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HomeMy WebLinkAboutBuilding Permit #1108-2016 - 21 LINCOLN STREET 4/25/2016 Illy AA 4 4 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: Date Received Date Issued: 4 121JI-) IMPORTANT: Applicant must complete all items on this page LOCATION - - -. Print. . PROPERTY OWNER kznny _Layg6_r-w_ Print 100 Year Old Fstructure yesno-� MAP NO: 76_-PARCEL- . ZONING D.IS �RICT _ _ . ,Historic District ye t Machine)Shop Villa e _ e _g_ y TYPE OF IMPROVEMENT, PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑ Two or more family ❑ Industrial 0 Alteration No. of units: ❑ Commercial ❑ Repair, replacement 0 Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic 0 Well ; 0 Floodplain ❑Wetlands, " Watershed District 0 Water/Sewer _ .. DESCRIPTION OF WORK TO BE PERFORMED: ' i Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: CONTRACTOR Nam � e:�tc c I ETZ.-c4 Kre,Id z_ _=Phone; 971 ?ql' 7 ) 22 dl 1_Q 6O _yl� -. .. O a 6.0. - A � -dress: �'o51�s' LT Po , ec, Supervisor's Construction License -0.9-.9-'t.33 _ Exp Oate: .6.'__I Home Improvement License: _/Y//a?L/ _ _ Exp.. Date: J-`/? "I 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: $ '7030. 0 G FEE: $ Check No.: I d`� Receipt No.: a2� NOTE: Persons contracting with unregistered nt actors do no ass to,�he guara ty fund Signr a u ofAgentJQwner. Igafure of onfractor:... _ _ ': Plans Submitted �J Plans Waived ❑ ertified Plot Plan ❑ Stamped Plans ❑ -_ Plans Submitted ❑ Plans Waived El- ._.Certified Plot Plan ❑ Stamped Plans ❑ "TYPE_OF::SEWERAGEDISPOSAL- Public Sewer ❑ Tanning/MassageBodyArt ❑ Swimming Pools ❑ Well ❑ Tobacco-Sales Food Packaging/Sales ❑ _.. ❑ Private.(septic tank,etc.- . Permanent D'nnpster on,Site THEFO.LLOWING SECTIONS FOR"OFFICE USE ONLY INTERDEPARTMENTAL SIGN.OFF - U FORM DATE REJECTED DATEAPPROVED PLANNING& DEVELOPMENT` ❑ ❑ COMMENTS _CONSERVATION Reviewed on Simaturenature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes-.. Planning Board Decision: Comments f Conservation Decision: :Comments Water-& Sewer Connection/Signature&Date Driveway Permit DPW TOW2 Engineer: Signature: Located 384 Osgood Street FIRE DEPARTINia�lT Temp Dumpster on site yes.. . no Located at:124iMam Street < " a Fire Departmd!i signatur_e/date COMMENTS 6 Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. _Total land area; sq. ft.: ELECTRICAL: Movement of Meter I.ocatron., rn"ast or service drop requires approval of Electrical Inspector Yes No DANGER..Z®NE LITERATURE: . -Yes No MGL-.Chapter-1-66.Section 21A.=F and G min.$100=$1000.fin.e NOTES and DATA— (For department use ® Notified for pickup - Date Doc.Building Permit Revised 2010 i I Building Department -- The fol�w ng is'a list of the requ red.forms to be filled outJor.the.appropriate-permit to`be obtained. Roofing, Siding, Interior Rehabilitation Permits o B,Ailding Permit Application ❑ Vkr.kers Comp Affidavit ❑ ' Photo Copy Of H.I.C. And/Or G.S.L Licenses I ❑ 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 f ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy C 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) o 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 pp Permit Application o 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 cans if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the apwaal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submAted with the building application Doc: Doc.Building Permit Revised 2012 Location 0% - _d Date 1 2 . • TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $814- Foundation Permit Fee $ 1 Other Permit Fee ' $ TOTAL $ � Check# 30279 0279 Building Inspector F NORTH oven of 2Andover O 0 No. J2 ?, h ver, Mass 4 o > > A_ COCNIC NIWKN 7,95 RATED �Pa��S U BOARD OF HEALTH Food/Kitchen Septic SystPERMITT LD em THIS CERTIFIES THAT ........ �kAN... .....U....... BUILDING INSPECTOR has permission to erect .......................... buildin s on ..j,. U�wto ►� ... Foundation .. ... .. .... .. Rough ��oo t to be occupied as ....o.....14r. .`..1.s. ... ...... ...... ,.. ... ........ Chimney provided that the person accepting this permit shall in every 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 TARTS Rough Service ................ .... ....... ... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on,Athe 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. AAM, UNERAL CONTRACTING 119 R o FO STE R ST. PEABODY, MA 01, 960 i I 978-741 -7777 To whom it may concern. I Michael Fitzgerald CSL #099933 give Neil Moore authorization to drop off and pick up permits on my behalf. From 01-10-2016 to 12-31- 2016 for A&M General Contracting. If you have any questions or. concerns Please call me at 978-741-7777 Thank you. Operations Manager A&M General Contracting Michael Fitzgerald c rit d ar.� AS- 2016 Notar EXP:`04-01-2020 Work Order GREATER LAWRENCE COMMUNITY ACTION Job Number:20150246 COUNCIL,INC. Work Order Date:3/2/2016 305 Essex Street Ownership:Owner Lawrence,MA 01840 Phone:978 681-4956 A&M GENERAL CONTRACTING Auditor:Keith Young 119 R.FOSTER ST Email:kyoung@glcac.org PEABODY MA 01960 Cell:978 857-7841 Email:mikefitz@amgeneralcontractinginc.com Phone:978 681-4955 x4793 Phone:978 741-7777 Cell:508 726-1058 Kenny LaughtersColumbia Gas $7,030.91 21 Lincoln St Total $7,030.91 North Andover Ma 01845-2701 Author5zedAaw ctual ,. .;; Measure Description Comments' Price. Qty Tota Qty . Total.. Attic Insulation Attic/Kneewall Floor Transition 53 $2.82 $149.46 53 $149.46 Dense Pack w/cellulose R-11 FGB in open rafters/walls/ 175 $1.47 $257.25 175 $257.25 kneewalls R-18-20 restricted-slopes/floored 360 $1.55 $558.00 360 $558.00 slopes and floored area fill w/cellulose R-30 restricted-slopes/floored fill 300 $1.59 $477.00 300 $477.00 Flat slope w/cellulose R49 unrestricted-settled cellulose 502 $1.80 $903.60 502 $903.60 flat in knee wall Basement Insulation: Sill two-part foam w/fiberglass batt 143 $2.46 $351.78 143 $351.78 Doors . . Fixed Sweep 3 $17.64 $52.92 3 1$52.92 attic/base.int./base.ext. Thermax(or equivalent)on door 2 $57.00 $114.00 2 1$114.00 attic/base. Weatherstrip s/Q-lon or equal 3 $51.00 $153.00 3 1$153.00 attic/base.int./base.ext. Date:3/2/2016 Page 1 i Restricted To:CSSL-RF-Roofing ^- — CSSL-IC-Insulation Contractor CSSL-WS-Windows and Siding Massacnuserts t7eaanmant at u0"C Safetj, Soara of Buiotn R , CSSL-DM-Demolition tg , 09.grac;�sx102, °NA rtcense CS'L'09933 NIGH UL p nT Failure to possess a current edition of the Massach ° usetts ;Peabody ?C 119 R FOSTER S MA 01%0 State Building Code is cause for revocation of this license. For DPS Ucensing Information visit: wWW-Mass.Gov/DPS - `X3er3itpr Co tsstoner 08/12mole i i /f!/ C1 '�• ac//� Cf,��Office oConsumer Af as d Businesse u�atr<on g 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Reqistration: 141124 Type: Supplement Card A+M GENERAL CONTRACTING INC. Expiration: 111212018 MICHAEL FITZGERALD - - 5 SOUTH RIDGE CIRCLE LYNN, MA 01904 Update Address and return card. Mark reason for change. Address Renewal Employment Lost Card The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO HE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organizatiott/Individual):A&M General Contracting Address: 119 R. f=oster St. j City/State/Zip:Peabody, MA 01960 phone 4:978-741-7777 Are you an employer"Check the appropriate box: Type of project(required): 1,Q 1 am a emplover with 20 employees(full and/or part-time).• 7. El New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] g 3.01 am a homeowner doing all work myself.INo workers'comp.insurance required.]' 9• ❑Demolition 4,❑1 am a homeowner and will be hirin contractors to conduct all work on m 10❑ Building addition g y properly. ]will ensure that all contractors either have workers'compensation insurance or are sole 1 I.❑Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions S.❑i am a general contractor and I have hired the sub-contractors listed on the attached sheet. l3.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.: b.❑We area corporation and its officers have exercised their right ofexemption per MGh c. 14.[D Other Insulation 152.§1(4),and we have no employees.[No workers'comp.insurance required.] "Any applicant that checks box 91 must also fill out the section below showing their workers'compensation policy information. v 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 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 lite policy and job site information. Insurance Company Name:TGA Cross Policy#or Self-ins,Lic.#:AMWC345622 Expiration Date:03-20-2016 Job Site Address: L!n c o kn y p or7�_ OrPi11 I Cit (State/Zi N n ever�1 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$250.00 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 der the pains and penalties of perjut iy that the information provided above is true and correct. Si ature: Date: PJtone#; 978-741'7777 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#• i Community Software Consortium Page 1 of 1 Ot NORT.1ti p Borth Andover Board of Assessors F ` Back to Results I Search for Parcels I Search for Sales I View/Print Record Card Parcel ID: 210/070.0.0033-0000.0 FY: 2016 Community: North Andover View Summary Photo(Click on Photo to Enlarg Location: 21 LINCOLN STREET � FI P Card y Owner Name: LAUGHTERS,KENNETH Residence Owner Name2: Map View Owner Address: 21 LINCOLN STREET Land City: NORTH ANDOVER State: MA Zip: 01845 View Segments Abutters 9 Neighborhood: 5 Land Area: 0.12 acres Properties Use Code: 101-SNGL-FAM-RES Total Finished Area: 1628 sgft Detached Structure Tax Class: T Pct-Exempt-Land: 0 Pct-Exempt-Bldg: 0 f/ 21 LINCOLN STREET Sales Sewer: Road Type: T Histo Water: Road Condition: p Sketch(Click on Sketch to En History arge) Value Assessments Current Year Previous Year History Total Value: 273,700 290,500 Cond« Building Value: 119,000 141,100 Land Value: 154,700 149,400 Market Land Value: 154,700 Gom��erc.J Chapter Land Value: Latest Sale Sale Price: 303,500 Sale Date: 11/12/2013 Arms Length Sale Code: Y-YES-VALID Grantor: WINTERS/MORRIS Cert Doc: Book: 13698 Page: 0259 CaytyrWA O 2015 C nwwnhy SoRwme C.arAwft s AN Rligi t Rsrxwtd http://epas.csc-ma.us/PublicAccess/Pages/Parcel Summary.aspx?MenuID=3&LinkID=1823... 4/8/2016 j '4C OR& CERTIFICATE OF LIABILITY I DATE,MM/DD,>YYY) INSURANCE 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 REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the pollcy(Ies)must have ADDITIONAL INSURED provisions or 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 rl hts to the certificate holder in lieu of such endorsements. PRODUCER TGA Cross Insurance, Inca 401 Edgewater Place, Suite 220 NAME' TGA Cross Insurance,Inc. PHONE Wakefield, MA 01880 BLF.SIo.-EXtI: 781-914-1000 I i s 781-246-2601 MAIL oD-RESs: switchboard across,com �t�_.� www.tgacross.com --- INSURER(S)AFFORDING COVERAGE NAIC N INSURED INSURER A: Excelsior �1 11045 A& M General Contracting, Inc INSUREIR a: Peerless Insurance CO I , 1y8 1198 Foster St. Bldg 14 wsuRERc: AmGuard Insurance Peabody MA 019617 INSURER D; — INSURER E: COVERAGES INSURER F CERTIFICATE NUMBER: 28931672 THIS IS TO CERTIFY TAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSUR DENAM D ABOVE FOR THE VISION UMBER: INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TOLWHICH PERIOD TIHIIS 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. 1NSR; (ADDL SUBR L R TYPE OF INSURANCE ) POLICY NUMBER POLICY EFF POLICY EXP . A / I COMMERCIAL GENERAL UABILlTY j MIDD/YYYY I MM/D LIMITS ICBP8947488 3/20/2016 3/20/2017 EACH OCCURRENCE I S 1,000,000 CLAIMS-MADE '' y l OCCUR 1 PREM SES Ea occur°nce $ 100,000 ✓ IS Form cG000l � f I �-- c- �� � j MED EXP An one person) is 5,000 �✓�Contractual LlabiBtV � � ( Y I PERI SONAL&ADV INJURY I S 1.000,000 GEN'L AGGREGATE LIMIT APPLIES PER � � --- I r IPR - GEN R POLICY L�JECT LOC l E AL AGGREGATE I S 2,000,000 I OTHER: I PRODUCTS•COMP/OP AGG S 2,000,000 B AUTOMOSILELIABILITY S ANY AUTO 1 BA8947688 i 3/20/2018 3/20/2017 COMBINED SINGLE LIMIT j a acG�ent) S 1 000 000 OWNEpSCHEDULED BODILY INJURY(Per person) S AUTOS ONLY ✓ AUTOS NON-OWNED BODILY INJURY(Per accident) $ ✓ AUTOS ONLY �✓I AUTOS ONLY I PROPERTY DgMAGE —I Per capent 1 S B / I UMBRELLALIAB j i S ✓j OCCUR CU8947888 3/20/2016 13/20/2017 !EACH OCCURRENCE EXCESS UAB I I$ 1 OOQ CLAIMS-MADEI i ` ,ODI) IAGGREGATE _ Mgn ✓ c,-Tra n. N S 10,0 $00 1 AO .-000 C WORKERS COMPENSATION S AND EMPLOYERS'LIABILITY 11MWC5(2468 i 3/20/2016 j,51,euILUj7 PER 0TH• �ANYPROPRIETOR/PARTNER/EXECUTIVE YIN -/ STATUTE ER OFFICER/MEM BER EXCLUDED? ❑ N/A 1 E.L.EACH ACCIDENT S (Mandatory in NH) 500,000 descnbe under E.L.DI A y SE SE-EA EMPLOYEE S .DESCRIPTION OF OPERATIONS below � I SOO,000 E.L.DISEASE-POLICY LIMIT S 500,000 I I � , DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORO 101,Additional Ramad(s Schedule,may be attached N more space Is required) CERTIFICATE HOLDER CANCELLATION Town of North Andover SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 120 Main Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN North Andover MA 01845 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Thomas I Gre o ©1988.2015 ACORD CORPORATION. All rights reserved, ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD «893167« ( 221503 1 1.6-1.7 GL,Auno,Umb,WC Master I Marianne Noyeradt 1 3/11./2016 9:02:90 AM (EST) I Page 1 of 1