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HomeMy WebLinkAboutBuilding Permit #672 - 18 SUMMER STREET 3/21/2012Permit N0: TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION _-LL-- IMPORTANT: Ap �tl 01 C Date Received ant must complE e (^ - �4- Print n all items on this - Print V MAP No: _/,I PARCEL: ZONING DISTRICT: Historic District yes n Machine Shop Village ye no 100 year-old structure yeno TYPE OF IMPROVEMENT PROPOSED USE Re ' ential Non- Residential ❑ New Building bf One family ❑ Addition ❑ Two or more family 0 Industrial ❑ Ateration No. of units: ❑ Commercial Repair, replacement 0 Assessory Bldg ❑ Others: 0 Demolition ❑ Other ; ® opted ®W6ll � oor" plain PM 1:11 ,*xs hry- a IN ,his nct 1 0 SF..i NON kr.-, - "r.'1 �7_0,0-1 i.,' �, `'� ti`»}•-n ,' _R-"� I �� D�S�G' � "1"lU0 UN' W U� 'l -U ti � Y C, OWNER: Name:_ PL Type or Print Clearly) Address: tkM1`6 (f C- l"V fund D UPir . " c CONTRACTOR Name: U'CC PL' ' / Phone: Address: Supervisor's Construction Licenser 0 �o o� Exp. Date: Home Improvement License: l 7` Ll Exp. Date: ARCHITECT/ENGINEER Phone: `7s5 3 -� 87 3 -A!'r- 21 D / 4� Address: Reg. No. FEE SCHEDULE: BOLDING PERMIT: $92.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: FEE: $ �� Receipt No. Check No.: p C)� NOTE: Persons contracting with unregister n�ra�� o not have access to the guaranty fund Ct 6fr i-gn,n (nrin int- h , i :-..- Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanuing/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 & DEVELOPMENTEl COMME CONSERVATION COMMENTS HEALTH COMMENTS DATE REJECTED DATE APPROVED IN Reviewed on Signature Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT .-,TPS l ster.onsite. ,yes ., no Located at 124 Main Str et Fire Department signatute/date 3-,2 COMMENTS s: .k 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 Doc:.Building Permit Revised 2011 June/mi 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 o 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 EMOTE: 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 khat 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: Doc.Building Permit Revised 2008mi Location No. --7 Date • - + TOWN OF NORTH ANDOVER e �1 T'} LIsU 164,' . e Certificate of Occupancy $ `' Building/Frame Permit Fee Foundation Permit FeeIto $ tia Other Permit Fee $ TOTAL $ Check 25120 Building Inspector f M Contractor Agreement ..................................................................................................................................................................................................... THIS AGREEMENT made 26th day of February, 2012 by and between Patrick Reilly, hereinafter called the Contractor and Charlotte Pellegrino, hereinafter called the Owner. Witnesseth, that the Contractor and the Owner for the consideration names as follows: Article 1. Scope of the Work The Contractor shall furnish all of the materials and perform all of the work shown on the Drawings and/or described in the Specifications entitled bid memo, as annexed hereto as it pertains to work to be performed on property at 18 Summer St. North Andover, MA. 01845. Article 2. Time of Completion The work to be performed under this Contract shall be commenced on or after March 31 st, 2012 and shall be substantially completed on or before April 23rd, 2012. Article 3. The Contract Price The Owner shall pay the Contractor for the material and labor to be performed under the Contract the sum of Eight Thousand Two Hundred Twenty Five Dollars ($8,225.00), subject to additions and deductions pursuant to authorized change order. Article 4. Progress Payments Payments of the Contract Price shall be paid in the manner following: 'h upon start of job in the amount of $4112.50. Y2 upon completion of job in the amount of $4112.50. Article 5. General Provisions Any alteration or deviation from the above specifications, including but not limited to any such alterations of deviation involving additional material and/or labor costs, will be executed only upon written order for same, signed by Owner and Contractor, and if there is any charge for such alteration or deviation, the additional charge will be added to the contract price of this contract. If payment is not made when due, Contractor may suspend work on the job until such time as all payments due have been made. A failure to make payments for a period in excess of 14 days from the due date of the payment shall be deemed a material breach of this contract. In addition, the following general provisions apply: 1. All work shall be completed in a workman -like manner and in compliance with all building codes and other applicable laws. 2. The contractor shall furnish a plan and scale drawing showing the shape, size dimensions, and construction and equipment specifications for home improvements, a description of the work to be done and description of materials to be used and the equipment to be used or installed, and the agreed consideration for the work. 3. To the extent required by law all work shall be performed by individuals duly licensed and authorized by law to perform said work. 4. Contractor may at its discretion engage sub -contractors to perform work www.socrates.com Page 1 of 3 SS4301-230 • Rev. 05/04 z s.' O as a� °o a A a o � o o v a o a w o q o .A C W w v a 14 o z �% cn v Q ° co c o c � O L S � C O .) CL R W r: m e :mss Q L m E a c m cjJCD �t v o c c m u s CD fti m c ca L = JC O � N : s m � o v CD o CMCD cmC Va V m .s r V N Z O Eo C_ F o. m y_.mC C = m m=r...p N F- 4- h o O H m Z W +=+ 'O t : C ++ .y C.t ev c Z CO2 O a..= m z1b U z U Cf) till all U O O I CD O CD L _ O O v Z o CL o y D C CD I Com_ CO2 p 'C c y m m CD CD L O � 03 co 0 m o Q a v�Q y C cc CA Z G3 o . CL v c ev C cc a CO) 0 W U) W W 19 W C4 hereunder, provided Contractor shall fully pay said sub -contractor and in all instances remain responsible for the proper completion of this Contract. 5. Contractor shall furnish Owner appropriate releases or waivers of lien for all work performed or materials provided at the time the next periodic payment shall be due. 6. All change orders shall be in writing and signed both by Owner and Contractor, and shall be incorporated in, and become part of the contract. 7. Contractor warrants it is adequately insured for injury to its employees and others incurring loss or injury as a result of the acts of Contractor or its employees or sub -contractors. 8. Contractor shall at its own expense obtain all permits necessary for the work to be performed. 9. Contractor agrees to remove all debris and leave the premises in broom clean condition. 10. In the event Owner shall fail to pay any periodic or installment payment due hereunder, Contractor may cease work without breach pending payment or resolution of any dispute. 11. All disputes hereunder shall be resolved by binding arbitration in accordance with rules of the American Arbitration Association. 12. Contractor shall not be liable for any delay due to circumstances beyond its control including strikes, casualty or general unavailability of materials. 13. All home improvement contractors and subcontractors shall be registered and any inquiries about a contractor or subcontractor relating to a registration should be directed to: Director, Home Improvement Contractor Registration P.O. Box 871 Taunton, MA 02780-0871 Tel: 508-821-9375. 14. The homeowner has three day cancellation rights under MGL c 93 s 48, MGL c 140D s 10 or MGL c 225D s14 as may be applicable. 15. Homeowners who secure their own construction -related permits or deal with unregistered contractors will be excluded from the guaranty fund provisions of MGL c 142A. 16. Contractor warrants all work for a period of 12 months following completion. Signed this 26th day of February, 2012. Signed in the presence of: Witness Witness Name of Owner: Charlotte Pellegrino By (Signature): @ (ML _ T www.socrates.com Page 2 of 3 SS4301-230 • Rev. 05/04 Name of Contractor: By (Signature): Street Address: City/State/Zip: Telephone No.: Contractor's License No. www.socrates.com e -V i ai i ayut .�. Lowell, MA. 01854 978-735-5637 80702 Page 3 of 3 SS4301-230 • Rev. 05/04 BID MEMO BID NO. 1 DATE: 2/26/2012 JOB CHARLOTTE PELLEGRINO LOCATION 18 SUMMER ST. NORTH ANDOVER MA. 01845 FIRM B.P.R. CONSTRUCTION PREPARED BY PATRICK REILLY ADDRESS 28 FARRAGUT ST. APPROVED BY City/State/Zip LOWELL, MA. 01854 TYPE OF WORK ROOF PHONE 978-735-5637 WORK INCLUDED AMOUNT OF BID REMOVAL AND DISPOSAL OF EXISTING THREE TAB SHINGLES. INSTALLATION OF NEW 30 YEAR ARCHITECTUAL ASPHAULT SHINGLE. INSTALLATION OF NEW 81N. WHITE ALUMINUM DRIP EDGE. INSTALLATION OF NEW ICE AND WATER SHIELD. INSTALLATION OF NEW 15LB. FELT PAPER. INSTALLATION OF NEW RIDGE VENT SYSTEM. DUMPSTER WILL BE DELIVERED FOR DISPOSAL AND REMOVAL OF EXISTING ASPHAULT SHINGLE AND OTHER DEBRIS OR WASTE FROM WORK BEING PERFORMED AT JOBSITE. TOTAL COST OF LABOR AND MATERIAL. 8,225.00 TOTAL BID 8,225.00 EXCLUSIONS AND QUALIFICATIONS ACKNOWLEDGEMENT OF ADDENDA TAX DELIVERY EXCLUDED INCLUDED RECEIVED BY The Commonwealth ofMassachusetts De partment q flndustr&Mccidents Off1ce oflnvestigatioug 600 Washingtpn Street UW Boston, MA 02111 www ma s-gov/dia Workers' Compensation Insurance Affidavit: Buiilders/Contractors/Flectricians/Plumbers plicant Infolrmation Naine (Business/Organizationgndividual : .1 . � - rt d'l Address: �- �ccrd'a 164 C . City/State/Zip: Dials Phone #: . 23 .2 7 Are you an employer? Check the appropriate box: L ❑ am a employer with 4. ❑ I am a general contractor (fulland/orpart-time).* 2. and I have hiredthesub-contractors Iemployeesam a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub -contractors have working forme in any capacity. [No workers' comp. insurance workers' comp, insurance. 5. ❑ We are a corporation and its 3. Erequired.] ]I am a homeowner doing all work- .officers have exercised their right of exemption MCrL myself. [No workers' comp, per c. 152, §1(4), and wehaveno insurance -required.] ; employees. [No workers' comp imuranc Type Ofproject (required): 6. ❑ New construction 7. ❑ Remodeling 8. [1 Demolition 9. [] Building addition 10. ❑ Electrical repairs or additions 11•[] dumbing repairs or additions 12.1�� /Roofrepairs .required.] 13.[] Other =Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policyknformation. Homeowners who submitthis affidavit indiCatingthey are doing alI 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 their workers' comp. policyinformation. I am an employer that is providing workers' compensation znsuYance for• yny employees Below is the policy and job site information, Insurance Company Name Policy # or Self -ins. La #; Expiration Date: 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 Section 25A ofMGL c.152 can lead to the imposition of criminal penalties of a 'no 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 Ifup to $250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of nvestigations of the DIA for insurance coverage verification. do hereby cer I Y Un r t1 epain andpen lties of erjury that the inforazzation provided above is true and correct. nature: • r�i Date - , ate: gone #: 9 / 1' .. 7 .? Official use only. DO not write in this area, to be completed by city or town official City or To wn: permit/License Iuing.Authority (circle one): [. Board of Health 2. Building Department 3. City/TgWn Clerk' Other 4. Electrical inspector 5, plumbing Inspector Inforimati®n' and Ii istr cti®ns 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 engaged in a joint enterprise, and including the legal representative rs of a deceased employer, or the eceiver ox trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the o dwelling house of another who employs persons to do maintenance, construction ox repair Work o such dwelling house or on the grounds or building appurtenant thereto shallnot because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "everystate or local licensing agency shall 'Withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for nny applicant who has not produced acceptable evidence of compliance with the insuraned coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any enter into any contract for the performance ofpubTic work of its political subdivisions shall until acceptable evidence of compliance with the insurance requirements of this chapter have beenpresented 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) andphone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited members or partners, are not required to carry workersiabiliiy Partmerships (LLP) with no employees other than the, ' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit maybe submitted to the Department of' Accidents for confirmation-ofinsurance coverage. Also be sure to sign and ddusfrial ate the affidavit be return . The affidavitshoulded to the city or town that the application for the per -+nit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required 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 Please be sure that the affidavit is complete and printed legibly. The Departmenthas providedaspace atthe bottom of the affidavit for you to fill out in the event the Office of investigations has to contact you regarding the applicant. PIease be sure to fill in the permit/li0ens a number which will be used as a referencd numb that must submit multiple permit/license applications in any giver. In addition, an applicant n year, need only submit one affidavit indicating current Policy information (ifnecessary) 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 the city or town may be provided to the applicant as pro of that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit notxelated for any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affiddvit. 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 fax number. I Colmi-.mweale0h of Ivil sa setts Z?ep.az ent of frtdu WEd Aceiciextts Office of InveAlgaiions 600 Was%ington Street BostQ.a M -A Q211 Z Tel. # 617-727-4900 ext 406 ox X,877-MA88Mg REILL-2 OP ID: CA ACORD' CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 02/29/12 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 978-957-3588 CONTACT NAME: CHARLES J COUGHLIN 9789576612 - - INSURANCE AGENCY 14 DINLEY ST. P.O.BOX 10 DRACUT, MA 01826-0010 PHONE FAX AIC No Ext): A1C No): E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC # INSURER A: National Grange Ins Co 14788 EACH OCCURRENCE $ 1,000,000 INSURED Patrick Reilly INSURER B: Workers Comp. Bureau of Mass DBA: BPR Construction 28 Farragut Street Lowell, MA 01854-2423 INSURERC:A.I.M. Mutual Insurance Co. INSURER D : GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO LOC PRODUCTS - COMP/OP AGG $ 2,000,000 INSURER E: INSURER F : AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS 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 LTR TYPE OF INSURANCE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN UB POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MMIDDIYYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR MPT6413D 02/24/12 02/24/13 EACH OCCURRENCE $ 1,000,000 PREMISES Ea occurrence $ 500,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per accident UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? Fy] (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A ISSUE BY COMPANY 02/29/12 02/28/13 X I WC STATU- OTH- TORY LIMI S E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE - EA EMPLOYEE $ 100,000 E.L. DISEASE -POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) CARPENTRY roorlrlrATG Un! nGR CANCELLATION ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Charlotte Pellegrino ACCORDANCE WITH THE POLICY PROVISIONS. 18 Summer Street North Andover, MA 01845 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD ƒ x w � \ ® \ CD . 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