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HomeMy WebLinkAboutBuilding Permit #145 - 125 SHERWOOD DRIVE 8/19/2011 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: 7r. Date Received Date Issued: 'l7 IMPORTANT:Applicant must complete all items on this page LOCATION Pri _ PROPERTY OWNER r Unit 4 Print MAP NO/d,5esPARCEL: 7Z0NING DISTRICT: Historic District yesGno Machine Shop Village yes100 year-old structure yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ane family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic El Well ❑Floodplain 0 Wetlands 0 Watershed District ❑ Water/Sewer _ DESC TION OF WORK TO BE PERFORMED: Lo e colon �� �� (Identification glease Type or Print Clearly) OWNER: Name: / Phone: _ Address: / _ CONTRACTOR Name:f/�/�q � ' , /� �� ; ,hone: , Address: = l Supervisor's Construction License: Exp. Date: Home Improvement License: Z&?2 7 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: $_ C FEE: �- Check No.: YReceipt No.: NOTE: Persons contra ting with,unregst ed contractors do not have access to the guars ty fund �S_ignature of A" ent�Owner. -g - �/. �' Signature of contrae_ r� ;, 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 i CONSERVATION Reviewed on Signature COMMENTS e 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.$10041000 fine NOTES and DATA— For department use ❑ Notified for pickup - Date Doc:.Building Permit Revised 2011 June/mi 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 o Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract o 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 o 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 2008mi T — Location / S� S h C4W,9 00'---� No. .��� Date r NOR71r TOWN OF NORTH ANDOVER O Certificate of Occupancy $ Building/Frame Permit Fee $ U Foundation Permit Fee $ d Other Permit Fee $ TOTAL $ Check #t (! 2Cr � t Building Inspector AORTH Town of : Andover .. 0 No. o dower, 1Vlass., CI • COCMICKE WICK y�. ADRATED `S U BOARD OF HEALTH PERMIT. T D Food/Kitchen Septic System • BUILDING INSPECTOR THIS CERTIFIES THAT.......... j.. .. 1�� .......... .....L� y........'.. ..�....................................................... Foundation has permission to erect........................................ buildings on ......lal; ......... a. ........ �.... Rou h g to be occupied as —1,.64N Ato 1! Chimney ... ..... .................................................... provided that the perso cce ing this permit shall in every respect 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 ' PERMIT EXPIRES IN 6 MO S ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO T _ Rough , .. .....................................................:.................................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal No Lathing or Dry Wall To Be Done FIR_ E_DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. 014 ENTERPRISES 1199. ' EXTERIOR AND I NTEI r 617.623.4790 D 411A HIGHLAND AVE. SOMERVILLE, MA 02144 CONTRACT Property Location 125 Sherwood Dr. North Andover, MA 978-387-2590 Linda Pegalis August 17, 2011 Dear Mrs. Pegalis, Pursuant our meeting I have prepared the following contract for replacing your windows. Below is a description of the work to be performed. WINDOWS REPLACEMENT 1. Replace two windows above garage left side of the house.. 2. Replace one window at the right side of the house(piano room). 3. Replace one window first floor(office). 4. Replace two windows in the second floor(Alex's bedroom). 5. Replace one window in the second floor(Eric's bedroom). 6. Replace one window in the second floor(Guest bedroom). 7. Replace one window on the bedroom above garage.. All windows will be Harvey double hung vinyl windows energy efficient. We Are a General Contractor Licensed and Fully Insured.HIC # 161337- CSL# 102210 Clean all debris produced by the job. Total Cost With Labor,Material and all fees and permits $5,000.00 Payment methods: 40%when we start the job, 40% on half way and balance will be due at completion the job period. Start Date: We'll start the job on August 22,2011 weather permitting and we'll finish by August 27, 2011 weather permitting. All home improvement contractors and subcontractors shall be registered and that any inquires about a contractor or subcontractor relating to a registration should be direct to: Office of Consumer Affairs and Business Regulation Ten Park Plaza, Suite 5170 Boston,MA 021116 Phone 617-973-8700 Dome owner's has three day cancellation rights under MGL c93 s48; MGL c 14013s 10 or MGL c 255d s 14 as may be applicable. All warranties on the owner's right under the provision of and MGL c 142A. Warranty: Magic Painting Ent. Inc. We guarantee all material used in this proposal to be as specified above and all the work will be performed with professional manner. Any variation from the plan or alterations requiring extra labor or material will be performed only upon written order and billed in addition to the sum covered by this proposal. If any problems occur in a period of two years we'll cover the cost of all labor and material necessary to correct the problem and meet the customers satisfaction. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES 1. Whether any lien or security interest is on the residence as a consequence of the contract. 2. An enumeration of such other matters upon which the owner and contractor may lawfully agree. 3. Any other provisions otherwise required by the applicable laws of the commonwealth. 4. Permit Notice: Contractor will obtain all necessary construction related permits. 5. Home Owner who secure their own construction related permits or deal with unregistered contractor shall be exclude from access to the Guarantee Fund. Acceptance of Proposal the above specifications are satisfactory, and (we) hereby authorize this work i 1 (Will Wiva Co ta, Manager Linda Pegalis, Home OWner 08/15/2011 09:22 5087527172 d CERTIFICATE OF LIABILITY INSURANCE DATE(MM(D 11, ���RIS 0811612 THIS CERTIFICATE IS ISSUED AS MATTER OF INFORMATION PRODUCER ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Blackstone Insurance HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 37 Harvard Street Suite 213 ALTER THE COVERAGE AFFORDED EIY THE POLICIES BELOW. Worcester, MA 01609NAIL$ INSURERS AFFORDING COVERAGE 11 SURERA: A,E,I,C' INSURED i Magic Painting Enterprises Inc. INSURER B! 411A Highland Avenue INSURER C: j Somerville,MA 02144 INSURER O: INSURER E: COVERAGES THE POLICIES OF INSURANCER CIOTED NDITEION OF ANY CONTRACT OR OTHER DO UMENT WITH RESPEC THE INSURED NAMED ABOVE FOR WHICH THIS CERT1 KATE MAY BE SUED OR MAY ANY REQUIREMENT,TERM 0 CH PERTAIN,THE INSURANCE LIMITS SHOWN MAY HAVE POLICIES DESCRIBED HEREIN IS REDUCED BY PAID CLAIMS.SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF$U POLICIES.AGGREGATELIMITS LTR INSRD TYPE OF INSURANCE POLICY NUMBER EACH OCCURRENCE 8 GENERAL LIABILITY QA PREMI ES Roeeurence $ COMMERCIAL GENERAL LIABILITY MED EXP(An onA Person) $ EICLAIMS MADE R OCCUR PERSONAL&ADV INJURY S GENERAL AGGREGATE 1 PRODUCTS•COMP70P AGG S GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PROJECT LOC AUTOMOBILE LIABILITY COMBINED A $IN01-E LIMIT Ctlent) $ ANY AUTO ALL OWNED AUTOS BODILYP r emurl) RY a SCHEDULED AUTOS aoDiLY HIRED AUTOS (PCf OCCIden�1Y ) S NON-OWNED AUTOS PROPERTY DAMAGE 3 (Per accldcM) AUTO ONLY-EA ACCIDENT S GARAGE UABILITYEA ACC S ANY AUTO AUTO O11 NLY: AGG AGG S EACH OCCURRENCE $ EXCES9fUMBRELLA LIABILITY AGGREGATE a OCCUR CLAIMS MADF $ R DEDUCTIBLE S RETENTION TORY LIMI S ER WORKERS COMPENSATION AND100,000 EMPLOYERS LIABILITY WCC5008137012011 4/112011 411/2012 E.I.EACH ACCIDENT $ A ANY PROPRIETORIPARTNERIFXECUTNE100,000 E,L.DISEASE.EAEMPLOYEE $ 500,OOD OFFICERIMEMSPR EXCLUDED? It ye9CI,describe under E.L.DISEASE-POLICY LIMI $ SPEAL PROVISIONS below OTHER CANCELLATION CERTIFICATE HOLDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Town of North Andover DATE THEREOF,THE IS9UIN01NSURER WILL ENDEAVOR TO MAIL 15 DAYS WRITTEN 1600 Osgood Street NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SMALL North Andover, MA 01845 IM1509E NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,rr6 AGENTS OR REPRESENTATIVES. AUTNORTiEO REPRESENTATIVE I t C ACORD CORPORATION 1BOB ACORD 25(2001109) I f . { The Commonwealth of Massachusetts Department of Industrial.Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov1dia Workers' Compensation Insurance Affidavit: 13uilders/Contractors/lElectri.cians/Plumbers Applicant Information Please Print Legibly NaMC(Business/Organization/Individual): Address: /���9N� �kl City/State/Zip:f l,Q,/1%G (�I Com, 0p�M one Are you an employer?Check the appropriate box: Type of project(required): 1 Itff-I-em 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 2.01 am a sole proprietor or partner- listed on the attached sheet.1 7• ❑Remodeling ship and have no employees These sub-contractors have 8. []Demolition working for me in any capacity. workers' comp.insurance. 9. [J 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 I LE]Plumbing repairs or additions myself.[No workers'comp. c. 152,§1(4),and we have no 12.❑Roofrepairs insurance required.]t employees.No workers' comp.insurance required.] 13.❑Other *Any applicant that checks box#1 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. #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. lam an employer that is providing workers'compensation insurance for my employees. Below is the policy andjob site information. Insurance Company Name: IIVAex __5 �D-✓4 !/!�(✓��� Policy#or SeIf-ins.Lia �0o'6713 7 of� Expiration Date: DI G� Job Site Address: 5,6!t -9 City/State/Zip:_ 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. Ido hereby certify under the pa'�and penalties of perjury that the information provided above is true and correct. Si ature: ©� Date: Phone#: /� J �HO Offic:1se only. Do not write in this area,to be completed by city or town official City wn: Permit/License# -Issuihority(circle one): 1.BoHealth 2.Building Department 3.City/Town Clerk 4.EIectrical Inspector 5.Plumbing Inspecto6.OtContrsoin: Phone#: I �� -\ Office of Consumer Affairs&Business Regulation. HOME IMPROVEMENT CONTRACTOR Registration:,--?1.61337 Type: Expiration: -`_10/14/2012 Private Corporatio ZZ iY' MAGICPAINTINGENTERPRISES LNC. WIVALDO COSTA, _ 23 R TH0RNDIKE ST#2 EVERETT, MA 02149'> Undersecretary .t, artmcnt of Public Sate setts Dch .. chuStandards .�.:-,. MassaI Board of Building Re!e Iat visor sLicensei Construction Sup License: CS 102210 �I i WIVALDO COSTA 411A HIGHLAND AVE 177 SOMERVILLE, MA 02144 Expiration:. 8/8/2012 T r#: 790 r--( ummissiuocr—_