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Home My WebLink AboutBuilding Permit #391-15 - 91 WAVERLY ROAD 10/24/2014 BUILDING PERMIT 01 NORTH TOWN OF NORTH ANDOVER �? y '` `='^ '° o o APPLICATION FOR PLAN EXAMINATION * - Permit No#: t Date Received �9SSACHUSE�� Date Issued: "41-7(/ I ORTANT: Applicant must complete all items on this page LOCATIONPrint ' PROPERTY OWNER GZ tL_ ` Z Print 100 Year structure yes no MAP _ / l PARCEL: �-- ZONING DISTRICT. Historic District yes no Machine Shop Village yes 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 ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Septic ❑Well ❑ Floodplain 0 Wetlands El Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: -J-- S/o/9rt ?� Ax Ai1owy 11, ee-111-1 Se. ,Acres/ SJ'��,� �v r!/t•-c S �i 144 le Identification- Please Type or Print Clearly . , OWNER: Name: 1�-,e 51-e �`�n Gl,�,g Phone: el76 �5-6& Address: W 4 yep-l e fio Contractor Name:. Aord&ns-r s PhV . one:_ 7? 0 {7S' 'xo-2 Address: 292.0 tri bO ,.r .g o C� Supervisor's Construction License: �7 __ _ _. Exp. Date: Home Improvement.License: /_G. f - g_ Exp-. ,Date:ll / 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: $ fr7�3 s �i 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 �� ; II 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 n Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street � FIRE DEPARTMENT - Temp Dumpster on site ,yes . no Located at 124 Main Street Fire Department signature/date s COMMENTS Dimension 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— (For 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 NOTE: 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 NOTE: 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 a 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 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 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 91 ova Location 1,76q / Da No. te . - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ a f4 Other Permit Fee $ TOTAL $ Check 4- �n 28179 Building Inspector l:h -�-o �ic � dhi �e d U M The Commonwealth of Massachusetts - Department of lndustria[Accidents Office ofInvestigations 600 Washington Street Boston,MA.02111 www.mass gov/dna Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information l Please Print Lep-ib / ly Name(Business/Organi-zatiorAndividual): /� "N << 0{f 2 Address: 28 City/Stat 6/9d,o Phone#: 2o5S'- Are you an employer?Check the appropriate box: Type of project(required): 1. I am a employer with a 4. ❑ I am a general contractor and I 6. F1 Now construction F employees(full and/or part-time).* have hired the sub-contractors 2.El am a sole proprietor or partner- listed on the attached sheet. �• F1 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.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑Roofrepairs insurance required.]i employees.[No workers' 13.❑Other comp.insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. I-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 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:. d�`* Policy#or S elf-ins.Lie.9: 04 0 LJ C S Oa Expiration Date: S' L Job Site Address: 0 4JA vc r A y rl City/state/Zip: .Uo��G 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 o.152 can lead to the imposition of criminal penalties of a 0 or one= ear imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine fine u to 1 500.0 and/ P $ � Y p � of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cert under the pains and penalties of perjury that the information provided above is true and correct. Signafore: Date: IP 41-- l Phone#• 'Vi 7 S_- Official -Official use only. Do not write in this area,to be completed by city or town official. City or Town: PermitUcense# 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 lie-easing 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 retained 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 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 Com onwealth of Massachusetts Department of laa.dus z7ial Accidents Office of Investigationa 600 Washingtoa Street Boston}MA Q2111 Tei.#617-7.27_4900 ext 406 or 1-877-MASS.AFE Revised 5-26-05 Fax#617-727-7749 www-mass,govldia � r10RTF/ Own of E ...' r, Andover O - r No. 1� ticc) h ver, Mass, COC NIC N�WICK �• 5 aA re o O4��5 U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT ..........................SAA.l jr rzw..... BUILDING INSPECTOR Foundation has permission to erect .......................... buildings on ....... .,.�......... .. .. ....... ... .. ......... � Rough to be occupied as ........... .. ��...., ......-IF !...... .s�.�.�/ ... ...... Chimney provided that the person ccepting 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 MO T S - " ELECTRICAL INSPECTOR UNLESS CONSTRUCT TS 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. �yORTH Town of 'rAndover No. - h ver, Mass, r COC HICHI WICK � o ��- .qs A?ATE D U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT ..........................S.CJ&6k.e.P.&W........................... .........., . ,,..,,,, BUILDING INSPECTOR Foundation %.I has permission to erect .......................... buildings on ...... . .. • Rough to be occupied as 1 .... �! ........... .. �..... .... ...... .d�•�•�... ��............... ...... Chimney provided that the person ccepting 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 MO LS ELECTRICAL INSPECTOR UNLESS CONSTRUCT 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. _ dnzn'ooa'Affairs&Business Regulation I t Office of Consumer CTOR T CONTRA .Type: ` TOME 1MPROVEMEN egistration 164893 Corporation 1113012015 � ENERGY SOLUTIONS LIC. t ` ADVANCED -BORGES RICHARD.. 28 HAMILTON RD. k Undersecretary PEABODY'MA 01960 r Massachusetts -De Board of$ Partment of Public Safety wilding Regulations and Standards Construction Su Standards Pei %isor License: CS-090902 `` `lei RIS BORES _ 28 HAM&TON ItpAI) Peabody MA 0190 Commissioner Expiration cnent L MIM OdDIV110L address 91 Waverly Rd City Itown North Andover 978-476-5680 contractor 1.WEATHERSTRIPPINGICAULKING QUANTITY TOTAL AUDITOR NOTES Door Kits Q-Lon or Equiv. 1 51.00 Door Sweeps(Regular) 0.00 Door sweeps(Automatic) 1 26.00 Reglaze Windows M.inch 0.00 Window.Weathstr Schlegel per side 0.00 Recessed light cover per SWS.Not a tenmat cover 0.00 attic sealing 2 part foam 0.00 attic sealing 1 part foam 2,5 175.00 basement and living space air sealing 1 part 4.5 315.00 SUBTOTALS 567.00 2A.INFILTRATION/INSULATION AUDITOR NOTES Domestic pipe Hot Water Tank 1st 6' 1 17.70 Sill Two Part Foam w/Fiberglass Batt 0.00 1"T-max only foam DoerdPerir titer per!ECC&SWS sq.ft. 0.00 2"T-max only foam boardPerimeter per IECC&SWS sq.ft. 0.00 Drape DOOR R-5 or T-max only 0.00 Tape Joints(Aluma Grip only)per hr. 0.00 Duct Ins w/Tape sq,ft.R-5 conditioned space 0.00 Duct Ins w/Tape sq,ft.R-8 unconditioned crawl/garage/attic 0.00 Hydronic pipe insulation to 1"R-5 136 519.52 Hydronic pipe ins-1.25"-2"R-5 0.00 Steampipe Ins. 1.25"-2"iron pipe R-5 0.00 Steampipe Ins.2.5"-3"iron pipe R-5 0.00 Air Conditioner Meeting Rail 0.00 Air Conditioner Cover 0.00 Air Conditioner Cover Special Order 0.00 SUBTOTALS 537.22 2B.INSULATION AUDITOR NOTES Open Unrestricted R 49 626 1126.80 Open Unrestricted R 38 0.00 Open Unrestricted R 30 0.00 Open Unrestricted R 20 0.00 Open Unrestricted R 10 0.00 Restrict FUSloped R 38 0.00 Restrict FUSloped R 30 0.00 Restricted FUSloped R 20 165 255.75 Restrict FL/Sloped R 10 0.00 R-19 FGB open rafters/walls/kneewalls 0.00 R-11 FGB open rafters/walls/kneewalls 0.00 Attic Stairs(stairwell&common wall) 0.00 Cover Pull Down Stairs Thermadome up to R49 per SWS 0.00 Site built pull down stairs 2"foam box 0.00 nuw r nrieewai rwui i iansiuun.urns Nacrt cxuuwsts u.uu W.S.Hatch Q-Lon or equal 0.00 W.S.&bat Hatch,dam around etc.complete to attic R value 0.00 Kneewall R-12 cell behind Per.Memb 0.00 Open Rafter R-20 Cell.1w poly 0.00 Open Rafter R-30 Cell.AN poly 0,00 Basement Overhead R-19 fiberglass 0.00 Basement Overhead R-30 fiberglass 0.00 Crawlpace Overhead<4'high R19 0.00 Crawlpace Overhead<4'high R30 0.00 Garage Ceiling cavity filled w/cellulose 0.00 Wood,Shake,Clapboard,ShinglesVinyl 1320 2640.00 test drill 1st Asbestos(single nail)/Asphalt 0.00 Asbestos(doub.Nail)/Aluminum 0.00 Brick/Stucco 2 hole 0.00 Vinyl over Asbestos 0.00 Multi-layered 3 or more layers 0.00 Drill rough plaster or finish wood plug 0.00 Drill finish plaster 0.00 Test Drill Wails(all 4) 0.00 SUBTOTALS 4022.55 2.INSULATION TOTAL 2A.t2B. 4559.77 3.STORM WINDOWS/DEADLITES AUDITOR NOTES Plexiglass up to 88 u.i. 0.00 Additional per UI over 88" 0.00 Dead light 0.00 SUBTOTALS 0.00 5.OTHER MATERIAL AUDTfOR NOTES Ridge vent In ft. 0.00 Gable Vent rectangular 0.00 Varipitch Vent 0.00 Roof Vent 135(1 sq ft NFV)Large 0.00 Roof Vent 865(A sq ft NFV)Small 3 270.00 up high Soffit Vent Rectangular 0.00 Turbine Vents All 0.00 Stack Vent 0,00 Acuvent proper(Must be this product)available Q HomeDepot 0.00 Permable House Wrap 0.00 6 mil poly on ground 0.00 Energy Star R-4 Rigid Vinyl Repi 94101 U.I. 0.00 SUBTOTALS 270.00 6J7.E.C.MATERIALILABOR 5396.77 Oct. nrML.I n a QNrc I I HUUI I VK NV 1 tb CO detector 0.00 Vent Bath/Kitchen Fan 0.00 r Dryer vent w/exhaust duct Heartland 0.00 Dryer Transition Duct only 1 45.00 Bath fan 50 CFM(replace exsiskng)fan only 0.00 Bath fan 50 CFM(new install)with timer 0.00 Bath fan Smart timer 0.00 Blower Door Test Pre Post 1 45.00 SUBTOTALS 90.00 8b.REPAIR MATERIAULABOR AUDITOR NOTES Basement outside door solild core inc all hardware 0.00 Basement outside door w/jambs inc all hardware 0.00 Basement outside door site built per SWS inc all hardware 0.00 Door Repl pre hung 32-36"Steel"w/Lite 0.00 Door Repl interior solid core 28-32" 0.00 Door Repl pre hung 32-36"wood;w/Lite 0.00 Window Replacement w/SIR less than 1 0.00 Basement Window Repl.Awning/Hopper 0.00 Basement Window Repi.With a frame 0.00 Lockset(door)Schlage or equal 0.00 Repair/Refit Door 0.00 Replace Side Stop 0.00 Replace Casing 0.00 Glass Replacement to 64 mi. 0.00 Glass Replacement per W.over 64 0.00 Thermo pane Glass replacement 0.00 Sash Si I p Sidelock/Top Replacement 0,00 Threshold(Wood) 0.00 Threshold(Aluminum) 0.00 Slide Bolts/pull handle 0.00 Cut/finish attic-kneewall access 0.00 Cut/close attic-kneewall access 0.00 Labor Rate Hours 1 67.00 remove old pipe wrap Labor Rate Hours 0.00 Labor Rate Hours 0.00 Labor Rate Hours 0.00 Labor Rate Hours 0.00 Permits I Fees(Wap only) 0.00 SUBTOTALS 67.00 TOTAL REPAIR+HEALTH&SAFETY 157.00 GRAND TOTAL WORK ORDER# (A) 5054 5553.77 Any alterations or deviations from the above specifications involving extra costs must be cleared in writing before installation. The Work Order must be complete within 15 working days from acceptance date below: CONTRACTORICOMPANY: 0 ACC EPTANC E:Company/Contractor AUTHORIZED SIGNATURE: Date AGENCY APPROVALS: CTI Authorized Signature: Date GLCAC Authorized Signature: Date