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Home My WebLink AboutBuilding Permit # 3/7/2016 TON N OF NORTH °aANDOVER 0 �- APPLICATION FOR PLAN EXAMINATION A , ®„ Permit NO: Date Received °° °7 pRATFp LSSA C HUSH Date Issued: PORTANT: Applicant must complete all items on this page LOCATION gg Print PROPERTY OWNERS�l '� 1 i1n a ►`� Print MAP NOJ PARCEL. ZONING DISTRICT: - Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential % Non- Residential Q New Building KDne family [I Addition [I Two or more family 11 Industrial 11 Alteration No. of units:pR [I Commercial Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: CONTRACTOR Name: v` mc !'e i1c, �' � Phone: Address: Supervisor's Construction License: Exp. Date: Ccs ;> Home Improrcement License: Exp. Date: oil �S 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: $ O FEE: $ Check No.: 7_6 y- Receipt No.: 'S669 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agen�Owne Signature of contract r NORTH own t EAndover o Eh ver, ass z i > cOC"I"EWICK 1' d�AOORATED I,P V BOARD OF HEALTH Food/Kitchen PE .RMI- T T LD Septic'System THIS CERTIFIES THAT .J.��. ..6.0,ri�r�a�'� ..,. BUILDING INSPECTOR ................ ................................ ................................ Foundation has permission to erect .......................... buildings on ...+0�. �3...i�►x.... . . .. . ... . . .... ..... Rough to be occupied as ......... .. ...7 ........ � ... ...... .......... Chimney provided that the person accepting this pe it 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 CONSTRUCTIO T Rough { Service 3 ................... •. ....... .... ....................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz Rough Islay 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. Serving Greater Boston for Over 25 Yuri « Dave "Tomolillo " huh11411, `° CSL#: 064063 HIM 158936 UI ,➢ 9,;.R6! IOotXlf61d1 .911 tF.t I'F4 Standards & Quality are out Priority! SolarCity Quote ® Re-Roof February 25,2016 John Gorman 203 Boxford St North Andover,MA 01845 (508) 265-7695 jjgorman2l@verizon.net Roofing Specification: MP1&MP2 Only. • Remove old comp shingles down to the existing roof sheathing • Remove all nails and replace up to 32 square ft.of plywood,if needed ■ Additional plywood will be charged at$55.00 per sheet • Apply 6'of Water Shield along the lower eaves • Apply 3'of Water Shield along the valleys • Install new vent pipe water diverters where needed • Apply 15 lb.felt underlayment as protective base • Install 8"aluminum drip edge along entire roofline perimeter • Includes [57'] color matching caps • Includes [2] 12"roof vents • Removal of roofing debris by dumpster • Total number of roof squares [ 1.1. ] • Owens Corning'"TruDefinitionO Duration@ 30-year Architectural shingles. • Providing all Insurances,Licenses and Permits Materials and Labor: $4840.00 Permits&Admin: $120.00 Ilaa11inark Ilomes Associates,fnc:,9 t",0,Box 885, Medford,MA 02155• (781.)1I.81 0789• w wr v.iiallni ar•kiiom esRatmodeliw�g.c:c:m _.._... . OWN � wr r w r�c har for er r°° f ARK CSI,#�064063 am vale y ore out, riorityr! WN For BUilding PC' e 11 , - x, 14" , i s rrovi( 1° 1 1 11 11 c 1c p1 j-—t1t of thi's form The sole, P111,W). 1 11 1 111 it r1 1 1 0 weell r11 'r tow(, � 1�1 J ,1! ll wtth the necessary Ap,pl Ica d 011 0s) 111M' X111 is Co .m 1Y " AMSUvw w'r ' rc1 t J 11 prols rs Z°, ° S A d es, P . � fox 885, Me o + , 02iss Contractor N vv ,r r r rr ,rr /// ar�N,, Z r rr sw/rh „��1�7HNRrr�ur9 `+inmfia "'uwu„u'�r,,A��dPFu.Gw� Vrmr��frr�jrr rir�ifyry �Wi'rw�H�lo rl�w'vlr� i5��1J�/�� r�li r � � ' " R f+ r riU Jr r% //r r 111 rr vs, %,�� r /r r 111111/r /i r r�i,,,, , ia? ' r r g r ai rii S Front of House ED _ Inv e �r�u��ruw��ie�r�rrrrr�r�rr�i�� r��urrRraaRuw�raRwau,www,wuc✓�rrrrre�wrc��r�rr��r��ru�er„ ci„ z� 6".—_ 24'-4 i i ,� J��r�wxm7��y�y+��mn�Yuu�oum�arrunr!��+�n��l�l'v»nu�u�; 1y�»y�l�d'rN�m��;mJnnnimDhl¢9��1��'rm�mmrw,,�nirg�mr,om�m��{nromr�wmyprro�ruom��umam�m�rurynnnuwinl�I�� 0'-3 40"6 ”6 _ a E 30'-2" llallmmmark llommmes Associates,Inc. w 11.0.Box 885,Medford,MA 0 155 (781)833-0789 nmrww,lE-iallinarktlonsiesiti�*ni(yd tiri ,c(. nit The Commonwealth of Massachusetts Department ofIndustrialAccidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 www mass gov1dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FIELED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organizationftdiiducl):1-1alknark Homes) Associates, Inc. Address: 56 Wilson Street City/State/zip: Medford, MA 02155 Phone#: (781) 838-0789 Are you an employer?Check the appropriate box: Type of project(required): L[Z 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. E]Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.Q 1 am a homeowner doing all work myself.[No workers'' comp.insurance required.]t 10 ®Building addition 4. 1 am 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 ll.E]Electrical repairs or additions proprietors with no employees. 12.[]Plumbing repairs or additions 5.FJ I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.�Roof repairs These sub-contractors have employees and have workers'comp.insurance.: 14.F1 Other�_ 6.M 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.] *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 far my employees. Below is the policy and job site information. InsuranceCompany Name: The "Travelers Policy#or Self-ins.Lic.#: 6KUB-5B29684-3-14 Expiration Date: 03/17/2016 — p: iv� Job Site Address: City/State/Zi 2[,� "C -1)24 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 verificatj9n,_ A I do hereby cer an rthe pallsand p esofp ury that the Information provided above is true and correct I Sinate re: 9/17/2015 Phone#• (7 1) 838-0789 -- 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#: E(MMID CERTIFICATE OF LIABILITY INSURANCE DATDlYYYY) NCE 0E(MMID015 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 NAME: Peter A. Rossetti Ins.Agcy. '.... Peter A. Rossetti Ins.Agcy. PHONE FAX 436 Lincoln Avenue AD No Ex1:781-233-1855 (AIC Ne: 781-231-3752 Saugus,MA 01906 E-MAIL Peter A.Rossetti Ins.Agcy. ss:pnickerson@rossettiinsurance.com INSURERS AFFORDING COVERAGE NAIC k INSURER A:Western World INSURED Hallmark Homes Associates Inc INSURER B:Pilgrim Insurance PO Box 885 INSURER C:Travelers Medford, MA 02155 INSURER D INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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 ADDLSUTYPE OF INSURANCE IVSD WVD POLICY EFF POLICY EXP LTR WSD BR POLICY NUMBER MM/DD/YYYY MM DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE a OCCUR NPP1349917 06/11/2015 06/11/2016 PREMISESDAMAGE ERENTED oc u encs $ 50,000 MED EXP(Any one person) $ 1,000 PERSONAL&ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 JECT POLICY❑ PRO ❑LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: Emp Ben. $ N AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000 00 Ea accident _ > B ANY AUTO PRC00001001303 04/23/2015 04/23/2016 BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X X NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION PER 0TH- AND EMPLOYERS'LIABILITY STATUTE X ER C ANY PROPRIETOR/PARTNEWEXECUTIVE YIN N 6KUB-5B29684-3-14 03/17/2015 03/17/2016 E.L.EACH ACCIDENT $ 1,000,000 OFFICERIMEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS!LOCATIONS!VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Carpentry Operations. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Inspectional Services ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE M9 ✓ � Hallmark Homes Associates, Inco David Tomolill® MAI! I Illlllllll Illllll�lfll�ll aT� wwwanall's Vvlrmv MA 02-l UJiJm� +dxENO rade '.CrtA869EY w �, yp C � t� NO ' O;S"O"NOU less ftn 2001 n r 1G 4 � h1 S55 ' IIFp„exrroDtsarihol buc. „ t'fs�”",�„. ,""' +9 03 1 ENbORSEMEMtB NESfRICiIONS• ✓ / M , arca;;"E k Is SER M Akj;N NOME NONE DAVID C U 96 Wrlm'rr7 Sired � cr1ANnEorADDRESS.PRINT BELOW.rEsunNENruuc `p r. Md'Clford1 NIA 02155 �m�� J � , A cirri s m Dearllt,;ea t of N16114 �j/ 'Unrestricted-Buildings of any use group which Sward of Buillding Regulations and Staro ar a ! ontain less than 35,000 cubic feet(991m )of enclosed space, i.cenw CS-064063 DAVID I+TOMOI fLLq,,, 56WILSON ST MEDFORD MA 02155 Failure to possess a current edition of the Massachusetts 9''":xpt rlorr State Building Code is cause for revocation of this license. akuaarmaaa srpaurcac d 03/15/2016 For DPS Licensing information visit: www.Mass.Gov/DPS ry^� , ...., ,._..�_ ,„ ....„ , / %i;" d war%rye r ar,„�e r FegigtrAtion Valid ltfr 11 divfd Office of Consurner Affairs&134itiness Ne trft�t l , s `1f fawe th s ertpiration date. 1f found retort)tot r0M IMPROVEMENT CONTRACTOR ' Utrice of Constuner Affairs and Business ReguIa14t egistration: '158836l 1Np 1tl.park Plaza-Suite 5i70 m Explration: 5/18/2016 Private CoFporati .:., Boston,MA 02116 � HALLMARK HOMES ASSOCIATES INC. � I DAVID TOMOLILLO ^!STONEHILL DR. IF STONEHAM,MA 02180 UnclErNaaaetaw^y Nnt valid wi rout signature