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HomeMy WebLinkAboutBuilding Permit #678-12 - 13 BELMONT STREET 3/27/2012 NORTFf BUILDING PERMIT o�t�LED qq.� TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received ^„TED �SSACH�15�� Date Issued: I IMPORTANT Applicant must complete all items on this page 3,'fiTi^ad,'r �10*1 .. - K �ki' am 51.3 '��'�:x'�� ,�k�g� � ���,�� ��� az=�T' � �?s:,• .� tft�°�' � s E 1�ti� � "�>�A'..-��'���� " '�� ''� 45�`�3f�. WN `��PRT� � 'xP. RCIti. ZONLNOtISTRT'�� � �storic �st�ict � �a es ' Y .��'� TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family El Addition .P-Two or more family ❑ Industrial [I Alteration No. of units: ,� ❑ Commercial A?Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other F. - " FID 1111WEtlow adS � �x ��aB#Shd ©lIC ; � a77a 'N. z - �' VT3s �„°' '��'��`"� ����-11�tater`ISew�r��� �'��• .__ �.� �z�.. ...,. � N� �:�„��:� .3�. DESCRIPTION OF WORK TO BE PREFORMED: Identification Please Type or Print Clearly) rS OWNER: Name: A Phone: 7e� G� Address y a ,�- ;`r-.�`.r-'�. �� .�„3� ?'s �x�-�„"��' � �.'' �� r'� y�•F"�'�� -��+r <�'""s' ,x'� �5�'�#� x'$.� z� "`.r� z r �� CONTRICTORamei> ' k A 11 Phoney a "+ �'`�✓ 'fir- ��x, „����,w,. l� �.��,'*ya,aN� �� ,.r,:�r,., T' t:,,per, F :.� - t„zr�'�: "�,x,s' -"�` y„" .c^,^ey ',-�� 'sw"�-, a.r.*�""�-,.'E "�."s���s i �'4 r* ,�..� „'��•'�` '�°'Z,�. "�'�' �i-=x'-. Spervisot'sGonsrctic�n �cense �� R :� c^, > 3 - .t E i ARCHITECT/ENGINEER Phone: 6 Address: Reg. No. FEE SCHEDULE.BOLDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Tota! Project Cost: $ /6SOD �=- FEE: $ ��'PAO Check No.: /��� Receipt No.: �/3 unregistered contractors do not have access to the guarantyfund unreg NOTE: Persons contracting with Signattare of Agen�/Owner` �. >." ��° `: . �t ySignature of contractor, � Location �3 ��� `�0^1" No. 4� Date a e - TOWN OF NORTH ANDOVER > Certificate of Occupancy $ f Building/Frame Permit Fee $ ��a Foundation Permit Fee $ u r Other Permit Fee $ TOTAL $ Check# d =' 1�117 25135 Building Inspector w 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 J DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS i DATE REJECTED DATE APPROVED HEALTH ❑ ❑ 3 A COMMENTS Zonin Board of a 9 Appeals: Variance Petition No: Zoning Decision/receipt submitted yes �J Planning Board Decision: Comments a Cb�.servation Decision: Comments Water & Sewer Connection/Signature& Date Drivewav Permit d Located at 384 Osgood Street es � x.; 'Yry FIREy'DEPAMRTMENTTemp.�Durllpster dh suer yhof COMMENTS 3F fiY7r � ky�� 1kG c 25' a d t u y S z K Dimension i 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 2 1 A—F and G min.$100-$1000 fine ti NOTES and DATA— (For department use i I I i i ❑ Notified for pickup - Date h Doc.Building Permit Revised 2007 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 o 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) o Building Permit Application ❑ Certified Proposed Plot Plan r ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) t o 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 orspecial 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 DEPARTMENT:BPFORM07 Revised 2.2007 1 NORTH ® of No. 7 l � _ LAKE o� dover, Mass., COCHICKEWICK V 0''A T E D P"P 11 V V ii BOARD OF HEALTH WNW PEnMIT T D Food/Kitchen Septic System I. r BUILDING INSPECTOR THIS CERTIFIES THAT....................����....��. Foundation permission to erect.................... has p ... -�.... ........................gs on ..................................................... Rough ............ . buildings /�-� to be occupied as................- s�`f� . .C.°�.��r^�s..................................... ......................:.......:................... Chimney .� .4 provided that the person accepting 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 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION / TS Rough ................................. ............................................................................ Service .. BUILDING INSPECTOR Final Occupancy Permit Required to Ocmpy 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. RightFax C1-2 2/14/2012 5:40:25 AM PAGE 3100:3 rax berver ��YYy w ISSUE DATE 1 ER° tr 2/14/2012 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),AUTHOR12 ED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER IMPORTANT:if the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed.If SUBROGATION IS WANED,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 MARKETING ASSOC INS AGCY NAME: PHONE FAX 150 WELLS AVE,#1 (A/C,No,Est): (A(C,No): NEWTON,MA 02459 EAWL ADDRESS: PRODUCER CUSTOMER ID is INSURED INSURERS AFFORDING COVERAGE NAIC# VALDEZ,WILSON DBA MASTER ROOF INSURER A ACE AMERICAN INSURANCE COMPANY &UNIENVIOUS-MA INSURER B PO BOX 83 INSURER C MILFORD,MA 01757 INSURER D INSURER E INSURER F COVERAGES - CERTIFICATE NUMBER: 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 REQUIRE vaNT,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 NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR W VD D D GENERAL LIABILITY EACH OCCURRENCE S DAMAGE TO RENTED f D COMMERCIAL GENERAL LIABILITY PREMISES(Each occurrence MID.EXPENSE(Any one f D CLAIMSMADE D OCCUR person D PERSONAL&ADV S INJURY D GENERAL AGGREGATE S GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP S D POLICY D PROJECT D LOC AGO AUTOMORIT LIABILITY COMBINED SINGLE S LIMIT (Each accident D ANY AUTO BODILYINJURY S (PuPerson) D ALL OWNED AUTOS BODILYINJURY S er Accident) 0 SCHEDULED AUTOS PROPERTY DAMAGE S (Per accident) 0 HIRED AUTOS f D NON-OWNED AUTOS S 0 D UMBRELLALJAB D OCCUR EACHOCCVRRENCE S D EXCESS LiAB D CLAIMS-MADE AGGREGATE S 0 DEDUCTIBLE S D RETENTION$ S WORB:ERS'COMPENSATION WC A AND EMPLOYERS LIABILITY N/A STATUTORY YIN LIMITS ANY PROPRIETOR/PARTNER/ EXECUTIVE OFFICER/ME1"1BII2 Y N/A 6S62UB-4505P574 03/15/12 03!15/13 E.L.EACH ACCIDENT $100,000 EXCLUDED? WANDATORYINNH) E.L.DISEASE—EACH EMPLOYEE $100,000 If yes,describe under DESCRIPTION OF .L.DISEASE-POLICY 5500,000 OPERATIONS below DESCRIPTION OF OPERATTONS/LOCATIONSNEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) THE WORKERS'COMPENSATION POLICY DOES NOT PROVIDE COVERAGE FOR VALDEZ,WILSON THE INSURED'S MA WORKERS COMPENSATION POLICY AND ITS LIMITED OTHER STATES INSURANCE ENDORSEMENT AUTHORIZES THE PAYMENT OF BENEFITS FOR CLAIMS MADE BY THE INSURED EMPLOYEES IN STATES OTHER THAN MA NO AUTHORIZATION IS GIVEN TO PAY CLAIMS FOR BENEFITS IN ANY STATE OTHER THAN MAIF THE INSURED HIRES,OR HAS HIRED,EMPLOYEES OUTSIDE ./. »bTHIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE .. v! ttsl:Alr�tE..:>, ..,>..r .,.: .. LOWE'S COMPANIES INC ATTN:IS INSURANCE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE PO BOX 1111 THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. N.WILKESBORO,NC 28656 AMOK=RFPRIMMATIVE 'BYLAN�j..}A.C�.BGCVV 151 Main St. Milford, MA 01757 Phone: 1-888-333-7006 AW=ffW BUM- sae . SIDING . l�lEP�#tRs Fax. 508-634-6780 0 PROPOSAL SUBMITTED TO: PHONE: DATE:, $GSA 375'`7 3 �2r I z STREET: OTHER PHONE: CITY,STATE AND CODE DATE OF PLANS: In regard to the ove roect MASTER ROOF proposes to remove and replace roofing for the sum of$_ =Mls scope of work includes the following: House and grounds to be protected with tarps during roof removal. Remove entire existing roofing and renail all loose boards. Replace all rotted roof boards and plywood if any as necessary;boards$5,00 per foot and plywood$85 per piece,stock and labor if needed. Install new 0 drip edge at all rakes iii eaves. Install 3 o(S_gf ice ill water shield at all eaves,valleys,chimneys,step flashings and pens ns. ➢ Install 151b felt underlayment on remaining roof deck. ➢ Install new pipe boots to all vent pipes. Install new roof shingle and caps,to all roofs on house(manufacturer,C)6ZIC- &APIIIY6.� le / ears I r � .sty ) co 0 Y [� ➢ Install now counter base flashing on chimney ba e. Install ridge vent or low profile vents to all peaks for proper ventilation. ➢ New lead chimney flashing. Fiat roofs:_ ' Roll roofs: ➢ Place all roofing debris in a container daily.Container to be stored on site. Magnetic clean-up for nails. This proposal does take not responsibility for dust or debris in your attic please cover or remove valuables.Also not responsible for lost signal of your dish satellite All debris to be removed.Fully licensed and insured.MASTER ROOF provides all labor for 5 years warranty excluding storm or fire damage. Upon acceptance of this proposal payment shall be made as follows:30%deposit when the contract is signed and the balance upon completion. Customer's signatur j ntractoes signature4- d—' Print Name(IfT�� l.l�'1�� QiL Print Name `' The Commonwealth of Massachusetts - Department of Industrigl Accidents Office of Investigations to 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):�l t�koa,7_5:7 Address: ® S, ' City/State/Zip: � /� (�/7F�r7 Phone '70®� Are yo n employer?Check the appropriate box: Type of project(required): I.Wrl am a employer with Al4. ElI am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have lured the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. ?• ❑Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9, El Building addition [No workers'comp.insurance 5. El We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.01 am a homeowner doing all work right of exemption per MGL 11.0 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 comp.insurance required.] *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 aie 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 and job site information. Insurance Company Name:. � / �0�� Policy#or Self-ins.Lic.#: 4�2 U.61 ����y Expiration Date: Job Site Address: 7 gd% T en Pity/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. I do hereby certio under ilz pains andpenalties ofperjury that the information provided above is true and correct. signature: �- Date: 3 vL �. Phone#• 177V ;V? AA v 2_ Officialuse only. Do not write in this area,to be completed bycity 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.PIumbing Inspector 6.Other - - Contact Person: Phone#: Information and Instructa®lms 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-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 maybe 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 Commonwoaltb of Massachusetts Department of Industrial Accidents Office of Investigations 6.00 Washington Street Boston.,MA 02111 Tel,#61.7-727-4900 ext 406 or 1-877-MASS.A.BB I Revised 5-26-05 Fax#617-727;7749 _WWW-mass,gov/dia. i - M;vi5}34'husctts'= Depat-talent of Public,Safety Baird of Building; Regulations and Standard: Construction Supervisor License License: CS 102403 Restricted to: 00 #; WILSON VALDEZ 151 MAIN STREET -t4 MILFORD, MA 01757 Expiration: 11/20/2012 ('unm:i siuncr Tr#: 102403 -._.° ✓1ze �anmZor�iuea/,�1 o�..�aa�ac�uaelz Office of Consumer Affairs&Business Regulatiol HOME IMPROVEMENT CONTRACTOR Registratior _�n--.50577 ww Expiratonv h4(1 1172012 Tr# 294553 Type-, :DBA ' MASTERROOF ==__' ._„ ' WILSON VALDEZ�-_ fJ 151 MAIN ST , i MILFORD,MA 01757``'`.'_° Undersecretary • .G