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HomeMy WebLinkAboutBuilding Permit #687 - 35 CRANBERRY LANE 3/30/2012Permit NO: Date Issued: TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION IMPORTANT: Date Received must complete all items on this 3S nzA06C/"q zr-) 1 11111. PROPERTY OWNER T ��� SN/� ISL �" /� Unit # Print MAP NO: _PARCEL: 7� ZONING DISTRICT: Historic District ye no\ Machine Shop Village ye no 100 year-old structure yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Buildingne family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: []Demolition- ❑ Other lSeptcz '� Well ��Flpodplain O�Wetlancls 1 Watershed►Distr"ict MWater/Sewer DESCRIPTION OF WORK TO BE PERFORMED: (Identification Please Type gr Print Clearly) OWNER: Name: /)-er? e -A S 14A 0 �ZN _.. c244 . i 1JA CONTRACTOR Name: j �� h L� Phone: Address: 3 t� I0 f -C 04 %t -e-TWck,►'l fiw/?a.S ()I /P (� C_Y`1120 - Supervisor's Construction License: Exp. Date: Home Improvement License: /,3) e, S q Exp. Date: /� 2 z --r Z - ARCH ITECT/ENGINEER 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: $ FEE: $ Y(90 �— I qc,( Check No.: :-230� Receipt No.: � 5 NOTE: Pers a wit red contractors coo not have access to t e gu my fu iClrrn�fi Ira h 1•iant �nmPr; . " .. - •. , .. _ �-�I(7r1AtUfP nf•C(1rlt(Art(lr: _ Location elle ti h No.Ce r r Date al Check #�i 25144 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $� Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 'building Inspector 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. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT COMMENTS CONSERVATION COMMENTS r HEALTH COMMENTS DATE REJECTED 11 DATE APPROVED Reviewed on Signature Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comm Conservation Decision: Comments Wafter & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS 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.$10041000 fine NOTES and DATA — (For department use LJ Notified for pickup - Date Doc:.Building Permit Revised 2011 June/mi J 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 ❑ 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 V®TE: 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: Doc.Building Permit Revised 2008mi . 0 Ok W W P as o w v 41 E U)w c p O w U ca G u. a O rx is C . w � W O w v cn w" a O w is G V4 G C q z p cn o OE cn C3 c � o ` C N O C C.3 C. cc � C CD m C N = Ea • o_ oc. N . •.OCDL •o i.r m cm m C �r a c 4m� s y C : m� s a H ll m T E -0o - y m O c C �a M! oo� C� H Z C O w : o . a Q m im C = mao :mh y __ •' m WAD -M � •N at O C o +� y CLCLLU 'E v ems,,. co V O p C S eyv ��y= O O U 0 z O U 0 .Izv v ar co O c■ O ts Z °D 0. O CO) O cm C CO) C y CL) O 'g m m CD CD co CL_■+ CD Pft co CD m o m o a CL CMa c .o o Cc V J 'fl O ca C Z CD CL �..� y C C ev � CO2 LLI U) U) 19W W 19 W U) The Commonwealth of Massachusetts - Department of Industrial Accidents Office of Investigations U1V 600 Washington Street Boston, MA. 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/ElectricianslPlumbers Applicant Information Please Print Le ibl Name (Business/�Organization/Individual): �,� 4L Address:_ <...) b /�� City/State/Zip: /-t -c d C" I 1"4' Phone #: Are you an employer? Check the appropriate box: 1.01 am a employer with f 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. t ship and'have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. ❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.E] Roof repairs 13.❑ Other *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 ire doing all work and then hire outside contractors must submit anew affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees. Below is thepolicy and job site information. //�� Insurance Company Name:. 1061 r /L'^ %/t'l 6-1 VW t Policy # or Self -ins. Lic. #: �� 6 0 i' Z" 1I- Expiration Date: t/ A 17-a /-L- Job - -Job Site Address: C ` "� " / City/State/Zip: 141A '` Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as requiredunder 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. Ido hereby certify under9tlZ afn andpe alties ofperjury that the information provided above 's true and correct. 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 #: 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 j oint 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: Tho Commonwealth of Massachusetts Department of Industrial .Accidents Office ofInvestigations 600 Washington Street Boston, NIA, 021 It Tel, # 617-727-4900 ext 406 or 1-877,MA.SSAFF, Revised 5-26-05 Fax # 617,4727-7749 www.mass.gov/dia At' CERTIFICATE OF LIABILITY INSURANCE TIHIS CERTIMATE IS ISSUED AS A MATTER Of INFORMA ONLY "D CoweRs NO RIGHTS UPON THE CERTIFI(:A't 4OLM THIS CERTIFICATE DOES NOT AIVENV ALTER THE CCNER^GE AFV0Rt)Eo!jy THE Poi iNStMERS AFFORDING COVERAGE .,JHpv L'_AMi. INSWi_R c7 AW ._)bA'4iA Y TEMPLF 11,21tlk?: 14 L) viET�WEN .�A(11844 POLICIES OF INSLWAN(:� L,L5TEO8EjOW HAVE. BEEN LSSUECTOTME MUREDNAAFI? Afjr)vt FQA THE- P0LiCyPEPi(,DM)W_ArEV ANYRUOUIPEMENT TERM CQ (-�ONDfUON CW ANY CONTRACT OR OTHER DOC(AfENT WITH RESPECT TO WHICH ImS CEQ_ f 1t.' , CATP MAY RI­ L^`AIN -H NSURAWE Af'FORDFO SY THE POL r-JES DESCRJ8M HERM IS SUBJECT TO Ai -i T)4t f.,'XCt L)SfON!, N{' t. E AGGREGATE t IMI SHOWN MAY HAVE BEEN R E mucm BY PAID C L A_LW OF7L� L -AEC U oL W'U AlJTU W4 9 M%*V11AWfYjVx>N 1 11 1OW2012 V AWC70OW401201C) i /ogrzo 11 J� VV % CANCELLATIO1,4 S"OM D ANY Or I HE ^SOY* DE. liC pa#[, plot I, IT, . lix -.ate- OATS THeft<W rmf ISS.Aw. !ft$LpajEft wu t r,r. 4,t r VA, MCTCt It ,,Ffj Ml.__ W --4-t— > 4-t— Afft'Irs and dwslness Rego ulati011 0 Park Plaza -quite 5l 7U 1j,)5ton, Massachusetts 0211 joil',)rovertle"t Contractor Registration RpOiStfati0f) 13 tub 1 I'vpe DBA xost ation 1()/2;20l L I. t-1 N U F !()HN L.ANZ- 1 ME !66 A MERRI�,11;�CK 1,1FTHFUN Pj,- 111844 HOME IMPROVEVIEW ,;k)NrRACTC)R Type C,12%, '141 j;pjj2jr and relit"ll cat -J, ll"I% Address Renewal E.IllploN , of regIsIrallo" % alid ter Andv% idui U,xv un) before the cvpirstion date- if found return to: ()tT,r ,c of Consumer Affairs and Business Reettlation ,a park plaaS - Suite 5170 Host on. MA 02 116 Not v2lid without Signf!uO NO 1� I t, I), 64111dill': 69120 JOHN VV LANZAFA&4F- 30 TEMPLE DR METHUEN, MA 01844 4WO13 14108 Proposal To: Peter Shaheen 'x �7�"-i-*t • M1:.3.'F, :c:i` ^'4i t vtf• s" ik._ �ia z`rx`..a %.. moi"^ t .Y +9Mi.Rayr�.:= ? X -Sr_ Y.. 978-660-0245 N. Andover, MA Roof proposal pgslaw@gmail.com Chir;' ne s Residential & Commercial Roofing I . Protect house exterior and landscaping as best as Types Of�iainra CHIMNEYS PO.INTE®-REna.lILT-GAPPED A Masonry Expel Work 2. Strip all shingles from entire main and garage Total cost: $ 12,200.00 Mass Toll Free .x ucensed & insure u t,. -iBY </tt•fwd �l")/'flll!•Cf .11:;. y' %�%!f) P '1 -800 -WAIT -4 -US License #034200 � (924-8487) AKo � � oevt'z o� ,�ZV 1r i=2j We- 'Work Year Round placed at an additional cost of $50.00 per sheet of ' Proposal To: Peter Shaheen Date 9/14/2011 Street: 35 Cranberry Lane 978-660-0245 N. Andover, MA Roof proposal pgslaw@gmail.com a � C' I . Protect house exterior and landscaping as best as possible. (tarps etc.) 2. Strip all shingles from entire main and garage Total cost: $ 12,200.00 roofs. 3. Inspect and re— nail any loose or lifted plywood or boards. Any compromised plywood will be re- placed at an additional cost of $50.00 per sheet of 1/2" cdx fir. Any compromised boards will be re- Balance due upon completion placed at an additional cost of $2.50 per linear foot Referrals available upon request of 1 x8 spruce. 4. Install heavy gauge aluminum drip edge to all eaves and rakes. Highly rated member of the accredited BBB and Amies' List 5. Install 6' of IKO Armourguard ice and water shield along all eaves, wall connections and top to bottom in all valleys. 441es- Thank you! 6. Install all new pipe boots. 7. Above the ice and water shield, install IKO syn- thetic underlayment to the remaining sheathing up to the ridge. 8. Install IKO starter shingles to all eaves. 9. Install IKO Cambridge 30 AR or Certainteed Landmark Limited Lifetime architectural shingles to entire main and garage roofs. 10. Install new GAF Cobra ridge vents. 11. Cut and install all new lead flashing, counter -flash chimney and skylights with ice and water shield, seal and tie into new roof. 12. Shingles are covered by mfg. warranty 13. Building permit included. 14. Removal of all work related debris. 15. Contractor workmanship warranty =10 years un- der normal wind and rain conditions.