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HomeMy WebLinkAboutBuilding Permit #783-2016 - 1538 TURNPIKE STREET 1/6/2016 NORTH BUILDING PERMITD o� "`rwt �tLB ,6 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION VL Z� 4 Permit No#: 411ORTANT: Date Received °0 ArED / gSSACHu`s Date Issued: Applicant must complete all items on this page LOCATION �� 3L�J .P, Q c �_ Print PROPERTY OWNER 0 Print 100 Year Structure yesQnoMAPPARCEL: ZONING DISTRICT: Historic District yeMachine Shop Village ye TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: RCommercial Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other I ❑ Sept c ❑Well, s � ❑E Flood bine V Wetl`antl ❑°tWaters;heclb!D:istnct' nn,:ateSewer_ DESCR,�PTION OF WORK TO BE PERFORMED: l�— w S s Identification- Please Type or Print Clearly OWNER: Name: ' E Phone: " Address: �� 02ep Contractor Name Phone: S� Email: (fk%4-e-V t I Address: Supervisor's Construction License: C _ (CfL3 c--4p Exp. Date: Io 15, t so l'? s f Home Improvement License: ( O Exp. Date: ( ?wA ARCHITECT/ENGINEER Phone: 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: $ 2 G , c-9C�) FEE: $ Check No.: `� Receipt No.: �� �1 NOTE: Persons contracting with unregistered contractors do not have a c s t the uaranty fund bf/ y ,'. 3{ _rt�,.�,.9.:,., sale,-:.� - ;. - p ".!c G x- r p_ --KL, _ _ .. .. .. .__._ --s=.—r-, ,j Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL > Public Sewer ❑ Taming/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ ❑ ❑ d, Private(septic tank,etc. permanent Dempster on Site THE FOLLOWING SECTIONS POR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF m U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION._ ---- Reviewed-on - - - -._-Signature._ --- i COMMENTS ti HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes e Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FI�R�E�DEPAER MERIT ,remp Dumpsfer onsite, ;yes, , u �k� s�'` � °no i Located at 124 Main Street '' ` $-; _z�,j-��"' �7'`�'e. �'� f ' Fire De artm nt si nature/date -� j s -� - tiy♦q�y'r �j �"'},^-!fi 't�` �"�l' '4%i, "J Z:.+„¢� a}`"Is 44jy #� 5�" y'... *� ., 7.�•j i ni vr.♦ lis av rc.'r ;x"�;r r ri.%`. y s i • 1to .}� 5 4 � � '�• ' �'d•�r"`�t�.��siFk^4 M1...� COMMENTS;.' 1 , � � � =; � � � ;'ti i 1 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 DANGER ZONE LITERATURE: lies No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine i NOTES and DATA— (For department use) i I i ® Notified for pickup Call Email Date Time Contact Name Doc.B-ailding 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 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 j OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit i 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 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 variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals In all cases if a v p p q p pp 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 Location No. (S :—20 11so Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $,�k4 Foundation Permit Fee $ ° Other Permit Fee r ru xv TOTAL $ Check# 29887 Building Inspector r 1 � NORTH � W" :: . _ c ve,. . No. ��. 3 I � Z h ver, Mass, �Q ZO CO[NIr.«IWICK �1•. �S p#ATED P"Iff �y U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System 7T�Nj. �r�THIS CERTIFIES THAT............ ...................... ... BUILDING INSPECTOR _ 3g 'Ciera s�,� Foundation has permission to erect .......................... buildings on ,..... ..........:.....................�.................. ...... ....... Rough to be occupied as .....rq&m!vh*.Ok.....WN'to.... ..4....................................................... 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 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STA Rough s4vService .................................C .. .. �. .-... �..:— 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. 1 Y +1 G.L. Clark Construction Tony Delourie 177 Jenkins Rd. 1538 Turnpike St. Andover MA 01810 N.Andover MA 978-375-3425 978-230-1609 CSL#102350 HIC#164510 SCOPE OF SERVICES—Windows and Small Roofs '/z of Building only 1) Windows- Remove existing windows and replace with new construction Double Hung Vinyl weld widows with Low E and Argon. Energy Star Rated r Y, f , 2) Total Lg. windows 20 @ $700 installed each Total Sm. Windows 15 @ $600 installed each. $23,000.00 Both include cost of window and installation. Does not include any replacement of fixed windows. Re-frame all openings. Trim out all windows and sheetrock where windows were removed only. Owner to mud tape and replace sheetrock around window openings not due to window replacement or areas due to water damage. May be replaced at time and materials at owners request 3) Remove siding from sloped window openings and install new fascia and Architectural shingles and flash cheek walls.(2nd floor only) $2500.00 4) Rent boom lift.I month Includes fuel $3500.00 3) Clean up and removal of all debris. Notes* Any changes to scope of work or changes due to any unforeseen issues may change the cost of the project such as Rot, Code upgrades or any engineering that may be needed. Or any changes the customer may make that will change the scope of work to be done. All changes to be done will have a change order to be signed prior to start of any new work to be done not included in original scope. a)All work will be done with the required permits and to building code. Homeowner will pay for permits. b)All extras will be done at time and material Total cost of proposed work. $29,000.00 I Payment schedule $7000.00. Deposit $7000.00. Upon delivery of windows $8000.00. Upon start of installation of windows. $3500.00. Upon Installation of%2 of windows $3500.00. Upon completion of completion of windows Tony Delourie �7 Gregory L Clark The Commonwealth of Massachusetts Department oflndustrialAccidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FMED WITH THE PERNHTTING AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organization/Individual): n,2 OC40 Address-__L77 cv� City/State/Zip: Phone#: �(`�g :5-7 X_ -3 Z• Are you an employer?Check the appropriate box: Type of project(required): 1.❑I am a employer with employees(full and/or part-time).* 7. 0 New construction 2.Q I am a sole proprietor or partnership and have no employees working for me in 8. F1, Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.Q I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10❑Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.EB'�am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13. oof repairs These sub-contractors have employees and have workers'comp.insurance.$ 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other 152,§1(4),and we have no.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 workeis'comp.policy number. -(am an employer that is providing workers'compensation insurance for my employees.'Below is the policy and job site information. f Insurance Company Name: A (80 k O V ' k A, C ff� Policy#or Self-ins.Lic.#: C— II DO— `7�',j L °—Z0/ Expiration Date: 7IT4 2/ Job Site Address: . 1 3F Tt�Rnpite 10:�32 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 MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi under the pains and penalties ofperjury that the information provid d above is tr a and c rect. Si natu e� Date: 'd Phone#• '- 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#: V CLARGR1 OP ID: DL '4 RoR CERTIFICATE OF LIABILITY INSURANCE DATE 14 11 21201 5Y) 11112!2015 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 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). CONTACT PRODUCER Phone:978-777-9394 NAME: Dan Hurley Dan Hurley Insurance Agency Fax:978-777-3306 PHONE 978-777-9394 Chestnut Green,Suite 24 CPA No Ell):978 Alc No): 978-777-3306 Seven Federal Street E-MAIL Danvers,MA 01923-3620 ADDREss:danp_hurleyinsurance.com_ Daniel J Hurley INSURER(S)AFFORDING COVERAGE NAIC N INSURERA:Providence Mutual 15040 INSURED Gregory Clark INSURERB:AIM Mutual Ins.Co. 117 Jenkins Road Andover, MA 01810 INSURER C: INSURER D INSURER E INSURER F 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. INR TYPE OF INSURANCE POLICY EFF POLICY EXP LIMITS INSR WVD POLICY NUMBER MMIDDIYYY MMIDDIYYYY GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 AMAGE TO RENTED A X COMMERCIAL GENERAL LIABILITY 130P0070029 04/23/2015 04/23/2016 PREM SES Ea occurrence $ 50,000 CLAIMS-MADE rx-1 OCCUR MED EXP(Any one person) $ 5,00 -PERSONAL&ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,00 POLICY JECT LOC $ AUTOMOBILE LIABILITY EINED a accident) LIMIT $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS AUTOS ( ) NON-OWNED PROPERT Yent DAMAGE HIREDAUTOS AUTOS Peraccid $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY YIN X Y S E B ANY PROPRIETORIPARTNERIEXECUTIVE C-100-6017451-2015A 04/24/2015 04/24/2016 E.L.EACH ACCIDENT $ 100,00 OFFICERIMEMBER EXCLUDED? N I A (Mandatory in NH) SEE NOTES E.L.DISEASE-EA EMPLOYEE $ 100,00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) per policies: Gregory Clark is exempted from workers compensation. WC Insurance coverage applies only to the workers compensation laws of the state of Massachusetts. CERTIFICATE HOLDER CANCELLATION TOWNNOA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood St. AUTHORIZED REPRESENTATIVE 1 Bldg.20,Ste 2035 N.Andover, MA 01845 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD