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Home My WebLink AboutBuilding Permit #1247-16 - 127 ADAMS AVENUE 5/1/2018 i p10RTN L (� �� 1',/ BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION o ` 7z,/ 7 0 _ Permit No#: ATE Date Received �,�° H. �SSNCHUS�� Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION ��-n'� Ay e—n not PROPERTY OWNER �� ' �-�0. �`�Gt.rrl, S Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no 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 ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: r , ( 5- i Identi cation- Please Type or Print Clearly OWNER: Name: Me, 1`n Q- ar hl S. Phone: 912 -7dN-1- 3 4 Address: Contractor Name: T � -' P- O'Phone: 50S-4K-003I Email: c�-rvu, c�r� Address: 1cxAe 4--, qeCL&J- M OW 011y Supervisor's Construction LicenselYrok ex 11 An Exp. Date: Home Improvement License: arcL ct15 Lc: Exp. Date- 07- 1 w 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: $ 7,� d0 FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access t the guar n n Signature of�g -_ _ T Location l fi 7 5 a10,1 No. /,2 �/7 /E, Date • - TOWN OF NORTH ANDOVER . ,.A. • 0", �. • Certificate of Occupancy $ Building/Frame Permit Fee $ G% Foundation Permit Fee $ Other Permit Fee TOTAL $ 4+_ Check# C1 � ':ci Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL , I Public Sewer ❑ Tanning/MassageBody 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 I PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS f CONSERVATION Reviewed on Signature COMMENTS o k I HEALTH Reviewed on Signature COMMENTS t Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes i Planning Board Decision: Comments Conservation Decision: Comments Water&Sewer Connection/Signature&Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street DEPfgR�TMENT� yTlernp ®umpsteraonzsifeyes I�L�ocatedat 24tMainStreet, tFire ®apartment`Alb nature'%date____ _ t _ l I I � Dimension r i f a Number of Stories: Total square feet of floor area, based on Exterior dimensions. I Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No ®ANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— For department use) I l I i =LUINotified for pickup Call Email f Date Time Contact Name Doc.Building Permit Revised 2014 -- - F Building Department ? The following is a list of the required forms to be filled out for theappropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits 4 Building Permit Application 4. Workers Comp Affidavit >a. Photo Copy Of H.I.C. And/Or C.S.L. Licenses a� Copy of Contract 4 Floor Plan Or Proposed Interior Work Engineering Affidavits for Engineered products OTE: 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 4r Copy Of Contract Floor/Cross Section/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 OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) 4, Building Permit Application 4, 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 2012 IECC Energy code Engineering Affidavits for Engineered products OTE: 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 I 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 Doe:Building Permit Revised 2014 NORTH Town ofV E 4 L Andover 0 •� '•tir 't h ver, Mass 'lii9s RATED r'P��,`'�y U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT ........ ... ......................................................... BUILDING INSPECTOR buildings on .. .. �... ° ''S • J Foundation has permission to erect....................... l ................................................. Rough to be occupied as ...... /.Il'.. ..�1.:./:.£>.4. .............'....... .,`1..' !.�GJ.?.t............................... 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough Service ............ 0 .................... BUILDING INSPECTOR. Final 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. A- We are fullyinsured �( 4 Evergreen Lai' UC� Hopedale, MA 01747 and licensed. Hopedale,Email: infioC�lctroofing.com T f f 22 Ictroofingxom i TOLL FREE: 1-877-211-0212 MEMBEROFF -508-488-6639 C- FAX:CE: 508-488-6640 MOO) 24 MA- CT HIC 0628RI-HIC 369481C 166876 Quality Products + Quality Installations = Complete Satisfaction P O O SUBTTED TO Q HO HONE: DATE: lJ�=-Y�f STREET" CELL PHONE: EMAIL: ) 19�Z ^5- CIT�TATE P CODE n f REPRESENTATIVE: CELL: We hereby submit specifications and estimates for Strip main home down to bare boardsfplywood. Projectmeasuressq feet Replace rotten boards/plywood @ 1.50 per sq ft.($50.per sheet of plywood if needed) eas New roof system to consist of -6 feet of High Tamp/High Talc ice and water barrier with full fascia wrapapplied to all a Ile as and a roof p ions (skylights,vent pipes,chimneys,step flashing). -Diammnd Deck High performance undertayment to be applied to remaining roof deck surface. -8"R•.etal Drip edge installed on all eaves and rakes to allow for proper water diversion into existing gutters. a•-Apply 40 years CertainTeed Landmark Pros Shingle in one color of choice_Lifetime warranty. -App'ry 60 years CertainTeed Landmark Premium°Shingle in one color of choice for an additional$ .Lifetime warranty. -Install CertainTeed vent to entire length of ridge. ��' -Replace flashing on Chimney and seat all flashing with Geoce112300 Roofing sealant J -C Ridga with matching Hip and Ridge shingle accessory cap from CertainTeed r All trash will be removed via on site dumpster(s).Ground will be fully cleaned and left in same condition as when we arrive. �. 15 yr Watertight guarantee offered by LCT V Lifetime CertainTeed ShingleMaster warranw witi't SureStart Protection®fully transferable applies to the entire CertamTeed Integrity Roofing System° V e oppo0e h y to furnish material a labor -complete yr iacoordappe with atimflspectfications,for the the sum of dollars, _ Payment to be made as tollows 'NOTICE TO OWNER" Under the Mechanics Lien law,any contractor,subcontractor,laborer,matedalman,or other person who helps to Improve your an is not:paid for his ervices or material,has a right to enforce his claim against your property. / Under the law,you may protect yourself against such claims by filing,before commencing such work of improvement,an original contra for the work of improvement of modification thereof,in the office of the county recorder of the county where the property is situated and requiring that a contractor's paym.Tt bond be recorded in such office. Said bond shall be in an amount not less than tii ty percent(50%)of the contract price and shall,in addition to any con ' for the per, anoe of the contract, conditioned for the payment In full of the claims of all persons fumishing labor,services,equipment or materials for the work deson ed in id Authorized Signature ZItCeltaTCtC Of PT'OP00al--rhe above prices,specifications Note this proposal may be withdrawn and conditions are satisfactory and are hereby accepted.You are authortzed to do by us if not accepted within days the work as specified.Payment will be made_ as outlined above. / ' Owner Signa"?—, /16 /� Date of Acceptance / l� � Owner c � s /o/ 4# The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations I 600 Washington Street Boston,AM 02111 www.mass gov1dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(BusineNdOrganization!Individual): --T 06 na 3 rV l CC,- Inc, Address: Cts City/State/Zip: +? 0-1 e, y► 7y 7 Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.0,I am a employer with 151 4- ❑ 1 am a general contractor and 1 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 for me in any capacity. workers'comp.insurance. 9. ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their I0.❑ Electrical repairs or additions 3.❑ 1 am a homemvrter doing all work right of exemption per MGL 11.❑Plumbing repairs or additions j myself.[No workers'comp. e. 152,§1(4),and we have no 12.EZ Roof repairs insurance required.]t employees.fNo workers' 13.0 Other comp.insurance required.] "Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t liomeowners who submit this affidavit indicating thry are doing all work and then hire outside contractors must submit a new alTidavit indicating such. *Contractors that check this box must attached an additional sheet showing the name orthe sub-contractors and their workers'comp.policy information. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: AC, i Policy#or Self-ins.Lic.#:IM Expiration Date: — I Job Site Address: VI /UaMS City/State/Zip:_ MA j 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. 1 do hereby ce y r t! ns and p realties of perjury that the information provided above is true and correct Si nature: p l Date: Phone i Official use only. Do not write in this area,to be completed by city or town official i City or Town: PermitfLiccnse# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.CityrFown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: f ACo LIABILITY INSURANCE /2016 CERTIFICATE OF 2/18/2016 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, 17C-END 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(les)must be endorsed. ff SUBROGAMON 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 cewficate buider in lieu of such endorsement(s). CONTACT House PRODUCER NAME STEPHEN RSH INSUI2A1TC8 PHONE (508)485-1926 FAX((o (508)485-8519 r--MAa 9 Monument AVE ADDRESS: AFFORDING COVERAGE NAIC II Marlborough MA 01752 IN5URERAWOXthland Insurance INSURED INSURER S- Lct Construction 6 Service INSURER C: 144 Hopedale St INSURERD, INSURER E: ,Hopedale 14A 01747 61SURERF• COVERAGES CERTIFICATE NUMBER:CL1612101488 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_ IrRSR TYPE OF INSURANCE WD POLICY NUMBER POLICY E� POLICY EXP LIMITS LTR ! X COMMERCIAL GENERAL LABILITYI f FACE OCCURRENCE S 1,000,000 ED A ;CLAIMS MADE �OCCUR PREMISES R omarenm $ 100,000 X �6pDg7 10/11/2015 10/11/2016 MED EXP(Any am posen) $ 5,000 i PERSONAL&ADVINJURY $ 1,000,000 GN1 AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 PRODUCTS-COMPIOPAGG I S 2,000,000 g'POLICY❑JECT F-1 LOC EmWpyeeBalefits $ OTHER: AUTOMOBILE LIABILITY COMBIN@ SINGLE LIMB $ t ANY AUTO BODILY MURY(Per person) b ALL OWNED SCHEDULED I 6 DDILY INJURY(Per amdent) S AUTOS AUTOS PROPERTY DAMAGE $ NON-OWNED HIRED AUTOS AUTOS Per a $ UMBRELLA UAB HOCCUR EACH OCCUR R6VCE S I EXCESS UAB CLAIMS-MADE AGGREGATE $ I D® RE-..ON$ $ {WORKERS COMPENSATION PERSTAH 07t1- f AND EMPLOYERS LIABILITY AC I YIN EL EACH ACCIDENT S ANY pROPR1ETOR)PAFtTNER1EXECUIfVE I 11N/A OFFICEMMEMBER EXCLUDEW EL DISEASE- (M �in HH)� FJa EMPLO S BT�die unQer IF DISEASE-POLICY LIMIT S DESCRIPTION OF OPERA ROM eebw DESCFWM014 OF OPERATIONS!LOCATIONS f VEHICLES(ACORD 101,AdEMna1 RemaFUS SCh Bute,mar beattached it mm spy's sequbmd) Fred Falcone Roofing and Property Services LLC is listed as an additional insured with respects to general liability. I 'I ! 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. AUTHORIZED REPRESENTAMW li Colleen Power/GERSH O 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS025 nnl4mi ' A RD® CERTIFICATE OF LIABILITY INSURANCE DATEFWDI o4n4rzo16 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), AUMRIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the pol-Wles)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the Policy,certain Polite may require an endorsement A statement on this certificate dots not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER cA0.NT.AcT Karin Afagao STEPHEN W.GERSH INSURANCE AGENCY =O No . (508)4&5,4926 of No EMAIL kava insurance.Com 9 MONUMENT AVENUE M AFFORDING COVERAGE NAZCA MARLBOROUGH MA 01752 INSURERA: ACADIAINS CO 31325 INSURED INSURE Re: LCT CONSTRUCTION&SERVICES INC INSURER C: INSURERD: 144 HOPEDALE STREET INSURER E: HOPEDALE MA 01747 INSURER F. COVERAGES CERTIFICATE NUMBER: 44832 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. LTR TYPE OF9MURANCE POLtCYAnDL SUER NUMBER — POLtCYI3F YOIP LnWS COMMOMIALGENERALLIASIIJITY I £ACHOCCURRENCE S DAMAGE TO RENTED I CLAIMS-MADE r_1 OCCUR PREMISES Ma occurrence) S MID EXP(Any one person)S NIA PERSONAL BADVINJURY S GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ JET n LOC PRODUCTS-COMPIOP AGG S POLICY El $ OTHER AUTOMOBILELJABIL TY COMB(�SiNq.E LIMIT S ANY AUTO BODILY INJURY(Perpersoo) $ ALL OWNED SCHEDULED NIA BODILY INJURY(PeracWM) S AUTOS (AUTOS HNON-OWNED - EHIREDAUTOSAUTOS5 UMBRELLA LIAR 1 OCCUR EACH OCCURRENCE S EXCESS DAB CLgIMS-MADE NIA AGGREGATE S DED RETENTIONS I I IS WOR10ERS COMPENSATION X nrtrTE � AND EMPLOYERS'LLI BUTT ANYPROPRIEToRwARTNFRIEXECUnVE Y f N EL EACH ACCIDENT S 10O,QOO A OFRCERIMEMBEREXCLUDED'1 NIA NIA MAAIZM1081 03@612016 03/2612017 (Mandatory in NH) E.L.DISEASE-EA EMPLOI S 100,000 desonbe RATIONS EL DISEASE-POUCYUMrT s 500;000 DESCRIPTION OF j WA DESCRIPTION OF OPERATIONS I L OCATIONSI VBVCLES(ACORD 101,Adel Remarks Schedule,may be alladmed Ir more space Is requrred) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(Unless the expiration date on the above policy precedes the issue date of this certificate of insurance)_ The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at vnwr_mass.govfinnlfwodcers-compensationfmves#gationsf. r CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELVER® IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTH0t0ZEDREPRE.SENTATIVE Dante!M.Croiiv ey,CPCU,Vice President—Residual Market—WCRIBMA O 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD i I I ii office of Consumu Affa1T5 and Bu6inesS Regaj Moll 10 Farb Plgza-Sure 5170 Boston.,Masswhusets 02116 Home Improvement COntractor Registration - - Re9istmuon: 466876 Type: Corporation EJ(R111Of1: 7/4612026 Tc# 254613 LCT CONSTRUCTION&SERVICES;--lNQ- -- _ SARA GASTRO _. 144 HOPDAL_E ST - - HOPEDAL.E.MA 01747 _ — Update Address and retmted.Mark reason for Change. address J Renewal d£mptaymer't f Lost Card I MAI C- 2DM-05F" i I GS-107753 I DERBKRINGUETTE 132?vJOI i 41 NOCK SMET Gard.ner MA 014" �- 1111'!1201` • I, I