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HomeMy WebLinkAboutBuilding Permit # 9/1/2016 BUILDING PERMIT TOWN OF NORTH ANDOVER 4 APPLICATION ION EOR PLAN EXAMINATION ire wt O: ��' � Date Received d. Date Issued: t �$,�C T' .NT: Il an$MUSt ccs sletc all items on this... ' ^ - PROPERITYY lstai leis rars.. " P .: . PIE : -` lltflTl6 Machine ' "p . llsg TYPE OF I P VEME ` g PROPOSED U E Residential Pt #cn- ldt:rrtal �...1 Ne 6rsi`tdinc �:? Care family - .._ _ :?Addition [1 Two or more family :.; la°adtrstrll Alteration .of n ts: � i"tommercial � Repair, replscernent C,Asssessory Bldg : Others: Demolition Other 0 Septic 4y Well _. ElFloodplain 1-2 Wetlands 0 ' eters l��str€ct E; etr/ xer . a Identification Please Type or Print-Clearly) OWNER: Nerve. Pore: < '. I ` ? err e:CONT CT R Phone: Address: e ea :J' jc- upery sor`s Construction License: Home Improvement License, . µ Ile Epp, rete. ARCHITECT[ENGINEER Phone: Address: Peg No. FEE SCHEDULE.SYLDING PERMIT MOO PER$1000.00 OF THE TOTAL ESTIMATED C AS Sb25,00 P _E Total Project Cost: _ EEE:. l Check o.: e ipt icy.: t NOTE: er''sons conXia °ta . ft�t nre r contractor not t e axccess to eguaraystyfutV Al -r � nature of. Intracter44� Signature tr re of + entt/Owne r / 0_o N oe m IAoRTH Town ofndover _ � 6 O 0 J- 4-- No. — p roL„�f h ver, Mass, nJz( �a��,��rwKK �- .�4o�1TED pv C7 s u BOARD OF HEALTH Food/Kitchen P -ER Septic System THIS CERTIFIES THAT ... BUILDING INSPECTOR has permission to erect ............ buildings on .�. .��. .., ..... ... .... ...... Foundation .. ................. ..... . . .. . . . ................ Rough to be occupied as .......... . . . ....... ....16 ... .. ....................,.......,......,........,................:....... Chimney provided that the person accepting t is 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 C®NST CTI®N Rough Service .. .. . ... ........... .... ......... Fina[ BUILDIN SP CTOR GAS INSPECTOR Occupancy Permit Required to ®ecu By 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. Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ]LJFood Swimming Pools ❑ Well � ❑ Tobacco Sales 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 ❑ ❑ COMENTS CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Si nature& Date Drlvewa Permit Located at 384 Osgood Street FIRE DEPARTMENT - Temp DumpSter o site' yes rte` no Located at 124 Nlatn Sheet Fire t7epart .ent signature/date . lG COMMENTS ORTFf BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received .0 OAYeD SACH Date Issued: IMPORTANT: Applicant must complete all items on-this page LOCATION /V PROPERTY OWNER 1„6r'617 AI' 7c4)oll,„ Pri L Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential U New Building Li One family [-I Addition 1I Two or more family I I Industrial V 1-1 Alteration No. of units: seCommercial Repair, replacement U Assessory Bldg l�,i Others: I I Demolition I I Other I] Septic 0 Well 11 Floodplain u Wetlands Watershed District F.] Water/Sewer j4L-L, d 2, Identification Please Type or Print Clearly) OWNER: Name: Z6dl,; Armldil4�"K KmAmj A Phone: Address: CONTRACTOR Name: Phone: Address: Supervisor's construction License: Exp. Date: Home Improvement License: ;z Exp. Date: 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: $ F -721 CC, FEE:EN, r � Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the gaaranty.fund Signature of Agent/Owner Signature of contractor sof Maintenance & Systems Incorporated March 29, 2016 Ms. Ann Moreno Property Manager Horizons Management Associates, LLC 990 Washington Street, Suite 212 Dedham, MA 02026 Re: Rear Roof Replacement Rocky's Ace Hardware North Andover, MA Dear Ms. Moreno, Per your request we propose to furnish equipment material and labor to successfully complete the following work. Rear Roof Replacement • Remove existing roofs and underlying insulation to steel deck, dispose of in a proper mann/er. • Supply and install wood blocking to outer perimeter of the roof to reach a thickness of 6".V • Supply and install 1 layer of 2.6" and 1 layer of 2" polyisocyanurate insWtion attached with plate and screw per manufacturers' specifications. • Supply and install tapered polyisocyanurate insulation at eave of roof to direct water to 4 scuppers, • Supply and install Carlisle 060 EPDM rubber roof in a fully adhered manner. • Supply and install flashing to all existing roof penetrations per Carlisle specifications_ Supply and install 040 aluminum gravel stop with continuous hook strip utilizing stainless steel fasteners, in the standard color of your choice. • Supply and install 4-040 aluminum scuppers with 3x4 down spout in the standard color of your choice. • Clean all work related debris and dispose of in a proper manner. • Supply 20 year systems warranty from Carlisle. All for the sura53::— t).fl0 c a - The existing HVAC units will have to be disconnected by others and may need to be lifted from roof.A meeting should take place to go over this Issue with the HVAC Company. If you have any questions or if i can be of any further assistance, please don't hesitate to call me. Sincerely, Robert P. Ellard Vice President Cc: FilelE032916-1 Norlh Andover 30 Merchants Drive, P.O. Box 638,Walpole, MA 02081 Phone 508-668-0100, Fax -508-668-0619,E-Mail, Roofmain(aPJTAC.net The Commonwealth of Massachusetts Department oJIndustrialAccidents I Congress Street,Suite 100 Boston,MA 02114-2017 wtimmass.govIdia Workers'Compensation Insurance Affidavit:Builders/Contractors/El lectricians/Plumbers. TO BE FILED WITH THE PEPIVUTTING AUTHORITY. Applicant Information Please Print Le ib] Name(Business/Organization/ln(lividual).' ""ilel V AI e,ddress: City/State/Zip I 11, Phone M, 1) Are you an employer?Check the appropriate box: Type of project(required): 4" L[A"l am a employer with / 'i employees(full and/or part-time).* 7. F1 New construction 2,F1 I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[Na workers'comp.insurance required.] 9. Demolition 3.E]I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 0 Building addition 4.F_J 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 tire sole ILE]Electrical repairs or additions proprietors with no employees. 12,[:]Plumbing repairs or additions S.E]I am a general contractor and I have hired the sub-contractors listed on the attached sheet, 13.n Roof repairs These sub-contractors have employees and have workers'comp.insurance.; 14,F]Other 6.0 We are acorporation and its officers have exercised their right of'exemption per MOL e. 152,§1(4),and we have no employees.[No Nvorkers'comp.insurance required.] *Any applicant that checks box til 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 lure outside contractors must submit a new affidavit indicating such. ;Contractors that check this box must attached an additional shoot 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 arrr art employer that is pi ovldltig workers'compensation irrsur'artce for''rrty entployees. Below is the policy andjob site inforination. Insurance Company Name: —Ak, Policy#or Self-ins.Lic.It: ,,A "Y �7 Expiration Date: /y Job Site Address: ry 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 verificatiop"1111 ,I I d thy v-t Yy it oder ile i tire,e a"t,ai i(!lOi ai�i�ls'ofp e iju ty M a i th e i nfo i-i i i a/10 11 p 1-0 V i de I ahoy is trite a i i d co I I I lee 7 1,7 St nature: Date: Phone Official use only. Do not iprite lit this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): i 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#.- From:Cocrdn & HdVlin 1+781+235+1622 09/01/2016 12:13 #634 P. 002/002 RO.OFMAI-01 EMCDONOUGH CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDJYYYY)9/1/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY ANC]CONFERS NO.RIGHTS UPON THE CERTIFICATE HOOLR.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 TIME CERTIFICATE HOLDER. IMPORTANT- If the certi irate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the torms and conditions ofthe 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 1Both F McDonough,CIC The Corcoran&Havlln Insurance Group Pklo Na e>t:(781)235-31rQ0 260. arc No): (789 235-1622 287 Linden Street No Wellesley,NIA 02482 -ADDRESS;BlAcdonough chinsur.ance.com INSURER(S)AFFORDING COVERAGE NAIC q INSURER A:Continental Casualty Company 20443 INSURED INSURER 9:America n Casualty CO.of Reading IPA 20427 Roof"Maintenance&Systems,Inc. INauRSR c;National Fire Insurance Co of Hartford 20478 P:O.Box 638 INSURER 13; Walpoie,MA 02081 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 1W THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THETERMS, EXCLUSIONS-AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRADDL. POI F PQLICY EXP TYPE OF INSURANCE LTR INSD WVD POLICY NUMBER MhVDDlY MMIr DIYYYY LIMITS A x COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ _ 1,000,900 CLAIMS-MADEF3(1 occuR 4021113243 03101l2076 0510112017 -REMTURERTED- ISES(Ea o wifenue $ 100,000 MED EXP(Ady.cne person) $ 5,000 'PERSONAL ADV!INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY JECT LOC PRODUCTS-COMPIOP AGG $ 2,000,00 OTHER: $ AUTOMOBILE LIABILITY COMBINED ddnISINGLE LIMIT' $ 1,000,0o0 B ANYAUTO 021113260 05/0112016 0,510112617 BODILY IWURY(Per person) $ ALLOWNED X SCHEOULED BODILY IWURY(Per aceldent) S AUTOSAUTOS - x HIREDAUTOS x NON-OWNED PROPERTY e rpac�tdea� AGE g AUTOS $ _X UMBRELLA LIAB X OCCUR r402111327EACH OCCURRENCEA EXGE55 LIAR CLAIMS-MAGE= 4 05101!2016 05101/2017 AGGREGATE $ 5,006,000 DED X RETEf+ITION$ 10,000 $ WORKERS COMPENSATION x PER DTH- STATUTE ER AND EMPLOYERS'LIAE9ILITY YIN 0217 73257 05/01/2616 0,51011201 E.L.EACH ACCIDENT $ 1,000,060 C ANY PROPRIETORMARTNERIEXECUTIVE a NIA OFFICERIMEMBER EXCLUDED? (Manct'atarylnNH) E.LDISEgSE-EAEMPLOYE $ 1,000,006 If yes,describe under 11000,090 DESCRIPTION OF OPERATIONS below E.L.QISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHIdLES (ACORD 101,Additional Remarks Schedule,may 6e attached IF mom space Is required) Town of North Andover is listed as additional insured if required by written contract for General Liability of the named insured operations. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE vxPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS, Building Department 1600 Osgood St North Andover,MA 01845 AUTHORIZED REPRESENTATWE ©1988-2014 ACORD CORPORATION. Alt rights reserved, ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD i 'tir a� Massachusatts Department of Public Safety Board of Building Regulations and Standards 1 License: CSSL-'00946 Construction Supervisor Specialty GREGORY M LAWLOR .7 t 52 NORTH WASHINGTON ST. NORTON MA 02766 Expiration: Commissioner 03/06/2018