HomeMy WebLinkAboutBuilding Permit #810-16 - 26 STANTON WAY 1/15/2016tx-41�ty 4J� Lk
BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit No#:
Date Issued:
IMPORTANT: Applicant must
LOCATION: , --Z6
Date Received
all items on this
PROPERTY OWNER W�('
MZO� Piint, 100 Year
P Z
- 'D QN1NG-'Ql$TRIC-T--,: Historic,,
AP, L
CE /Z - Z
-7
Ct
r. - ' 0
yo p
"ArED P'V
es, no
yes no
ves, no.
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
El New Building
N"One family
El Addition
0 Two or more family
11 Industrial
VAlteration
No. of units:
11 Commercial
0 Repair, replacement
D Assessory Bldg
0 Others:
0 Demolition
11 Other
0 Septic, 0 Well
0, Floodplain 0 Wetlands
11 `Watershed District
11 Water/Sewer
DESCRIPTION OF WORK TO BE PLK1-UKMLU:
Identification - Please Type or Print Clearly
OWNER: Name: 1ces,, Phone: 1118 No 110(a
ArltlraQQ-
t
3
ARCH ITECT/ENG I NEER 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: $ /S., 2Z5 - 0c) FEE: $ 0i q "'-'
Check No.: I
Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access toe guaranty fund
tA N -
nature oT-Aaent1Uvvner,'/.-j.#A - 0 /4-- _,z')iq.naiure 01 coniracior
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
❑ Building Permit Application
❑ Workers Comp Affidavit
Li 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
❑ Workers Comp Affidavit
o Photo Copy of H.I.C. And C.S.L. Licenses
o Copy Of Contract
L3 Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
o Mass check Energy Compliance Report (If Applicable)
Li 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
o Photo of H.I.C. And C.S.L. Licenses
Li 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 Clerics 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
Plans Submitted ❑ Plans Waived.❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑
Tanning/Massage/Body Art ❑
Swimming Pools ❑
Well ❑
Tobacco Sales ❑
Food Packaging/Sales ❑
Private (septic tank, etc. ❑
Pennanent Dumpster on Site ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING & DEVELOPMENT
COMMENTS
CONSERVATION
r
COMMENTS
6:
Reviewed On
Signature,
Reviewed on Siqnature
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision:
a
Conservation Decision:_
Comments
Comments
Water & Sewer Connection/Signature & Date Driveway Permit
DPW Town Engineer: Signature:
Located 384 Osqood Street
r,rr« UChTHK11RIVIC:IY�.i 'uempA. uiqpTegr;on - te_,
Gated :af 1
Fire me,._ -
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: Yes No
MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine
Nu i t, ana UA I A — (For department use
❑ Notified for pickup Call Emai
Date Time Contact Name
Doc.Building Permit Revised 2014
Location f�1� �S/ TIn-_ 1�1
No. + Date
Check #
a
29916
TOWN OF NORTH ANDOVER
Certificate of Occupancy $�
Building/Frame Permit Fee
Foundation Permit Fee�
Other Permit Fee $�
TOTAL.
%/2
� J�
Building Inspector
North Andover Health Department
fommunity Development Division
Date: December 22, 2015
North Andover, MA 01845
Re: Building Permit Application forfinishing a room at 26Stanton Way;
Dear: Mrs. Brosnihan,
Your application for a building addition was reviewed by the Health Department on December
22, 2015. Unfortunately, the application cannot be approved by the Health Department for the
following reasons found below. Please see email correspondence between you and the Health
office on prior occasions; May 28, 2014 and November 10, 2014. Your proposal exceeds the
allowed total number of rooms as related to the septic system.
1. x Missing information - A deed restriction for the numbers of rooms has not been
accepted by the Board of Health as required by Title V
2. x Undersized septic system — home is maxed out with number of rooms as related to the
flow of the septic system.
To address the problem(s):.
Please supply:
a. A draft deed restriction must be submitted for review.
Please feel free to call the Health Office at 978-688-9540 with any questions you may have.
LA I I
G
Michele Grant,
Health Inspector
Cc: Building Department
File
Enter construction cost for fee cal -
North Andover F@@ Calculation
Construction Cost
$ 189225.00
m
$ -
$
218.70
Plumbing Fee
$
27.34
Gas Fee 100 comm.
$
100.00
Electrical Fee
$
27.34
Total fees collected
$
373.38
26 Stanton Way
810-2016 on 1/15/2016
Finish Basement
< o - c _', i
0 ��r. _ �• 0.nCD
rn •
C O O rt CL p m 00
CDW CD y p N
N CD CD CD 2 cp
^ c• N
`+ D �• rt n r
e� CD
W CD
ci Z N C C, p
EL
0 U3
=r
c7' m to :E N
O �C C ca p N N
C �
>(� N n s
N < CL 0 N
< Q < CD
CD N o
a C'1 oo
—cD �Z CD
CD O -� O U) � S �c ♦` O
Ov oo cDO°N`
CD
CD
y O oo v
CD O �-- c r
O c-): CD v� C
O a: "
< 0
CD oCL
o
Q, .
14
N
0
rp
0
(Aw
rD
—
Z
O
C
7o
m
V
D
Z
T
O1
::o
C'
S
G1
H
-n
O1
V)
rD
n
fD
w
C
r
m
n
>
O
T
Dl
=
C
S
C
O
T
C1
n
S
7
M
<
.Z7
C
an\
S
T
C
Q
cu
O
O
W
C
p
z
G
m
0
N
'Q
A
N
N
3
T
O
f+
3
N
=3
WO
>
0
D
_
I
a
K, -A M Cay
D
Bill and Teresa Brosnihan
North Andover, Ma
Estimate Drafted: 10/7/15
Job Description:
Framing
1) Frame out approx 108 linear ft of wall space.
2) Wall height to be approx 8ft
3) Frame one utility closet to enclose water main and sprinkler main.
4) Frame one utility closet to enclose utilities in comer next to knee wall
5) Frame out opening in wall for access to furnace area.
6) Frame half wall for shelf along basement wall with window.
7) Frame any bump downs needed to accept drop ceiling.
Insulation
1) insulate all new wall space.
2) all insulation to be used will have vapor barrier
3) install rock wool fire insulation where needed.
Rough Electrical
1) Run all necessary wiring for all outlet switches and lighting.
2) Install all necessary arc fault circuits.
3) lower and reposition smoke and carbon detector for new ceiling height.
4) Run coaxial cable for tv
5) Run all necessary wiring for electric baseboard heat.
Sheetrock phase
1) Install approx 32 sheets of mold resistant sheetrock.
2) Tape mud and sand all walls to smooth finish.
3) Prime all sheetrock installed.
Paint Phase
1) Paint all walls with two coats of finish paint.
2) Paint all wood work with semi gloss finish white.
Doors -gad -Ceiling
1) Install one Six ft bifold door to access furnace area.
2) Install one six ft or five ft bifold to access water main and sprinkler main.
3) Install 2 six panel swing doors.
4) Install approx 720 sq ft of drop ceiling.
5) ceiling to be installed is a 2x2 recessed panel with sand finish.
Plumb i g
1) Drop all sprinkler heads in basement to finish drop ceiling height.
Finish electrical
1) Install all tamper resistant outlets.
2) Install approx eight 5" recessed can lights.
3) All can lights to be operated off of dimmer switches.
4) Install all necessary hook ups for cable tv.
5) Install approx 28ft of electric base board heat.
Finish Ca gn _
1) Install all 5,1/4 white speed bas baseboard throughout basement.
2) Install all trim around all doors.
3) Install approx 9" shelf along top of half wall.
4) shelf to be painted white.
5) Build and install custom built in.
6) Built to be installed in designated mud room area.
7) Built in to consist of cubbies, bench seat, beadboard, coat hooks, and draws/bins/ cabinet style
doors under bench seat.
8) built in to be constructed out of pine and painted white.
Flooring
1) Contractor to lay tile floor in mud room area. (approx 80 Sqft)
2) Home owner responsible for remaining flooring throughout finished off space.
3) tile allowance is, $3.00 a sq ft.
4) grout to be used is a cement based sanded grout.
5) customer to choose grout color.
Total Job Cost = $18.225
* Total job cost includes all materials & labor).
** Estimate includes all disposal fees.
*** Estimate includes all sub -contract labor.
* * * * Additional charges may apply due to unforeseen construction upon demolition.
*****Payment schedule to be determined after agreement upon contract.
* * * * * * This price DOES include permit fees.
Sign Unon Agree
Ian Fenton
Bill or Teresa Brosnihan
Date +; 2 3115
Page 12
I
The Commonwealth of Massachusetts
Department oflndustrialAlccidents
I Congress Street, Suite 100
`} Boston, MA 02114-2017
A www mass.gov/dia
4J• Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Let=ib�
Name (Business/Organization/Individual): M �*id I, Qs
Address:
City/State/Zip:_ j e``g) JkJ C330?J Phone #: 603 941 S5
Are you an employer? Check the appropriate box:
1. ❑ I am a employer with employees (full and/or part-time).*
am'a sole proprietor or partnership and have no employees working for me in
any capacity. [No workers' comp. insurance required.]
3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t
4. ❑ I am a homeowner and will be hiring contractors to conduct all work on my property. I will
ensure that all contractors either have workers' compensation insurance or are sole
proprietors with no employees.
5. ❑ I am a general contractor and I have hired the sub -contractors listed on the attached sheet.
These sub -contractors have employees and have workers' comp. insurance.$
6. n 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. 0 Remodeling
9. ❑ Demolition
10 Building addition
11. E] Electrical repairs or additions
12. F1 Plumbing repairs or additions
13. F1 Roof repairs
14.0 Other
Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information.
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, tliey 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:
Policy # or Self -ins. Lic. #:,
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 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 r.Ader t n.&and penalties ofperjury Mat the information provided above is true and correct.
l5
Official use only. Do not write in this area, to be completed by city or town official.
City or Town: PermitA icense #
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 Iii re,
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 be 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'contractoi(s) 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 Department of Industrial
Accidents foi• 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 or
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
Ami b'® CERTIFICATE OF LIABILITY INSURANCE
DATE(MMJpp/YYYY)
12/3/2015
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, EXTENb 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 endorsement(s).
PRODUCER
13ernard M_ Sullivan Insurance Agency
12 Market St.
P.O. Box 568
Ipswich MA 01938
CONTACT Jeremiah Lewis
PHONExm (978)356-5511 FAXtAIC (918)356-osY�
E-MAIL ADDRESS• jtlewis®sullivaninsuranoe.com
INSURER 3 AFFORDING COVERAGE NAIL f!
INSURERA:MAin Street America Ina. Co. 29939
an Fent011
56 N MAIN ST
SALEM ISH 03079-2434
INSURER 9: r„
_
INSL(RtR C:
_-
INSURER D;
INSURER E:
_
INSURER F:
COVERAGES CERTIFICATE NUMI35R:CL1S12304357 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.
INSR TYPE OF INSURANCE M POLICY EFF POLICY I:XP
LTR POLICY NUMBER MM DD M LIMITS
X I COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE $ 1, ODO, 000
A J CLAIMS -MADE C OCCUR
pR 6 N„ n $ 500,000
MEC EXP (AnY onDWSOn) g 10,000
MPT30400 11/1/2015
11/1/2016
PER$ONAL_8. ADV INJURY $ 1,000,000
GENLAG13RE43ATE LIMIT APPLIES PER:
I
GENERAL AGGREGATE Is 2,000,000
X POLICY 1:1PRO- JECT I LOC
PRODUCTS-COMPIOP AGG $ 2,000,000
_
Emp-pyment PracGcea Liability $
OTHER:
AUTOMOBILE LIABILITY
COt�enl SINGLE LIMIT Is
BODILY INJURY (Per pemon) I $
ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
BODILY INJURY (Peracci0an0 3
NON -OWNED
H(REO AUTOS
;f,
PROPERTY DGE
I
�$
UMBRELLA LIAR
OCCUR
EAC4 OCCURRENCE I $_
. EXCESS LIAB
CLAIMS -MADE
-
AGGREGATE $ '
DED . RETENTION 5
—'-- g
!WORKERS COMPENSATIONI
AND EMPLOYERS' LIASILIYY YIN
ANY PROPRIUTOR/PARTNER/EXECUTIVE� f
OFFICERIMEMBER EXCLUDED' :
NIA
1OTH-
STATUTE ER
'E.L. EACH ACCIDENT ; S
------
(MandLfory in NN) I
E.L. DISEASE, EA F-MPLCYC4 S
Ifyes, describa under
DESCRIPTION OF OPERATIONS below
---"-
I E.L. DISEASE - POLICY LIMIT I $
(
I
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Addn(onaf Remark& 5ehedule, may be attached if more apace is required)
CERTIFICATE HOLDER CANCELLATION
978)688-9542
Town of North Andover
120 Main St
North Andoverr, MA 01845
ACORD 25 (2014/01)
INSn7s onla , I
100%100d WPVZ:01 SM 6 39a
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
J"exemiah Lewis/CHRIS
J�
O 1988-2014 ACORD CORPORATION. All rights
The ACORD name and logo are registered marks of ACORD
86669968L61 XPJ 3mdm I NdAI ns
airs and Business Regulation
Office of Consumer Aff
10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Registration: 178487
Type: DBA
R & M SPECIALTIES Expiration: 4/22/2016 Tr# 251201
IAN FENTON
56 NORTH MAIN ST
SALEM, NH 03079
SCA 1 ca 20M-05/11 Update Address and return card. Mark reason for change.
- E] Address R
- — ---- enewal
Employment [j Lost Card
--
/J��(fC9J(IC-fZCI,JC.(/j --
Office of Consumer Affairs &Business Regulation License or registration valid for individul use only
Aya t(30ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
-registration: 178487
Type: Office of Consumer Affairs and Business Regulation
7 xpiration: 4/22/2016 DBA 10 Park Plaza -Suite 5170
R & M SPECIALTIES Boston, 4A 02116
IAN FENTON
56 NORTH MAIN ST
SALEM, NH 03079 g--
Undersecretary -
Not valid without signature
Massachusetts -Department of Pubitc Safety
Board of Budding Rcgulutiors and Stan da'�t
Construction Supers iso'
License: CS-055,336
WCHAEL J DEB�IEDETTJ-O
4 HEATHBROOIG RII
MERR13UC Wk 01860
� 4
01 Expiration.
08/25/2016
Commissioner