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HomeMy WebLinkAboutBuilding Permit #266-14 - 15 COLUMBIA ROAD 9/23/2013 TOWN OF NORTH ANDOVER PPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued. 13 J fWORTANT:Applicant must complete all items on this page LOCATION C6 j C�/ > - 919 Print PROPERTY OWNER 9-LL IKIV t9 C- L 4 KA S Print MAP NO: PARCEL:_ZONING DISTRICT: Historic District yesOno Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building P-6ne family ❑Addition 0 Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial [;repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition _ ❑ Other .,. _- a ®Flood 1Weands Wat sliedDist ct�. _- �.._. ' Cl Water/S�vuei _ DESCRIPTION OF WORD TO BE P ERFO' ED: 4 LOgn fnVur 511 al ye- ,F-. �� g�- U ?K� ! S 7 0 1� �"E /52« rQyG tet- � ��i��- (Identification Please Type or Print Clearly) OWNER: Name: EL L-LYDV '-7 ,4C-Z-Ak14 S Phone: F7cl?-629-6307 Address: G aL U,�," CONTRACTOR Name: N, r, GU v /Jrs/d_- ov Z;v, _Phone: `) ?,9-6 9- 0(991 Address: �•-Z 4 Z0urX_,LL. 57— WIZ . h1,4 , Supervisor's Construction License: 0 o $`,-x S Exp. Date: Home Improvement License: l d'"/ Exp. Date: 'j - -2,- ARCH ITECT/ENG IN EER 2,—ARCHITECT/ENGINEER 14 A Phone: Address: 1\4 A. Reg. No. FEE SCHEDULE.BULDING PERMIT:$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ =Q d, FEE: $ Check No.: 3 -7 q q Receipt No.: �s NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature'ofyAgen x.0wne g contractors .� �t � �_ . �z• Location No. L Date AL1 3 . • TOWN OF NORTH ANDOVER . y. Certificate of Occupancy $ Building/Frame Permit Fee I $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# l 26603 6603 Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL 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 OFFICE USE ONLY 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 Wafer& 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 i Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. i.: 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.$1o0-$1000 fine NOTES and DATA— For department use ® Notified for pickup - Date Doc:.Building Permit Revised 2008mi 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 ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract o 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 ([DOTE: 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 NORTH own of EAndover No. Z(P(P- 14 * :-t : - Z - ti o : SAKE h , ver, Mass, �.� COCMIC..W,C '1. ATED IkPK� s U BOARD OF HEALTH Food/Kitchen PE ' IT T LD Septic System n THIS CERTIFIES THAT ...... .1. :>C.......OZ4. .�.A,rr.. -A............................................................. has permission to erect buildings on .. I Foundation BUILDING INSPECTOR .......................... Rough to be occupied as ... ......: :.... ��.....V� .. ....CA. ......�bn Chimney provided that the person accepting this permit shall in every respect conform to the�erms of the appliFinal 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 CONSTRU S TS Rough t 6 - Service .......... ... .............................................................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinm 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. SEE REVERSE SIDE 03/15/2013 14: 12 9785319442 43292 P. 001/001 ACORD� �+�RTIFIV/''�J PATE�..---- E OF LIABILITY INSURANCE ) THIS CERTIFICATE IS ISSUEp AS A MATTER OF INFORMATION ONLY AN CONFERS NO R1GH7S UPON THE CERTIFICATE HOLDER/1TH1S � CERTIFICATE DOES NOT AFFIRMAT1VEt_Y OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLJCIESD F i' BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSUSER(S), AUTHORIZE REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER, IMPORTANT; If the ccrkificate holder is an:; ?RITIONAL ENSURED, the policy(ies) must pa endorsed. If SUl3R0GAT10N IS WA1VEp, subject to the terms and conditions of the policy,;certain politics may require an endorsement A statement on this certiff�te does not Confer rights to the certificate holder in lieu of Such endor"semOng$). PRODUCER CONTACT Kilgore 14surance Agency PHM e- - 5 Centennial Drive 978) 31-6550 A No: (998) 531-9442 Peabody, MA 01966 ADDRESS: „ INSURER/B)AFFORDING COV;.M¢,F M ryAlC p —'—""" _, 1NSURERA:Western World Insurance New England CuStOm Design _!%RERB;Safety. In uxance Comloar},y Ron Weinberg 1NsuRERc:TXaVe�.ers Pr )p E Ca$ult _ 226 Lowell Street / Unit B4-A INSUJt,FR,O;, _ WilmingtOn, MA 01887 INSURER E: INSURER F; COVERAGES CERTIFICATE NUMBE=R: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE USTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE:FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT,,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN I$ SUBJECT TO ALL THE TERMS, EXCLUSIONS ANDCONDTIONS OFSUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, ADD 3UBR LTR TYPE OF INSURANCE _JV f POLICf��FF 'PpuCy EKP�1"'""'--_' I ^� POLICYN NUMBER MML-,% YY MMIDLYYYYY I LIMITS GENERAL LIABILITY Y.; iNPP1349227 3/14/13 S/14/14 A EACH OCCURRENCE $ 1, 000 004 ........-_�.J COMMERCIAL GENE PAL LIAaILITY D�ORENTED """ J REEDMFIXEP y(.AIkHorwBCLAIMS-MADE OCCVR 550,0000 A -""' PERSON1L8ADVINeJU _3 1100000 0 _ . 000 0 GEN'LAGCRFGATELIMITAPPLIES PER GENERAL AGGREGATE 5— 2 —•-••f•00 ••... ` I I PRODUCfS.COMP/OP ACG $ 21Q0Q•,000 POLICY. PI QT RD, I LOC AVTOMOBILELIABIUTY 5054921 4/5/13 4/5/14 � aaccINltD _IN_L_EL IM_T ANYAUM 0 rid ALLOWNFD 80DILYINJURY(Perpetio n_lCHEOULED S 2Q,QQQ AUTOS x AUTOS BODILY INJURY(Per xCidcni $ 500,4 00 HIRVIJpp PROPERTY 0& CE COAVTOS _AUTOS AUTOSNOWDParnecidenq __ $ 1001000 UMBRELLA LIAR OCCUR EACH OCCURRENCE (EXC ES S LIAR -— �.._.__..._..._ CLAIMS-MAD_E AGGREGATE $ I DED RETENTION MR8fin COMPENSATION C AND 1.7PJUB-0239N23-2-13 3/14/13 3/14/14 X WCSTATU 0TH- �AND EMPLOYERS'UAdILITY .ORY.LIMI7S_�_.� Fd ANY PROPRIETOR/PARTNER/EYECUTNE Y l N _ QF It^ _ F.F.RMEMBER EXCLUDCD? _ N/A E.L.E. H ACCIDENT S _100,'000 (Mandatory In and F,4 DISEASE- A EMPLC)_Y,EF•ti_ __100 _ If yyr.L.p�iSGlbi7 under DESCRIPTION OF OPERATIONS below E.L.D18EASE-POLICY LIMIT S 5500,000 I DESCRIPTION OF OPERATIONS I LOCATIONt/VEHICLES (Attach ACORD 101,Addikna!RcrharR6 Schedule,if more space israqured) 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 REPRESENTATIV Cyrus A. KilGor The Commonwealth of Massachusetts Department of Industrial`Accidents Office 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/fndividual): Address: tO w le.iLK $ W, - City/State/Zip: P4 k O 1 H7 Phone#: 017 9- 41, 5,'- - Are you an employer?Check the appropriate box: Type of project(required): 1.[1,1 m a employer with _ 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hiredthe sub-contractors 2.El am a sole proprietor or partner- listed on the attached sheet.i �• El Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacityworkers'comp.insurance. 9, El Building addition [No workers' comp.insurance 5. El We are a corporation and its 10.❑Electrical repairs or additions required.] officers have exercised their 3.❑ 1 am a homeowner.doing all work right of exemption per MGL 1111 Plumbing repairs or additions myself.[No workers'comp. c. 152,§1(4),and wehave no 12.❑Roofrepairs insurance �ired.re q ui employees.[No workers' 13.[i Other comp,insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. I Homeowners who submit this affidavit indicating they a're doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this boar must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name:. Policy#or Self-ins.Lic.#: 77 10 TV OT, —D piration Date: 3 1 Job Site Address: (� Y� 1 o i �' City/State/Zip: _kU Q6 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date)®!� Failure to secure coverage as requiredunder 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cer�under the pains anrd penalties ofperjury that flee information provided above is true and correct. - Si afire: Date: Phone#: 7 4 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 - - - Information and Instruction's Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee 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,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 p w lhng 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 commonwealth 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 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 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 carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit maybe submitted to the Department of Industrial Accidents for 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(ifnecessary)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 ii on file for future permits or licenses. Anew 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 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: The Cox onwealt�of Massa..chv.,sotts Departmeut of Industrial Accidents Office ofIavestigatioas 600 Washington Street Boston}MA 02 1 X 1 `f`el,#61.7-72.7-4900 eYt 406 or 1.-877,MASSA.FB Revised 5-26-05 Fax#617"727"7749 . P'. Vieparru��wmureac a�Gac`u�sel .:'- Office of Consumer Affairs&Business Regulation ME IMPROVEMENT CONTRACTOR egistration 02467 Type ,xpiration:, 7J2120*-U Private Co rpRi e atlo NEW ENGLAND CUs"'If, fGNr NC. ' Val'Lanza 226 LOWELL ST. WILMINGTON, MA 01887 Undetsecretary i V s Massachusetts -Department of Public Safety Board of Buifding Regulations and Standard5� Construction Supervisor- License: CS-008828 tit s �9 v VAL J LANZ)k��� r� 34 BDMY SV' i REVERE 14 02 Y I 3 i Expi.rat+on Commissioner 04/20/2014 F NEW ENGLAND CUSTOM DESIGN, INC. 226 LOWELL STREET r WILMINGTON,MA 01887 #978-658-0881 Home Improvement Contract Registration No. 102467 ROOFING AND SIDING AGREEMENT This is a legally binding contract.Make sure you read this Agreement and understand it before signing it.Do not sign this contract if there are any blank spaces. NOTICE:All home improvement contractors and subcontractors,unless specifically exempted by Massachusetts law,must be registered with the Commonwealth of Massachusetts.All inquiries about registration should be directed to: DIRECTOR-HOME IMPROVEMENT CONTRACTOR REGISTRATION One Ashburton Place,Room 1301 Boston,Massachusetts 02108 Telephone:#617 727-8598 As Agreement is made n 20 ,by and between New England Custom Design,Inc.(hereinafter,"Contractor") A owner (hereinafter,"Owner'),of v� ty/.Town /7t omf 4iyd 0Vzn-Q State dila Zip O (/j' (H)Phone �'J CAP` 036� M�T9A1_ b Address("The Premises') -_G1 1U,0 4/%¢ Phone Siding will be applied only on outside perpendicular/ti walls where specified below: MATERIAL C-laAg it 12 ©a9/c- S!g �GMATERIAL/CORNERS Ct`!4C/`t/? (,�/4 Color!1'1Ii17`l tvu. Color Underlay (Pa P' a Applywhere -W&Al AAer4 Enclosed porch:House wall? y Wood trim specified below will be covered with aluminum trim. Window casings:Number Color Gl�l�tl Door casings:Number Color a Soffitat fa da blor: /l rf .Q Facia Only:Color Wkik-t- d Other and where-- rtfcf�Cy�r,�/c 4 �rz„Y �dre4 G✓i L �Q�� Pri/t! 1�1,s CU1CGlRg'�-• -.t;.tsN:���au.��ar'i3�s*`3.°�<*cs-��cia��:r� si�Bta^�.+t.'�,':�,�a;�3�urr5�tw4�i-1:.irBA^<ai Aluminum Gutters:Color Where !S rpt.r t v f7`cw-1 Aluminum Leaders:Color L(/ 4't Where f, Remove existing gutters and leaders? Where C7 ENMRKS /EXTRAS:Missing or defective lumber is not incl in anycategoty of work unless specified heere. Aw,N rO/,*-"rC C*"'.1 of The Contmct/araaggrms to perfonn in agood aid wm*manhke manneraU work detailed abwe.7D CASH PRICE$ 17 loon. -�" rNU r4, CDOWN PAYMENT$ 0 0UG s ' PAYABLE ON START OF WORK/�$ 02 Neto Et��and C�ls[oml5esign TnC rwallnotbe s. PAYABLE C2 LIArS �CT$ G- 0 held responsible fqi dust andtdebns Eallulgur i Cw attic areas dutmg roofing tnstaIlanon Pleasea PAYABLE ON COM LET[ON$46I'm i DATE: / 20 , remove or cover4valuables RIGHT TO CANCEL Owner may cancel this agreement if it has been signed by the Owner at a place other than the address of the Contractor,which may be his main office or branch thereof,provided that the Owner fies the Contractor in writing at his main office or branch by ordinary mail posted,by telegram sent or by delivery,not later than midnight of the third business day following the signing ofthis Agree- u.See attached Notice of Cancellation.A cancellation fee representing 300%of the contract price will be in effect if cancellation is requested after the legally allotted time has elapsed :Owner hereby certifies that he has read this Agreement,that the terms and conditions and the meaning thereof have b e to him,and that he fully understands them and that there is no erstanding between the patties,verbal or otherwise,than that which is contained N this Agreement,and agrees th a said Con for is esponsible nor bound by any representations not con- ed in this Agreement,made by any of its agents,unless the same be reduced to writing and signed by the Con ctor. HOMEOWNER DO NOT SIGN THIS CO CT IF THERE ARE ANY B SP2 ter�gnature D t—e e— New glanunto ign,Inc. J Date ner's Signature Date