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HomeMy WebLinkAboutBuilding Permit #734 - 154 MAIN STREET 6/11/2008 pORTH BUILDING PERMIT Oftt�eo ,bq�. TOWN OF NORTH ANDOVER or APPLICATION FOR PLAN EXAMINATION q 1� Permit NO: Date Received > ��SSwCHus�� Date Issued: /`o/ / �IjMPORTANT: Applicant must complete all items on this page LOCATION / -J CS �I 'I-5t) f �'/O • I�fie(Mel' P� PROPERTY OWNER J,- n /< D)c Iltme/rl e-a.-, Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Abmfign No. of units: ommercial $/9� it replacement` Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: a Identification Please Type or Print Clearly) OWNER: Name: &nK 4r 1gMEr—iL,+ Phone: Address: /%5�qQ ff� S%f A10. CONTRACTOR Name: 00� Qi�r� - hone: Address: ,5p *-MAA J t" % d 0V Supervisor's Construction License: Exp. Date: Home Improvement License: / d aJ Exp. Date: D 7 D d g ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BCA/SED ON$125.00 PER S.F. Total Project Cost: $ o�� , e' yj`• �� FEE: $ a �I Check No.: .2-(�3'2 l Receipt No.: r)l 931 NOTE: Persons contractlhg6vith unregistered contractors do not have access to the guaranty fund w Signature of Agent/OwSignature of contractor99� 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 HEA, TH Reviewed on Signature 4 tl. COMMENTS r 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 on site yes no Located at 924 Main Street Fire Department signature/date COMMENTS 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: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— For department use ❑ Notified for pickup - Date Doc.Building Permit Revised 2008 i Building Department i 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/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 ❑ 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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 Location Zo �� No. Date Z/ MOA�h TOWN OF NORTH ANDOVER 3?O�t•`•o •,�O O Certificate of Occupancy $ s �+sACMus Building/Frame Permit Fee $ Foundation Permit Fee $ ` Other Permit Fee $ TOTAL $ Check # �)(/ 3�;L ' 2 1 231 vBuilding Inspector oof Maintenance & Systems Incorporated April 21, 2008 Ms. Tina Daigle CB Richard Ellis MA6-535-01-05 1075 Main Street Waltham, MA 02451 Re: Roof Replacement Bank of America 154 Main Street North Andover, MA Dear Ms. Daigle, The roof at the above location is in fair-poor condition. Gutters appear to be too small for associated eave trim, this condition will allow water in to the soffit. Per your request we propose to furnish equipment material and labor to successfully complete the following work. Shingle Roof(approximately 2300 square feet) • Remove existing shingle roof to deck, dispose of the debris in a proper manner. • Supply and install 6' of ice and water shield at eaves and 3' at valleys. • Supply and install underlayment felt to the remaining surface of the wood deck. • Supply and install 8" aluminum drip edge to the perimeter of the roof, in the standard color of your choice. • Supply and install 30 year architectural grade shingles per manufacturers specifications. Manufacturer and color of your choice. • Supply and install ridge vent with appropriate hip and ridge shingles. • Flash all existing roof penetrations per NRCA's "Roofing & Waterproofing Manual" specifications. • Supply and install 032 white aluminum "soffit- ledge" cap at gutter locations. • Supply and install 6" 032 white aluminum gutter. • Clean all work related debris and dispose of in a proper manner. • Supply 30 year shingle warranty from the manufacturer. All for the sum of$18,585.00 Flat Roof Installation (50 square feet ) • Supply and install 2x6 wood blocking to the outer perimeter of the roofs. 30 Merchants Drive, P.O. Box 638, Walpole, MA 02081 Phone .508-668-0100, Fax 508-668-0619, E-Mail, Roof nainnaTlAC.net • Supply and install 1.5" polyisocyanurate insulation to the surface of the roof attached with plate and screw per manufacturers specifications. • Supply and install Carlisle/ Firestone 060 EPDM rubber roof in a fully adhered manner. • Supply and install 040 aluminum gravel/ drip edge to the perimeter of the roof, in the standard color of your choice. • Clean all work related debris and dispose of in a proper manner. All for the sum of$1,495.00 Asbestos Testing for 2 roofs, $495.00 If you have any questions or if I can be of any further assistance, please don't hesitate to call me. ince `ely Robert and Vice President Cc: File/E04218-CD ; 7 �qa� i NORTH TO" of No. - �` o , dover, Mass., (V 0 1)A COC HIC HE WIC I(`y� D ?-A ED Cl S ` BOARD OF HEALTH Food/Kitchen Septic System PERMIT T D BUILDING INSPECTOR ....... THIS CERTIFIES THAT.......... .. .�ir.. ............ ......... .... •�.............. ................ Foundation has permission to erect.... .... bu gs on ......n.wy............ .�A►�r�.......... .... , Rough to be occupied as........ .......... '......... � ........... +.. .......... .............................................. Chimney provided that the person accepting this permit sh in every respect conform t he terms of the application on file in Final 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 JY3 PERMIT EXPIRES INb THS ELECTRICAL INSPECTOR UNLESS CONSTRUC N S TS Rough Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR 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. SEE REVERSE SIDE Smoke Det. Information and Instructions 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 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 of public 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-contractor(s)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 may be 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(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 affidavit is on file for future permits 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 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 Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-7274900 ext 406 or 1-877- M ASSAFE Revised 5-26-05 Fax# 617-727-7749 www.mass.gov/dia The Commonwealth of Massachusetts c N; 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/Individual): �OD� �"l YJ O, P.e t e.;Y Pi1 z /I7C� Address: City/State/Zip: Phone #: Are you an employer?Check the appropriate box: Type of project(required): 1.® I am a em to er with 4. ❑ I am a general contractor and I P —1� 6. ❑ New construction employeesull nd/or part-time).* have hired the sub-contractors 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. workers' comp.insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its officers have exercised their 10.❑ Electrical repairs or additions required.] 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.X Roof repairs insurance required.] t employees. [No workers' 13.❑ Other comp. insurance required.] 'Any applicant that checks box#t 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 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. � 7 . Insurance Company Name: Policy#or Self-ins. Lic.#: We, 0 3 O 7�C.Y Expiration Date: e� iol 0 k Job Site Address: Oy Mai Uy-• City/State/Zip: 1Vd•n4;1e4. W 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 andpenalties of perjury that the information provided above is true and correct. Signature: Date: Phone#: JO- 66 9'o/o o 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#: Massachusetts - Departntent of Public Saferh Board of Buildin!- Re!-ulations and Standards Construction Supervisor Specialty License i License: CS SL 99387 -Restricted to: RF ROBERT ELLARD 227 CAUSEWAY STREET MEDFIELD, MA 02052 Expiration: 7/12/2011 ('ununissiuncr Tr#: 99387 TOR �'egi5trat'I'olt: tQ2431 i Exp;i,ratign;" 711/2008 Hype: Fr vat-Corporation , ROOF-MAfNTENANq* ND SYSTfs ms, I ; t r,r 30'M iAt `. Depute Administrator /282A RQ CERTIFICATE OF LIABILITY INSURANCE DATE PRODUCER (781)235-3100 FAX (781)235-7190 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Corcoran & Havlin Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR Insurance Agency, Inc. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 287 Linden Street Wellesley, MA 02482 INSURERS AFFORDING COVERAGE NAIC# INSURED Roof Maintenance & Systems Inc. INSURERA: Acadia Insurance P. 0. BOX 638 INSURERS: American Home Assurance Co. Walpole, MA 02081 INSURER C: INSURER D: INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DDT TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR NSL_ DATE 1MM/DD/YY1 GENERAL LIABILITY CPA017950211 05/01/2008 05/01/2009 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 300,000 CLAIMS MADE M OCCUR MED EXP Any one person) $ 15,000 A X Employee Benefits PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000, GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY M PJECTRO LOC AUTOMOBILE LIABILITY MAA017958611 05/01/2008 05/01/2009 COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ 1,000,000 ALL OWNED AUTOS BODILY INJURY X SCHEDULED AUTOS (Per person) $ A X HIRED AUTOS BODILY INJURY $ X NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY CUA017958711 05/01/2008 05/01/2009 EACH OCCURRENCE $ 5,000,000 X OCCUR ❑ CLAIMS MADE AGGREGATE $ 5,000,000 A $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND WC6838706 05/01/2008 05/01/2009 X I WC STATU- OTH- ' I FIR EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $ 1 000 B ANY PROPRIETOR/PARTNER/EXECUTIVE , ,000 OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION (J SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL by 20 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, [] BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. 08-09 Clients Copy AUTHORIZED REPRESENTATIVE�George Doherty/CHERYL ACORD 25(2001/08) ©ACORD CORPORATION 1988