HomeMy WebLinkAboutBuilding Permit #478 - 121 COLGATE DRIVE 1/11/2010 TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received
Date Issued:
IMPORTANT: Applicant must complete all items on this page
VLOCATION— �� '�� ` ✓' 1.1v t- A,
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PROPERTY OWNER �e r t�o q� r�cin co-y\\VA, vx i tkoot
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MAP NO.'�FARCEL: ZONING DISTRICT; Historic District yes
w^- 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
Water/Sewer
DESCRIPTION OF WO TO BE PERFORMED:
t r00 D f 71
Identification Please Type or Print Clearly)
OWNER: Name: Phone:
Address:
CONTRACTOR Name: tA Phone: �( "4; -� O
.Address: 1�)'D}t 31 t ov��po im
Supervisor's C,onstruction.License: ' Exp.. Date:--3/2,5'/ /2..,.,
Home Improvement'License: Exp. Date:
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE:BOLDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S
Total Project Cost: $ FEE:
Check No.: /�---1-D �- Receipt No.: -�-
NOTE: Persons contracting with unregistered contractors do not have access to he guaranty and
Signature of Agent/Owner Signature of contract r
r
LocationNo. r/ ) Date
MQRTN TOWN OF NORTH ANDOVER
f �+
0 s
t Certificate of Occupancy $
ti a —
�'�s'••'°''�t�' Building/Frame Permit Fee $ "� 7
AC MUSE
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check #
r r
Building Inspector
Plans Submitted Plans Waived Certified Plot Plan Stamped Plans
TYPE OF SEWERAGE DISPOSAL 1
11
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
DP•W 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
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
❑ Notified for pickup - Date
Doc:.Building Permit Revised 2008
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)
❑ 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: Doc.Building Permit Revised 2008
ACORQ. CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY)
111
11 2010
PRODUCER Phone: 781-681-6656 Fax: 781-681-6686 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
The Driscoll Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
93 Longwater Circle HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P.O. Box 9120 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Norwell MA 02061
INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURERAStar Indemnity & Liability Com
Building Maintenance Corp. INSURER B:Peerless Insurance Company 4198
DBA U Roofing
58 R Pulaski Street INSURERC:Everest National Insurance Co
Peabody MA 01961 INSURERMACE Property & Casualty Insur
INSURER E:
COVERAGES
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR ADD'L pOUCYNUMBER POUCYEFFECTIVE POUCYEXPIRATIONTYPE OF INSURANCE LIMITS
A GENERAL LIABILITY WCSICON30006109 12/23/2009 12/23/2010 EACH OCCURRENCE $1,000,000
DAMAGE TO-RrNTEU
X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurence $100,000
CLAIMS MADE Fx—]OCCUR MED EXP(Any one person) $5,000
PERSONAL BADV INJURY $1,000,000
GENERAL AGGREGATE $2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $2,000,000
POLICY X PRO JEF
LOC
B AUTOMOBILE LIABILITY BA 8730382 12/23/2009 12/23/2010 COMBINED SINGLE LIMIT
ANY AUTO (Ea accident) $1,000,000
ALL OWNED AUTOS
BODILY INJURY $
X SCHEDULEDAUTOS (Per person)
X HIREDAUTOS
BODILY INJURY $
X NON-OWNED AUTOS (Per accident)
PROPERTYDAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $
ANY AUTO OTHERTHAN EAACC $
AUTO ONLY: AGG $
C EXCESSIUMBRELLALIABILITY 71C8000264-091 12/23/2009 12/23/2010 EACHOCCURRENCE $5,000,000
X I OCCUR CLAIMS MADE AGGREGATE $5,000,000
DEDUCTIBLE $
RETENTION $ $
ITATU
D WORKERS COMPENSATK)NAND 045855119 12/23/2009 12/23/2010 X TORY UMTS ER
EMPLOYERS'LIABILITY
ANY PROPRIETOR/PARTNERlEXECUTNE
E.L.EACH ACCIDENT $500,000
OFFICERIMEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE I$5 0 0 0 0 0
If es,describe under
SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT 1$500,000
B OTHER CBP 8732582 12/23/2009 12/23/2010 Job Site Limit $100,000
Installation Floater
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
E: 58-60 Edgelawn Ave., North Andover MA
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
Town of North Andover Massachusetts BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER
WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE
Attn: Building Department CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO
1600 Osgood St. SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON
North Andover MA 01845 THE INSURER, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE _
ACORD 25(2001108) pACORD CORPORATION 1988
W WA� U.S. Roofing
a division of Building Maintenance Corp,
1-MaNNNNOMW P.Q. Box 3118
FIOOFIIVG Peabody. MA 01961-3118
CONTRACT
The Owner(s) of the premises described below, hereinafter Job Address, hereby contract with and
authorize U.S. Roofing, hereinafter Contractor,to furnish all necessary materials, supplies, labor and
workmanship, and to install, construct, and place improvements at the said Job Address, according to the
following specifications,terms, and conditions:
1. Owner's Name: Heritage Green Condominiums
39 Farrwood Ave., Ste. 1, North Andover, MA
C/o Affinity Realty
63 Atlantic Ave
Boston, MA 02110
2. Sob Addresses: 58-60 Edgelawn Ave., North Andover MA
3. Specifications: Contractor agrees to perform the following services in a
good and workmanlike manner:
- Remove all existing shingle layers down to exposed roof boards
- Dispose of all roofing debris in a legal landfill
- Install Ice and Water Shield at all gutter edges; including valleys and all roof
penetrations
- Nail TRI-FLEX®High Tech Roofing Underlayment over remaining roof surface
- Install 8" aluminum drip edge to all roof perimeters
- Cut away opening in ridge boards (to allow ventilation)
- Install CertainteedYm 30-Year Three-Tab shingles to all roof surfaces; storm
nailing each (six nails per shingle)
- Flash all roof penetrations according to National Roofing Standards
- Install coil ridge vent at roof peaks
- Cap ridge with Certainteedt`" 30-year cap shingles
- Clean all gutters at completion of project
COST OF WORK: $ 7,225.00
4. Extras:
• In the event that the Contractor discovers rotten boards, they shall be replaced and the Owner
shall pay an additional $3.50 per square foot for labor and materials.
• In the event that the Contractor discovers multiple shingle layers greater than two, removal of
each additional layer of shingles over two layers would be an additional charge of$2.00/sq, ft.
S. Warranties: The above work comes with Certainteed's 30-Year Shingle Warranty
(furnished to Owner from Certainteed directly)for materials and a two-year warranty
(furnished by Contractor)for labor.
6. Payment Terms: The total cost of the contract is $ $ 7,225.00 Payment shall be rendered
in the following manner:
Balance (100%of the total project cost) shall be paid upon successful completion of all roof work
Now Available: Visa & Mastercard Credit Cards are accepted as payment.
NORrh
Town of
t 4Andover
o dover, Mass.
'QA COCMIC MEW11 K`y'k'
ATE D C7
S BOARD OF HEALTH
Food/Kitchen
PERMIT T D Septic System
THIS CERTIFIES THAT..... BUILDING INSPECTOR
.. .C <.. lT.. i h.......�d� 1'10 m.......................
J............................................ Foundation
has permission to erect.............................:.......... buildings on ...�.?�. P.'..J(0-0.........��G� I Gv .................
Rough
to be occupied as...S...... .... #-
......./e'4> .. Chimney.
provided that the person a cepting this permit shall i very respect co orm 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 Construction of Final
Buildings in the Town of North Andover.
PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
PERMEXPIRES IN 6 MONTHS Final
IT
UNLESS CONSTRUPRON STARTS ELECTRICAL INSPECTOR
Rough
............................O.... Service
BUILDING INSPECTR
Final
Occupancy Permit Required to Ocatpy Building GAS INSPECTOR
Display in a Conspicuous Place on the Premises — Do Not Remove Rough
Final
No Lathing or Dry Wall To Be Done
Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT
Burner
Street No.
SEE REVERSE SIDE Smoke Det.
7. Attorney's Fees: In the event of default, the Owner shall pay costs for collecting amounts
owing including, without limitation, court costs, expenses and reasonable attorney's fees, in
addition to any sum that the member may be called on to pay.
S. Entire Agreement: This contract constitutes the entire agreement between the parties and any
prior understanding or representation of any kind preceding the date of this Agreement shall not
be binding upon either party except to the extent incorporated in this Agreement. The Owner
agrees that Contractor has made no statements, promises, commitments or representations not
contained herein.
9. Modification: Other than that required as a result of paragraph 4 above, any modification of
this Agreement or additional obligation assumed by either party in connection with this
Agreement shall be binding only if evidenced in writing signed by each party or an authorized
representative of each party.
10. Unforseen Circumstances: Contractor is not liable for delays due to weather, strikes,
accidents, acts of God or other circumstances arising out of causes beyond its reasonable control
and without its fault or negligence.
11. Governing Law: It is agreed that this agreement shall be governed by, construed, and
enforced in accordance with the laws of the State of Maine.
IN WITNESS WHEREOF, the parties have signed their names hereto:
Date: 12-29-2009 Date: I - q - )O
.S. Roofing, by its agent, Z Agen for Affinity Realty:
Willard H. Murray
List desired shingle color:
(Please Print)
Massachusetts - Depal'tntent of Puhlic SafetN
Board of Building Regulation, and Standards
Construction Supervisor License
.License: CS 99551
Restricted to: 00
PETER ALLARD
2 CARVER ST
BEVERLY, MA 01915
Expiration: 3/25/2012
( nurni� i�dicr Tr#.: X99551.