HomeMy WebLinkAboutBuilding Permit #376-14 - 12 WALKER ROAD 10/22/2013 `� tl t10RTf{
BUILDING PERMIT orp�`'Laa `°*.M9
TOWN OF NORTH ANDOVER ►-
�� �I APPLICATION FOR PLAN EXAMINATION "
Permit NO: Date Received,,
Date Issued: !> 22
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I PORTANT: Applicant must complete all items on this page
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TYPE OFIMPROVEMENT PROPOSED USE
_. _ ...._.._ .. ----..,,_ __._° __...._ _ �_._ ___� . .....__ __.._......... ........._..........
Residential Non- Residential
New Building One family E
Addition Two or more family Industrial
Alteration No. of units: Commercial
Repair, replacement Assessory Bldg Others:
Demolition Other
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Identification Please Type or Print Clearly)
OWNER: Name: Phone:
Address:
CONTRACT( I me, p ones ,
uper�isor� onstrEtionLtGense � 00, "i", ate r}
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ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE:BULD! RMIT: $'12.00 PER$9000.00 OF THE TOTAL ESTIMATED
//COST BASED ON$125.00 PER S.F.
Total Project Cost: � FEE: $ T 7 • Ob
Check No.: Receipt No.:
NOTE: Persons contra 4Wg with unregistered contractors do not have access to a guar fund
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TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit N0: Date Received
Date Issued:
IMPORTANT:Applicant must complete all items on this page
LOCATION
Print
PROPERTY OWNER
Print 100 Year Old Structure yes no
MAP NO: 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
❑Alteration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District
11 Water/Sewer
DESCRIPTION OF WORK TO BE PERFORMED:
Identification Please Type or Print Clearly)
OWNER: Name: Phone:
Address:
CONTRACTOR Name:__ _ Phone:
Address:
Supervisor's Construction License: Exp. Date:
Home Improvement License: Exp. Date:
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ FEE: $
Check No.: Receipt NO.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Signature of e\gent%Ovvner y Signature of contrac ar -,
Plans Submitted E Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
Plans Submitted ❑ Plans Waived❑ -Certified Plot Plan ❑ Stamped Plans ❑
TYP-_ORSEWERAGE:DISPOSAL
Public Sewer ❑ Tanning/MassageBodyArt F]. . .Swimming Pools ❑
Well ❑ Tobacco.Sales ❑ Food Packaging/Sales ❑
Private(septic tank,etc..- ❑. Permanent Dumpster on Site ❑
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THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
DATE REJECTED " DATEAPPROVED
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PLANNING & DEVELOPMENT ❑ ❑
COMMENTS
.CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on Signature
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COMMENTS
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Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
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Planning Board Decision: Comments
Conservation Decision: Comments
Water & Sewer Connection/Signature& Date Driveway Permit
DPW To` ;2 Engineer: Signature:
Located 384 Osgood Street
EIRE DEPARTML_NT - Temp Dumpster on site yes no
Located-at 124 Mair Street
Fire DepartM6riteiignature/date-y
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
MGL-Chapter 166 Section 21A,-F and G min.$100-$1000.fine
NOTES and DATA— (For department use
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El Notified for pickup - Date
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Doc.Building Permit Revised 2010
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Building Department
The fol swing is--a list of the required.forms to be filled out the appropriate.permit to.be obtained.
Roofing, Siding, Interior Rehabilitation Permits
❑ Building Permit Application
❑ Workers Comp Affidavit
Li 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)
❑ Building Permit Application
❑ Certified Proposed Plot Plan
o 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 Permit
In all csscs if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals
that the apv-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.Buhding permit Revised 2012 .
Location ��� (Z ' U r-A Z--
No.
No. �(0 Date
TOWN OF NORTH ANDOVER
• 5 ren ' .
Certificate of Occupancy• $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check#
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G 7 U ;� Building Inspector
The Commonwealth of Massachusetts -
Department oflndustrialAccidents
Office of Investigations
600 Washington.Street
Boston,MA 02111
www massgov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Business/Orgmization/Individual):V� nelk +a'�4�
Address: 37 I Z�la db'1D`f-/ t -
City/State/Zip: LAeij MA G Phone#:
Are you an employer?Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4. ❑ I am a general contractor and l 6. ❑New construction
employees(full and/or part-time).* have hired the sub-contractors
2. lam a sole proprietor or partner- listed on the attached sheet. 7• ❑Remodeling
2)�
These sub-contractors have 8. ❑Demolition
ship and'have no employees _,
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.F1 Electrical repairs or additions 3.❑ I am a homeowner,doing all work right of exemption per MGL 11.❑Plumbing repairs or additions
myself. [No workers'comp. c.152,§1(4),and we have no 12.❑Roof repairs
insurance required.]i employees.[No workers' 13.❑Other
comp.insurance required.]
'Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information.
7 Homeowners who submit this affidavit indicating they are 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.
Z 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 S elf-ins.Liz.#: 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 the DIA for insurance coverage verification.
f do hereby certio under the pains ndpenalties ofperjury tliat the information provided a ve its lie and correct.
Signafore: Date:
Phone#:
O not rite in this area to he coin leted b city or town official
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Official use only. Do w P Y tY .ff
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.PIumbing Inspector
6.Other - -
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Information and Anstructions
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 deemed to be an employer."
MGL chapter 152,§25C(6)also states that"every state or local lie-ensing 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 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 LL C or LLP does have
employees,a policy is required. Be advised that this affidavit maybe 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 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(ifnecessary)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. Anew affidavit must be filled out each
year.Where a homeowner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e.a dog license or permit to burn 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 Coxnmmwait� of'Massar?�vsPtts
Depafteut of Mustdal Accidents
Office of Investigations
�Q�'�a��hlg�Ot7.S�ree�
• BQStQri} .Q.�X X�.
Tel,#617-727-4900 ext or 406 . •
. . X 877.,MASS.AFE _
Revised 5-26-05 Fax#617-727-7749
6
NORTH
own of
TAndover
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PERMIT BOARD OF HEALTH
Food/Kitchen
Septic System
THIS CERTIFIES THAT ��k \,a,/�
........ .................r�,. .............................................................. BUILDING INSPECTOR
has permission to erect .......................... buildings on Acr). ....kQcz.L � ^^ Foundation
�.. .�4,sF!�.................lam...
to be occupied as ........M..O...w,,,,,,,,,,,,,,,,,,, -�'Z
. Rough
.........�.�......�.�......................................................... Chimney
provided that the person accepting this permit shall in every respect conform to the terms of the application
on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Final
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
1� UNLESS CONSTRUCTION TAT Rough
Service
Final
BUILDING INSPECTOR
Occupancy Permit Required to Occupy Building
Rough GAS INSPECTOR
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.
Advanced Mold
Detection Services
978-452-2260
12 Walker Rd.,#2 Date: 10/2/2013
North Andover MA
Attention: John Larkin,
Inspection:
The tenant has noticed mold growing on personal belongings inside this lower right front corner
basement unit. The landlord,John Larkin called for me to inspect the property.
I first visited the property on 9/16/2013. Contractors were replacing the front decks. I noticed mold
growth on the front sheetrocked wall behind the removed brickwork. It was a whitish grey mold
type. It looked like aspergillus.Images from my Canon camera 99319 and #9320 show this front
wall area.Water entering from the front exterior wall was wetting this inside wall board. It could of
happened from poor deck flashing on the old decks.I wasn't able to look inside at this time because
the tenant wasn't able to make this appointment,so it was rescheduled.
I returned on 9/30/2013 at 4:OOPM. The humidity inside the unit was 64% and the outside humidity
was 47%.Mold was growing on shoes,carpeting and mattresses. There was visible mold growth on
the front corner bedroom baseboard molding.The rug in the right front corner bedroom has been
getting wet next to the right side wall. Testing with a moisture meter showed high moisture levels
along the lower front exterior wall of the livingroom,lower front& right side exterior walls of the
front corner bedroom and the lower exterior wall of the child's bedroom.
This unit is currently damp from moisture intrusion from the lower exterior walls,and also a
possible high water table. There is a slight downward grade towards the exterior of this unit.
Note: A high water table will cause moisture penetration through an unsealed cement floor.
The carpeting will need to be removed and the exterior walls will need to be removed and
remediated inside.Because of the damp floors tiled flooring should be installed-not carpeting.
A dehumidifier will need to be set up to maintain humidity levels below 55%.
Note: This brick building has 2 layers of exterior sheetrocked walls. One is hidden between the
exterior brick and interior wall studs. The other is visible from the inside. When the inside walls are
removed we can inspect the condition of the exterior wallboard. If it's not to contaminated we can
clean and seal the backside from the interior. If it's very damaged or heavily contaminated it will
need to be removed. This is usually done from the outside.
Pg.l �
Ad"i-vianced Mold
......
Detection Services
978-452-2260
Mold Remediation Services
Scope of Work:
We shall provide the following services to the client.
Advanced Mold Detection Services shall provide all necessary supervision,labor, materials,
equipment,and insurance.Air Filtration Devices (Air Scrubbers) equipped with HEPA filters shall
be installed in the unit during mold remediation procedures. We'll contain the work areas. The
work area(s) requiring disinfection/abatement of fungal contamination and building materials are
noted to be located in the following area(s):
Livingroom - Advanced Mold will remove and dispose of the carpeting and front exterior
sheetrocked wall &wall insulation from floor to ceiling.
Front Right Corner Bedroom -Advanced Mold will remove and dispose of the carpeting and front
exterior sheetrocked wall &wall insulation from floor to ceiling. We'll also remove and dispose of
the right side exterior sheetrock wall &wall insulation from the floor to 4 feet high.
Right Side Child's Bedroom -We'll remove and dispose of the right side exterior sheetrocked wall
&wall insulation from the floor to 4 feet high.
Advanced Mold Remediation will then inspect inside these walls.If the exterior wall board is in
satisfactory condition we'll then perform mold remediation inside these newly opened wall areas.
We'll hepa vac the wall cavities and clean the mold growth with an EPA registered
disinfectant/sanitizer/cleaner specially designed for mold remediation.We'll also clean the floors
and perform a mold fogging treatment inside the unit.We'll leave a dehumidifier& air scrubber
running.We'll return to apply an anti-microbial sealer inside all the newly opened & remediated
wall areas.
Note: You should rebuild any basement walls with a mold/mildew resistant type of
wallboard/sheetrock and leave a 2 inch gap along the bottom. This gap can easily be covered with
the new molding. Suggestion-Repaint any newly installed mold/mildew resistant wallboard with
California Kitchen and Bath Interior Paint-This is an acrylic latex paint developed to withstand
the moist, humid conditions in bathrooms, kitchens and basements.This formulation includes
Microban Antimicrobial Protection and is recommended for areas requiring maximum moisture
and mold resistance.
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Advanced M
Detection Services
978-452-2260
Soleus Powered by Gree 70-Pint 3-Speed Dehumidifier ENERGY STAR
Item#: 4165681 Model#: GL-DEH-70EIP-6 Available on-line at Lowe's$279.
Basement Dehumidification
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a`.
Note: After all mold remediation is completed we regularly suggest that occupants with
damp basements install a basement dehumidifier system and set it to turn on at 45% to
50% humidity. This is because mold needs humidity levels above 55% to grow. Get a
unit with a digital readout so you know what to set it at. A condensate pump can be
purchased that will collect the dehumidifier water and can pump it uphill through a tube
to a nearby washer, sink or sump pump so you will not have to empty the bucket. Also, a
plumber could connect the drain tubing to your drain system. Some dehumidifier come
equipped with this self purging feature, such as the Soleus Air model above. This model
comes with a drain hose and can pump out the removed water up to 16 ft. high.
Note: Get a separate humidity gauge to double check the room humidity level. This is
because it's common for the humidity readouts to be off on most dehumidifiers.
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Advanced told
Detection Services
978-452-2260
Standard of Care
The company warrants that its services shall be performed by personnel possessing competency
consistent with applicable industry standards. Advanced Mold Services employees will follow the
Standard Respiratory Protection Guidelines.
Liability
Limitation.The company's liability,including but not limited to Client's claims of contributions
and indemnification related to third party claims arising out of services rendered by the Company.
And for any losses,injury or damages to persons or properties or work performed arising out of or
in connection with this Agreement and for any other claim,shall be limited to the lesser of twice the
contract value or twice the payment received by the Company from the Client for the particular
service provided giving rise to the claim.Advanced Mold has full liability insurance coverage to
$1,000,000. and $500,000.workmans comp coverage. Advanced Mold Remediation is not
responsible for materials removed or damaged during the mold removal process,or replacement of
any removed materials.
Warranty
We'll warranty the cleaned and sealed exterior wall materials against live mold re-growth for
6 years,if there isn't a new water intrusion incident. If mold growth re-appears we'll remediate for
no additional charge.
Certifications
Advanced Mold Detection Services is a Certified Mold Remediation contractor.
We hold the current MA Contractor Registration License# 167724 with zero complaints.
Note: We are fully insured. Our agent is Fred. C. Church Insurance. Advanced Mold Detection's
owner,Vance DeVincent is certified in mold testing and mold remediation through Micro.Vance
Devincent has had license#22936 for 17 years in the state of Massachusetts. Our job site
supervisors are Brian Sadowski,John Maher and Derek Boucher. One will always be working
hands on at the job site. They are certified mold technicians by IOT(Interactive Occupational
Training).All Advanced Mold remediators are IOT Mold Tech Certified. Our employees are also
required to attend training and safety courses covering the hazards involved with working with
mold abatement exposure,safety,and health precautions,the use and requirements of protective
clothing,equipment and respirators. In addition all workers will be trained in accordance with the
United States Environmental Protection Agency 40 CFR,part 763 AHERA Model Accreditation
Guidelines.
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Advanced Mold
Detection Services
978-452-2260
Payment:
Basement Mold Remediation— (Detailed in the Scope of Work) $3900.
* Payment due on initial day of service $1950.
* Payment due on completion of the scope of work $1950.
Authorization:
I , authorize the above described mold remediation
(Print Name)
work(described in the scope of work) to be performed at 12 Walker Rd. #2, North
Andover MA and I agree to the payment terms stated above.
Payment Methods:
Check - Credit Card - Cash
------------------------------------------------- ------------------------
Client Signatures: Date
-�- - -�t� ---------------i------ ----0- �J
Vance DeVincent VP Date