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HomeMy WebLinkAboutBuilding Permit #254-11 - 20 MORNINGSIDE LANE 9/24/2010 BUILDING-PERMIT of TOWN OF NORTH ANDOVER 3z yEtT 164° APPLICATION FOR PLAN EXAMINATION Permit NO--d5y Date Received g/? V/?O/U - Date Issued: i �SSacHusE` IMPORTANT:Applicant must complete all items on this page Ion _ _'''.:';A:z_�,_:i�1:?"_ I�_.�f_�- T""1+- - at9v - - - - 1'{.,._ "1r.":':r= - ;1r•^}"C-r' ::'.�:i,8_ _ ..'1 ..< c`:Y:i - ,?7. - 'l, Eli -"`:-l._ "SYS _ _ :�::�'..w..,r.,.,.e-! _<=.+'ice ^` ,�• " .,�.><...y a:}. i2-n "a;S; .. .:_.• '-',n-ylY:w. � �-•r.. 3•'- t,.r._}.: _ �:5.'. 7/�n - 4• _ ".f `nif :_. 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"_�rissL�r;,.a/t'-a:°:d:':Z:.�..;• ' �kr±er�cY'T;.T.:e�v, -�.vrl-�k��;�_?rS'Ctl.-^?{ti��t 4�G?�.v:'-'-'..�:.r9.,_..g°rleii,'�x•ri a:r.., i�NF; Fx,4!te,e��.h�]:;':'c ..z_.'f_... _UTi_:-rrPe%kc;r+;,9v_-,,.`.:•:r•'��,.:-+,+3�ri�".`.�.',_:•Ei::^_x r - '.e�,�y:,�r�tac'�ti�'' .:,K;1 ��__ �' DESCRIPTION�O� fit✓ WORK T BE PREFORMED: �' Identification PIease Type or Print Clearly) OWNER: Name: Phone: Address: 1-1e)Y " i de ,[_A' _'-,-ciL :�d'=f"' .;^'i'•" 2'^ Z:w '°%n:� aeys;:.'�,•, iaiLti-.moi=-;:r;�="vr;.:e• _ _ u,4 .1 n�. w d sz�sr .�Fa�s.s z� -':mit=`_'_ _,t'c.• - - - �=T::G_��-•{�a;'hi'-=' ,;:i:r'n.. •n,-+>;.- S _Fr. :��J:1.�;•xihr�':' -�iT°-'-ra..:x-x__ __ �>r'�'=S: �` >.�u, -a5;,�?-i;� L_S!i ,.L� u.•�,���rS.``•1 _ .h„ �_,.�:.v��,rS�,. - nr;�-:'T!-�. 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'a��i�,ia"t�Rl �- ea .:y=..a,: b'`_�e r�`;'Srs.•-2.-r's't?L_i:..r'c� .,s- "- 'I. -::v::�,;:1.#m.�c - ups_= T'µn'.•�.:4rt!-.. 'aa•-�•�;?-. - Y;- .a. - - - •r'�L�: _ �rr•� sir.^•':--�z 1,;y„2.'.�T ,,,w....;�-._.r,� ;' ���3��'I-a'S,T.$3tU- A" - =�.r�.r•:�'� }�r� 'r=`:�... �-�r. =t� �-.�:.-.;,.___ r:�.�>�:•: �:?r...:..:� �;::�r:r.�. -•�'--�,�- �TA's�3.'_.T�1� 1���1�5��,.�_ ,� :�-r ��__ .i ��.e�<_'- .�•.•:'a�•,-..`.T����,: -. •. ,�-�".-=� ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.'BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$425.00 PER S.F. Total Project Cost: FEE: ''- Check No.: Receipt No.: 9 3• t NOTE: Persons contracting with unregistered contractors do not have ace e s to the a fund �•• �n��i%r�e fwa �:� Oaen '`� -=::;::n.:,T�,r�_.__�:-��.r`Y: :�-^ --.� - - --.�:..�= �°-- - .-..�.�_r ..r...._.:.,s..,_.v �'••= - - - -•�5�gna::�a�e�.o��co��•r� `�¢=��`�'�tfi; �i�� .� i I Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public S e e . 7' r 7Tanning(Massage-/BodySwimming Pools WeII Food Packaging/Sales Private(septic tank,etc. THE FOLLOWING SECTIONS.FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED- PLANNING &.DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature (DiOIVI10 N TS t . Tr� 1a HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals'.'Variance, Petition No: Zoning Decisionfreceipt submitted yes Planniri.,r,- Board Decision: Comments Conservation Decision: Comments Wafer& Sewer Connectio[7/Stgrtature&L}ate Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street {{ - -E, -- P.y;._ _ _ _`;.\i: "; __-Yx._-•,'r r p -;(pct: •..ia.'_ __ _ __ _ _ Esll .4T. :.v`�..-::..":.•;.... -T .rte;. >.D,�ra-i.h - = - - -:_-��::.;..�:�_:=-•z� -- :3 .�:;sE-=• -- -:=if,: �:s,.. ;r,,�;--::,;�__ - ;:ems'_ -,x:- :,� -- .��.::-�. _ rm Lr _ -fit$ - - _ -- -- - - — .d f=12 7 3 - - �•n.�ti — s�..'.^.Y.�.:z~+A_ --- :fa:.:' ��:.. - - - .e1•. _ lsh�•u.e...-+.-a l_._�_n��-">'=Y' ':5.. }�f;a _ - _ -.,rte•.h:. yt<:. •:^-Z:-:>:F`+- ;.}_`:wry _ - - 4,� - 'r - - 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 NOTES and DATA— (For department use) ❑ Notified for pickup - Date Doc_Building Permit Revised 2010 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 o 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 a 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) ❑ IVI "'ass 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 ❑ Mv. ►Llr�rniuil r rPoiivei I'll r ❑ 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 must be submitted with the-building application Doc:Building Permit Revised 2008 p C Location, /17U�[ �'.:r' %' nrr No. "' Date NORTH TOWN OF NORTH ANDOVER O:••.ao ,a 1�.0 9 1� a ; ; Certificate of Occupancy $ s�CHUst<� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # �0 2341x4 Building Inspector ORTH Town of And 0 No. -o dower, Mass., o LAK I� COCMICMEWICK %d AOA?ATE D `s U BOARD OF HEALTH PERMIT T D . Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT....... ... .......... ...................:................... ........................... . � � Foundation has permission to erect... g ...Q1. ..�.... g ..................................... b ildin s on ...... �a1I.��...5.... ..... Rough .. .... ...... 6 to be occupied as............ 'r . . . .. . . . . .. .i14 ...... ......................�. Chimney provided that the person accept ng this permit shall in every res t conform to the terms of t application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Altera on and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final 81doom PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTR N STARTS ELECTRICAL INSPECTOR Rough .... .. Service BUILDING TOR Final Occupancy Permit Required t0 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. Butner Street No. SEE REVERSE SIDE Smoke Det. i - Massachusetts- Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License License: CS 103628 Restricted to: 00 ELVIN ESMURRIA 86 JONES RD jai!'REVERE, MA 02151 —=::r-!=L '` Expiration: 7/10/2013 Commissioner Tr#: 103628 1 ea e ulatiou wn 'Business R g p �"'�� er Affairs S, Oq{ice oS Consum ENT CONTRACTOR -Type: 1 . HOPR�VEM ME IMCOrp9ratio: '159797 . private _ ; Registration:,•':; 5129/2012 i = = Expiration RYAN`AND SON ROOFING zNC RYAN' g PETER Undersecretary 13 SUNSET p1880.r= Y The Commonwealth of Massachusetts Department oflndustrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print'Leizibly Name (Business/Organization/Individual): RVA't at.A_ so,.. VC.D��� � < Address: 1 3 Sj c4 SA 104,z- City/State/zip: ASCity/State/Zip: tn9k�e- �,��. �,� a Phone#: �2f 7-� 71 �6S-6 Are you an employer?Check the appropriate box: Type of project(required): 1.® I am a employer with j 4. ❑ I am a general contractor and 1 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling 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 10.❑ Electrical repairs or additions required.] officers have exercised their 3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself.[No workers'comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.]i employees. [No workers' 13.PrOther ao cam' comp.insurance required.] *Any applicant that checks box#I 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. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors acid their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy andjob site information. Insurance Company Name:i t.��a ,�v►Su"A+,r Q A!?) C t4 Policy#or Self-ins. Lie.#: Z a.0 3 6 ISr Expiration Date: Job Site Address: 30 d`to�u�i�►t S Q_ Ln City/State/Zip: R, • 4".Gyev< .,M 4 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 fonn 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 certify nd r the pains and penalties of peljui that the information provided above is true and correct.' Signature: Date: 1?./41 q /It,) Phone#: ? T -21 T U 5 6 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 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-contractor(s)name(s),addresses)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 confinnation 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 pen-nit 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 sur&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 pennit/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 pen-nits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or pen-nit 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: `. The 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 Fax#617-727-7749 Revised 5-26-05 wvvw.mass.govldia .y tvatid-Sons R ° FER Proposal www.R_VanAndSonRoofinji.com RyanandSonRoofing@yahoo.com Wakefield,MA 01880 (617)571-9056 Date:9/21/10 Submitted To: Job Location: Robert Howard Same 20 Morningside Ln North Andover, Ma We are pleased to hereby submit this proposal to furnish materials and labor,completely in accordance with the below specifications: (Additional charges may apply for any changes not included below in proposal either by request of owner, or if Ryan and Son Roofing finds unforeseen circumstances that will affect the performance, quality or integrity of this job). In the event that legal action is taken to enforce any provision of this agreement, the prevailing party shall be entitled to all its reasonable costs, including reasonable in-house or outside attorneys fees. Not responsible for debris in attic. This Proposal is to: Perform Work at Above address Strip roof down to barewood * Any unforeseen layers over 2 Layers will be an additional $ 50.00 per sq Check for rotted wood, if needed, we will replace up to one sheet of plywood. Anything additional will be $35.00 ea 4x8 sheet. Nail down any loose wood r� Install Ice &Water shield first 6' (or 2 rows) and in all valleys elm Install 301b felt paper to remainder of roof Install all new 8" white drip edge on perimeter 8& step flashing where needed Install 30-yr architect shingles, color of your choice Install Ridge vent, Hip and Ridge Cap to match Reseal Chimney 4- Will cover area with tarps to minimize debris 01-- Properly flash any protrusions, if any on roof Use all new pipe flanges for pipes, if any on roof o6 Remove debris related to work r NOTE: Please cover any belongings in attic, as it could get dusty. Payment Terms made as follows: This includes: Labor& Materials Original Price: $ 6,770 Dumpster/Removal Cost: Included Total Cost:(If no changes) $ 6,770 1st Payment Due Upon Scheduling: $ 170 2"a and Last payment upon completion:$6,600 Respectfully Sub►>}�t'toIt by: (Make checks payable to Peter Ryan) Accepted by: All work is 100% Guaranteed for S years on all craftsmanship,all other Warrantees through the manufacturer. Thank You for letting us serve you!!!Ryan and Son Roofing,Inc.is Fully Licensed(#159797)&Insured TE(MMIDDIYYYY) A� CERTIFICATE OF LIABILITY INSURANCE DA 07/22/10 PRODUCER 781-395-3030 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Pasciuto Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 9 y HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 84 High Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Medford, Ma 02155 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A:Tower Group Ryan and Son Roofing Inc. INSURER B: AIG 13 Sunset Drive INSURER C: Wakefield MA 01880 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 ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION-LI& OF INSURANCE DATE(MMIDDhM-n DATE(MMIDD!YYYYI LIMBS A GENERAL LIABILITY B203169745 05/12/10 05/12/11 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $ CLAIMS MADE W OCCUR MED FRCP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1,000,000 JFCT F-1 XXI POLICY PRO- LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY NON-OWNEDAUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ F I ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR F—I CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ B WORKERS COMPENSATION 0405025 05/12/10 05/12/11 XX WC STATU-LIM OTH- T"YAND EMPLOYERS'LIABILITY YIN No exclusions for owner ANY PROPRIETOR/PARTNER/EXECUTNE E.L.EACH ACCIDENT $ 100,000 OFFICERIMEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEO$ 500,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT 1$ 100,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANYOF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Jameson Mathews DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 1 O DAYS WRITTEN 104 Clark Ave NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Chelsea, Ma 02150 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2009/01) ©1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD