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HomeMy WebLinkAboutBuilding Permit #111-16 - 19 SECOND STREET 7/27/2015 BUILDING PERMIT N°pT bgtio TOWN OF NORTH ANDOVER �� y ."`- =? *` APPLICATION FOR PLAN EXAMINATION Permit No#. Date ReceivedRwreo S " � nPP •(5 '9S0� Date Issued: �. gCHus JJ IMPORTAN l' Aco plete all items on this page LOCATI Oaf rint PROPERTY OWNER ��r1 �' 3� JQ3tF6_/ 5 r r �^ Print 100 Year Structure yes no MAP 0770 PARCEL:W5(,,0 ZONING DISTRICT: Historic District s / Machine Shop Village yes o TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition 1fwo or more family ❑ Industrial Alteration No. of units: commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer �c DESCRIPTION OF WOR TO 9E PERf ORM /71;;�7 /_(r'-_C0C[7f C, C)P? /i Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: Contractor Name: �CC.L /J70 Phone: C7 Email: Address: ,r . v lvll, Supervisor's Construction License:_Q(!�/-/ Exp. Date: / Home Improvement License: ,J 6Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PE F. Total Project Cost: $ > FEE: V�/- Z Check No.: Receipt No.: ��� NOTE: Persons c9fitracting with unregistered contractors do not have ccess to the guaranty fund &[.67nature of Ac -- 1 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 Signature_ 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 FIREtD;jV,4-MENT = Tempi®umpster on;site Located►at 41241MamStfeet, - •- _ . -_ �__,__ ,_ �_ Fire;Departmentsignature/date...... COMMENTS i i Dimension i 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 1 NOTES and DATA— (For department use) ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Pennit Revised 2014 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 OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ,4. 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/Cross Section/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 OTE: 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 2012 I ECC Energy code Engineering Affidavits for Engineered products OTE: 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 Doe:Building Permit Revised 2014 Q3LLocation; ­77- ,T7 / No. Date J • - TOWN. OF NORTH ANDOVER • ��.�rL�n r6�` . • Certificate of Occupancy $ Building/Frame Permit Fee $ _ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# rJ Building Inspector f F OORTH Town of t E , ndover O - 0 No. 2oiIll.. Z - n h ver, Massr:0000' coc MIc"IWICK �d A�'#ATE0 S U BOARD OF HEALTH PERMIT T LD Food/Kitchen Septic System THIS CERTIFIES THAT ....................... ... .V ....... .. ... ..................................................... BUILDING INSPECTOR has permission to erect .......................... buildings on .�a.�.�►.�,..... .....4 Foundation 94"% Rough to be occupied as .....'r..... ...... ..... .......................... Chimney provided that the person accep Ing this permit shall in ery 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MeTH ELECTRICAL INSPECTOR 14 UNLESS CONSTRUCRough Service .......... ... ...................................... 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. The Commonwealth of Massachusetts Department of IndustrialAceldents I Congress Street,Suite 100 Boston,AM 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Pldase Print Le 'bl Name(Business/Organization/Individual): Address: t.^ City/State/Zip: ri�/� �/� � Phone#: �� r �� o Are you an employer?Check the appropriate box: Type of project(required): 1.F&*'g'J I am.a.employer with �... : employees(full and/or part-time).* 7. ❑New construction 2.F1 I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 3.F-1I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. F1 Demolition ❑4.F1 am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. • 12.❑Plumbing repairs or additions 5.F1 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.FJ Roof repairs These sub-contractors have employees and have workers'comp.insurance.# 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14. Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. I Homeowners who submit•this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must-attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors fiave employees,they must provide their workeis'comp.policy number. I am an employer that is pioviding workers'compensation insurance for my employees.'Below is the policy and job site information. � V Insurance Company Name: lei } I Policy#or Self-ins.Lie.#: Expiration Date: v �Job Site Address: 1 - 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 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under thepains and penaltie perjury that thaiafarmationprovided above is true and correct. Signature: Date: / / Phone 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#: Information and 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 engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or 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 dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building 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 to operate a business or to construct buildings in the commonwealth for any applicant who has pp not produced acceptable evidence of compliance with the insurance coverage wired. P g q Additional 1 ,MGL chapter 152 25C 7 states Neither the commonwealth no an 't Y P �§ ( ) r y of i sp olitical 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-contractor(s)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'compensation 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 sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit 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 Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license 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 the 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 filled 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 burn leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel. #617-727-4900 ext.7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia 7/27/2015 1D:15 AM FROM: Fax Microsoft TO: 919786889592 PAGE: 002 OF 002 ,ACORL® CERTIFICATE OF LIABILITY INSURANCE DATE(MMfDD1YYYY) 11111 1 7/27/2015 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(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 certificate holder in lieu of such endorsement(s). PRODUCER CONTACT y NAME: e James Tarpey, CIC, V Pres Tarpey Insurance Group AfCINo Ex : (781)246-2677 AIC No: (781)229-0973 442 Water St E-MAIL im@tar a insurance.com ADDRESS: P y PO BOX 567 INSURER(S)AFFORDING COVERAGE NAIC I# Wakefield MA 01880 INSURERA Essex Insurance Company INSURED INSURERB:The Hartford Insurance Company A.C. Castle Construction Co.InC INSURER C:Continental Casual( 9 Tibbetts Avenue INSURERD: INSURER E: Danvers MA 01923 1 INSURER F COVERAGES CERTIFICATE NUMBER:GL 15 WC 14 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 TY OF INSURANCE ADDL SUER POLIPOLICY NUMBER MMIDDIYYYYY MMIDDIYYYY POLICY EXP LIMITS LTR X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADEOCCUR AM GET 50,000A PREMISES Ea occurrence $ 3EB0728 7/20/2015 7/20/2016 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY PRO ❑LOC PRODUCTS-COMP/OPAGG $ 1,000,000 X PRO- OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident ANY AUTO BODILY INJURY(Per person) $ B ALL OWNEDSCHEDULED AUTOS X AUTOS 08VECAX3361 10/6/2019 10/6/2015 BODILY INJURY(Per accident) $ X X NON-OWNED PPROPERTYtDAMAGE $ HIRED AUTOS AUTOS PIP-Basic $ 8,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION X STATUTE EMPLOYERS'LIABILITY STATUTE ER YIN ANY PRO FIR RE.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? FN] N/A C (Mandatory in NH) 6S59VB9638L91614-AR 11/13/2014 11/13/2015 E.L.DISEASE-EA EMPLOYE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I$ 500,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) CERTIFICATE HOLDER CANCELLATION (978)688-9542 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 120 Main St ACCORDANCE WITH THE POLICY PROVISIONS. North Andover, MA 01845 AUTHORIZED REPRESENTATIVE J Tarpey, CIC, V Pre ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401) 7&& W Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration 4 =' Registration: 166565 Type: Corporation Expiration: 6/9/2016 Tr# 251720 A.C. CASTLE CONSTRUCTION CO'4NC- BRIAN LEBLANC 9 TIBBETTS AVE : DANVERS, MA 01923 l y e.Update Address and return card.Mark reason for change. P g SCA 1 Co 20M-05/11 Address [—] Renewal F] Employment ❑ Lost Card f �j ie �Oo�rt�rrorculeca�i a�C�a.�cr�eC� Office of Consumer Affairs&Business Regulation License or registration valid for individul use only IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: . 166565 Type: Office of Consumer Affairs and Business Regulation Expiration: 6/9/2016 Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 A.C.CASTLE CONSTRUCTION CO INC. BRIAN LEBLANC 9 TIBBETTS AVE DANVERS,MA 01923 Undersecretary Not valid without signature Massachusetts -Department of Public Safety «� l 385 S.14ty-d Board of Building Regulations and Standards � �� ' -` � �� Construction Supervisor License: CS-054882 This card acknowledges that the recipient has successfully completed a 30-hour Occupational Safety and Health Training Course in BRIAN A LEBLAPIt - ' Construction Safety and Health 9 TIBBETTS AVE ° Danvers MA 01923 BRIAN LEBLANC } 'i''` Expiration --- Ob A— e--- Commissioner 09/17/2015 (Trainer name—print of type) (Course end date) .I Propoat `BBB�E A.C. CASTLE CONSTRUCTION CO. INC. MEMBER Telephone(800)505-LEAK(5325) • Fax (978) 777-7750 Brian LeBlanc, President Please mail accepted proposal to the office located at: 9 Tibbetts Avenue • Danvers, MA 01923 ' Unrestricted Mass Builders License No. 054882 Contractors Registration No. 166565 PROPOSAL BMITTED TO PHPN DATE STREET _ JOEPAME _!��G O S "'T /r/0 CITY,STATE AND ZIP ODE JOB LOCATION _od� on, A -,2 S /61 DATE WORK IS SCHEDULED TO BEGIN' DATE WORK IS SCHEDULED TO BE COMPLETED JOB PHONE Ve Propoae hereby to furnish m terial and labor-complete in accordance with specif tions elow for the sum of: Irl t - / dollars($ 13 t/ ) Payment to be as follows: ^ 113�1dow , the balance due upon com 1-ti'' U " ' 1W NOTICE: All home improvement contractors and subcontractors engaged in home Authorized a improvement contracting unless specifically exempt from registration by Signatur provisions of Chapter 142A of the General Laws,must be registered with Agent the Commonwealth of Massachusetts. Inquiries about registration and :This proposal may be status should be made to the Office of Consumer Affairs and Business Regulation,Ten Park Plaza,Suite 5170,Boston,MA 02116. withdrawn by us if not accepted within days. WE HEREBY SUBMIT SPECIFICATIONS AND ESTIMATES FOR: A ROOF STRIP We will cover the,Siding, bushesand grasses with Blue Tarps in order to protect the property during stripping. We will Strip up tb�I1yers of roofing and remove all nails,screws and staples down to the Bare Wood and renail all loose boards. The Ice and Water Shield will then be installed at the bottom of all Edges,under all Step flashings,under all Roll flashing, around all Chimneys,Skylights,and into all Valleys,in heated areas only. /J� We will install 30 Ib.Synthetic Deck Protector Underlayment to all other areas of the roofdeck. "y y lT The 8"aluminum Dripedge will then be installgd to all roof edges.Any existin Pipes will be covered with]new Aluminum Rubber Flanges. W YI The roofing material to be used will be r /!� The bottom of all roof edges will have a Pro Starter course with a glued edge for wind uplift.We will Storm Naii ll shingles,using 6 nails per shingle. All the Debris will be cleaned and Dumped by us on a daily basis.We will cleanout all Gutters,Downspouts and Elbows.Magnetic brooms will be used to extract all nails from your property.We will protect your property as best we can,however some foliage matting,breakage,or marring could occur. We cannot accept responsibility for possessions inside of the house,or debris falling into attic areas.Customer should protect personal belongings. EXTRA WORK IN WHICH APOST WILEADDED TO THE ABOVE PRICE. Replace Rotted Roofboards 45 txr ly / Install Aluminum Gutters Relead Chimney(s) _ Z2!� C Install Aluminum Downspouts Replace Facia Boards C Install Skylight(s) Install RidgeventI f_ Rotted Roof To Wall Flashings ✓�e" �� % Install Roof Louvers Gutter Repairs NOTES: P f P r i l� f PPY� Warranty by manuftstucfree of defects for years, see manufacturer's warranty for exact warranty performance. All labor pLoider7hts con ct shall be of good quality and free from defects not inherent in the ualit re uired or ermitted for q Y q pa period oars.IThis war anty excludes remedy for damage or defect caused by abuse, modification, improper or insufficient maintenaner operati , or normal wear and tear under normal usage.This warranty shall be limited to the work performed by A.C. Cast] ion C ., nc. and limited to either repair or replacement by A.C. Castle Construction Co., Inc. at its'sole discretion and electiI claims are waived unless made in writing to A.C. Castle Construction Co., Inc. within 21 days after the occurrence of the event giving rise to such claim.This warranty shall not extend beyond any limits imposed by applicable law. It is our obligation to obtain any and all necessary related permits. PLEASE NOTE:owners who secure their own construction-related permits shall be excluded from access to the Guarantee Fund. Payment and Penalties - Upon substantial completion of all work under this contract, customer shall within 3 days make final and full payment of the contract price. Any and all unpaid balances shall accrue with interest at 5% interest per month. You agree to pay all court costs and collection expenses incurred by A.C. Castle Construction Co., Inc. in the collection of any amount you owe under this contract, including without limitation reasonable attorney's fees. Please note:any illegal layers of roofing beyond a second layer will be an extra cost of 35 cents per square foot. Arbitration -Any controversy or claim arising out of or related to this contract, or the breach thereof, shall be settled by arbitration with the American Arbitration Association or a mutually agreed upon third-party. Any judgment upon an award entered in arbitration may be entered in any court having jurisdiction thereof. This section shall not apply to claims of A.C. Castle Construction Co., Inc. for collection of past due accounts owed by the customer. The homeowner's three day cancellation rights under MGL c 93 s 48; MGL c 140D s 10 or MGL c 255D s 14 as may be applicable. Z(tteptanre of Propogal -Signing this proposal means you have accepted all the terms as stated and us as acting agent for permitting. Date of Acceptance ,I&" F - Signature 33