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HomeMy WebLinkAboutBuilding Permit #257-12 - 19 SURREY DRIVE 5/1/2018 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Perrnif NO, 7� Date Received Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION I S i 1 r r e-,r b r�V L Print PROPERTY OWNER rn N t m as T i►r 6-7 L Y jv>v Unit# Print MAP NO:--) PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no 100 year-old structure yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building [4-6ne family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial C4<epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other rSep a {® Te li 'W` E '�ff od la nI ©Wetlands ®tMter ed Districts }�r' i L Cater/Sewers' _ _� � __ _mJ _ DESCRIPTION OF WORK TO BE PERFORMED: , YNGw i/1r)%1 1 ziId ns i Alt s i�s,r,o�.e Girt `ra �sr2r� i �c �:c3in� h���►\ 11cw G-t1'fiT� �` (Identification Please Type or Print Clearly) OWNER: Name: VNR . P)AS i vn Phone: 78 5-501180 Address: i !J S U r(`e,i h riVL 11J, AW)JoV,,r r.cisZ CONTRACTOR Name: 7-)io M cc, CC)I SA(-W SS 0 Phone: 617 - 47,1- 071/ Address: Supervisor's Construction License: -71K Exp. Date: %I- R - i I Home Improvement License: / -302/ 7 Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASEED'ON$925.00 PER S.F. Total Project Cost: $_ %t ROD 10� FEE: $ P302 Check No.: Receipt No.: c�L443L NOTE: Persons��ntracting with unregistered contractors do not have access to the guaranty fund ;:F,A':J...-.�%ll:..r...:- Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/MassageBody 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 COMMr NTS HEALTH Reviewed on Signature COMMENTS ^� Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Wafer& Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT -Temp Dumpster on site yes no Located at 124 Main Street Fire Departrn.ent signature/date T COMMENTS 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 M—F and G min.$10041000 fine NOTES and DATA— For department use LJ Notified for pickup - Date 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 orkers Comp Affidavit photo Copy of H.I.C. And/Or C.S.L. Licenses v�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 VOTE: 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 CIerks 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 nust be submitted with the building application Doc: Doc.Building Permit Revised 2008mi Location No. r Date 3 TOWN OF NORTH ANDOVER f w • i Certificate of Occupancy $ cNus9 t' Buildin /Frame Permit Fee $ s� o Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # t d 2 4 6 2 5 Building Inspector A RTFI TONM o _ Andover .. . dover, Mass., T O LAKE COC HI C HEWICK ORATED p'Pa�,�S vv ` BOARD OF HEALTH Food/Kitchen PERMIT T D I Septic System BUILDING INSPECTOR THIS CERTIFIES THAT...... i r'lO ...... ...1�.M!!�.......................................................................................... Foundation �� Sur.1C- y �/`. has permission to erect...........:............................ buildings on .4 Rough to be occupied as......................�F.�...��./......�:.:7��-�1�..... ............................................:.......:................... Chimn y e provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final. 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 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough Service B INSPECTOR Final Occupancy Permit Required to Occupy Building . GAS INSPECTOR 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. SEE REVERSE SIDE Smoke Det. ADVANCED BUILDING AND SIDING CO., INC. 11 STANLEY CIRCLE QUINCY, MA 02169 TEL. (617) 472-0741 FAX. (617) 472-9022 Mr. and Mrs. Tim Glynn 19 Surrey Drive Andover, MA (978) 335-8180 We hereby propose to furnish all the materials and to perform all the labor necessary for the completion of work at 19 Surrey Srive, Andover, MA- Roof work, gutters work, and siding work. Removal roof work 1. Remove existing roof shingles. 2. Remove existing drip edge. Finished roof work .1. Install ice and water shield 3 ft. 2. Install 5 I/2" drip edge. 3. Install new timberline 30 yr roof shingles. 4. Install 15 lb black paper under new shingles above ice and water shield. 5. Install new GAF cobra ridge roll vent as needed. 6. Install new ridge vent as needed. Gutter work 1. Install 5" residential gutter. 2. Install 3" x 4"downspouts as needed to accommodate new gutter. Removal siding work 1. Remove existing masonite siding. Finished vinyl siding 1. Install Typar house wrap. 2. Install 5" outside corner post to accommodate new siding. 3. Install J channels and finish trim. 4. Install double 4" Main Street certainteed vinyl siding. ► 5. Install trim coil over upper fascia:board. 6. Install trim coil around window trim and window sill. I i All material is guaranteed to be as specified, and the above work to be performed in accordance with the drawings and specifications submitted for above work and completed in a substantial workmanlike manner for the sum of 19,800.00 with payment plan to follow: 1. Deposit of$4,700.00 due upon signing of this contract. 2. Payment of$7,000.00 due upon completion of roof work. 3. Payment of$2,100.00 due upon completion of gutter work. 4. Payment of$4,000.00 due upon completion of removal of siding work. S. Final payment of$2,000.00 due upon completion of vinyl siding and overall job with sign off by building department. I Any alteration or deviation from the above specifications involving extra costs, will be executed only upon written orders, and will become an extra charge over and above the estimate.All agreements are contingent upon strikes, accidents, or delays beyond our control. Owners to carry fire, tornado,flood and other necessary insurance upon above work. Workmen's compensation and public liability on above work to be taken I out by Advanced Building and Siding Co.,Inc. to be provided prior to commencement i of work. Respectfully submitted- Thomas Colarusso ACCEPTANCE OF PROPOSAL The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined. Accepted J Wie &IL Ann Signature Date 9 /Zi / It `T�m 1 , Signature Note: There are no warranties on the work unless the final payment is received. If the homeowner does not pay the final payment within 30 days upon completion of the job, receipt of certificate of occupancy and completion of punch list(if necessary), the homeowner will pay back interest and any legal fees incurred. The Commonwealth ofMassachusetts Department oflndustrialAccidents Office oflnvestigations 600 Washington Street Boston,MA 02111 www.mass gov/din Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le�libly Name(Business/Organization/Individual): Address: A\ /N 1 Ly i v,%e —r, City/State/Zip: rD Vi h e�fyn Sss p a l t rf Phone#: (00- 2A c J I Are yon employer?Check the appropriate box: _ I. a employer with L 4. ❑I am a general contractor and I Type of project(required): employees full 6. New construction ( and/or part-time), have hired the sub-contractors ❑ n a sole proprietor or partner- listed on the attached sheet.t 7. ❑Remodeling and have no employees These sub-contractors have 8. [�Demblition ing forme is any capacity. workers'comp.insurance. workers coin .insurance 5. 9. ❑Building addition ' p ❑ We are a corporation and its ired.] .officers have exercised their 10•❑Electrical repairs or additions a homeowner doing all work right of exemption per MGL 11.❑Plumbingrepairs or additions lf. [No workers'comp. c.152,§1(4),and we have no ance re uired. em to ees. 12.El Roofrepairs q ] p y [No workers' comp,insurance required.) 13.0 Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information T Homeowners who submit this affidavit indicating they are doing all 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,policy information. I am an employer that is providing workers'compensation insu information. rance for my employees Below is the policy and job site Insurance Company Name: o Policy#or Self-ins.Lie.#: �P' -`yp , a,�fat i a Expiration Date: ra J 2��.s�Z . Job Site Address:_ i 9 yrre-I Ci /State/Zi t3' :P Af. AW*1oycr V"Ss 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 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 ofthis statement maybe forwarded to the Office of Investigations of the DIA-for insurance coverage verification. Ido hereby certify un r the pains andpenalfies ofperjury that the information provided above is true and correct._ Signature: Date: ?none 7 7 P 7 Official use only. Do not write in this area,to be completed by city or town official • City or Town: PermitUcense# 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 not produced acceptable evidence of compliance 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'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 contirmatiort 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 Iicense 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 permiWicense number which will be used as a referencd 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 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: Tue CO MMOrDweatd;of ZZ assacn lsetts Deparitent of Industrial Accidents O ce of Investigatlous 600 Washington Street Boston}MA.02111 Tel.#617•-727-•4900 ext 4406 or 1-877-MASS.A.FE Revised 5-26-05 Fax#617,727.7749 ' WWW.mass.g-ovaa CERTIFICATE OF LIABILITY INSURANCE DAT04104DfrYYY, 04!04111 '.'ISS 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(SJ 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 torts and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder at lieu of such endorsement(al PRODUCER 781-4312500 REACT NorthStar Ins.Services,Inc. 78131-61 _ 300 First Ave,Suite 100 PHrn No Needham,MA02494 EAo mss: House Account PRODUCER CUSTOMERID#ADVABUI INSURER(S)AFFORDING COVERAGE NAC; INSURED Advanced Building and Siding wsuRERA:Peerless Insurance Company 18333 Thomas Colarusso muRim 9:Associated Employers Ins.Co. 11 Stanley Circle INSURER C: Quincy,MA 02169 INS D: INSURER E: MIRERF: 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 MAYHAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE of INSURANCE POLICY EFF DLtCt LTR POLICY NUMBER MlDGlYYYY LIMITS GENERAL LIABILITY EAL'FIOCCURRENCE i 1,000, A DAMAGETORFATED X COMMERCIAL GENERAL LIABILITY BP5097537 11127110 11127/11 PREMISES Eeomrnence i CLAIMS-MADE a OCCUR MED EXP(My one person) i 15,0 PERSONAL&ADV 94d1RY i 1,000,00 X Per Projed Aggre GENERAL AGGREGATE i 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $ ZOOO,O POLICY PRO LOC i AUTOMOBILE LIABILITY COMBINED SNGLE LIMIT i (Ea accident) ANYAUrO BODILY NJURY(Per person) i ALL OWNED AUTOS BODILY NdURY(Per acddumt) i SCHEDULED AUTOS PROPERTYOAMAGE i HIRED AUTOS (Per socidenl) NON-O NEDAUTOS i i UMBRELLA LIAROCCUR EACs OCCURRENCE i EXCESS LIAR HCLAIMS-MADE AGGREGATE i DEDUCTIBLE i RETENTION i i WORKERS COMPEN.SATIONVYCSTATU- OTH- AND EMPLOYERS'LIABILITY X TORY LIMITS ER B ANY PROPRETORlPARTNERIEeCUTNE Y/N CC5002185012011 03123/41 031 12 EL.EACH ACCIDENT i 100,00( OFFICERIIAR BER EXCLUDED? NIA (Mandatory In NH) EL DISEASE-EA EMPLOYEE i 100, If yes.describe udder DESCRIPTION OF OPERATIONS betow E-L.DISEASE-POLICY LIMIT i 5001 1 71 DESCRIPTION OF OPERATIONS I LOCATIONS I VERCLES(Attcr ACORD IM,AdcNorrol Remarks ScheWe,if mora apace is required) CERTIFICATE HOLDER CANCELLATION PROOFOF SHOULD ANY OF THE ABOVE DESCR13ED POLICIES BE CANCELLED BEFORE Proof of Insurance THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE —y p 0 1988-2008 ACORD CORPORATION. All rights reserved. ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD ✓!e -r�om��wy.,ue�u�✓t'�vaacl�uaet,Gs Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR I Registratio6 130817 Expgattb�-�4f2 12 Ta'# 294236 Types EDBA t ADVANCED BU!'} If SEETi1IG'Co. THOMAS COLAR 11 STANLEY CIRGL`'E - QUINCY,MA 02169 ` "" '` t --- `Undersecretary ' liussachusetts- Department of Public SafetN Board of Building Regulations and Standards �. Construction S;-,per4isor License w License: CS 71528 Restricted to: 00 THOMAS J COLARUSSO 11 STANLEY CIR QUINCY, MA 42169` Expiration: 11/8/2011 (,+onuisi+aeca Tr=: 7478