Loading...
HomeMy WebLinkAboutBuilding Permit #059-15 - 162 HILLSIDE ROAD 7/17/2014 J � tSUILUINU t'tKMI 1 TOWN OF NORTH ANDOVER ` h � ® � APPLICATION FOR PLAN EXAMINATION +1 Permit NO: •J ' Date Received ` .r Date Issued: i 1 �RS-T CHU$'A r ' IMPORTANT: Applicant must coni lete all items on this ane LOCATION f Z i!/�jtol !2 / PROPERTY OWNER Print Print MAP NO &_, PARCEL: ZONING DISTRICT: Historic Districtyes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential Dl New Building -<One family -- 0 Addition Two or more family Industrial 0 Alteration No. of units: Commercial )<Repair, replacement Assessory Bldg Others: Demolition Other Septic C Well Floodplain Wetlands0 Water/Sewer Watershed District Identification Please Type or Print Clearly) OWNER: Name: Phone. Address: CONTRACTOR Name; Phone: Address: Icl- 1�7X arc Supervisor's Construction License: pp, _ Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE;BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ ` ✓fir. '0 FEE: $_, i� Check No.: ��-� Receipt No.:___ Z NOTE: Persons contractr9 iv'tlr ur egistered c�alztrctctors d�not lrrrve access t��theity�`ctrtcl Signature of Agent/Own "': Ignature of contractor T — - 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 o Floor Plan Or Proposed Interior Work o 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 o 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 i Dimension 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 No MGL Chapter 166 Section 21A—F and G min.$10041000 fine NOTES and DATA — (For department use) i ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 r _ I Plans Submitted Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swmmning 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 PLANNING & DEVELOPMENT Reviewed On Signature_ 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 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 124 Main Street Fire Department signature/date COMMENTS -- 7 T Location I V 2 � �' Qcy- No. D — Date • - TOWN OF NORTH ANDOVER . Certificate of Occupancy F $� AN � Building/Frame Permit Fee $ vt�� Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# t♦ Y' / �. � JJJ Bw ding Inspector NORTH Town of .. tAndover No. I * t — I 2-04 h ver, Mass, l coc NIc"t WICK 1• S U BOARD OF HEALTH PERMIT T LD Food/Kitchen Septic System Al THIS CERTIFIES THAT ... .... ....... �� ... .IAd BUILDING INSPECTOR ...... , �t Foundation ............ has permission to erect .......................... buildings on ..� �......................... • ............ ... .................... Rough It to be occupied as ........ .. . . ......... ..... .................................................................... 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 CONSTRUCTIO A 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. ACORo® CERTIFICATE OF LIABILITY I DATE(MMIDDdYYYY) INSURANCE 5/16/1, 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 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 ME Sabatino Insurance AgencyPHONE 564 Broadway 617 387-7466 1 FAX No: (617) 381-9186 E�naL Everett, MA 02149 ADDRESS: INSURERS)AFFORDING COVERAGE NAIC# INSURED INSURERA:NORTHLAND INSURANCE COMPANY INSURERB:Safet Insurance Action Construction Inc David Krasny INSURERC:Amcruard Insurance Co 19 Hamilton Ave INSURER 0: Billerica, MA 01821 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. R SBR POUCNUMER /LI �FLTTYPE MD/YPOUCY A GENERALLU3ILITY MMC/YYYY LIMITS WS160230 1/1/14 1/1/15 EACH OCCURRENCE $ 1,000,000 X COMNERCIALGENERALLIABIUTY DAMAGE TO RENTED tincel $ 100 000 CLAIMS-MADE a OCCUR MED EXP(Anyone person) $ X PER PROJECT PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2.000,000 GEN'L AGGREGATE LIMITAPP LIES PER PRODUCTS-COMP/OPAGG $ 1,000,000 POLICY r7 PRO LOC $ B AUTOMOBILE LIABILITY 6227978 3/17/14 3/17/15I 0 1 MR aacc�den $ 1,000,000 ANYAUTO ALLOWNED SCHEDULED BODILY INJURY(Per parson) $ OWNE AUTOS AUTOS BODILY INJURY(Per accident) $ HIREDAUTO5 _N - WNAUTOSED PROPERTY DAMAGE eraccideM $ ,i—MABRELLA LIAB OCCUR EXCESS UAB CLAIMS-MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION 5 C WORKERS COMPENSATION $ AND EMPLOYERS'LIABILITY WC501320 4/1/14 4/1/15 WCSTATU- OTH- O CERMEMBEREXCCLUDED? FR �CU N/A E.L.EACHACgDENT $ 100 OOO YIN TnRYLlMrrq (Mandatory in NH) l(yyesdeacrlbeunder E.L.DISEASE-EA EMPLOYEE $ 100 000 DESG�RIPTIO N OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is requi red) ELITE CONSTRUCTION LISTED AS ADDITIONAL INSURED. CERTIFICATE HOLD CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANC ELLE D BEFORE EL E CONSTRUCTION THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 1 CONTI7AL BLVD RRIMACH 03054 AUTHORIZED REPRESENTATIVE el ©1988-2010 ACORD CORP RATION. All rights reserved. ACORD 25(2010/05) The AC ORD name and logo are registered marks of ACORD 'hone: Fax: g E-Mail: • ��11C' f'C II!IIIC I!!!'rp�lf!!���� � }� � 99 .. .. ,. ... ..,_ CfJJCCC'ffCJf(CJ 'rlc Su2C:.,,,a4:':S Office of Consumer Affairs&Business Regulation T� • ME IMPROVEMENT CONTRACTOR +tsgistration: 157671 TY pal Construction Supcni►urSprcialT} y ,expiration: 10/29!2015 DBA ee se CSSL-099498 -ACTION CONSTRUCTION DAVIDKRASIVY r 19 Hamilton Avenue DAVID KRASNY Billerica MA 01821 " 19 HAMILTON AVE SILLERICA, MA 01$21 Undersecretary J' 3rr 02/22/2016 The Commonwealth of Massachusetts rani rorm . : _ - Department of Industrial Accidents Office of Investigations -1 1 Congress Street, Suite 100 Boston, MA 02114-2017 -?'=- www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Auplicant Information Please Print Legibly Name(Business/Organization/Individual): 14C7/USC cr?ic-s:A&C-J701. //,c Address: /�) 1-1X1W-UOrt A1,1 13/ICC` ��i� �'3i9 v/.'Z / City/State/Zip: Phone #: � 7P_ 7Z6_.570 l Are you an employer?Check the appropriate box: Type of project(required): 1.[5-1 am a employer with / 4. ❑ 1 am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. ❑ New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.* 9 Building addition required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doingall work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.©"Roof repairs insurance required.] c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box X11 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. lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: 41-76*61, 1,7P 11,561/1,4ACe- Policy#or Self-ins. Lic. #: t K-C 5-01 3 Z U Expiration Date:_ Job Site Address: S11PE` "IV_/ Ae00-1'Ty,�!/,/�r �C y State/Zips 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 cerci under the pains and enalties ofperjury that the information provided above is true and correct. Si nature: Date G / Zal Phone#: C' 7P- -7267 70 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 Ih DAVID KRASNY Cell: 978 726 9709 ACTION CONSTRUCTION INC Email: action.david-@yaho®.com. 19 Hamilton Ave www.theaction_roofinn._com Billerica, MA 01821 Proposal Date: 07/14/2014 Proposal Submitted To: Work to be performed at: Name: Maureen and Mark Alterio Address: 162 Hillside Rd Address: 162 Hillside Rd North Andover, MA North Andover, MA Phone: 978-886-4590 The price of $17,900.00includes: • Strip all existing roofing material down to the sheeting. • Inspect the sheeting. • Remove the solar panels. • White 8" aluminum drip edge along the eaves and up the rakes. • Certainteed Winterguard / GAF Ice and Water 6' high on all eaves, up the valleys, under the step flashing and around the chimneys and pipes. • Certainteed Diamond Deck synthetic underlayment/ GAF Tiger Paw synthetic underlayment on the rest of the roof. • Certainteed Svift Start/ GAF Pro starter strip on all eaves. • Roofing material — CERTAINTEED LANMARK WOODSCAPE /GAF TIMBERLINE High Definition asphalt shingles with LIFETIME MANUFACTURER WARRANTY. 6 nails will be used. Color TBD • Certainteed Shingle Vent II / GAF Cobra ridge vent on the ridges. • Certainteed Shadow Ridge / GAF Seal a Ridge Cap shingle matching the shingles. • Chimney re-lead. • Pipe boots replacement. • Siding, plants and lawn covered with tarps. • Thorough ground and gutter clean up, magnetic clean up of all nails in the property. • Material dropped in the driveway. • Dumpster dropped in the driveway and picked up immediately after completion of the job. • All necessary permits. • 5 years labor warranty. • LIFETIME CERTAINTEED OR GAF WEATHER STOPPER SYSTEM PLUS MANUFACTURER WARRANTY. 1 DAVID KRASNY Cell: 978 726 9709 ACTION CONSTRUCTION INC Email: action,davidi@yahoo.com 19 Hamilton Ave www.theactionroofing.com Billerica, MA 01821 Additional charges may appy Replacement of 32 linear feet of the roof board or 1 sheet of plywood is included in a price. If additional roof sheeting is found in unacceptable condition (ex. rotten, cracked, wide gaps between the boards...) Action Construction will charge $45.00 for every sheet 7/16 4x8 CDX plywood installed or$3.50 for every linear foot of roof board replaced. $8.00 for every linear foot of fascia board replaced. We do not hire subcontractors. alb Respectfully submitted by: 0}�� 6 10 Action Krasny 0J�� SLG o Construction Inc. �,�0 k vo 19 Hamilton Ave �,IS Billerica, MA 01821 - Home improvement contractor registration number 157671 Construction Supervisor Specialty License number 99498 Date 06/14/2014' 7 Signature: "=� Acceptance of proposal The above prices, specifications and conditions are satisfactory and _ you are hereby accepted. You are authorized to do the work as specified. Payments will be made as outlined below. Deposit $5,966.00 When a half is done $5,966.00 Within one week after completion of the job $5,968.00 Maureen and Mark Alterio Address: 162 Hillside Rd North Andover, MA Date 06/14/2014 Signature: 2