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Home My WebLink AboutBuilding Permit #91 - 1405 GREAT POND ROAD 8/2/2011 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION a �Permit NO: Date Received Date Issued: ` IMPORTANT: Applicant must complete all items on this page LOCATION l S G )0'o' 1-VD AV �^/ Print PROPERTY OWNER Icy'/ f- �� Unit# Print MAP NO. G PARCEL:ZONING DISTRICT: Historic District yano Machine Shop Village y 100 year-old structure y TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building One family ❑Addition ❑Two or more family ❑ Industrial ❑ eration No. of units: ElCommercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other p Septic p Well ❑Floodplain ❑ Wetlands ❑ Watershed District El Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: (Identification Please Type or Print Clearly) —ZV 4fCA95-C7f/4,M,4 OWNER: Name: /e �1 C_1AIA Phone: Address: CONTRACTOR Name: ��-�✓/'� le- �� 0��/" •Phone: Address: � �'�D�✓ ( � `� �l�f B Supervisor's Construction License: Q T"� Exp. Date: O Home Improvement License: Exp. Date: 4 21 ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: g6/� _FEE: $ Check No.: & ( Receipt No.: Ann— NO-T-F: P si�n ontracting wit u e istered c tactors do not have access to the guaranty fund Si nature of Agent/Owner ignature of contractor ; ig[w._ 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 o 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: Doc.Building Permit Revised 2008mi 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.$100-$1000 fine NOTES and DATA— For department use ❑ Notified for pickup - Date Doc:.Building Permit Revised 2011 June/mi Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped flans ❑ iE #t TYPE OF SEWERAGE DISPOSAL r 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 OF FrGE USE ONLY 7 INTERDEPARTMENTAL SIGN OFF - U FORM .,� DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature COMMENTS 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 Engineer4 S1 nature: Located 384 Osgood Street FIRE D4P._4R-T NT temp Dempster on site yes no Located it 124�In,�t�'�e Fire Department signature/date COMMENTS Location No. Date ^ // NORTh TOWN OF NORTH ANDOVER WNW ` Certificate of Occupancy $ i i � • s' 't�' Buildin /Frame Permit Fee $ s�CMusa Building /Frame Permit Fee $ Other Permit Fee $ TOTAL $ Check # , 244 . r/ Building Inspector h: y' m� �. ,'..4kl 4 N ,w r„ d^ I I i 1 Y Y� Y` The Commonwealth of Massachusetts Department of IndustrialAceidents Office of Investigations 600 Washington Street Boston,MA. 02I11 www.massgov1dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information / Please Print Legibly Name(Business/Organization/Individual): 1 URWPI E C7L-"/1/SV L 6o v7n4crN� -, ['jVC_ 1)/3,¢ Address: a 39 8osTaJvSj- I City/State/Zip: _7o_PfF1E1_P, ,/L1,4 0/9_4p Phone#: 5G0-SS3S- X131� Are you an employer?Check the appropriate box: Type of project(required): 1. 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. 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 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself.[No workers'comp. c. 152, 1 ,and we have no § 4( ) 12.ffRoofxepairs insurance required.] 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 and job site information. Insurance Company Name:CH451' 1CZy vT C Policy#or Self-ins.Lic.#: L78- 9 y l 9 Po 9 Y-%d Expiration Date: Job Site Address: /oivD RD. City/State/Zip:_ N,iv0oy E t7,/"4 c2/,9q,5-- 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 certify un der the pains andpenalties ofperjury that the information provided above is true and correct. Signature: Date: 8/a Phone#: 800 — ,QE— q3/2 6 A2, a a a 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): L6. oard of health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector ther act Person: Phone#: ACORD. CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS /2011 OR PRODUCER,AND THE CERTIFICATE HOLDER. 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 IMPORTANT:H the certificate holder is an ADDITIONAL INSURED,the PORC0e3)must be endorsed. N SUBROGATION IS WAIVED,subject to the terms and conditions of the Policy,certain policies may require and endorsement. A statement on this certificate does not corder rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: CHASE&LUNT LLC PHONE FAX (A1C,No,Ext): FAX POB 590 EMAIL (AIC,No): ADDRESS: NEWBURYPORT,MA 01950 PRODUCER 77BPK CUSTOMER ID k ' INSURED INSURER(S)AFFORDING COVERAGE NAIC/ INSURER A: TRAVELERS DIRECT ASSIGNbVM INSURER B: ''URNPUM GENERAL CONTRACTING INC DBA OLYMPIC INSURER C: PAIN'MG& 239 BOSTON STREET INSURER D: TOPSFIEI,D,MA 01983 INSURER E: COVERAGES CERTIFICATE NUMBER: INSURER F: THIS IS TO CERTIFY THATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO INSURED NAMED ABOVE FOR THE POLICY EPERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WINCH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAINTHE INSURANCEDUCE AFFORDED AI THE POLICIES DESCRIBED HEREIN 18 SUBJECT TO ALLTHE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. i UMRS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. NSR ADOLSUBR POLICY EFF DATE POLICY EXP DATE TYPEOFINSURANCE NSR WVD POUCYNUMBER (MMADMYYYY) (MMlD01YYYY) LTR LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS MADE OCCUR. DAMAGE TO RENTED $ PREMISES(Ea occurrence) MED EXP(Any one person) $ GENL AGGREGATE LIMIT APPLIES PER: PERSONAL IL&ADV INJURY $ POLICY PROJECT LOC GENERAL AGGREGATE $ AUTOMOBILE LIABILITYPRODUCTS-COMP/OP AGO $ ANYAUTO COMBWEDSINGLE $ ALL OWNED AUTOS LIMIT(Ea accident) SCHEDULE AUTOS BODILY INJURY $ HIRED AUTOS (Per person) BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) UMBRELLA LUAB OCCUR EXCESS LIAR CLAIMS-MADE EACH OCCURRENCE $ DEDUCTIBLE AGGREGATE $ RETENTION$ $ $ WORKERS COMPENSATON AND YIN WCSTAMORYUMITS OTHFJt ANY PRO ERrr.....ARTNE UB-4419PO94.10 10/2212010 10/2212011 E.L EACH ACCIDENT ANY PROPERITOWPARTNERIE)(ECUIIVE N OFFEMMEMBER EXCLUDED! $ 1,000,000 0kndalolyinKH) E.L.DISEASE-EA EMPLOYEE $ 11000,000 If Y811.deecdbe under E.L.DISEASE-POLICY LIMIT $ 11000,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES!RESTRICTIONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIRCAIE ISSUED TO THE CERTIFICATE HOLDER AFPECIING W ORIQ32S COMP COVERAGE 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 REPRESENTATIVE Charles J Clark ACORD 25(2009!09) 1986.2009 ACORD CORPORATION. All rights reserved. .Y ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID LB DATE(MWDDIYYYY) PRODUCER TURNP-3 05/03/11 Chase & Lunt LLC THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION P O Box 590 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 47 State Street Newburyport MA 01950 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Phone: 978-462-4434 Fax:978-465-6204 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER Northland Insurance Coupasies Turnpike General Contracting, INSURER B: Torus specialty Inausanca Co Inc. dba Olymic Painting & Roofing INSURER C: Commerce Insurance Com an TopsfieldnMAt01983 INSURER D: E COVERAGES INSURER 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR IRNUSLRI'll TYPE OF INSURANCENouPrompomw POLICY NUMBER DATE(MWDDNyi DATE MM/DD/YY LIMITS GENERAL LIABILITY EACH OCCURRENCE S 1 000000 A X COMMERCIAL GENERAL LIABILITY WS084566 10/20/10 10/20/11 PREMISES E.occvrem $100,000 CLAIMS MADE X❑OCCUR MED EXP(Any one Person) $5,000 PERSONAL BADV INJURY $1,000,000 GENERALAGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X jE- LOC PRODUCTS-COMPIOPAGG 52,000,000 AUTOMOBILE LIABILITY C ANY AUTO BDBRJM 10/2010 10/20 11 (Ea MCI ED SINGLEUMR (EaaeBINED) 51,000,000 ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY S (Per person) X HIREDAUTOS X NON-OWNED AUTOS BODILY INJURY S (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY ANY AUTO AUTO ONLY-EA ACCIDENT $ OTHERTHAN EAACC S AUTO ONLY: AGG S EXCESSIUMBRELLAIJABIUTY _ OC B X OCCUR �CLAIMSMADE 40342A100ALI 11/23/10 10/21/11 �GATE E $5000000 $5000000 DEDUCTIBLE a 0X RETENTION so S WORKERS COMPENSATION AND $ EMPLOYERs'LLOMIL TYTORY OMTA ITS ER OFFIE MEMBE�upE�ECUTIVE EL EACH ACCIDENT $ PALSECPROVISIONS below E.L.DISEASE-EA EMPLOYEE $ OTHER EL DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLU51UN5 ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AU R PRES E/ 2� ACORD 25(2001108) v 0 ACORD CORPORATION 1988 i IMPORTANT If the certificate holder is an ADDIT10NAL INSURED,the policy(ies)must be endorsed.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s),authorized representative or producer,and the certificate holder,nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. i I , ACORD 26(2001108) Restricted to: 00 00-Unrestricted 1G-1 2 Family Homes minchusem-Department of Public Sarety Board or Building Regulations and Standartis 0'phstruction Supervisor License Failure to possess a current edition of the License: CS 80145 Massachusetts State Building Code Restricted.to: 0,0 Is cause for revocation of this license. Refer to: WWW.Mass.GovADPS GEORGE tWAY 5 PITCAI IPSWICH, 195 Expiration: 10!26/2011 Conn iksloner Tr#: 6238 ............ O�e Office of Consumer AffaiVa�d'�Bus=ss�Regdation 10 Park Plaza - Suite 5170 Boston, Nkssachusetts 02116 Home Improve,"" 'Vontractor Registration Registration: 167567 Type: Supplement Card Z Expiration: 1014/2012 TURNPIKE GENERAL CONTRA GEORGE VASILIADES > 239 BOSTON STREET BOX 365 TOPSFIELD, MA 01983 Update Address and return card.Mark reason for change. :)PS-CA1 0 50M-04/040101216 Address [] Renewal E] Employment E)Lost Card Office of Consumer Affairs&.Business Regulation License or registration valid for individul use only OMEIMPROVF before the expiration date. If found return to: ' . MENT CO*NTRACTOR Office of Consumer Affairs and Business Regulation Registration-46Nh67 Type: 10 Park Plaza-Suite 5170 Expira .. Supplement Card TURNPIKE GE I Boston,MA 02116 ING INC. GEORGE VASI 239 BOSTON ST TOPSFIELD,MA 0198Undersecretary Not valid without signature HIC#167567 EIN#27-3470462 OL YMPIC Job#: Roofing—Siding- Painting Office:978-887-5870 239 Boston Street—Toasfield.MA 01983 Fax: 978-887-5875 Earnie McNair 1405 Great Pond Rd. North Andover,MA 01845 (847)414-1364 Email: etmenair8l@iyahoo.com July 15.201 1 Dear Earnie. The following estimate is for the roof repair for the property located at the above address. The following paragraphs describe the work that will be performed. RoofRepair OPTION 1: -4 Repair roof leak over damaged closet area 4Re-clash at top of corner board 4 Repair roof leak over living room area to include 20 feet of shingles—seal and reapply shingles correctly OPTION 2: 4 Repair damaged ceiling and walls in closet area to include new sheetrock on ceiling and walls.new R-19 insulation in walls and R-38 in ceiling.replace trim,prime and paint Additional Specification ,i. All work will be done in a professional manner,and timely basis 4. We will remove all of the job related debris Please initial till options you are choosing below: Cost for Labor& Material for OPTION 1: $1,250.00 Cost for Labor&Material for OPTION 2: $1,425.00 Turnpike General Contracting lnc. does not warranty any roof repair work. In order to qualify for a warranty, the roof must fal/v be replaced Payment Terms: 113 deposit due upon signing contract: $ 113 payment due upon start of job: $ 113 payment due upon completion of job: $ Total Amount Agreed To Be Paid: $ Remit to: Turnpike General Contracting hoc.-P.O. Box 365, Topsfield,MA 01983 The following schedule will be adhered to unless circumstances beyond Turnpike's control arise: Work Scheduled to Begin: TBD Expected Date of Completion: TBD (additional provisions follow and are incorporated herein by this reference) P ) Davc Loehr—Operations Managerar�ieMN�air �� Turnpike General Contracting Inc. Homeowner NORTH Town of : Andover . , to No. .p. -r w�,: or,� dover, Mass., Y Q — LA KE 2lb COCHICHEWICK 5 RATED D'P�,`�� U BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT............�.��.''...1k.1... ..........................`...N4.1 .................. ................ ....... """'. . Foundation has permission to erect.... ................ buildings on ......t.q...0 7...........&.4... t �c..... ...... .. ..ft..... Rough tobe occupied as............. ..:........ .. 4 ... .V.j.. ......I'Cob.�,....................................................................... Chimney provided that the person accepting this permit shall i very 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 6S ELECTRICAL INSPECTOR UNLESS CONSTRUC O TS Rough - ................................................ ............. Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR , Display in a Conspicuous Place on the Premises — Do Rough Not Remove Final No Lathing or Dry Wall To Be Done FIRE-DEPARTMENT Until Inspected and Approved by the Building Inspector. I Burner Street No. SEE REVERSE SIDE Smoke Det.