Loading...
HomeMy WebLinkAboutBuilding Permit #1343-2016 - 61 FOREST STREET 6/28/2014 1ly NLED /�(� �{-� V ORTil BUILDING PERMIT o�,tLE �b�ti,4o TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: ©) Date Received ^TEO (� SSAC H►1`'� Date Issued: IMPOJRTANT: Applicant must complete all items on this page LOCATION ( �D 12 e l g pnnt PROPERTY OWNER S Cb°IG //�^, / Print 100 Year Structure yes no MAP PARCEL: v1� ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building erOne family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial +'Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic El ❑ Floodplain ❑Wetlands ❑ Watershed District L ❑Water/Sow_er DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: SC arr �2-coIZ Phone:7r/- Address: Contractor Name: Phone: Email: L 1?5"? CL 44 4 GW-Swl Address: o -rte /z t�74 -c- kw-ti FT1 1pi-lw Supervisor's Construction License: 0 (2-1 Exp. Date: CSC- C Z r jZ, Home Improvement License: `�� S ' Exp. Date: b ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $�/, S ° ° ° FEE: $ 70 " Check No.: (.Q [- Receipt No.: 6 NOTE: Persons contracting with unre ' tered contractors do not have access to the guaranty fund Location n i No. �' r !j Date • • TOWN OF NORTH ANDOVER • Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# !r Building fSpector �` ' 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 PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes ening Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIREyDEPAl, TMENT Termp Loc �2.4tfVlain�Street� COMMENW Dimension Number of Stories: Total square feet of floor area, based on Bderior 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 Call Email I Date Time Contact Name -._.--------- Doc.Building Permit Revised 2014 < .x 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 4. Building Permit Application 4 Certified Surveyed Plot Plan Workers Comp Affidavit 4. Photo Copy of H.I.C. And C.S.L. Licenses 4 Copy Of Contract ;6 Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) 4 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 :6 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 NORTH E � Town 3� Andover 0 :. . No. h ver, Ma U O LANE COC NICHE WI[N � �.�poR'�TED HPa,�'�y S U BOARD OF HEALTH Food/Kitchen PER T LD Septic System THIS CERTIFIES THAT ................. . ..... .......... .04 . ....................................................................... BUILDING INSPECTOR has permission to erect .... bu' dings on .1.... r@ .�� .......,, Foundation ........... .......... .... ....... .... ....... ........... Rough �l Ina to be occupied as ............... .......... .......... .......................................................................................... 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONST TION Rough Service .... .. .. ....... ..... ...... ......... Final B L INSP CTOR ~ 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. Arl, �tt1 firs ZZ,a.[ CID M 8 " t Q)M I M EN Chimneys Residential & Commercial Roofing All Types Of CHIMNEYS POINTED-REBUILT-CAPPED Siding , Expert Masonry Work Mass Toll Free tRoof Leaks Experts *1 Licensed & Insured 1-800-WAIT-4-US ® Locally Owned& Operated Sirce 1976 ='••• License#034200 (924-8487) IKO Czee Wozrsa ar �Zohw We Work Year Round Proposal To: Scott Cooke Date 16/13/2016 za Street: 61 Forest St. scookesk8@aol.com N.Andover, MA Roof proposal 781-710-6880 Certainteed Landmark 1. Extra caution will be taken to protect house and 12. Removal of all work related debris. Planks will be �0 landscaping as best as possible. (tarps etc.) placed under dumpster to prevent any damage to Magnets run at final clean up. driveway. 2. Remove all shingles from entire house. 13. Building permit included. 3. Inspect and re-nail any loose or lifted plywood. 14.Contractor workmanship warranty: 10 years under v Any compromised plywood will be replaced at an normal wind and rain conditions. additional cost of$70.00 per sheet of 1/2" CDX. 4. Install heavy gauge 8"aluminum drip edge to all Total roof cost: $ 7,500.00 eaves and rakes. White, brown or mill finish 5. Install 6' of Certainteed Winter Guard ice and water shield along all eaves. Certainteed 3Star extended direct MFG warranty v 6. Install Diamond Deck synthetic underlayment to A fully transferable 100% coverage against remaining sheathing up to ridge. material defects for a fully non pro rated period of 7. Install all new pipe boots. 20 years. Please refer to pamphlet left in estimate 8. Install Certainteed Swift Start starter shingles to folder. Offered to our local referrals and included all eaves. in this proposal at no additional cost. 9. Install Certainteed Landmark Limited Lifetime architectural shingles to entire house. 10 year Balance due upon completion material MFG. warranty. (See extended warranty) All shingles will be installed and fastened References available upon request according to mfg. specs. 10. Cut and install new GAF Cobra ridge vent and cap Highly rated member of the accredited RBB and with color matched Certainteed Shadow hip and Angie's List ridge shingles. (MA code) 11. Counter flash existing chimney flashing and all Thank you! roof protrusions with ice and water shield, tie into new shingles and seal with clear Geo-Cel sealant. L�� C A Acceptance of Proposal—The above prices, specifications and conditions are satisfactory and are herby accepted. You are authorized to do the work as specified. Payment will de as outlined above. Date of Acceptance: �/2�/ Signature`' The Commonwealth of Massachusetts F Department of IndustriadAccidents 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 Legibly NaMe(Business/Organization&dividual): At/ (fh�"4 Oki<_ fez-��°y�5' Address: /;Ik aW(V City/State/Zip: pvv✓l -<AJ-r-� AM/71J Phone Are you an employer?Check the appropriate box: Type of project(required): 1.Q I am aemployerwith employees(full and/or part-time).* 7. El New construction 2.Q I am a sole proprietor or partnership and have no employees working for me in 8. 0 Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3..F1I am a homeowner doing all work myself[No workers'comp.insurance required.]t 10 n Building addition 4.F1 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 11Electrical repairs or additions proprietors with no employees. 12.[J Plumbing repairs or additions 5.�am a general contractor and I have hired the sub-contractors listed on the attached sheet. These sub-contractors Have employees and have workers'comp.insurance.# 13.[J Roof rep/a�irs 6.F1 We are a corporation and its officers have exercised their right of exemption per MGL c. 14. Other /�6 1/1152,§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. T Homeowners who suliniif•this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors jhat 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-coniz d&s have employees,they must provide their workers'comp.policy number. I ain an employer that is providing workerscompensation 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: ,moa g� 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 DTA for insurance coverage verification. I do hereby certify under th. sins and penalties ofperjury that the information provided above is true and corrects Signature: 0 Date: Phone#• 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 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-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 regi fired 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 polio*y 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 WORKERS COMPENSATION AND EMPLOY RS LIABILITY INSURANCE POLICY iNFORMATION PAGE A.I.M. Mutual Insura 00 Company 54 Third Avenue, Burlington, M ssachusetts 01803.0970 (800)876-2 res - NC-01 NO 26158 POLICY NO. AWS}, 009484-20.(SA PRIOR N0, �WG400d00 4464.2014A ITEM I. The insured: All Under One Roof DSA: Mailing address: CIO John Lanzefema Ft;IN:**-*"8251 30 Temple 01844 Legal Entity Type: sole Proprietor Other workplaces not shown above: See Location 2. The policy period is from t 1!09/2016 to 11109!2016 12:01 a.m,standard time at the lnsured's mailing address. 3. A. Workers Compensatlon Insurance:Pert One of the policy 1PPI10s to the Workers Compensation Law of the states listed here: MA B, Employers'Usbility insurance:Part TWO of the policy appli s tc work to each state listed In Item 3.A The limits or liability under Part Two are: Bodily Injun by Accident S 100 000 each accident Bodily Inju by Disease $ '— "—giG`000 policy limit Bodity Inju by Disease $ """ ,00 each employee C Other States Insurance: Coverage Replaced by Endorserr ant WC 20 03 00 a 0. This Policy Includes these Endorsements and Schedules; SEE SCHEDULE 4. The premium for this policy will be determined by our Manuals f Rules,Ciassiiioatlons,Rates and Rating Plans. Ali Information required below is subject to verirication and chat go by audit. vTaaslfioe ons """ •••- _.. „, ,13rem u I Basis Maes' CoNO.de 4311= at An u i ParS100 Lsitmated muner tion Remuneration Annual "----•••• .».._.._._._,,.,,_- Remunerartlon Premium INTRA 174366 I { . INTER I SEP-CLASS CODE 30HEOUIE Minimum Premium 1r ---------• Yo at Estimated Annual Premium STA.E'C q88 D Posit Premium `' 74 St to AssessmenwSurch:arges $1 .00 X 5 7500% $1 This Policy,Including all endorsements,Is hereby countersigned by Nuftrlwd prm urro � 1010612015 Service OfnOe: 64 Third Avenue n 01603 F MY Insurance Agency LLO 522 Chickering Rd,Rt 125 N *Andover,MA 01846 WC 00 00 01 A(7-11 InCluUsed les Its pe missla ttartai of the Nation•!Coueap on Companratlon Instronas, , used with its rJvh1*arpn, 11/13/2015 WED 11166 FAX 781 598 8430 DAVID ZELLER INSURANQ$ Q001/001 i k, O CERTIFICATE OF LIABILITY0An(rBJtDe1YYYY) INSURANCE ttneno THIS CERTIFICATE rs ISSUED AS A MATTBIt OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THe ceRTIFICATB HoLekle THIS I CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND.EXTEND OR ALM THIS COVERAGE AFFORORD BY THF POLICIES = !BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURBR(Sh AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT. If the eomflesto holdor s on ADDITIONAL INSURED,the pollay(taa must be endorsed. If SUBROGATION 18 WAIVED,"act to � the terms end oonditlons of the pDiiey,eeftain Policies may require an endorssmsnL A statement on this caraficate dose not Corder rights to the asrtifionte holder In lieu of such endorsements). PaoouclR Maryellen Goodwin DAVID E,ZELLER INSURANCE AGENCY INC ft370 LYNNWAY MaivalledLdevIcIzellermarn i LYNN = INSURED N,ucs MA 01001 N RER ACE AMERICAN INSURANCE CO 22687 i INE R i BERRY FRANK&BERRY JAMES DBA FRANK&SONS es$ I ; 46 WINBROQK DRIVE aar � EPPING NH 03042 COVERAGES CERTIFICATE NUMBER' 1314 REVISION NUMBER., THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE USM BELOW HAV&BEEN ISSUCD TO THIS INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOiYYITH3TANDW3fiNY REQUIREMENT.TeRtr OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS C"TIFICATE MAY BE ISSUED OR MAY PERTAIN•THE INSURANCE AFFORDED By THE POLICIES DESCRIBED HEREIN IS SUBJECT TO EXCLUSIONS AND CONDITIONS OF SUCH POLICIES-LIMIT8 SHOWN MAY HAVE BM REDUCED BY PAID CLAYA8. ALL THE TERMS, INeR TOZOPM&URANCEAWL QR i COMMERCULOEN[RAUdAIrPM D D LIMITS EACH OCCURRENCE j 0.0111 fAAOE El OCCUR VAMA PREMISES a MED EXP M sa eRen NIA Ra NAL!Aby1 01N'LAGOR[OATELRArAPPU GPelt 0 AOOREOATE ti POLICY[� Lj Loo PRooucre. MPD a° AUTOMOBILE W1enm $ OWNEDAASCH�DUIPD BODILYWURY(pWparur) a AUr0a uuT NON•ON/A a0D1LYINJURYIParaoadsnq !: HIRIDAVTOS AUTosWNED i UMERIMULAa OCCUR g t ECESSUAsC RENC& AsTEMON D WA A R : WORKIRSCOMPBNSAAON ANDEMPLDYIERe'UASIUIY N AOFFINYPltOPRIETORlPARTNE E.L.EACH ACCIDENT s 100 000 ; A (Minn SIR m'"M WA WA NrA OSOW6999BL43415 11!06/2015 11/05/2018 (Mu=datoNlnNN) _ u duellba under E.L 0191A Z-OARMPLOM 0 100 i000 1 o e rove LL013EASE-PO LIMB 500000 WA ! t OESCRIPT=ONOPOPERJ►T101,111LOCATIONa/VEHICLES tACORO/e1,AddINtMIROMOkstofudulkmaybooruhNUmuaepuhtpnJnd) Workers'Compenasfio=t benerJts vAp be pard to Massachusetts employees only.Pursuant to EndusemaH WO 20 OS 00 S,no I employes$In states other Otan Massachusetts U the Insured hires,Of rise Wad those employees outside of Msssschuaeas- authorization Is gtYen to pay claims for benefits to We Certificate of insurance shows the policy in force on the date that ft Certificate was Issued(unless the expl atien dale on Iris[bone Policy precedes the Issue date of INS certificate cf insurance). The Status of ft coverage can be monlixed dally by accessing the Proof of Coversge-CM,09e VeejWsgon ea&mh tool et wwwmau.povAwMNftw$-�gmpeMattoMnvesUgetioml. No pannus have elected coverage. i CERTIFICATE HOLDERCANCELLATION I 9,18- 195% OLAO BHOtn.p ANY of TH[AIIOYR DlfSCRIBBD POLICIES SE CANCFLLED BEFORE t TIM IMPIRATION DATE THEREOF, NOTICE WILL BE ORNRED IN I ALL UNDER ONE ROOF ACCOIWuiCjWITH THE PouCYPROV01ON& 30 TEMPLE DRIVE AL"NORIX10 RUPRe36NTAT1Va METHUEN MA 01844 D^ 11414y.CPCU,Vice President-Residual Market—WCRIBMA AcoRD zb(zolatol) The ACORD name and Ingo are registered marks of ACORD Ra coRPowq�noN.Alt rl8tlta reserved. M�raae�ohuaefts. Bcstrd or Bpiidinq cgulaftn an Co►natrwetion SuPorvi„rr License;C$-0°9120 Zo 30 T>r1MSE� NDR S r "• METH MMA DlU4 d .4,r' COMMISSronu• 04/0312017 Click on the reglat►OSOn number to view complaint history,you tan 2180 1118tbN. �leat,g�br; The list is current us Of Wednesday,*CWber S, 2014, Search Results Rl:Gl37RANT �8POMSMMM RaCGurcPA=0" "AMR INDMMMAL ;yam ADORMS "PMqTWN AUVMpgRONZRpop LAMrAF`AME. DATe BTATu8 JOHN � S86 A MERRIMACK ST 10102/2416 Current MMEUK MIA 01844 � ~••••. @Zptg Qommomvsatth ofM�sa�ctrusetrs. `"�. Ma:txtto�isahQiatered servloe marls orlho ComMonwoDllhV fjafesohuaetts. Ajj%MA14