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HomeMy WebLinkAboutBuilding Permit #1143-2016 - 59 SALEM STREET 5/3/2016 L BUILDING PERMIT NORry w• i { 0��. LEO f/✓�/) l� ��� �IXC TOWN OF NORTH ANDOVER � i -�� . �< • : p APPLICATION FOR PLAN EXAMINATION , Permit No#: I 1� �1 Date Received �ySSgcHus��c5 { a Date Issued: '1 I PORTANT: Applicant must complete all items on this page LOCATION � 1O Pint ` I PF20PERTY OWNER Glh 4o� � ✓ ff>? I rint -100 Year.Structure ' yes no MAP PARCEL: : ZONING DISTRICT:. Historic District yes. no Machine Shop Village. yes; no I TYPE OF IMPROVEMENT PROPOSED USE Resid ntial Non- Residential ❑ New Building ne family ❑A ition ❑Two or more family ❑ Industrial Iteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ©UUell d Floodplain Wetlands El Watershed.District, s LWater•/Sewer DESCRIPTION OF WORK TO BE PERFORMED: 6n ile r� �v rf�I� G'o c e-iCd SC.v-ems? Q��'G�- �a � >` v« Sa go ro 0/?1- Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: - Contractor Name: Phone: 97 7,3 'Z 3 Z-j 7- Email: &V Address; /� ,t�✓`nl. r� T .0,� '�o��1J: . Supervisor's Construction LicenseExp'.'. Date: l�/����/7. Home Improvement License` ? Ex Date: p: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST B,ISED ON$125.00 PER S.F. Total Project Cost: $ 12,66 , L� FEE: $ Check No.: Receipt No.:_O�� NOTE: Persons contracting with unregistered contractors do not have access to he uaranty and ro r-- Building Department f f 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 f 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 p g 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 Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) j 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 IS OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit I es if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals n all cases one co and roof of recording must then et this recorded at the Registry of Deeds. O copy p that the appeal period is over. The applicant g at pp p must be submitted with the building application Doe:Building Permit Revised 2014 J Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ F PE OF SEWERAGE DISPOSALlic Sewer ❑ Tanning/MassageBody Art ❑ Swimming Pools ❑ll ❑ 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 C®NSERVATION Reviewed on SI h Si nature COMMENTS k c ��-o�.,rr-ivy�; a\-Lz , U HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes e 4lanning Board Decision: Comments Conservation Decision: Comments ` Water& Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEP R�TMENT Temp will on sit yes' t d at 1 Loca e � nt ature/ 24 Ma _ � " `.,�, _. � Fire Departms g date ' f Dimension Number of Stories: Total square feet of floor area, based on-Exterior dimensions. 1 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.$1oo-$1o00 fine NOTES and DATA— (For For department p use) II ❑ Notified for pickup Call Email Date Time Contact Name ` Doc.Building Permit Revised 2014 I r' Location ' No. t G}� Date I • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $40z.- Foundation ��Foundation Permit Fee $ Other Permit Fee $ J TOTAL $ . I � Check# �'o v,.0 30316 Building Inspector v Location Date 7/l� r • • TOWN OF NORTH ANDOVER �." Certificate of Occupancy $ s Building/Frame Permit Fee $ " Foundation Permit Fee $ Other Permit Fee $ TOTAL $ r Check#5V3 30850 Building4lnspector Enter construction cost for fee cal- North Andover Fee Calculation Construction Cost $ 349066.00 m. $ - $ 408.79 Plumbing Fee $ 51.10 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 51.10 Total fees collected $ 610.99 59 Salem Street 1143-2016 on 5/3/2016 Screened Porch to 3 season room NORTh Town of :; - 0 No. o h ver, Mass, COC NICMIWICN �,9s RATEO P '�5 V BOARD OF HEALTH PERMIT L D Food/Kitchen Septic System le-A BUILDING INSPECTOR THISCERTIFIES THAT ........................................... ............. .... ............ ..... .... ......................... ......���. �� Foundation has permission to erect .......................... buildings on ... .......... .. ............�.. Rough to be occupied as ... ... � ......ip......3.. �... 0-1............. Chimney 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 Rough VIOLATION of the Zoning or Building Regulations voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONST TION Rough Service .. .. ....... ...... Final BUILDING SPEC OR 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. ISBELL GENERAL CO ACTING 10 Korinthian Way Andover, ma CS#-081684 HIC#172105 March 29, 2016. Contract for the remodel of the back porch at 59 Salem st North Andover, Ma for Cathy and Glen Johnson by Isbell General Contracting, I.I.C. We propose to remodel the current back porch to a three season closed in and insulated porch for a total cost of$34,066..This project is expected to take approximately five weeks and includes all of the following. Framing:demo the current structure to the ground with the exception of the roof framing. Demo the current interior ceiling and floor.Reframe floor using 2x10 PT framing. The floor sheathing to be Advantec floor sheathing.The underside to be%"Zipwall coated plywood..Walls to be framed to accept Harvey Classic vinyl double hung windows spaced evenly around the porch,and an Anderson slider door.All interior walls and trim are to match the built in panel pattern inside the family room. Reframe the roof structure to accept two 2x5 skylights.Interior Ceiling to be 1x6 v groove primed pine beadboard. Insulation; Insulate the floor to R-38,the ceiling to R-38,and the walls to R-15 using fiberglass batts and targeted sprayfoam airsealing. Electrical work;Supply and install four recessed lights in the ceiling, install one customer supplied fan/light between skylights.Install outlets in walls to code,and provide one outlet up higle undei =� rir on the Or tor crinstmas ugnting. install one coaxiai cable outlet. install one run of eiectricai baseboard heat. Flooring; Install vinyl plank flooring.color and pattern TBD, over the entire floor.. Roofine: Install new Architectural shingles over the entire roof around two new Velux skylights,up for the existing sidewall sheathing. _ Exterior trim;To be PVC board throughout the project,with vinyl siding to match the house. Paint;interior primer and 2 coats of Benjamin Moore,color TBD. No exterior painting.included. This contract includes all permit and disoosal fees.Thank you for the opportunity to work on your home. Accepted: t��.� �J�� ' - ",l Date.• � 2—( ,' / n 5 Isbell General Contracting: Gr,� Date: g F Ml r � r The Commonwealth ofMassachusetts Department oflndustarialAecidents t. :•':; , d I Congress Street,Suite 100 l Boston,MA 02-114-2 017 www mass.gov/dia Workers'CompensationInsurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print LeObly Name(Business/Organization/Individual): 6dr Tbe— Address: l0 k01-1'n 1 ,in L.yA1 City/State/Zip: 1'I P al�-1 J Phone#: 9 7 r!�- -3 S1/7: 37-17- Are you Zl7- Areyou an employer?6e&6e appropriate box: Type of project(required): 1.❑I aemployerwithemployees(full and/or part-time).' 7. Q NeW construction 2. I am a sole proprietor or partnership and have no employees working for me in 8. []Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3_❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 []Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11,.Q 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.[�Roof repairs These sub-contractors have employees and have workers'comp.insurance. 14. Other 6.Q We are a corporation and its,officers have exercised their right of exemption per MGL G. ❑ 152,§1(4),and we have na employees.[No workers'comp.insurance required.] *Any applicant that checks bdx#1 must also fill out the section below showing their workers'compensation policy information. i 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-cbn6ciors tave employees,they must provide their werkeis'comp.policy number.' lam' an employer that is pioviding workers'compensation insurance for my employees.'Below is•the policy and job site information. Insurance Company Name: Policy#or Self-ins,Lie..#: / Expiration Date: �! b Site Address--,V ���� S�`• City/State/Zip:-/,4 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 under the pains and penalties ofpetjury that the information provided above is true and correct. Signature: � Date: Phone#: Official use only. Do not write in this area,to be completed by city or town official.. i 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 contrdct 31hire, 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 anotherwho 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 tbe'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 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 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"fob 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 ACbmy DATE(MM/DDNYYY) �� CERTIFICATE OF LIABILITY INSURANCE 5/3/2016 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(les) 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 JESS]Ca Reid Rep P Encharter-MAPH�"E (800)675-6695 NC No:(800)754-1602 Encharter Insurance LLC E-MAIL ADDRESS: reid@encharter.com 25 University Drive INSURERS AFFORDING COVERAGE NAIC# Amherst MA 01002 INSURERAXS Brokers Ins. Agency XS13001 INSURED INSURER B Robert Isbell, DBA: Isbell General Contracting INSURERC: 10 Rorinthian Way INSURER D: INSURER E: Andover MA 01810 INSURER F: COVERAGES CERTIFICATE NUMBER CL1632505706 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR I POLICY NUMBER MWDDNYYY MM/DD/YYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DA AGE TA CLAIMS-MADE FX OCCUR PREM SESOEa occurRENTErence) $ 50,000 3EC8449 11/25/2015 11/25/2016 MED EXP(Any one person) $ 1,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY jE O- 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 BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION IPER OTH- AND EMPLOYERS'LIABILITY YIN ISTATUTE ER ANY PROPRIETOR/PARTNER/EX-'-IV-E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? ❑ N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ Ryes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I 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 1600 Osgood St. ACCORDANCE WITH THE POLICY PROVISIONS. Bldg 20, Ste. 2035 North Andover, MA 01845 AUTHORIZED REPRESENTATIVE William Dowd/NOlEB1 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025 r9mdnn Massachusetts Dep;rtment of public Safety Board of Building Regulations and Standards License: Cs-0,o4 } j Construction Supervisor 5 1 ROBERT E ISBELL 10 KORINTHIAN WAY 0 ANDOVER MA 01890 j 1 ✓r� D)4511\ Expiration: I. Commissioner 1010912017 r irmac�V.c, a t - Le �nnrra�zu�eczlC� a�, u,at5cn` . ?ffift of R Coasumer Affair'& s nCTO 1>�iE IMFROV�I�IENT G�NTRA T;pd: grstration 17210b Individual � ,;xprratrci~ rr5,.�12212016 ISBLLL= ' fir;"4-bO z-NTHI�11 'AY OYER,MA 01.844 'Undersaretgry r �,pdC1O