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HomeMy WebLinkAboutBuilding Permit #573-2017 - 54 COVENTRY LANE 11/29/2016 � TOWN OF NORTH ANDOVER NORT►i APPLICATION FOR PLAN EXAMINATION °�•��'° ""o O � Permit NO: 573 - 2-0/ 7 Date Received /1,1611 •!J wwr°�e�•`4g �ss�c►+us�s Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION rint PROPERTY OWNER Vy)in1-1 1) � F� ©5-T`l Q O Print MAP NO.: f® V PARCEL: I ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non-Residential ❑New Building @ane family ❑addition ❑Two or more family 0 Industrial Alteration No. of units: ❑Repair,replacement ❑Assessory Bldg ❑Commercial 0 Demolition ❑Moving relocation ❑Other ❑ Others: a ❑Foundation only ` DESCRIPTION OF WORK TO BE PREFORMED I vc(L4, (0S;-e Identification Please Type or Print Clearly) OWNER: Name: (Y) f A 6(0 S c (N Phone: !I Address: 5 v�'-�`� Gam` CONTRACTOR Name: i Phone: S�Z 3. `l b Address: 2 6 0 nJ yr t 0-2-129' Supervisor's Construction License: G cf 0-2,0 Exp. Date: Home Improvement License: S Exp. Date: 1-2- ( 7 ARCHITECT/ENGINEER iJ Name: Phone: Address: Reg.No. FEE SCHEDULE:BULDING PERMIT:$12.00 ER$1000.00 OF THE TOTAL ESTIMATED COST BAS ON$125.00 PER S.F. Total Project Cost :$ - � �!- q I x12.00=FEE:$3_ Check No.: l 7 Receipt No.: 3! �� Page lof4 Location ' i( C U V (*'1 l`7 L No. S7 3- ui 7 ; .. Date • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ 3 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# / �, t Building Inspector G. O '� 5 � I Plans Submitted ❑ Plans Waived 0. Certified Plot Plan ❑ Stamped Plans ❑ TYPE bF SEWERAGE DISPOSAL I Public Sewer ❑ Tanuing/Massage/Body Art ❑ Swimming Pools ❑ I 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 Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Siqnature J COMMENTS HEALTH Reviewed on Siqnature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Siqnature& 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 COMMENT ) `1 1 -)imension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, roast or service drop.requires approval of Electrical Inspector fres No ®ANGER ZONE LITERATURE: fres No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use) ❑ Notified for pickup Call Email ate Time Contact Name Doc.Building Permit Revised 2014 ;. Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. r . 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/Cross Section/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 act ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products 40TE: 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 0ai-, RTFI Town of '9 _ .�� tt_\ h ver, Mass,LAKG lb 4111 0606 9 cOCHICHI—c" 1• �,ps RA t! BOARD OF HEALTH LD Food/Kitchen PERMIT T Septic System THIS CERTIFIES THAT ...CAPA .� :� .... �. � �. BUILDING INSPECTOR ......... ....... .... has permission to erect .......................... buildings on ..... �0 Foundation to be occupied as ........t... ..I.VL*1.f...... '. A chimp y ...... ....... ......... .. .! 14010460 Rough he provided that the person accepting this permit shall in every 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 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIObb START Rough Service .............. ........... .... ................ .. . .. ................. BUILDING. . . .INSPECTOR.. Final 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. Planview Diagram Customer MAS p�A nes r0 Advisor Name: a"t %cL _ Address S 4 ce'tAT-y Ln Advisor Phone #: j 1q 306` TownN, kf\�Mvv Any limitations to access by truck? site ID yy NOTES Any work scoped outside of Best Practice „ 1 Approved by: �r 2. �o A Qon� AIS Kw Tr-ns W S � 0 poky Got wo.N\S lduwl Ga'Mye CG.1�, pro�ov s �` 3 ,y to 64 6 8 GH' Zy v E nvww.RovIscEngrgy.com R�'VISG 11C't�►11 home Performance Contractor 5 Soutir Sumtner Street,Bradford,MA 018&5 CONTRACT '4713-914-2214 FAX(401)7$4,3710 Page I PROGRAM CbtA-HPC WSW DATE eucmr a WM ORM Matt Degotitto (978)681-5617 10/18/2016 441999 00001 Gomm&TftV 54 SUM STRUT Lane 9 54 Coventry Lane 9 014M CITY,6TATL JW North Andover,MA 01845 North Andover,MA 01845 JOB DESCRIPTION AIR SL"AUNG:Provide labor and materials to sea)areas of}xwr forme against wasteful,excess air leakage. This work will be P"Irmed is cont with the use of special tools and diagnostic tests to assure that your home will be left with it healthful level of air exchange and indoor air quality.Materials to be used to seal your home can include caulks,foamsand other products. Primary areas for scaling include air leakage to attics,basements,attached gams and other unheated areas(windows are not gcneralty a(ldressad.) This will require(4)working hours.A reduction In cubic feet per minute(cli )of air infiltration will occur,but the actual number of cf n is not guareatce d. At the Completion of the weatheriration work,and at no additional Bost to the homeowner.a final blower door andlor combustion safety analysis will be Conducted by the sub-contractor to ensure the safety of the indoor air quality. $360.110 KNEEWALL SLOPE:Provide tabor and materials to instull 2"PSK faced semi-rigid fiberglass board insulation to(105)square fret of kneewall rafter area $367.50 KNEEWALLS:Provide labor and materials to install 2" FSK faced semi-rigid fiberglass board insulation to(20)square feet of kneewall area $70.00 A171C ACCESS:Provide labor and materials to insulate the back of the attic door with 2"rigid Them=board and seal the door's edge with weat1mrstrfpping to restrict air leakage. $73.91 VL'tMLAT1ON:Provide labor and materials to insWld ventilation chutes in(22)reflex bays to nhointain air flow. $41.00 GARAGE CEILING:Provide labor and materials to install 10"R-35 densely packed Class l Cellulose insulation to 500 square feet of garage ceiling located below a heated floor area,by drilling holes in the ceiling from below. Holes drilled will be plugged. Plugs will be spacklod and left in a relatively smooth condition.Finish sanding and touch-up priming/painting will be the customer's responsibility., di1,035.00 CRAWLSPACE:Provide labor and materials to install (75)square feet of R-10 rigid Thermax insulation to the crawlspacc Perimeter wall up to the sill and against the bond joist. $277.50 1 i 4 r i i t t Worker's Comoensation and Employer's Liability Policy National Liability & Fire Insurance Company -A Stock Company Policy Number V9WC600604 Renewal of NEW Policy Information Page [1]Named Insured and Mailing Address Agency Environmental Abatement Inc V3 INSURANCE PARTNERS LLC 1200 Bennington St 115 Pheasant Run East Boston, MA 02128 Suite 218 Newtown, PA 18940 Agency Code: PAVTHR20 Federal Employer's ID 27-5382735 Insured is Corporation [2] Policy Period From December 19, 2015 to December 19, 2016, 12:01 AM, standard time at the insured's mailing address. [3] Coverage A. Workers' Compensation Insurance - Part One of this policy applies to the Workers' Compensation Law of the following states: Massachusetts B. Employer's Liability Insurance - Part Two of this policy applies to work in each of the states listed in item [3]A. The limits of our liability under Part Two are: Bodily Injury by Accident - each accident $500,000 Bodily Injury by Disease - each employee $500,000 Bodily Injury by Disease - policy limit $500,000 C. Other States Insurance - Part Three of this policy applies to all states, except any state listed in item [3]A. and the states of North Dakota, Ohio, Washington, and Wyoming. D. This policy includes these endorsements and schedules: See Extension of Information Page - Schedule of Forms [4] Premium The Premium Basis and, therefore, the premium will be determined by our Manual of Rules, Classifications, Rates, and Rating Plans. All required information is subject to verification and change by audit. (Continued on another page) Total Estimated Policy Premium $ 17,777 Total Surcharges/Assessments $ 1,026.00 Total Estimated Cost $ 18,803.00 INTERNAL USE BM Page- 1 - Information Page MGA :V9WC600604 WC 000001A Date : 12/22/2015 MANOTE To Report a Loss •Dial toll-free#1 (844)777-8323 or visit our Issuing Office: 100 First Stamford Place, P.O. Box 113247,Stamford,CT 06911-3 ?sRe!+ftVrs4'r�,'P � :/claimsfnol RPSCHIC/SC/2016.01.05 •Contact Insurer directly(see policy section) The Commonwealth of Massachusetts -� Department of Industrial Accidents Office of Investigations 1 Congress Street, Suite 100 ' Boston,MA 02114-2017 wwTv.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/El lectricians/Plumbers Annlicant Information Please Print Leiibly Name (Business/Organization/Individual): ��}�( �B�att�r6t' 1 � � t�� Address: r2iz W' I'll61ut-2 ST _C City/State/Zip: C-,�. �8UN , Md(j- (;Ult> ..Phone#: 1�s 2_,C(��` ` TID Are you an employer?Check the appropriate box: Type of project(required); 1. I am a employer with . 4. I am a general contractor and I have hired the sub-contractors 6. New construction employees(full and/or part-time). ' 2. 1 am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no employees Tbbse sub-contractors have g. Demolition working for me in any capacity. employees and have workers' [No workers' comp, insurance comp. insurance 9. Building addition required.] 5. We are a corporation and its 10. Electrical repairs or additions 3. 1 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 � d employees. [No workers' OM- Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners 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. Tf the sub-contractors have employees,they must provide their workers'comp.policy number. Inn:an eneployer Cleat is providing workers'coneperrsation insuraeece for niy employees. Below Is the policy mrd job site Information. Insurance Company Name: N A 11 0 Nf1L.. t FIR aC ),3NC4G Policy#or Self-ins.Lic.#: VQ(,tom CC)�,7(�.� Expiration Date: Job Site Address: 4 City/State/Zip: f Attach a copy of the workers' compensation pol cy declaration page(showing the policy number and expiration dAte). Failure to secure coverage as requited 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. Ido hereby certiry raider tree paiiis and penalties of perleery tliat tlee information provided abov Is true and correct Si nature:, _._._............. .._ /._.__.............. .. .. ............_ ..... ................... ...... Date: �.. Z 11 Phone#: Official use only. Do not write in this area,to be completed by city or to►pn 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 Pei-son: Phone#: s Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 177555 Type: Corporation Expiration: 1/2/2018 Till 273986 ENVIROMENTAL ABATEMENT, INC. GEORGE WATTENDORF III 1200 BENNINGTON ST EAST BOSTON, MA 02128 Update Address and return card.Maric reason for change. SCA 1 t5 20M•05111 E] Address E] Renewal [] Employment E] Lost Card �J/IC C(U/I!/IIUI![![Y!l!If l�C'!'L.IIJJIIC�IIJPIIJ \ Office of Consumer Affairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: 177555 Type: Office of Consumer Affairs and Business Regulation krItegIstration: Expiration: 1/2/2018 Corporation10 Park Plaza-Suite 5170 Boston,MA 02116 ENVIROMENTAL ABATEMENT, INC. GEORGE WATTENDORF III 1200 BENNINGTON ST �fk EAST BOSTON, MA 02128 Undersecretary Not vat without slgnature `.1-tssachLlSetts Department Of Public Safety Board Of SLIitding Regu9atiOns and Standards Lice-nse, CS-090209 `-1 GEORGE V WATTENDORIF 14_MILLETT LANE. SWAMPSCOTT MA 01907 0311612018