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HomeMy WebLinkAboutBuilding Permit #797-16 - 17 SUGARCANE LANE 1/11/2016V 4�y WA �Lr/ BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received Date Issued TANT: Applicant must L0CATT I O.N1i PROPER; Y OWNER MAV/aiFAR -.FL,. all items on this eat v-�tLeo 16V6 o A m \4 �fa A°awreo 0r C5 es no, ye$T no! TYPE OF IMPROVEMENT PROPOSED USE Resioential Non- Residential ❑ New Building t2lone, family ❑ Addition ❑ Two or more family ❑ Industrial ❑ teration No. of units: ❑ Commercial t epair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other 0 °Septic ❑ UVelh - _ ❑ Floodplain3 �TWetlancJs; ❑ 1Natershed� District,. ❑'Water<Sewer: s. _._-- DESCRIPTION OF WORK TO BE PERFORMED: Ide tification - Please Type or Print Clearly OWNER: Name: '- [-111: C t �a4 Phone: AririrPcc• ©ntractor Name:©� !Phone,'-..- '0 Phone Address ` _ - _ _ ( _ - -- _- �,1+ r S'upervisor's Const'ruction�;License '2- .-T _Exp Date: - - s Home Improvement LicenseExp Date; _. - - - - -_ -- - _ s- -_ -- -- ARCHITECT Phone: Address: Reg. No. FEE SCHED E: BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: l g Receipt No.: NOTE: Persons f ratting wit unregistered contractors do not have access to the guaranty fund 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 PLANNING & DEVELOPMENT Reviewed On COMMENTS CONSERVATION COMMENTS HEALTH r� `COMMENTS Signature Reviewed on Signature Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments 1, Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FfREDEPARTMENTi Tem `®u ¢`steron site �yesti _Y Win, aka — �" I fac Located :at C 0. A C �41VIam�Street p 1 Fre�� a artmentsi nature/d�'te� � { SCO M IVI'F NTSli j - 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 MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine NOTES and DATA — (For department use) ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Pennit Revised 2014 No 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 u Building Permit Application o Workers Comp Affidavit a Photo Copy Of H.I.C. And/Or C.S.L. Licenses o 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 D Building Permit Application Li Certified Surveyed Plot Plan o Workers Comp Affidavit o Photo Copy of H.I.C.-And C.S.L. Licenses u Copy Of Contract o Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) Li Mass check Energy Compliance Report (If Applicable) o 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) o Building Permit Application o Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract o Mass check Energy Compliance Report o 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 Location No. . - TOWN OF NORTH ANDOVER • . Certificate of Occupancy $ Building/Frame Permit Fee $!!5-7& l - Foundation Permit Fee $ M Other Permit Fee $_ TOTAL $: t ' Check'# .Building Inspector n rA O i OLi O O O V cD 33Q 3 0 yr y v E Q N O d d w C C� (J (n e >+ C i > > O-0 r - `0 0 a� O z �r� ® N_ .0 0 � N 3 L CL 0) Q L L a .a co m W O _ O O um] N N C 0 v v Lu. E0 m V Q O -0 m >c 2 o cn OL O O O W 'Z V C3 J .m O Cl) E N N W LL w Z c O UJ V cn cuj W J m � O .0 N O t O M O Q J O > e O O F- u oC Z BUW W W O W d � W Q, H H V = Z Z Z Lila . LL D Z V Z W uiZ m W L1. m Y C W t u ? O O a N y N 41 Z v to O Q. ro co - j� m ro v O LL (n LLL d' U LL d' LL W N LL c LL m V) N O i OLi O O O V cD 33Q 3 0 yr y v E Q N O d d w C C� (J (n e >+ C i > > O-0 r - `0 0 a� O z �r� ® N_ .0 0 � N 3 L CL 0) Q L L a .a co m W O _ O O um] N N C 0 v v Lu. E0 m V Q O -0 m >c 2 o cn OL O O O W 'Z V C3 J .m O Cl) E N N W LL w Z c O UJ V cn cuj W J m � O .0 N O t O M O Q J O > e Proposal AB Carnes. Roofing, Inc. ✓ 29-1 age 1 of 1 Zv�w 30 Arrowhead farm Rd Boxford, Ma. 01924�„ -T 978.887.1431 MA. CS•000230 and HIC:Reg.17692S Proposal Submitted To: WILLAIM & KELLY SILVA Date October 26, 2015 17 SUGARCANE LN ProjedtName SAME NORTH ANDOVER, MA 01845 Address 978-557-5728 We propose to furnish material and labor- in accordance with the specifications below: Twelve Thousand Three Hundred Dollars ($12,300.00) Payment to be made as follows: $300.00 Deposit, Balance Uponj Completion9 once: All home improvement contractors and subcontractors engaged in home improvement contracting, unless specifically exempt from registration by provisions of Chapter 142A of the General Laws, must be registered with the Commonwealth of Massachusetts. Inquiries about registration and status should be made to the Mass.govllicenses website. ROOF PROPOSAL ® STRIP ROOF OF ALL LAYERS OF ASPHALT SHINGLES. COVER ROOF DECK WITH THE, PGRADED RHINOROOF TITANIUM U20 HIGH PERFORMANCE SYNTHETIC UNDERLAYMENT MEMBRANE. COVER EXTERIOR WALLS AND FOLIAGE. WITH TARPS TO HELP PREVENT DAMAGE. ® ICE DAM PROTECTION! INSTALL CARLISLE HIGH PERFORMANCE ICE & WATER BARRIER OVERALL HEATED AREAS .i�Tf EEI WIDE AT THE LEADING EDGE OF ROOF AND THREE FEET IN ALL VALLEYS. WRAP THE CHIMNEY(S) AND SKYLIGHT CURBS WITH ICE AND WATER BARRIER. 0 COVER ALL PERIMETERS WITH EIGHT INCH PREFORMED ALUMINUM DRIP EDGE. ® INSTALL GAF COBRA RIDGE VENT AND/OR ❑ ROOF LOUVERS FOR ADDED ATTIC VENTILATION. Z COVER SOIL PIPES WITH NEW RUBBER FLASHING BOOTS AND FLANGE. ® REPLACE WALL FLASHING (S) AS NEEDED WITH ALUMINUM OR LEAD AT THE ADDITIONAL COST OF $25:00PLFT: WE MAY NEED TO REMOVE THE SIDING TO PERFORM THIS WORK AND YOU MAY NEED TO HAVE A CARPENTER REINSTALL OR REPLACE THE SIDING THAT WAS REMOVED. ®HIMNEYC — FLAS_H G CUT ALL EXISTING TAR AND LEAD FROM ONE C 100ST CUT NEW REGLET WITH CARBIDE SAW AND SECURE NEW LEAD FLASHING IN PLACE WITH METAL ANCHORS. PROPERLY S EGLET PLEASE ADD $450.0070 ABOVE PRICE. ® COVER ROOF SURFACE WITHCERTAINTEED LANDMARK 2411CB LIFETIME NTY DESIGNERSHINGLES.. ® REPLACE DEFECTIVE ROOF DECK AS NEEDED WITH SIMICA AN DI1COST OF$4.00PSQFT. ❑ COVER ROOF DECK WITH CDX PLYWOOD AS NEEDED TO REPLACE OR REPAIR DEFECTIVE DECKING; AT AN ADDITIONAL COST OF ®.NAILING' SECURE SHINGLES WITH EIGHT IN TOTAL COATED ROOFING NAILS AS PER CERTAINTEED SPECIFICATIONS. E] SKYLIGHTS: REPLACE EXISTING SKYLIGHTS WITH NEW VELUX OR WASCO UNITS. WE WILL PROVIDE THE SKYLIGHTS &FLASHING KITS AT OUR EXACT COST FROM OUR SUPPLIER. OUR LABOR CHARGE IS $75.00 EACH IF THEY ARE THE SAME SIZE. INTERIOR WORK IS EXCLUDED. ❑ REMOVE EXISTING GUTTERS ❑INSTALL NEW SEAMLESS .032 ALUMINUM GUTTERS USING THE HIDDEN ZIP SCREW HANGER SYSTEM. ❑- REPLACE DEFECTIVE TRIM BOARDS WITH CUSTOMERS APPROVAL USING NO.2 PRIMED PINE, ADD $15.00PLFT TO THE ABOVE PROPOSAL. ❑ INSTALL NEW ALUMINUM DOWNSPOUTS AND MECHANICALLY FASTEN ALL CONNECTIONS. CLEAN ALL PROJECT RELATED DEBRIS FROM OUTSIDE WORK AREA: THE PROPERTY OWNER AUTHORIZES AB CARNES ROOFING TO OBTAIN . ALL PERMITS. WE CANNOT ACCEPT RESPONSIBILITY FOR DEBRIS FALLING INTO ATTIC AREAS. CUSTOMER SHOULD COVER VALUABLES. GREAT CARE WILL BE USED TO PROTECT THE STRUCTURE AND FOLIAGE, HOWEVER, SOME MARRING AND OR MINOR DAMAGE COULD OCCUR. IN ADDITION, WE CANNOT BE RESPONSIBLE FOR ITEMS FALLING FROM WALLS, SHELVES OR CEILINGS DURING THE ROOFING PROCESS. .SPECIAL INSTRUCTIONS: THE ABOVE PROPOSAL INCLUDES ALL.SHiNGLED ROOF SECTIONS OF THE HOUSE. SHINGLE UPGRADE: UPGRADE TO THE LANDMARK 300L6 HIGH DEF PREMIUM SHINGLES, ADD $1705.00. YES ( ► THIS IS OUR EXACT COST WARRANTY UPGRADE: THE CERTAINTEED WIND WARRANTY WILL BE UPGRADED FROM 110 MPH TO 130 MPH WITq AN UPGRADE TO THE CERTAINTEED HIGH ERFORMANCE HIP & RIDGE CAPS AND STARTER COURSE AT NO ADDITIONAL CHARGE. YESjj� EMAIL ADDRES S r v` S✓� G U G o (I'll(( Warranty: All work warranted against installation defects for 5 years; this warranty is limited to the installed item (s) and its repair only. Material is warranted by the manufacturer against defects for 50 years; see the manufacturer's warranty for exact warranty performance. Cancellation:. Customer has legal right under federal law to cancel this contract without penalty or obligation within three business days from the date of signing this agreement via Priority Mail Delivery Confirmation. Please see reverse side. Dispute Resolution under Massachusetts Home Improvement Law 142a: All parties agree that any and all disputes relating to-this proposal shall be settled by arbitration. This forum js user fdendly.and does not require lawyers. Please see reverse side. Signing this Proposal mens, y u have.accepted all the terms as stated on the front and back of this agreement. Please see reverse side. *Date of Acceptance Signature *Signature Signature PLEASE SEE REVERSE SIDE TOWN OF NORTH ANDOVER WASTE AFFIDAVIT As a result of the provisions of MGL Ch.40-s54, I acknowledge that as a condition of building permit # all debris resulting from the construction activity governed by this building permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL Ch.111-s150A. Waste Disposal or Solid Waste Facility: ALLIED WASTE Address: 300 FOREST ST Town/City, State, Zip: PEABODY, MA 01960 NAME OF HAULER: AB CARNES ROOFING, INC. DUMP TRUCKS DATE: 1-11-2016 SIGNATURE OF APPLICANT: The Commonwealth of'Massachusetts w Department of Industrial Accidents 1 Congress Street, Suite 1.00 Boston, MA 02114-2017 .�y www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Apolicant Information Please Print Legibly Name (Business/Organization/individual)' AB CARNES ROOFING INC Address: 30 ARROWHEAD FARM RD City/State/Zip: BOXFORD, MA 01921 Are you an employer? Check the appropriate box: Phone. #: 978-887-1431 I.Q 1 am a employer with some employees (full and/or pan -time).'" 2.a I am a sole proprietor or partnership and have no employees working for me. in wiy capacity. [No workers' comp, insurance required:] 3.Q I am a homeowner doing all work myself. [No workers' comp, insurance required.]' 4.❑ 1 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 proprietors with no employees. 5.❑ I am a general contractor and I have hired the sub -contractus listed on the attached sheet. These sub -contractors have employees and have workers' comp. insurance.$ 6.o We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required,], Type of project (required): 7. [❑ New construction 8. Q Remodeling 9. 0 Demolition 10E] Building addition I Ln Electrical repairs or additions 12. ❑ Plumbing repairs or additions 13.R] Roof repairs 14. ❑ Other *Any applicant that checks box #1 must also till out the section below showing their workers' compensation policy information. t Homeowners who Submit this allidavit indicating they are doing all work and then hue outside contractus must submit a new affidavit indicating such, tContr actors that check this box must attached an additional sheet showing the name of the sub -contractus and state whether or not those entitle_ s have employees. If (be sub -contractors have employees, they must provide their workers' comp. policy number. ]am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site inforueation. Insurance Company N TRAVELERS INDEMNITY CO OF AMERICA Policy # or Self -i s. Lic. #: 6HUB-OG36156-6-15 Date: 10/15/2016 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 foe 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 certify un hens and pen !ties of perjury that the information provided above is true and correct. 978-887-1f 31 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 #: AeCOR a CERTIFICATE OF LIABILITY INSURANCEF DATE(MMI DIY ) 1/11/2016 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 NAME: BRIAN L. PRESCOTT & SONS INS PHONE FAX AIC No Ext), AIC No): 963 EASTERN AVE - E-MAIL ADDRESS: MALDEN, MA 02148 INSURERS AFFORDING COVERAGE NAIC # INSURER A : MED EXP (Any one person) $ INSURED % RNES ROOFING INC INSURER B: Travelers Indemnity Company of America INSURERC: OWHEAD FARM RD LBOXFORD, PRODUCTS - COMP/OP AGG $ MA 01921 INSURER D: AUTOMOBILE LIABILITYCOMBINED ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS 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 CONTRACTOR 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. ITR - TYPE OF INSURANCE ADDL SUBR POLICY NUMBER - MMI DPLICYEFF /YYYY POLICY EXP MMIDD/YYYY - LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 1:1 OCCUR r I� - EACH OCCURRENCE $ PREM NT PREMISES Ea occurrence $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ - GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO - ECT LOC PRODUCTS - COMP/OP AGG $ $ AUTOMOBILE LIABILITYCOMBINED ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per accident UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE II! � 1111) F EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY y/ ANY PROPRIETOR/PARTNER/EXECUTIVEE.L. OFFICE/MEMBER EXCLUDED? �I (Mandatory in NH) If yes, describe under DFSCRIPIION OF OPERATIONS hP.In. N I A _ . 6i•1UB-OG36156-6-15 10/15/2015 10/15/2016 STATU- OTH- TO LIMITS ER EACH CCIDENT $ 100 000 E.L. DISE SE - EA EMPLOYE $ 100,000 E4-15ISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) ROOFING CONTRACTOR CERTIF_IeA-FE HOLDER CANCFI I ATIAN \ / WILLIAM SILVA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 17 SUGARCANE LANE ACCORDANCE WITH THE POLICY PROVISIONS. NORTH ANDOVER, MA 01845 AUTHORIZED REPRESENTATIVE Brian N. Leary, PRESCOTT & SONS INS ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD NOTICE TO EMPLOYEES -I W NOTICE W a TO W e EMPLOYEES y�W The Commonwealth of Massachusetts DEPARTMENT OF INDUSTRIAL ACCIDENTS 1 Congress Street, Suite 100, Boston, Massachusetts. 02114 - 2017 617-727-4900— http://www.state.ma.us/dia As required by Massachusetts General Law, Chapter 152, Sections 21, 22 & 30, this will give you notice. that I (we) have provided for payment to our injured employees under the above mentioned chapter by insuring with: THE TRAVELERS INSURANCE COMPANIES NAME OF INSURANCE COMPANY P.O. BOX 1 450 MIDDLEBORO MA 02344-1450 ADDRESS OF -INSURANCE COMPANY (6HU6-OG361 56-6-15) 10-15-1.5 . TO 10-15-16 POLICY NUMBER J EFFECTIVE DATES PRESCOTT & SON INS- 963 EASTERN AVE MALDEN MA 02148 N SOF-INSIURANCE AGENT ADDRESS PHONE # AB CARNES ROOFING INC 30 ARROWHEAD FARM RD BOXFORD MA 01921 MPLOYER ADDRESS EMPLOYER'S WORKERS COMPENSATION OFFICER (IF ANY) DATE MEDICAL TREATMENT The above named insurer is required in cases of personal injuries arising out of and in the course of employment to furnish adequate and reasonable hospital and medical services in accordance with the provisions of the Workers' Compensation Act. A copy of the First Report of Injury must be given to the injured employee. The employee may select his or her own physician. The reasonable cost of the services provided by the treating. physician will be paid by the insurer, if the treatment is necessary and reasonably connected to the work related injury. In cases requiring hospital attention, employees are hereby notified that the insurer has arranged for such attention at the NAME OF HOSPITAL ADDRESS 000849 W20PiG15 TO BE POSTED BY EMPLOYER //r�noiritorzrurr.///, �r"nl�rsar•✓%uaeJ.f, _. Office of Consumer Affairs & Business Regulation HOME IMPROVEMENT CONTRACTOR Registration: 176928 Type: Expiration: 10/10/2017 Corporation AB CARNES ROOFING, INC. -BARRY CARNES 30 ARROWHEAD FARM RD _ BOXFORD, MA 01921 Undersecretary .h Massachusetts - Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS -000230 BARRY S CARNO" 30 ARROWHIEAUFAIlln RD~� Boxford MA 0191 '+ r J.•�... -.11 tSsfw "" Expiration Commissioner 03/07/2016