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HomeMy WebLinkAboutBuilding Permit #147-2016 - 135 MASSACHUSETTS AVENUE 8/3/2015 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page LO CATION . .IS=.r ®R J..? q_ Print'. PROPERTY OWNER:.,aR �(lVv .._.,-n__ _. _ .fa• ✓`!` e- Print 1:00 Year Did Structure yes no- _,. .. . MAP NO:3 PARCERL: . ZONING Dl'STRICT -_ .a Historic District yes r:o- Machine Shop Village yes no. TYPE.OF IMPROVEMENT, PROPOSED USE Residential Non- Residential ❑ New Building c�-One family ❑Addition ❑Two or more family ❑ Industrial 0 Alteration No. of units: : ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other 11 Septic ❑Well 11 Floodplain ❑Wetlands ❑ Watershed}District o Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: 5 Identification Ple se Type or Print Clearly) OWNER: Name: Pr_V Vn\J r MJ\Ar, Phone: Q 6g� laS 3 Address: CONT -RACTOR'`Na me: C�-,PrvDk o= Address: Sapervis.of's Construction License: 1?S -Exp. tate: .0 _ Q �` 5 �? ` . Dater Home Improvement License: 4.. . _ Ex p _ 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: $ �I �� �� FEE: $ Check No.: , �'� Receipt No.: NOTE: Persons contracting ith unregistered contractors do not have access to the guarantyfund SignatureRof,Agent/Owner: Sig nature of contractor. Plans Submitted Lj Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ i Building Department The following i"s"a list of the required.forms to be filled outfor.the.appropriate permit to be obtained. Roofil�g, Siding, Interior Rehabilitation Permits I o.. Building Permit Application ❑ V-Jorkers Comp Affidavit ❑ Photo Copy Of H.I.C. And!O'r-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 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 apw-�al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm.tted with the building application Doc: Doe.Bui?ding permit Revised 2012 . -: Plans Submitted ❑ `PI`ans Waived ❑:- .::Certified Plot Plan ❑ . Stamped Plans ❑ TYPE OF_=SEWERAGEDiSEOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ . Tobacco Sales Food Packaging/Sales ❑ Private:(septic tank,etc_ =`:.-Peimarient Ditmpster 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 f 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')codon s Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT Temp Dump;ster on site yes no Located"at:124 Mair,Street '' Fire Depaitine'�f COMMENTS I Dimension.. Number of Stories: Total square feet of floor area, based on Exterior dimensions. :Total land area;.sq. ft.- ELECTRICAL: .ELECTRICAL: Movement of.Meter:Location., mast-or service drop q pp requires approval of .Electrical Inspector Yes No DANGERZONE LITERATURE: Yes No MGL.Cfi'apter166.Section 21A. F and G min.$100=$1000fine NOTES and DATA— (For department use I I B Notified for pickup - Date Doc.Building Permit_Revised 2010 x Location 1 J c5 Hass No. 141 _�0�? Date � --7, e •IXED TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $Lb—I—c�0 OIL- '3 Foundation Permit Fee $ Other Permit Fee T*Uvk S TOTAL $ Check# leo =1 29146 Building Inspector S µORTH Town of . � E 1, Andover 0�- *� C, h ver, Mass, COCMICMIWICK U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT ` Llk.fte ................................................................. BUILDING INSPECTOR has permission to erect ...... buildings on r A. ...... ................... Foundation y Rough to be occupied as ..............fit...... ... ...............� .� ................................ Chimney provided that the person accepting th s permit shall in every respect nform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws re ating to the Inspection,Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTI ` 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 Street No. Smoke Det. ' PROPOSAL/ESTIMATE 170 Main St,North Reading,MA,01864 781-321-1991 WINTER HILL Claudio Araujo—License CS 105185 GilrNER.At, cCsWTFtAwww.winterhillgc.com I G"�"OR.tiri�, g Arthur Laflamme Email:alaflamme007@comcast.net 135 Mass Av.—North Andover MA Phone: 978-687-1953 Date: 06/26/2015 Job Location: Shingle Roof Tear Off: The following paragraphs describe the work that will be performed. • Remove existing shingle roof on the entire house and garage • Install an 8 inch drip edge on all leading edges(Color:_) • Install 6 feet of ice&water shield on front leading edges&valleys • Hurricane Nailing:6 Nails per Shingle • Install starter strip on all leading edges. • Install shingle mate felt paper on all areas not covered by ice&water shield • Install New Ridge Vent • Install new vent pipe flanges • Replace any rotten or damaged roof decking ledger board'(, allow 32 ft.at no charge;;$3 501ft thereafter) • Replace any rotten or damaged fascia or rake boards_at ooift. • Install new GAF Timberline High Definition Architecture Shingles • Remove existing lead flashing on chimney,instill-Ice&Water Shield,step flashing,and grind New Lead Flashing into Chimney • Warranty included in contract •(x)System`Pius • Shingle Color= ' � tv i ' � • Replace existing gutternewseaniless gutter • All debris will be removed fro" m the property; Cost for Labor&Material:for New Shingle Roof: $ 8,900.00_ Payment Terms: p r44 Z / ��• 113 deposit due upon signing contract: $t 113 payment due upon start of job.-.- 113 ob:_.113 payment due upon completion of job.; $ Total Amount Agreed To Be Paid: $ Work Scheduled to Begin: TBD Job expected to be completed within 60 days of actual start date. Warranty:GAF.guarantees all material for lifetime and work performed for a period often(15)years.If any problems occur we will cover the cost of all labor and material to correct the problem and meet the customer's satisfaction. C16dio..Araujo P anager Winter Hill General Contractor,Inc. Date Home Owner Date I The Commonwealth of Massa chusetts Department of IndustrialAccidents 1 Congress Street,Suite 100 Boston,MA.02114-2017 www massgov/dna Workers'Compensation Insurance.Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly anization/Individual): W 1 -41 ) L t, y Name(Business/Org Address: 1 ST City/State/Zip: Phone#: 3 1 Are you an employer?Check the appropriate box: Type of project(required): 6AI am a employer with__—_3__employces(full and/or part-time).* 7. ❑New construction 2.❑1 am a sole proprietor or partnership and have no employees working for me in 8. 0 Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3..Q 1 am a homeowner doing all work myself[No workers'comp.insurance required.]t 10E]Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole ME]❑Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.❑1 am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.0 Roof repairs These sub-contractors have employees and have workers'comp,insurance.# 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.0 Other 152,§1(4),and we have no.employees.[No workers'comp.insurance required.] 'Any applicant that checks box 41 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. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors fiave employees,they,must provide their workers'comp.policy number. d am an employer that is providing workers'compensation insurance for my employees.'Below is the policy and job site information. ������ „i' Insurance Company Name: Policy#or Self-ins.Lie.#:iA Cl- 7A" ZO - P03 /I L? —101 Expiration Date: ,� 2 6 a Job Site Address: I✓ 4Aq �'h e,0 A/ City/State/Zip: P• A A-90 the workers' com ensation otic declaration page(showing the policy number and expiration da Attach a copy of P . , P Y Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi ri nder the pains andpenalties ofperjury that the information provided above is true,anddcorrect. sign e: Date: Phone#: Z 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 Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation fortheir employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract 61&e, 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 commonwealths 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 cant'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 foi•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 Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel.# 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia �-� WINTE-2 OP ID:JJ ACORO� CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)03/18/2015 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 CONTANAME: Crown Insurance Agency,Inc. Bradly S.Michals Insurance -924-1 617-924-1100 n No):617-926-2162 A ency,Inc. A/c No Ext 85 Main Street E-MAIL Watertown,MA 02472 ADDRESS: Crown Insurance Agency,Inc. INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Acadia Insurance Company INSURED Winter Hill General Contractor INSURER 8:Essex Insurance Company Claudio Mcuhna Araujo INSURER C:Arbella Insurance Co. 17000 170 Main St North Reading,MA 01864 INSURER D: INSURER E: INSURER F i 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 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. IADDLSUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MWDD/YYYY MM/DDIYYYY LIMITS B X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 -DAMAGE TO RENTED CLAIMS-MADE a OCCUR 3DX7960 02/13/2015 02/13/2016 PREMISES Ea occurrence) $ _ 100,000 MED EXP(Any one person) $ 5,00 PERSONAL&ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY❑JECT F-1 LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1000,000 Ea accident) > C ANY AUTO 1020001551 04/0912015 04/09/2016 BODILY INJURY(Per person) $ ALL OWNEDLXC SHEDULED BODILY INJURY(Per accident) $ S AUTOS AUTOS $ NON-OWNED P X HIRED AUTOea cidentDAMAGE AUTOS UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER A ANY PROPRIETOR/PARTNER/EXECUTIVE YIN N/A WC-20-20-003174-01 03/26/2015 03/26/2016 E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE: Operations of The Named Insured CERTIFICATE HOLDER CANCELLATION XXXXXXX SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE FOR BIDDING ONLY THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN FOR BIDDING ONLY ACCORDANCE WITH THE POLICY PROVISIONS. FOR BIDDING ONLY FOR BIDDING ONLY AUTHORIZED REPRESENTATIVE FOR BIDDING ONLY FOR BIDDIN L! /G%�✓� ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Massachusetts-Department of Public Safety Board of Building Regulations and Standards License: CS-105185 Claudio M Araujo�` L 163 Hancock Stre4,141l NP Everett MA 02149 Expiration Commissioner 07/1312017 rfi�t��rrntyftn�rrr,t+-if��r��5�lr�is,:rrt,'�r�sr'((J 0 "'t"'Consumer Affairs&Business Regulation �� f,A'OME IMPROVEMENT CONTRACTOR registration: 168583 Typo: Expirat�pn:v 3/8/2017 Corporation WINTER HILL GENERAL CONTRACTOR,INC. CLAUDIO ARAUJO 170 MAIN ST i NORTH READING,MA 01889 Undersecretary Q '