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HomeMy WebLinkAboutBuilding Permit #462-13 - 468 WOOD LANE 12/11/2012TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: G�' 1 Date Received Date Issued: 1v IMPORTANT: Applicant must complete all items on this page ff..11 LOCATION _ ._ lJ� PROPERTY OWNER r _-ov�±r _4 I dlJ - :- - v _ Prmt y 100 YearFOltl,Structure L T yes; nog.. F. ' , istio District yes not MA,P�NO ' _ PARCEL ZONING .DISTRICT s H N �, Machine,.Slop.Village, yes,no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building kf6ne family ❑ Addition ❑ Two or more family ❑ Industrial Iteration No. of units: ❑ Commercial epair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other - ❑Septic ❑Well+ ❑ Floodplain; Wetlands. ❑ WatershedI®istricta - ❑ Water/Sewer ASU /" Rlk� NtDF WORK ?, T iB CPE a�MED:Jq f.Cllcl, ne-eig'D is, /`iii ret��r `its Identi tiiory Please Type or Print Clearly) OWNER: Name:°n✓1� C1 Iry Address- 46� W 170-0 LkNs CONTRACTOR` Name:AtA-T!1-1 &4� 5_ Phi Add'ress:, A- .. In1w wt lam. Supervisor s Construction. License: a21 Expi Date Home�lmprovement`License;'1�C) Exp Date ARCHITECT/ENGINEER Phone: 36Z( Address: Reg. No. FEE SCHEDULE: BOLDING PERMIT: Vou $12.PER $1 49P7HE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ `TFEE: $ Jt Check No.: 2— Receipt No.: NOTE: Persons contracting 4ith unregistered contractors do not have a o a a ty fund Signatu�eofgAgent/Ovvnery , _ Signature of'contraet ` Plans Submitted 0 Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ 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 USBONLY INTERDEPARTMENTAL SIGN OFF - U FORM , DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMEN CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Planning Board Decision: Conservation Decision: Comments Comments ning Decision/receipt submitted yes Water & Sewer Connection/Signature Date Driveway Permit DPW Towp. Engineer: Signature: FIREIDEPARTMERIT = Temp Dumpster on site yes, Located at 124 Main street Fire Department-signature/date ` COMMENTS LOcatea 3b4 usgooa Street no Dimension Number of Stories:_ Total land area, sq. ft.: Total square feet of floor area, based on Exterior dimensions. 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 ® Notified for pickup - Date Doc.Building Permit Revised 2010 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 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 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 subm;tted with the building application Doc: Doc.Building permit Revised 2012 Location—'OV Z,+�� ��id Yl'C•-� No Date / • ! f 91- J, Check # �5 4 L TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ :— Other Permit Fee $ TOTAL $ 26029 Building Inspector 12/11/2012 15:17 19785212751 ANTHONY&MALCOLM INS PAGE 01/02 CORD,ICERTIFICATE OF LIABILITY INSURANCE DATE oz�z i-HONY CER (978)373-5623 FAX (978)521-2751 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION & MALCOLM INSURANCE AGCY., INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 3 S0. CENTRAL 5T. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. BRADFORD, MA 01835 INSURED Allan Vei l l eux, Jr. d/b/a Heat Quest Insulation Company LLC 5 Shawsheen Rd. Lawrence, MA 01843 INSURERS AFFORDING COVERAGE NAIC 8 INSURERA Phenix Insurance Co. INSURERB: Safety Insurance INSURER C, The Hartford INSURER D: INSURER E' 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSRDD im TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION DATE(MMID= UMITS GENERAL LIABILITY CPP0713253 12/27/2011 12/27/2012 EACHOCCURRENCE $ 1'_000.000 COMGENERAL LIABILITY CLAIMS MADE T OCCUR DAMAGE TO RENTED $ 50,000 •MERCIAL ISES_Faee MED EXP (Any one person) S 5,00 PERSONAL & ADV INJURY $ 1,000,000 A GENERAL AGGREGATE $ 2,000000 GEN'LAQGREGATELIMITAPPLIES PER! PRODUCTS-COMP/OP AGO $ 2,000,00 POLICY jE�T F7 LOC AUTOMOBILE LIABILITY ANY AUTO 5021421COM06 12/26/2011 12/26/2012 COMBINED SINGLE LIMIT (E;j aooidenl) S 1,000,000 BODILY INJURY $ (Pgrpwson) B ALL OWNED AUTOS X SCHEOULEDAUTOS X HIRED AUTOS X NON -OWNED AUTOS BODILY INJURY (Por aeadenl) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO AUTO ONLY: AGO $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR ❑ CLAIMS MADE AGGREGATE $ $ S DEDUCTIBLE $ RETENTION S WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EJ(ECUTIVE 6S60UB9609L39012 11/08/2012 11/08/2013 WC STATU- I I OTH- BxLIMlz3I ER E.L. EACH ACCIDENT $ 11000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 OF EXCLUDED? FFICERIMEMBER ySPdescrCbe under ECIAL PROVISIONS below E,L DISEASE - POLICY LIMIT I S 1,000,00 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS Insulation Town of North Andover Inspectional Services 1600 Osgood St. Bldg. 20 Suite 2/36 North Andover, MA 01845 ACORD 25 (2001108) FAX: (978)688-9542 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THERLOF, THE ISSUING INSURER VALL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES, AUTHORIZED REPRESENTATIVE — .— , 0��2 i r • s -c/' v'� ©ACORD CORPORATION 1988 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/Zia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers pnlicant Information I Please Print Legibl, Name (Business/Organization/Individual): Address: City/State/Zip: �,kSUk--nrI- U . LLC-, Phone #: q—N "3o (_�0®ci Are vA an employer? Check the appropriate box: 1,remployee m a emplo with 4. El am a general contractor and I 1 d/or part-time).* have hired the sub -contractors 2.m a sole prietor 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. E] 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. El Plumbing repairs or additions 12. oof repairs / 13 Other (h Sy � F)"r Gc ofDL 14 kny 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. :ontractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site formation. . ( , n tsurance Company N :)licy # or Self-ins. ``L''ic. #: �Sb OU3 _q(006? LJ 0 I d' Expiration Date:—( ►b Site Address: 1410 D Wctp City/State/Zip: ttach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). tilure to secure coverage as requirX under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a ae up to $1,500.00 and/or o e- r prisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine up to $250.00 a da s viq ator. Be advised that a copy of this statement may be forwarded to the Office of vestigations of e A o radce coverage verification. to hereby c rti t d e ' s and penalties of perjury that the information provided ab ve is trite and correct nature: Date: a' l 1 Lone #: Vl31 Official use only. Do not write in this area, to be completed by city or town official. City or Town: IPermit/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 #: Informati®n 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 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 of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or, 1-$77-MASSAFE Fax # 617-727-7749 evised 5 -26 -OS WWW.mass.anv/dia (51 Qd �I u ii M 5 CD N O to O o. to CD U3 0 U) 0 Q. CD 00,99 <D N 0CD n rID rn C ? 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(n ro ,o ct am: > ;u > z m : i Z cn < 0 2: m c m in m F (n� m z ,a -(D > c X X z @ m /= .00 p 4 0 \ 0 13 \tL m z 0 0 Ztz 'N L Io S co > CD INEATHERSTRIPPINGicAULmNG QUANTITY • TOTAL Door Kits Q Lon or Equiv. .. 0 0.00 Door Sweeps (Regular) 0 0.00 Door Sweeps (Automatic) 2 46.00 Reglaze Windows An inch 0 0.00 Wmdow.Weathstr-Schlegal per side 0 0.00 Tenmat Recessed Can. Cover 0 .0.00 Attic(Basement bypass sealing manlhr :.. 2 : 150.00. Attic. sealing with. 2 -_part foam'ma6thr :..0 0.00 SUBTOTALS 196.00 2A.INFILTRATION I INSULATION Domestic pipe Hot Water rank 1st 6' 0 0.00 Sill Insulation R-19'CF 0 0.00 Sill. Two Part.Poam iro1 Fiberglass. Batt . .......0 0 0.00 Drape Perimeter R-5 Anch. Sq. fL 0 0.00 Perimeter 2" T-max or equivalent'foarn board sq. ft. 0 0.00 Drape -DOOR R-5 or T-max or'equivalent.on door. 0 0.00. Tape Joints (Alums Grip only) per hr- 0 O.OD Duct.lnsulation:&Tape-sq.-A.R-5 _ 0 0.00 :. Rigid Foam Board Anch. 1" per board - 0. 0.00 Hydronic pipe Insulation .to 1" R-6 .. 0 0.00 Hydronic pipe ins.. 25%1.5" R=5 0 0.00 Steampipe Ins.•to1.25"Iron pipe R-5 0 0.00 : Steampipe Ins. _1.5"= 2" Iron pipe R-5 0 0.00 Steampipe Ift.-W iron pipe R=5_.. 0 '0.00 Air Conditioner Meeting' Rail .. 0 0.00 Air Conditioner. Cover ., 0.. 0.00 AirConditioner Cover Special Order 0 0.00. SUBTOTALS 0.00 2B. INSULATION . AUDITOR NOTES . Open Unrestricted R 49 0 0.00 Open Unrestdcted:R 38. 216 317:52 Open Unrestricted R 30 0 0.00 Open Unrestdded.R 20 672 ...866.88 Open Unresidcted:R 1.0 0 0.00 Restrict FUSloped R 30 0 0.00 Restrict FUSloped R 20. 0 0.00. Restrict FUSloped R 10 120 156.00 R-19 FGB open raiterstwallsAmeewalis 0 _ 0-00 R-11 PGB:open'raftersfwaiislkneewalls 0 0.00:. . Attic. Stairs(stairwi ell.& common wall) .0 0.00 Cover Pull Down Stairs'Thermadome. 0 0.00 : Site. built pull down. stairs'2" foam box. 1 180.00 Attic / Kneewal Floor Transition. Dense pack cellulose W.S. Hatch Q=Lon:or equal. W.S. & bat Hatch R -30 -4 -1 -on or Kneetivall R-12 Dell behind Per.Mernb Open.liafter IR 2O Cell: 1w poly . Open Rafter R-30 Cell. hu poly Basement Overhead R-19 fiberglass Sasefient OVerhaad R-30 fiberglass Crawlpace Overhead. < 4' high - R19. Crawlpace Overhead < 4' high _ R30 Garage Ceiling cavity filled wl.cellulose Wood ;Shake,Clapboard,Shingies Vinyl. Asbestos (single nail) / Asphait Asbestos (doub. Nail) /Aluminum Brick/Stucco Vinyl.overA'sbsstos.. . Multi -layered 3. br more layers Drill: rough' plaster or finish wood plug . Drilt finish plaster Test Drill Walis:(a114 ) 0 0.00 . . 0 d.00 0 0.00 0 0.00: 0 4.00 0 O.DO : - 0 0.00: 0 0.00 0 0.D0 0 0.00:. . 1040 2184.00 0 0.00 0 0.00 0 0.00 0 0.00:.... 0 .0.00 0 0.00 0 0.00:. . 120 228.00 0 0.00 5.OTHER MATERIAL . Ridge vent In ft: Vents Gable rectangular VM,phch Vent Vent Roof 135-(I -sq fl NFV) Large _ Vertt Roof 865.(.4 sq ft NFV) Small Vent Soffit Rectangular_ Turbine Vents All Stack Vent Props Vent . Permable House .Wrap :. . Vapor tiarrier. Energy .Star: R-4 Rigid.Vnyl Repl 94-101 U.I. SUBTOTALS 0.17. E.C. MATERIAULABOR . 8a. . HEALTH' &.SAFETY 0 0.00 0. .... 0.00... . 0 0.00 0 0.00 0 0.00 4. 108.00 . 0 0.00, 0 0.00 4 .16.00 a : UP:. . 0 . .. ': 0.00. 0 .0.00 Bb. REPAIR MATERIAULABOR Basement outside:dooronly - 0 0.00' Basement outside :door wl iambs _ '0 `0.00 Door Rept pre hung -32-36" Steel`* w i Lite 0 0.00 Door Rept interiorsolid core 28-32" 0• 0.00 Door Repl pre. hang 32-38^ wood"' w t Lite 0. 0.00 Window Replacement w/.SIR less than 1 0 0.00 Basement Window Repl. Awningf Hopper. 0 0.00 Basement Window Repl. With:a frame 0-. 0.00 Lod(set ( door) Schlage or equal 0 :.. : 0.00:. . Repair! Refit. Door .. 0 :..0.00 Replace Side. Stop . 0 0.00 Replace Casing 0 0.00: Glass Repiacementto 64 u.i. 0 0.00 Glass Replacement per 0. over 64 0 •0.00 Sash Sidelock rrop Replacement 0 0.00 Threshold (Wood). 0, 0.00 Threshold (Aluminum) 0 0.00 Slide Bolts 0 0.00 . Plug Plate Cover 0. 0.00 Cutl finish attic krieeurall access 0 . _ . 0.00:. . Cut ! close attiwkneewall access 0 0.00 Labor Rate Hours . 0 .0.00 Permits I fees. (Wap only) 0. 0.00: SUBTOTALS 0.00 TOTAL REPAIR t HEALTH & SAFETY 85.00 GRAND TOTAL WORK ORDER* (A) 4414 4337.40 Donna Vecchione '08 Wood Lane No. Andover 978-655-3621. Any alterations or deviations from the above specifications involving 'extra costs must b cleared In writing before installation. The Work Omer must be complete within 15 working days from acceptance date below:. CONTRACTORICOMPANY: :.. Heat Qu.eSt. AC CEPTANCE,Company/Co ntractor AUTHORIZED SIGNATURE: Date AGENCY APPROVALS: CTI Authorized Signature: Date GLCAC Authorized Signature` . . Date .W G.L.C.A.C., INC. 350 ESSEX STREET o�td 12.0 3'7'-T LAWRENCE, MA 01840 WEATHERIZATION ASSISTANCE PROGRAM 97$- & 55- 3(oc. l m WORK PERMIT I, bo mv'q V6- d G H I p A/2 certify that I am the owner/ authorized agent for the property at: -/(OF w UU D L dA ro et (Address) I further certify that I have given my permission to allow work on the property listed above in accordance with the following provisions: 1. WEATHERIZATION 2.HEATING SYSTEM WORK 3. 4. and such other particular as may be attached to this agreement.