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HomeMy WebLinkAboutBuilding Permit #576-2017 - 142 BERRY STREET 11/28/2016 BUILDING PERMIT IAO oT � y (��Q A � Vl TOWN OF NORTH ANDOVER io APPLICATION FOR PLAN EXAMINATION Permit No#: ` !tel Date Received 11 �SS•aCHus�� pate Issued: ORTANT:Applicant must complete all items on this page „ y s ht, f PROPERTYtyn Pnnt �1DDY,earfSt�uctu[e es ' MAP' -__+PARCEL Z®NINGfD1STRICT; � S once®stnct� byein :s� o..r _ �.. ; Hist_ Machine;ShopVillage; ,-Y TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building )'One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial Y Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other >, - Septi Well R �PF16 o`dplair� Wetlands 0 Watershed'Distract �� DWate_r_/Se_we_ r.. �� _ _x .�. '- ${; s t :. - DESCRIPTION OF WORK TO DE PERFORMED: 2Yrs�ots -sh•-s(es tinrlsrl-G(C SAX 4-4- off' �r4cL A44 3v �/C�•. ,�vc�r�Cc-ii ti r•�� S��w��ts. �0\ v x cx, .•S, (.90 t!'eti� a r•t(� GJIi�.-� �oC/ l`te F ' G{v� /'Sd•wcl. i IdentifitatTi Please Type or Print Clearly' OWNER: Name: Ile A '� hn SCin- Phone: Address: 5--- A. A"k -e, 'Contract©r-Name:C� �NLSc,��' Phone:-��J 7J-:7 ;Adtlress: � .. , LU Supervisor'stConsteuction License �. '��.�,_��' Exp':tDafen 2-` 7 ~ Homel`rnproverenfLicense -�K4`3"T4 ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COSTBASED ON$125.00 PER S.F. L '.,__,Total Project Goat: $ r, 6G S• — FEE: $ �. Check No.: Receipt No.. i Z NOTE: Persons contracting witli unre istered contractors do not have:access to the guaranty fund 5i "_natu�e_of_Agentl0wne.r' " Signature of contractor'' 9 _�. . ._. .__ ..... c Location 4 �i ��!✓W i � �No. Date bV • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ 1(} Foundation Permit Fee $ w Other Permit Fee $ � TOTAL $ Check# t �� . Building Inspector Plans Submitted ❑ Plans Waived 0 Certified Plot Plan ❑ Stamped Plans ❑ FTYPFWERAGE DISPOSAL ❑ Tanning/MassageBody ArtSwimming pools❑ 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 PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Siqnature COMMENTS HEALTH Reviewed on Siqnature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes ri Planning Board Decision: Comments 4 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 limension 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 lies No DANCER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$10041000 fine NOTES and DATA — (For department use) ❑ Notified for pickup Call Email ate Time Contact Name Doc.Building Pennit Revised 2014 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 ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks o Building Permit Application ❑ Certified Surveyed Plot Plan o Workers Comp m Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses o 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 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 o Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy o CContr act o Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products j 40TE: A(1 dumpster permits require sign offrom Fire Department prior to issuance of Bldg.. Permit , In all cases if a variance ors special permit was required the Town Clerks office must stain the decision from the Board of Appeals P P q P 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 own o ndover 0 . � No. 0%11 zh ver, Mass - c A 2COC"IC Kl WICK A. %S RATED PPa��S U BOARD OF HEALTH PERM LD Food/Kitchen Septic System • THIS CERTIFIES THAT ck............I.. . „� �!!�,...... BUILDING INSPECTOR has permission to erect ............ ............. buildings on ..........�................15.:C. Foundation...... ...........'................. Rough ire.. to be occupied as .............. . . Xpermit � .....�..... ... . ... . . .............................................................. Chimney provided that the person accepting 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 CONSTRUCTI N STA Rough ..................... Service ........ ... .... t .. 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. • Uni-Ply Roofing, Inc. 3 Forms Way Phone# 978-774-8111 Middleton,MA 01949 uniplyroofing rr comcast.net a Fax# 978-750-4888 e oo . NAME/ADDRESS i O Keith Thompson D PROPOSAL 142 Berry Street ]----- North Andover, MA O DATE PROPOSAL# O�n 11/2/2016 2874 DESCRIPTION TOTAL New roof at above address: Roof is approximately 1,200 square feet Metal roof(roof must be leveled by owner in advance): $6.50/ft=$7,800.00 Asphalt shingles,30 year: $5.35/ft=$6,420.00 New fascia&gutters: 80 lineal feet of gutter:$1,440.00 80 LF fascia(1x8")and 80 LF drip board(1x3")@$5.75/ft=$460.00 60 LF rake board(lx8")and 60 LF of drip board(1x3")@$5.75/ft=$345.00 Cover fascia with bronze metal The specifications,prices and conditions are satisfactory and are hereby accepted. Uni-Ply Roofing,Inc., is authorized to perform the work as specified. Payment will be made as outlined. Signature Final Pa ent(due on completion) 8,665.00 plus metal over fascia 0.00 i TOTAL $81;665.00 The payment schedule associated with this contract shall be strictly adhered oto during t``ie' course of this project. Any deviation from this schedule without sufficient cause (i.e. leaks from the re-roofed section) will constitute breach of contract.and the project'will be shut down until resolved. Invoices are due upon receipt. � J {7 � Z > f Ilk, Jk gym; r Y w y - 0 W4 lk ogle 1 G . �w y il. .II1i �a ,• � ��� yy c���, .�}� ...� \ � Y a. yah`,�} # a r i the Commonwealth of Massachusetts ,err Department of Industrial Accidents Office of Investigations 1 Congress Street, Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information n Please Print Legibly 06/_Name (Business/organization/Individual): pl–;K v — Address: 3 14ayK.S we. City/State/Zip: 11.MC4-C-,-- t1 ot- el4e(f Phone #: 'i *- 1175— I&N Are you an employer? Check the appropriate box: Type of project(required): 1.[9I am a employer with 12— 4. ❑ I am a general contractor and I employees(full and/or part-time). * have hired the sub-contractors 6. F]New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.+ required.] 5. ❑ We are a corporation and its 10.EJ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No 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 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 state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp-policy olic number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. �J Insurance Company Name: "1 �'�'' SUryzce 00— Policy#or Self-ins. Lic.#: C G7 lR e33 S Expiration Date: 2_-2-(.- - 17 Job Site Address: /3es- 'y 54- City/State/Zip: ti� 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 certifyu' er A ains and penalties qfpedury that the in ormation provided above is true and correct. Si ature- Date• Phone#: 107r '7J-- Official use only. Do not write inthis 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#: AC�® DATE(MM/DD/YYYY) �� CERTIFICATE OF LIABILITY INSURANCE 11/28/2016 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, 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(les) 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 CONTACT Laura Wiesner NAME: C & S Insurance Agency, Inc. PHONE (508)339-2951 AIC No:(508)339-4811 190 Chauncy Street/P.O Box 406 E-MAILss:laura@candsins.com ADDRE INSURERS AFFORDING COVERAGE NAIC# Mansfield MA 02048 INSURERAAcadia Insurance Company INSURED INSURER B:Star Insurance Uni-Ply Roofing Inc. INSURERC: 3 Forms Way INSURER D: INSURER E: Middleton MA 01949 INSURER F: COVERAGES CERTIFICATE NUMBER Policy Synchronization 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM/DD/YYYY MWDD/YYYY X COMMERCIAL GENERAL LIABILITY11000,000 EACH OCCURRENCE $ A CLAIMS-MADE ❑X PREMISES DAMAGE TO 250,000 PREMISES Ea occurrence $ CPA0074506-24 2-15-2016 2-15-2017 M ED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 CFLOC 2,000,000POLICY�JET OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident A ANY AUTO MAA0074476-24 2-15-2016 2-15-2017 BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED P OPEf dentDAMAGE X HIRED AUTOS X AUTOS $ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE_ $ 1,000,000 EXCESS LIAB CLAIMS-MADE CUA0074507-24 2-15-2016 2-15-2017 AGGREGATE $ 11000,000 DED RETENTION$ $ B WORKERS COMPENSATION - X PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE WC0719335 2-26-2016 2-26-2017 E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Project: Keith Thompson 142 Berry Street N Andover MA CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 120 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. N Andover, MA 01845 AUTHORIZED REPRESENTATIVE Laura Wiesner/JAS ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025 r?o14olt Massachusetts -Department of Public Safety Commonwealth of Massachusetts Board of Building Regulations and Standards Qepartment of Public Safety C1r'nstrul:t;oa,5u;Ief;>>;,- —_NQZ:1 License: HE-076413 License: CS-084282 Hoisting Engineer KEVINA C.+AN1PO, ES /,. ;, KEVIN A CAMPONESCKI 3 Norman Road 3 NORMAN ROADPI� i Reading MA 01897 E���� '" 'READING MA 01867 '• °�. •. �. jc. " w Expiration l� Commissioner 02/04/2017 Expiration: Commissioner 02/04/2018 Office of Consumer Affairs&Business Regulation License or registration valid for individul use only fI1~ ! HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: , u ;Registration: 140376 Type: Office of Consumer Affairs and Business Regulation A Expiration: 10/28/2017 Individual 10 Park Plaza-Suite 5170 ='` Boston,MA 02116 + KEVIN A CAMPONESCKI KEVIN CAMPONESCKI 3 NORMAN RD READING,MA 01867 Undersecretary ` Not valid without ' nature ^ 1 CAL CY_UtiNER•S CERTIFICATE —_____ _,_, —_ _.�._.... _.._ ME0 —.,_—_____ .... '1.rrWy mntn v[mived /.r L..• i r',,,,,,,,;,,,,,, In[r:eN,neo«IIh,M1e o:xrnlMvmr Ca.rbr i.', :.«.._:_._-_-_j_j—T�•^�—,._._�.1 ` -- ___ -'_-_= Re(W IIeN(G CFA79IAi•77IA91.nd xYlh ble.kd7k of lM1edNrlvE dvNn,l Oed Nu prnev bgv.liRN,wd,ll.ppllahlpavkwhn: r . 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STATE Ea7ll jaI ... ..,�� �YES � 13 Ri41AN RD — C'—v+::3 "• •AbDILEM OF DRIVERNO RE WING,MA 0186.2714 a •.:>• ' � L 1 n.EDlc.ccwrlFlunDN EIIPtRAT1pn DATE —� S 00 02.Ofi•2015 ReV07-15.2099 i.J/�/7�/