HomeMy WebLinkAboutBuilding Permit #796 - 18 CABOT ROAD 6/8/2010BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
TYPE OF IMPROVEMENT
PROPOSED USE
Residenti
Non- Residential
New Building
ne am
Addition
Two or more family
Industrial
Alteration
No. of units:
Commercial
Repair, replacement
Assessory Bldg
Others:
Demolition
Other
x 5eptic'T Well ,
;Floodplain Wetlands �
Watershed District '
Yater/Sewer.
DE5GRIPT N OF WORK TO BE PREFORMED:
OWNER: Name: -fir
Address:
Type or Print Clearly)
S P
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE: BOLDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Total Project Cost: $ �'�L6-OD FEE: $�(l�p .�
Check No.: Receipt No.:
NOTE: Persons contrac ing with unregistered contractors do not have accesf to te upranty fun¢,
Location C(4 0
No.
- 6 -k -
Date `
NORTN TOWN OF NORTH ANDOVER
s
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee
TOTAL
Check J 20q�
2324 ,
Building Inspector
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
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
PIRE,DEiPARTMENT - Terhp Dumpster.on si#e yes o `
Locate&a .124;Main Street,
Fire �Depairtmert signaturd1date. e
COMNfENT&
�,
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 2010
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
❑ 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: Building Permit Revised 2008
EIG Fax Server
5/5/2010 10:23:10 AM PAGE 2/003 Fax Server
ACORN,, CERTIFICATE OF
LIABILITY INSURANCE DATE(MWDDIYYYY)
PRODUCER (gpp) 78Z_p251 05/OS/2010
FAX (781) 261-2099 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Eastern Insurance Group LLC - Commercial
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
77 Accord Park Drive
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
Unit B1
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Norwell, NIA 02061
INSURERS AFFORDING COVERAGE NAIC 0
INSURED Bay State Roofers. Inc.
INSURER Gemini Insurance Company
Po Box 189
INSURER B: Commerce Insurance Company 34754
North Reading, KA 01864
INSURERC: ACE USA
MED EXP (Anyone person) $ 100 04
INSURER D:
INSURER E:
cnvcQer_cc
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 01
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
POLICY EXPIRATION
OMITS
A
GENERAL LIABILITY
X COMMERCIAL GENER.oL LIABILITY
CLAIMS MADE a OCCUR
TBA4046
06/1S/2009
06/lS/2010
EACH OCCURRENCE $ 1
DAMAGE TO RENTED $ 1
MED EXP (Anyone person) $ 100 04
PERSONAL & ADV INJURY $ 1
GENERAL AGGREGATE $ 2
GENLAGGREGATE LIMIT APPLIES PER:
X POLICY JET LOC
PRODUGTS•COMP/OPAGG $ 2
71
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
08MNBCCXKR
06/1S/2009
06/lS/2010
COMBINED SINGLELIMIT
(Ea accident) $ 1
BODILY INJURY
(Per person) $
B
X
X
SCHEDULED AUTOS
HIRED AUTOS
BODILY INJURY $
(Per accident)
X
NON -OWNED AUTOS
PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY
ANY AUTO
AUTO ONLY - EAACCIDENT $
OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESSIUMBRELLA LIABILITY
OCCUR DCLAIMSMADE
EACH OCCURRENCE $
AGGREGATE $
$
DEDUCTIBLE
$
RETENTION $
$
C
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITYLIMITS
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICERMIEMBER EXCLUDED?
C4628113S
04/03/2010
04/03/2011
X WC�TATW X OT H.
E.L. EACH ACCIDENT $ 500
E.L. DISEASE - EA EMPLOYEE $ SOO.
If yes, describe under'
SPECIAL PROVISIONS below
OTHER
E.L. DISEASE. POLICY LIMIT $ Spp�
DESCRIPTION
OF OPERATIONS I LOCATIONS I VEHICLES
f FXnLLLCInNe nnnGn nv
Evidence of Insurance
ACORD 25 (2001/08)
AL F—"."rains
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
30 _ 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.
AUTHORIZED REPRESENTATIVE
Cl
(DACORD CORPORATION 1988
The Commonwetzlth of Massachusetts
Department o f rndustrial _,accidents
Office of Lnvesz�eadons
600 GT,ashing%n Street
Boston, MA 02111
www•nzasS-gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
�iicant Informafion
Name (Business/Or.-aanization/Individual):
Address:
City/State/Zip: r
• Phone #: `C
A;; Ya an employer? Check appropriate boa:
1 • LJ 1 am a employer with 4. ❑ I am a Q TyE
f project (required):
general contractor and I
2 • ❑employees (full and/or parr -time) * have hired the sub -contractors 6• New construction
I am a sole proprietor or partner_ listed on the attached sheet 1 ?• ❑ Remodeling
ship and have no employees These sub -contractors have
working for me in any capacity, workers' comp. insurance. 8• ❑ Demolition
[No workers' comp. insurance 5. ❑ We are a corp .orati9. ❑ Building addition
required) on and its
officers have exercised their 10. [1 Electrical repairs or additions
3. ❑ I am a homeowner doing all work right of exemption
m self P 4),aPer MGL 11.0 Plumbing repairs or additions
Y [No workers comp. C. 152 14 •
( ), and or have no 12•❑ Roof repairs
insurance required_] t employees_ ,
Epp
[No workers
Ii t+hat zh comp. msurmcerequired-] 13•7 Other
Romeo .hoy.�I must slso a,cu± inc sects^• below ^at. n...� w
wners who submit this affidavit indicating the,, ase d , work com
doing aL work andr---- r V-�
+Contractors that chezk this box must attached an additional sheet showing �� hire outside contrrc,--M 1163t submit a new affidavit indicating such.
the name of the sub -contractors and their workers' comp. policy information.
i o an employer that is Providing workers' compensation insurance for my employees: Below is thepolicy and job site
information.
Insurance Company Name:_
Policy # or Self -ins. Lic.
Expiration Date: r -L
Job Site Address: ���
City/State/Zip:
Attach a copy of the workers' compensation policy declaration Pape (showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A ofMGL 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
Of up to $250.00 a day against the violator. Be advised that a co penalties in the form of a STOP WORK ORDER and a fine
fication Py of thiss� ent may be forwarded to the Office of
Investigations of the 1 for insurance coverage veritem
I do hereby
q
;�y'perjury than the information provided above is true and correct.
(> _ r C?
Official use only. De not write in this area, to be completed by city or town offciaL
City or Town:
Permit/License #
issuing Authority (circle one):
I. Board of Health 2. Building. Department 3. City/Town Clerk 4. Electrical Inspector S. Plumbing
6. Otherb Inspector
Contact Person:
Phone n:
Information an- d 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 en -aged in a joint enterprise, and including the legal representatives of a deceased employer, or the
receiver or trustee of an individual, partnership, association ox- other legal entity, employing employees. However the
owner of a dwelling house having not more than three apartracutr and who resides therein, or the occupant of the
dwelling house of another who employs persons to do mainte;Manee, construction or repair work on such dwelling house
or on the grounds or budding 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 io operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of commpliance 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 -contractors) 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' comp emation 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 siure to sign and date the affidavit. The affidavit should
be rettuued to the city or ui�vvri tha—t time ati ucuuoL for the perriamt'or lis :s being request --4 not the Department of
Industrial Accidents. Should you have any questions regardizag the law or if you are zmTdired 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 J
Please be sure that the affidavit is complete and printed legibly,. The Department has provided a space at the bottom
Of thi affidavit for yon'to fill out in the event the Office of Investigations has to contact you regarding` the applicant
Please be sure to fill in the permittlicense number which will be used as a reference number. In addition. an applicant
that must submit multiple permit/licemmse 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 time 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 fiIled 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 bum 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 im number. .
The Commonwealth of Massachusetts.
DeRartmmt of Industrial Accidents
Office of Investigatians
600 Washington Street
Boston, IIIA 02111
Tel. # 617-72.7-4900 east 406 or 1-9 7 7-MASSAFE
Revised 5-26-05 Fax # 617-72.7-7749
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Baystate Roofers, Inc.
P.O. Box 189
North Reading, MA 01864
Tel. 978-664-0668
Fax 978-664-4333
Name / Address
Jeff Julius
18 Cabot Road
North Andover, MA 01845
Proposal
Date
Estimate #
4/15/2010
10116
Bay State Roofers Inc proposes:
Remove approximately 1900 square feet of the existing asphalt shingle roof down to the wood decking.
Install new ice and water shield along the 6' roof edge, valleys and around all the roof penetrations.
Install new 151b felt paper throughout roof area.
Install new white aluminum drip edge along the roof perimeter.
A new 30 Year GAF Architectural asphalt shingle will be installed over the prepared substrate.
A new ridge vent will be installed to ensure the proper roof ventilation.
All roof penetrations and flashing will be installed according to manufacturers recommendation, specification
and details.
Install new pipe flanges.
Bay State Roofers will properly dispose of all roof debris in our own waste containers.
Any wood decking that needs replacement will be an additional $2.50 per square foot.
New Shingle Roof
Authorized Signature:
fids--
Total $51.510.00
Deposit Required $1835.00
Waste containers supplied by Bay State Roofers, Inc. are for sole purpose of roof debris.
Under no circumstance is the homeowner to use these containers for personal refurse.
10 Year Workmanship Warranty on all roofs. (Except Repair Jobs)
CONTRACT ACCEPTANCE
►uc spcciucauons, prices, payment scneauie are satistactory and hereby accepted. Date:
BAY STATE.ROO.FERS, INC. is authorized to perform work as specified.
Payment will be.made as previously outlined: Signature
All bills over 30 days are subject to"l 1/2% finance charge per month (18%
annual). Color
PROVISIONS OF THE AGREEMENT
f. PROJECT PROVISIONS
a. Guideline: The Project will be. constructed in strict conformance
to the plans and . specifications which have been examined and
approved by the Owner.
b. Compliance: The Project will be Meted in strict compliance
with all laws, ordinances; rules and regulations of the applicable
government authorities.
c. Control: The Agreement plans and specifications ate intended
to supplement each other In case of conflict, the plans will control the
specifications and the Agreement provisions will contrd both.
d. Charge Orders: As directed by the Owner, construction lender,
public body or i spedor, any alteration or deviation from the specifications
that involves extra cost (subcontract, labor materials) w� be executed
only upon the parties entering into a written change order. Expense
Incurred because of unusual or unanticipated conditions will be paid for
by the Owner.
e. Allowances. tt rhe Agreement price i KA des allowances, and
the cost of perfomgng the work is greater or less than this allowance,
then the Agreement price will be adjusted accordingly.
11. FINANCIAL RIGHTS AND RESPONSIBILITIES -
a. tabor and Materials Contractor. will provide. and pay for all
labor and materials necessary to complete the Project. Contractor is
released from this obligation for expenses incurred when the Owner is
in arrears in making progress payments.
b. Permits: Contractor will obtain and pay for all required. building
permits and licenses.
c.Takes, Assessments and Charges: Taxes. special assessments
of all descriptions, and charges required by public bodes and utilities
will be paid for by the Owner.
d. Deposit of Payments: Contractor is required to deposit all
payments received prior.to completion in an escrow account. in lieu of
such a deposit, the Contractor may post a bond or contract of indemnity
with the Ownerguaranteeing the return or proper application of such
payments to the purposes of the contract. All advanced funds will be
.deposited as indicated under Special Provisions. Monies used in
escrow become the. property of the Contractor when they are applied
according to the Agreement payment schedule, when a breach of
contract by the Owner occurs, or when the Agreement has been
substantially performed.
e. Bankruptcy: If either party becomes bankrupt, the other party
has the right to cancel this Agreement.
Ill. OWNER'S RIGHTS AND RESPONSIBILITIES
a. Cancellation: Owner has an unconditional right to cancel the
Agreement, without penalty or obligation, unfit midnight of the .third
business day after the Agreement was signed. Cancellation must be
done in writing. Upon cancellation, any property traded in, any-
payments
nypayments made under this Agreement,' and any negotiated instrument
executed will be returned within 10 business days following receipt by
the Contractor of cancellation notice_
b. Property Lines: Owner shall locate and point out property
fines to the Contractor. Contractor may, at his option, require the Owner
to provide a licensed land surveyor's map of the property.
c. Liens: Failure to pay persons supplying materials or services
according to the terms of this Agreement may result in the filing of
mechanic's hens on the affected property. Owner has the right to ask
the Contractor for lien waivers from all persons supplying these
materials or services. fn -the event any mechanic's lien is filed through
no fault of the Owner, then the Contractor agrees to take all steps
necessary for the release and discharge of such fien-
d. Insurance: Owner will maintain property damage insurance at
least equal to the Agreement price.
e. Damage to Project: Contractor will not be responsible for any
damage caused by the Owner. or other causes beyond the control of
the Contractor. Owner will pay for any restoration work.
IV. CONTRACTOR'S RIGHTS ANO RESPONSIBILITIES
a. Delay: Contractor uh1l be excused for any delay beyond his
reasonable control These delays may include. but are.not limited to
Acts of God. Labor disputes, inclement weather, acts of public authority,
acts of the Owner, or other unforeseen contingencies.
b. Right to Stop Wor1c If any payment under thus Agreement is
not made. when due. the Contractor may suspend work on the job until
such time as all. payments due have been made. Any failure to make
payment is su>bjed to a claim enforced against the property in
accordance with tha applicable Gen laws.
c. Substitution of Materials: Contractor may substitute materials
'without notice to the Owner in order to allow work to proceed. provided
that the subsUged materials are of no lesser quality than those fisted
in the specifications.
d. Salvage: All salvage resulting from work under this Agreement
is to be retained by the ContractoL unless other agreements are
contained in the written specifications.
e. Insurance: Contractor will maintain workers' disability
compensation insurance for his employees and comprehensive public
liability insurance policies.
V. COMPLETION OF PROJECT
a. Notice: Owner agrees to sign a Notice of Completion within 5
days after completion of the project. If project passes final inspection
and the Owner does not sign the Notice, the Contractor may act as the
Owner's agent and sign the Notice.
b. Clean-up: Contractor is responsible for removing debris and
surplus material .from the property, and leaving the property in a neat
and orderly condition.
V1. CONFLICT PROVISIONS
a. Arbitration: Any controversy .or claim arising out of. this
Agreement that cannot be resolved, is subject to arbitration, with
an arbitrator of mutual agreement, and all parties (including
Owner, Contractor, Architect and Sub -Contractors) are bound to
this arbitration. If any party does. not appear at arbitration
proceedings, the arbitrator is empowered to decide the controversy
in accordance with whatever evidence is presented by the
party(ies) that do participate.
b. Attorney Fees' If either party becomes involved in litigation
arising out of Agreement, the Court shall award costs/expenses
including attorney fees to the party justly entitled to them.
c. Limitations: No action related to this Project may be made
by either party against the-\otl er more than 2' years after the
completion of work , i \
VII. GENERAL PROVISIONS
a. Notice: Any notice required or permitted under this Agreement
may be given by certified or registered mail at the addresses contained
in the Agreement
. b. Prohibition of Assignment: Neither party may .assign this
Agreement or payment due tinder this Agreement without the written
consent of the other party.
c. Qualification: This document constitutes the entire agreement
of the parties. No other agreements exist. This Agreement can be
modified only by written agreement signed by both parties.
d. Governance: This Agreement shall be construed in accordance
with and governed by, he laws of the state in which the Project is
located. -