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HomeMy WebLinkAboutBuilding Permit #1316-2016 - 73 BRADSTREET ROAD 6/17/2006 BUILDING PERMIT of NoerH 6�O 1i,1-EC' D E , TOWN OF NORTH ANDOVER �� h ''- =J APPLICATION FOR PLAN EXAMINATION :A � Z y Permit No#: �24F Date Received gSSACHUS Date Issued: IM ORTANT:Applicant must complete all items on this page LOCATION cJsr / PROPERTY OWNER I �!� Print Print 100 Year Structure yes no MAP _PARCEL: Zj_ZONING DISTRICT: Historic District yes no Machine Shop Village yes. no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building CeOne family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial P-Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Milk, A, ®Wetlands _ ®. Wafiershed ®ist^ct� � ':= ®W ter/Sewer . . r #_ xe- DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: '-�? '-J-e—n -� Phone: 1�7'?-6-10 Address: 1�j Contractor Name: T C Vk-% &f Phone: Email: nn11�. t9S9 y-1G�Qa W��s Address: 6 Supervisor's Construction License: (S-C3 Exp. Date: . l p l 7� �' S� E.p. Date: 12 / 2,/ 4 Home Improvement License: 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: $ c�! % � r FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unreg' er contractors do not have access the g aranty fund Location / I No. / r' .� � Date (ro � • - TOWN OF NORTH ANDOVER. • Certificate of Occupancy $ dZ p- I Building/Frame Permit Fee $ i Foundation Permit Fee $ i Other Permit Fee $ TOTAL $ K121- 1 C h e c k# , j�j � l i Building Inspector dP i Flans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL .a Public Sewer ❑ Tanning/Massage/Body Art ❑ SW"' Mui Well ❑ Tobacco Sales ❑ Food Packale i Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ +, 4 m s THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF m 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 - r Planning Board Decision: Comments Conservation Decision: Comments i Water& Sewer Connection/Signature & Date DrivewaV Permit DPW Town Engineer: Signature: Located 384 Osgood Street <r"'e.+w""".�`. .<iT*`.A'ls� =t AFIRE DEP; R I�IENT Terrip'DumpsterFonisite_ yes ,�' � �z «e r �'_ - - F1Locatecl x�i`" F a Department sign tune/date . � � � a .' a+ '�'x�` �: r I ,:- '* _ >.,y C;OMMENTvS�.�.,�a�� �� w ��:��� �� Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL, Movement of Deter 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— Gorr department use) ❑ 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 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 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 I NORTH own of o - No. o h ver, Mass> 112a(* COCNICNl W.c" ��- �.95 RArEo rPp,��(5 U BOARD OF HEALTH Food/Kitchen 1T T LD Septic System THIS CERTIFIES THAT .............. .... .. .........MAN(i... .... ... ......................................... BUILDING INSPECTOR . . ........ ... .... has permission to erect ...... buildin s on -.7b.....I& Foundation ��, Rough to be occupied as ......... :... . ...... �.................:........... ...:. ......................... Chimney provided that the person acce tinlhis permit shall In eve respect conform to the terms of thea Iication p p p g p every 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 CONST ION Rough Service Final BUILDING IN CT 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. 6/17/2016 Community Software Consortium E�a� a ..> North Andover Board of Assp�sprsr s s• a , 3•�S Back to Results I Search for Parcels I Search for Sales View/Print Record Card Parcel ID: 2101057.0-0021-0000.0 FY: 2016 Community: North Andover Photo(Click on Photo to Enlarge View Location: 73 BRADSTREET ROAD K y Summary t' Property Owner Name: PATRICIA A.GLYNN REVOCABLE TRST i Card r.: ResidencE Owner Name2. CIO PATRICIA A.GLYNN IRREVOCABLE TRUST Map View Owner Address: 73 BRADSTREET ROAD _ View Land City. NORTH ANDOVER State: MA Zip: 01645 Segments 9 Neighborhood: Area:borhoad• 6 Land ea 046 acres I , Abutters � Properties Use Code: 101SNGL•FAM-RES Total Finished Area: 2001 sgft c Tax Class: T Pct-Exempt-Land: 0 a Pct-E)empt-BUg: 0 73 BRADSTREET ROAD y Sales Sewer. Road Type: T History Water: Road Condition: p Sketch(Click on Sketch to Enlargf) -h Value Assessments Current Year Previous Year History Total Value: 416,500 398,100 Building Value: 222,100 208,600 Condo Lard Vakie: 196AN 189,500 Market Land Value: 196AN Comsnei CI 0 Chapter Land Value: Latest Sale Sale Price: 1 Sale Date: 06/23/2014 Amis Length Sale Code: A-NO-FAMILY Grantor: GLYNN Cert Doc Book 13888 Page: 0254 Copyright©2015 Community Software Consortium.All Rights Reserved http://epas.csc-ma.us/PublicAccess/Pages/ParcelSummary.aspx?MenuID=3&LinkID=181009&Commcode=210 1/1 rye `, a r '� � &a a F Cz .rL� a ay r e �' a` WA - xis? "w � 21, ig Re sig e tiai > oe r r ial Roofing All Types Of EXPert Masonry Work Mass Toll Free " .. Licensed & Insured 1-8004JA{T-444 License#034200 cl ' �w�3'�."h't s � �. x �� �. ,•a� We Work Year fou nd Proposal To: Pat Glenn Date 2/9/16 Street: 73 Bradstreet Rd. 978-682-2688 N.Andover, MA 978-764-6692 Vinyl Siding Proposal 1. Remove all existing siding and corner boards 11. Install all new vinyl accessories: light blocks, from entire house and garage. gable vents, dryer vent, split blocks, meter block etc. 2. Remove all shutters. 12. Removing and re-installing electrical meter by 3. Inspect all wood components of entire house. licensed electrician all included in proposal. Any compromised material will not be left. Any 13. Removal and installation of light fixtures and existing damage or rot will be discussed, doorbells included. New fixtures and doorbells must confirmed with homeowner and replaced at an be provided by homeowner if wanted. additional cost of time and material. 1 st 32sq/ft of 14. Install composite kick plates under all entry doors sheathing boards. at no additional cost. where applicable. 4. Install 3/8" solid Styrofoam insulation board to 15. Proposal does not include any painting or staining. entire house. All seams will be taped. No generic 16. Building and electrical permits included Mfg. 17. Removal of all work related debris 5. Install double 7" Cedar Impression corners to all 18. Limited Lifetime vinyl siding warranty from outside corners. Color Sable Brown MFG. , not contractor. 6. Install double 7" Cedar Impression vinyl siding 19. Contractor workmanship warranty: 10 years under panels to entire house and garage. Color Sable normal weather conditions. Brown. Total Cost: $ 31,400.00 7. Soffit area: Drill holes in all rafter bays for added ventilation where needed. Install vinyl perforated � Orion: Install all new vinyl louvered or raised Invisivent soffit panels for excellent attic airflow. Panel shutters to all existing areas. $60.00 per 8. Install j-channel to all areas that need to accept pair installed additional cost. vinyl siding. All j-channel will be self-flashed and angle cut for clean professional appearance. 9. Install custom bent Alcoa aluminum trim coverage to all fascia's, rakes, window casings and sills. Finish aesthetic appearance to match Payment schedule: new and existing windows as close as possible. 1/3 on project start date 1/3 at project halfway point 10. Install all new composite jambs, casing and weather bands around garage doors. Final balance including any extras due upon project completion Acceptance of Proposal—The above prices, specific itions and conditions are satisfactory and are herby accepted. You are authorized to do the work as specif ed. Payment will be made as outlined above. Date of Acceptance: Signature: �\ The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street,Suite 100 Boston, MA 02114-2017 UV www.massgov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Lepibly Name(Business/Organization/Individual):Ad Address: Jt, J--e�� aK ' W,4d -e' )Wafj City/State/Zip: (5 u q I Phone#: ?q J�� Are you an employer?Check the appropriate box: Type of project(required): 1.[J I am a employer with employees(full and/or part-time).* 7. ❑New construction 2.❑1 am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.fNo workers'comp.insurance required.) 3.01 am a homeowner doing all work myself.[No workers'comp.insurance required.)r 9. ❑Demolition 10 Building addition 4.[:]l am a homeowner and will be hiring contractors to conduct all work on my property. 1 will ensure that all contractors either have workers'compensation insurance or are sok I I.❑Electrical repairs or additions proprietors with no employees. 12.E]Plumbing repairs or additions 50 1 am a general contractor and I have hived the sub-contractors listed on the attached sheet. 13.E]Roof repairs These sub-contractors have employees and have workers comp_instaance.t p ,e 14E]Other 6.E]We are a corporation and its officers have exercised their right of exemption per MGL c. 152,§1(4).and we have no employees.[No workers'comp.insurance required.) *Anyapplicant 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 arc doing all work and then hire outside contractors must submit a new affidavit indicating such_ 'Contractors dies'check this box raw 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. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy andjob site information. Insurance Company Name: A,'P,- /,*w c1-fvy)4 n f Policy#or Self-ins.Lic.#: "" �e' ' wog —T'- 6 Expiration Date: 1 `l Job Site Address: City/State/Zip: - 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 51,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signa Date: 04� c1 )� ,A7--1 hone#: Of trial use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct budding$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 chocking the boxes that apply to your situation and,if necessary,supply sub-contractors)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 for 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"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 I Congress Street,Suite 100 Boston,MA 02114-2017 Tel.#617-7274900 ext. 7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia WORKERS COMPENSATION AND EMPLOYRS LIABILITY INSURANCE INFORMATION PAGEA.I.M. Mutual Insm POLICY 54 Third Avenue, urlington,m sahus00 etts 0'1803.0 (800)876-2 O 970 NCGI NO 24108 POLICY NO. AWO-400-70084e4.20.1 PRIOR N0, 'q_ 1NC�400.100q.2Q141� GA ITEM 1. The Insured; All Under One Roof DBA: Mailing address: C/O John Lentaferne 30 Temple Drive PE;IN;+-'•*8251 Methuen,MA 01844 Legal Entity Type: Sole Proprietor Other workplaces not shown above: See Location 2• The Policy period is from 11/094015 to 11/09/2018 12'01 S.M. 3. A. Workers Compensatlon Insurance:Part One of the policy pt s to therWorkers Compnallon Lad time at the Insured's iw of theress. states listed here: MA S. Employers'Liability Insurance:Part Two of the policy 81515114 s to work in each state listed In Item 3.A. The limits of liability under part Two are: Bodily inju by Accident $ Bodily inju by Disease $ "— 100 000 each accident Bodily inju by Disease $ Opp polilimit eacs elmp oyes C Other States insurance: Coverage Replaced by 6ndomerr ant WC 20 03 0 B D, This Policy includes these Endorsements and Schedules: SEE SCHEDULE 4. The premium for this policy will be determined by our Manuals I if Rules C168311`10800118,Rates and Rating Plans. All Information required below is subject to vorinoation and Cha go by audit rIlassiri:ons TOCHEOU Cods pa Of Op Estimated otAnnual RemRentunerat(an premium INTRA 174366INTEROr-GAWWW CMinimum Premium 911ttaD + —� To al Estimated Annual Premium AU premium De osit p STATS tLASB � M '.` 474 St to AssessmenW/Surcharges $1 .00 X 6 7500% $1 This PClicy,Including all endorsements,Is hereby oounterslned by i g 0. 4 br DnalUf~'A ..10105/2015 S4Service ThirdMeAvanue 64 on en 01803 P rry Insurance Agency LLC 6 2 Chickering Rd,Rt 126 N rth Andover,MA 01845 WC 00 00 01 A(7-11) tncludss eopyrtphbd mabrtat or the Nallonal Councit on Compsnsatten Insuranes, , usotl eNfh Its permt�ston. WORKERS COMPENSATION AND EMPLOY RS LIABILITY INSURANCE POLICY INFORMATION PAGE A.I.M. Mutual Insure ce Company 54 Third Avenue, Burlington, Massachusetts 0 - g 'l8t}3 0974 (800) 876-2766 NCCI NO 26158 POLICY NO. AWC7400-7009484-201A PRIOR N0, --_`__ AW-0 400.7009464.2014A ITEM 1. The Insured: All Under One Root DBA; Mailing address: C/O John Lenzafeme FEIN:**--8251 30 Temple Drive Methuen,MA 01844 Legal Entity Type: Sole Proprietor Other workplaces not shown above: Sae Location 2. The policy period is from 11/09/2015 to 11/09/2016 12:01 a.m.standard time at the insureds mailing address. 3. A. Workers Compensatlon Insurance:Part Ohs of the POilcy pplies to the Workers Compensation Law of the states listed here: MA B. Employers,Liability Insurance:Part Two of the policy applies to work in each state listed In Item 3.A. The limits or liability under Part Two are: Bodily Injuq by Accident $ 100,000 each accident Bodily Inju by Disease 3 '"'—�policy limit Bodily Inju by Disease $ ": _ 100,000 each employee C Other States Insurance: Coverage Replaced by Endorse ent WC 20 03 00 5 D. This Policy includes these Endorsements and Schedules: EE SCHEDULE 4. The premium for this policy,will be determined by our Manuals f Rules,Classifications,Rates and Rating Plans. All information required below is subject to verification and Choi go by audit. ��lessificatfons ""_ "" dem u " ass Mates Code Estimat id PerS100� Estimated�� No. Total Ani ual of Annual .._. ,_ Remuner tion Remuneration Premium i I INTRA 174366 , i I INTER SEE;CLASS CODE SCHEDULE Minimum Premium 9ifdD + w- i Tcal Estimated Annual Premium GOV GOV De osit Premium STATE CLASS MA 64 4 Sti to Assessments)Surcharges $1 .00 X 5 7500% $1 This policy,Including all endorsements,Is hereby countersigned by 10105/2015 u ar 8 . Qna ur. .'— WIT---- hind Avenue Office: 64 TrP rry Insurance Agency LLC s4 Thi Burlington MA 01803 W2 Chickering Rd,Rt 126 N Drth Andover,MA 01$45 WC 00 00 01 A(7-11) e Copyrighted ma•tat oftheNaon:tUaod with Its p oneounett on compensation insurance, roassachusetts -Depart-iment of Pul✓';ic f1 iOns aH/tl v CCarLi ::x rsuli..irty {iCCtuIaY�..„� „ l” Irfense; CS-069120 JOHN IN LANZAFAM 30 TEMPLE DR METHUEN MA 01844 ` Comm}s s i o n er 04/03/2017 Click on the registration number to view complaint history.`fou can also r�iebv 2rbitration and Guaranty Fund history. The list is current as of Wednesday, October 8, 2014, Search Results REGISTRANT RESP®ll 501 E REGISTPATtON EXPIRATION ADDRESSDATESTATUS NAME 1lAtll MDUAL H UNUM Au.umbER rt F-RooF LANZAFAMi<, 437t)4� 1fr4i A t1�dF.RRtf�ACiC ST 10/02/2f316 Current .JOHN METHEUN, MA 01844 02012 Commonwealth of Massachusetts. Mass.GoAD is a registered service mark of the Commonweatth'of Massachusetts. i