: ❑ Yes ❑No Decision# (s): 8. Preservation Commission: Date: Comments: Application# (s) 9. Zoning Board of Appeals:. Date: Comments: Application# (s) SECTION 9: CHECKLIST ® Plans Submitted ❑ Yes ❑ No ® Stamped Plans ❑ Yes ❑ No ® Plans Waived ❑ Yes ❑ No ® Certified Plot Plan ❑ Yes ❑ No ® Dumpster Required ❑ Yes ❑ No o Fire Dept. Permit ❑ Yes ❑ No o Health Div. Permit ❑ Yes ❑ No If no,how will debris be disposed of? ® Certificate of Libility Insurance filed with the Town Cleric's Office for a sign projecting over a public right-of-way in the amount of$2,000,000 0 Yes 0 No The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): n(� ✓� �'�z / s�' Address: 1,94 City/State/Zip: fA -L-Icl 3-c " vel Phone#: Are you an employer? Check the appropriate bog: 'Type of project(required): 1.❑ I am a employer with 4.L/11It a general contractor and I employees (full and/or part-time). have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition working for me in any capacity. employees and have workers' insurance. 9. El Building addition [No workers comp.comp. insurance required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions officers r 11. Plumbin have exercised their re airs or additions �.❑ I am a homeowner doing all work g rep right[No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4), and we have no employees.,[No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are 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 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. Below is the policy and job site information. Insurance Company Name: ,Y�_--����_j Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workerscompensation 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 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 the pains ap4penalties of perjury that the information provided above is true and correct Signature: 5t rkl— Date: S 2� 13 Phone#: 1 - 9 - '07 S-3 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#: