Loading...
HomeMy WebLinkAboutBuilding Permit #918-15 - 1589 SALEM STREET 5/14/2015 IJUILUINU IJLKMI I 3a �b:�• r '•'a o� . � TOWN OF NORTH ANDOVER ° VA Y45 APPLICATION FOR PLAN EXAMINATION Permit NO: C11Date Received Date Issued: "i 4SSACHUS EMPORTANT:Applicant must complete all items on this p2e LOCATION �- mt n PROPERTY OWNER.:_: , Print , MAP NO PARCEL,` ZONING DISTRI CT: Machine Sho Villa e. ye ;;no , p 9 y a 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 q;Septic ❑V1/ell ❑ Floodplain - 11.Wetlands ❑•Watershed-District b Water/Sewer Identification Please Type or Print Clearly) OWNER: Name: \Q�zZ I Phone: Address: S►'rtS�- -J 6Q� , o\ryS CONTRACTOR Name, Phone ` 8'�661/1a 5"S"_"7 „ Address: K)0 ` Supervisor's Construction'License: Exp k� fDate tk 3 � Home Improvement License Exp. "Pate", c 10 ARCHITECT/ENGINEER Phone: Address: Reg. No. i FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ &<1' 70 FEE: $ 161 •bo 2 Check No.: `Z 2-°t Receipt No.: 2-Ck OTE: Persons contracting with unre istered contractors do not have access to the guaranty fund Signature�of 6gent/Owne �Signature__of.go ntractof 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. ❑ Pennanent Dumpster on Site ❑ TIME FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF m U FORM PLANNING & DEVELOPMENT Reviewed On Signature— COMMENTS i9natureCOMMENT'S CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS 0 Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes t Planning Board Decision: Comments ti Conservation Decision: Comments j Water& Sewer Connection/Signature ®ate Driveway Permit JDP`V6r Town Engineer: Signature: r RE DEPA '�"' Located 384 Osgood tFf n R�TMEidT Temp D � , Street to pO is i r A-_7th+ -:�-. umps r� visite yesA„� i3 no f p{Located at 124 Main Streets � �,}rw=i3 } Fire Departments .�,3w 's ` . � . , 'y ;� �,� ` gnatu're/date '�.: +} � ��_ �TY.N �. l yv� �t.t ^�t~f'L� � l itl�.. d�F'��^• �•t� �.�'n� ...., '�'"”` , CQMMEIVT{S 44 T} x1 ., �, �, •.,., �+�.� ,����}� .,�, .� �s�E� � r.�,�f `g,` ,; � ;,,� a ,�, , Dimension I Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: i ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes N® MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use) I I I Iii II Notified for pickup Call Email Date Time Contact Name Doc.Bnilding Permit Revised 2014 J 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 4. Building Permit Application Workers Comp Affidavit 4. Photo Copy Of H.I.C. And/Or C.S.L. Licenses 4� 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 4- Building Permit Application Certified Surveyed Plot Plan Workers Comp Affidavit Photo Copy of H.I.C. And C.S.L. Licenses Copy Of Contract 4. 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 OTE: 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 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 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 � I Location / ay t -jib"7 No. Date . • TOWN OF NORTH ANDOVER Certificate of Occupancy $ m Building/Frame Permit Fee $ � Foundation Permit FeeAT $ - �k Other Permit Fee $ TOTAL $ Check# Z � _ P 28774 -BuildingInspector NORTH Town of EAnd-over O .. _ In 4iA- a n No. 5 * '-t C%o h ,h ver, Mass, , 1 coc Nlc"twl[« 1' 04gTEO Ok*p �(y S U BOARD OF HEALTH Food/Kitchen PE.R l T LD Septic System 00) • THIS CERTIFIES THAT ........ .. • BUILDING INSPECTOR Foundation has permission to erect .......................... buildings on . ...... ........... .....S. Rough to be occupied as .......5.�.. .. .. . .........4.... ,,.... .. . . .......... ................................ . Chimney provided that the person acce i this permit shall in every respect nform 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 do+ • UNLESS CONSTRUCTI TA S 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 of Massachusetts Department of Industrial Accidents I Congress Street, Suite 100 Boston,MA 02114-2017 www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): Duval Roofing LLC Address: P.O. Box 637 City/State/Zip: North Reading, MA 01864 Phone#: 978-664-2557 Are you an employer?Check the appropriate box: Type of project(required): 1.2 I am a employer with $ mployces full and/or part-time).* 7. New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.❑I am a homeowner doing all work myself[No workers'comp.insurance required.]t 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10❑Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑ p Roof 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 41 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 workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy andjob site information Travelers Insurance Company Name: I Policy#or Self-ins.Lic. #:7PJUB-023ON91-9-15 Expiration Date:3/9/16 1589 Salem Street No Andover ma Job Site Address: 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 herebycerti der the pains and penalties of perjury that the in ormation provided above is true and correct Si natur . --��7z�- Date:5-13-15 Phone#:978-664-2557 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 12.City/.i own Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Prune#: CERTIFICATE OF LIABILITY INSURANCE 3/12/2015�J) 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(ies) 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). PRODUCER CONTACT Barbara McDonough NAME: g Gilbert Insurance Agency, Inc. PHONE . (781)942-2225 FAX (781)942-2226 137 Main Street E DRE .bmcdonough@gilbertinsurance.com INSURERS AFFORDING COVERAGE NAIC# Reading MA 01867-3922 INSURER A:Harle svi1le/Nationwide 26182 INSURED INSURER B:Pl oath Rock Assurance Corp. 04154 Duval Roofing, LLC. INSURERC:Travelers Ins. Co. 0031 P.O. BOX 637 INSURER D: INSURER E: North Reading MA 01864 INSURER F. COVERAGES CERTIFICATE NUMBER CL1411601329 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. INSR TYPE OF INSURANCE ADDL S BR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED 100,000 PREMISES Ea occurrence $ A CLAIMS-MADE ❑X OCCUR GL00000064158G 10/23/201410/23/2015 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GE N'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY JrCTPRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident 500,000 B ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X AUTO SCHEDULED RC00001003799 10/23/201410/23/2015 BODILY INJURY(Per accident) $ AUTOS S X HIRED AUTOS X NON OWNED PROPERTY DAMAGE $ AUTOS Per accident Uninsured motorist BI split limit $ 100,00 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ C WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS LIABILITYTORY LIMITS I ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N PJUB-0230N91-9-15 E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? F-] N/A (Mandatory In NH) /11/2015 /11/2016 E.L.DISEASE-EA EMPLOYEJ$ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Soo,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space Is required) Evidence of Coverage CERTIFICATE HOLDER CANCELLATION I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Evidence of Coverage ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE M Gilbert, CIC/BARBAR Arnon os/on-in/nai n ioau_onIn Arnen rrnonnoe Ttnhl Au rinhrc rnen.,,nrl M m N. Cn 'a M- IT Or U W r .A fn CLL Q i � Q & 4 QE t/! 8 �i�a c Ln .+e,' \ O ' � INit O G7 0 z � 0° a � z Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration --� Registration: 167338 Type: LLC lR � Expiration: 9/10/2016 Tr# 256221 DUVAL ROOFING LLC. KENNETH DUVAL ------ P.O. BOX 637 - - -- — NO. READING, MA 01864 � � — Update Address and return card.Mark reason for change. SCA i 0 20M-05/11 "'"' Addressj Renewal Employment Lost Card Page No. of Pages J Builders License # 58443 / Home Construction Reg. # 167338 eM�U,V, (781)944-1994 (978)664-2557 READING NORTH READING P.O. Box 637, North Reading, MA 01864 Please visit us at www.duvalroofing.com PROPOSAL'SUBMITTEDTO f Pp,ONE DATE 7 ?e--S-90 �/� 2c-//-`� STREET �.. �. CITY,STATE AND ZIP CODE We hereby submit specifications and estimates for: f C">fs pi ti �.i G1 .1�� f.�C. _ 0 Rip& Remove all existing roof related debris from roof as well as job site with our own disposal truck. NO DRIVEWAY DUMPSTERS j ❑ 1 layer of existing roof shingles LJ/2 layers of existing roof shingles ❑3 layers or more of existing roof shingles ©'Replace any damaged roof decking; not to exceed 32sq.ft. (additional at$1.70 per sq.ft.) ❑Install 8"Aluminum Drip-edge/Rake-edge along entire perimeter(Choice of White, Brown or Mill) ❑`Install ICE&WATER UNDERLAYMENT on all horizontal eaves, sidewalls,skylights,chimney flashing and valley areas ❑ I nstall a premium base sheet underlayment(felt)that is in compliance with the asphalt shingle manufacturer chosen by the hom caner Install The Homeowner's Choice of the selected Tamko/IKO or GAF Limited Lifetime Architectural Roof Shingles See individual manufacturer's warranty for specific details or please call us with any questions I _-._.__.._........ .. d Replace all existing bathroom louver and/or exhaust pipe(s)with new aluminum flanges Chimney(s)-counter-flash and re-step existing flashing ❑Cut& Install new lead flashing LI Install a continuous low profile Ridge-Vent on all ridge lines ❑Soffit-Vents ❑ Roof Louver-Vents ❑Seamless Aluminum Gutters-Custom fabricated on site with our own gutter machine i ❑Downspouts at additional ❑Leaf Guards l ! ❑Roof Insulation- Increase existing R. value to R.value i f ....._...... t I Pe Prapase hereby to furnish material and labor-complete in accordance with above specifications,for the sum of: i 2t10o Total price not including options. dollars($ �S l 47 Zn ). Payment to be made as follows: 30%deposit required before ordering materials. Balance due in full upon day of completion. Please make all payments out to Kenneth Duval, mailed to: P.O. Box 637, No. Reading, MA 01864 Final Payment is due upon day of completion and is subject to the Authorized supplemented Terms&Condition sheet when scheduling. Signature )J THIS PROPOSAL IS VALID FOR DAYS DUE TO FLUCTUATIONS IN MATERIAL&DISPOSAL PRICES.