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HomeMy WebLinkAboutBuilding Permit #380-2016 - 100 JOHNNY CAKE STREET 9/25/2015 �5"cA�rr�vEv 9/�9/�s' r10RT11 BUILDING PERMIT o� (L ED TOWN OF NORTH ANDOVER 03� a�J v6 Om APPLICATION FOR PLAN EXAMINATION ( l ?D .m a° Permit No#: ` Date Received 7ED 15* 9 Ssgc►+US� Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION { 6 6 Print PROPERTY OWNER t ��t r"-�''l 0, //,�� Print 100 Year Structure yes no MAPPARCEL: l� `� ZONING DISTRICT: Historic District yes no 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 ❑Assessory Bldg C4/'Others: ❑ Demolition ❑ Other 91k- ❑ Septic ❑Well ❑ Floodplain O Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: i Identiificat'o - Please Type or Print Clearly OWNER: Name: i IJkWN, Phone: `l�� • `�� " Z-`1�� Address: Cie ©� ;�) 5 t 0-b 3G5 —77 -- Contractor Name: tfo4by z, L_LC Phone: T--_ Email: Address: P,0 r f2 C,>t # ZZ tt't 5 1�� �-v► �za -� 1�_ �3n�`'1 Supervisor's Construction License: Exp. Date: _ 'Lot Home Improvement License: Exp. Date: Z i 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. Total Project Cost: $ Z�. G ®p FEE: $ 01N Check No.: �14- Receipt No.: C q,q o� NOTE: Persons contracting with unregistered contractors do not have access�g y my fund Signature of Agent/Owner ignature of contracto 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 Siqnature COMMENTS HEALTH Reviewed on Siqnature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments f 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 COMMENTS I 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 E 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 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 ❑ 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 ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit o 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 ❑ 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 Clerics 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 Vr CE Location /G® 9 No. � Date . - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ 7 47 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# Z �° E� j Building Inspector r 1 � NORTI� . .A ver 0 No. ();4"w h ver, Mass, 2NI6 COCHICnew$CK A S U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT ....... BUILDING INSPECTOR ...1.. ....�.I.. .�. :�"1................. ... ........... .. ............ ..... . . ........ .. .. .... ..... ..IM.... .. ... Foundation has permission to erect ....:..................... buildin son .............. ........ Rough to be occupied as ... ... .. . .. ....... ..As ..... .�:1 ....... ..... .......... Chimney provided that the person accepting this permit shall in eve respit cWform to the t s of the application p p p g p every p pP 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 CONSTRUC 0 RTS Rough Service ................................................................................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinga 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. UAr'Leri.INC TF ZUZ IZ V - A. ni.,nay x r' Owens Corning Preferred Contractor#212828 MA CSL#104728 "y OSHA 30 Hour Construction Safety Training Q EPA Lead Safe Certified �-- '�B` ll Genera/ Contracting, LLC Aal 51 S.Broadway 42214 Salem, NH 03079 (603)890-0084 110 Stevens Street#141 • Andover,MA 01810 • (978)475-0095 PROPOSAL SUBMITTED To PHONE 7 } DATE ' /1 STREET yy E-MAIL / I S C4 CITY,STATE,AND ZIP CODE - 3] x JOB LOCATION+ Completely protect the home with tarps to catch falling debris.Respect and protect shrubbery and flower beds. Strip off ( layers of roofing material down to the bare roof deck.Inspect the roof deck for structural defects. Determine the condition of the underlying plywood or boards,and repair and replace as necessary*. Inspect roof ridge for proper 11/2"spacing on either side of ridge for maximum exhaust ventilation.Cut in if necessary. Install new heavy gauge L t,' c (color) .f S"yl:.va drip edge at roof eaves. Install fi.'z zrPr Jcs°3 ice and water shield to meet manufacturer's specifications(i.e.6 feet from roof edge,3 feet centered in valleys,around all skylights,chimney bases,roof penetrations and at all sidewall transitions). Install Drc F, A< CT7 breathable roof deck protection to remainder of the roof deck. Install new heavy gauge t_. ii t IC (color) ,11�rk�i;�ut�� drip edge at roof rakes. Install Pre; Irstarter strip at roof eaves and rakes. Install ���t� i�rl?'� i;�P ) :�n!'t�f desired color. lT: (color) Install new flashings to meet manufacturer's specifications.(i.e.sidewalls,chimneys,skylights and roof penetrations). Install t IC4 (feet)of f 'r �^ vc-u fe�,^a"ir•a ridge vent at roof ridge to allow maximum ventilation. Hand nail to ensure proper fastening. Install A L (feet)of "f rrlrTj?i:' i lc distinctive hip and ridge cap.Hand nail to ensure proper fastening. Thoroughly clean up and dispose of all roofing debris on property.Magnetically sweep property for nails. 1 I i Notes: I'-F 115�� �1lt 41"1)`ih-yE',i TCS ro1r'l 7f7� -uJ < /lC`kFt L ^fC �� L'aL'` \fCSarX ES'iL (,.s- isLF �1=r {t K 1 3 �L1e `9i�IlI .1td�sj a•a` tL2C:4`'T r is Edmunds General Contracting will: •Obtain all necessary construction-related permits to complete this project. •Perform work as efficiently as possible without sacrificing quality. •Furnish and install all necessary materials to complete the project. •Provide a thorough clean-up and disposal of all debris generated during project. Edmunds General Contracting LLC agrees to commence work on/or about D /'_V/(_ and described work will be completed in about' days. days. Product Upgrade 1: . 5fxLfi ' ,v cf� 151 ti 't i'-ch 54,11i,bit Product Upgrade 2:_ � <<;r'� � r r-# s )t< >E��1jfSS cy lk'17Sv 41,rL ,,. •-IWr* Contractor's employees are fully covered by workmen's compensation and liability It is further agreed that this contract may be assigned by the contractor,aorestates lso insurance. that the obligations hereof shall bind and apply to their heirs,successors of the parties. Upon completion of the above work,all undersigned agree to execute and deliver to the contractor,their joint note in accordance with his(their)above obligations as Edmunds General Contracting LLC guarantees all workmanship performed for requested by contractor.Upon refusal to do so,contractor may at its option declare 2(years. the entire contract price or so much as then remains unpaid,immediately due and LL payable.It is agreed that,if permitted by law,contractor shall be paid by the We will register .S1JS7h a'f'y C��= factory enhanced warranty owners)all reasonable costs,attorney fees,and expenses,in addition to the providing i=years of material defect c ve ale and l� years of amount due and unpaid,that shall be incurred in enforcing the terms and conditions workmanship defect coverage through ?-f-1- for: of the contract and/or any lien in connection herewith. —�no charge the additional cost of 'Edmunds General Contacting LLC will provide the materials,labor and disposal to replace up to 64 sq.ft.of roof decking and 20 fl of fascia at no additional cost. Any additional materials including labor and disposal vdll be replaced at �_ .'_per sheet or ci.ocs linear foot. Edmunds General Contracting,LLC agrees to furnish the material and All material is guammeed as specmed.All work to be completed in awallmanfke manner accordin71ormdo rd practice.Any atteraton or deviation imm abovespedficatiDm inwmng exim costsvnll be exemtedrrinn labor complete in accordance with the above specifications,for the sum orders,and will become an extra charge over and above the stated contract price.Contractor is sible for bdamaga due b high winds,tomadces.hurticanes,fico or other harards.Owrrerys)agree to tarty firnd other of ff ic.FtY ii, �?LJe 'vfy dollars($ . . necessary insurance.Contractor o .mosideradahurricane of owners landscaping and but due fe the nanoting L+' CfY.` installation some damage may Dour.We attempt to minimize an demo a and vAll not be held responsible g an 'moi;; <S 9 Y P Y age, Y '� icJ{`,b damage occurs. Contractor is not responsible for any damage to the inferior of propeM,including pre-exisfing Payment Terms: conditions fie.wafer stains,crumbling plaster exposed nails)or conddions resulting from application of materials as specified above.hems in the attic may need to be covered by the Avner.Contactor is not responsible for damage • A deposit of W.5JC 3 (not to exceed 1/3 of the total contract)is mused by ice dam build-up.All agreements9,-"' ar[e mnb gent utpon at lkes,accidents,or delays beyond our contra due upon start of work.The balance of!�6 D(h is due when work Authorized Signature: .l•.-7•ra- ! is completed to the satisfaction of all parties. '/Edmunds General contracting LLC • A finance charge of 1.5%per month(18%per year)will be charged on Note: This proposal cony be withdrawn by us if not accepted within tDate due accounts over 30 days ` �g days. ptatrte 0f PropoVat -The above prices,specifications,and 00 NOT SIGN THIS CO IF THERE ANY BLANK SPACES. ons are satisfactory and are hereby accepted.You are authorized to do rk as specified.Payment will eeymage as outlined above. Authorized Signature: f acceptance: r (/� Authorized Signature: The Commonwealth of Massachusetts W Department of IndustrialAccidents d 1 Congress Street,Suite 100 Boston,MA 02114-2017 www mass.gov/dia . yJ1 Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information L Please Print rLe ibl Name(Business/Organization/Individual): f:3 Address: ZW H n'07``l City/State/Zip: S� tv t'f 650_7Q\ Phone -7 73 Areyo an employer?Check the appropriate box: Type of project(required): 1. I am a employer with �... : employees(full and/or part-time).* 7. El New construction 2.❑1 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.FJ I am a homeowner doing all work myself[No workers'comp.insurance required.]t 4.F1I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 ❑Building addition 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. 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.t 6.F]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 my employees.'Below is the policy and job site information. Insurance Company Name: �- Policy#or Self-ins.Lie.#: WL - ,Zr'_� i S 3 �-1 Expiration Date: AG "Alob Site Address: `, s City/State/Zip: N �� /"�t ' 7� :> Attach a copy oft a workers'compensa on 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 verif6atio , I do hereby ertify u t ie pains and penalties of perjury that the information provided above is true and correct. Signature: I Date: `lZ l-5— Phone#� G.Q C. 5 2- Official use only o 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#: ® DATE(MM/DD/YYYY) ACC�R o CERTIFICATE OF LIABILITY INSURANCE 9/18/2015 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 PLANRIGHT INSURANCE& FINANCIAL LLC NAME:CONTACT 224 MAIN STREET STE 3C PHONE I FAX SALEM, NH 03079 E AAA Lo Extim AC.No ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: LM Insurance Corporation 33600 INSURED INSURER B: EDMUNDS GENERAL CONTRACTING LLC P 0 BOX 2214 INSURERC: SALEM NH 03079 INSURER D: INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: 26473324 _ 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 ADDL SUER POLICY EFF POLICY EXP LTR POLICY NUMBER MMIDDIIYYYY MM D IYYYYI LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 15AMAGE_T0 CLAIMS-MADE 17 OCCUR PREM SES(Ea occurrence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO ❑LOC PRODUCTS-COMP/OP AGG $ JECT $ OTHER: IN AUTOMOBILE LIABILITY COaa acccidentSINGLE LIMIT $ 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 RETENTION$ $ A WORKERS COMPENSATION WC5-31S-369752-025 1/26/2015 1/26/2016 L STATUTE EERH AND EMPLOYERS'LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE NIA E.L.EACH ACCIDENT $ 50�0�0 OFFICER/MEMBER EXCLUDED? ❑Y (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 500000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Workers compensation insurance coverage applies only to the workers compensation laws of the state of MA. This certificate cancels and supersedes all previously issued certificates,only as they relate to workers compensation coverage. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TOWN OF NORTH ANDOVER, MA THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 120 MAIN STREET ACCORDANCE WITH THE POLICY PROVISIONS. NORTH ANDOVER MA 01845 AUTHORIZED REPRESENTATIVE LM Insurance Corporation ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD 26473324 11-369752 115-16 WC I Ashish Borgaonkar 1 9/18/2015 10:41:30 AM (EDT) I Page 1 of 1 f ,p� �te�po�nn�w�ruueaC�N�C��aa�urJelts I I \ Office of Consumer Affairs&Business Regulation OVOME IMPROVEMENT CONTRACTOR egistration: 166661 Type:xpiration: --6(2:1-12616 Corporation i EDMUNDS GENERAL CONTRACTING,LLC. DAVID EDMUNDS 18 ASHFORD RD HAMPSTEAD,NH 03841 Undersecretary License or registration valid for individul use only . before the expiration date. If found return to: I Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Boston,MA 02116 I 4otN ►d ut signature 1 Massachusetts-Department of Public Safety Board of Building Regulations and Standards Construction Supen'isor License: CS-104728 I DAVID C EDMUNDS j. P.O.BOX 2214 SALEM NH 03079 r' } I