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HomeMy WebLinkAboutBuilding Permit #306 - 20 LINCOLN STREET 10/18/2006 TOWN OF NORTH ANDOVER NO R TH APPLICATION FOR PLAN EXAMINATION o�,t�'° quo y0 I ~ A � i .fid Date Pertriit NO: 0 Received Argo Date Issued: CH E IMPORTANT: Ap plicant must complete all items on this page LOCATION aC> )--LWC(:)L-N ST Print PROPERTY OWNEd 1. Print MAP NO.: -70 PARCEL: ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non-Residential ❑ New Building One family ❑Industrial C, Addition ❑Two or more family = Alteration No. of units: Repair, replacement ❑ Assessory Bldg ❑ Commercial ❑ Demolition ❑ Moving(relocation) ❑ Other ❑ Others: ❑ Foundation only DESCRIPTION OF WORK TO BE PREFORMED / REIJo�IA-r�� S W::r I As ER. �S 'C3`I DES=-C�F� pPT�I't�G25N�-P � �ZSTZ�� C�RduP >--IoM ` Identification Please Type or Print Clearly) OWNER: Name: 1,,RT-HW?— �3Rl�el� P.N�ER2C.AtJ -c(ZAZN�IJ�� Phone �l1`b $l5 3139 I Address: 102 �LEIJh1 ST ® 1�.W CLF ` MP• OlQ,L13 CONTRACTOR Name:TdD'D 1\N CMC-- M_u-tE� cess Phone: Address: GSA '� ST � �,�Z�Ac, MA• ���C� z Supervisor's Construction License: CS4 O(o9 L40ta Exp. Date: Home Improvement License: !-1�L- ' Exp. Date: 2-- ARCH ITECT/ENGIN EER --ARCHITECT/ENGINEER DESIGN Pp.CZ�CNEQSN�P Name: Phone: Address:S5 64ZOC-K.-oN b�E -* W'`JER\-\7--" �" Reg. No. LA FEE SCHEDULE:BULDING PE AJIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost x12.00=FEE:$ �� ' Check No.: ��-�— Receipt No.: Page lof4 TYPE OF SEWERAGE DISPOSAL Swimming Pools 11Tanning/Massage/Body Art ❑ g Public Sewer Well 1-1Tobacco Sales ❑ Food Packaging/Sales ❑ Permanent Dumpster on Site ElPrivate(septic tank,etc. El Permanent Meter location.to project NOTE: Persons contracting with unregi tered contractors do not have access to the guarantyfund Signature of Agent/OwnerKSignature of contractor Plans Submitted ❑ Plans W ' ed ❑ ertified Plot Plan Stamped Plans THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF-U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ ❑Water Shed Special Permit ❑ Site Plan Special Permit ❑ Other COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ o 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 Temp Dumpster on site yes no Fire Department signature/date t�T E' D Ew�o 2F►�v ca �A�i..E y �3y TaDa M Building Setback Front Yard Side Yard Rear Yard Required Provided Required Provides Required Provided Dimension Number of Stories: Total square feet of floor area,based on Exterior dimensions. Total land area,sq. ft.: NOTES and DATA—(For department use) f i I �I Page 3 44 Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 Created JMC.Jan'006 I i I 7 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing g, Siding, Interior Rehabilitation Permits I ❑ 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 Addition Or Decks ❑ Building Permit Application ❑ 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) 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 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:INSPECI'IONA1.SERVICES DEPARTMENT:11PFORb105 P:we 4 of 4 Location �- ► hCy � v� S�` ra F No. Q Date 10-1k rpRTly TOWN OF NORTH ANDOVER 0 Certificate of Occupancy $ !i •►CNusttA Building/Frame Permit Fee $ 136 Foundation Permit Fee $ Ik` Other Permit Fee $ TOTAL $ I Check # � q 9700 Building Inspector �•i'�^a��� "�..nSse^trs�'t'��T'ib'�'i.."1� •.._._.r.S:s4i::`��'r:L'e"xs..-.�-^5- - —"'� . .• � c+s�u�D�o�.�iaaaor6ua�- toll"*Rl • �o�rd P�Bulfo�ng Regatatioas�e�$tupiYsrds [ifS6 ;lM7 tiQV i{6ENT CONTMTOR 1 007 OWL TODOO TODt3:t4�GFt1 ' 108 WEs ,', ; ' MgRRit; �C;•tA.01860: Admi�}Jrst., I The Commonwealth of Massachusetts I .Department of Industrial Accidents Office of investigations . 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information A - Please Print Legibly Name (Business/Organizatiowlndividual): Moyp Address: City/State/Zip: 1:,RK-21AAG VA, Phone #: �`��� G?:,o cK,42_ Are you an employer? Check the-appropriate box: Type of project(re aired )= 1..V I am a employer with -7 4. ❑ I am a general contractor and 1 6_ ❑ New construction employees (full and/or part-time).* have hired the sub-contractors 2. El I am a sole proprietor or partner- listed on the attached sheet. # temodelvag ship and have no employees These sub-contractors have 8. © Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers'.comp. insurance . 5. ❑ We are a corporation and its required.] officers have.exercised their 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself CN o workers' comp. c. 1.52,,§1(4), and we have no 12.❑ Roof repairs Y P insurance required.] t 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: #Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such xContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I ant an employer that is providing workers'compensation insurance for my employees. Below is the.policy andjob site information. Insurance Company Name:. Q CAVI 'IMTrERKA 1 1.04A L_ GRW P Policy#or elf-ins.L ic. # Expiration Date.� 0 I Job Site Address:2Q L11�COLN City/State/Zip:ORZTk APbOyEV, Po,,, 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 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 insuzanc,ecoverage.verificatiorL I do hereby certify under the pair and penalties of perjury that the information provided above is true and correct. Si ature: Date: �7—CJ'-< (:v, Phone#: (17Z S60 ct(®q 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 Ofhnr ACORD DATE(MM/DD/YYYY) W. CERTIFICATE OF LIABILITY INSURANCE 10/16/2006 PRODUCER Phone: 978.346-8761 Fax: 978-346.9620 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION JOURNEAY INSURANCE AGENCY INC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 8 WEST MAIN STREET HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR MERRIMAC MA 01860 ALTER THE COVERAGE AFFORDED BY THLZPJJCIES BELOW. INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: National Grange Mutual Insurance Co 14788 TODD MICHEL CONSTRUCTION,LLC INSURER B: American International Group C/O TODD MICHEL INSURER C: 109 WEST MAIN STREET MERRIMAC MA 01860 INSURER D: INSURER E: COVERAGES 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 ALLTHE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'LTYPE OF INSURANCE POLICY NUMBER POLICY EFFECTNE POLICY EXPIRATION LIMITS LTR INSR DATE MM/DD DATE MWDD GENERAL LIABILITY MSB92418 04/01/06 04/01/07 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES(Ea occurence) $ 300,000 CLAIMS MADE 7 OCCUR MED.EXP(Any one person) $ 5,000 A PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG. $ 2,000,000 - POLICY JECPROT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $- HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) I PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY $ AUTO ONLY-EA ACCIDENT ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR F�CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WC STATLL WORKERS COMPENSATION AND WC893-83-95 02/25/06 02/25/07 TORY LIMITS OTHER EMPLOYERS'LIABILITY ANY PROPRIETOPJPARTNERIEXECUTNE E.L.EACH ACCIDENT $ 500,000 B OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 500,000 H yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 OTHER: DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE TOWN HALL EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO NORTH ANDOVER,MA. DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE 9 Attention: Derek Journeay ACORD 25(2001/08) Certificate# 1274 ©ACORD CORPORATION 1988 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 hue, 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 t f the or the occupant o who resides therein, Ilia ho use havin not more than three apartments and op owner of dwelling g . dwelling house of another who employs persons to do maintenance,constriction 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." n hall withhold the issuance or also states that eve agency s MGL chapter 152,§25C(6) "every state or local licensing age 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." I 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 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 obtam 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 lime. City or Town Officials i Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom i 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 perrnittlicense number which will be used as a reference-►umber. In addition, an applicant that must submit multiple permit/liceiise 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 you;cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: Tile Commonwealth of Massachusetts Department of Industrial Accidents Office of investigations 600 Washington Street Boston, MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE T7-- 44 A 17717-77,10 U-FACTOR AND R-VALUE Sim Hr �NOtJ'.3TR/ES Harvey Manufactured >® Windows and Doors WHOLESALE PRICING - U-Factor in accordance with NFRC-100-97 - Based on residential sizes - U-Factor and R Value are subject to change without notice •Whole window values Harvey vinyl windows with Low-E/Argon andrajThl ty double hung windows with Low-EWrypton qualify for the ENERGY STA gram throughout the U.S" utatad' Low-e Low-E/Argon' U-Faiue U*actor 11-Value U-Factor R Value VINYL WINDOWS a Classic Double Hung(Welded Sash&Frame) 0.49 . 2.04 0.36, 2.78 0.33 3.03 Classic Acoustical Double Hung STC40 0.33 3.03 0.25 - 4.00 0.24 4.17 Signature Double Hung(Mechanical) 0.50 2.00 0.37 .70 0.34 2..94 i Slimfine Double Hung(Welded Sash&Frame) 0.50 2.00 0.37 2.70 0.33 3.03 Slimiine Single Hung(Welded Sash&Frame) 0.50 2.00 0.37 2.70 0.33 3.03 Vinyl Casement/Awning 0.47 2.13 0.34 2.94 0.31 3.23 Vinyl Casement/Awning and Thermal Panel 0.32 3.13 0.26 3.85 0.25 4.00 i Vinyl Designer Shapes 0.49 2.04 0.33 3.03 0.29 3.45 Vinyl Hopper 0.47 2.13 0.35 2.86 0.32 3.13 Vinyl Picture Window 0. ;i . ti213 0.32 3.13 0.28 3.57 Vinyl Roller-2 Lite and 3 Lite 0. 700 0.38 2.63 0.35 2.86 ...; V_INYL NEW CONSTRUCTION WINDOWS Clear nsulated Law-E- tow-etargoW 1.11-Factor R-Value U-Factor R-Value U-Factor R-Value Vicon Double Hung(Welded Sash&Frame) 0.50 2.00 0.37 2.70 0.33 3.03 Vicon Single Hung(Welded Sash&Frame) 0.50 2.00 0.37 2.70 0.33 3.03 Vicon Classic Double Hung(Welded Sash&Frame) 0.49 2.04 0.36 2.78 0.33 3.03 Vicon CasemenUAwning 0.47 2.13 0.34 2.94 0.31 3.23 Vicon Picture Window 0.47 2.13 0.32 3.13 0.28 3.57 Vicon Designer Shapes 0.49 2.04 0.32 3.13 0.29 3.45 Vicon Hopper 0.47 2.13 0.35 2.86 0.32 3.13 Temp.Clear Temp.Low-E Temp.Low-ElArgon PATIO DOOR 1,11-Factor R Value 1.1-Factor R Value 1,11-Factor R-Value Harvey Solid Vinyl Patio Door(standard sizes) 0.52.00 0.37 2.70 0.34 2.94 Low-FJKrypton- F WOOD WINDOWS RValue L11-Factor R•Value Majesty Double Hung `' A NIA 0.35 2.86 Majesty Fixed Casement(PW) 36 2.78 NIA NIA Majesty Casement/Awning 0.41 2.44 NIA N/A Majesty Picture Window(DH) 0.35 2.86 a N/A N/A "The use of tempered Law E glass may effect-ENERGY STAR qualificatjon in your region. E.1-Factor and R-Value are sub'ect to change without notice. Pricing and information arg subject to change without notice&may vary from region to region. For current pricing, tail your local branch or visit www.harveyindcom. 51 Effective 3/20/06 I TODD MICHEL CONSTRUCTION, LLC 109 WEST MAIN STREET MERRIMAC, MA 01860 (978) 346-0464 CS LICENSE#069490 HIC LICENSE# 138046 PROPOSAL SUBMITTED TO: American Training,Inc. DATE: July 10, 2006 ADDRESS: 20 Lincoln Street GOOD UNTIL: 60 Days North Andover, MA START DATE: TBD PHONE: END DATE: TBD I Thank you for allowing us to quote your project. We propose to furnish all material and perform all labor necessary to complete the following: PROJECT DESCRIPTION: Materials and labor for the renovations at 20 Lincoln Street,North Andover, MA as per the plans and specifications dated 04/04/2005 drawn by Design Partnership Architects. OTHER SERVICES: BUILDING PERMIT APPLICABLE INSURANCES REMOVAL OF DEBRIS PRICE: Todd Michel Construction, LLC,agrees to do all work as described above for a total price of 61,298.00(Sixty-OneThousand, Two Hundred Ninety-Eight and 00/100 Dollars). Payments to be made as follows: As per Contractor's Requisition form Please note: IRS Form W-9 (Certification of Taxpayer ID Number)will be furnished by Contractor with first billing or by request at any time following the signing of this contract. Contractor's signature: Date: aU-y 4o- tab 6 ACCEPTANCE OF PROPOSAL Timely decisions and selection of any products and fixtures that are the responsibility of the Owner must be provided in a timeframe reasonable to the progression of the job. Todd Michel Construction, LLC will work with the Owners to provide the highest quality products within the schedule and budget of the project,but is not responsible for job delays caused by Owners' failure to provide specific instructions,products,or product selections. 1 To the extent permitted by law, if the Owners are in default due to failure to pay according to the Disbursement Schedule,the Owners are responsible for any collection costs,attorneys' fees, court costs, and all other expenses of enforcing the rights of Todd Michel Construction,LLC under this agreement. Note: Any hazardous materials uncovered during demolition and required to be removed by licensed professionals will require additional fees not included in this contract. The above price, specifications,and conditions are satisfactory and are hereby accepted. Todd Michel Construction,LLC, is authorized to do the work as specified Payment will be made as stated above. Owner's signature: L�C� ate: o-/(j--o W OWNER'S RIGHTS AND BENEFITS: The owner may have 3- day cancellation rights under one or more of Mass. Gen. Law Chap. 93, Sec.48; Chap.140 D, Sec. 10;and Chap. 255D, Sec. 14. The owner is entitled to certain rights and benefits under Mass. Gen. Law Chap. 142A. I 2 F tAORTfy ovm Of _ No. dover, Mass., LA COCMICKEWICK ATED `s BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System • • BUILDING INSPECTOR THIS CERTIFIES THAT........... ......................�....�.. ................. . . .t�N.gh!I.TM !IIIl.�. ""' "" Foundation has permission to erect........................................ buildings on... L... �. �. Rough to be occupied as K#4* .... ......Jw.�................ .. � ........................................................ Chimney provided that the person accept ng permit shall in every respect conform to the terms of the appiication 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 1107doov PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR CTOR UNLESS CONSTRU L� Rough .... ........t .. Service UILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises .— Rough Do Not Remove Final No Lathing or Dry Wall To BeDone FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE '� Smoke Det.