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HomeMy WebLinkAboutBuilding Permit #692-15 - 210 RALEIGH TAVERN LANE 5/1/2018 t {�� NORTH A BUILDING=PERMIfi � :: �1tDj- � ..tLED !6 TOWN:OF NORTH ANDOVER., APPLICATION FOR PLAN EXAMINATTQN"- i / ���-1"J D"ate:Received12Al� 4"�R .� a. Permit No#: 4TED �SSACHUSE -Date Issued: a' IMPORTANT: Applicant-musticomplete'all-items on:this page � � �" •, � � � � •Pnn �,, �. x'10 ea � . .r. �� � esr _ o MPP`' yo �. ' .. x TYPE OF IMPROVEMENT PROPOSED USE Residential K Non".;Residential ❑ New Building ❑ One family s ❑Addition ElTwo or more family ❑Industrial Alteration No of units: Q`Commercial ❑ epair, ,replacement ElAssessory Bldg ❑ ;Others: ❑ Demolition ❑ Other p ® ,loodplan ®U1%tlands ** " [7 ate she= ®istciet " q �Setic r,t el _ , .. DES RIPTION OF WO K ILAN T ` E.PERFORMEIQ ;t j.y t A-4h y eJt J Identification-Please Type.or Print:Ckarly OWNER: Name: Phone: 21� EK)7 � Address: OR AConftract®r Na-777M �upemsorsC®ns�ctioBY La.c rases = g El a _ X K, ARCH ARCHITECT/ENGINEER Phone Address: Reg N' -" FEE SCHEDULE.BULDING PERMIT.•$12.00 PER$1000.00'OF:THE TOTAL ESTIMATED cosT:.'BASED ON$125.00 PER S_F= Total Project Coat: $ 00 FEE,:$'" �� Check No.: Receipt,'No'" ° ��2 NOTE: Persons contracts g with unregistered"contractoridonot'have-.access to the g ty f d s Signature of Agnt/®w_ner _ _ Signatures wantraeor ;. M.r: I I Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ElStamped Plans ❑ TypF,5F SEWERAGE DISPOSAL. P»blic Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ i THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM M PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Siqnature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes ,14 P Planning Board Decision: Comments Conservation.Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street LORE DEP,ITQMENT Temp� umpster©n situ yeses € C2t@datt' 2Mtaalr� Stra et" ep De:arteria s�i nature/d to y CO,M�IVI;EJ�IJ�ITS. k � - r 1 ,64 Dimension '^Qao Number of Stories: Total square feet of.'floor area; basetl on Eterior dimensions. Total land area, sq. ft.: 4 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-$1000 fine NOTES and DATA— (For department use) 1 ❑ Notified for pickup Call Email DateTime Contact Name Doc.Building Permit 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 o 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 o 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 o Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract ❑ Floor/Cross Section/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) o Building Permit Application o Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses 'I o Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) { o Copy of Contract ❑ Mass check Energy Compliance Report o Engineering Affidavits for Engineered products VOTE: 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 Location `d +Q 1 No.U! 1j— x. Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ } Other Permit Fee_ $ ; 'r�u TOTAL $ K Check# { `� `� Building Inspector tAORT►i Town of : _ ,, Andover O = ;' NO. 'z *� h ver, Mass, — co'"Ic"IWIC. 1 BAITED #pkv �5 U BOARD OF HEALTH Food/Kitchen PERMIT LD.... Septic System • THIS CERTIFIES THAT VA ............. BUILDING INSPECTOR . . ........ . � � has permission to erect buildings onah R ��'� . ... Foundation 4111111" Rough '......, ..�. Qdr.+ to be occupied as .... ... %.... ........................................ Chimney provided that the person accepting this per mitshall in every respect conform to the terms of thea application pp 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 S ATS Rough Service ... ............................. BUILDING.INSPECTOR' Final GAS INSPECTOR Occupancy Permit Required to Occupy Buildink 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. RISE Engineering RIConWctorRegistrattenNo fAA Contractor Reglst allon No A division orThielsch Entineenng CT ContractorRogls(rmdon'No bq 5hatYinuEUnit ,Canton,MA 0202IONTRACT 439-5026335 FAX 339-502-6343 Page ' I S PROMAM THIS eotmrAGT Is ENTERED INTO IIETv,EEN RISE C1t•7iA41 ES ENGINEERING AM THE CUSTOMER FOR WORK AS ENGINEERING DESCRIBED Siam _...._.. ...._..........................._ ............._ .,,._._.___. __._.__.............. _..,._._.. .......... ........ .. CUSTOMER PHONE DATE CLIENT a wow ORM wililiam Driscoll (978)857-2571 11/20/2014 406394 00003 _.......... .,......_._ ..___.__ SExvrca STREET SMUNo STREET 210 Raleigh Tavern Lane 210 Raleigh Tavern.Lane _..... ............ ..._..�....... ._.....m....... . .. _� _— .... _ .__..........................._..... _. SERVICE CnY,STAMDP BILLING CITY,STATE.ZIP North Andover,MA 01845 North Andover,MA 01845 .............w._.........................._..............----..............._... ._................ JOB DESCRIPTION AIR SEAL NQ Provide labor and materials to seat ureas ofyour home against wasteful,excess Dir leakage- This wark will be perronmcd in concert with the use of special tools and diagnostic tests to assure that your home will be left withabwI iful level of air exchange and indoor air quality.Materials to be used to seal your home can include caulks,foams,weatherstripping and other products. Primary areas for scaling include air leakage to attics,basements,attached garages and other unheated amus(windows arc not genemfly addressed;(12)working hours. At the completion of the weatheriration work,and at no additional cost to the homeowner.a final blower door and/or combustion safety analysis will be conducted by the sub-contractor to ensue:the surety arthe indoor air quality. SIX)OX0 A7"IC ACCESS:Provide tabor and materials to install(1) easily moved,insulating cover for the attic access folding stair. A small flat surface of plywood will be created around the opening within the attic. 'chis will allow the cover's integral weather-stripping to restrict air leakage. _ $237.65 � _'.� �a b✓�E�s°''' r Total: $1,137:65 Program Incentive: $1,003.24 Customer Total: $134.41 WE AGREE HERMY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE YAM:AWVE,SPECIFICA noes.FOR THE SUM OF ***One Hundred Thirty-Four 81491100 Dollars $134.41 UPON FINAL INSPECTION AND APPROVAL BY RISE ENGINEERING.CUST04ER AGREEB•TO REMITAMOUNT:OUE IN FULL INTEREST OF t%WALL SE CHARGED MONTHLY ON Am UhP=BALANCE AFTER JS DAYS.SEE REVERSE FOR IMPORTANT INFORMATION ON GUARANTEES;AfGHTS OF RECISION,SCHEDULING.AND CONTRACTOR REGISTRATION. _... _.._..._..... .. ....... .......„,_..�.. ...__. ...._..._.....,__...___ .._...._.......................... DO NOT SIGN THISCONTRACT IF THE ARE ANY BLANK SPACES Au iwTd. rs aNau�ERuaa....... cusTam Ae NOTE:THIS CONTRACT MAY BE WITHWLWM BY US IF NOT EXECUTES INIHIN GATE OF ACCEPTANCE ...,4..._.__..._....._,..,....,_ ACCEPTANCE OF CONTRACT-THE ABOVE PRICES,W PCIFICATIONS W CONDITIONS ARE SATISFACTORY TOUS ANO ARE HERESY ACCEPTED,YOU ARE AUTIIORM TODD THE WORK ............... ......__......,. GAYS. AS FiPF.CI. PAYMENT IWLL BE MADE AS OUTLINES ABOVE �l .r OWNER ER AUTH RIZAT'IO FORM (Owner's Name) owner of the property located at (Pro Address) (Property Address) hereby authorize , (Subcontractor) an authorized subcontractor for RISE Engineering,to act on my behalf to obtain a building permit and to perform work on my property. c-- Curt S' nature Date a (92apant�ao�uueu�fl o� ataurlu3ell3 Office of Consumer Affairs&Business Regulation License or registration valid for individul use only ME IMPROVEMENT CONTRACTOR before the expiration date. if found return to: e91strati°n: 464800 Type: Office of Consumer Affairs and Business Regulation pir2tion:;!7I51201fa Prrlrate Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 HUGH'S ENERGY CORPORATfON: 9 TDINS- -:,y CERWICATE OF LIABILITY INSURANCEOP ID:MR DATe(aIllto,Ymy,1 THIS CERTIFICATE Is(SSU®AS A MATT>:R OF INFORMATION O)tmr,Y AND CONFERS NO Rt13HTS UPON THE CER77FTCATE HOLDER,THIS CERTIFICATE DOW NOT AFFU MA 10/06/Z0T BELOW- THIS CERTIFICATE OF Rr.URA NCE IDES NOT Y AMEND, EXTEND OR ALTAR THE COVERAGE REPRESENTATIVE OR PRODUCER,AND THE CERTtFlCATE HOM A CONTRACT BETWEEN THE 15SUINGAFFORD INSUR BY THE POLICIES IMPORTANT Nth holder fs an ADDPR P ER(Sj, AUTHORIZED the terms and Conditions of the ��'INSURED the olle:y(Ies)mast 6e endorsed, If SUBROGATION IS W certiflm�tte holder ht lieu of such o ' � yes may e�aquire an andor�msnt, A sub mment on this eerhfieate d not connfe�rDrtg is to the PRODUCER $' TYG TeInsurance Agency,Ino. 88 Feumn Street Adln*u-MA 02474- 14 7$7-941.3002 No:781.641,3008 am ^ MURED i'D nsulatlon, nC- A:SCottSd8l9Insurans+%ovERaBE Noce ce Com n 258 On Street urlalRais:AmOtIlk d MsuMnw Com Dedham,(IIIA 02025 u+eaR to:AmlmeOa P rotection Ins Co. o: 41360 arm;uB�r iNSIIRFR E• _ COVERAGES CERTIFICATE NUMBER: INSUSER F: _ THI. IS f5 TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW aIAAVE ...............6�(SSU.TO THE INSURED NAMED ABOVE SION QR THE POLICY PERIOD INDICATED. NOTWfTHSTANDING ANY REwulKeMEK TERM OR COMMON OF ANY CONTRACT OR OTHER DOCUMENT WI7 H�pE�TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED By THE POLICIES DESCRIBED HEREIN 13 SUBJECT EC ALL THE TERMS. EXCLUSIONS AND CONDTRONS OF SUCHPOLICIES-UMI7 S SHOWN MAY HAVE BEEN REDUCED SY PAID CLAIMS, L7R Tm?EOFINSURANCE A X commam pLLtpOM �� �OCCUR X X s2o2oss2 os<t�/zola or1/1 o1s EACH act t�REn(ce s 1,000,00 s 5010001 MEDEXB mrope�on S 5.00 PouC GFMPOUCRE0ATELIMlTAPPUESPEt� PERSONALaADVOMM S 11000,00 Y Loc AoaTe s 2,000100 PROOucT5=co1�nIPAGO s 2,000,00 AUTOMOBILE LrABILimy w a ALLOWNED 10200327 " " 1,000,00 AVTOS tREO 081114 0B42 > tPetensN HREDAI A ,vo SODILVUWIlRY (ParnO S UMBRELLA UAB X5 A EXCEUAB OCCUR SS S CLMmsmWr, 044"10 EACNOCCURFtBVCE s 1,00010 DED X aErENNTmoNs 10000 1O/OT/2Q1a 08/'(4/201§ WDR� ERSAnoNE°ATE s 1,000,00 LIANUTV s B OFHC RETOR1PARnuERIo�uTIVE r� R2WC513035 srxrurE mCm,LubFm N NIA 08H212014 08/12/2015 Ell UYes,desafba umer EL EACFI ACCIDENT S 500,00 ONOP OPEftATtONS 6Nmy EL DISEASE-EA EMPLOY 5 500,00 COmmerclalAppRea ELDlSEASE-PbLICYLiMIT S 500,00 065CRIPimONOFOPERATIOHS/Lm!CATlONSlVEN[CLE�IgCpRD1�. •---- - -- .. _ _ - 4alaybog48ehaQURe0r6spaegjetaqu,�yj CERTIFICATE HOt17ER cANc>:uu,ATinN ADI:I�CI{E THE SHOULDANY OF THEABOVB D==8W POLICIES BE CANCPLLED BEFORE ACCO�CSVMHTHMON EPoUoV- N C W" 13E DELgmW IN AUTHOROEOtrA7NE ACORD 25(2014/01) might r 190(1.2014 ACORD CORPIt.AORA110ll m3s9mat The ACORD name and logo are legisteled marks of ACORD .The Commonwealth of Massachusetts F Department of IndustrialAccidents I Congress Street,Suite 100 Boston,MA 02114-2017 y't www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Ledbiy Name(Business/Organization/Individual)7 U (� t CT J Address: ! GaJ f1/Yl�n City/State/Zip: Phone#: 7 Tf o 6 /-3 3 d6( Are you an employer?Check the appropriate box: Type Of project(required): ___L -htYi'a employer with employees(full and/or part-time).* 7. ❑New coh8trubtion 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'comp.insurance required.] 3.FJI am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. El Demolition ' 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10❑Building addition ensure that all contractors either have workers'compensation insurance or are sole I L❑Electrical repairs or additions proprietors with no employees. ` '' 12.❑Plumbing repairs or additions S.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13. Roof re airs These sub-contractors have employees and have workers comp.insurance.t ❑ _ p, ^ 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14. Cher 152,§1(4),and we have no employees.[No workers'comp.insurance required.] 2 *Any applicant that checks box#1 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 state whether or not those entities have employees. If the sub-contractors have employee's,they must provide their workers'comp.policy number. I am an employer that is provid6ig workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: y Policy#or Self-ins.Lic.,#: UL W(^_Z j Expiration Date: F Z 4):7: --d/5 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 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 cert under tli ins nd p naltie erjury that the information provided above is true and correct. Signature: Date: 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.Plumbing Inspector 6.Other Contact Person: Phone#: