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HomeMy WebLinkAboutBuilding Permit #40-12 - 1094 SALEM STREET 6/10/2011 I TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION 1 Permit 111®. Date Received ®fid Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION I ��� >c�(� In f�I�f1"; ,' rCl U i`�5`-t� Pr PROPERTY OWNER 7z(L,K V�2. �is r Unit# Print MAP NO. PARCEL: ZONING DISTRICT: Historic District yes no Qk Machine Shop Village ye ' no -nit Machine year-old structure ye no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition El Two or more family E01 Industrial ❑AIteration No. of units: ❑ Commercial Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other F! ;er,,f F1 We`ll F► �,t ��. n W.1ty:,bed 1 Iigtrict - ` DESCRIPTION OF WORK TO BE PERFORMED: it (ldentitication Please Type or Print Clearly) G OWNER: Name: (Lt L Phone: Address: !C'�4 h —ywv CONTRACTOR Name: Phone: 1 i Address: �l C. ���� 0-rj wl, Supervisor's Construction License: I ow(,Z"4 1 Exp. Date: I ZC i P r Home Improvement License: f o`foo Exp. Date: ARCHITECT/ENGINEER Phone: 11't Address: Reg. No. - FEE SCHEDULE.BULDING PERMIT.$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.0 P R S.F. rnS Total Project Cost: $ 'L.0 . % (o FEE: $ x Z = d Check No.: ' ,- � Receipt No.: y � NOTE: Persons contracting with unregistered contractors do not have access to e u u Signature 6fi Agent/Ovyrier _ Signature-of contractor - — f i Building Department t 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 Per i Addition or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ui C orji/ O'i Contrac-': C, 'iol l'/til 1 Loti 3i`i/�IeiidLlC3i1 Pial i 0-i- P"moose, vVorK vvl'll i opi-11`Aler 6-ian 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 Perry 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 ❑ 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 .Perr 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 recordinj must be submitted with the building application Doe: Doc.Building Permit Revised 2008mi i I 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. ❑ Peimanent Durnpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - 1J FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ -4 COMMENTS �Jtltita RVik-i {fid l ui9a uii: COMMENTS �k3' Pc HEALTH Reviewed on Signature COMMENTS L ell I Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes i Planning Board Decision: Comments ' I 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 r Dimensi®n Number of Stories: Total square feet of floor area, based on Exterior dimensions._ Total land area sq. ft.: ELECTRICAL: Movement of Kiefer 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 F❑ Notified for pickup - Date Doc:.Building Permit Revised 2011 June/mi Location No. v' � Date NORTIy TOWN OF NORTH ANDOVER M i Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # v 246 €ori Building Inspector TAORTH 0 of over O '.... IV 's o , clover, Mass., o - LAKE COCHIC) :.CK ORATE0 BOARD OF HEALTH PEM IT T U Food/Kitchen Septic System A 01• BUILDING INSPECTOR THIS CERTIFIES THAT......... .... . .................. .......... .. �................................ ................. Foundation. has permission to erect........................................ buildings on ...1 ogq ....... �I r............. .....0...... Rough .... AMME to be occupied as.......... .. � ......�a i ..... ...... .................................................... Chimney h' provided that the perso accept g this permit shall in every respec 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 Ins ection, Alteration and Construction of Buildings in the Town of North Andover. s' ou"Cmum, PLUMBING INSPECTOR ,w==z' Sw74*WVIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final V2 PERMIT ExPIRES IN 6 THS UNLESS CONSTRU ONS TS 2 ELECTRICAL INSPECTOR Rough zo _ Service ........... . ............. ..................................................... . . BUILDING INSPECTOR 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 BeDone FIRE,DEPARTMENT Until Inspected and Approved -by the Building Inspector. Burner Street No. SEE REVERSE SIDE smoke Det. z NCS , Inc. 314 Clark Street North Andover MA 01845 9.78-685-0568/fax 794-3780 Construction Work-New Deck installation 1` May 24, 2011 ' Proposal submitted to: Rick Miller Address: Salem Street, North Andover, MA 01845 Service Address: same Phone, Email: rsr4@comcast.net Salesman: Norman V.Lee GC# 104295 HIC# 167900 We hereby submit a description of work and materials to be used with estimated cost, subject to all terms and conditions as follows: Project# Job: Remove and install new deck + Scope of Work: 237- • Removal of existing decking and rails- • Removal of existing framing and support beams • Dispose of material properly. . • Dig 5 new sonar tube for 6x6 posts v r • Frame new 8'wide x 37' long deck on backside of house j • Frame new 12'wide x 20.5' long deck on side of house • Frame 5'x 6.6' area on side of house • Frame new 4'wide stairs • Install timber tech screw-less mountain cedar decking in deck field • Install timber tech pacific walnut decking for picture frame around perimeter of deck • Install timber tech 1x10 pacific walnut rim stock around perimeter of deck • Install timber tech 1x8 and 1x12pacific walnut for risers and stair stringers • Install timber tech black 4x4 post'sleeves with post cap and skirt • Install timber tech black composite railings around perimeter of deck Total for decking quote $20,810.12 Final stock colors to be decided(extra for special order colors) No extra if stock colors Additional cost of Builders Rail .,��— � T D Permit c $350 approx. Permits required to be obtained , obtained by Contractor ��° CS l _5�vc Owners that secure-their own construction related permits shall be excluded from Guarantee Fund Mold, ledge, rotting materials,code related issues or other unforeseen situations encountered that affect pricing,job duration,or other issues will be discussed with the client,and change order submitted and signed off on by client to continue work. Like or similar material will be substituted in the event that contractor is not able to obtain specified material, pending designer's and/or client's approval.Slight fluctuations in texture,colors can be expected-contractor will make diligent effort to match Items as close as possible. This contract will act as the final bill, and final payments will be made from this document.Any additional work in change orders will be collected in the same manner. Massachusetts provides a three day cancellation right to homeowners. Non-payment can lead to liens on your property. Questions?Call us,write us and checkout our website @ www.ncsne.com for more information on our other services. PAYMENTS AND DISBURSEMENTS: Customer is responsible for obtaining any financing he deems necessary to comply with this Agreement. If Customer is obtaining financing form a third party, Customeragrees to apply for such financing without delay and thisAgreement is subject to Customer being approved for such financing. All payments are due and payable as specified in the Proposal/Contract. Northeast Contracting Solutions reserves the right to assess a $25.00 fee if Customer requests us to re-invoice them for any reason. Overdue payments will bear a 1.5%service charge. Failure by Customer to pay any invoice within five(5)days after payment is due per contract shall constitute a material beach of this Agreement. All legal, court or otherwise collection cost incurred by Contractor are to be paid by Customer. LABOR AND MATERIALS:Contractor agrees to furnish the materials for the project and complete the work to be done in a workmanlike manner. All materials furnished under thisAgreement shall be construction grade and meet indust andards. Client Initials--<414K nitials < K _ 1 _ 1 The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov1dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organizatiori/Individual): Address: L( City/State/Zip: I(Ui�ir�.Jci.li' 0 tPhone#: 1 T 5 -(358 Are>you an employer?Check the appropriate box: Type of project(required): 1.© I am a employer with ?—, 4. ❑ 1 am a general contractor and I 6. F1 Now construction employees(full and/or part-time).* have hired the sub-contractors ,�,� 2.❑ I am a sole proprietor or partner- listed on the attached sheet.# 7• [O/Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 1011 Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.F1 Plumbing repairs or additions myself. [No workers'comp. c. 152,§1(4),and we haven 12.0 Roof repairs insurance required.] employees.[No workers' q � i- 13F]Other comp.insurance required.] *Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. T Homemyners who submit this affidavit indicating they are 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. X am an employer that isproviding workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self--ins.Lie.#: Expiration Date: Job Site Address: Cify/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 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 the DIA for insurance coverage verification. X do hereby c Af under• h s nd enalties ofperjury that the information provided above is true and correct. signature: 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.EIectrical Inspector 5.Plumbing Inspector 6.Other Contact Persoin: Phone#: i 91te &mmowweald F Office of Consumer Affairs and usiness Regulation 10 Park Plaza`- Suite 5170 " Boston, Massachusetts 02116 Home Improvement Contractor Registration t Registration: 167900 r t'. Type: Private Corporation Expiration: 11/17/2.012 Tr# 206007 NORTHEAST CONTRACTING SOL�IJTOSa=r U NORMAN LEES 4 314 CLARK ST t - N. ANDOVER, MA 01845 3x Update Address and return card.Mark reason for change. :7—S, Address Renewal [] Employment Lost Card CAI is 50M-04/04-G101216 I ✓�Czaaczcjucael7a Office f , o�onsumer Affairs& usiness Regutation License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: .,A.67900 Type: Office of Consumer Affairs and Business Regulation Expiration: 1.111762012 Private Corporation 10 Park.Plaza-Suite 5170 Boston,M 116 RHEAST CONTR_ACtNC. OLUTIONS INC. ORMAN LEE - 14 CLARK ST g � ANDOVER,'MA 01845_. ._,. Undersecretary ".. Y t valid without signature i I i I ,aco CERTIFICATE OF LIABILITY INSURANCEDATE(MM/DDNYYY) 6 10 2011 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:. Eastern Insurance Group LLC - Main PHONE FAX 233 West Central Street E-MAIL Natick MA 01760 ADDRESS: INSURERS AFFORDING COVERAGE NAIC# INSURERA:^Tli.- IrayplerS Insurance Co INSURED 147765 INSURERB: r e Company Northeast Contracting Solutions Inc . INSURER C: 314 Clark St INSURER D N Andover MA 01845 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1096363775 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 I ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MM/DD MMIDD LIMITS B GENERAL LIABILITY RENOPCPS1107194 /31/2011 /31/2012 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $50,000 CLAIMS-MADE F1 OCCUR MED EXP(Any one person) $10,000 PERSONAL BADV INJURY $1,000,000 GENERALAGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $2,000,000 X7 POLICY PRO JECTLOC - $ AUTOMOBILE LIABILITY COMBINED5INGLF LIMIT Ea accident ANY AUTO - BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED - PROPERTY DAMAGE HIRED AUTOS AUTOS Per acddent1 $ UMBRELLA LIAB [::[OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ - $ A WORKERS COMPENSATION BAWCAR147765 6/10/2011 /10/2012 X WCSTATU- OH- ETR YIN ANY PROPRIETOR/PARTNER/EXECUTIVEE.L.EACH ACCIDENT $100,000 ED? OFFICER/MEMBEREXCLUDNIA - (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $100,000 If as,describe under DYSCRIPTIONOFOPERATIONS below E.L.DISEASE-POLICY LIMIT 1$500,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space is required) Norman Lee is excluded from Worker's Comp Coverage CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Northeast Contracting Solutions Inc ACCORDANCE WITH THE POLICY PROVISIONS. 314 Clark St N Andover MA 01845 AUTHORIZED REPRESENTATIVE Qom.. ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD r �lassachusettx- Department of Public Sal'etA Bo;u'd of Building Rc.„ulations and Standar* Construction Supervisor License License: Cs 104241 MARK DELGRECO 33 STONEGATE LANE DERRY, NH 03038 Jam— Expiration: 8/18/2013 ('umuiisi„ncr Tr#: 104241 Office of Consumer Affairs and Erusiness Regulation 10 Park Plaza= Suite 5170 N Boston, Massachusetts 02116 Home Improvement Contr ctor Registration -Y Registration: 167900 I — �rn r71 Type: Private Corporation i` Expiration: 11/17/2012 Tr# 206007 NORTHEAST CONTRACTING SOL'>J -Or , 'I NORMAN LEE 314 CLARK ST N. ANDOVER, MA 01845 Update Address and return card.Mark reason for change. --” Address Renewal [] Employment Lost Card N ie SOM-04/04-G101216 � G— oo L�anvnzoozus Office of Consumer Affairs& usiness egul�aho n License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: _;;1.67900 Type: Office of Consumer Affairs and Business Regulation Expiration: A 012 Private Corporation 10 Park.Plaza-Suite 5170 Boston,M 116 FHEAST CONTR_ACTF _ 1y:OLUTIONS INC. OMAN LEE 's _:� -s "` -' - : CLARK ST kNDOVER,MA 01845_- Undersecretary t Valid without signature r I