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Home My WebLink AboutBuilding Permit #385-2017 - 150 SALEM STREET 10/11/2016 NORT/1 BUILDING PERMIT °� TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION * y Permit No#: � ' O"Lo/7 Date Received gSSACHUS�� Date Issued: I O ' /1 - 2--®1 ff i IMPORTANT: Applicant must complete all items on this page LOCATION `- /.t.11 _ Prnt - . . PROPERTY OWNER - ! - _ - Pant' s 100.Year Structure. yes _ o MAP PARCEL: _ ZONING DISTRICT-:, istoriG District yes no _. _ - Machine Shop Villagev._ryes n° - _ TYPE OF IMPROVEMENT PROPOSED USE Non- Residential Residential ❑ New Building ne family ❑Addition ❑Two or more family ❑ Industrial El Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg tethers: .O. ❑ Demolition ❑ Other 70W-atershed o Septic ❑Well >] rloodplain h Wetlands District Water/Sewer _- f - . DESCR�TION OF WORK TO BE PERFORMED: ti - lease Type or Print Cl rly OWNER: Name: C, �� Phone: I�V, �-�- Address: b _ 1 -_�•—r r Contractor Name: ,.-Phone: - Email - - Address: Supervisor s:Construction L-icense:. p,. Home Improvement License: ARCHITECT/ENGINEER Phone: t Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F- Total Project Cost: FEE: $ Check No.: 711 y Receipt No.: 31 0 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund - ignafure of Agent/Owner g Si nature of contractor - � 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 ❑ 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 ❑ 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:Building Permit Revised 2014 1 1 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL + Public Sewer ❑ Tanning/MassageB �'1'� Tanning/Massage/Body Art ❑ Sing Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ElPrivate(septic tank,etc. ❑ permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM 1 PLANNING & DEVELOPMENT Reviewed On Signature COMMENTS CONSERVATION Reviewed on Signature COMMENTS I .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/sig nature& Date - Driveway Permit DPW Town Engineer: Signature: ?FIRES{DEP,�gR�1TM Tem mp rFo- —�O 4 Osgood E �. f NTDu )tY _ -� p. �ste �n site Located od Street L ocatedtatr124�Ma1nSteet� Fi.reY'Departrren'tsignature/d'ate r COMMENTS:.._.__ Dimension Number of Stories:__ Total square feet of floor area, based on Exterior dimensio _ ns. 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 MGL Chapter 166 Section 21A—F and G min.$1oo-$1000 fine NO NOTES and DATA — (For department use) ❑ Notified for pickup Call Email DateTime - Contact Name _.� Doe-Building Pennit Revised 2014 Location ;� � ► iQ No. S i' a 01-7 Date ! 0 - r t_ a Q /{Q • - TOWN OF NORTH ANDOVER .., Certificate of Occupancy $ Building/Frame Permit Fee $ 2 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# —71041 ' `� 2 1 'f Building Inspector NORTH Town of 1 _ sAndover No. 0%11 hver, Mass, / 0/ 6 C OCNICNl WICK ��Oo PNI- ERM IT ' T S U LD BOARD OF HEALTH Food/Kitchen Septic System THIS CERTIFIES THAT ................. . .�jA.A...! ...................C.. a T Ir�K BUILDING INSPECTOR .......................................................... S^0 S A r+� sIr Foundation has permission to erect .......................... buildings on ..................................................................... ........ Rough to be occupied as ............................................ Chimney ..........s7 ... .......-�............ ......... . .. . 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 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIA�oARTS 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. EMPRESS ROOFING PROPOSAL DATE OF PROPOSAL: ESTABLISHED 1985mike@ P.O.Bex542, helm 1br EXPRERS ROOFING P.O.Box 542,Chelmstortl,MA 01824 Phone;978-256-23331 Fax:978-251-2907 Quality You Can Look Up To p PosALsuami rEoTO: www.expressroofer.com NACY PACE CONSTRUCTION SUPERVISOR LICENCE N99497 SALEM ST HONE IMPROVEMENT CONTRACTORS LICENSE N 108126 L_._ _ _ NORTH ANDOVER AAA 01846 f ei8-s>Is•2914 � We horeby propose to ru"Herr materials andporform die labor necessary lorthe completion op STRIP ALL ASPHALT SHINGLES OFF HOUSE AND GARAGE ROOFS CLEAN UP AND HAUL AWAY TAR FF HOU E TO HELP PR NT DAMAGE TO HODS ND LAWN AREA OMPLEfELY DE-NAIL OLD ROOFING NAILS AND RE-NAIL ROOFING 8 ARDS AS NEEDED WIT 8D RING SHANK NAILS ALL WALL F HIN WILL BE INSPECTED ANDREPLACED AS NEEDED Install:WO Storm Shield 6 FEET u from the bottom eaves IKO Storm Shield under Chimney lead and down on roof IKO Storm Shield around skVliclhts IKO Storm Shield in valle RHINOROOF SYNTHETIC ROOF JNG UNDE -1 YMENT over roof boards IKO Storm Shield on roof w ere roof buts mto walls IK Leadin E e Plus Starter stri onall roof deckinged es DYNASTY Architectural shin les a install 6 nal s per-shingle fora 130 mon IKO wind wsrran Cut in 1 12"o enin on peak of roof and install Roof Saver rid a vent along all rid a surfaces CAII rid a vent Is Hand Nalled IKO rida Ca shin les 8"Drip ed on ail outside roof ed es white New pipe flan es over vent pines 2'-4" All shin les will lac astened usin ! '/;'- 1 '/7'roofi nails BLOW OFF E I E ROOF AND CLEAN GUTTER AND DOWNSPOUTS ROLL 3 FOO I GNETS OUT T PI K NAILSLAWN AREA FOR NL CLEANUP INCLUDES:ALL LABOR AND MATERIALS FOR THE ABOVE ALL ROOFING PERMITS ARE INCLUDED ALL ROOFING MATERIALS STRIPPED OFF YOUR ROOF WILL BE RECYCLED AT ROOF TOP RECYCLING ' • • • 1 , a ' ' , • , . . , CLEAN UP AND HAUL AWAY ALL SHINGLES Lu q Note:No v ertanly on probpms and/ordamn*d caused by ke backups Nowarranty on oro skyugIrs All material is guaranteed to be as speMQed,and the work to be pa{ormed in accordance with the drawings and speelRca Cons submitted for above pork and completed rn a sabstenNal workmanlike manner for the sum or. 0 - NO MONEY DOWN i PAYMENTlN FULL AT COMPLETION OF JOB KITH CASH OR BANK CHECK MADE OUT W THE NAME OF Express Roofing INC. Cal Toll Free Respectfuffy Samoa 1-888-210-ROOF ••• Nate-This proposal may be withdrawn by us 11 nol aweptad by: All wofkers fully in 912412016 AOCEPTANCE OF PROPOSAL The above prices,specifications and Condidons are satisfactory and are hereby accepted,You are authorized to do the work as specified. Payments will be made as outlined above Any additional work dean the above wilt be an extra charge. UPGRADE TO OWE INS CORNING DURATION ARCHITECURAIL SHINIS LES WITH"SURE NAIL PATENTED TECHNOLOGY" INCLUDES A UMIITED 50 YEAR NON-PRORATED COVERAGE ON MATERIALS AND LABOR OWENS CORNING SYSTEM ADVANTAGE W NTY S FULLY ANSFERABLE Signature `Dale ts1 SHINGLE OLOR Homeowners espo ibM for protecting and cleaning content oratOc from poss' dust and debris during your roofi rojecG not fespoasible for any issues caused by InoM Any 112 in.Plywood installation for roof will be an additional charge of$60.00 per heet Labor and materials No warranty on old skylights We recommend old skylights to be replaced with Velux skylights for an extra charge We recommend new chimney lead with all newr000fs for an extra chaprrgge of$595.00 per chimney L'd L0Z999Z9L6 S-10OU e1e-101-100 e0ed 890:6091, LZ&S (MM ACCRV CERTIFICATE OF LIABILITY INSURANCE DAT 06/24/26/24/2lYYYY) 016 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 WANED,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 SAME ' ANDRE SILVA RAPO&JEPSEN INSURANCE SERVICES INC ° � c @$75-5�QQ T AICC No'T -1375-5$i} 191 CONCORD ST n MAIL FRAMINGHAM MA 01702 INSURERES)AFFORDING COVERAGE— INSURER A: OVERAGEINSURERA: ENDURANCE INSURANCE CO INsulaEo...........�,....,.�._____�____�.�..�..__._�..w... -- INSURER 13: LIBERTY MUTUAL INSURANCE CO FIVE STAR GENERAL CONSTRUCTION CORP 153 ARLINGTON ST APT 2 INSURER C: FRAMINGHAM MA 01702 INSURER D INSURERE• - .- -- •...._.•--,_._..,_....,....._...,._.n.}.-..Y.r.-_,.—N,_..� INSURER F: I 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 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. )N9pDD��._........ ....�i F O Y EFF' POLICY EXP LTR TYPE OF INSURANCE IINSS M1 POLICY NUMBER IMMIDDIYYYYI, (MM/DD"YYYYILIMITS GENERAL LIABILITY j EACH OCCURRENCE '''�'"I. ,1,�0000,QQO-,-,_,_ COMMERCIAL GENERAL LIABILITY I!('�'' '' I PREM: i nCeL l 5 100.00Q L I CLAIMS-MADE I��OCCUR j` f MED EXP(Any one person) 510=0 _• _ A CBC20001273700 i 04/06/2016 104f0612017 °ERsoNaL s ADV INJURY ;s 1,000 OQO ' I I 1 GENERAL AGGREGATE 8 2,00_0,000 i r(�EN'L AGGREGATE LIMIT APPLIES PER: � I �'PRODUCTS-COMP/OP AGG� POLICY! 1"' F7 LOC 1 AUTOMOBILE LIABILITY II if— ANY � F-- I ANY AUTO ! I BODILY INJURY(Per person) $ ALL OWNED [__',SCHEDULED I I I BODILY INJURY(Per accident)I$ AUTOSAUT1 HIRED AUTOS �NON-0+NNED 1 i E PRO-PETiTY OAMAc�E $ AUTOStk._._...e_-...- UMBRELLA UAB Fi0CCUERRENCE g OC k I EXCESS UAB C -MADEMAGIREGAT 1— _ DETENTION S $ WORKERS COMPENSATION ( � ( x A IOT. I AND EMPLOYERS'LIABILITY YIN �1T�Y.LIMIT& B I ANY OFF!CERdEMSEREXCL.UDEpEXECUTIVE a'NIAIF I WC2-31S-601154-036 106121/20161,0612112017 E?GHACCI�DENT S 1,0 00'9_ (Mandatory in NH) I I I I � .L�DISEA$EEA EMPLOYE�I�OGO 11 yes,Gaecribe untler I I i I E.L.DISEASE-POLICY LIMIT S 1,000,000 } 1 ) I j DE$CRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Ramarks Scheduta,If mon spate Is required) CERTIFICATE HOLDER CANCELLATION w. T SHOULD ANY OF THE ABOVE DE:iCRE8E0 P CIE E NCE! BEFORE EXPRESS ROOFING T9IE EXPIRATION DATE THE EOF NOTIC E D EKED IN 16 JONAS RD N` h�Gv �� ACCORDANCE WITH THE POLIC PROVISIONS. I 4 I WESTFORD MA 01886 AUTHORIZED REPRESENTATIVE ' !01888-2010 ACORD _PQRATION. All rights res Ettl, ACORD 25(201 0103) The ACORD name and Togo are registered marks of ACORD The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations f , 600 Washington Street Boston, MA 02111 ' www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/plumbers lease Print Leizibly App licant Information i r Name (Business/Organization/Individual): Il Al i i I�l tl 1 Address: - c(l 7j", Phone#: City/State/Zip: ' Type of project(required): Are you,an employer? Check the appropriate box 4. [ I amt a general contractor and I 6 �New construction 1.0 I am.a employer with have hired the sub-contractors employees(full and/or part-time).* listed%ori the attached sheet 7. E] Remodeling 2. I am a sole proprietor or partner- -These-sub-c.ontractors:have g. Demolition = employeesworkers'ork ship and haveemployees and have wo g. Building addition working for me in any capacity. . t „ insurance comp insurance., 10 Q Electrical repairs or additions com and its [No workers p 5 We are a.corporation Plumbing repairs or additions re uired.] officers have exercised their 11.[] g q w ork 3,R I am a homeowner doing all. . right of exemption per MGL 12. oof repairs myself. [No workers' comp. C. 152, §1(4);.and we have no 13.❑ Other insurance required.]t employees. No workers' comp.insurance required.] icy * applicant that checks box#I must also fill out the sane dointion elall work and then hie outside ow showing their workers' clontractors mpensation ust submit aan w affidavit indicating such. Any t Homeowners who submit this affidavit indicating they t $Contractors that check this boxrsmhat attached ve employees whey must provide heir showing tworkers'comp.policy number. of the sub-contractors and state whether or not those entities have employees. If the sub co II am an employer that is providing workers'compensation insurance for my employees. Below is tlTepolicy and job site information. Insurance Company Name: .e/. `��'((,b�(� Expiration Date: Policy'#or Self-ins.Lic.#: City/State/Zip: Job Site Address: f4(� S &expiration Attach a copy of the workers' compensation policy declaration page canoiead t ing hthepolicy impos tion of an penalties date a Failure to secure coverage as required under Section 25A of MGL c. 1 52 e u to$1,500.00 and/or one-year imprisonment,as well as civil penalties nform of a STOP be forwarded too the offic of d a fine � fm p of up to$250.00 a day against the violator. Be advised that a copy of this sta Y Investigations of the DIA for insur ce coverage verification. I do hereby certify under ns and penalties of perjury that the information provided above is true and orrect. Date: �� Si nature: j Phone#: i Official use only. Do not write in this area, to be completed by city or town official Permit/License# City or Town: Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Phone#: Contact Person: Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CSSL-099497 Construction Supervisor Specialty MICHAEL L CORTNER 16 JONAS ROAD ,3—, WESTFORD MA 01886 �-JZn CA-- Expiration: Commissioner 04/24/2018 Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR jMy Registration: 185252 Type: Expiration: 5H612018 Corporation EXPRESS ROOFING INC. MICHAEL CORNTER 16 JONAS RD. WESTFORD, MA 01886 Undersecretary