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HomeMy WebLinkAboutBuilding Permit #694-11 - 125 BRIDGES LANE 4/13/2011 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit ANO: J Date Received Date IssPORTANT:Applicant must complete all items on this page LOCATION Z� ���� Ll�il•�� Print PROPERTY OWNER FQf-_t0 CD(_Pre- o SSO Print MAP NO: [c4*D PARCEL:.01(4 ZONING DISTRICT: Historic District yes Machine Shop Village yes 9) TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building )�+Ae family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other p11; Wig{ 44� �':3x �. k iP =i„"Y 6 r �' 4.r' T d U ,®'Sept1C , D Well ,, � # < , ®Floodplain _:£®Wetlands I ®Wrssheds 4�ict¢ z ' Ylww er/Sewer ��: ,.x-�_s-._3�,� DESCRIPTION OF WORK TO BE PERFORMED: —C (Identification Please Type or Print Clearly) OWNER: Name: Phone: cp 3903 , Address: 2S _ e=Z� r-� LNO E—� •+,u-bAAS- 0(e)c('5— t OoN CONTRACTOR Name: —12-T- - SZ i � � J �-� � Phone: 3Z-4(o( Address: lyL� W aJc7���j�eef�� � - 03p5�!, Supervisor's Construction License: 2 2-g Exp. Date: t Z I l 2-- Home Improvement License: V Exp. Date: 3(Z-9 It ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERI $12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST SED ON 925.00 PER S.F. Tot ii U �"� FEE: Total Protect Cost: $ l � $ Check No.: Receipt No.: y� NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund, SiSignature�oftcontractor yr Location ( No. � Date TOWN OF NORTH ANDOVER 3? •� ' o a 41 s si I o ; . certificate of Occupancy $ CMUs<�' Building/Frame Permit Fee $p --� —F Foundation Permit Fee $ { Other Permit Fee $„ TOTAL $ i Check # t 24C6S Building Inspector i I Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL 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 DPW 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 2008mi i 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 Calculationspp If Applicable) e ( ❑ 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 DOTE: All dumpster permits require sign off from Fire Department prior to issuance o BBldg .Permit n all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals hat the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording lust be submitted with the building application Doc: Doc.Building Permit Revised 2008mi Page_1_of_1_ A6,poid P.O. Box 1028 Londonderry, New Hampshire 03053 I Phone 1-800-432-1461 Fax 603-425-2671 �-- www.tristatewindow.com Proposal Submitted to: Additional Information: 417514W-I) /� ��D. FRED COLARUSSO Work Phone: �7 � -�'/�,C2�� 125 BRIDGES LN. Cell Phone: N.ANDOVER MA. Other Phone: Home Phone: 1-978-685-3003 Date: 2-19-11 E-Mail:f.colarusso@comcast.net Scope of work to be performed: �1 ►T�'E �it+vl�o1.:./ �AsNGS \(i t-t r T el VINYL SIDING i ti �rUuT -��� 56L-t 0 sarFt , -B C)c.K S T c-, r t T R I C H TS 1. Remove existing masonite from exterior walls. 2. Exterior sheathing to be covered with rigid 3/8"insulation board. 3. Cover exterior walls with CERTAINTEED MONOGRAM solid vinyl siding. Includes bottom section of screen porch included. 4. Window and door casings to be covered with ALCOA custom aluminum. Garage doors to be cased with AZEK composite trim boards. Front door casing not to be covered. 5. Install 13 vinyl 3 V lineal window mantels. 6. Remove kick-plate under front door seal and install AZEK composite trim boards. Note: under door and meeting of roof to walls to be covered with Ice&Watershield. 7. Add vents to soffit boards. Cover soffit boards with perforated vinyl panels. I Nva 5 A- V Cks_L> 8. Replace missing fascia boards then cover with ALCOA custom aluminum. 9. Venting (gable&dryer) to be replaced with vinyl vents. 10. Install 16 pr. of=G�vinyl shutters. be, �se n -per-�C-L r.t t t�)- /) m F k c A 11. Roof system to be constructed over bay window. Includes: complete frame, insulation, watershield, roof shingles and custom trim. 12. Remove debris from job site. 13. Workmanship guaranteed for the length of ownership of Fred Colarusso. We 9 w.paoe hereby to furnish material and labor-complete in accordance with above specifications, for the sum of: EIGHTEEN THOUSAND SIX HUNDRED U DRED EIGHTY AND 00/100 ($18,680.00) Payment to be made as follows: PAID UPON COMPLETION Note:This proposal may a wit r if not accepted within 15 days. Authorized Sig Date C1cceptatwe of Y po6cd—The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do Jhe work specified. Payment will be made as outlined above. Authorized Signat rte--CC� (D Date of Acceptance Authorized Signature Date of Acceptance ORTH oNvn o Andover , A9jg O5 r M `t No. 70 . 4 $ = A K _o dover, Mass., COCHICHEWICK V ADRATE D `S U BOARD OF HEALTH 3� ERMIT T D Food/Kitchen 3. Septic System -.. BUILDING INSPECTOR � . THIS CERTIFIES THAT .............. .�..Gt cScSv............ . ....................................... .........�................. . Foundation has permission to erect..... ..................... buildings on . Rough p 9 �p�'�'. ..........1<� Ldi4l..... to be occupied.as.....rAl....... �h.. . ....C.�.�.T"% Chimney provided that the person accepting thi�permit shalespect conform to the terms of the application on file in Final 3. 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 Zoningor Building Regulations Voids this Permit. Rough 9 9 g ,�•� PERMEXPIRES IN 6 MONTHS Final IT lN� ELECTRICAL INSPECTOR UNLESS CONSTRUC O TARTS 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. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations to 600 Washington Street Y Boston MA 02111 www.naass.gov/dia . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): ��r-—IMIE h",,( U01rk) i ' -WoC )6 00, zwc Address: /tom- .. 0. ,-,5cj< /02k City/State/Zip:..LOA.O,rO /V.//, D.253 Phone #:Z&3) -K,32_/V�0/ Arrl an employer?Check the appropriate box: Type of project(required): 1. m aemployer with 4. ❑ I am a general contractor and I 6. 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 forme in any capacity, workers' comp. insurance. q, ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its officers have exercised their 10.❑ Electrical repairs or additions required.] 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.]t employees. [No workers' 13.],Other V'WYLa�tJCj comp. insurance required.) *Any applicant that checks boz#l must also fill out the section below showing their workers'compensation policy information, T Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. xContractors 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: Policy#or Self-ins. Lie.#: ��c(�jZ'7? -j Expiration Date: t Z$' Sob Site Address: �47BRn)C-,QS LQ. YJ.ANDDyF-P- M,4 City/State/Zip: 0/82/04 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required.under Section 25A of MGL c. 152 can Iead 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. I do hereby certify and a pains and penalties of perjury tit at the information provided above is true and correct ,firY !!�zo Signature: Date: �3 43Z-�44 ' Phone# " i 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 I Contact Person: Phone#: ACO® DATE(MM/DD/YYYY) i AC� CERTIFICATE OF LIABILITY INSURANCE 4/12/2011 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(ies) 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 CONTACT Patricia Blais NAME: Financial Insurance Services Inc UVCN o Ext); (603)432-6414 NC No:(603)432-3852 PO Box 950 ADDRESS:Pblais@fisins.com CUSTOMER ID#90001244 Derry NH 03038 INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A National Grange Insurance Cc INSURER B:Peerless Insurance Co Tri-State Window & Siding Co INSURER C: PO Box 1028 INSURER D: INSURER E: Londonderry NH 03053 INSURER F: COVERAGES CERTIFICATE NUMBER:11-12 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 MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE IA SR SWVD POLICY NUMBER UBR POLICY EFF MM/LDD//YYYI LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 11000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED 500 000 PREMISES Ea occurrence $ � A CLAIMS-MADE F] OCCUR MPT2995U 4/16/2011 4/16/2012 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 $ POLICY JE� LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO A ALL OWNED AUTOS 1T2995U 4/16/2011 4/16/2012 BODILY INJURY(Per person) $ BODILY INJURY(Per accident) $ X SCHEDULED AUTOS PROPERTY DAMAGE $ X HIRED AUTOS (Per accident) X NON-OWNED AUTOS Uninsured motorist combined $ 1,000,000 Non-owned $ - UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATIONS OTH- AND EMPLOYERS'LIABILITY Y/N T RY LIMIT E ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ B IM9827743 11/25/2010 11/25/2011 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town of North Andover Massachusetts 120 Main Street North Andover, MA 01845 AUTHORIZED REPRESENTATIVE Sam Fragala/PAT 2' ACORD 25(2009/09) ©1988-2009 ACORD.CORPORATION. All rights reserved. INS025(200909) The ACORD name and logo are registered marks of ACORD I ACCO CERTIFICATE OF LIABILITY INSURANCEDATE(MM/DDNYYY) `...� 4/12/2011 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(ies) 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 CONTACT Patricia Blais NAME: Financial Insurance Services Inc PHONE X ; (603)432-6414 FA No:(603)432-3652 PO Box 950 A�DRESS:Pblais@fisins.com PRODUCER A0001244 CUSTOMER I Derry NH 03038 INSURERS)AFFORDING COVERAGE NAIC# INSURED INSURERA.National Grange Insurance Cc INSURER B:Guard Tri-State Window & Siding Cc INSURER C: PO Box 1028 INSURER D: INSURER E: Londonderry NH 03053 INSURERF: COVERAGES CERTIFICATE NUMBER-CL114503548 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 MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE ( RENTED PREMISESS Ea occurrence) $ 500,000 A CLAIMS-MADE ElOCCUR MPT2995U 4/16/2011 4/16/2012 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY PRO JECT 7 LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ A ALL OWNED AUTOS 1T2995U 4/16/2011 4/16/2012 X SCHEDULED AUTOS BODILY INJURY(Per accident) $ PROPERTY DAMAGE $ X HIRED AUTOS -(Per accident) X NON-OWNED AUTOS Uninsured motorist combined $ 1,000,000 Non-owned $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ B WORKERS COMPENSATIONWC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N T R I T ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) TRWC222290 4/4/2011 4/4/2012 E.L.DISEASE-EA EMPLOYEq $ 100,000 If 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) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Fred Colarusso 125 Bridges Lane AUTHORIZED REPRESENTATIVE North Andover, MA 01845 1 Sam Fragala/DEBRA ��� ACORD 25(2009/09) ©1988-2009 ACORD CORPORATION. All rights reserved. INS025(200909) The ACORD name and logo are registered marks of ACORD Board of Building ltt-pilau s,and Standards 4 gxe&Vm �. Cbr stru i i Supervisor License Office ee ofConsutaerAftairs-.4 Business Requtatiot A. ^facense:,#":$ 102828 . WE IMPR@VFIT CQNTRAG'fQR s afi r. Registration�'�'r4681 AERIC$BENN TT F Y Expirat fs 13 Suppe A-m '-� i7 � .E TRI-STATE WIN t,1631N1`QEGE�NOf?I�4#.ANE ��:� � IMANC1-tES'C E�2, NI'i:t33Tt9 4 ERIC BEfNtrf8 4 •k .g., P.O.80) ^ fi `ation* 1114712012 LONDONDERRY;Nt-f�53= Lndc�secretary � C.14"r lfwfir, Tr#: 102828 � I •