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HomeMy WebLinkAboutBuilding Permit #142-16 - 55 TURTLE LANE 7/31/2015 4" LF BUILDING PERMITNORTH A. 0��. lED Ib�-rO TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION 70 T Z` 00 Permit No#• Date Received gSSACHl1S Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION 77,A,-L/e AYE e Print PROPERTY OWNER -t W e g f7ey S Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes o TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ,WRepair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain p Wetlands ❑ Watershed District 0 Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: ,,Z',,rsTe /� .ti<<.!/ fla�t.G� ��o it/c ,f►•.L�'�?g Identification- Please Type or Print Clearly OWNER: Name: kR%sT.•n Xweel;e Y Phone: 6/7- Y17-41J-7 Address: J-,f 7V /e-It e Contractor Name: h%=�ec4 �'•����`j' r9 Phone: 9Tp' 1171- 00'r6k Email: Address: .Zp A.�Re�.�o. sT /ytef�iv�� �st•c m/8yy Supervisor's Construction License: v ? gr 5/6 Exp. Date: 7 -,9 -14 Home Improvement License: /!8 X36 Exp. Date: 7 it 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: $ ;?14C;?14C70o FEE: $ 30 $1 Check No.: Receipt No.: 019 Il � NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ i TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swiunming 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 m U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Siqnature COMMENTS HEALTH Reviewed on . Signature COMMENTS ZoningBoard of Appeals: Variance pp Petition No: Zoning Decision/recei t submitted yes r.Planning Board Decision: Comments Conservation Decision: Comments Wafter& Sewer Connection/signature& Date Drivewav Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARATME ST Te�np�©umpster,on-site ,yes ,Locatedlaf�1.24�MainrSfreet �`" '- ��'y"- FiretDepar"tmentsig;natur,.e%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 ❑ Notified for pickup Call Email Date 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. 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 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 Workers Comp Affidavit Photo Copy of H.I.C. And C.S.L. Licenses Copy Of Contract ;r« Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) :rE Mass check Energy Compliance Report (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 Location 4014ze, No. Date / • TOWN OF NORTH ANDOVER . LEI) . a, Certificate of Occupancy $ Building/Frame Permit Fee $� Foundation Permit Fee $ Other Permit Fee $ TOTAL $ L Check ? J t la 3 Building Inspector Ir 7 NORTH - ve. ... O No. h ver, Mass, COC HIC"IWICK A"ATED r.P���S S V BOARD OF HEALTH Food/Kitchen PER' MIT T LD Septic System i THIS CERTIFIES THAT ..:ci. ... . .�.,,`,r. , , ,, ,,,,,,,, ,, , ,, ,,,,,,,, ,, BUILDING INSPECTOR ...... .. . . Uc`, .,. Foundation has permission to erect .........:....... ... buildings on - �+ .:. ..... .,.�........................ ...... .......�.�.. Rough to be occupied as ......: .... .�.�....... �. ....... ....�i.r!1�.�...... t. ...... .......................... Chimney provided that the person accepting this permit II in eve respect conform to the term thea application p g p � p pp 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCT ST S 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. G"i-Tech Window & Siding, inc. SIDING 20 Aegean Drive Unit 4 'OSIN ss0G MA Reg. # 118836 Methuen, MA 01844 �e MA LiC # CS - 106508 1-800-851-0900 www.hitechcorp.biz MEMBER Date: Ob / � / Is Consultant: '��(, °•� Job Name: k r5 t n Wf p Telephon W5 Job Address: 551hLV Town: Contractor agrees to start described work on or about weeks after final fittings,and complete described work in about working days.Contractor shall not be held liable for delays due to cause beyond our control.Hi-Tech shall not be held liable for any damage to lawns or plants.Contractor shall not be liable for any damage to painting-or stain during installation of windows or doors.Hi-Tech does not do any paint- ing or staining. In the event that a punch list should accrue at the end of the job,a maximum of 2d/e is the allowab e amount to be held back. The following work includes all labor and materials needed to complete yourjob in a workmanlike manner. 6 Job Includes 6v Trim Combination Job-Siding With Other Work P.V.C.Coated Alum Aluminum Buildi79mi.Permit Fascia Trim Fascia Treatment Siding El Soffit Trim Fascia Calor Prepage �Window&Door TrimEl Full CustomAccese ShuttersLocation ivt 11UndereE as GuttersSidingP DownspoutsSoffit Treatment RemoSoffit Color 10 Lock.Elec.Meter Preparation Includes ❑Center vent Fully Vented Non-Vented Location eplace Visible Rot El Vented as Needed Energy Savings/Bug Guard Starter / Window And Door Casing Treatment Window And Door Casing Color Accessory Package Includes K .^' Full Custom Formed J-Less Full Custom Formed Color: C Da!V Blind Stop Capping None Location �t t c y Vinyl Light Blocks Vinyl Dryer Blocks J C Vinyl Electric Outlet Blocks Vinyl Exhaust Vents Gutter&Downspouts Vinyl Faucets Blocks Gutter Color Downspouts Color Vinyl Gable Vents Location Underlayment Insulation To Be Used y,Special Notes Hi-Tech 3/8 Othe 7 Q Location 61 itat ot At, e Area T Be Sided Complete House Garage (b d j Sl�� o dh W/ Siding To Be Psed A 111t0iltCeAhAng Color Or r e J " Payment Policy Brand Profile Bank Financing owner To Arrange Hi-Tech To Arrange Cash Or Check � Master Card Corner Post To Be Used Corner Post Color: Total Investment S/ 0(J Q Wide Insulated E]Wide Non-Insulated 1/3 Deposit 7 Regular 1pflulated El Regular Non-Insulated 1!3 Payment2 111 CO C 113 Balance of Day Substantial Completion J You may cancel this agreement if it has been signed by a party thereto at a place other than the address of the seller,which may be his main office or branch thereto,provided you notify the seller in writing at his main office or branch by ordinary mail posted, by telegram sent,or by delivery,not later than midnight of the third business day following the signing of this agreement.See the attached notice of cancellation form for an explanation of this right. An interest charge of 1.5%per month(18%per year)will be added to any amount unpaid after 30 days from invoice date. tate of/Acceptance In the event of default of payment of this order or any part thereof and the account is referred to an attorney for collection,the purchaser agrees to pay reasonable attorney fees. SZatu t I We give Hi-Tech permission to obtain all necessary permits. ( omeown Signature Signature (Hi-Tech) The Commonwealth of Massa chusetts Department oflndustrialAccidents d 1 Congress Street,Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Leeibly Name(Business/Organization/Individual): 7 c W A-.-.y 4,v- V- Address: .Z y ,M Aayr✓a•o< <ST City/State/Zip:,,W0114,e ' oVo. o/FYy Phone#: ys6fr Are yon an employer?6ec'U6 appropriate box: Type of project(xequired): 1.Lgl am.a employer with employees(fall and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in g. Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3..Q I am a homeowner doing all work myself[No workers'comp.insurance required.]t 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10E]Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5. I am a general contractor and I have hired the sub-contractors listed on the attached sheet. ❑ 13.ORoof repairs These sub-contractors have employees and have workers'comp.insruance.t 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14. Other 152,§1(4),and we have no.employees.[No workers'comp.insurance required.] *Any 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. tContractors 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. am an employer that is pNoviding workers'compensation insurance for my employees.'Below is the policy and job site information. Reil! i/lsr��ac� Insurance Company Name: OtRAy ✓• Policy#or Self-ins.Lie. —915'`GiT kl-Y Expiration Date: /,p - Job Site Address: TS PAfAe A?4e City/State/Zip: A✓' .4i1.!•i'G/� 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 rtfunderthepains and penalties of perjury that the information provided above is true and correct. Signature: % /''t►� Date: T X/�J Phone#- y&- Official &-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 trustoe 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=contractoi(s)name(s),address(es)and-phone number(s)along with their certificates)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 foi•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 yoti'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 pen-nit/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 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.#617-727-4900 ext. 7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia --�- o:ut -XI PST FtOhi: 10000 5— I97d 7331-6n�c PAGE 01:rid CERTIFICATE OF LIABILITY yABrLI! g INSURANCE CE DATE(MNJDD%YYvvj ! THIS IFICATCGRTIFIC Oe S5 15SUEQ AS A MgTTER OF INFORBiATION ONLY Ah9Q CONFERS NO RIGHTS Upt)N THE CERT BELOCERTIFICATE D4l:S IFIC fIFFiRI�AATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTEt3 THE COVERAGE AFFORDED T 91DCR-ll T _ REPIR . THIS CERTiFIGATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUINGEAF INSUR S TOLQERI THIS REF�RE3E!JTATIVE OR PRODUCER,APIA THE CgRTjF(CATE HOLDER, THE POLICIES- the to , s NT: If the certincate holder is an ADDITIONAL INSURED,the poli Ies must be endorsed. ( }' AUTHORlZI:D the terns and conditions of the policy cy(' } I A cy,certain policies may require an endorsement. A statement on this certificate does not confer rights Ito tho ceatificat0 holder in lieu of such endor�Emen s. SUBROGA�IORI IS WAIVED,subject to PRODUCER BARRY J KITTR>=OGE INSURANCE coNTACT S1 S MAIN ST NAIdE: BRADFORD, MA 01635 FI=oNE I E•MAILJ-9X!1• F�1 ADOREINSURERS AFFORDING COVERAGE INSURED SYSURERA- LM Insurance CO oration FUVC3 HI-TECH WINDOW o'r SIDING INSTALLATIONS INC 336DD - 29 ARROWWI_1f�D S7 INSURER _ METHUEN MA 01844- MIM Rc: aISURERO: I OISURER E COVERAGES _ CERTIFICATE NUMI3ER: EI$URERF: ! THIg{g TG CERTIFY THAT THE POLICtF9 O. 1NS E NU LI 22315250 I INDICATED. NOTWITHSTANDING AMY REOUtR6tdENT TERM REVISION A LIMBER STED BELOW HAVE BEEN ISSUED Tp THE mtSURED NAMED ABOVE FOR THE POLICY PERIOD CERTIFICATE NAY SE-IssuED OR MAY PERTAIN,TH IN OR COND)frON OF ANY COAfi pA�Op OTHER DOCUMENT WITH RESPECT TO ICY P THIS EXCLUSIONS�yDCONDITIONSOFSUCH eE SURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TIERMS,• NS POLICIES,LL;itTS SHOWN MAY HAVE BEEN RE DUC.D BY PAID CLAIMS. TYPE OF INSURANCE trL SUR I COMMERCIAL CENERALLABILTfY INep vWD POUCYNUMBER POUCYEFF pOU EXP IxQUO 1.314 3 I r CL41AtS•kiADE OCCUR j EACH CCCURftENCE S - ,I P O t S ) rI,ED E9CP{Arty one oar_dn) $ GEN'!ACGRE GATE LI&IrTAPFUES PER: r PERSOFIAL 3 ADV INJURY S POLICY JcCY LOC GENERAL AGGREGATE OTWER• 5 AUTOtADBILE UABRRY PRODUCTS_COMPIOPAGG S i 3 , ANYAIn-0 C e � I -5 i tF 'q Irtant ALL OWNED.;, SCHEGULEp t AUtL7AUTOS BOOILY ItILIURY(Per•¢ontw) 5 NON-OUlT9- ..,. HIREDAllTO,e, AUTOS cD "DILYINJURY(Per -d a)I S I ! Parz a DAtAAGE c un�BRL:I.ay tsAQ GCt7JR S - ! EKCd3$UAB , CLAWS-MADE I EACH OCCURRENCE $ � DFD i REYENnONS AGGREGATE A WORKERS COMP $I S ! ANDEtPLOYrRg,I,rgaILliy WC5-31S-607814-0ta 1DY31/201a 10!31!2015 PER ' ''4YPROPRI`TOFLPARraEfVU..ECUTnrF YtN _ Qnj - OFFL^,_Nh1EMSERFJCCLUOED: PER (Hand=tory in NH) 1r 1A ityp.dl,—er2ra und:r I E—I EACHACcgoe " 5 �odpD D'c6CRIPTtONOFOPERATtON51-._hw I OMEA$ EL- -E-EAGhipLOYE S I 1500 QD E-L DISEASE-POLICY LIMIT 5 ( SOOCjOD i ! DESCRMT*NOFOPERATIONS/LOCATIONS/veHicl.es(ACOROJGJ'Adtlgn.r.IKar rk.SchedWgmsybea2mchedifmorWorkecpaceioreyWred) This car fic�atLl cancels and upars des a(I prey 1Wsly issued the rates mpenSation lst r �a Of the stale(s)of N H I i y RS they relate to vorkers Oornpensation coverage. f i - I CEf2TIFICATE hfOLO6R I G4NGELLl�TtOAI � SHOULD AMY OF THE ABOVE DESCRIBED POLICIES Be CANCELLED BEFOR CCORRDANRCEWITHTHEPOLICYPROVISIONS.TION DATE THeReop 14077CE VMLL BE DELNERED I r I Alrl-HnFt2EtJ RFPRFSENTATNE UA Insurance Corporation �L��� >C9RB 25(2014Y01) 12'1938-2014 ACORD CORPORATION. All rights r'sscry The ACORO name and logo are ragisteren marKs of AOORb iy� - !.Gl-0or L ' ,7 I YAy }1, I •U ice of Consumer o�rrvaarmcaea�������aoaaclj Affairs& uJ� Business Regulation f � � F.'IMPROVEMENT CONT= RACTOR egistration:>:1ygg36` Expiration: 4/26/20174"j Type: HI TECH WINDOW�SIDING INSTALL INC Supplement Cz TIM WICKS `� }t`'E LL - ` 29 ARROWWOOD ST METHUEN, i MA 01844 �..--' ��-G,-�r_..M1 �,i•-_._,_ i Undersecretary Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-096516 p i TIMOTHY W WIVkS 3 ELLIS STf+ s Methuen MA 01144 r ` y Expiration Commissioner 09/09/2016