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HomeMy WebLinkAboutBuilding Permit #496 - 122 MILLPOND 12/12/2013 �IORTF/ O`ti�eo 6q1•o BUILDING PERMIT TOWN OF NORTH ANDOVER ° APPLICATION FOR PLAN EXAMINATION - Permit NO: Date Received �9SSACHIIS try r. Date Issued: Z� IMPORTANT: Applicant must complete all items on this page LOCATION � aj N-\" L �f0�1 o1 aota-f:ek XAW </L PROPERTY OWNER � int oio Print 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 -5*/o or more family- _ter [I Industrial ❑Alteration No. of units 2> 64 bu ❑ Commercial repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer �j-- 1 Identificat�Please Type or Print Clearly) NUaA-)PN�n.. (� OWNER: Name: +�� ` QUO 1 -I - '-- Address: P-J— P3(11-A CONTRACTOR Name: �E I Phone: -�— Address: n W Supervisor's Construction License: Exp. Date: 1 I J ao Home Improvement License: y �a ` Exp. Date: ) ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BOLDING PERMIT.-$12. 0 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: ,L�'d Receipt No.: NOTE: Persons contracting with unregistered contractors do not have ac ess to g aranty fund Signature of Agent/Owner Signature of contractor TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received Permit NO: ti ` Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION. PROPERTY OWNER - - � Print: 100 Year,Old Structure yes no PARCEL—1 ___ ZONING.DISTRICT: Historic District yes no MAP NO: Machine Shop Village yes no TPOF IMPROVEMENT. PROPOSED USE _ ential ResidentialNon Residw Building ❑ One family ❑Two or more family ❑ Industrial El Addition ❑ Commercial ❑Alteration No. of units: El Repair, replacement ElAssessory Bldg ❑ Others: ❑ Demolition ❑ Other =cttipSeptic ❑ Well ❑ FloodplainD Wetlands IW:!i:ers D Water/Sewer _ - it DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) Phone: OWNER: Name: I . Address: - Phone: . .._ CONTRACTOR Name: ,r _ ..� - _ r - - , Address: Supervisor's Construction License: .: .-_ _ Exp. 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.: p NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund SI ilature,of contractor' r` �jgn5ture ot�Agent/Owner - -_ -- _ g---- Plans SubmittedIL J Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ i. Building Department wing is 4_li`st of the required-forms to be'filled out,for the.appropriate.permit to The f4 .be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑` B'ailding Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. An&Or G.S.-L. Licenses o 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 apw-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.Buii\icing Permit Revised 2012 -Plans Submitted ❑ PlansWaived-E] Certified.Plot Plan ❑ Stamped Plans ❑ WPE_QF=.-SEWERAGE DiSP:OSAL Public Sewer ❑. Swimming Pools ❑ Tanning/MassageBodyArt ❑ .. . Well ❑ Tobacco.Sales Food Packaging/Sales ❑ Private(septic tank,etc. ❑- _ permanent Dempster on Site El THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM - ._:_.-DATE REJECTED DATE.APPR-OVED PLANNING & DEVELOPMENT' ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature d COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes - Planning Board Decision: Comments Conservation Decision: :Comments Water & Sewer Connection/S_ignature& Date Driveway Permit DPW'Tows Engineer: Signature: Located 384 Osgood Street FIRED-EP�►I�TM� NT��Ternp Dumpsfer'on site yes no Lo ateci at 2124((Mi`rr' ain`St�eet we�-•.j ,- d-•. c ,iw. .� .'�y,, ti { ,'.,�t, *A,�`ktv:i ,�•^ �*t_+K+4'.J.r'1.§.'.,e3t, + �.�-..eL�v- `i,.� 'M''�:` Ft reg artm D P ��..�� e eyyritignature/date C011IIIVI.ENT ' I k- 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 s; DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section.21 A-F and G min.$100-$1000,fine NOTES and DATA — For department use EI Notified for pickup - Date s I ' Doc.Building Permit Revised 2010 Location No. — Date i . - TOWN OF NORTH ANDOVER . Certificate of Occupancy $ Building/Frame Permit Fee $ " . , Foundation Permit Fee $ �a Other Permit Fee $ TOTAL $ Check of 2 7 1 7 6 Building Inspector 1t:usachu.:ett.- Dclru-imcnt`nf Public t�,aft'IA guard of Building Rc�ulatinn,and standards- -Construction Supervisor License License: CS 93403 SEAN OCONNOR f 26 CHESTNUT ST SALEM, MA 01970 ' Expiration: 12/31/2013 Tr` 7996 Oflice _ of Consumer Affairs&Business Regulation ME IMPROVEMENT CONTRACTOR � egistration: 123553 Type: � ., xpiration: 3/6/2015 DBA Preserve Painting Sean O'Connor 203 WASHINGTON ST.#256 _ SALEM,MA 01970 g Undersecretary � �ORTN Town of ndover No. h , ver, Mass, M& 11 j4-M_ c0 "1 "IWICK ADRATED S V BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT ......OlLtIt.teQk � vwNt.. ...ww. .......................... BUILDING INSPECTOR has permission to erect.......................... buildings on taw. �,,,�,`�„� ���,,,�1.. � nc�ation ............ ..... ..... ....... Rough % to be occupied as ..... ..... . .(*�.......Q%A .... ...�..... t�k4a.....AAA �...40..... Chimney provided that the erson acctin this perm shall in ewe res ect conform to the terms of thea lication p p p g p rY p pp 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 gONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTI - S Rough Service .............. ...................................................... 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 - --- - — J ACCORV CERTIFICATE OF LIABILITY INSURANCE 041t.WW'DWYM) 6/3/2013 1%.� AB --- - - - - I THIS CERT1171CATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES, NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEIND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE .A: CONTRACT BETWEEN THE ISSUING INSURERJS), AUTHORIZED REPRESENTATWE OR PRODUCER,AND THE CERTIFICATE HOLDER, IMPORTANT; If the carjificate holftr Is on ADDITIONAL INSURED, the policy(k-s) must be endorsed, If 3V5RQQATJON IS WAJIVED, subjest to tilm forms and conditions of Ow policy,certain policies may require an andor-sernftnt- A statement on this corlificato dofts not confor rights iothe CoflifiCale holder In lieu of such endorsefnenlisj. 'PRODUCERNAMEACT Boynton lnsur*nce Boynton ITiaurseace Agency PHONE FAX, Nol- (AX 72 River Park Street No-adham MA 02494 tN341RERISI AFFONONGCOVERAGE WAX X WSURED R A xyron ln4, rw&uout a--Hartf Ord Insurance DBA Preserve Services tusupEncMt HawAey_1na C*"pny. 201 Washington Street,#256 043VACRII)Coumnterce Insurance I S*14M,VAA, 01910 1 PISURER E CERTIFICATE NUMBER.C-L,1341606928 REVISION NIDI SER.: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED AROVr: FOR THE PrAICY PP.RtOD INDICATED. NOTVATHS?ANDINO ANY REMIREmENI. :IERNI OR CONDITION OF ANY CX NrRAC7 OR, OTHER DOCUMENT WITH RESPECT TO WHICH THIS U-13TIFICATE, MAY DL ISSUED OR WY PERTA04. THE :NjUrWvCE OtHFOROCO BY THE P%tCICS DIE5CRIDLD HEI' IN IS SUBJECT TO ALL THE TERMS. MdLUSIONS AND CONDITIONS OF SUCH POJC-ES.LIMITS SHOWN MAY HAVE BEEN PEDLKED 81f PAID 0-AIIAS. ADDLISLIkEUR J �O 5i V EXP %W I typtar N3UftANC9 MRWD •FOUCyr NUVaER ,MPIfPAM-DINVYWI, LINPtcS CCCLRRE%Ce 1,000,0100 X ir, Of,NERAj.UAFA ITY 1 -50,0100 C f CIAjk4S4AA0F LX,OCCURLX 5,123/2013 5/2312014 W-ri FAP 1—!a� 5,000 r, 00 o�, 1[A()V INk.WY 1,000,0 CIESERAL AGGREGATE Is 2,000,000 &Nt AC:4EGATE LtWT APPLIES PER, i 11RCMC-79.Covpur ADO s 2,000,000 L 3 1 0MICY L01, lEtltCalDatLE UAWL" DOWUNFO IMT 1,000,000 -ro -..A&)AA, MY(Pw J�-) ALL OWSELI A�TOS 33 121 11/0212012 /2013 I 21102I SO-7LY NJURY ear amow.1,I PROPERTY DAW,,,-E mrnw a0m- 404U0%%%EZ)Ako'T'04 tMBRtLtA Lbka OCCVR tg31b54S123/2013 5/23/2014 1 EAC.4(W'CijRRLhC1,. 5 2,000,000 -'-F,XCf$S UAR CLAIASAODC kGOREGATE s 2,000,00W "-D rWLOYERT 1UAeftfrY YiN ANY PROfOlIE�.'O;LPARTNER,EX.ECUTreE EL V#C10ACCjr)!Nj s 500 OrF)CEROMEEMBER , 000 4mmut"MM11) 6S6OUB0523N009!2 5/2012013 5/20/2014 600 I00-0 0--SCP.I=7V01.OF CPERATMNS be*w OCA 11�V,tPAII �,Q Qqp DESCRIPTION OF OPERATIONS I LOCATIONS f VEHICLES fAMwh ACORD 10i,A"blanal Rowits Schadulik,V mrt sp*; fs r*qaI,*d) CERTIFICATE f1di-DER CANCELLA110N SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE.' THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE ViffM TRE POLICY PROVISIONS. I Wi1liosp Pohz/XNTZAw ACORD j.20W*kjt--- 0 1983.2009 ACORD CORPORATION. Ali rights tosetvod, INSD25 zow9i TheACORD namq and logo,re ragistarod marits of ACORD The Commonwealth of Massachusetts Department ofIndustrial Accidents Office of Investigations 600 Washington Street Boston,MA.02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Nari10(Business/Organization/Individual): �••••--= Address:Oolj , � City/State/Zip: Y�(\ Phone#: pl 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 I ' 6. El New 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.t 7• ❑Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9 E]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.❑Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑Roofrepairs insurance required.]t employees.[No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. I Homeowners who submit this affidavit indicating they aie doing all work and then hire outside contractors must submit a new 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. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:.' 1�' �v � s AN Policy#or Self-ins.Lie.# C 0 A J (DM:16 j Expiration Date: lI Job Site Address: I 1�L City/State/Zip: L___ 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. Ido hereby certify unde ' s and penalties ofperjury that the information provided above is true nd corr/ec/t. Signature: Date: y ` 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.Electrical Inspector 5.Plumbing Inspector 6.Other - - - Contact Person: Phone#: Information and Instructions 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 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 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 licensing 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 ofpublic 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-contractors)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 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. AIso 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,rived only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in I(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. 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 venture (i.e.a dog license or permit to bum 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 Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 6.00 Washington Street Boston,NIA.02111 Tel#617-727-4900 ext 406 or 1-877- ASSAFE Revised 5-26-05 Fax#617-727-7749 wF�waxxass,go�fdxa I -- 203 WASHINGTON ST.#256 PRESERVE SALEM,MA 01.970 SERVICEScarpentry(painting(roofingI gutters PHONE:978.745.8745 FAx:978.745.3476 �? SALES@PRESERVESERVICES.COM h{' Millpond Townhomes Date Bid:8/5/2013 Corner of Pleasant St. and Stevens St. Estimator:Sean O'Connor North Andover,MA 01845 Mobile:(978)395-7737 (978) 590-0728 Email:sean@preserveservices.com wlazo5329@verizon.net SCOPE Replace the siding, skirt boards. Replacement of siding and trim on the deck is not included. PROCEDURE The below process is meant to give an overview to the proposed siding replacement project. Specifics of the process were provided by Millpond Townhomes in their"Siding Spec2013" and shall be followed. Pull a building permit. Most siding replacement building permits are non-inspectional. The cost of the permit is included below. Remove the siding; dispose of the siding; install Harvey's housewrap;replace skirt boards with Harvey industries pvc; flash as specified by the manufacture; install owner supplied siding using stainless steel nails. Painting of the new siding and trim is NOT included. Bid for Building 4 Unit 13 North Side Replace the siding(excluding the new area on the right near the new window), skirt board Price $7,450 including all labor and materials. I Bid for Building 7 Unit 60 North Side Replace the siding,skirt board, and all doors and Nvindows. Price$9,150 including all labor and materials except the siding,door, and windows. Payment Terms: a. fed in the bid package ) �� � t Scan,. O'Connor onnor Customer Signature �- ADDITIONAL TO ABOVE; ESTIMATE: BID 1: Labor for carpenter$55 per hour. **** Warranty: Craftsmanship: Kyron Inc. DBA Preserve Services warrantees all exterior painting against blistering and peeling for a period of 2 years. The only exclusions are: wooded gutters; walked art Surfaces, and structural problems such as but not limited to"mill glazing." Should peeling or blistering occur we will fix the affected arca including labor and materials. For the warranty to be valid the invoice that was presented at the time of completion must have been paid in full. Licenses: Home Improvement Contractor(HIC): 123553 Protection: It is required by law that exterior painting contractors have a home improvement contractor license. If a contractor is properly registered, you are entitled to limited protection by the Residential Contractor Guaranty Fund up to 510;000 (The above is a only a summary of Massachusetts General Law t 42A). To check our license or our competitors go to: hit and check license 123553. Construction Supervisor(CS): 93403 The Construction Supervisors license is under an individual's naive,nota company name. To check Sean O'Connors, owner of the Kyron Inc. DBA Preserve, license go to: III11):1/dh.state.nur.us/dps/licenseeIist_asi select Construction Supervisor and license 93403. Our policy is under Kyron Inc. DBA Preserve Services Protection: Covers the injury of a worker employed by the contractor doing work at your home. To check our policy or our compititions go to hM2://mass.gov/dia/ on this page go to"check worker's compensation proof of coverage"our license is under Kyron zip code 01970. Liability Insurance Our policy is under Kyron Inc. DBA Preserve Services and has limit of$4,000,000. Protection: Covers your property in the event of accidental damage up to a dollar limit specified on the policy. To check our policy we will provide a certificate from our insurance company. EPA: Renovation,Repair and Painting(RRP) Nat-21650-0 ` To do work on homes built prior to 1978. All painting&remodeling contractors have to be trained and registered with the EPA. The fines for noncompliance are up to $33,000 per day. Protection: Helps educate the consumer and the contractors on safe practices when handling lead. To check our registration or our competitors go to:hiip:Hcfj2ub.epa.gov/flpp/searcLrM ov/flpp/searchrM firm.htm and search for firms located in Salem Ma.