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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 )Arvkr'x7-mass.. grov/dia W-1 O z 03 1 0 F. z O U goill U 0 O O E L O V Z m CL O CA C � O cm CA O CD ._ y O O m m CD CD CD L O � 3� O O cc o a a =a ca S o cc �� c cv CJ -J `p d O ♦CD ca O Z d v c cc C _c d CO2 0 0 LU U) o9 W LU1 LUW N � w° cn U U 00 b X G_ C W x 0 a W W` = v 0 p p C� W W w z O 0 F. z O U goill U 0 O O E L O V Z m CL O CA C � O cm CA O CD ._ y O O m m CD CD CD L O � 3� O O cc o a a =a ca S o cc �� c cv CJ -J `p d O ♦CD ca O Z d v c cc C _c d CO2 0 0 LU U) o9 W LU1 LUW N o C.i y O ;m c C 0 CL H 0 :.0 O = C :moo 0 1— C� LLJ :'ate CL C N m r0 :mm O H ;CD L C 'm W 'E � C2 O O 0 ® _ Ea 0 F. z O U goill U 0 O O E L O V Z m CL O CA C � O cm CA O CD ._ y O O m m CD CD CD L O � 3� O O cc o a a =a ca S o cc �� c cv CJ -J `p d O ♦CD ca O Z d v c cc C _c d CO2 0 0 LU U) o9 W LU1 LUW N C.i y O cc u 0 CL H 0 : N m C = O 0 1— d .- ~ LLJ r0+ C cc, N m r0 LL Mo is W e.+ 'C H y L C 'm W 'E v C2 m 0 ® _ CA OL mOO� _ US _ OM= 0 F. z O U goill U 0 O O E L O V Z m CL O CA C � O cm CA O CD ._ y O O m m CD CD CD L O � 3� O O cc o a a =a ca S o cc �� c cv CJ -J `p d O ♦CD ca O Z d v c cc C _c d CO2 0 0 LU U) o9 W LU1 LUW N D xm D --o D 0-0, -,0, ti I i o � � m O MW Z CLm 4 :1 ID&,0y rn x 'a o if ( ltifK m77 ix n 0-F m m � O m va m [(D Ir,- C CA Orn� C6 o s y a 0 1 D ..�. a y � ti 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. -