Loading...
HomeMy WebLinkAboutBuilding Permit #349-14 - 47 WOODCREST DRIVE 10/15/2013 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: �4I—H Date Received Date Issued: 1 PORTANT: Applicant must complete all items on this page LO- TION L- PROPERTY 01/VNER Print 100 Year old steuctufe yes nor VAR NQ I_. _ PARCEL_' _ZONING D,I:S�TRICT -_ Mistonc District ye noa llllachme�Shopgeye �Villa { 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 r o Septic ❑Well �. ❑ Floodplain ❑;Wetlantls ❑ 1Natershed�D'istnct o Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: 'jA Identification Please Type or Print Clearly) OWNER: Name: rM I-IZt Jr4n /q-,I Z.' Phone: Address: 17 ''S bv�9 CONTRA-TOR Name ' _ J " `�'h - 'Z! %y !?G Phone: 1� �'�lJ�' c� s = w - s Address — _ Supervisor'sC-gnstructionLicense �_ �Z_L) _ Exp. Date Horne�Improvement�Licen`e _ ____ _ _ p � _ �_�'� __• 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: $ f ° 9 S-b FEE: $ z.v �• ____ Check No.: �J Receipt No.: ZAP 07.0c-/d NOTE: Persons contracting ' unregistered contractors do not have access to e guar my fund Sig-�atI u_a f��.cont a to.r SignatureofAgent/Qwnerrr;. _ Plans Submitted D Ndhs Waived ❑ Certified Plot Plan ❑ mped Plans ❑ Plans Submitted ❑ Plans Waived ❑ -Certified Plot Plan ❑ Stamped Plans ❑ -TYPE_OF-SEWERAGEDISEOSAL 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 DATE REJECTED: DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS .CONSERVATION Reviewed on Signature COMMENTS I HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sevier Connection/Signature & Date Driveway Permit DPW Tow;z Engineer: Signature: ` Located 384 Osgood Street FIRE DERARTm NT Temp Dumpster on site yes no Located at-124iMair, Street - Fire ®epartme►it 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.$100-$1000 fine NOTES and DATA— (For department use I I i i i ® Notified for pickup - Date i Doe.Building Permit Revised 2010 Building Department The fol; wing is a list of the requi-red.forms to be filled out for the appropriate permit to.be obtained. Roofivg, 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 o 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 o Photo of H.I.C. And C.S.L. Licenses o 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 apw 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 i Doc: Doc.Bui?ding Permit Revised 2012 . i Location�/i W��i� i No. Date ! / I o - TOWN OF NORTH ANDOVER a � a o Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee Other Permit Fee $ TOTAL $ Check# 26989 Building Inspector NORTH Town of tAn.dover 0 No. Y Z � o : LAKf h , ver, Mass, S coc"Ic«ewic RATE o U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT ....................�r. '.. ................................................................ BUILDING INSPECTOR �( 7. Foundation has permission to erect .......................... buildings on ..........I I Rough to be occupied as ...... .. � ....'t...l,w ID . .....'":"':.............................................................. Chimney provided that the person accepting this permit shall in a ery respect conform to the terms of the application 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 &p ` PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION9.. R 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 Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. SEE REVERSE SIDE Rightfax N1-1 8/29/2013 5 : 59 : 22 AM PAGE 2/002 Fax Server CERTIFICATE OF LIABILITY INSURANCE DATE 08/25)/2013 (MM/DD/YYYY) T TIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND 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 and endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: DAVID E ZELLER INS AGCY PHONE FAX 370 LYNNWAY (A/C,No,Ext): (A/C,No): EMAIL LYNN,MA 01901 ADDRESS: 25D6D INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: ACE AMERICAN INSURANCE COMPANY BERRY,FRANK&BERRY,JAMES DBA FRANK&SONS INSURER B. INSURER C: INSL R D. 45 WINDBROOK DR INSURER E: EPPING,NH 03042 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: HIS 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 CLANS. MSR ADD SUB POLICY EFF DATE POLICY EXP DATE LTR TYPE OF INSURANCE L R POLICY NUMBER W=D\YYYY) (MM10D\YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ CLAIMS MADE [:]OCCUR. DREMISES(Ea occurrence) ED EXP(Any one person) $ RSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY a PROJECT a LOC ODUCTS-COMP/OP AGG $ AUTOMOBILE LIABILITY COMBINED SINGLE $ ANY AUTO LIMIT(Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULE AUTOS (Per person) HIRED AUTOS BODILY INJURY $ (Per accident) NON-OWNED AUTOS PROPERTY DAMAGE $ (Per accident) UMBRELLA LAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ A WORKER'S COMPENSATION AND XWC STATUTORY OTHER EMPLOYER'S LIABILITY YIN UB-4689PB93-13 0722/2013 07222014 LIMITS ANY PROPER ITOR/PARTNER/EXECUT IVE OFFICER/MEMBER EXCLUDED? N/A E.L.EACH ACCIDENT $ 100,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONSISPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. NO PARTNERS ARE COVERED BY THE WORKERS'COMPENSATIONPOLICY CERTIFICATE HOLDER CANCELLATION ALL UNDER ONE ROOF SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED ATTN:NORMAN JOHN BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL B DEL IN ACCORDANCE WITH THE POLICY PROVI y, 30 TEMPLE DRIVE AUTHORIZED REPRESENTATIVE METHUEN,MA 01844 ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 1988-2010 ACORD CORPO rights reserved. . a Theo;c�aJda is {� e Commonwealth of Massachusetts ,c:rz�Prnt_FoYrri,i",..a; Department of Industrial Accidents _.. Office of Investigations 1 Congress Street, Suite 100 y Boston, MA 021142017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers AppUcant Information Please Print Legibly Name (Business/organization/Individual): /f JY7!�/7•csl C072 /�Z­ Address: Tom...,.^ /a1-c. 6r'j M til+s -eh �s1 City/State/Zip: 0 Phone#: �� Are you an employer. Check the appropriate box: Type of protect(required): 1.❑ I am a employer with 4. am a general contractor and I employees(full and/or part-time).- have hired the sub-contractors 6. EJ New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition working for me in any capacity. employees and have workers' 9. Buildingaddition [No workers' comp. insurance comp. insurance. required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.F-1 Plumbing repairs or additions right of exemption per MGL myself. [No workers comp. 12.❑ Roof repairs insurance required.] t c. 152, §1(4), and we have no a employees. [No workers' 13�Other J2 C -/�J . 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. #: Expiration Date: Job Site Address: 4'7 � �s�2 �/�'�S� City/State/Zip: /Vtq 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 u to$250.00 a da against the violator. Be advised that a co of this statement may be forwarded to the Office of P Y g copy Y Investigations of the DIA for insurance coverage verification. I-do hereby certify un Y th .. ains nd enal 'es of ! ury that the information provided above is true and correct _. - -. _ Signature: '....... Phone#: q1) _q 1J ��s I l 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 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 i 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-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 pennit/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 coy of the affidavit that has been officially stamped or marked by the city or town may be provided to the P applicant as proof that a valid affidavit is on file for future permits or licenses. Anew 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 Tn6§.fcial Accidents i Office of Investigations i 1 Congress Street, Suite 100 i Boston,MA.02114-2017 i Tel. 4 617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 7-2010 www.mass.gov/dia. (i airs & Business Re"latlon - "as. -10% Aftcs&Suseles's R,Vj&Wn joCASR) (Jsi�"e of Consume ConsurnerAfrairs snd Business P`ellu'a"on 'U.IqlA Regisbia"on Lookup Home IMPrOvement Contractor stration list by any of the criteria beiovv, you can searchtfliter the regi Searchl Search by Registration t4urnber 37057 Search by Registran'Warne Zip Code Search OY City Search Rgei you can also on the reqjstrajif'n number to view Wrnpialnt history t a-, of Thursday, SePtembler 2(), 2-012- The list is Curre"' Search Resufts RE ADDRESS EXPIRATION STATUS REGISTRANT Spot4SIBLE REGISTRAT10" DATE t4AME INDmDUAL NUMBER 166 A FINACHARO 1 0/02,12C 14 '11 t4 k jDER 014F RCK)I- LANZ.AFAME, 13705 BUILDING ,)©HN METHEUN,MA 01844 Massachusetts Ith Of Mlfi""fil mass GovO is 2 feg'sle"'J seance mark of the COMMONJ" MaSSaChU-St!t!-S E�eDa,ri ot 120 Jo"W LANZA 30 TEMPLE OR MET*WEN MA pit.jziort 41 ARME ' •� `a z .� " �@' <r pas z ^- „,•., cSa '• ac 6 f P. a rgEr s� �.C.l ,.,�.�... ... ”" .tt t ' � ,�' z� � �� � ,� '•rte � � � ro < Types O�'• VVY 1 HS E "OP,t EEBUI .T-CAPPED Expert Masonry Work x 'rr 3 Liconsed & Ins.�rt c, � Mass Toll Fq�€��5g� [[rnn., rr5�� }}{{ (�a � "UVU"§VNtT"4i'"'w°•�.7 CO Ci L'tlf�: C.,P VP/(,'LI CS' Cl6 J['e^!f l!!1 S1 a.`t .�.f7F JD ae 1- !_rt.eEJ�Je fYo342o0 (924-B487) a 7e. Work Year k�extnrnefl Proposal To: Mike Venanzi Date 8/21/2013 Street: 47 Wooderest Dr. 978-975-9617 N.Andover, MA Roof proposal mikevenanzi@comcast.net IKO Cambridge/Certainteed Landmark 1. Extra caution will be taken to protect house 13. 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 shingles from entire house. 14. Building permit included. 3. Inspect and re-nail any loose or lifted plywood. 15. Contractor workmanship warranty: 10 years under Any compromised plywood will be replaced at an normal wind and rain conditions. additional cost of$55.00 per sheet of 1/2"cdx. 16. Shingles covered under MFG. warranty 4. Install heavy gauge 8",white aluminum drip edge Total cost: 16,750.00 to all eaves and rakes. 5. Install 9' of IKO Armourguard ice and water Both IKO and Certainteed direct extended non shield along all eaves and top to bottom in all valleys. pro rated 20 year warranties included in this 6. Install IKO roof guard synthetic underlayment to proposal. Offered to our existing customers at no additional cost. Please refer to info remaining sheathing up to ridge. 7. Install all new pipe boots. pamphlets in estimate package. 8. Install IKO Leading Edge starter shingles to all If Certainteed MFG. is chosen then all eaves. accessory material will be Certainteed. 9. Install IKO Cambridge AR(algae resistant) *Note*: Please be advised if applicable, valuables in Limited Lifetime architectural shingles to entire the attic should be moved or covered due to minor house and garage. 15 year non pro-rated warranty debris, dust and asphalt particles that will accumulate by mfg. 10 year if Certainteed is chosen. All shingles will be installed and fastened according during the stripping process. All Under One Roof not responsible for any damage or clean up that may to mfg.specs. Existing rubber membrane will be inspected during the stripping process. If occur in attic. membrane is compromised at all, it will be removed and replaced at no additional cost. Balance due upon completion 10. Counter-flash existing chimney lead flashing with ice.and water shield,tie into new shingles References available upon request and seal. Highly rated member of the accredited BBB and 11. Install a new GAF Cobra ridge vent capped with color,matched IKO hip and ridge shingles. An2ie's List Thank you!