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
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f APPLICATION FOR PLAN EXAMINATION
Permit N0: G�or / Date Received
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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
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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.
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Total Project Cost: $ Z�;SSJo. FEE: $ , ,
Check No.: C�a,/ Receipt No.: IZ.1 )`/40 17,
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NOTE: Persons contracting it Zni:,tte4reddontractors do not have access to the guaranty fund
Signature of Agent/Owner Signature,of contractor
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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