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Home My WebLink AboutBuilding Permit #100-13 - 125 SHERWOOD DRIVE 8/3/2012 BUILDING PERMIT °F "°pT" qti ryE�rl. ..:.676 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: / (J Q 4s Date ReceivedriED SHCHUS�� Date Issued: -3 IMPORTANT:Applicant must complete all items on this page ".LOCATION /�S� S#P-n-L<110 o �� . �j� Print PROPERTY_ 'OWNER z -�M/,J Print 'MAP NO' S G PARCEL:9,2 ZONING DISTRICT:(t-2 Historic Disteictyes no 'Machine Shop Village yes, no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One famil Addition Two or more family Industrial Alteration No. of units: Commercial Re air, re lacement Assessory Bldg Others: Demolition Other Septic =- Well - Floodplain Wetlands Watershed:Distdcf Watef/Sewer DESCRIPTION OF WORK T BE PREFORMED: d l O J m Identification Please Type or Print Clearly) OWNER: Name:_,-�, 2z S Phone Address: 2-5 E(c woo CONTRACTOR Name: Rhon_ej��/ --_ Y�,4-2-/133 Address: 0.2-(2_5 Supervisor's Construction License: -r-S Oq6 Exp. Date: V/_/ 3-2,o 11 Home Improvement proveent License: /. �3 Exp. Date:_O(o:-2r 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: $ �/, goto oo FEE: $ Check No.: Z Receipt No.: %��3-�'Z NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund - --- 9 _ . - Si nature of A entfOwner - - 9 9.. Si nature of contractor_ 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 I i COMMENTS i HEALTH Reviewed on Siqnature I 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 MainStreet Fire DepartiMent:signatureldate COMMENTS i Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: I 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) i f ❑ 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:INSPECTIONAL SERVICES DEPARTMENTMFORM07 Revised 2.2008 Location� 0 /M Z�/', u- No. � Date e p/�,// • - TOWN OF NORTH ANDOVER . " a Certificate of Occupancy $ '° Building/Frame Permit Fee $ ,O 0 ' Foundation Permit FeeOR $ y 'k Other Permit Fee $ TOTAL $ Check# , 25582 Building Inspector NORTF{ Town of ` E ,, ndover O �• I No. Zo hver, Mass, �YIL COC NIC HI WICK "�• AERATED I '�C S V BOARD OF HEALTH Food/Kitchen PERMIT T LD f Septic System G l � BUILDING INSPECTOR CERTIFIES THAT ....... .......................................... ................................... Foundation has permission toerect .......................... buildings on ...................... Rough t0be occupied as ..........✓........:... l�....�...:........................................................................... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application 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 i Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. .Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO TARTS 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 s Street No. Smoke Det. SEE REVERSE SIDE GRANITE STATE INSURANCE COMPANY 0070553-00 WC 009-94-7734 13102 --------------------------------------------- 013-66-0911-00 d:101111111 k,1114:11119 s 1:1 S HERBERT F I ALHO C H A R T I S tT�F 16 CANNELL PLACE - EVERETT, MA 02149-0000 A Chartis company EXECUTIVE OFFICES: SEE EXTENSION OF ITEM 1. OF THE INFORMATION PAGE - WC990610 175 Water Street New York, NY 10038 AL PONTE INSURANCE AGENCY INC WORKERS COMPENSATION AND EMPLOYERS 819 CAMBR I DGE ST LIABILITY POLICY INFORMATION PAGE CAMBRIDGE, MA 02141-1428 INSURED IS PREVIOUS POLICY NUMBER INDIVIDUAL NEW OTHER WORKPLACES NOT SHOWN ABOVE: SEE EXTENSION OF ITEM 1. OF THE INFORMATION PAGE - WC990610 ITEM 2 POLICY PERIOD 12:01 A.M.standard time at the insured's mailing address FROM 09/01/11 TO 09/01/12 ITEM 3 A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: MA B. Employers Liability Insurance: Part Two of the policy applies to the work in each state listed in item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident $_ 100,000 each accident Bodily Injury by Disease $ 500.000 policy limit Bodily Injury by Disease $ 100.000 each employee C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here: SEE ENDORSEMENT - WC200306A D. This policy includes these endorsements and schedules: SEE EXTENSION OF ITEM 3.D. OF THE INFORMATION PAGE - WC990612 ITEM 4 The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. Premium Basis Rate Per Estimated Classifications Code Number Total Remuneration $100 OF Re- Premium Annual n 3 Year muneration Annual E]3 Year SEE EXTENSION OF ITEM 4. OF THE INFORMATION PAGE - WC7754 TAXES/ASSESSMENTS/SURCHARGES $71 EXPENSE CONSTANT(EXCEPT WHERE APPLICABLE BY STATE) $33F MA MINIMUM PREMIUM $500 MA TOTAL ESTIMATED ANNUAL PREMIUM 1 549 If indicated below, interim adjustments of premium shall be made. 1_! Semi-Annually I I Quarterly n Monthly DEPOSIT PREMIUM 09/30/11 ASSIGNED RISK Issue Date 39967 (Rev'd 04/08) Issuing Office Authorized Representative WC 00 00 OIA -" ✓fie �ir arnJrrwozcueall/a ��/��aaaac/uiaelta~ �. License or registration valid for individul use only t Office of Consumer Affairs&Bdsiness Regulation t I before the expiration date. If found return to: I r HOME IMPROVEMENT CONTRACTOR P_ Registration: :,-156373 Type:' Office of Consumer Affairs and Business Regulation 4 4 10 Park Plaza-Suite 5170 _ = Expiration: '6/25/201�. Individual o Boston A STOGRIECO_='= MA 02116 = =_ , i AUGUSTO GRIECOt- 81 FIRST STREETS` MEDFORD, MA 02155, No alid without signature . . Undersecretary 7W Massachusetts Department of Public Safety Board of Building Regulations and Standards -_— Construction Supervisor .Unrestricted-Buildings of an License: CS-096161 contain less than 35,000 cubic feet(grOUP 991m3Which ��` � s AUGUSTO A CC�RIECO enclosed space. of 81 FIRST STREET ` MEDFORD f1A 02155 E r Commissioner Expiration Failure to possess a current edition of the Massachusetts 01/13/2014 State Building — i g Code is cause for revocation of t'iis license. For DPS Licensing information visit: W NW.Mass.Gov/DPS - J . J j" J, The Commonwealth of Massachusetts Department of Industrial 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 Name (Business/Organization/Individual): ,/SFn-Yt1 Address: 2 slo s City/State/Zip:)7 n xr -2,t - Esc, CAG-1 Phone#: t- Are you an employer?Check the appropriate box: Type of project(required): 1.9 I am a employer with._ 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.El am a sole proprietor or partner- listed on the attached sheet.I �• ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9. []Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions required.] officers have exercised their right of exemption per MGL 11.[]Plumbing repairs or additions 3.El I am a homeowner doing all work g p myself.[No workers' comp. c. 152, §1(4),and we have no 12.E]Roof repairs insurance required.] 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. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors 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.Lic.#: 01 _ 6 C>qtl O a Expiration Date: i Ci /State/Zi - S cc/ tUU ty p:.��i�16Aft_ Job Site Address:-.--- 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 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. T do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Si natur Date: Zd�L Phone#: /-6�, u� 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 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 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 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(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 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 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 Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel.#617-727.4900 ext 406 or 1-877-MASSAFE evised 5-26-05 Fax 4 617-727--7749 t HEBERTH FIALHO AUGUSTO CREIGO 07-25-2012 50 BURNSIDE ST-LOWELL-MA 01851 FONE#781-8442183 CELL I LINDA PEGALIS 125 SHERWOOD DRIVE-NORTH ANDOVER-MA (JOB DESCRIPTION) *STRIP OLD ROOF SHINGLES. *STRIP ALL THE OLD METAL EDGES DRIPEDGE. *STRIP ALL THE OLD ICE AND WATERSHIELD OF THE EDGES,AND VALLEYS OF HOUSE. *INSTALL NEW BLACK FELP PAPER ON THE ENTIRE ROOF OF HOUSE. *INSTALL NEW#30 YEARS ARCHITECTURAL ROOF SHINGLES. *INSTALL NEW WHITE METAL DRIPEDGES ON THE EDGES OF THE ROOF. *INSTALL NEW ICE AND WATERSHIELD#3 FEET ON THE ENTIRE BOTTOM,AND ON ALL THE ROOF VALLEYS. *INSTALL NEW RIDGE VENT ON THE MAIN ROOF OF HOUSE. TOTAL PRICE FOR THE JOB IS$11900.00 DOLLARS WHEN SIGN THE CONTRACT IS DUE$OFS,950.00 DOLLARS WHEN THE JOB IS DONE THE REMAIN BALANCE IS DUE OF5,950.00 DOLLARS CUSTOMER SIGN HEBERTH FIALHO XL ALL THE MATERIALS WILL BE PROVIDED BY THE CONTRACTOR. MATERIALS TO BE USED FOR THE JOB IS#30 YEARS ARCHITECTURAL ROOFING SHINGLES THIS PRICE DOES NOT INCLUID THE BACK SUN ROOM PORCH HEBERTH FIALH O WILL GIVE GUARANTEE ON LABOR ONLY FOR#7 YEARS IN CASE OF WATER LEAK.