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HomeMy WebLinkAboutBuilding Permit #1194-2016 - 356 RALEIGH TAVERN LANE 5/16/2016 1 44YW4 aBUILDING PERMIT of NORTH Y TOWN OF NORTH ANDOVER s,� ��.: , r•: , •6 0 O APPLICATION FOR PLAN EXAMINATIONFm �0 Permit No#: Date Received y �gssacHusE��S Date Issued: I ORTANT: Applicant must complete all items on this page I LOCATION Print . PROPERTY OWNERa _ -o __ Print 100 Year Structure yesno PARCEL::� ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential f ❑ New Building L2110"ne family - ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other -- - - Wr- - �a _ hdDnct❑ SpV1ee ), t - .. ❑Watef 8-.' ' uer DESCRIPTION OF WORK TO BE PERFORMED: I Identification- Please Type or Print Clearly OWNER: Name: -rae,, ��ST� �-�'n o Phone: Address: ,3 ��livt L r � Contractor Name:L�J ��� ��n2A� LJ Phone: Email: TOv1gL ( S _ _d J h4�o` . 0 6�. Address: 3 t, Supervisor's Construction'Lidense k^ 0&°l:'/-- 0 Exp: Date: Home Improvement License: � `� a S Exp. Date: ARCHITECT/ENGINEER Phone: ti 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: $ O �0 0 0 0 FEE: $ 72,� Check No.: 1 Receipt No.: -�b�- NOTE: Persons contracting with registered contractors do not have access to th guaranty fund J i Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanaing/Massage/Body Art ❑ SwimmingPools ❑ well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ i Private(septic tank, etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF m U FORM i PLANNING & DEVELOPMENT Reviewed On Signature_ � 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: Comments Conservation Decision: Comments Waiter & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street E FIRE DEP R ME 's _ a I .� . - t N Temp Damp is er�o�n site,, �yes3 � ono [Located at12?4 Main SUreef Faire Depart ents�`ig a ure/te9 � a �COMME �� Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: - ELECTRICAL; Movement of Meter location, trust or service;drop recjuires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No i MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA-- (For department use) Notified for pickup Call Email Date Time Contact Name Doc.Buildinb Pennit Revised 2014 _ r Building Department q The following is a list of the required forms to be filled out for the appropriate permit to be obtained. f Roofing, Siding, Interior Rehabilitation Permits 4. Building Permit Application Workers Comp Affidavit Photo Copy Of H.I.C. And/Or C.S.L. Licenses aCopy 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 4 Workers Comp Affidavit � Photo Copy of H.I.C. And C.S.L. Licenses 4. Copy Of Contract Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) MasEnergy Compliance check Ener Com liance Repoli (If Applicable) Engineering Affidavits for Engineered products OTE: 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 OTE: 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 III NORTH Town -0 3� _ ndover O I No. 41L ' h ver MassHO A-.Q cocNic"awlcw 1 7,9 A� IL OA'rE O � S U BOARD OF HEALTH PER D Food/Kitchen Septic System THIS CERTIFIES THAT 'S, ..,.,.. BUILDING INSPECTOR ........ ...w�....... .. .. ....... ..... ....... .r,�............. .. .. .... .. .. . .. 2 5 has permission to erect .......................... buildings on � . �.. �� .......... Foundation Rough � �c tobe occupied as .................. ... .... . ... ... .. ............................................................ Chimney provided that the person accepting this L�rmit shall in eve respect conform to the terms of the application pro p p g p 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 CONSTRUCTITARTS Rough Service ............... ................. ... .......................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Jntil Inspected and Approved by the Building Inspector. Burner I Street No. Smoke Det. 1 � I ,O 6 41r 5 Residential & Comraercial Raofinq, #. Y , 3 { - - : �- � s .i: � i � Et � �All Types Of I Masonry Mark say s xamara LI{;E fiSC'(� Insured Mass Toil ? to(9e f•Clvttt!<4 .'3r f r t t•r! St e r"77•:: -;<' Y License#034200 5-800"WAI5"4-Ute �t (924-8487) ear Ra tnmlTrcc &- � a '' `'�`• �y „,.�%8 sa i�'i�-y ,�� �g �.s ,�1.�°�.l its r d��. 3 A.} ' v l gg § t ,y e .�a;.tF. R § ��,i t _c.,.a��..•.: dim' "- '•^,C, .:..: Proposal To: Tom Destirino Date 12/16/2015 Street: 356 Raleigh Tavern Lane 978-682-5666 N.Andover, MA Roof proposal grinch2@comcast.net IKO Cambridge 1. Extra caution will be taken to protect building 12. Removal of all work related debris. Planks will be exterior and landscaping as best as possible. (tarps placed under dumpster to prevent any damage to etc.)Magnets run at final clean up. driveway. 2. Remove all shingles from entire house up to (2) 13. Building permit included. layers. 14. Contractor workmanship warranty: 10 years 3. Inspect and re-nail any loose or lifted roof boards under normal wind and rain conditions. or plywood. Any compromised roof boards will be Total roof cost: $ 10,400.00 replaced at an additional cost of$3.00 per lineal foot of 1x8 Spruce. Any compromised plywood will be replaced at an additional cost of$65.00 per IKO Shield Pro Plus Extended MFG warranty: sheet of 1/2" CDX fir. A full 100% coverage on material, labor and 4. Install heavy gauge 8"white aluminum drip edge debris removal for a full non pro rated period to all eaves and rakes. of 20 years. Included to our local referrals at no 5. Install 6' of IKO Armourguard ice and water additional cost. shield along all eaves and top to bottom in all valleys. Install full coverage of WR Grace ice and *Note*: Please be advised if applicable, valuables in water shield to entire rear low slope area.. the attic should be moved or covered due to minor (Industry best defense against water infiltration debris, dust and asphalt particles that will accumulate from ice dams.) during the stripping process. All Under One Roof not 6. Install IKO roof guard synthetic underlayment to responsible for any damage or clean up that may remaining sheathing up to ridge. occur in attic. 7. Install all new pipe boots. 8. Install IKO Leading Edge starter shingles to all Balance due upon completion, no deposit required! eaves. 9. Install IKO Cambridge Limited Lifetime References available upon request architectural shingles to the entire house. 15 year non pro-rated warranty by mfg. (See warranty Hiahly rated member of the accredited BBB and info) All shingles will be installed and fastened An ie's Li according to mfg. specs. 14L;04 �� 10. Counter flash chimney lead, skylights and all roof Thank you! protrusions with ice and water shield and seal. 11. Install a new GAF Cobra ridge vent capped with color matched IKO hip and ridge shingles. �\ The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street,Suite 100 Boston,MA 02114-2017 www.massgov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERM]TT1NG AUTHORITY. Applicant Information n Please Print Leeibly Name(Business/Organization/Individual): Address: City/State/Zip: lc",LyPyw l" Phone#: Are you as employs'!Check the appropriate box: Type of project(required): I.Q I am a employer with employees(full and/or part-time).* 7. ❑New construction 2.E]I am a sole proprietor or partnership and have no employees working for me in $, E]Remodeling any capacity.fNo workers'comp.insurance required.] 9• 0 Demolition 3.01 am a homeowner doing all work myself.[No workers'comp.insurance required.]r Building 10�Buuilding additione- 4.0 1 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 arc sole 11.Q Electrical repairs or additions proprietors with no employees. 12.[]Plumbing repairs or additions 5.0 i!:am a general contractor and I have hired the sub-contractors listed on the attached sheet. s' These sub-contractors have employees and have workers' ne comp.insraae.t 1Roof repairs 6.O We are a corporation and its officers have exercised their righterupt of exemption per MGL c. 14.D.OD[her 152,§1(4),and we have no employees.[No workers'comp.insurance required.] •Any applicant that checks box N I must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they arc 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 subcontractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'sump.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: �� �' 101L t �/� ��`� L/.� 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 un urs anfpenaldes of perjury that the information provided above is true and correct Si stun Dat 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 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 Uceusing agency sbaU 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 bas 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 yoursituation 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 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 bum 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. #617-7274900 ext.7406 or l-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia 1118/2015 IVSD 11:55 FAX 781 598 8430 DAVID ZELLER INSURANCE C¢i 001/001 i i .acoR CERTIFICATE OF LIABILITY INSURANCE DAM(MM,DDIYYYY) r Tr1Is ce:RnPICATE 13 ISSUED AS A MATTER OF INFORMATION ONLY AND D TE CONFEFICATE HOLDER.THIS OR ALTER THE COVERAGE AFFORD RS NO RIGHTS UPON THE CERTI1 CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND. EXTEND El BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING ORD 0 By THE POLICIES AUTHORIZES I REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER J IMPORTANT: if the Certificate hOldsr is an ADDITIONAL INSURED,the polieypes)must be endorsetl. if SUBROGATION 13 WAIVED,subject to ! the terms and conditions of the policy,Certain policies may require an endorsement. A stateme certificate holder in lieu of such endorsements. nt on this certificate does not confer rights to the PRODUCER 1 CONTACT a DAVID E,ZELLER INSURANCE AGENCY INC N MEs (751)e0 HONfi 59585.2071 No 370 LYNNWAY m9st-ASTY611angdavidgeller.com LYNN NMMI .00VEPAGN NAI R i INSURED MA 01801 tN rtes ACE AMERICAN INSURANCE CO 44667 IN R I BERRY FRANK&BERRY JAMES DBA FRANK&SONS suRER i 46 WINSROOK DRIVE Na I EPPING "IUFR COVERAGES NH 03042 CERTIFICATE NUMBER; 13141 REVISION NUMBER: INDICATED. 19 TO CERTIFY THAT THE POLICIES OF INSURANCE USTED BELOW HAVE BEEN ISS UED TO THE INSURED NAMED A80VE POR THE POLICY PERIOD INDICATES• NOTWITHITTANDING ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO ICYWHICHPE THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TD ALL THE TERMS, , EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IN50. TYPEOPINSURANCE POLIi COMMERCIALOENERALLIABUM M D UMIiII CLAIMS-MADE 0 OCCUR EACH OCCURRENCE IceI a MED EX0Mronepegen) s NIA OENLAGGREGATE LIM�I.APPLIES PER: PERSONALAADVINJURY = POLICY Q JERCi LOC GENERAL AGGREGATE _ OMEFL PRODUCTS-COMPiOP AGO AUTOMOeILELGaTUTY >; ANYAUTO ALL'ITSO A�uiOSUlEO N/A BODILY INJURY(Perp ! HIREDAVTOE NONAWNED BODILY INJURY(Persoxdenq a AUTOS S ! UMBREU•ALIAa OfxUR Z EXCE44LIAe MS•MAOE NIA EACHOCCIRRENCE _ N AGORCO a WORKER/COMPENSATION ANDEtPLOYERerLIABILITY N ANWROPRItTORiPARTNE(�XECUrta A OFFIC(MAndaP/MEMNREXCLU0E01 wA wA NIA OS02U69998L43415 11105/2015 11/05/2015 el EACNACQDENT s 100000 '. tMyyegqndERM In NN) OE30fu TIOON ffin FOPIRA E•L•OIBEABE- HMPL EE 6 100000 r @.L.OrsEAaE•POCKY LNIT S 500 000 N/A 1 DESCRIPTION OFOPERATIONNILOCATIONS/VEHICLES(ACONO101,AddRieMlRemsrkaaobedute,msybesaeehWltmenseseebrequtnd) Workers'Compensation bene►,ss wifi be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 OS 8,no euthorizatton b given to pay clatrns for be to employees in States other than Massachusetts if the insured hires,or has hired Ihose employees Outside of Massa03 08 to _ This eArtifiate Of insurance shows Iha poncy in torte on the date that Ws Certificate was Issued(unless the expiration date on the above policy precedes the Issue data of thus certificate el ineurance). The status of this coverage can be monitored dally by accessing the Proof orcov www.mass.govmvd/workers-compensaerags•Coverage Verification Search tool at tloMnvestlgsponsl. i No partners haus stented ooveraga. CERTIFICATE H LDARCANCELLATION THS EXPIRATIONHDATE THEREOF, NOTICEIES 0 WILL BE DELIVER O IN t ALL UNDER ONE ROOF ACCORDANCE WITH THS POLiCYPROVISIONS. 30 TEMPLE DRIVE AUTHORIZEOREPRESENTATIVE METHUEN MA 01844 21VIM. 4Cry,CPCU,Vice President—Residual Market—WCRIBMA ACORD 25(2014101) The ACORD name and logo are registered mark of ACORD RD coRPoriATioN.All rlgt►ts reserved, WORKERS COMPENSATION ANO EMPLOY RS LIABILITY INSURANCE POLICY INFORMATION PAGE A.I.M. Mutual Insura Ce Company 54 Third Avenue, Burlington, M ssachusetts 01803-0970 (800) 876-2 65 NCCI NO 28158 POLICY NO. AWC-400-7009484-2015A PRIOR NO. 'AWC-400.7009464.2014A ITEM _ . 1, The Insured: All Under One Roof DSA: Mailing address: C/O John Lenzafame FEIN:+'-18251 30 Temple Drive Methuen,MA 01844 Legal Entity Type: Sole Proprietor Other workplaces not shown above: See Location 2. The policy period Is from 11/09/2015 to 11/09/2016 12:01 a.m.standard time at the insured's mailing address. 3. A. Workers Compensation Insurance:Part One of the policy pplies to the Workers Compensation Law of the states listed here: MA S. Employers'Liability Insurance: Part Two of the policy appii s to work In each state listed in Item 3.A. The limits or liability under part Two are: Bodily Inju by Accident $ 100 000 each accident Bodily Inju by Disease $ policy limit Bodily Inju by Disease $ *--­ 100,000 each employee C Other States Insurance: Coverage Replaced by EndorsorrentWo 20 03 00 B D. This Policy Includes these Endorsements and Schedules: EE SCHEDULE 4. The premium for this policy will be determined by our Manualsf Rules,Classifications,Rates and Rating Plans. All information required below is subject to verification and cha ge by audit. CI'assifc_ettons - .• _fjrem[ui Bass -- Code Estimat id per$to0r •Estimated^� No. Total An ual ` Of Annual --,-• Remuner lion.....�,•_,_„_, � Remuneration Premium ; INTRA 174355 INTER SEE.CI.ASS CODE SCHEDULE Minimum Premium 91il7V To al Estimated Annual Premium GOV . GOV De osit Premium STATE CLASS MA 5474 St to Assessments/Surcharges $1 .00 x 5,-7500% $1 This policy,Including all endorsements,Is hereby countersigned by 10/05/2015 4 or signature •' �� Service Office: 54 Third Avenue P rry Insurance Agency LLC Burlington MA 01$03 5 2 Chickering Rd,Rt 125 N rth Andover,MA 01845 WC 00 00 01 A(7-11) Includes copyrighted material of the National Council on Compensation insurance, used with its permission. t(�t Massachusetts -Department �4?ubsi;, �f Board oY Buiiding RegNi31i0"'G anN eta^u= runitructiun supei'0sull " License; CS-069120 %.k /J� JOHN W LANZAi�. 30 TEMPLE DR S -s'.:s s v METHUEN MA 111840.1.W. • Commissioner 04/03/2017 Click on the registration number to view complaint history.'Ybu can*ISO vle%v 9rbitratitatt and guaranty Fund history The list is current as of Wednesday, October•8, 2414. Search Results REGISTRANT RESPOI+1 WLE REMTPATtC94 ADDRESSEXPIRA110H STATUS NAME MDMMUAL "10161M DATE ALLUNDU zONX Hoof LANZAF E. j37 -? 166 A MERRIMACK ST 10102/2016 Current JOHN METHEUN,MA 01844 ._ ©2Q14 Commonwealth of Massachusetts. Mass.aave is a registered service mark of the Commonwealth-of fAsssachuseft. I A 1A/11 A 1 4 ( l Location `Xt— �v P 2 No. 1 1 `1 ZOk Date . - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $� Foundation Permit Fee $ Y Other Permit Fee $ TOTAL $ _ o l " Check# J 0 3 7 Building Inspector