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Home My WebLink AboutBuilding Permit #779 - 1060 OSGOOD STREET 6/2/2010 BUILDING PERMIT NORT1I O�tt�ec TOWN OF NORTH ANDOVER 0 ." APPLICATION FOR PLAN EXAMINATION 4E C% Permit NO: Date Received "�q,T.o SACit Date Issued: %� �`� IMPORTANT:Applicant must complete all items on this page LOCATION / ' Print— "S PROPERTY OWNEt''''' Print MAP 210 PARCEL: 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 No. of units: Commercial =eptic lacement Assessory Bldg Others: Other Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: Identification Please Type or Print Clearly) OWNER: Name: Phone: 97tY VZ Address: c Si�vErvS /vL10r� Z, 4. 01510 CONTRACTOR Name: ubo z L r�o �M- SF 'Phonef-�S��l Address:/G+ �}iLi6 ' ,s /� fJ3e ' Supervisor's Construction License: 1 j/�� Exp, Date: Co 1 `j Home Improvement License Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PEAR/MIST:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ Z7, �-g dy FEE: $ `]. 0z) Check No.: �� Receipt No.: NOTE: Persons contracting with unregistered contractors do not have acis to the guar��tyfund signature of Agent/Owner �L ,pIIU.L � Signature of contractor llri - 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 DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS 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: LocaW 384 Osgood Street FIRE DEPARTMENT - Temp D umpster on site yes no Located at 124 Alain Street Fire Department signature/date ,rvti2�.cri, COMMENTS x. Dimension Number of Stories: .r2 Total square feet of floor area, based on Exterior dimensions. L D U 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 - Date Doc.Building Permit Revised 2010 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/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) L3 Building Permit Application ❑ Certified Proposed Plot Plan ❑ 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 ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered d 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 2008 SLocation 0 0 � 11 No. 2-- Date NORTH TOWN OF NORTH ANDOVER 0 • • 09 • Certificate of Occupancy $ �►�S°,^°•'<� Building/Frame Permit Fee $ s<+CHU Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 1-9- 2 37 2 '2'232 Building Inspector i � NORTIy ToVM of Aindover W;a h' ' No. - LAKE AKE o " dover, Mass., COCHICHEWICK ��• �•9A0 RATEo PP5 SS BOARD OF HEALTH PERMIT T/ D Food/Kitchen Septic System BUILDING INSPECTOR THISCERTIFIES THAT... .......................................... .......................................... Foundation has permission to erect........................................ buildings on ../.....0.6.!�..... � .Gl.t ................................... Rough mn to be occu pied as.........Aa...�/ (` l Chiy pe�c?. .......... ,�i e�....... .. .r' ... ............................................................ e provided that the person accepting this permit shall in every r spect conform to the terms of the application on file in.. Final 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 r UNLESS CONSTRUCTION__STARTS Rough �_ � Service BUIL • Final Occupancy Permit Required to Occupy Building GAS INSPECTOR 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. SEE REVERSE SIDE Smoke Det. _ „SSC The. Commonwealth ®f Massachusetts Department of Fire Services Office of the State Fire Marshal P.0.Box 1025 State Road,Stow,MA 01775 PERMIT Date: North Andover City of Town 7PermitNo (If.Applicable) Dig Safel`lum er { J In accordance with the provisions of M GJ-14 8 Chapter_L(Z as provided in section 5 7 7 (',MR 34 Start Date /7 This Permit is granted to:. Zi9r/c- cr,9, Full name of person,Firm or Corporation Permission Eo locate dumpster for construction/renovation/d emolition of building. Comments: dumpster must be . 25from structure if unable to place with reouired Restrictions:clearance dump/ster must be covered with 'plywood or tarp end of work -day at —zg (Give location by street and no.,or describe in such manner as to provied adequate identification of location) FeePaid$ 50 .00 Fire Chief This Permit will expire 6 —z r3)/J (sighl K r ftroTica granting permit) Offical granting permit (Title) �l.�v,:teftu�ctt,�- [Jclf;trtmcnt t►f-fuftlir �rtlMt Roard of Oui:lxling ReLytihiaiotts �tttd StuncJ;trcl� Cons.tructiop Supervisor License License: CS 74147 Restricted to: 00 ROBERT R .POULIN 0 COU NTR'Y CLUB WAY NORTON,'MA 02MO !; � EXpirat;On: W 7W10 - RINS indAr• Tl* 2107 100/l00l�jj _ --- -- — _ _ xvJ vz: lz- 0_LozI_l0.1.E0-- N° FD 7249 Date - .-.. .... NpRTN TOWN OF NORTH ANDOVER RECEIPT ,S•SOCHUS�S This certifies that hasp�.......� ...rte. .................................................................... for........!'/..�rv�r��it✓....C:.��°./yr.!/�,��d...�4��.�d.�c�/ Received by``� '-t/i`'`�r?-rr✓ Department....... % ......................................................... WHITE: Applicant CANARY:Departrnent PINK:Treasurer The Commonwealth o•f Massachusetts Department o f Industrial Accidents Office of fnvesfiv ations 600 Wavhi baton Street Boston, 114 02111 www mase ov/tits Workers' Compensation Insurance Affidavit: guidrs/Contractors/ElectriA licant Information cians/Plumber s PIease Print Legibly Name (Business/Organization/Individual): Address: l k�) (J-) LI*-.., City/State/Zip:- Are ity/State/ZiP Phone#: loe7 3 fd-5S Z�f',5'� F� m you an employer?Check the appropriate box; I ama to er with T e of r�P 4 0Y ❑ I am a general contractor and I P Ject(required):employees(full and/orpart-time).* have hired the sub-contractors 6 ❑New comstraction I am a sole proprietor or P oP Partner- listed on the attached sheet I �• 0 Remodeling slop and have no employees These sub-contractors have working for me in any capacity. work ' 8. ❑Demolition workers' comp.insurance. [No workers com , insurance 5. 9 P We ❑ area corporation and its ❑Building addition required.) officers have exercised their 10•❑Electrical repairs or addi 3. ElI am a homeowner doing all work right of extions emption per MGL 11.0 Plumbing repairs or additions myself, [No workers'comp. c. 152,§I(4),and we have no insurance required.] t employees. [No work=, 12.0 Roof rep airs ` '^alicant comp.insurance required.) 13.0 Other -r. that Checks beivi mus!a?so a out t'ne section bemw showit. fY I�omeownets who submit this affidavit indicating the,am doing a..worL-and m weticws'comp....s_�*:on....i: .. r, r....,., rc.Ws ion +Contractors that chert:this boy must attached an additions;sheet showing- teen'hire outside eontractars must.. t cubn t a new affidavit indicating such, e the name of the sub-contractors and their workers'comp.POUCY information. I am an employer that is providing workers'compensation insurance or my e informatiox f inployees. Below is the policy and job site Insurance Company Name: �11�5 ttrva. Policy#or Self-ins.Lic.#.- All'C S Expiration Date. Z b Job Site Address: Attach a copy of the workers'compensation policy declarationP ace (showing Cty/State/Zip: the Failure to secure coverage as required under Section 25A ofMGL 152 can to policy number and expiration date). fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP pial penalties of a of up to$250.00 a day against the violator. Be advised that a co RK ORDER and a fine Investigations of the DIA for insurance coverage verification. PY of stat.-ment may be forwarded to the Office of Ido here c under the p enaliies o er u fp J r7 that the information Provided P above ' Signature: �1� is true and correct Da •_ Ct Z Phone#: 0O.fficiat use only. Do not write in this area, to be completed c , bj itj or town official City or Town: Permit/License# Issuing Authority(circle one); L Board of health 2.Building-Department 3. City/Town Clerk 4.Electrical 6. Other „� Inspector P 5. Plumbiab Inspector Contact Person: -, Phone#r: Information an` d 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 oy 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 m2inte3nance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not be cause of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or tical lie ensinb 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 co:xmpliance 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 Workum-til it acceptable evidence of compliance with the instance 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 certificates)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' comp=sation 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. Also be sure to sign and date the affidavit. The affidavit should be retained to the city or L-mm that the application for the pert�if or license us being requested,not the.;lepart:r:eat.of Industrial Accidents. Should you have any questions regardira_the law or if you are regar red to obtain a worlkers' 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 bice to than 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.numbez_..... The Commonwealth Gf Massachusetts Dep:.aftment of Industrial Accidents Office of hirestigations 600 W ashmg-lan Street Boston,b A 02111 Tel. # 617-727-4900 ext 4406 or 1-9 77-MASSAFE Revised 5-26-05 Faa 4 617-72.7-7749 u'Vru'.masS..aov/dia. 06/02/2010 09:27 5086953957 G: GILMORE INS PAGE 01/02 PaD�a CERTIFICATE OF LIABILITY INSURANCE qTl (508)699-7511 THIS CERTIFICATE IS ISSUED AS A MATTER OF NFORMA� SG7mzoseI�aurance Agency, Inc. ONLY AND CONFERS NO RIGHtS UPON THE CERTIFI27 Elm St. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEN P• O. Box 126 ALTER THE COVERAGE AFFORDED BY THE POLICIES 6ELOlA1. N• .Attleboro MA 02761 INSURERS AFFORDING COVERAGE INSURED ...._..... ........___....... NA Andover Industria]. Services I . . INSURERn Admiral Tnsur C t� az>,ee Cons .an _ . . 10 Willi INSURER o:ACE Pzopert Drive y & casualty INSURER C; Pelham INSURER..: .. .._.- . NH 03076 ._....__. COVERAGES INSURER E: THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUED TO THE INSURED NAMED ABOVE FOk THE POLICY PERIOD INDICATED, ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT VVITH RESPECT TO WHICH THIS CERTIFICATE MAY FSITHSTAN E ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS 0 SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, 1NSR 4BD°" • POLICY NUMBER hOLICV EFfL�CTIVf PO�IGY EXPIR/�TION GENERAL LIABILITY TF•LMMIDD/YYYY1 I iSAT [ft l�fpp LIMITS X 'COMMERCIAL GENERAL LIABILITY I EACH OCCURRENCE A DAMIAGF•Ia RENTE•L5 I a r,Q�,�,000 OLa�tnS MADE X I OCCUR 00001398701 FREMISF8(Eapccurroncn) 50 000 IS/29/2010 3/28/2011 - _. � IMED EXP(Any one pereon) ¢ 51 000 AL A . . .... ... . PERSONAOV INJURY - I ¢ 1 000,000 GENT.AOGREGnTE LIMB APPLIES PER: GENERAL AGGREGATE $___2.1.000,000 X POLICY JE _ 1 PRODUCTS-COMP/OP AGG ¢ Loc 2 , IAUTOMOBILE uABILnY ,000 000 . ANY AUTO I COMBINED SINGLE LIMIT ALL OWNED AUTOS I I(FR eacldent) ¢ SCHEDULED AUTOS BODILY INJURY HIRED AUTOS (Per person) R NON-OWNED AUTOS BOOILY INJURY i (Persecldonl) $ i PROPERTY DAMAGE GARAGE LIABILITY (Por Scefdont) 9 ANY AUTO AUTO ONLY-EA ACCIOF_NT S OTHER TI•IAN EA ACC 9: EXCESS I UMBRELLA UAMUTY AUTO ONI,y; � AGG'$ „ I OCCUR I CLAIMS MADE EACH OCCURRENCE g AGGREGATE ¢ DEDUCTIBLE - ¢ RETENTION $ WORKERS COMPENSATION B AND EMPLOYERS'LIABILITY 4 MI1 PROPRIETORrPARTN[R/r�cEcuTlvE Y/N I X ORY I ATU- I I ER OFFICF.RAIEMOER EXCLUDED? (Mandatory In NH) E.L.EACH ACGIDENT 100,000 rc Q• d�—rlbounder ❑ C45834505 12/14/2009 . 12/14/20 S�E�IAL PROVISIONS below / /2010 E,I.,D)gEggg.EA EMPLOYE S ioo 000 OTHER ,..... .. E.L.DISEASE-POLICY LIMIT ¢ 500 000 05SGRiP710N OF OPERATIONS!LOCATIONS!VEHICLES!EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER 52_5 CANCELLATION SamplA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER NLL ENDEAVOR TC MAIL NOTICE TO THE CERTIFICATE HOLDER NAMED TO T>iP DAYS WRITTEN .LEFT,BUT FAILURE TO D D SD SHALI, IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 26(2009101) Tim Gi.7.mo.re/F�B.P,YAIV INS025(200501) Cd 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD i ANDOVER INDUSTRIAL SERVICES INC. ROOFING AND SHEET METAL CONTRACTORS I APRIL 21, 2010 i DAVID M McCUE 37'EVERETT ST. WILMINGTON,MA. 01887 RE, 1060 OSGOOD ST. UPPER ROOF REPLACEMENT SCOPE OF WORK: 1) COMPLETELY REMOVE UPPER ROOF SYSTEM DOWN TO ROOF SHEATHING 2) INSPECT AND REPLACE ANY DAMAGED WOOD SHEATHING UP TO 500 SQ. FT. (ANYTHING OVER 500 SQ. FT. WILL AT A COST OF $4.00 PER SQ. FT. 3) INSTALL 1.5" OF PRESSURE TREATED WOOD BLOCKING AROUND PERIMETER EDGE ON UPPER ROOF AND 2" ON LOWER ROOF 4) MECHANICALLY ATTACH NEW 2"FLAT INSULATION TO ROOF SHEATHING ON UPPER ROOF AREA 5) APPLY NEW .060"FIRESTONE EPDM FULLY ADHERED TO NEW INSULATION 6) FABRICATE AND INSTALL NEW ALUMINUM EDGE METAL FLASHING AND A LARGE COMMERCIAL GUTTER WITH DOWNSPOUTS ON UPPER ROOF 7) FLASH ALL PENETRATIONS PER MANUFACTURERS SPECIFICATIONS 8) PROVIDE BUILDING OWNER WITH A MANUFACTURERS (15)FIFTEEN YEAR LIMITED WARRANTY 9) ALL ROOF DEBRIS WILL BE REMOVED FROM JOB SITE AND DISPOSED OF PROPERLY BY ANDOVER INDUSTRIAL SERVICES INC. COST: $43,850.00 PAYMENT TERMS: PAYMENT OF $14,000.00 DUE AT CONTRACT SIGNING WEEKLY INVOICES SUBMITTED FOR WORK COMPLETED TO DATE NET 7 DAYS FINAL PAYMENT OF $2,000.00 DUE AFTER WARRANTY ACCEPTANCE ANDOVER INDUSTRIAL SERVICES INC-V�M Wd1.2we., DATE AUTHORIZED SIGNATURE DATE 10 WILLIAM DR. PELHAM NH 03076 TEL; 1-888-957-7663 FAX; 1-603-635-7843