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HomeMy WebLinkAboutBuilding Permit #775-14 - 148 MAIN STREET 4/29/2014 TOWN OF NORTH ANDOVER PLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: � G P RTANT: Applicant must complete all items on this page e LOCATION PROPERTY OWNER e 40116(ioa�4 Print 100 Year Old Structure yes no MAP NO: PARCE ZON I G DISTRICT: Historic District no d Machine Shop Village y s no .TYPE OF IMPROVEMENT. PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic 0 Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification Please T pe or Print Clearly) OWNER: Name: (9,/dej + oei Plans-Submitted ❑ .Plans-Waived ❑.. .-..Certified Plot Plan ❑ Stamped Plans F1 :TYPE O){;SEWERAGEDiSP.OSAL Public Sewer ❑ 'Tanning/Massage/Body Art ❑. . _Swimming Pools ❑ Well ❑ Tobacco.Sales El Food Packaging/Sales ❑ -Private.(septic tank,etc:_ �-� " _Permanent Diunpster on=Site ❑ •" -THE.FOLLOWING SECTIONS FOR-OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF'- U FORM . DATE REJECTED DATE:APPR=OVED PLANKING & DEVELOPMENT ❑ ❑ I COMMENTS CONSERVATION Reviewed on_ Signature COMMENTS HEALTH Reviewed on Si9 nature 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 Toiv;, Engineer: Signature: Located 384 Osgood Street FIRE DEPARTKENT 'Ternp'Dumpster on site yes no Located-at 124,Mair Street 1 Fire Departine►it signature/date""' -- " �" .. - r - ' COMMENTS r . "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 DANGERZONE LITERATURE: -Yes No MGL--.Chapter 166.Section 21A-F and G min.$100=$1000.:fine NOTES and DATA— (For department use El Notified for pickup - Date Doc.Building Permit Revised 2010 Building Department -:-The fol owing is a-list of the required.forms to be'filled outfor:the appropriate:permit to be obtained. Roofh,g, Siding, Interior Rehabilitation Permits o Building Permit Application " _V/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 a Building Permit Application ❑ Certified Surveyed Plot Plan a 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 o Certified Proposed Plot Plan Li 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) ❑ Copy of Contract ❑ Mass check Energy Compliance Report o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cans 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 submJted with the building application Doc: Doc.Building permit Revised 2012 Location No. Date • • TOWN OF NORTH ANDOVER • Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# Building Inspector NORTH Town of . 1 : ndover - h h ver, Mass, LAKE coc HIc HewlcH AoOA' Eo I.Pa�,�S S V BOARD OF HEALTH PER Food/Kitchen Septic System . IT LD THIS CERTIFIES THAT BUILDING INSPECTOR ..... .......4� , ...... ... �. ... ............. ......... . . .. .. ., Foundation has permission to erect ...................... buildin son Rough ........................................�................. to be occupied as ....... ........ A � ........ 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 ONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCT STA 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. The Commonwealth ofMass'achusetts - Department of I'nclzcstrircl Accid iks Office of Investigations 600 Washington.Street .Boston,MA 02111 www.mass gov1dia Workexrs'Compensation Insurance Affidavit:Swilders/Contractors/Electri.clansiVIiimbers Anujeant Information Please Print I�e bzv Name(Businesslorganizatiioonlludividual): 6,64 Aez .Address: City/State/Zip: �� Phone# (ald Are you an employer?Check the appropriate box: Type of project:(required): 1.❑ I am a employer with d•. El am a general contractor and I 6. New construction employees(full and/or part-time).* have like dthe sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7• Remodeling ship andhaveno.employees These sub-contractors have S. ❑Demalition working forme in any capacity. workers'comp.insurance. g. ElBuilding addition (No workers' comp.insurance 5. We are a corporation and its 1011 Electrical repairs or additions xeciuired.] officers have exercised.their 3.0 1 am a homeowner(ting all work right of exemption per MGL II.[f Plumbing repairs or additions myself.[No workers' comp. c.152,NO),and.wehaveno 12.❑Roofrepairs insurancerequixed.]i employees.[No workers' 13.❑Other /�P ti��riL(/ comp.insurance required.] Mny applicantthat checks box#1 mustalso fill outthe section below showingtheir workers'compensaioapoHry information. 7 Homeowners who submit this affidavit indicatingthey Re doing allwork and then hire outside contractors must submit a new affidavit indicating such. TContractors that checkthis box must attached m additional sheet showing the name of the sub-contractors and their workers'comp.policy information. f am an employer that is providing workers'compensatdon insurance for my employees Below is the policy arab joi'i site information. Insurance Company Name% Policy#or Self ins.UG.ff: Expiration Date: Job Site Address:, ��� ltLr/ f' �4 City/State/Zip: fVl��n Gfi1 Attach a copy oftthe workers'compensation-polley declaration page(showing the policy number and expiration date). Failure to secure coverage,as reguixedunder Section25A ofMGL o.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 tine 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 e eytijy Un di T paand ad's"p erjury tliat the in•formation•provided alcove is ue and correct. - .% Date: Sa. afar �) Phone#• 1 O 3 6'/y J�e9V�0 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.CkNown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other - - Contact Person: Phone#: Information and Instruction Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an ernployee 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,co Oratifln or other legal entity,or any two or more of the foxegoing engaged in a joint enterprise,and including the legal representatives of a-deceased employer,or the receiver ,trustee of an individual,partnership,askoiation or other legal entity,employing employees. However tho 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,contraction orxepair 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 Iocal 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,MCL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance ofpublic 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 cheeldag the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)andphonenumber(s)along with their certibcate(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 thatthis affidavit maybe submitted to the Department of Industrial Accidents fox cont"umation 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 andprinted 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 affidavitis on file for future p ermits 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 orpermit 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: 'he Coxowealttt of]1!rassa..chv.:sPtts - Depatieut ofWustrial Accidents Me OfTAVos aga#ona 60 Wakkgtoa Stxeet Boston,MA021Xf Tel#617.72'-4900 ext 406 or 1-877- SS _ Revised 5 26-05 `ay,0 617-727-7749 _ Www.Ma%g¢v1dia i �e cprn���aaizcuea��a�C?�oa�ec�eGl� '� Office of Consumer Affairs&Business Regulation ME IMPROVEMENT CONTRACTOR egistration: 114134 Type: piration: -8/6/2015--- DBA Salem Vinyl,Siding,&Windows it f GLENN COTE f 46 HERRICK CIRCLE PELHAM,NH 03076 Undersecretary I t' Massachusetts -Department of Public Safety �✓ Board of Building Regulations and Standards Construction Supervisor License: CS-035162 , GLENN C COTE fes% ° 46 HERRICK CIRCLE _ PELHAM NH 03-076 " �1 J >, oA Expiration 08/31/2015 commissioner Apr 29 14 10:32a Pappathan Insurance 603-635-1328 p.2 i CERTIFICATE OF LIABILITY EDATE(MNWD/YYYY) INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.9TH S14 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(Pes)must be endorsed. If SUBROGATION 15 WAIVED,subject to the terns 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 rieu of such endorsements}. PRODUCER CONTACT NAME_ Chip Pappathan Pappathan Insurance Agency, Inc PHONE , (603)635-1099 a N,;(603)6351328 PO Box 878 ADMAD_RIESS_ Ch1 �L Pelham,NH 03076 __ch INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER Ar CO-Operative InSuranCe CompLanies 18686 Glenn Cote INSURERS: CO-Operative In urance Companies DBA:Salem Vinyl Siding I INSURER C: Travelers Indemft Company 46 Herrick Circle INSURER D: Pelham, NH 03076 INSURER E' COVERAGESINSURERF CERTIFICATE NUMBER: 00000804-0 REVISION NUMBER: 1 'H'S' HIS 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 ADDLSU13R LTR TYPE OF INSURANCEINSR POLICY NUMBER POLICYEFF POLICY EXP A GENERAL LIAB'My MAir� MMfptUYYYY LIMITS BP0169234 05/19/2013 05119/2014 EACH CCCURRENCE s 1 000 000 X COMMERCIAL GENERAL LIABILITY DAMq E TO FE ED CLAIMS-MADE �OCCUR PREMISES Ea ooalrrence $ r5Q 000 MED EXP{Any one person) $ .�000 PERSONAL BADV INJURY 8 GENERAL AGGREGATE 3 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POL:CY PRO- F LOC PRODUCTS-COMP/OPAGG $ 2,000,000 B AUTOMOBILELIABIUTY $ CA0169203 05/1712013 05M712014 COMBINEDSINGLELIMIT ANYALITO Ea accident s 1 000 000 I ALL OWNED X SCHEDULED BODILY INJURY(Per person) S AUTOS BODILY INJURY(Per accident) S HIREDALrTOS VON-0WNED AUTOS PRO E.YOAMAGE erS B X UMORE LLALJABX S OCCUR UC0169467 05/19/2013 05/19/2014 EACH OCCURRENCE S 1,000,000 EXCESS LAB :CLAIMS-MADE DED X' RETENTrONS 10000 AGGREGATE $ 1,000,000 C WORKERS COMPENSATION $ AND EMPLOYERS'LIABILITY YIN 6JUB-2E13212-3-14 04/06/2014 03/24/2015 X MSTATU- OTH- AW PROPRIETORrPARTNEaiEXECUTIVE OFFICERAIEMEEREXCLUDED? Q NIA (Mandatory in NH) E.L.EACHP.CCIDENT 3 100,000 If yes,describe under EL.DISEASE-EA EMPLOY S 100,000 DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ 600,()00 DESCRIPTION OF OPERATIONS!LOCATIONS!VEHICLES(Attach ACORD 101,Additional Remarks Schedule,i/more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Gloria Philbrick THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN 148 Main Street,Apt. 0-403 ACCORDANCE WITH THE POLICY PROVISIONS. North Andover, MA 01845 AUTHORIZED REPRESENTATIVE l ACORD 25(2010105) ©9988-2010 ACORD CORPORATION, All rights reserved.The ACORD name and logo are registered marks of ACORD Printed by ADP on April 29,2014 at 11:35AM t N. �. .�. Salem Vinyl Siding & Windows Co. LLC 46 Herrick Circle, Pelham, N.H. 03076 Glenn C. Cote < > 603-893-8043 Name of Purchaser: Gloria Philbrick Date: 02-27-2014 Address: 148 Main Street...apt#0-403 Phone#: 978-794-0565 City: North Andover State: Mass. Zip Code: 01845 Furnish and install Paradigm Vinyl Replacement windows......I. .....units. Paradigm Model : Tapestry premium model.... replacement style Options: 1. ----- Grid Patton( divided lites)...8...over...8... 2. -----Color ......white 3. ----- Screens...1/2 requested...... 4. ----- Energy Efficient......Low-E glass+Argon filled glass... 5. -----Repair of any rotted wood is additional.. 6. -----Removal of debris and old windows is included. 7. -----Building permit is additional. Remove all existing wood sash windows and aluminum storm windows units. Installation of all windows will be preformed using fiberglass insulation installed on all sides. Outside and inside of casing will be sealed with a color matching tri polymer sealant. We agree to pay for the aforementioned materials and labor the sum of $_1,590.00 Dollars, in the following manner: • Windows to be special ordered with a deposit here with of$ 590.00 Dollars: • The balance of$ 1,000.00 Dollars to be paid in_l_payment of$_1,000.00. • This order is subject to acceptance by seller. The seller shall not be liable for delays caused by strikes, shortage of material or any other causes beyond his control. The seller warrants that it will perform the terms of this contract in a good and workmanlike manner and makes no other warranties expressed or implied other than =hose written warranties of the manufacturer and furnished to the buver by the seller of :any goods or materials supplied by seller. t ou may cancel this agreement by a written notice directed to the seller at hie main office by ordinary mail or telegram not later than midnight of the third business day following the signing of this agreement. This constitutes the entire agreement, no other agreement, oral or written expressed w implied shall qualify the term herein. 42 Years Experience Mass Lie;#CS 035152 Mass H.I.C.# 114134 VSI Lie;#800003878 Ins.Cooperative Ins&Travelers Ins. Accepted Date .............. Glenn C. Cote .................................. Accepting Purchaser.... .mss .. .1. .. C I Gloria Philbrick