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HomeMy WebLinkAboutBuilding Permit #425-16 - 87 COACHMANS LANE 10/5/2015 w� f NORTFI q ���y�✓ni�1� 1d�611-,� BUILDING PERMIT ?o6„Eo6'.6�0 TOWN OF NORTH ANDOVER n f APPLICATION FOR PLAN EXAMINATION Permit N0: G�or / Date Received s5� Date Issued: �� ACNU IMPORTANT: Applicant must complete all items on this page LOCATION C TVl C H H A-N`S L A Nc , Print PROPERTY OWNER_ ER A-N K f..Ccs (-4 f + , Print MAP NO:y37 PARCEL:D)ZS ZONING DISTRICT: Historic District yes no !Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED•USE Residential Non- Residential ❑ New Building ne family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial kAepair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑ Wetlands ❑ Watershed District ❑Water/Sewer �. EFi�vL rK��`r7K� izodFw6D ON itfiF- F> i s_ a 4-S IILs)IE-7S 0 E TffffH S-i AND lam-E:24 Cffw + ref N-F—ccJ A/Q C H(Tt-C'TuaAL S H IWa te S - CT, 1,A Nb H&z k( /30 N-Mi Ea,p rte– OF I+&JS.E ( S H-37— T-0 RE S N E Identification Please Type or Print Clearly) OWNER: Name: F)2A N is 1,Eo N E Phone: l-? Address: CONTRACTOR Name: (00-3�-q31 5T s7 Phone: A-y/-oNb -3• 4o L M S Address: ,a T-6 -zox 6.9ia&N t A"o, N ff 0`3 �y0 Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date. 16 ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. ad Total Project Cost: $ Z�;SSJo. FEE: $ , , Check No.: C�a,/ Receipt No.: IZ.1 )`/40 17, e NOTE: Persons contracting it Zni:,tte4reddontractors do not have access to the guaranty fund Signature of Agent/Owner Signature,of contractor g J* r BUILDING PERMIT _ °ANO oT bgtio TOWN OF NORTH ANDOVER ` 02 APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received �gSSgCHU Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION. Print r PROPERTY OWNER Print, , "` f 100 Year.St�ucture yes no PARCEL,: �._ ZONIN&DI$TRICT: Historic,Dstnct yes: . no, 4 Machine,Shop Village yes no 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 0 Assessory Bldg ❑ Others: ❑ Demolition ❑ Other O'Septic Well r Floodplain * f,Wetlands..#` 0 Watershed District ':Water/Sewer , DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: Contractor,,Name: - . _ r. .r. . =�.. Phone:., -Email: -y- - -- Address Supervisor's Construction L'icense __Exp}.=bate: __ Home`IrYiprovement,Licerse: _ ?Exp .Dater 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: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner� Signature of contractor Location co 6 NoA��C — �° Date F I I TOWN OF NORTH ANDOVER . f Certificate of Occupancy $ Building/Frame Permit Fee $ 1a Foundation Permit Fee $ Other Permit FeerMED $ TOTAL Check# �� ! t} C} 13014194Inspector GJ Plans Suamitfed ❑ 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 s 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 Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Sic nature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE;DEPARTMENT Temp Dumpster,pntsite: t Located.bt 124,Maihi Street 2 ` FireiDepartment signature/date _ _ 4; COMMENTS, t> • . s.< h 4 i i Dimension I 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— (Fordepartment use) I I ❑ Notified for pickup Call Email Date Time Contact Name I Doc.Building Permit Revised 2014 r 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 VWorkers Comp Affidavit Li Photo Copy Of H.I.C. And/Or C.S.L. Licenses u/ Copy of Contract o Floor Plan Or Proposed Interior Work o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks o Building Permit Application o Certified Surveyed Plot Plan o Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract o Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) Li Mass check Energy Compliance Report (If Applicable) o 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) o Building Permit Application Li Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract o Mass check Energy Compliance Report u 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:Building Permit Revised 2014 NORTH q own of ? EAndover 0 - * � h ver, Mass, A- COCNICNEWICK- 7,95 RATE D Ok U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT .......... ..` !. .... !. ......................................................................... BUILDING INSPECTOR has permission to erect .......................... buildings on ...... 7. : .:r:? :Y..`S..`lFoundation ..e—we ............. Rough to be occupied as ........ �'.....r��......P.`.... . .�... :Xf ........ O!4................. 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 CONSTRUCTION 4TARTS Rough Service ................................................................................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz 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. R. B. HOLMES, Inc. Custom Builders AGREEMENT R. B. Holmes,Inc. Custom Builders shall perform the following work on the Home of Frank and Angela Leone, North Andover, MA 1. Scope of the work (this work shall be defined by the area over the garage and the rear of the house and does not included the front of the home which does not need re-roofing) * Protect house with tarps and remove the old roofing and underlayment. * Inspect sheathing for condition. If major nailing or replacement of sheathing is necessary, it shall be billed as an extra charge. * Install new metal drip edge and apply Grace Ice and Water(HT) to the first 6' of all eaves, 3' in valleys, and around 4 skylights, 10 vents, and 2 chimneys. * The remainder of the roof to have Tri-Flex roofing underlayment installed. * Install Certainteed Landmark shingles. * Install roll ridge vent as required. * Inspect chimney flashing and try to work with existing flashing * Place all waste in on site dumpster and final clean of property. Price for above work: $ 15,500.00 Agreed: j "e/ OwnerDate _RzLr - Ray Holmes Date Architectural Design New Homes Renovations P. O. Box 758, 1 Bayside Road, Suite#9, Greenland, NH 03840 Phone and Fax 603. 431. 5787 Cell 207. 337. 2630 The Commonwealth of Massachusetts Department of IndustrialAceidents I Congress Street,Suite 100 Boston,MA 02114-2017 .t www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Annlicant Information Please Print Legibly Name (Business/Organization/Individual): 'P, . L-r{j: 77H c e U-j;M m '9O`(Lb t=�, Address: 'P-6 .3-8Y. —7!�Yj &P-e—:E(4Lt{q7) , M4 C)5 ,�6,410 City/State/Zip: 6 P-E6 9LAN61 144 0-?$ '(y Phone#: 6d`-S `f 3/-'v 7-g7 Are you an employer?Check the appropriate box: Type of project(required): 1.❑I am a employer with employees(full and/or part-time).* 7. ❑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 0 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.❑Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.E]I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.[<oof repairs These sub-contractors have employees and have workers'comp.insurance.= 6.We are a corporation and its officers have exercised their right of exemption per MGL C. 14.Q 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. 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 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»ry employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lie.#: Expiration Date: 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$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 tit e pf ains and penalties of perjufy that the information provided above is tri[(L e and correct. Signature: T� �L Date: �l 7 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#: L rid- - Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 169391 r; Type: Corporation Expiration: 6/16/2017 Tr# 268538 R.B. HOLMES, CUSTOM BUILDERS,INCA- RAYMOND HOLMES a P.O. BOX 758 W , GREENLAND, NH 03840 ' E = Update Address and return card.Mark reason for change. SCA 1 i. 20M-05111 Address ❑ Renewal E] Employment E] Lost Card o�/P�o�rr77zTrrriJeUl�/t��C��GC�JJaCIIrcJe(�i Office of Consumer Affairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: ',Registration: 169391 Type: Office of Consumer Affairs and Business Regulation V; > Expiration: 6/16!2017 Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 R.B.HOLMES,CUSTOM BUILDERS, INC. _ RAYMOND HOLMES 1 BAYSIDE RD No.9 GREENLAND,NH 03840 Undersecretary 'Not valid without signature Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CSFA-105544 Construction Supervisor 1 & 2 fp Family RAYMOND B HOLMES 399 CIDER HILL ROA6; YORK ME 03909: Di O A Expiration: Commissioner 07/22/2017 Construction Supervisor 1&2 Family Restricted to: • � e Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. DPS Licensing information visit: WWW.MASS.GOV/DPS