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HomeMy WebLinkAboutBuilding Permit #897-13 - 89 WINDSOR LANE 5/1/2018 z / O� 'OOROT d BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMIN TI Permit NO: �7�l� Date Received Date Issued: �SSACHus�t O GIMPORTANT:Applicant must complete all items on this page LOCATION O / Gl�//U��O� Z_"4-vz Print PROPERTY OWNER �JT�y� 6,')/Z,-J5#!:�7 Print MAP NO:�D PARCEL ZONING DISTRICT: Historic District yesOno Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑One family XAdition El Two or more family 11 Industrial ration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: C�-6emolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer 7� Gl �R-Sdry ,i?oaryt Identification Please Type or Print Clearly) OWNER: Name: 672FV_ IA//L5 S Phone: %7&"- 3 Sd- Q 9 7 3 Address: L'tV CONTRACTOR Name: 9?s-9s�` 1ok4 Phone: Address: 55 119 g 15 OIX44 Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: Y' 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: $ 20 15 3 0 , no 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 contractorNA� Ems. Plans Submitted❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE-OF.SEWERAGE DISPOSAL Public Sewer ❑ Tanning/MassageBodyArt ❑. . 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 DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS r Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes i Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit �. DPW B'oiv�* Engineer: Signature: i Located 384 Osgood Street FIRE DEPARTM*L-'NT - Temp Dumpster on site yes no Located at 124 Mair'Street Fire Departmerit signature/date' COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions.__ Total land area, sq. ft.: ELECTRICAL: Movement of fleeter location, roast 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 foricku - Date p p 4 Doc.Building Permit Revised 2010 Building Department The fol owing is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofivg, Siding, Interior Rehabilitation Permits u Building Permit Application u Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Co of Contract Copy tact Li Floor Plan Or Proposed Interior Work i u Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks Li Building Permit Application o Certified Surveyed Plot Plan o Workers Comp Affidavit Li Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract u Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) u 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) Li Building Permit Application Li Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses a 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 o 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 I that the apnaal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submated with the building application Doc: Doc.Buiiding permit Revised 2012 Location No. F17 —/,7 Date • - TOWN OF NORTH ANDOVER r Certificate of Occupancy $ Building/Frame Permit Fee $�7•�v �r C;; Foundation Permit Fee $ � •. '� Other Permit Fee $ TOTAL $ Check# .� 'O 26548 '`t `Building Inspector Enter construction cost for fee cal - North Andover Fee Cakulaf/on Construction Cost $ 205530.00 m $ - $ 246.36 Plumbing Fee $ 30.80 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 30.80 Total fees collected $ 407.95 Foundation 100 89 Windsor Lane 897-13 on 6/24/2013 Convert exisiting 3 season room to a 4 season room r 7 NORT1i _ t Jc . - ve' . o No. 1— I _ �- ­ * _ ver, Mass, i V BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT S'�.�.�V'e �l ��5� BUILDING INSPECTOR ..................... .......................... ...................................................................... � ' • � Foundation has permission to erect .......................... buildings on . ... ......�........:f�......... . ......................... .'. Rough to be occupied as ............4-e � � ,f. .'u :... S� sc�+t.....�®. .`.t.. �:.... Sri Chimney provided that the person accepting this permit shall in ever 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 Jnspection,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 CONSTRUCTIO STARTS Rough Service .......... .... . :............................................... Final BUILDING INSPECTOR 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. SEE REVERSE SIDE • F� 1...o _ P. M0FZTGAc-gc PURPOSCs '""C 5.4%N V. L)5 E. ON 4.x (.�lA►5E R l3Palrl Pu6Ll G RECORDS SND �vr D�1,lGE oNt '1"Ne C'�uNr,� . IvIOR'T'GAGoR EP4 E.M W(t..,rsS i, P' . .. . 'mak. - r; � -z. N �- : -.. ,� � --•- •• 3,04-�'�� ,• � �° ,.,,�'�� �`• 11, � � �Q i � � G� • `• `. ice_ ;' , �/ fry- VQ N �Z7 u- PO RT I o*1\614r,:,F ,>�OT • CPA� (lr 39.` 8 - l 380.3/•. 1V .35= 59'•.5'7•�w. . OWNERS) : RCERTIFICATE REGISTRY: S �D '14 _ I CERTIFY that the Lot shown hereon DEED: BK. 9374. P.2 9 N that the _DW E LL t 0 C, �bown PLAN :4 (OZ•S2 _ co�. CERT OF TITLE: YNE_ present- Zoning NOTE: of •the, ) of DK T(-� The premises do F- a not lie within designated of 4%, Flood Hazard � �� ` I!ny ' a'4`�� `r� Y Zone.(ImiA,PAN�L. i "�` '`'� t: . " .f' RORT ROBERT G. GOODWIN R V `, `�? TT ` I.. Lc" r' 82 • CENTRAL STREET �5� �%' c?c� ,.1::•In ANDOVER, MAS°: O'i�U.r'"�• :.�..d;.. .�, ,i�\� �f�rSrf."• ` .M r .0 , l A� CERTIFICATE OF LIABILITY INSURANCE 6/19/2013 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(ies)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 Tracy Loeschen DeAngelis Insurance PHONE (978)682-3397 FAX (978)681-0773 283 Merrimack Street E-MAIL ADDRE INSURERS AFFORDING COVERAGE NAIC# Methuen MA 01844 INSURER National Grange Mutual Ins Co 42 INSURED INSURER B: Raymond St. Amand, DBA: My Carpenter INSURERC: 55 Davis Road INSURER D: INSURER E: Methuen MA 01844 INSURER F: COVERAGES CERTIFICATE NUMBER:2013 Term 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 A D UB POLICY EFF POLICY EXP LTR POLICY NUMBER MM/DD MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISE TENTED ES Ea occurrence $ 500,000 ACLAIMS-MADE OCCUR 044869 /16/2013 /16/2014 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY PRO LOC $ 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 LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATIONWC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? ❑ N/A E.L.EACH ACCIDENT $ (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below I I I E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS 1 LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if morespace is required) Certificate is issued in the interest of the named insured and holder listed below. Subject to company conditions and exclusions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Steve Wyles ACCORDANCE WITH THE POLICY PROVISIONS. 89 Windsor Lane North Andover, MA 01845 AUTHORIZED REPRESENTATIVE p David Segal/NM �`` c� '1 ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025 mmnnsi ni Tho Arnpin nnma mnA Innn nm rnnic*orarl mor4c of Ar-nDn �lzc� i' i r R T c (3� �r My Carpenter Estimate 55 Davis Road Methuen,MA 01844 Date Estimate# 978-457-1084 ray@mycrpntr.com &12013 20110853 Name/Address Steve Wiles 89 Windsor Lane No Andover,Ma 01845 Project Item Description Total rework covered deck to add room to living space 01.2 Building Permits submit plan and obtain permit 350.00 02.10 Demo demo existing 10'x12'deck(at rear of house)up to roof structure which will be 1,680.00 supported and kept,to rework as needed(tbd)according to plan,remove debris 06 Floor Frame to frame up new deck w/2x10 lumber,to reuse existing foundation support,(rote 1,840.00 and water damage not included)apply 3/4"t&g underlayment at subfloor 07 Wall Frame to frame up walls as needed to create new room w/Marvin windows and door 2,170.00 using 3/4"composite trim at exterior and openings,siding at exterior to match house,to close in bottom at exterior with venting as needed. 17 Insulation to insulate at floor,walls,and ceiling as needed and conditions allow,to add ridge 1,180.00 vent and button vents drywall/Plaster to drywall interior at walls and ceiling make ready for paint 970.00 13 Windows&Trim to supply and install Marvin windows(7 in count)two of these at peak,2 1/2" g�— colonial trim at interior ' 12 Doors&Trim Marvin slider supplied and installed 6'0"x 6'8" 1,470.00 12 Doors&Trim to remove slider to house,add threshold,trim out opening 540.00 16 Electrical&Lighting as discussed,outlets,fan,radiant floor,thermostat 2,800.00 23 Floor Coverings tile at floor,labor included 1,000.00 allowance for tile and mat]. 200.00 25 Cleanup install baseboard,finish up,final inspections,final clean up 650.00 20 530. Tota 1 Ufae ia�n7�aoozcc,ealt�o�C/`L�aa:t�rc•�uae Office of Consumer Affairs&Business Regulation �O ME IMPROVEMENT CONTRACTOR registration 146286 Type: r xpiration 4/14%20151 DBA I MY CARPENTER RAYMOND ST.AMAND 55 DAVIS RD. METHUEN,MA 01844 Undersecretary f Massachusetts Department of Public Safety Board of Building Regulations and nd Standards Construction Supenisor License: CS-053532 RAYMOND D ST 55 DAVID RD ' + METHUEN MA 8184 9 s Expiration Commissioner 05/15/2015 The Commonwealth of Massachusetts 1 07 Department of IndustrialAccidits Office of Investigations 600 Washington Street Boston,MA.02111 U1W www.mass.gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le0b Name(Business/Organization/Individual): W&,l �o Address:_ 5-,5 City/State/Zip: AE 7W v E I?/ 01Y'44 Phone#: PY- 467— /0 9 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction prrnployees(full and/or part-time).* have hired the sub-contractors 2.21I am a sole proprietor or partner- listed on the attached sheet.T �• ❑Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.E]Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑Roofrepairs insurance required.]t employees.[No workers' comp.insurance required.] 13.❑Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. At Homeowners who submit this affidavit indicating they aie doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation 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: 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 requiredunder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do herebycer fy nder the sins andp fperju tlt t the information provided above is true and correct. - Si ature: Date: Phone#: `97k- 457— A-11-4 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 Instruction's 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 Iegal 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-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 maybe 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-De a biit has rovided a s ace at the bottom P Pp p— p --- 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 bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of assaclivsPtts Department of Industrial Accidents Office of Investigations I 694 Washington Street Boston,MA.0211.1 Tel,#617-727-4900 ext 406 or 1--877, A.SSAFE Revised 5-26-05 Fax#617"727-7749 WWW— Aass,govfdia