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HomeMy WebLinkAboutBuilding Permit #623-13 - 1027 GREAT POND ROAD 3/26/2013 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: J / Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page e P `PROPER4YPOWNERJ`A`d �. Prin 10.O Year Old St ture MAPNO f( �� PARGELF Z®NINGDISaTRICT Hlstonc_Distnct yes nod h .,a 11llachine Sh6 `Villa-et esu r o 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 ❑Possessory Bldg ❑ Others: ❑ Demolition Other g ❑;S_eptic ,❑Well. - o Flootl.plam�RD UVetland's3 ❑, Watershed,Distrct DESCRIPTION OF WORK TO BE PERFORMED: Ident'fication Please Type r Print Clearly) OWNER: Name: S ilAz Phone: -9 Address: I 4 C®NTRAC ;ORS Name Phone s rt_ _ lAd'd_ress. 1�410 Supe:rvasorsConstructiFon L cense.; 0 9G ,l I HomeImp�ovementgLicense`; y� 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: $ S ��0 FEE: $_ Check No.: l T4 Receipt No.: f YA NOTE: Persons contracting with unregistered contractors do not have a ess to t e guaranty fund r—^;a'iu:"'�1t �,r s-p^^,n,.,„- .....—•^`s^- - .x+.w.»..--<rw.,c-r• ? },.��+'""' �'aafwp• g t..w�-n�er, ^[' *.g t ' ..r f^ :is`� •�, Signature of Agent/®wne ignature of�contracto _ _ R µ �:; ' -. .. _ _ - . Plans Submitted ❑ Plans Waived 11 Certified Plot Plan ❑ tam I,Plans ❑ j f Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/BodyArt ❑ Swimming Pools r ❑ . 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 Siqnature { COMMENTS HEALTH Reviewed on Signature COMMENTS t i 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 Towo ]Engineer: Signature: _ Located 384 Osgood Street FIRE DEPAkt'MEPJT - Temp Dumpster on site yes no Located at'124 Mair]Street. Fire Deparfriier�t sigraure/date COMMENTS r Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: e i ELECTRICAL: Movement of Meter location, hast 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 I II D Notified for pickup - Date t E f Doc.Buildinb Permit Revised 2010 1 i Building Department The foliowing 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 o 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 t NOTE: All dumpster permits r'equ'ire sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Pp Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/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 o Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic-Calculations (If Applicable) , ❑ Copy of Contract ❑ 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 Clerks office must stamp the decision from the Board of Appeals that the app;-al 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.Bui?ding Permit Revised 2012 Location No. 3-12 Date * TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ ' Foundation Permit Fee $ Other Permit Fee $ ' TOTAL $ Check#/ 26228 Building Inspector . NpRTH _ r ow._ . .c . . ver oh ver, Mass, COC NIC Nl WICK y�. A0RArEO s V BOARD OF HEALTH Food/Kitchen PERM .IT T D Septic System THIS CERTIFIES THAT ...........G.'. Me. .. Aq' ................................................ BUILDING INSPECTOR ................ .... .� Lt ,Q� Foundation has permission to erect .......................... buildings on .[.��:.. ......(�' .. .....!:�.....411:2011:a.-I.......... Rough to be occupied as ..`5.�. . .. ....... /�vf` !.� ..... ...................................................................... Chimney provided that the person ac epting 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS - ELECTRICAL INSPECTOR UNLESS CONSTRUCTIW SRough T TS g 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 1 OP ID:LC CERTIFICATE OF LIABILITY INSURANCE °"01110113 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(tes)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 978-9754300CONTACT Segreve&Hall InSurAssoc.InC 305 North Main St 978-975-7596 L FAX ft me Andover,MA 01810 E rra1L Lawrence J.Hall ADDRES: CUSTOMERID is = OLDSC4 INSURERS)AFFORDING COVERAGE NAIL C INSURED Old School Group Inc INSURERA:Chartis dba Old School Roofing INSURER B:Atiantic Casualty Insurance Co 297 Littieton Rd.Unit 1 INSURER C:Arbella Protection Ins.Co. 41360 Chelmsford,MA 01824 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 MIHICH 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. LTR TYPE OF INSURANCE INSR POLICY NUMBER DWO EFF POLICY EXP UNITS GBIERALtJABWTY EACH OCCURRENCE $ 1,000,0001 B X COMMERCIAL GENERAL LIABILITY L0211007278 05/19/12 05/19/13 PREMISES Ea $ 100, CLAIMS-MADE FKOCCUR MED EXP(Any one Person) $ 5,00 PERSONAL a ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GENIAGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOPAGG $ 1,000,00 POLICYF-1 SECT F-1 PRO- r] LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ 1,000, BODILY INJURY(Per person) $ ALL OWNED AUTOS X SCHEDULED AUTOS BODILY INJURY(Per accident) $ C X HIRED AUTOS 1020007302 07/26/12 07/28/13 PROPERTY DAMAGE $(Per accident) X NON-OWNED AUTOS $ UhWELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION X WCSTATLL Til AND EMPLOYERS'LIABILITY YIN TORY LIMITS ER A ANY PROPRIETORIPARTNEWEXECUTIVE OFFICERIMEMBER EXCLUDED? F] MIA EACH ACCIDENT $ SWI NIA r (MandatorynbIn UN)er X51751092 04/20/12 04=113 E.L.DISEASE-EA EMPLOYE 50 $ 0,00 DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ 500wa 17 DESCRIPTION OF OPERATIONS t LOCATIONS I VEHICLES(Attach ACORD 1 11,Addltionai Remarks Schedute,K more space Is required) CERTIFICATE.HOLDER CANCELLATION - -- — --- ------ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts - Department of IndustrialAccidints Office of Investigations 600 Washington Street Boston,MA 02111 Uf www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/El Please Print mbers Legibly- NameApplicant Information Name(Business/Organization/Individual): C.// Address: Zg7 h. '�"��a� �� ne City/State/Zip: / �-4!"�a ,� ! Pho #: 7 ���'S'� ?(G Aree u an employer?Check the appropriate box: Type of project(required): 1.Lv! I am a employer with 4• ❑ I am a general contractor and I 6, 0 New construction employees(full and/or part-time).* have hired the sub-contractors 7. ❑Remodeling 2.❑ I am a sole proprietor or partner- listed on the attached sheet.I ship and'have no employees These sub-contractors have 8. F1 Demolition working for me in any capacity. workers' comp.insurance. 9, []Building addition [No workers'comp.insurance 5, ❑ We are a corporation and its officers repairs or additions tion required.] officers have exercised their ri ht of exemption per MGL 11.[]Plumbing repairs or additions I am a homeowner doingall work g p 3 ❑ myself. [No workers' comp. c. 152,§1(4),and we have no 12,�Roof repairs insurance required.]t employees.anc[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 a're 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 may be forwarded to the Office of Investigations of e DIA for insurance coverage verification. s - I do hereby cert y rider tlae pains and penalties of perjury that the information provided above is true and correct. Si ature: Date: Phone#: 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 Instructiolms 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 ofhire,- 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 dee' med to be-an'einployer." 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 producedacceptable 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-contractor(s)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 may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. AIso 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 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 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 Massachusetts Department of Industrial Accidents Office of Investigations 604 Washington Street Boston?MA 02111 Tei,#617-7274900 ext 406 or 1-877,7MASSAFB Revised 5-26-05 F40 617-727-7749 www.mass,gov/dia - Massachusetts-Department of Public Safety Board of Buiiding Regulations and Standards C'onstructian Supen"isor Specialty License: CSSL-099649 0 " } ANTHONY N DOWD - 13 VV11"W:bRIVE, TOWNS19?%MA 01469 f r Expiration Commissioner 02/2812014 ';r�� ✓die�rvnvna,�nule � . �\ Office of Consumer Affai rs&fiutsiness g o : nmomHOME IMPROVEMENT CONTRACTOR Re a . istration• 9 " •. :15744. YP 7 Type: - f. � �!'fxpirabon 10/212013 Private Corporation ()LDSCHOOL GROUP,.1N_ C ANTHONY DOWD,' 6 ADAMS STREET N.CHELMSFORD,MA_01863 " Undersecretary �Fo 00 0 A YaC#1574471 C SL#099649 CONTINUALLY TRAINED AND CERTIFIED BY AMERICA'S LARRERS March 3, 2013 Christine Sylvester Old School Roofing 1027 Great Pond Rd. 297 Littleton Rd. N.Andover, MA 01845 Chelmsford,MA 01824 978-451-7737 978-251-7663(office) 978-794-3414 978-251-7664(Fax) www.oldschoolroofs.com Thank you for considering Old School Roofing and giving us the opportunity to provide you with a quality roofing project. At Old School Roofing,we are committed to customer service and satisfaction and prompt response to your needs or concerns. 1. Job Specifications: Entire Home 2. Job Preparation: ♦Set up job site and insure attention to your particular concerns. Installing tarps around the areas of the home being worked on to prevent damage to siding, plantings and any landscaping. .3. Remove Old Roof. +We will remove the existing layers of roofing from the home. This allows for inspection of the roof decking, and repair any damaged boards. NOTE: We will replace any damaged or rotted plywood at$2.00 per square foot for % CDX plywood, $2.25 for 5B CDX plywood and $3.00 per lineal foot for deck boards 4. Install Leak Barrier. *Install ice and water barrier. *We will install 6'feet along eave for extra protection against"ice damming"- as recommended by manufacturers, 3' feet up the valleys and in all other necessary areas. 5. Install Decking Protection: *We use a premium synthetic underlayment in place of standard 30#felt. -This provides a better vapor barrier and no water absorption. -Also prevents profiling through the shingles. 6. Flashing Details: +Install new aluminum drip edge to all rakes and eaves,and pipe flashing Re-flash chimney. Re-lead chimney as needed. If new lead is needed an additional cost of$185.00 would apply. 7. Shingle Application: *Install a Lifetime Architectural Shingle Certainteed Weathered Wood, 8. Ventilation: ♦Install a new ridge9 Y vent. We use a ridged vinyl baffle vent which allows for the best ridge ventilation. 1 I 9. Hip &Ridge Shingles: ♦Install new hip and cap shingles, this provides protection of the ridge vent and a finished look to the roof line. 10. Roof Warranty: ♦ Limited Lifetime Manufactures Warranty. We back our work with a 10 year workmanship warranty 11. Clean-up/Disposal: ♦Old School Roofing supplies the dumpster. Our disposal costs are based on recycling of the asphalt shingles. Please do not throw any household trash or foreign materials into the dumpster. We will thoroughly clean up and dispose of all materials and debris associated with the job. *Your horse will be treated tike our own throughout the entire proiect. *Protecfion and clean-up of the property are our biggest concerns. 1Z. Permits: ♦Old School Roofing will be responsible for obtaining any and all necessary permits to insure the work is performed legally. 13. Scheduling: ♦We do our best to stay within stated scheduling, however, Mother Nature and emergencies can lead to delays. We will do our best to limit those delays. We will contact you within 48 hours before installing your new roof and work will not be commenced until you are contacted first. If more time is necessary to accommodate your schedule, kindly let us know. Total Cost: $5,550.00 Payments shall be made as follows: 113 deposit due before scheduling work, balance due upon completion of the work. Customer is aware of their 3 day fight to cancel. SIGNING INDICATES ACCEPTANCE OF THE PRICES AND SPECIFICATIONS SET FORTH HEREIN AND ACCEPTANCE OF THE TERMS AND CONDITIONS OF THIS CONTRACT. Old hool Roofing: Home 0 ner:Date:3 �' Zaiate 3 �� Aut oriz d Representative *Work to begin the week of March 25,2013/Estimated 1-1 %day completion. Please feel free to call me with any questions. Thank you, Tony Dowd—978-251-7663 2