Loading...
HomeMy WebLinkAboutBuilding Permit #103-2017 - 1463 GREAT POND ROAD 8/2/2016 B NORrh pF tato °qh �® BUILDING PERMIT TOWN OF NORTH ANDOVER ° APPLICATION FOR PLAN EXAMINATION s00 � Permit NO: l-0 ��L Date Received �9SSACHUS���� Date Issued: ©7/ IMPORTANT:Applicant must complete all items on this 2age � �� ' LOCATION -„K :Print PROPERTY OWNER�����_ J:4' Print MAP NOW PARCEL i ZONING DISTRI T Hjstorlc District yes no M1 achine Sh€sp Village ye, no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building NrOne family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑Other I: Septic €j Well D FIldplain 0 Wetlands €1 Watershed pistrict €'1 Water/Sewer v� �- ac c'o ► `� Identification Please Type or Print Clearly) OWNER: Name: P' c� Phone: Address: 14tv3 19 �S CONTRACTOR Name 'Phor ( j9ti L- LC> L G_-, Address, � Ex Date Supervisor's Cons,caon Lien p r Home Irpraveaent License exp .Gate ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. i Total Project Cost: $ FEE: $ Check No.: 1150 Receipt No.: 30 NOTE: Persons contracting with unregistered contractors do not have access to the gua tyfund i naturae of Aq ent/ veer i ature of contractor I j 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 a�- 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 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 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) Building Permit Application Certified Proposed Plot Plan Photo of H.I.C. And C.S.L. Licenses 4 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 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 l ' 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 lies No DANGER ZONE LITERATURE- Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use) i ® Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 „ Plans Subrnitt�d Plans Waived Certified Plot Plan 17"4' rnped Plans ❑ TYPE OF SEWER-AGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank, etc. ❑ Permanent Dempster on Site ❑ THE FOLLOWINGS SECTIONS TI®NS F®R OFFICE USE ®NLIt' INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Siqnature 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 Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster onsite yes. . . no Located at 12.4 Main Street Fire Department signature/date �� ,t1. ,�� c� ICOMMMISrc, Location No. ! Date e5,r �- 2,1)46 • - TOWN OF NORTH ANDOVER ' Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ ` TOTAL $ _ Check# l Building Inspector /� NORTH Town of t 1�. 6 ndover O �++ 1 No. 1 h y sw ver, Mass, DEW ZED/ 9A COCNIc"AWICK y1. S U BOARD OF HEALTH Food/Kitchen PERMIT D Septic System THIS CERTIFIES THAT ...... 'll!.e............... .... . ......................................... ,.. ... ....... Foundation .. . BUILDING INSPECTOR ,�� �. .� �� ..... has permission to erect .......................... buildings on .... .... Rough to be occupied as 57V.ff#0A(AP00F.......................................................................... 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONST TION Rough Service .... ... . . ......... ...... Final BUILDING IN ECT 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. I _......__..._......_.._._.._......_.__....._............ ._............__...... --------------, r *EXTERIORS eft RECYCLING 25 Spaulding Rd • Suite 17-2 • Fremont, NH 03044 PH 603-895-0400 • Fax 603-895-0445 May 19, 2016 Gene Fay 1463 Great Pond Rd North Andover MA, 01845 Dear Gene, RE: Roof Replacement : Main home As per your request and our site visit to 1463 Great Pond Rd North Andover MA, we are pleased to provide pricing for the removal, disposal and installation of roofing at the address referenced above. Scope of work: • Install tarps to protect lawn and any plants and brick walkway • Remove &dispose of existing roof shingles &flashing • Inspect sheathing and trim and siding for rot • Inspect roof and soffit to ensure balanced ventilation system • Supply and Install Owens Corning Tru Definition Duration shingles o Lifetime (50 YR)Architectural shingle o Color: To Be Determined from standard colors o Owens Corning Cap shingles at hips/ridge to match shingles • Supply and install 8"White Aluminum drip edge and to all eaves and rakes • Supply and Install Owens Corning Weather Lock Flex Ice and Water barrier for 6'of roof, all eves and valley's • Supply and Install Owens Corning Weather Lock Flex Ice and Water barrier for cheek wall, approximately 82'up minimum 24" • Supply and Install lead for chimney • Supply and Install Owens Corning Pro Armor synthetic underlayment(comparable to 15# • felt) • Supply and Install new roof boots as needed • Includes Permit and Dumpster for work above Pricing: Main House: $15,015.00 New lead for chimney: $350.00 Platinum Warranty, if wanted: $585.00 New Cedar Clap boards cheek walls: $2,865.00 Total job with Warranty, $18,815.00 Unit Prices: • Replace rotted sheathing-$60.00/sheet if needed. Warranty KTM Properties, LLC includes with their price a preferred contractor warranty through Owen's Corning. The preferred warranty includes 10 years Non-prorated workmanship and 20 years Non-prorated on Materials(Limited Lifetime warranty, proration period starts after year 20). Please find a copy of this warranty attached to bid. Warranty Upgrade: KTM Properties, LLC is a platinum contractor with Owens Corning and can offer a platinum warranty. The platinum warranty includes 20 years Non-prorated workmanship and 20 years Non-prorated on Materials(Limited Lifetime warranty, proration period starts after year 20). Please find a copy of this warranty attached to bid. Insurance: KTM holds the following insurance limits(Illustration of Coverage Included) • Commercial General Liability(CGL) with limits of Insurance of not less than $1,000,000 each occurrence and $1,000,000 Annual Aggregate. • Worker's Compensation and Employer's Liability with limits of Insurance of not less than $1,000,000 each occurrence. • Automobile Liability with limits of Insurance of not less than $1,000,000 combined single limit. • Umbrella Liability with limits of Insurance of not less than $5,000,000 each occurrence. • This quote is good for 60 Days If you have any questions, please feel free to contact me directly at 603-548 4085. Sincerely, Dave Brennick A44j- Accepted By: d:PDate: f� Signature r 1'' Date: Print Name I I I I The Commonwealth of Massachusetts Department of Industrial Accidents VOffice of Investigations 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): KTM Properties, LLC Address: 25 Spaulding Rd - Suite 17-2 City/State/Zip: Fremont, NH 03044 Phone #: 603-895-0400 Are you an employer?Check the appropriate box: Type of project(required): 1.0 I am a employer with 25 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑ 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' [No workers' comp.insurance comp.insurance.: 9. Building addition required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.F] 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 13.❑ Other employees. [No workers' 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 number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Union Insurance Company Policy#or Self-ins.Lic.#: WCA5152316-10 Expiration Date: 6/16/2017 Job Site Address: 1463 Great Pond Rd N. Andover, MA City/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 certify under the pains and penalties of perjury that the information provided above is true and correct Signature: e4e," Date: 07/28/16 Phone#: 603-895-0400 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#: KTMPR-1 OP lD• BB CERTIFICATE OF LIABILITY INSURANCE 1 00810212016 08/02/2016 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 pollcy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the tannt: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 endorsemen s_ PRODUCER Phone:603-424-9901 CONTACT Brown a Brown`Merrimack) vHONE FAx 309 Daniel Webster Highway Fax:866-848-1223 Merrimack NH 03054 &ML Chris McRall INSURERS AFFORDING COVERAGE NAIC* INSURERA:Union Insurance Company 255844 INSURED KTM Properties LLC INSURERS: KTM Exteriors&Recycling LLC INSURERC: 25 Spaulding Road Fremont,NH 03044 INSURERO: INSURER e: INSURERF: 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 Y_rzlrqPJR uI NT,1EW qR,. 1;9NpITaO, Q,F,ANY.C.QNTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE I35UED:9 I" h� .PSTa�yP1 '>i E;NsuR E �j'SD T POLICIES DESCR18ED HEREIN IS SUBJECT TO ALL THE TEF MS, EXCLUSIONS AND CONDITIONS.OF..$.11�}t.P..QClG1Eb .0 I 'S JO Nl�►Y IGiV� )� -ETWED BY PAID CLAIMS. .LTR. TYPE OF INSURANCE ��::: !wDl MPR:I,: i?..;.:�::^''��"y"�''s!•.� t. ,��,>,'• _F v POC(GV�ItVMdEwd Y i" LIMITS GENERAL LIABILITY /::..;•':.: �. ./r- :.�c�:rtir::-: .n• -.vu , ::i-.,uq. :..:•. .�• EACMOCCURRENCE S 1,000,000 pS�SpI�S ::/�s .'":•.N 271; :. i4 t .. ,,. „ „ _ A X COMMERCIAL 6ENER IAB�LITIF:: a 153Q.Ss12 66I16�2016 06116/2017 100,000 ...;F. 'i�''{4: ".'I'-i-.:. >L,S.�:�,ci�, ': ... ., .. PREMISEe Eaomwmnro $ CLAIM6-NAPE X 1.`..f.=.. :�'.. _ .r..,1: .S.._. .. . MED EXP one ercon S $.00 :•iAb_ ; C F;;!• i:'. :iii..\�,.:ts� .'v;;: ': i:.• •(r0(,J� -i:R'_i. ._f<.•:c Cys;±,,;ie. _;';'t�'"iCf` �'•. ?". •PERSONALli.ADVMJURY S 1,000,00 ' ""' GENERA 2 000 00 QLN'L AeaREOATE LIMIT APPLIES PERI PRODUCTS•COMP/OP AGG $ 2,000,00 POLICY X PRO- LOC is�,•'.:-ii N:•F:+i{":.•i:��/i.;i.1i�: s AUTOMOBILE uAelinY ',-:� COMBINED SIN3LE LIMIT 11000,00 A ANY AUTO CAASIS2308-12 06/16/2016;:,06/4012017; AODI Ly-INJURY(Parpemon) $ ALLOWNED SCHEDULED r AUTOE X AUTOS ;'',SL);.;.,�A.J1.•" ." i ,'::_: iBODILY-INJURY(Pora=[dant) $ X HIRED AUTOS x'1i1Ui9 r. "c' Paraxldent $ X UMBRELLA LIAR X OCCUR EACH OCCURRENCE S $1000,000 A EXCESS LIAS CLAIMS-MADE CUAS192314-12 : ::xrsce::;O'S/16/2015 06/16/2017 AGGREGATE g 5,000,000 r Deo X O 10.000. WORKERS COMPENSATION <' X WCSTATU. OTH- AND EMPLOYERS'LIABafTY' '�Yl N' - •' A ANYPROPRCEM"AR7NER/EXECUTIVE CA51S231642' 06116/2016 06/1612017 E.L.EACNACGDENT $ 11000,00 OFFICER/MEMBEREXCLUDED? :N'I�' (Mandatory to HH) \. •, Vii:;ir;a:;:�,:;. _`; :c •�:• E.L.DISEASE-EAEMPLOYEE $ 1,000,000 II yyea descMe under '• . DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHI,CL9S.(AtEaah AC,OHU'iui,'niidhlonal'Riimarks89KfiErilo,,d'.6m, spaoe Is required) LD CANCELLATION " 5HQULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE •..:._..._,..,.._...,,.._,.._. ...:THEXPIRATION"•DATE-'THEREOF NOTICE WILL BE DEUVERIED IN Town of North Andover, MA �ACCORDANCE WITH TNF POLICY PROVISIONS. •• AUTHORIZED REPRESENTATIVE 01888-2010 ACORD CORPORATION. All fights reserved_ ACORD 25(2010/05) The ACORD name and,lobo are re0isterad marks of ACORD 100/100 'd 'ON M Yid 90 : 10 Hn/910z/zM Massachusetts Department of Public Safety 19 Board of Building Regulations and Standards n�//� ai,ar,zr��ruecr//1r r��c�/ na:r��clrr:reLla License: CS-020261 I _ _ffice of Consumer Affairs&Business Regulation Construction Supervisor OME IMPROVEMENT CONTRACTOR Registration ,10139 Type: ANTHONY R PETINOSu lement Card 1 FIRST ST Expiratudn •6/25/2D18« pp MEDFORD MA 02155 KTM PROPERTIES,LLC.f'�„ - I ANTHONY PETINOi�.\'� (� 25 SPAULDING RD SUITE.17-2 "= >'• "—„ ^^!� CA-- Expiration: FREMONT,NH 03044 Undersecretary Commissioner 05/16/2019 i µ .td i C}t ice o� o umcr airs u iness'egutation 10 Park Plaza- Suite 5170 Boston;,1*sachusetts 012115 Home lmpro emit Gpritractor Registration Regtstiation. 160135 e >„ Type, Supptement Card KTM PROPERTII'S, LLC. Expiration: 6r2512016 ANTHONY PETIyO ,fF _ e m w� 25 SPAULDING RD SMITE 17-2, FREMONT, NH 03044 Update Address and return card.Nark reason for ehange: .WAI 4D Wit, .Address Renewal ""_ Employment: Lost Card ��+' iGtN ill#rlttvn(Xfa�ft t��-f'ltld:i/b�[GPI� s... fare of pnsumft Affatm&Business Regulatif License or registration valid for Individual use only za— .., ME MPROY MENT CONTRACTOR before the cxpiratWim date. If found return to: Office of ConsumerAffalrs and Business Regulation Plegie tbon 60130 Type: 10Pork?I*-&u1 5170 Expiration,,$asgot8 Suppieme_nt Card Boston,MA 02116 KTM PROPi»RTI t.LO . i % ANTHONY PETINP t o 25 SPAUt.!ING RCY SUIT 7-2 FREMONT,NH 03044iloderstcrotary Plot va ithottt signature i Massachusetts Department of public Safety lugBoard of Building Regulations and Standards License: CS-020261 k # 3 Construction Supervisor i ANTHONY R PETINO 1 FIRST ST ,a MEDFCyRD MA 0215�5 tv j } ✓ -=--- Expiration: 'E '„'�,n, 03/1612018 Commissioner l 1 t i l i i t i i The Commonwealth of Massachusetts Department of Fire Services Office of the State Fire Marshal P.G.Box 1025 State Road,Stow,MA 01775 PERMIT Date: Permit No ( URT of Town) (IfApplicable) Dig Safe Number In accordance with the provisions of M.G.L. Chapter--1 Oas provided in section 5 2 7 CMR 34 This Permit is granted to: p� Start Date Full ame of person,Firm or Corporation Pennissionto locate dumpster for construction/renovation/demolition of structure Comments: d .. � umpster be 25 ` from structure or covered with tarp or plywood Restrictions: at end of workday at J V41? 11�lf .o-T G� (Give location by street and no.,or describe in such manner as to provied adequate identification of location) Fee Paid$ ,sem r This Permit will expire F —/"./. (Si o antrn rmi f / g Pe ) granting permit Ti e } �� TNLC ppRMIT MI 1_CT RR (tnhlCpli--1 Int I-CI V pflCZTi=n I IpnK[ TI-II< PP;:MIC[=G 4*0�