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HomeMy WebLinkAboutBuilding Permit #704-14 - 296 RALEIGH TAVERN LANE 4/14/2014TOWN OF NORTH ANDOVER PPLICATION FOR PLAN EXAMINATION Permit NO: 04— 4 Date Received Date Issued: TANT: AoDlicant must complete all items on this :. LOCATION PROPERTY OWNER I'f-46/ _M1. (. &J`�.__ Pri nV 100 Year Old Structure yes MAP NO��C_. PARCEL: ZONING DISTRICT: .,Historic District yes no Machine Shop Villaqe ves 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 El Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) OWNER: Name: 1 � W C J� Phone: Address: a?6AL4_ ,' CQ4 Z A.) /VA CONTRACTOR Name: �,AV\2Arr 4-7 9%9` 9-yJ_-' r5 1 Address: i;J� 1 -c��-� / f�l'►'I ��''trA- �s Supervisor's Construction License: Exp. Date: Home Improvement License: _ j� �S~ _ . ,Exp. Date: (® ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ 60, c�'® FEE: $ & e Check No.: t4 I Receipt No.: p1 "A�'( \ NOTE: Persons contractinkMith uiregistered contractors do not have access to,the guaranty fund Signature of Agent/Owner Sigat"ure of contractor Plans Submitted Di ffLAs Aived ❑ Certified Plot Plan 11 taimpeq Plans 0 Plans Submitted ❑ Plans Waived ❑ .Certified Plot Plan ❑ Stamped Plans ❑ . TYPE_OF--SEWERACTEDfSPOSAL Public Sewer ❑Swimming Tann%ng/MassageBodyArt ❑ Pools ❑ Well ❑ Tobacco.Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc.- ❑ . ...:permanent Dempster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED: DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ 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: Com Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW To` o Engineer: Signature: Locatea ju4 us 000 3ireei FIRE DEPARTI E"NT -'-Temp Dumpster on sitees no Located at•124,Mair Street Y Fire Departme►i#-signature/date`' COMMENTS w -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 MGL -Chapter -166 Section 21A —F and G min.$100-$1000.fine NOTES and DATA — (For department use ® Notified for pickup - Date Doe.Building Permit Revised 2010 Building Department The fohowing 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 ❑ 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 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 ❑ Photo Copy 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) ❑ 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 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 ❑ 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 Clerks office must stamp the decision from the Board of Appeals that the apn,,al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm.tted with the building application Doc: Doc.Bui?ding Permit Revised 2012 0 EH * a, rA rA M w LL O-1 C r S� EJ T a In r� 1 C O LL K E LL 0 O a Z Z G D d. Y 0 c <v W O04r ►Z ~ a s a - V " o w LL O-1 C O LL EJ T a In 0 O - u a Z Z m C O LL K E LL 0 O a Z Z G D d. to W LL o V a Z U V LU W N LL oC W H z w LL Z LU oC Q w W LL m p N Y N O'� Ncu J E a a > _ L o m U) c > O o _o CL CD W N = O O O M 3 tm a' o D Q� Gm�++m 0 w' L MEMO cc 0 U 0 U c c c _ L L m 5 O H 0 U) 4) CL .2 m i N W O 'a O O . u)•N Uj �O Pct O w S.. O W E Q.a a 0 d' p L - FE H= o 0 _O F— t . QOV > 0 LU z Z_ J M m N 2 OU) CO Z V W U a. Z x U Cl) LLJ -i a. Z M 'N O 0 w 0 0 a ■e ■e The Commonwealth ofMassachusetts Focmil I�:......)'xJ'o4ltiMvd>y!e..i.isl_ti'... __ .....__. Department of Industrial Accidents Office of Investigations 1 Congress Street, Suite 100 Y Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): All Lr0t/J--A Cg <- 9y�� Address: Or� City/State/Zip: µ � th44- S Phone M ��d-.27 Are you an employer? Check he appropriate box: s'- '7J- 3 / Type of project (required): 1. L21 am a employer with 5 4. ❑ I am a general contractor and I 6. ❑ New construction employees (full and/or part-time).* 2. El I am a sole proprietor or partner- have hired the sub -contractors listed on the attached sheet. 7. E] Remodeling ship and have no employees These sub -contractors have g, F]Demolition working for me in any capacity. employees and have workers' 9 E] Building addition [No workers' comp. insurance comp. insurance.$ 5. ❑ We are a corporation and its 10. F-1 Electrical repairs or additions required.] 3. El I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12. ❑ Roof repairs insurance required.] t c. 152, §1(4), and we have no 13�Other�� employees. [No workers' comp. insurance required.] *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. tHo meowners 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 the policy and job site information. Insurance Company Name: Policy # or Self -ins. Lic. #: PLJCExpiration Date: t 9 Job Site Address: og 9 c 1?4 -1,A t &n0 lo3 City/State/Zip: t,3 A Attach a copy of the workers' compensation 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 and pegalties of perjury that the information provided above is true and correct 41 g i 2-i Phone #: 97,? ` 97f - 2j-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 #: 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 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-contractor(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 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 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 Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call: The Department's address, telephone and fax number: The Commonwealth ofMassachusetts Department of Industrial Accidents Office of Investigations 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. # 617-727-4900 ext. 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 7-2010 wwW.mass.gov/dia 14eg*1000" IOC Atftwfi " "eustle o at ConsuMer Affairs ..d sushvess magwa"O" ,,nt Contractor neS*stration LoOkUP HIDMe IMProVe", (,An search; tlfltf - trte regls"tton W by anv of dw criteria below. ReqlStFb*1 allort t4uM57057 Search! seamh by 1-f.,arch by Re9"'tra"t Nara ZIP Code i sedrct; Uy City :,ealLn Regislia-'15 1! 1,lumoet to view cOmP'alnl he -Wry You can also tne reoff ber 20, 2012 rhe ItSt IS (Urre it of Thursday, Septem Search Results EXPIRATION STATUS RESP AOLF_ REG4STRATtOW ADDRESS DATE REGISTRANT"UNSER IND g) VAL 05", IrO6 A FINACHARO oNoEp ONE ANZJ ME BUILE)ING Dir mETHEUN. MA 01844 r.Pdftll)eflt Of Pu011c Board of Building Regulations and Stafjc'.ards LicenSe: CS.&9120 JOHN W LANZA 30 TEMPLE DR METHUEN 14A j4 ;L '!•88618 ® 02/02 1 /6!2013 ? :38:43 PM( Z3 �3 _ aAIs n o' CERTI KATE OF LIABILITY INSURANCE it,,, WM3 RTlft�ll D t3 tS 0 A8 MAY tiFNEt#11 L �Y * ND �Ai L WC THE AIrFOR THEDPoucme Low T" CSR PMATE a$ tnau itde 8"m not � A CT BETNf�N TtiE tt 0 II�RER(S}, AUTHbRMt?D R PRgWrA nom PRtiDUCK AN Ta CARIFICAM "omit ,...�... t . to res col s <A ► : Pry jjW be wt OR WS cGWW i d�a iWANED � �gfvtn this VAWI •VVl dorsi, 81at+s t . Orn Root C�T THE POLICES Oi 617lZ�iiGB ttaTED tiE10YV HAVE Bi flEQNE iNHR��tiT AWA Sp% TO VVMMO4 TNtS oTTinpIt�TANDl AHY t�O1n1 t6iT. TERM OR COHI�ITI©N OF T TO ALtTE *jpjrSg g IJ�l'�H POU C�r�S:1�11 M8 i1MNi0AY S "WRmm D1 JtE0 d 1111I Ct MSBD HEREIN IffiTris -vw tlwcTO OF 0011R1►t11M OE14IiAt. UA0w CLAIVSAAAM M OCCUR .NIL AOGRSOATELD+MT• APPitES PER: a UMt►E0MMEW& M8D V1P (Arhr aM AO S* ! _ PERSONAL&ADVOUM ! OEAALA"MATE T RRdQt1G7S • COMPJQP AGO i AAANM�Y AUTO AUTOOS� SUVOSE0IAEO HmAUTOS (S Og EO t BOLTLY INJURY (PK oomcal ! QOOfLY INJURY (iM �cddrot} ! i LMS1d�31 A UWIE Iprets We OCCUR CLAIMSMADE EA04 OCCURRENCE ! AOCREOATE ! -- _ i' aw RETEW1014 ! A ECUr1 OryMNI$ N/A AWC•IgtF•1Q0148! 2811 iilSt�13 tt1912S14 x _ •• t 0,000.40 Ell. EACH ACCWW 10 U. Dt6EA5E • EA EMPLOYEE i 100,800.00 S.L. pSEAaE • Paucv LIMJr : 300 800,00 Desc wym 01OPHU1TI9tR/t+aCRTIQ!!!IV!»QEfiJ1COIWttt,AdADsnAlR{tlf�e,Y,HrAAns/�sibwssArsA 'Th* f%srs aompsm""m po" does not pmvM CovMp Ear 40M LOR9011 a+s aHOnD Mff OF M ASWE BMMM PD XR8 K P.ANWAAD I WOU il�itcr�°>Iar� T�iial�re drtsa waa. ss osstvsm ni 25 (2010" Ths ACORO nuns snd rano sro r*VOW" "Wks oiACORD SIVE: X0.9211 11/06/2013/1r8D 02r1EPM y 4 al R Ak q 8 •:r s�t,'£'7�s"-rx.' - —"•+'�: a . x__ amu-:.' a .-V4 aTHE H us .T #,!... 'a` .. k� C it R i fi lommercial Roofing CHIMNEYS POI TEn REnt�ILT-CAPPED All Types �f Siding Expert Masonry Work Mass Toll Free Licensed & Insured t _800-watT_4-u,.5. L,014 -4v U*t'ned & ' PP'atr ! Sr cel T 97G " 1K.`� �, h F = �_ License #034200 (924-3487) .� ° We Work Year Round Proposal To: Dan & Carol McQuaid Date 10/8/2013 Street: 296 Raleigh Tavern Lane 978-683-2660 N. Andover, MA Roof proposal dmturtle@aol.com Certainteed Landmark 1. Extra caution will be taken to protect house 12. 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 layers of shingles from entire house. 13. Building permit included. 3. Inspect and re -nail any loose or lifted plywood. 14. Contractor workmanship warranty: 10 years under Any compromised plywood will be replaced at an normal wind and rain conditio additional cost $55.00 per sheet of 1/2" cdx fir. 4. Total roof Cost: $ 6,900.00 ' Install heavy gauge 8" aluminum drip edge to all eaves and rakes. 3 Sides roof Cost: $ 59500.00 5. Install 6' of Certainteed Winter Guard ice and (All applicable discounts applied and included in water shield along all eaves. proposal) 6. Install Certainteed Diamond deck synthetic underlayment to remaining sheathing up to ridge. *Note*: Please be advised if applicable, valuables in 7. Install all new pipe boots. the attic should be moved or covered due to minor 8. Install Certainteed Swift Startstarter shingles to debris, dust and asphalt particles that will accumulate all eaves. during the stripping process. All Under One Roof not 9. Install Certianteed Landmark Limited Lifetime responsible for any damage or clean up that may architectural shingles to entire house. 10 year non occur in attic. pro -rated warranty by mfg. All shingles will be installed and fastened according to mfg. specs. 10. Counter -flash chimney lead with ice and water Balance due upon completion shield, tie into new shingles and seal 11. Install GAF Cobra ridge vent to entire ridge References available upon request capped with color matched hip and ridge cap shingles. 1EIighly rated member of the accredited BSB and Angie's List Acceptance of Proposal—The above prices, s accepted. You are authorized to do the work as Date of Acceptance: i 4 ( . ( a"a 1 Thank you! 1s and conditions are satisfactory and are herby Payment will be made as outlined above. SignatureK��4���. . Eg .�'r ,E „ g='' w n id ial ommercial Roofing1 Types Of CHIMNEYS OINTEo-n nUtt.`r-CAPPED Siid.inqExpert Masonry Work Mass Toll Freev _ Licensed & Insured J Vvd J 476 1-800-WAIT-4-US "••'••` License #034200 (024-8407) wee wazwv ov'.1'7 We Work Year ]Round Proposal To: Dan & Carol McQuaid Date 10/8/13 Street: 296 Raleigh Tavern Lane 978-683-2660 N. Andover, MA Vinyl Siding Proposal dmturtle@aol.com 1. Remove all existing siding ,corner boards and gutters from entire house. 2. Inspect all wood components of entire house. Any compromised material will not be left. Any existing damage or rot will be discussed, confirmed with homeowner and replaced at an additional cost of time and material. 3. Install Tyvek(no generics) housewrap to entire house. All seams will be taped to guard against air infiltration 4. Install 4" standard vinyl corner posts to all house corners. Color chosen by homeowner. 5. Install Mastic Quest or Certainteed Monogram double 4" vinyl siding to entire house. Standard colors only. Premium or deluxe colors can be quoted. 6. Soffit area: Drill holes in all rafter bays for added ventilation where needed. Install vinyl perforated Invisivent soffit panels for excellent attic airflow. Standard color to be chosen by homeowner. 7. Install j -channel to all areas that need to accept vinyl siding. All j -channel will be self -flashed and angle cut for clean professional appearance. 8. Install custom bent Alcoa aluminum trim coverage to all fascias, rakes and window casings. Window trim will be flat or have enhanced detailed bend to accept J -channel and have uniform and nicer aesthetic finish appearance throughout. Same trim detail can be done on rear sliding door if wanted. 12. Install all new vinyl accessories: light blocks, gable vents, split blocks, meter block etc. 13. Removing and re -installing electrical meter electrical permit by licensed electrician all included in proposal. 14. Removal and installation of light fixtures and doorbells included. New fixtures and doorbells must be provided by homeowner if wanted. 15. Install composite PVC kick plates under all entry doors where applicable. 16. Garage doors: Install composite PVC jamb, trim and weather bands. 17. Install all new white .032 aluminum seamless gutters with downspouts to entire perimeter. 18. Install new vinyl louvered or raised panel standard size shutters. No additional cost. 19. Existing AC unit: Remove and frame in rough opening. Vinyl side over on exterior. Insulate and drywall on interior. No painting included. 20. Proposal does not include any painting or staining. 21. Contractor workmanship warranty= 10 years 22. All materials covered by MFG, Limited Lifetime warrantees. Total cost: $ 18,800.00 (All discounts applied and included) Payment schedule: • 1/3 on project start date when material is delivered • 1/3 at project halfway point Final balance including any extras due upon project completion References gladly available upon request Highly rated member of the Accredited BBB and Angie's List. Thank you! Location � , No. Date 1, h TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $� Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # (. G rr�� / -.L;1 Building Inspector