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HomeMy WebLinkAboutBuilding Permit #119-16 - 59 CRANBERRY LANE 7/29/2015 BUILDING PERMIT 1-11 T" qti TOWN OF NORTH ANDOVER 3? �`<t,' hb'' ° VAPPLICATION FOR PLAN EXAMINATION ° : r 6 Permit NO: Date Received 4 ' L �gSSAGHUs�� Date Issued: -2lnn I PORTANT: Applicant must complete all items on this page C: CLOCATION X *«- Print PROPERTY OWNER 'V -+�" -- Print MAP NO:S PARCEL: f7 ZONING DISTRICT: Historic District yes o t Machine Shop Village yes 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 Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: 5TP-1P t —12-6a/= dentificatiop Please Type or Print Clearly) OWNER: Name: Love- 0,, Phone: Address: �d.��e rf_ e_ r-)0- )JOI/C r, o `/� r CONTRACTOR Mame: k A l n h /3u rz.b;r2, Phone: e,17 & G / // 0 Address: V- P1J7)QCc,K J-h N!!f 22 R 6 e ( T f ri H 6 Supervisor's Construction License: G �yel a Exp. Date: 7- ,1-/5- m1t Home Improvement License: 1231 h tu2kt korLg Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT.$12.00 PER$1 0.00 OF THE TOTAL ESTIMATED CW BAS N$125.00 PER S.F. Total Project Cost: $ c� FEE: $ Check No.: 6 2 Receipt No.: 9-1 NOTE: Persons contracting with unregistered contractors do not have access toh ara n i�gnature of Agent/Owner Signature of contractor _ _ ___ Location h 0✓ Noa Date y • - TOWN OF NORTH ANDOVER • SLED 764 • Certificate of Occupancy ' $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# � y '� 17 Building Inspector 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 USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEANTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments a Conservation Decision: Comments Water & Sewer Connection/Signature & 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 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 ❑ Notified for pickup - Date Doc.Building Permit Revised 2008 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 ❑ 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 submitted with the building application Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 i i r- , NORTH - _ . w: 1 E I, c ver No. 9.OV 2A? _ h C% h , ver, Mass, 1 S COCHICIIl WIC" X1,4 A°'QArE S U BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System THIS CERTIFIES THAT .D..V.:GII..,� BUILDING INSPECTOR ............. V. ........................................................................ I has permission to erect buildings on arAiw,.6 Foundation *a .� Rough to be occupied as ........... .........'.'r...... .�� .... m==. ........................................ Chimney provided that the person acceptin this permit shall in every respe onform 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 M NT ELECTRICAL INSPECTOR UNLESS CONSTRUCTI 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. Date: 7/:7-) /S RALPH J. BURKE A Family Business Since 1941 Roofing - Gutters Rubber Roofing DANIEL M. BURKE 781-249-7110 C 617-640-1110 C RALPH J.BURKE,JR. TELEPHONE 781-245-1110 office FULLY INSURED - LICENSED 27 BYRON STREET,WAKEFIELD,MA 01880 S`7 C r2 Estimated price for labor and material to: Remove all roof shingles Replace rotted/broken roof boards up to 100 square feet Re-nail loose boards Install aluminum drip edge 6 feet of ice and water barrier CERTAINTEED Synthetic roof underlayment CERTAINTEED LANDMARK ARCHITECTURAL shingles, hand nailed <-bliD ll1 e PDQ Reflash all vent pipes and chimney (ZL-'N_P6 RLL 6c(-IT,6F,2 j Remove all roofing debris from theY and Total cost 473 ?6 All workmanship guaranteed twenty years. Please remove or cover all items in attic,as dust and roof particles may settle on attic floor. Thank you The Commonwealth of Massachusetts Department oflndustrial Accidents Office of Investigations ' 600 Washington Street Boston,MA 02111 www mass gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly . dal'YFe.(BusiztessNQrganizationtindividual)- �`L��� 1,��O:�G. . Address: Yoe W City/State/Zip: . W PA�I G bO Phone.#: �Pl',7 Are you an employer?Check the appropriate box: . Type ofproject(required);_ 1.Ul am a employer with 4. ❑ I am a general contractor and I employees(foil and/or part-time).* have hired the sub-contractors 6 ❑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 Building addition [No workers'comp.insurance comp.insurance. required.] 5. [3 Weare a corporation and its 10.0-Electrical repairs or additions 3.❑ I am a homeowner doingall work officers have exercised their 11.0 Plumbing repairs or additions myself [No workers'comp. right bf exemption per MGL 12.0 Roof repairs insurance required.]t c. 152,§1(4),and we have no employees.[No workers' 13.0 Other comp.insurance required.] *Any applicant that checks bbx#I 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. tContractors 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 providb their workers'co lid number. .comp.p° Y lam an employer that is providing workers'compensation insurance for my employeex Beloit►is the policy and job site information. Insurance Company Name: I��ti� }Gl7 G�ttG Policy#or Self-ins.Lic.#: (0 Expiration Date: / �61 Job Site Address:_ City/State/Zip:A)1 `^0 V 0a,,_--e_ 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 up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investi ations of the DIA for insuran a covera a verification. . I do hereby ce e p ' s d Haloes of per,jury that the information provided ab ve is a and correct Si afore: Date- Phone#: ate:Phone#: FOther only. Do not write in this area,to be completed by city or town offrciat 7 n: Permit/License# hority(circle one): Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector son: Phone#: i. From:Linda J Caruso FaxID:SALEM03 Date:7129/2015 7:46:10 AM Paoe:2 of 2 RALPJBU-01 LCARUSO '4 Ro CERTIFICATE OF LIABILITY INSURANCE (MWDD 7!29!/202015 THIS CERTIFICATE 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 an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Salem Five Insurance Services,LLCPHONE 781 933-3100 FAX 445 Main Street A No Ext:( } arc,No: (781}933-9048 Woburn,MA 01801 ADDRESS:insurance.services@salemfiive.com INSURER(SI AFFORDING COVERAGE NAIC R INSURER A:Penn America Insurance INSURED INSURER B:Amguard Insurance CO Ralph J Burke Roofing INSURER C: 27 Byron StreetINSURER D: Wakefield,MA 01880 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS 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 CLAIMS. INSRTYPE OF INSURANCE D L POLICY EFF POLICY EXP LTR INSD WVD POLICY NUMBER MMIDDIYYYY) (MMIDDIYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 500,000 CLAIMS-MADE EK OCCUR PAC7052055 05117!2015 05/17/2016 PREM SES Ea occurrence $ 100,000 MED EXP(Any one person) $ 5,000 PERSONAL 8 ADV INJURY $ 500,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 1,000,000 X POLICY D PRO LOC PRODUCTS-COMP/OP AGG $ 1,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED 8001LY INJURY Per accident $ AUTOS AUTOS ( ) NON-OWNED PROPERTY DAMAGE HIREDAUTOS AUTOSPeraccdent $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATIONOT AND EMPLOYERS'LIABILITY YIN X STATUTE ERH B ANY PROPRIETOR/PARTNERIEXECUTIVE N/A R2WC627096 06/2012015 06/20/2016 E.L.EACH ACCIDENT 5 100,000 OFFICERWEMBER EXCLUDED? U (Mandatory in NH) I( E.L.DISEASE-EA EMPLOYE $ 100,000 yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Building Dept ACCORDANCE WITH THE POLICY PROVISIONS. North Andover,MA 01845 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD i julatio y Massachusetts -Department of Public Safet Board of Building-Regulations ns and Standards I l~.i/11.1�i Ul'1111�1 JV�IGI V 1.1111 SF/aC t11LV License: -s I CSSL-099814 t`�,c,V, Ralph JBurke S 54 Paddock bane Dracut mA 0182& Y 5 L ✓:2- Commissioner Expiration 07/03/2017 > �; Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 107146 Type: DBA Expiration: 7/29/2016 Tr# 253422 RALPH J. BURKE ROOFING Ralph Burke = 27 Byron St Wakefield, MA 01880 — Update Address and return card.Mark reason for change. SCA i 2or��sm `" ❑ Address ;] Renewal Employment [I Lost Card 67Co lit ill r""IGC((.l�-C Office of Consumer Affairs&Business Regulation License or registration valid for individul use only � 4IOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: C'te r. Type: Office of Consumer Affairs and Business Regulation -,� .Registration: 107146 g t" 10 Park Plaza-Suite 5170 •..� �:Expiration:: ':7!2912016. DBA Boston,MA 02116 RALPH J.BURKE ROOFING Ralph Burke 27 Byron St Wakefield,MA 01880 Undersecretary Not valid without signature NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with thevision of MGL c 40 S 54, a condition of Building Permit at: 51 C1Wek24Y ,4rois that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150 A. Also, note Permits are required under Fire Prevention laws Chapter 148 Section 10A. The debris will be disposed of in: B U R-K F 7-kttck tb 11I11ed WASTE LT 13 /'eP136bV (Location of Facility) ` Aeof itApplicant Date