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HomeMy WebLinkAboutBuilding Permit #702 - 120 WILLOW STREET 5/12/2010 BUILDING PERMITo.1 OORoTM qti TOWN OF NORTH ANDOVER oa t'. ...�6=6 00, APPLICATION FOR PLAN EXAMINATION H r �n4F 1e Permit NO: ®2� Date Received �4SSACHu`+�t�� Date Issued: �-�l IMPORTANT: Applicant must complete all items on this page LOCATION a_. A\�� E1.Lo '.�' - � tPrint PROPERTY OUVNER` \�G . 2•q r.rt3� �.Q: x -71( : f U . Si Pl- Print MAP 210 PARCEL: ZONING DISTRICT: Historic District g yes Mact n Shop Village Vires n 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 SepticV1/ell , = Floodplain Wetlands Watershed Di strrct '4INater/Sewer -P DESCRIPTION OF WORK TO BE PREFORMED: Identification Please Type or Print Clearly) OWNER: Name: U2, Phone: Address: �`® , k ` ���o V % S\U a; a CONTRACTOR f\larne.i c�w.� Phone: Co .1 Address`\ � c��+ _ 44 s Supervisor's Construction License —i "1\ Exp. Date:: tC3 w _ . - _ m 5 - 42 Home Irri'provement License: .. . r : . Exp. Date: s � t 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: $ SCI,wo FEE: $ �J2 Check No.: Receipt No.: �P 3/ � NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund S�gnature`�of Agent/Oirvner Signature of contractor, ,�u�.t-� Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer tl� 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 i CONSERVATION Reviewed n Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zorning 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: Located 384 Osgood Street :FIRETDEPARTME'NT - Temp Dempster on site yes ' :no 4` Located,at 124:'Main.-Strut < Fire Die.partment signatu re/date'` p v . 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) F. ❑ 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 dum ster permits re ;uire sign off from Fire Department artment rior 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 ❑ 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 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 Location /00 No. Date �oRTM TOWN OF NORTH ANDOVER 041 n Certificate of Occupancy $ Building/Frame Permit Fee $ s�CH " Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 23145 Building Inspector Edward L.Gorman. Senior Project Manager • A&M Roofing Services, LLC 123 Tewksbury Street,Andover,MA 01810 PHONE:978-475-4500-FAx:978-475-8778 EMAIL:EGorman@AMRoofing.net VAORT#q Town of _ 4Andover No. 76 Z = dower, Mass., Cb 1 L.. p A. COC MIC ME WICK V ADRATED PPS` �Cy `r E BOARD OF HEALTH Food/Kitchen Septic System PERMIT . T D BUILDING INSPECTOR THIS CERTIFIES THAT......... ...1.. .'..........� 4 .w .... .......... . ,........ .......................... Foundation (bohas permission to erect........................................ buildings on 1 .............. Rough to be occupied as.... Chimney . ....... .............. 4.u. ................................................ provided that the person accepting this permit shall in every pact 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 Z . PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRU ST Rough .......... 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 Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. tic Sat. t N 1i ►,sachusitts Dc ha4t►�►ent of Pnd,St ud�►ci ' Board of Building Regulations a Construction Supervisor License afi License. CS 78710 Restricted to: 00 ^itr EDWARD L GORMANti 12 FOURTH AVE °a.._ SCITUATE, MA 02066 m Expiration: 10/19/2010 cI T r#: 5697, Page Two Mr. Henry Bolton Chelsea Technology April 28,2010 The price for the above scope of work would be Thirty-Nine Thousand Dollars ($39,000.00). Our price includes the cost of obtaining the local building permit. The following would be the payment schedule for this project: 1. Due upon return of signed agreement $ 2,500.00 2. Due upon completion of work $ 32,500.00 3. Due upon delivery of warranty $ 4.000.00 Total Job $ 39,000.00 Please contact our office if you have any questions or need additional information. This proposal may be withdrawn if not accepted within 30 days. We appreciate the opportunity to quote you on this project and look forward to working with you again. Sincerely, aures A.Loos President The abov terms and conditions ed andyou are authorized to proceed: By: Title: Date: d Additional Provisions df this Proposal Concealed electric and communication lines:A&M shall not be liable or held responsible for the repair,replacement or for losses incurred in connection with electric wiring or communication cabling affixed to the roof deck,strung through the upper rib of the roof deck,located less than 3"from the bottom of the roof deck or otherwise failing to comply with the state electrical code. Pre-existing Conditions:Prior to commencement of work,A&M will be provided notice as to any roofing,plumbing or HVAC related leaks or other types of water infiltration having occurred on the property within 2 years of commencement of roof work. A&M shall not be liable or held responsible for the repair,replacement or losses incurred in connection with preexisting conditions. Owner's failure to disclose preexisting conditions will result in forfeiture of right to assert any claim for damages against A&M. Roof Leaks between commencement and completion of Work:A claim asserted for roof leak damage occurring after commencement of roofing work but prior to substantial completion of the work will be governed by the following procedure and limitations: 1)the Owner will notify A&M immediately by phone and in writing by fax of any alleged damage.2)A&M will be given prompt access to the area where damage is alleged prior to any remediation work for the purpose of performing a damage inspection.A&M shall not be liable or held responsible for any remediation work,if timely access is denied or if remediation has commenced prior to inspection by A&M.3)During damage inspection A&M may photograph and/or videotape for the purpose of maintaining an accurate mord of the damage.Likewise and as necessary this right of timely inspection shall also be accorded A&M's insurer or public adjuster for the purpose of placing a monetary value on the loss.4)During damage inspection,A&M will determine in its sole professional judgment whether it was responsible for causing the alleged damages and will advise Owner of its findings.5)In the event a claim for damages is asserted,and if either timely access is denied for whatever reason or if A&M is denied an opportunity to obtain an accurate record of the damage,then in such an eventuality,Owner shall indemnify,defend against and hold A&M harmless from any claim asserted therefrom. Right of Survivorship:Notwithstanding any contract language that may be to the contrary,these additional provisions of this roofing proposal shall survive the Project and shall be valid and enforceable by or against the parties hereto and their respective successors, subrogees and assigns. A&M Hoofing Services April 28,2010 Mr. Henry Bolton P.O. Box 7364 Reno,NV 89510 Re: Chelsea Technology 120 Willow Street North Andover,MA 01845 Dear Henry: We have inspected the roof at the above referenced project. We recommend roof replacement with new black EPDM membrane in accordance with the following general specifications: 1. The existing stone ballast would be vacuumed from the roof surface and disposed of off site. 2. The existing EPDM membrane would be stripped and properly disposed of off site. 3. The existing 2.5" thick insulation would remain. Replacement of wet,damaged or deteriorated insulation would be completed at a unit cost of Two Dollars and Fifty Cents ($2.50)per square foot. 4. New pressure-treated wood nailer would be installed at the roof perimeter equal in height to the new insulation. 5. A layer of 1.5"thick polyisocyanurate insulation having an LTTR-value of 9 would be installed over the existing and fastened to the metal deck.A new tapered insulation cricket would be installed between the roof drains.Total LTTR-value with existing insulation would be 24. 6. A layer o€60 mil thick black EPDM membrane would be fully adhered to the insulation in accordance with the manufacturer's standard specifications. , 7. The roof edges would be flashed with new .040"thick bronze aluminum gravel stop. 8. The existing roof-top units, flues,roof drains, vents,pipes and pitch pockets would be properly flashed to the new roof system. 9. Two new walkway pads would be installed at each roof-top unit. 10. The completed EPDM roof system would be guaranteed for a period of fifteen(15)years by the roofing manufacturer,covering labor and materials. 123 Tewksbury Street,Andover,MA 01810 PHONE-978-475-4500 FAX:978-478.87/8 The Commonwe alth of Massachusetts Department of Industrial Accidents Office of Lnvestigations 600 ff ashinoaton Street Boston, M4 02111 Workers' Compensation Insurance Affidavit Builders/Contra A licant Informationetors/Electricians/Plumbers PIease Print Legibly Name (Business/orgmization/Individual): &4,\Nk Address: tz �tvJ�l--C , City/State/Zip k_X> J\,T� b Phone Are yo employer?Check the appropriate box- 1. I am a employer with �© 4. ❑ I am a o Type of project(required): -----_ general contractor and I 2•❑ employees%L -time).* have hired the sub-contractors 6' ❑Nei"coasfruction I am a sole proprietor or partner- listed on the attached sheet t 7. construe ship and have no employees These sub-contractors have working for me in any capacity, workers' com . ' g' ❑Demolition p insurance. [No workers'comp. insurance 5. ❑ We are a c o 9. ❑Building addition required-] orp:ration and its officers have exercised their 10.0 Electrical repairs or additions 3.❑.I am a homeowner doing all work n t of ex emption per MGL 11.❑Plumbing repairs_additions Myself [No workers'comp, c. 152,§I(4),and we have no inattrsrn ce required_] t employees_ [No workers' i2 0 R fM�_� A comp.insurance required. 13 Other:.ny°Fplic attt that:.h:.�:boy.#1 mast also st�l out the ]t Homeownets who s sectio_ op a^oY _`= wori a s'co s_ ee c vomit this affidavit indicating the; air dont^all work-and Policy m-c-c-tion 'Contractors that check this box must atiched an additional sheet showing the �®hf t e Uide conut atm must submits new t name of the sub-can affidavn indicating such, tractors and their workers'comp•policy information. I am an employer that is providing workers'com ensation ' information. P Insurance for my employees. Below is the policy and,job site Insurance Company.Name: 3 : Policy#orSelf-ins.Lie.#: C Lkk_5A�%Si Expiration Date: 5 S I Job Site Address: � br6 City/State/Zip: Attach a copyAS of the workers'compensation policy declaration pate (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A ofMGL c. 152 can lead to the imposition of c ) fine up to$1,500.00 and/or one-year imprisonment,as well as civil 0P criminal penalties of a of up to $250.00 a day against the violator. Be advised that a co Penalties m the form of a STOP WORK ORDER and a�e Investigations of the DIA for insurance coverage verification. of statement may be forwarded to the Office of Ido hereby certify under the pains and enalties of perJury thw the information provided above is true and d correct ` Phone OffiCial use only. Do not write in this area, to be completed bj,city or town of cial City or Town: # Ensuing Authority(circle one): Permit/License I.Board of Health 2.Building Department.3. City/Town Clerk 4. Electrical Inspector 5.Plumbi 6. Other btiR Inspector Contact Person: Phone#: Information an- d Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Purm=t to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined.as"an individual,partnership,association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership,association o$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 mautte>Banee,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 licensing agency shall withhold the issuance or renewal of a license orermit too erste a business or to p p construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of co=mpliance 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 un-r:il.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-contractors)name(s),address(es) and phone numbers)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 carTY workers' comp enation 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 returned to the city or town that the application for the permoit or license:s beim requested,not the.Denartane:ut.or Industrial Accidents. Should you have any questions regardiD_.g the law or if you are required to obtain a woe Prs' 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 officiaEY 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 v=tmm (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 Ince 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,fiugmumber ...... The Commonweal& of Massachusetts DcPartm ent of industrial Accidents Office of 1mvestigat ions 600 Washington Street Boston,MA 02111 Tel. # 617-72.7-4900 ext4406 or 1-977-MASSAFE Revised 5-26-05 Fax 4 617-72:7-7749 v>v v,.mass..aov/dia.