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Home My WebLink AboutBuilding Permit #301-14 - 19 OLYMPIC LANE 10/1/2013 F NORTF/ 1 p BUILDING PERMIT ��°.```D.}`�s�°� TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION i �* Permit No.) Date Received Date Issued: �RSSACNUS IMPO 01A R TANT:Applicant must complete all items on this page LOCATION �iv PROPERTY OWNER A f.'TW/t, 'atr roaO J5(- Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes (nono !Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building F-One family ❑Addition ❑ Two or more family ❑ Industrial 2'Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑ Wetlands ❑ Watershed District ❑ Water/Sewer /-,9"W a, Identification Please Type or Print Clearly) OWNER: Name: r r Lj Phone: Address: .12 GC CONTRACTOR Name: Phone: 25- F t";r�j 53 Address: Supervisor's Construction License: Z Exp. Date: ' 3 2O1 Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:MOO PER$1000.00 OF THE TOTAL ESTIMATED COST B ED ON$125.00 PER S.F. Total Project Cost: $ ��S� FEE: $ *� Check No.: _' L/) 0 T� Receipt No.: NOTE: Person contracting with unregistered contractors do not have access t e uara/ fund „f Signature of'Agent/Owner Signature of contracto Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans El� TYPE_OF SEWERAGE.DiSPOSAL Public Sewer ❑ Tanning/Massage/Body Art E]. . .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 I PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Siqnature COMMENTS HEALTH Reviewed on Siqnature COMMENTS Y 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 Tow;z Engineer: Signature: Located 384 Osgood Street FIRE-DEPARTMENT --Temp Dump'ster on site yes. . no Located-at 124 Mair Street- Fire Departinent signature/date` COMMENTS i i 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 IYes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A-F and G min.$100-$1000 fine NOTES and DATA— (For department use B Notified for pickup - Date Doe.Building Permit Revised 2010 Building Department -The fo6wing 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 Li Photo Copy Of H.I.C. And/Or C.S.L. Licenses u Copy of Contract u Floor Plan Or Proposed Interior Work u Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks a Building Permit Application u Certified Surveyed Plot Plan u Workers Comp Affidavit u Photo Copy of H.I.C. And C.S.L. Licenses u Copy Of Contract u Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) u 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) u Building Permit Application Li Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit a Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) u Copy of Contract L3 Mass check Energy Compliance Report u Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all casts if a variance or special'permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the apnaal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submAted with the building application Doc: Doc.Building Permit Revised 2012 Location No. Date • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee TOTAL $ Check# u J J Building Inspector Mr Domenic F Terranova 1901ympicLn VOOSTER ROOFING PROPOSAL North Andover,MA 01845 —-- - ----- - — ALL TYPES OF ROOFS DATE: 9/27/13 &ROOF RELATED SERVICES Allways Hand Nailed License Numbers: Charlie and Steve Wooster Construction Supervisors 54268 One - 1-888 ROOFIN-1(766-3461) Home Improvement Contractor Main:978 251-7181 Registration 100712 Serving MA&NH since 1984 Fax:978 251-0159 Call For Our References Proposal Submitted To Work To Be Performed At Name Brenda Terranova Name rem. -e oc Company Name Company Name Street 19 Olvmnic Lane Street t`1.O L �(�, City No.Andover State-MA Zip Code 01845 City k[Cr't-A A-'d aver State !22A Zip Code Df 4 Home# 978 686-1549 Mobile# Work# a78-6 8 -is Fax# We hereby propose to furnish the materials and perform the labor necessary for the completion of the following'ob. Strip the entire roof to the roof deck. 1. Renail any loose decking and replace any rotted at$2.00 per foot. 2. Install 8"white aluminum dripedge. 3. Install 6' of Grace Ice and Water Shield on all eaves. 4. Paper remainder of roof with Grace Tri-Flex roofing underlayment. 5. Install Certainteed Landmark Lifetime shingles,hand nailed. 6. Flash chimneys to roof. 7. Flash vent pipe to roof. 8. Install Shinglevent H ridge vent on main roof. 9. Clean and dispose of all debris. 1, v (.L.�e,v�I/1 rkaA; &Y" I ovue, r�o/o 1{�-Q-9 Z, 00 G a'- UW9�' `e'y" J�']. LY li(iCti i SV•L�7°�� (7i1� 1�coq +t\a r ey up cu a( "r st ck j..0 IrE+.av, otd lR. Si-f- Workmanship guaranteed for 10 years.We are fully insured with workers'compensation as well as liability insurance. Please return copy of proposal: All material is guaranteed to be as specified,and the above work to be performed in accordance with the specifications submitted.All work will be completed in a substantial workmanlike manner for the sum of Dollars($7,800.00), with payments to be made as follows:Job paid upon completion. Respectfully submitted SE. wovptt r Note-This proposal may be withdrawn by us if not accepted within 30 days. ACCEPTANCE OF PROPOSAL The above prices,specifications and conditions are satisfactory and are hereby accepted.You are authorized to do the work as specified. nn Payment will be made as outlined above. Date 71Z-72013 Signature AAA-- n^ 0....OnC4 1 .......11 RA AA OC9 1 ..wwA:w... C7C IA/..L...... CSL.-....i T.....I...L...w. RAA AA 07G i J ��..., WOOST-1 OP iD.GM CERTIFICATE OF LIABILITY INSURANCEF10116112 TMS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CER71FiCATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. TMS 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(les)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 certiificate holder in lieu of such endorsement(s CafPRODUCER 781-848-8600 E� Gerry McDonald McSweeney&Ricci I ns Ag Inc 781-843-8807 PHONE 781-952-4143 AlA�C No):781-843-8807 420 Washington Street No. = P.O.Box 858.984 EawatL Braintree,MA 02185 ADDRESS Paul Marks WSUREK(S)AFFORDING COVERAGE NAiC t I ISURERA:Acadia insurance Company 31325 INSURED Charles J Wooster dba Wooster INSURERB:Star Insurance Company Roofing INSURER c: PO Box 8051 .Lowell,MA 01853 INSURER D INSURER E: WSUI ERF 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. POLICY EFF POLICY EXP LTSRR TYPE OF INSURANCE INSR WVD POLICY NUMBER MA LIMirS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 DAMAGE 10 REN I ED A X COMMERCIAL GENERAL LIABILITY CPA0088583 10/17112 10/17/13 PREMISES Es bccrm mce $ 250,004 CLAIMS-MADE a OCCUR MED EXP(Any one person) S 5100 PERSONAL&ADV INJURY S 1,000,000 X Per Project Aggre GENERAL AGGREGATE $ 2,000,00 GEMLAGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOPAGG $ 2,000,00 POLICY X PRO- LOC $ AUTOMOBILE LIABILITY Eaaccident) S6VGL-ELQdff S 1,000,00 AANY AUTO MAA0379734 10/17112 10/17/13 BODILY INJURY(Perperson) $ ALL OWNED71 SCHEDULED BODILY INJURY(Par accident) $ AUTOS X AUTOS NO"WNED PROPERTYDAMA S X HIREDAUTOS X AUTOS eraccident I S X UMBRELLA LIAB [I OCCUR EACH OCCURRENCE S 1,000,00 A EXCESS LIAS CLAMS-MADE CUAOM967 10/17112 10/17113 AGGREGATE $ 1,000,00 DED I X I RETWTION$ fl S WORKERS COMPENSATION X WC STA OTH- AND EMPLOYERS'LIABRiiY B ANY PROPRIETORIPARTNER0eaiTIVE Y/❑N NIA CD720869 10/17/12 10117/13 E.L.EACH ACCIDENT $ 1,00,00 OFRCERnA%1BER EN:LUDEO4 (Mandatory In NH) E.L_DISEASE-6A EMPLOYEE $ 1,000,0()c DESCRIPPnoNOFOPERATIONSbelow E_LDISEASE-POLICY LIMIT S 1,000,00 A Property CPA0083583 10/17112 [1:077113 3 A Equipment CPA00835M 10/17/12 DESCRIPTION OF OPERATIONS l LOCATIONS I VEHICLES(Afiedi ACOim 101,Additional Remaft SchedW%if more space is rewdred) CERTIFICATE HOLDER CANCELLATION EVIDENT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Evidence Of Coverage ACCORDANCO E WITH THEPOLIATION DATE ICCYRPROVIS ONS. WILL BE DELIVERED IN AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved- ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD Office of Consumer Affairs d Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Reqistration: 100712 .Type: Supplement Card CHARLES J. WOOSTER ROOFING Expiration: 6/23/2014 STEPHEN WOOSTER 525 WOBURN ST TEWKSBURY, MA 01876 Update Address and return card.Mark reason for change. 11 in 20M-05111 Address [j Renewal F] Employment 0 Lost Card � 'e UP a V11 Y)1104MVetz'44M o 3 _= Office of Consumer Affairs and Business Regulation R 4.110 Park Plaza- Suite 5170 �.. Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 100712 Type: DBA Expiration: 6/23/2014 Tr# 227218 CHARLES J. WOOSTER ROOFING Charles Wooster R.O. BOX 8051 LOWELL, MA 01853 Update Address and return card.Mark reason for change. Address ❑ Renewal Employment n Lost Card 4 j iftssac useµs - ?u?;;c ?oarci of Buiidintg, Reguiatioils and standards CI"%trUction ice CS-054268 CHARLES J WOOSTER PO BOX 8051 LOWELL MA OM3 �e ;"+ssionar 05/11/2014 The Commonwealth ofMassachusetts Department oflndustriglAccidents Office of Investigations 600 Washington Street Boston,MA 02111 ww�.massgov/ilia ' Workeris' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl Name(Business/Orgaaiz'ation/Iudividual): t Address: c(/ City/State/Zip: Z, Phone#: Are you an employer?Check tli,a ztipropriate box: Type of project(required): l am a employer with 5 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).' have Hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. �• ❑Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. g, El Building addition [No workers'comp.insurance 5. 0 We are a corporation and its 10.1]Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner,doing all work right of exemption per MGL 11.[]Plumbing repairs or additions myself.[No workers'comp. c. 152,§1(4),and wehave,no 1oofrepairs required.]insurance re employees.[No workers' ] 13.❑Other comp.insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. i Homeowners who submit this affidavit indicating they afire doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that checkthis box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. �� . Insurance Company Name:_ 5X ' Policy#or S elf-ins.Lie.#: Expiration Date: _ All Job Site Address: City/State/Zip: Attach a copy of the workers'co pens tion policy' e Iaration page(showing the policy number and expiration ate). Failure to secure coverage as requiredunder Section 25A of MGL 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 penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cerci u the ' s , d,pen /ties�ofperjury that the information provided ab ve i trne and correct. - Si ature: t/ bate: /-Z&Phone#: O 2�° Official use only. Do not write in this area,to be completed by city or town offrciai. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.CitylTown Clerk 4.Electrical Inspector s.Plumbing Inspector 6.Other - - Phnnp 4f• OORTH Town of t E ndover J.- _n No. h �O LA«E h , ver, Mass, 2%0 COC HIC Hf WICK RAreo Pe;" U BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System THIS CERTIFIES THAT ' , at� Off..... BUILDING INSPECTOR .. �.. .e.....La Foundation has permission to erect .......................... buildings on ... .. .. ......`..................... Q&P 6; Rough tobe occupied as ...... . .. �........t................................................................................................ chimney provided that the person accepting this 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 M NTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTI S Rough Service .................. ..... l .................................................... 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 Building Inspector. Burner Street No. Smoke Det. 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