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HomeMy WebLinkAboutBuilding Permit #508-2016 - 216 FOSTER STREET 10/22/2015A/b0 /D/2 9 BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#:24�jl�n/ i 1 Date Received NORTH 02 Date Issued:�- IMPORTANT: Applicant must complete all items on this page LOCATION c -,J- 7 r Pflrl� r PROPERTY OWNER I'� �A � L Print 100 Year Structure yes no MAP PARCEL: - DJC_ ZONING 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 0, 06 IJ WeIL o Floodplain El Wetlands ❑ Watershed'District'. OWNER: Name: DESCRIPTION OF WORK TO BE PERFORMED: e entification - Please or Print Clearly rh✓►z� 0v 6W Phone: Address: ro S-Ttlz 5,7— Contractor Name: Phone: Email: Address: Supervisor's Construction License: 00 Exp. Date: lb 49 Home Improvement License: ARCHITECT/ENGINEER vS Date: 1. %9/Z 12-4 4 Phone: Address: Reg. No. FEE SCHEDULE: BULDING PERMIT: $92.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ %ch FEE: $ t 3 Check No.: 65Hd Receipt No.: Z � NOTE: Persons contracting with ufyygistered,Fontractors do not have access to theguaranty fund Location No. Check #9*11:� '3�4a Date (C) 2 ZI i TOWN OF NORTH ANDOVER s., Certificate of Occupancy Building/Frame Permit Fee Foundation Permit Fee Other Permit Fee TOTAL ilding Inspector k ,,__4 R Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL f 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 PLANNING & DEVELOPMENT COMMENTS Reviewed On Signature_ CONSERVATION Reviewed on COMMENTS HEALTH COMMENTS Sianature Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Usgood Street .r-• x�•��s�.z.� {•t4 _r r .. iI ' S - �. � ria.... - ' -2�. ....'�„`.'v�,4.�...�. Z"$''"' `fe': F�jREDEPRaTMENtTkTemDumpsterion;site^u,yesua no E,Lo ated joij �'.R ntStraet Fire Dee �ment�signature/date, F s =`P i `*„y _...f ..il° ,. '-'x�4-� ri�ea� .'va,�.,..,•,��.:� �',.�.. ..._,�., ....w..._._._..._....sr.+..E.e= i tip i ,iii • ' t.. Yt,` 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: lies MGL Chapter 166 Section 21A —F and G min.$10041000 fine NOTES and DATA — (icor department use ❑ Notified for pickup Call Ema Date Time Contact Name Doc.Building Permit Revised 2014 lTm 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 4. Building Permit Application 4. 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 OTE: 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/Cross Section/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 . TE: 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 2012 IECC Energy code Engineering Affidavits for Engineered products TOTE: 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 CO) CD 0 Z 4D O Cr CL D cam. O "S 00 CD C� a2) CD O LWJ 0 0 U) �D CD CD cn O ,o CD a C CD O 0 n 9 j N 00 C Z Z CO) 0 m 0 1 O X <0 0Oo -° sa 2 N = < -0 N r O_• N n CD m O 0 CL C) Z p =r -0 N O d) a) -- TI rt.+n 0 m -h 0 3 fu y CD ID N to C (D"O m 2 �D D o m U) o o 3 o 0 CLv .0 � 3 = n W •" CD (D S D Q. --lo 5 �• O co o. Ts CD o�� h co Z U' 1. O =r r' Q O m toD 0 O CL CD < sz 0 N NCCD y CD O sv < R CL CnD cD • "' r C CD U) 3 0 c� 0 O =r�. CD CD (DD N C CD y O -+ — (D CCD -0 23 ci 0 sv - o CL (n � (n m ,-r o w c (U m m -o D m T ° �o o v�o 3 H y m O T D 2 VI N _ n � o ttra S m m r z M n T =. 41 Z7 o oma S fl C W G1 Z N n O T :. °—' n S < w o oma 7- T C 3 Q 0' :3m C p z H m q 0 N as a. n 3 T O Q- \ n m = O > v O 2 m q x 41 'q" ow 0 c Chimneys �* WaR ;a %XV.Dff All 'Tapes Of CHIMNEYS PONTED-REBUIll-T-CAPPED A ... Expert Masonry Work Mass iadi Frye @` � Licensed & insured i-X00-WAITt -4_, a License #034200 (924-8487) 1 Caff wae 00 0A r We. Work Year Round ....... � � � N .Sb � �� r� �.,. ;� §§,� p ^r" 'f �✓ 5x ee'Y ... ��. � ~�,,F:.� s �, .1 � k I �3 2.P 1 "' � F f i., Proposal To: Diane Bauer 216 Foster St. N. Andover MA Date 3/30/2015 978-682-0242 Roof proposal diane@bauerconsultingassociates.coln IKO Cambridge/Certainteed Landmark 1. Extra caution will be taken to protect house exterior and landscaping as best as possible. (tarps etc.) Magnets run at final clean up. 2. Remove all shingles from entire house. I Inspect and re -nail any loose or lifted plywood. Any compromised plywood will be replaced at an additional cost of $55.00 per sheet of 1/2" CDX fir. 4. Install heavy gauge 8" white aluminum drip edge to all applicable rakes. 5. Install 6' of IKO Armourguard or Certainteed Winter guard ice and water shield along all eaves. '6. Install IKO roof guard or Certainteed Diamond Deck synthetic underlayment to remaining sheathing up to ridge. 7. Install all new pipe boots. 8. Install IKO Leading Edge or Certainteed Swift Start shingles to all eaves. 9. Install IKO Cambridge or Certainteed Landmark Limited Lifetime architectural shingles to entire house. 15 year non pro -rated warranty by mfg. 10 year if Certainteed is chosen. All shingles will be installed and fastened according to mfg. specs. 10. Counter -flash chimney lead, wall connections and skylights with ice and water shield, tie into new shingles and seal. 11. Install a new GAF Cobra ridge vent capped with color matched IKO or Certainteed hip and ridge shingles. 12. Building permit included. 13. Contractor workmanship warranty: 12 years under normal wind and rain conditions. Total roof cost: CertainteeTional 900.00' • Option: Upgnd water shield. $350.cost. (Best defenseagainst ice d • Install (4) ne lux s ylights and flashing kits: Fixed unit: $650. a di -onal cost for each Venting units: $85 0 dditional cost for each • Install (1) Lomenc hermo/humidistat controlled power vent. $450.(0 ANWitional cost (does not in- clude electrical hook up • Both IKO and Certainteea direct extended non pro rated 20 year fully transferable warranties included in this proposal. Please refer to pamphlets in estimate package. Offered and included in this proposal to our local referrals at no additional cost. *Note*: Please be advised if applicable, valuables in the attic should be moved or covered due to minor debris, dust and asphalt particles that will accumulate during the stripping process. All Under One Roof not responsible for any damage or clean up that may occur in attic. Balance due upon completion, no deposit required References available upon request Highly rated member of the accredited BBB and AnjZie's List Thank you! The Commonwealth of Massachusetts A . Department of IndustrialAceidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 www mass.gov/dia yJ• Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Name (Business/Organization/Individual): lqt t Un12 ir11 O WC Z:W— Address: J -0 a,(f,ro City/State/Zip: ✓x -x-'QL0--k Are you an employer? Check the appropriate box: Phone #: 9'7 2r' `?i ) 1. ❑ I am a employer with : employees (full and/or part-time).'-, 2. ❑ I am a sole proprietor or partnership and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3.❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t 4. ❑ I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers' compensation insurance or are sole 5.1 proprietors with no employees. I am a general contractor and I have hired the sub -contractors listed on the attached sheet. These sub -contractors have employees and have workers' comp. insurance.: 6. ❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no. employees. [No workers' comp. insurance required.] Type of project (required): 7. ❑ New construction 8. ❑ Remodeling 9. ❑ Demolition 10 ❑ Building addition 11. ❑ Electrical repairs or additions 12. ❑ Plumbing repairs or additions 13. ❑ Roof repairs J � 14.1a0ther ' *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 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 thepolicy and job site information. Insurance Company Name; Policy # or Self -ins. Lie. #:. Expiration Date: Job Site Address: b 6(), 'ell � City/State/Zip: /V ^_1�76 d _e4 Attach a copy of the workers' compensa ion 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 under the Phone# i'J, - i-?- �s that the information provided above is true and correct. 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 #: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment b6 deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall. enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub=contractors) name(s), address(es) and -phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Depaftment of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should'enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city 01 town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 02-23-15 www.mass.gov/dia m� CERTIFICATELIABILITYINSURANCE,r 1111112M4 DATE (f'�'l'AIDDlyyyy) t I C IFICATE f5 t:MED A5 A MATTER OF tNF 0fMA-MN O*LY AND COfIF ERS go FitGMTS UPON CERTIFlCATE Nt3i.DEFt Tt-0!S IiE;ATE ROES N07 lti Ffii!4fa5lyEt"y 01i fiiEGATf1f1:LY AMEND,EXTEt n OR ALTER THE COVERAGE AFFORDED SY 7HE POLICIES BELOW. ato elRT' EICATE OF 1 N S U RME 0GES NOT CONS'IME A CON AG'T RET"i)lMTHE ISSUING INSURERP, AUTHORIZED REPRESENTATIVE RTANT: If the OwIflcate held' -w Is an ADOMONAL ti+t UREO, the polig1tas) mint t� a't4detsed, If SUBROGATION IS WAIVED, subject to the Eft Conrditiarts of the policy, Ce�rtaln P0iicles may require and endorsement. A strAement carr this ct" iicate does not confer right f© the F3;ra:c trolrlet in Iii?tl of su�1 asses41et1 s 1'"DDUCER -- ,-YAVID E ZELLER ItNS tl U k -174I,,YNNWAY �CtJE: (AM N LYNN, MA 01401 a-PWL ADDRESS: 2,5D6D tIi5URt3tiI5► A�F:giitsatG t;dVERAGt NAiC H ELJ !!>f34JRER A: ACE Ab1ERtCRA1LkSURAItiCE C(3MPAtti' KERRY, FRANK & BERRY. JAMES DBA FRANK 1$ SONS il4S RZR 8: tl+i�iRE#i &: 45 VJINSROOIC DRIVE INSURER D: EPPING, NH 03042 1t3SiJRER E: JE WINSURERF: -- 1i - ------ . •. - , . , v .sK suususs rtitfmsv JiG:rJ� 4F71f 771E if1i1GY >aEFrKID liL1FCJlTEe. tiOrYtiTN5TRN01ttG 4fl t?QtdD71 Kttd OF ANY Cpttt AACf OA OTiIEIi Dat tiltEtJT L"[fN itEf `T TOWK M TM CE M FMAT c MAY SE NS!lF.D OR MAY P.�tTAttd. TRE NSURAMM + isYlRL'kO >3V T3[E irZiil-MS tlE CK:SED fiFlilEiN tS 6"JECT TO ALLTHE'fEE1M E%GLl15i Z.9 AND t:t1MAQ)M Df Sl!l:4i FetSCtE9 L1f.413S 3N6N1Ft MAY HAVE SEf?r pGDUCaO BY Ataclasw. �+IEiLGENJERALL T`WOFIMBANCE L Rg POICYNUMER (13"ADDvM) X14. 40IYYYY� 114RtS ttAgiU7Y� tEPCFAi G94EFtA!- LIASIL1TY _ACEI OCGURRERiCECAWSWDE E]OCCUR. A.MAGE TO RENTED GERt'i. AGGREGATE MIT APPLIES PER: POLICY F'POJECT LOC AUTOMMILE IJASILfTv ANY Ai1TC ALL OWNED AUM-, SCHEDULE AUTOS MIRED AUTOS NON-OrA!!I_L! AUTCS UMBRELiAL1AB "OC: -.:JR E).GCSS LXPa M C_ i .tr&&MADE Per EYP (Any ora pemun) i$ XDJAL & ALV WJURY $ MAL AGGREGATE $ au pw AGG" 311'UED SINGLE Ig (Ea atcidw) LY MURY INIJURY accidart) , 4 OCCURRENCE i g MEGATE �$ RET'ENTMItE g . S A WORKERS COMPEIUSiAM3.1 rx"D VIC-STEt. PLOVEWS UABILrtY Y44 US IMBL434.14 1051420 14 1 ii05JZfJ15 X LIVITSATtI1t7RY Q` cR ANY PROP,E.yiIOF„PAtM4F=RE:XECU4;VE UfAI7S 6F� ft Ury 81 4) EX1 LUDEC? lUA E. L EACH ACCIDENT � 5 100,000 ll V=. alert' bra and E.L. DISEASE • EA DMIUM-F-1 $ 100,000 t! Imo. decsii}� utv:�a QESCRIPTi6:d LYr u?ECPAStLStiS ozarr E.L.iEA$i - POLICY I iJIIr i $ 500,000 B�fr'�TIUf:'�Y2:Tr�A76Ehts�lLQ: Allk3htSit;�trYCL.EEB�fiICiiQAfS;'�?Et�'AL.I'i'F.i+llS ttEEsIACir S .Ah"Y iris tOR Llai? f iFiL:A I L tSSiiEi3 i(i 7ti& CER`tYiiGAii? iiitr ilI14 R L"I'ititi WOhfCE}2S Ct7-MP C VERAGE u{j lsAii'i'n'8t?S ARE tr0VT 2kt211Z' 7Yit? Z17Q42!•i.GZtSCM 'EY$CdSATFCJN pot.IC1r. L UNDER ON.F Rt3x3F :)MULD, ANY OF 1"Lam7itEDESCFMEDPouctESSECANCELLED '10 T'8-IWIN is T2l2 BE-I3t: THE EXPM i ICA DATE 1"Me r, NOTICE 114 tag DELIfV�£II M ) t. Massaehuset s • Depsc'tment of Public Safety i3ogrd of 13uiiditig Regulations and Standard3 Cx)n'jtrUC$3%1% s�stzislar License: CS4M120 r" Nt WTHMUMA$ s i= piration Cmntntissioner OM20117 aCaftvt) ncyi5iia)wl Click on tiie registration number to view compiaiht history, You can also view arbitration and Guaranty Fund history. The list 19 -current as of Wednesday, October 8, 2014. . ff. REQ NT RESPONSIBLE 'tM INUMIDUAL Ai.t, umAvt one Boor• LANZAFAME, JOHN Search Results REGfSTMYION ADDRESS EXPIRATION STATUI. NUMBER DATE 337057 166 A MERRIMACK ST 1010MQ16 Current METHEUN, MA 01844 © 2012 Commonwealth of Massachusetts. Mess.GMD is a registered service mark of the Cibmmonwaaith of Massachusetts.