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HomeMy WebLinkAboutBuilding Permit #440-2016 - 196 SUMMER STREET 10/7/2015 NORTH BUILDING PERMIT o` tLE' bq"o TOWN OF NORTH ANDOVER 0 A APPLICATION FOR PLAN EXAMINATION Permit No#: � Date Receivedp�RA7ED gssgcnussc Date Issued: I r IMPORTANT: Applicant must complete all items on this age LOCATION �qCo scall Pf f Print PROPERTY OWNER N(G�('I� 05l00 ,�)) �7 Print 100 Year Structure yesOnoMAP PARCEL: yr /o ZONING DISTRICT: Historic District yesMachine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building 0 One family El Addition ❑Two or more family% [I Industrial Alteration No. of units: ❑ Commercial ❑ Repair, replacement 0 Assessory Bldg ❑ Others: ❑ Demolition ❑ Other rSeptic D Well> ^� `, D€Flootlpl;a n; `Wetlands. �� ❑ 4,a e-,sheds"®astrictw i W,ate /Sewer "' F DESCRIPTION OF WORK TO BE PERFORMED: 74 t r, L tRao IdentificaPleasrTlype or Print Clearly OWNER: Name: !U (,o(G�e s7i� Phone: �t Address: W/1 60(q� Phone: 6 94 7 Contractor Name: c�! ca>, = Email: Address_ Supervisor's Construction License: / o rcl 1( 3 Exp. Date: p i Home Improvement License: 170 .—Exp. Date: 1 ( l lO ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ ` L 4'(xj-09— FEE: $ Check No.: �'U o Receipt 2.9L4 NOTE: Persons contracting with unregistered c, retractors ccess to the guaranty fund en ra Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL . Public Sewer ❑ Tanning/Massage/Body Art ❑ Swfiming 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 � r Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation anon Deasion: Comments Water& Sewer Connection/Signature& Date Drivewav Permit DPW Town Engineer: Signature: Located 384 Osgood Street IFIFiEDEPAReTME11-2 Temp p" Yr pst�er4onjsitpj,-5 es-J (Located Fire Department signature/dat5,­&4, �1cJtl,-^te._tfN ENT�;`'�" ��► 4'''y(}'+���� ��` �.�' r.;. r,�fi r�:, � �,�, �. �, �,".,l,']'�`2�' , y ,t,, �,,•:fir y„ i SSA..•. ~ . v...,'3ti�.0__..:� i i.r ' `f�"S' '.r�.s_• .�. S _r—f._� :'ti.�s e.:,.�,�y.y„ ts ' .'F Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Dieter location, rust ®r 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 Buse) ® Notified for pickup Call Email Date Time Contact Name Doc.Building Permit 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 4. 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 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 IECC 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 Doc:Building Permit Revised 2014 C� Location No. U �. U Date s . - TOWN OF NORTH ANDOVER Certificate of Occupancy $ { Building/Frame Permit Fee $ 3 Foundation Permit.Fee $ Other Permit Fee $ TOTAL $ fi 's Check# i 9481 A © � tUfding Inspector r 1 NORTH +* . w: 1 It c . . ve. . 0 No. — *y _ S T Z h � I h ver, Mass, o coc NIc NIWKK ��AERATED I�Pa�,�y S U BOARD OF HEALTH Food/Kitchen PER I T LD Septic System BUILDING INSPECTOR THIS CERTIFIES THAT .................. CA! ..................:.OAO.wl....S.WVVS.VV*A.3k(q4 .............................................. Foundation has permission to erect .......................... Ildings on .........114.. ..... •• Rough tobe occupied as ............ . ... ........... .. �..l.M�.. ...... .............................................................. Chimney provided that the person accepting 1his permit shall in every respect conform to the terms of the application Final on file in this office, and Wthe 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 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIONS ARTS Rough 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 FIRE DEPARTMENT No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. CD Roofing Vincent Colangelo 3 Hodgson St. Koofing Tewksbury,Ma 01876 978-656-8497 vincentcolongelo@sbcglobai.net HIC Llc# 170575 _- CSSL Lic# 105943 Customer: 1% 5 �r -----� OWENS CORNING Aj ,�.� ,, PREFERRED CONTRACTOR Description of work Performed: Obtain required town permits&provide certificates of insurance&workers compensation rovide Dumpster set on planks*for contractors use only(materials all recycled) Attach Large Tarps to protect adjacent finishes, landscaping, and property. trip-off( ( )existing layers of roofing on'complete house& re-nail any loose decking Install flinch g_ et�J n Aluminum Drip edging!Owens Corning Starter Shingles `( Install Owens Corning Ice&Water shield 6ft at eaves, 3ft in valleys,around all penetrations (Install Synthetic felt paper to entire roof ,.Install Owens Corning LifeTime warranty TruDefinition Duration shingles ,Install new neoprene vent pipe flashings on all plumbing pipes - ,Install Owens Corning VentSure ridge venting with moisture guard C A& :rr ,S algr �Crn ,install Owens Corning ProEdge'hip& ridge cap shingles Completely re-flash chimney with lead t+Owens Corning Preferred contractor installation with full warranty All work will be completed according to state and manufacturing codes and specifications. Every day we will have the roof water tight,clean gutters, completely clean the job site, and use a magnet roller to collect scattered nails. Additional work to be performed Ir All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices. Any alteration or deviation from the above specifications must be made in wnting on an Add-on/Mo(fifrcatfon of Contract form and may become an extra charge over and above the amount stated herein. This agreement is contingent upon delays beyond our control.Owners to carry fire,tomado and ether necessary insurance.Our workers are fully covered by Worker's Compensation Insurance. Homeowner agrees to pay for all work as set forth below. if the homeowner defaults, iomeowner agrees to pay all costs of collection, including reasonable attorneys fees,in addition to other damages incurred by contractor.Full Payment is due upon completion of work We propose hereby to furnish material and labor - complete in accordance with the move specifications, for the sum of: dollars($ q06, ). Said amount shall be paid as follows: Note:This proposal may be withdrawn by us if not accepted within days. YOU, THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION. SEE THE ATTACKED NOTICE OF CANCELLATION FOR AN EXPLANATION OF THIS RIGHT. THIS SALE IS SUBJECT TO THE PROVISIONS OF THE HOME SOLICITATION SALES ACT AND THE HOME IMPROVEMENT ACT THIS INSTRUMENT IS NOT N4POTIABLE. Work will not begin until your right to cancel has expired and you h d o 't of dollars($ ), unless this agreement provides Signature of Contractor or authorized representative: *(UWe)have read the terms stated herein,they hav en explained to(me/us),and(I/We)find them to be satisfactory and hereby accept them. j Signature of Homeowner(s): j v The Commonwealth of Massa chusetts z Department of IndustrialAccidents i d 1 Congress Street,Suite 100 ' Boston,ALL 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE PILED WITH THE PERMITTING AUTHORITY. Applicant Information/Inb Please Print Le ' l Name (Business/Organizationdividual): �/F iA � C1�G�i Address: City/State/Zip: Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.❑I am a employer with employees(full and/or part-time).* 7, n New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. Q Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]t �Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 ensure that all contractors either have workers'compensation insurance or are sole 11.[�Electrical repairs or additions proprietors with no employees. • 12.E]Plumbing repairs or additions 5.�I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13. Roof repairs These sub-contractors have employees and have workers'comp.insurance.$ 6.Q We are a corporation and its officers have exercised their right of exemption per MGL c. 14.Q Other 152,§1(4),and we have no.employees.[No workers'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 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 have employees,lfiey must provide their workers'comp.policy number. lam an employer that is providing workers'compensation insurance for my employees.'.Below is the policy and job site information. Insurance Company Name: n Wes" Policy#or Self-ins.Lie.#: � n)I nFs(07 6 Expiration Date: /19k_ Job Site Address: 1,16 5u zi/t„0r ST City/State/Zip: /V_ 14it 10tor( 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 atement may be forwarded to the Office of Investigations of the DIA.for insurance coverage verification. I do hereby certif zdpains penalties etjury that the information provided above is true and correct. Si ature: Date: O 2 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#: ACC?RO CERTIFICATE OF LIABILITY INSURANCE 7 (IMn4/D/3115 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 NAME: Angela Westen Insurance Agency PHONE (9781 735-4094 Fax No: (gig 735-4095 557 Central Street E-MAILADDRESs: angela@awesten.com Lowell, MA 01852 INSURER(S) AFFORDING COVERAGE NAICB INSURER A:ATLANTIC CASUALTY INSURANCE CO INSURED INSURER B:HARTFORD UNDERWRITERS INS COMP FO CONSTRUCTION CORP. INSURER C: 40 READ ST. INSURER D: LOWELL, MA 01850 -INSURER E: INSURER F: 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 AWL SUBRPOLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MND/Y MM/DD/YYYY LIMITS A GENERAL LIABILITY L021008696 3/18/15 3/18/16 EACHOCCURRENCE $ 1,000,000 ]( COMMERCIAL GENE RALLIABILITY DAMAGE TO RENTED $ 100,000 CLAIMS-MADE OCCUR MEDEXP(Any one person) $ 5 000 PERSONAL&ADVINJURY $ 11000,000 GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER PRODUCTS-COMPIOPAGG $ 1 000 000 POLICYF—I .PERoi F1 LOC $ AUTOMOBILE LIABILITY COMB INED SINGLE L IM IT _JEa accident $ ANYAUTO BODILY INJURY(Per pe ison) $ ALLOWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PReOPPEE Y DAMAGE $ HIRED AUTOS !AUTOS $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION2EII2068 3/30/15 3/30/16 WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETORIPARTNERIEXECUTIVE 7 E.L.EACH ACCIDENT $ 100,000 OFFICERMEMBEREXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ X40,000 H yes describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 560,000 DESCRIP17ON OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Renarks Schedule,if more space is required) CERTIFICATE HOLDER — CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CHHODGSON ING ACCORDANCE WITH THE POLICY PROVISIONS. COLANGELO ST. AUTHORIZED REPRESENTATIVE RY, MA 0187 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: VINCENTCOLANGELO@SBCGLOBAL.NET y iW4a'- """h s's - .epat reit;of Public Safe#y :I Board of iti ding Reg P tiohS, Viand Star-dards C't�n:strtrcti�: supervisor specs ilt • License: CSSL105W VINCENT COLA&GEI;O - ��� 3 HODGSON STREET `=�, Tewksbury 1VIA 01:876 ' Ct}Cnr33i$Siflft$i 'l xpirafion S r . 03%091201.6 • 1-�--- .------•-<n-.s�-, :..ter-�-�_ ,. _..,,�..,...-.. _ ._ ,__._ - • Office of Consumer Affairs& Business Regulation € _ tME IMPROVEMENT CONTRACTOR i. eigistration: r575 Type: piration: r_1:J=:QQ15; DBA CD ROOFING {. VINCENT COLANGELO` �" 3 HODGSON ST TEWKSBURY, MA 01876 . Undersecretary } sem* . ,i r