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HomeMy WebLinkAboutBuilding Permit #091-14 - 12 RICHARDSON AVENUE 7/30/2013 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION 7 Permit NO: ( Date Received ! �L Date Issued:III I IMPORTANT:Applicant must complete all items on this age LOCATION--a / ^ /�u-iYUtg Pnn PROPERTY OWNERJJ�2.d Print 100 Year Old Structure yes n MAP NO:D�_PARCELM�ZONING DISTRICT: Historic District yes ' Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building PKOne family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial 4,Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer E CRIPTIO OF WORK TO BE PERFORME : r � � Identification Please Type or Print Clearly) Phone: OWNER: Name: alf (�c.1^rb Address: CONTRACTOR Name: Phone: S/• ` Address: Supervisor's Construction License: Exp. Date: Home Improvement License:/. Exp. Date:�� ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COS(BASED ON$125.00 PER S.F. , FEE. Total Project Cost: $ //��� � f- Check No.: " 1 U Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner # ignature of contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans T Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF.SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools 0 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 ❑ ❑ E COMMENTS 4 CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS i Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes_ .. Planning Board Decision: Comments Conservation Decision: Comments r Water & Sewer Connection/Signature& Date Driveway Permit DPW To-,,v;! Engineer: Signature: Located 384 Osgood Street EIRE DEPARTMENT =Temp Dump'ster on site yes_. no Located at 124 Mair, Street Fire Department signature/date COMMENTS 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 I MGL Chapter 166 Section 21A-F and G min.$100-$1000 fine NOTES and DATA— (For department use El Notified for pickup - Date s z Doe.Building Permit Revised 2010 r� Building Department The foifowing is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofivg, Siding, Interior Rehabilitation Permits Building Permit Application L3 Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses o 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 o Building Permit Application o Certified Surveyed Plot Plan Li Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses Li Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) o 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) o Building Permit Application o Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract o Mass check Energy Compliance Report o 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 apo•-al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm.tted with the building application Doc: Doc.Building Permit Revised 2012 Location No. v Date • - TOWN OF NORTH ANDOVER £ t Fv Certificate of Occupancy $ Building/Frame Permit Fee $ �� Foundation Permit Fee $ R Other Permit Fee $ TOTAL $ ,, Check# i. M c. j .1 : Ld Building Irispector UUL/30/2013/TUE 12; 39 PM A&K Fowler Insurance FAX No, 1-978-664-2209 P, 001/001 CERTIFICATE OF LIABILITY INSURANCE 7/30/D/30/201lDDK3 3 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(les)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 CNAOME'NTACT Commercial Lines FAX A & K Fowler Insurance aCNNo.Ext: (978)664-0366 (A/C. /C No:(978)664-2209 200 Park St. E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC# North Reading MA 01864 INSURERA:Penn America Insurance Co. INSURED INSURER B:Zurich American Insurance O'Keefe Construction INSURER C: 21 Francis St. INSURER D: INSURER E: North Reading MA 01864 INSURERF: COVERAGES CERTIFICATE NUMBER:CL1373002618 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 MAYHAVE BEEN REDUCED BY PAID CLAIMS. NSR TYPE OF INSURANCE POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTS 50,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ A CLAIMS-MADE a OCCUR PAC6891692 /8/2012 9/8/2013 MED EXP(Any one person) $ 5,000 PERSONAL&ADV IN AJRY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1,000,000 X POLICY PRO"Ci LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE 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 Peraccident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ B WORKERS COMPENSATION WC STATU- OTH- ORYAND EMPLOYERS'LIABILITY Y/N I FIR ANY PRO FIR IETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory in NH) 6ZZUB934X608812 /31/2012 /31/2013 E.L.DISEASE-EA EMPLOYEE $ 100,000 It yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Insurance Verification CERTIFICATE HOLDER CANCELLATION (978) 688-9545 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. North Andover, MA 01845 AUTHORIZED REPRESENTATIVE K Boutin, CIC CRM CIS ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025l7n1nnslm The-a('npr)name anti Innn are-re-nicfe-re-rl markt of ar ewn NORTH own of ndover C h , ver, Mass, of oQ coc�Ic"I 1. A_ cHeMcK � 7�ADRATED PQp��(5 S U BOARD OF HEALTH Food/Kitchen Septic System • THIS CERTIFIES THATPERMIT C Q�� BUILDING INSPECTOR %.... .......... 1zhas permission to erect .. buildings onAFoundation Rough rer tobe occupied as ...... ...* .... ..................Ola................................................................................ Chimney :. provided that the person accepting 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough ��`.y Service ........... ..... .L:t:.ti.�G+�w,... ccs,-:`rnr,�......................... 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 NORTH own of ndover O - 0 il— - � ]( 1qi A w , s., ver, Mass, 11�. Ill Zarb T O LAN! CONIC Ml WICK V �d A0RgEO ►`P T S U BOARD OF HEALTH Food/Kitchen Septic System • THIS CERTIFIES THATPERMIT � C C�� ,...,.. . BUILDING INSPECTOR ..... ...........................................................................................A&' .. Foundation has permission to erect .......................... buildings on ....1z....��. x.C............... .ua..... �. Rough tobe occupied as ...... �...... ....... . ...... ..................................................................... Chimney provided that the person accepting 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough Service ........... ..... .�Y•�c. ..�.,,,......................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Reguired 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 Page No. of / Pages Supervisor CS 068461 / / ��' • Fully Licensed & Insured Home Construction Reg.# 146722 O Itee� Ro PGOSETTs.� 0f M* yam— . o� North Reading, MAb�' 7920 y�'Authorized LOLL CTIO 97x8-27 —3043 �'7 11.00411121 R.0.1 WWI., Cert'inTeedE $�J L PROPOSAL SUBMITTED TO PHONE — I DATE STREET JOB NAME CITY,STATE AND ZIP CODE � JOB LOCATION We hereby submit specifications and estimates for: Recommended Optional A/V a 444e (Included in price) (Not included in price) Vol'Rip& Remove all shingle debris from roof&job site: ❑1 layer 2 layers ❑3 layers or more Repair/or Replace any roof decking; not to exceed 50sq.ft. 4 Install 8"aluminum drip-edge/and rake-edge along entire perimeter. Choice of mill white -r brown 1114 Install ICE&WATER underlayment along horizontal eaves,valleys,sidewalls and sky-lights&chi eys • Install premium base sheet underlayment between roof deck and roofing shingles LJ 15 Ib.felt 30#.felt • Install 25yr CertainTeed/GAF/IKO traditional 34ab roof shingles ❑30 year Install CertainTe d/GAF IKO architectural 9 Lifetime roof shingles "See manufacturer warranty policy for more details Install new aluminum vent-pipe flange(s) Chimney(s)-counter-flash and re-step existing flashing ❑Cut& Install new lead flashing Ridge-vent/exhaust vent with low profile design, hidden by shingle caps ❑Soffit-ventilation ❑ Roof louver-vents • Seamless style aluminum gutters-custom fabricated at job site ❑downspouts • Other O'Keefe roofers will properly dispose of all roof debris in our own dump truck. *Please Note:All items in roof attic should be removed or covered due to falling roof particles, at time of roof tear-off Price includes all items above that are checked only/others may be priced separately upon request. Pe Propose hereby to furnish material and labor-complete in accordance with above specifications,forthesum of: r Total price not including options. dollars($ Payment to be made as follows: 30%deposit required upon delivery of materials.Balance due in full upon day of completion. Please make all payments out to Michael O'Keefe,21 Francis St., No. Reading, MA 01864 Late charges of$50 per week for all outstanding bills due upon day of Authorized completion. Signature / -Accepting proposal means agreeing to the terms of the enclosed binder Note:This proposal may be contract. withdrawn by us if not accepted within days The Commonwealth ofMassachusetts Department o,flndustriglAccidiints Office of•Investigations 600 Washington Street Boston,MA 02111 www.mass gov1dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legib Name(Business/Organization/Individual): ev"ii _t/ Address: City/State/Zip: L, Phone#: 3 pv-7, Are you an employer?Check the appropriate box: Type of project(required): 1.ElI am a employer with 4. F1I am a general contractor and I ❑New ' 6. construction employees(full and/or part-time).* have hired the sub-contractors 2.El am a sole proprietor or partner- listed on the attached sheet.x �• E]Remodeling ship and'have no employees These sub-contractors have S. ❑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 10.El Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.F1 Plumbing repairs or additions myself. [Noworkers' comp. c.152,§1(4),and we have no ltoofrepairs insurance required.] employees.[No workers' comp.insurance required] 13.❑Other *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 aie doing all work and then hire outside contractors must submit anew affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy,information. lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. J Insurance Company Name:. Zc4 tc� gyIee-j,,-,� . -- -- . _ . . . . .. ..... .. . .. - - � --...._..._._.---- - - r .- _ _ ... . Policy#or Self-ins.- #:_ /��zi�4� _rr� 0��jt Expiration Date: t' 'I 3 Job Site Address:_ /� /I�i� _ fbi•�� 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. Do advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido Hereby cert under theeppains andpenaltie ofpeijury that the information provided above is true and correct. - signature: /' Date: 7— t' Phone#: 7 p 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.CitylTown CIerk 4.Electrical Inspector 5.PIumbing Inspector 6.Other - - - Contact Person: Phone#: i I 1 i Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor o License: CS-068461 MICHAEL J OW9F'E.-- 21 FRANCIS ST N READING MA'0186 I J4k Expiration Commissioner 02/2412014 I `-- 1/64-d6clatio�J���iJ e lation � I Office of Consumer Affairs&`Business DOME IMPROVEMENT CONTRACTOR Type: = egistration, 146722 DBA ...- i = xpiration: 5/1112015 - O'KEEFE CONSTRUCTION.-, MICHAEL O'KEEFE 21 FRANICIS STREET NORTH READING,MA 01864 Undersecretary ----- -