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HomeMy WebLinkAboutBuilding Permit #1160-2016 - 17 COBBLESTONE CIRCLE 5/9/2016 _y BUILDING PERMIT o� NORTy q '(. L.HU TOWN OF NORTH ANDOVER - APPLICATION FOR PLAN EXAMINATION- Date XAMINATION :" " Permit No#: r 6 'Z Date Received �gSSACHUS���� Date Issued: IMPORTANT: Applicant must complete all items on this-page LOCATION j 7 �h,��- SYfl�l2 �i ( • I r_ Print. PROPERTY OWNER 4VIn IG /•� Print 100 Year Structure yes no MAP J I PARCEL:nbz ZONING DISTRICT: Historic District yes no Machine Shop Village yes n TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building 1'One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial 5eRepair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District 0 Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identific tion PI ase Ty a or Print Clearly OWNER: Name: l �le � Phone: Address: O ? Contractor Name: ��'�, co��i-�G�t�o Phone: 97�,"�S�6- 1(11'7 Emaii: Address: S Supervisor's Construction License: 1 a5"tit 3 Exp_ .Clate: Home Improvement License: 1 .705_7,S_" - Exp.• Date._ ARCHITECT/ENGINEER Pho�<., _ r Address: .°Reg_ Na:,... FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATEDZOST'9AS87-_ '$925.00 PER S.F. Total Project Cost: $ © croo. FEES Check No.: d Recei t No '� o� P NOTE:, Persons contracting with unregistered contractors do not have-ace fund essf6 u Location 1 I C Q � ' �'� J-1— No. -1—No. o 2 v't_ Date "1 • • TOWN OF NORTH ANDOVER . . , Certificate of Occupancy $ Building/Frame Permit Fee $��_ - Foundation Permit Fee $ Other Permit Fee $,A— TOTAL $ �PCheck#-270 !r • - : Building Inspector I i Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ n Tanuing/Massage/Sody Art L] Swimmig Pools El Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ I Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ j THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF e 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 y Planning Board Decision: Comments Conservation Decision: Comments k Water& Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: i Located 384 Osgood Street 'FIREDEPAR�Tt Temp ®umpster �� `Ltocated ghl2,4 ,, on�Csite s� moi �` ir¢eDepartmensignature%date I Dimension Number of Stories: Total square feet of floor area, based a i 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.$10041000 fine i _ I NOTES and DATA-- (For department use) i i I I i I i i i ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 i i I 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 4. Workers Comp Affidavit '.Photo Copy Of H.I.C. And/Or C.S.L. Licenses 4A ,Copy of Contract �6 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 ;. Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (if Applicable) 4. 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 4 Certified Proposed Plot Plan Photo of H.I.C. And C.S.L. Licenses Workers Comp Affidavit i Two' Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) 4 Copy of Contract 4 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 II � %AORTH Town of � _ Andover 0 - p ]y. h ver, Mass, �I T O LAN! x,9CoCMICA C. 5RATED J'k5 11 BOARD OF HEALTH Food/Kitchen PER..M 11LD Septic System THIS CERTIFIES THAT j6LT C BUILDING INSPECTOR ....................... .. ................................... ............. ............................ ........ . ..�' � Foundation has permission to erect ....... ................. buildings on .. ...... .... Rough tobe occupied as ......... ........ ...."M........`................................................................... chimney provided that the person accepting his 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 STARTS 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 Buil-ding Inspector. Burner Street No. Smoke Det. CD Roofing Vincent Colangelo 3 Hodgson St. Roof • Tewksbury,Ma 01876 THERE'S NO ROOF WE CAN'T COVER • 978-656-8497 978-656-8497 + • vincentcolongelo@sbcglobal.net HIC Llc# 170575 CSSL Lic# 105943 Customer: OWENS CORNING 160e :s4it Ctst ►\)-.Ankv.,r- PREFERRED CONTRACTOR Description of work Performed: � � �c�l�-1 6 Pei 4"o (1iJ Obtain required town permits& provide certificates of insurance&workers compensation Provide Dumpster set on planks*for contractors use only(materials all recycled) lJ)'Attach Large Tarps to protect adjacent finishes, landscaping, and property. (�Iy Strip-off( J) existing layers of roofing on complete house& re-nail any loose decking (�) Install 8inch 1,4 6 9. Aluminum Drip edging/Owens Corning Starter Shingles Install Owens Corning Ice&Water shield 6ft at eaves, 3ft in valleys, around all pene tions (X) Install Synthetic felt paper to entire roof ( Install Owens Corning LifeTime warranty TruDefinition Duration shingles ( �Install new neoprene vent pipe flashings on all plumbing pipes w -,a (�) Install Owens Corning VentSure ridge venting with moisture guard JUe L- (�l Install Owens Corning ProEdge hip& ridge cap shingles Completely re-flash chimney with lead S ) Owens Corning Preferred contractor installation with full warranty �J �r Q S All work will be completed according to state and manufacturing codes and specification a day we will have e Y roof water tight, clean gutters, completely clean the job site, and use a magnet roller to collect scattere 1 Additional work to be performed All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices. Any alteration or deviation from the above specifications must be made in writing on an Add-on/Modification of Contract form and may become an extra charge over and above the amount stated herein. This agreement is contingent upon delays beyond our control.Owners to carry fire,tornado and other necessary insurance.Our workers are fully covered by Worker's Compensation Insurance. Homeowner agrees to pay for all work as set forth below. If the homeowner defaults, homeowner agrees to pay all costs of collection, including reasonable attorneys fees,in addition to other damages incurred by contractor.Full Payment is due upon completion of work. We propose hereby to furnish material and labor - complete in accordance with the abo a specifications, for the sum of: dollars($ 10,q00. r ). Said amount shall be paid as follows: Note:This proposal may be withdrawn by us if not accepted within C days. YOU, THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION. SEE THE ATTACHED NOTICE OF CANCELLATION FOR AN EXPLANATION, OF THIS RIGHT. THIS SALE IS SUBJECT TO THE PROVISIO OF THE HOME SOLICITATION SALES ACT AND THE HOME IMPROVEMENT ACT THIS INSTRUMENT IS NOT NEGOTIABLE. Work will not begin until your right to cancel has expired and.yo ave_ aid.a deposit of dollars($ ), unless this agreement proAdes other Ise.X Signature of Contractor or authorized representative: *(I/We)have read the terms stated er in,th ve been explained to(me/us),and(I/We)find them to be satisfactory and hereby accept them. Signature of Homeowner(s): y f The Commonwealth of Massachusetts, z' Department o f IndustrialAccidents X Congress Street,Suite 100 - fYa Boston,M4 02114-2017 I www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE JEiIGED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legib Name(Business/Organization/bidividual): (.-4i /►q Address: C� SU ST City/tate/Zip: �S�Ci �1 Phone#: R?$� —8(Z�, —7 A.reyou an employer?Cheekt]ie appropriate box: Type of project )required): 1.❑l am aemployerwith t employees(full and/or part-time).* 7. [l New construction 2.Q I am a sole proprietor or partnership and have no employees working for me in 8. E]ReMggeling 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 0 Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors withno employees. / 12.0 Plumbing repairs or additions 5.I?(I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13. Roof repairs ccc777 These subcontractors have employees and have workers'comp.insurance. 6.E]We are a corporation and its officers have exercised their right of exemption per MGL c. 14.Q Other 152,§1(4),and Nye 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 snlimit#his affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must•attached an additional sheet showing the name of the sub-contractors and state whether or 1 . 1not those entities have . employees.i If the sub-contractors fiave-'1 mployees,they must proz-ide their workers'camp.policy number. .ram'' an employer that is piavidiizg worriers'compensation insurance for my employees.'Below is the policy and job site information. All!� rInsurance'Company Name: /��l q, W e n Policy#or Self-ins.Lic.#: ��c� 1 O O ©(AG— Expiration Date: fob Site Address: t 7 U SS 41 e- C-,,,r-- City/State/Zip: � /V -1 cJ UP r� 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,asell as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. of this st tement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verificati f I do hereby of u er tl pains andal' erjury that the information provided above is trule and correct. Signafore: Date: l ' Phone#: _t ? �O 5_G' ?)Q9 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#: i I AC D® LIATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 4/13/16 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 endorsemen PRODUCER CNA O SACT I Angela, Westen Insurance Agency PHONE 978 735-4094 IAIC,FAX NII: (978) 735-4095 557 Central Street nDMOREss: angela@awesten.com I LOWell MA 01852 INSURE S AFFORDING COVERAGE NAIC# i INSURER A:ATLANTIC CASUALTY INSURANCE CO I INSURED INSURER B:HARTFORD UNDERWRITERS INS COMP F O CONSTRUCTION CORPORATION INSURERC: , 4 ASTOR ST AP. 4A INSURER D: 'LOWELL, MA 01852 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. INSR AWL SUBR POLICY EFF POLICY EXP LTR TYPE OF IN POLICY NUMBER DD MIY MMIDD/YYYY LIMITS A GENERALLIABILI Y L021008696-2 3/18/16 3/18/17 EACH OCCURRENCE $ 1,000,000 . $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTEDPREMISES(Eaoccune $ 100,000 CLAIM-MADE EIOCCUR MED B(P(Ary one person) $ 5,000 PERSONAL&ADV INJURY $ 11000,000 GENERAL AGGREGATE $ 2.000,000 GEWLAGGREGATE LIMITAPPLIES PER PRODUCTS-CC)MP/OP AGG $ 1 OOO OOO POLICY PRO LOC $ AUTOMOBILELIABILITY COMBINED SINGLE LIMIT a accident $ ANYAUTO BODILY INJURY(Per person) $ ALLOWNED SCHEDULED BODILY INJURY(Per accident $ AUTOS AUTOS ) 1 NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS era.Mint) $ UMBREUA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION2E112068-16 3/30/16 3/30/17 WCSTA . DTH- , IND EMPLOYERS'LIABILITY Y/N ANY PROPRIETORIPARTNERIEXECUTVE E.L.EACH ACCIDENT ZOO OOO OFFICERNEMBEREXCLUDED? N/A (MandMry In NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 DESCRIPTION describe under E.L.DISEASE-POLICYLIMIT $ _ __5001000 DESCRIPTION OF OPERATIONS below DESCRIPTION OFOPERATIONS/LOCATIONS/VEHICLFS (AuachACORD 101,AdditionalRenerksSchedule,Hmore space isreguired) i CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CD ROOFING ACCORDANCE WITH THE POLICY PROVISIONS. VINCENT COLANGELO 3 HODGSON ST AUTHORIZED REPRESENTATME TEWKSBURRY, MA 01876 @ 1988-2010 ACORD CORPORATION. All rights reserved. ACOR0 25(2010105) The ACORD name and logo are registered marks of ACORD Phone: (978) 656-8497 Fax: E-Mail: VINCENTCOLANGELO@SBCGLOBAL.NET i �c ,, of Office Consumer Affairs&Business Regulation I OME IMPROVEMENT CONTRACTTy e: o Registration: ,_x170575 Expiration: 1111.012017 DBA CD ROOFING "� s VINCENT COLANGELO 3 HODGSON ST Undersecretary i TEWKSBURY,MA 01876 Mass ' BO oard ac 6 tts Department of - -_ wilding Re ns Public Safety License: CSS Watio and St943 andards Construction SupervisoSSpecialty j VINCENT COLANGELO 3 HODGSON STREET TEVNICSBURy MA b1876 Commissioner -_ Expiration: 03/09/2018 I