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HomeMy WebLinkAboutBuilding Permit #819-14 - 196 WAVERLY ROAD 5/13/2014TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: glq, —/y Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION _ Print. PROPERTY OWNER I- 0/5 Print 100 Year Old Structure yes no MAP NO: �� PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes , ncy TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑ Well ❑ Floodplain ❑ Wetlands ❑ Watershed District ❑ Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: CONTRACTOR Name: _�3U vaA-1 A10bPA1 Phone: Address: Wo -43W (15�1 '? Supervisor's Construction License: Os 9- 4413 Exp. Date: / I� Home Improvement License: / �� Exp., Date: 5/;d/ / C, 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: $ Od FEE: $ 7� Check No.: l 7Receipt No.: _V i 5�_7 2 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Ow er igpature of contracto II Plans Submitted ❑ #lans'Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ I 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 DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ 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: Com Conservation Decision: Comments %%ter & Sewer Connection/Signature & Date Driveway Permit DPW T ovv . Engineer: Signature: FIRE DEPARTML-'NT - Temp Dumpster on site Located -at 124 Mair Street Fire Departi'ner-it signature/date COMMENTS Located 384 Osgood Street yes no 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 NU 1 tats and UA I A — 1 dor aepartment use ® Notified for pickup - Date Doc.Building Permit Revised 2010 Building Department The foh,.owing 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 ❑ 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 NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cascs if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the apw�,al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm-tted with the building application Doc: Doc.Bui"ding Permit Revised 2012 Location lO_ Q P� No. (' 1"1 Date Check r 27572 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $—_tea Foundation Permit Fee $ Other Permit Fee $ TOTAL $ J Buifdi6g Inspector 9 r o 0 r + 0 o 0 0 C.) V z W Q i d a0 N ui w a CD a Z o LL o Z z z E Q a oC L m C •`' p z Z CO Q v Z w Q tm2 m c o= �a N oQ W C R 0 vI m E m 0 J 6L Lm a w +O+ C d W >vN�; Y N 0 ca W N O ON Z cc c-0 \ ubn Cl) mo E ()a X Z N 7 0 O O0 (D_ 7 O Z i6 �U N O LL N �� U LL d' LL � 2' N LL Q:: LL m {n N r Iv =1 �: w L V N mm o 0 r + 0 C.) V W Q i d N z a CD c Z o o E Q L m C •`' CO Y O Cl) tm2 • o= �a C R 0 vI C J 0 Lm a Z N U >vN�; � 72> W � O cc c-0 Cl) ()a X Z LLI 0 L-oc �U v Noo � �� M � .-0 � uw i= a,'> o c W J <): cof- CZ �{ CL Q' 4)_ m V , . •� L 0 o .a Q i i lC -0 2 m Q. O N cq `� °' '2 m W •N 'a. O O O cc C WL U Q V N 0-0 NH =•o�- O F=- ca . CL00 > Iv =1 �: w L V N mm Page No. of Pages Builders License # 58443 Home Construction Reg. # 167338 310 � (781) 944-1994 (978) 664-2557 READING NORTH READING P.O. Box 637, North Reading, MA 01864 Please visit us at www.duvalroofing.com PROPOSAL SUBMITTED TO F � PHONE DATE STREET -� CITY, STATE AND ZIP CODE We hereby submit specifications and estimates for: U114p & Remove all existing roof related debris from roof as well as job site with our own disposal truck: NO DRIVEWAY DUMPSTERS ©layer of existing roof shingles ❑ 2 layers of existing roof shingles ❑ 3 layers or more of existing roof shingles W4place any damaged roof decking; not to exceed 32sq. ft. (additional at $1.70 per sq. ft.) ©'Install 8" Aluminum Drip-edge/Rake-edge along entire perimeter (Choice of White, Brown or Mill) Oinstall ICE & WATER UNDERLAYMENT on all horizontal eaves, sidewalls, skylights and chimney flashing ❑install a premium base sheet underlayment (felt) that is in compliance with the asphalt shingle manufacturer chosen by the homeowner ' ® Install The Homeowner's Choice of the selected Tamko/IKO or GAF Limited Lifetime Architectural Roof Shingles See individual manufacturer's warranty for specific details ® Replace all existing bathroom louver and/or exhaust pipe(s) with new aluminum flanges Qi Chimney(s) -counter-flash and re -step existing flashing ❑ Cut & Install new lead flashing 0' rnstall a continuous low profile Ridge -Vent on all ridge lines ❑ Soffit -Vents ❑ Roof Louver -Vents ❑ Seamless Aluminum Gutters - Custom fabricated on site with our own gutter machine ❑ Downspouts at additional ❑ Leaf Guards ❑ Other r / Alk "Please Note: All items in roof attic should be removed or covered due to falling roof particles, at time of roof tear -off Price includes all items above that are checked only / others may be priced separately upon request. We Propose hereby to furnish material and labor - complete in accordance with above specifications, for the sum of: Total price not including options. dollars ($ Payment to be made as follows: 30% deposit required before ordering materials. Balance due in full upon day of completion. Please make all payments out to Kenneth Duval, mailed to: P.O. Box 637, No. Reading, MA 01864 Final Payment is due upon day of completion and is subject to the Authorized ,. supplemented Terms & Condition sheet when scheduling. Signature,, THIS PROPOSAL IS VALID FOR fc! DAYS DUE TO rw%. 1 UM1 RiVU; 11111 rvuwr Qniml_ a vrQrvQr►1_ rnMor-Q. Massachusetts Home Improvement Sample Contract This form satisfies all basic requirements of the state's Home Improvement Contractor Law (MGL chapter 142A), but does not include standard language to protect homeowners. Seek legal advice if necessary. Any person planning home improvements should fust obtain a copy of "A Massachusetts Consumer Guide to Home Improvement" before agreeing to any work on your residence. You may obtain a free copy by calling the Office of Consumer Affairs and Business Regulation's Consumer Information Hotline at 617-973-8787 or 1-888-283-3757 or on our website. Homeowner Information Contractor Information The Contractor agrees to do the following work for the Homeowner: (Describe in detail the work to completed, specifying the , brand, and grade of materials to be used, use additional sheets if necessary.) Required Permits - The following building permits are required Proposed Start and Completion Schedule - The following schedule will and will be secured by the contractor as the homeowner's agent: be adhered to unless circu�beyond the contractor's control arise (Owners who secure their own permits will be excluded from the Guaranty Fund provisions of i I t- Date when contractor will begin contracted work. MGL chapter 142A,) t �J Date when contracted work will be su tantially completed. The Contractor agrees to perform the work, furnish the material and labor specified above for the total sum of: Payments will be made according to the following schedule: $ upon signing contract (not to exceed 1/3 of the total contract price 4i: the cost of special order items, whichever is greater) /_/_ or upon completion of $ by _/_/_ or upon completion of completion of the contract. (Law forbids demanding full payment until con act is completed to both parry's satisfaction) The following material/equipment most be special $ to be paid tfor ordered before the contracted work begins in order to meet the completion schedule.(**) $ to be paid NOTES: (*) Including all finance charges (**) Law requires that any deposit or down-paymem required by the contractor before work begins may not exceed the greater of (a) one-third of the total contract price or (b) the actual cost of any special equipment or custom made material which must be special ordered in advance to meet the completion schedule. Express Warranty - Is an express warranty beine provided by the contractor? © No Yes fall terms of the warranty must be attached to the contraco Subcontractors - The contractor agrees to be solely responsible for completion ofthe work described regardless of the actions of any third party/subcontractor utilized by the contractor. The contractor further agrees to be solely responsible for all payments to all subcontractors for materials and labor under this agreement Contract Acceptance - Upon signing, this document becomes a binding contract under law. Unless otherwise noted within this document, the contract shall not imply that any lien or other security interest has been placed on the residence. Review the following cautions and notices carefully before signing this contract. • Don't be pressured into signing the contract. Take time to read and Shcy understand it. Ask questions if something is unclear. • Make sure the contractor has a valid Home Improvement Contractor Reeistration. The law requires most home improvement contractors and subcontractors to be registered with the Director of Home Improvement Contractor Registration. You may inquire about contractor registration by writing to the Director at 10 Park Plaza, Room 5170, Boston, MA 02116 or by calling 617-973-8787 or 888-283-3757. • Does the contractor have insurance? Ask the Contractor for his insurance company information so that you can confirm coverage, or ask to see a copy of a "proof of insurance" document. • Know your rights and responsibilities. Read the Important Information on the reverse side of this form and get a copy of the Consumer Guide to the Home Improvement Contractor Law. You may cancel this agreement if it has been signed at a place other than the contractor's normal place of business, provided you notify the contractor in writing at his/her maim office or branch office by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the third business day following the signing of this agreement. Seethe attached notice of cancellation form for an explanation of this right. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACESM Two identical copies of the contract ansa{ be copkied and sig iad. Onc copy ShmW go to the . The on- copy should be kept by the comxactor. eowner's Signature Contractor s Signature Date Date F Street Address (do not use a Post Office Box ddress) Co ctor/ S person/ Owner Name (3 City/rows State Zip C e ,l Business Address (must include asttaddres ' � ��Z� Daytime Phone Evening Phone ciit�yrroownn State Zip Code p L r —X Q O t/ Mailing Address (It different from above) Business Phone Federal Employer ID or S.S. Number I,nsr regoiresth*t most home Home tmproyemens Commaor Reg. Number Expimum dare improvement eonts•eton hsrve a bd xrOstr,unu number The Contractor agrees to do the following work for the Homeowner: (Describe in detail the work to completed, specifying the , brand, and grade of materials to be used, use additional sheets if necessary.) Required Permits - The following building permits are required Proposed Start and Completion Schedule - The following schedule will and will be secured by the contractor as the homeowner's agent: be adhered to unless circu�beyond the contractor's control arise (Owners who secure their own permits will be excluded from the Guaranty Fund provisions of i I t- Date when contractor will begin contracted work. MGL chapter 142A,) t �J Date when contracted work will be su tantially completed. The Contractor agrees to perform the work, furnish the material and labor specified above for the total sum of: Payments will be made according to the following schedule: $ upon signing contract (not to exceed 1/3 of the total contract price 4i: the cost of special order items, whichever is greater) /_/_ or upon completion of $ by _/_/_ or upon completion of completion of the contract. (Law forbids demanding full payment until con act is completed to both parry's satisfaction) The following material/equipment most be special $ to be paid tfor ordered before the contracted work begins in order to meet the completion schedule.(**) $ to be paid NOTES: (*) Including all finance charges (**) Law requires that any deposit or down-paymem required by the contractor before work begins may not exceed the greater of (a) one-third of the total contract price or (b) the actual cost of any special equipment or custom made material which must be special ordered in advance to meet the completion schedule. Express Warranty - Is an express warranty beine provided by the contractor? © No Yes fall terms of the warranty must be attached to the contraco Subcontractors - The contractor agrees to be solely responsible for completion ofthe work described regardless of the actions of any third party/subcontractor utilized by the contractor. The contractor further agrees to be solely responsible for all payments to all subcontractors for materials and labor under this agreement Contract Acceptance - Upon signing, this document becomes a binding contract under law. Unless otherwise noted within this document, the contract shall not imply that any lien or other security interest has been placed on the residence. Review the following cautions and notices carefully before signing this contract. • Don't be pressured into signing the contract. Take time to read and Shcy understand it. Ask questions if something is unclear. • Make sure the contractor has a valid Home Improvement Contractor Reeistration. The law requires most home improvement contractors and subcontractors to be registered with the Director of Home Improvement Contractor Registration. You may inquire about contractor registration by writing to the Director at 10 Park Plaza, Room 5170, Boston, MA 02116 or by calling 617-973-8787 or 888-283-3757. • Does the contractor have insurance? Ask the Contractor for his insurance company information so that you can confirm coverage, or ask to see a copy of a "proof of insurance" document. • Know your rights and responsibilities. Read the Important Information on the reverse side of this form and get a copy of the Consumer Guide to the Home Improvement Contractor Law. You may cancel this agreement if it has been signed at a place other than the contractor's normal place of business, provided you notify the contractor in writing at his/her maim office or branch office by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the third business day following the signing of this agreement. Seethe attached notice of cancellation form for an explanation of this right. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACESM Two identical copies of the contract ansa{ be copkied and sig iad. Onc copy ShmW go to the . The on- copy should be kept by the comxactor. eowner's Signature Contractor s Signature Date Date F 4 3N NOTICE OF CANCELLATION YOU MAY CANCEL THIS TRANSACTION, WITHOUT PENALTY OR OBLIGATION, WITHIN THREE BUSINESS DAYS FROM THE ABOVE DATE. IF YOU CANCEL, ANY PROPERTY TRADED IN, ANY PAYMENTS MADE BY YOU UNDER THE CONTRACT OR SALE, AND ANY NEGOTIABLE INSTRUMENTS EXECUTED BY YOU WILL BE RETURNED WITHIN TEN BUSINESS DAYS FOLLOWING RECEIPT BY THE SELLER OF YOU CANCELLATION NOTICE, AND ANY SECURITY INTEREST ARISING OUT OF THE TRANSACTION WILL BE CANCELLED. IF YOU CANCEL, YOU MUST MAKE AVAILABLE TO THE SELLER AT YOUR RESIDENCE, IN SUBSTANTIALLY AS GOOD CONDITION AS WHEN RECEIVED, ANY GOODS DELIVERED TO YOU UNDER THIS CONTRACT OR SALE; OR YOU MAY, IF YOU WISH, COMPLY WITH THE INSTRUCTIONS OF THE SELLER REGARDING THE RETURN SHIPMENT OF THE GOODS AT THE SELLER'S EXPENSE AND RISK. IF YOU DO MAKE THE GOODS AVAILABLE TO THE SELLER AND THE SELLER DOES NOT PICK THEM UP WITHIN TWENTY DAYS OF THE DATE OF CANCELLATION, YOU MAY RETAIN OR DESPOSE OF THE GOODS WITHOUT ANY FURTHER OBLIGATION. IF YOU FAIL TO MAKE THE GOODS AVAILABLE TO THE SELLER, OR IF YOU AGREE TO RETURN THE GOODS TO THE SELLER AND FAIL TO DO SO, THEN YOU REMAIN LIABLE FOR PERFORMANCE OF ALL OBLIGATIONS UNDER THE CONTRACT. TO CANCEL THIS TRANSACTION, MAIL OR DELIVER A SIGNED AND DATED COPY OF THIS CANCELLATION NOTICE OR ANY OTHER WRITTEN NOTICE, OR SEND A TELEGRAM TO [Name of Seller], AT [Address of Seller's Place of Business] NOT LATER THAN MIDNIGHT OF (date). I HEREBY CANCEL THIS TRANSACTION. Date: Buyer's Signature: SLO IMU Jau0rsslww00 tuoi4eJidxA V981(y vw 9mGv3H N 061 XO$ Od - WAflG d IU3 NN3I t £"8S0-S3:asuaotj _..._ _ aam.taadnS uoNina;suoj spiepuelS pue suol;eln6a8 fuippq jo paeo8 A194eS oilgnd;o }uawpedao - sj4asny3esseW ffie �omvn � ,ss a�fionn 0 ce of Consumer Affairs & B CONTRACTOR HOME IMPROVEMENT CONTRA Type. — . Registration: -_ 167338 LLC Expiration: 91-10!4014 D qL ROOFING L'LC d w ti �a KENNETH DUVAL 72 NORTH ST --'—'"—`— NO. READING, MA 01864_ 'J • Undersecretary The Commonwealth of Massachusetts Department of IndustrialAccidents w Office of Investigations M d 1 Congress Street, Suite 100 Boston, MA 02114-2017 swww mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Duval ROOlfng, LLC Address: P.O. Box 637 North Reading, MA 01864 Phone #: 978-664-2557 Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 8 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors Z. ❑ I am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub -contractors have working for me in any capacity. employees and have workers' rNo workers' comm insurance comp. insurance.1 required.] ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t ❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' coma. insurance required.l Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. ❑ Electrical repairs or additions 11. ❑ Plumbing repairs or additions 12. ❑■ Roof repairs 13. ❑ Other *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, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Travelers Policy # or Self -ins. Lic. #: 7PJub-0230N91-14 Expiration Date: 3/11/15 Job Site Address:19 I City/State/Zip: Ll)n f knLkA Attach a copy of the workers' compensation po,16 declaration page (showing the policy number and expiration date). Failure to secure coverage as required under 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 may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby ce0i i udder the pains and penalties of perjury that the information provided above is true qnd correct. Phone #: 978-664-255 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 #: NOTICE EMPLOYEES NOTICE TO EMPLOYEES The Commonwealth of Massachusetts DEPARTMENT OF INDUSTRIAL ACCIDENTS 600 Washington Street, Boston, Massachusetts 02111 617-727-4900 — http://www.mass.gov/dia As required by Massachusetts General Law, Chapter 152, Sections 21, 22 & 30, this will give you notice that I (we) have provided for payment to our injured employees under the above mentioned chapter by insuring with: THE TRAVELERS INSURANCE COMPANIES NAME OF INSURANCE COMPANY P.O. BOX 1450 MIDDLEBORO, MA 02344-1450 ADDRESS OF INSURANCE COMPANY (7PJUB-0230N91 -9-14) 03-11-14 TO 03-11-15 POLICY NUMBER EFFECTIVE DATES GILBERT INS AGCY 137 MAIN ST READING MA 01867 NAME OF INSURANCE AGENT ADDRESS PHONE # a_ 0 DUVAL ROOFING LLC 184 PARK STREET o. NORTH READING MA 01864 EMPLOYER ADDRESS EMPLOYER'S WORKERS COMPENSATION OFFICER (IF ANY) DATE MEDICAL TREATMENT The above named insurer is required in cases of personal injuries arising out of and in the course of employment to furnish adequate and reasonable hospital and medical services in accordance with the provisions of the Workers' Compensation Act. A copy of the First Report of Injury must be given to the injured employee. The employee may select his or her own physician. The reasonable cost of the services provided by the treating physician will be paid by the insurer, if the treatment is necessary and reasonably connected to the work related injury. In cases requiring hospital attention, employees are hereby notified that the insurer has arranged for such attention at the NAME OF HOSPITAL ADDRESS 004315 W20PIG02 TO BE POSTED BY EMPLOYER