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Home My WebLink AboutBuilding Permit #945-2016 - 203 BOXFORD STREET 3/7/2016V (�� y II -A4 � Permit NO: 'r Date Issued: 17 1 "'1 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received 'ANT: Ai)Dlicant must comDlete all items on this IL ACHU LOCATION y-9()3 54 trj� 404i-wr-MA NOS - PROPERTY OWNER Print �-� 6A a I'\ Print MAP NO: PARCEL ZONING DISTRICT-- Historic District yes no Machine Shop Village yes_rno TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building �KZne family 0 Addition El Two or more family El Industrial 11 Alteration No. of units: 0 Commercial pR Repair, replacement 0 Assessory Bldg El Others: El Demolition [I Other 11 Septic 0 Well [I Floodplain 11 Wetlands El Watershed District 0 Water/Sewer Identification Please Type or Print Clearly) '0/1 OWNER: Name: 10h A C-7/1 /-/)/ Phone: Address CONTRACTOR Name: 61 'TOMOI,''Icl 7k� �6) Phone: Address: !��-6 Supervisor's Construction License: Exp. Date: Home Improvement License: i S-&c(�6 Exp. Date: 3/1 ARCH ITECT/ENGI NEER 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: $ rt tft]�= (90 — FEE: $ Check No.: Z's x -L- Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund $i66 at ure- 6iA66n-V(5w-nk1f(--.,,)- Signature of contract "-t Permit No#: Date Issued: BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received IMPORTANT: must complete all items on this LOCATION Print PROPERTY OWNE:;,' Print 100 Year Structure yes MAP -PARCEL:- ZONING DISTRICT: Historic District yes Machine Shop Village yes 0 no no no TYPE OF IMPROVEMENT USE --PROPOSED Residential Non- Residential 0 New Building El One family [I Industrial El Addition El Two or more family El Alteration No. of units: 0 Commercial 0 Others: 0 Repair, replacement 0 Assessory Bldg 0 Demolition M -t.,- Or WIN 0 Other WWI .0 I T n=0r1D1DT1r%K1ni: WnPK Tn RF PERFORMED: Identirication - Please Type or Print ClearlY Phone: OWNER: Name: Address: Contractor Name: Phone: Email: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. -Date: Phone: ARCH ITECTIENGI NEER Address: Reg. No. FEE SCHEDULE. BULDING PERMIT.'$12.00 PER $1000.00 OF THE TOTAL ESTIMATED COSTBASED ON $125.00 PER S.F. Total Project Cost: $ FEE: $ Receipt No.: Check No.: NOTE: Persons contracting with unregistered contractors do not have access 09 me guarantyfund I L F_ Location 2- c) I No. -94'::�— 2c) ��, C -) -L heck ,, C, k L; Date TOWN OF NORTH ANDOVER Certificate of Occupancy $- Building/Frame Permit Fee Foundation Permit Fee Other Permit Fee TOTAL Building Inspector Plans Submitted Plans Waived [I Pertified Plot PlanT] �famped Plans F1 TYPE OF SEWERAGE DIS�-OSAL Public Sewer Tanning/Massage[Body Art D SwimmilgP001s well Tobacco Sales F1 Food Packaging/Sales 0 Private (septic tank etc. El Permanent Dumpster on Site El THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM I PLANNING & DEVELOPMENT COMMENTS Reviewed On Signature, CONSERVATION Reviewed on Si gnature COMMENTS HEALTH COMMENTS Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: -7 oning Decisionfreceipt submitted yes _ Planning Board Decision: Comments Conservation Decision: t' Comments Water & Sewer Connectionis Driveway Permit DPW Town Engineer: Signature: t&ORT. 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 Electrical Inspector requires approval of DANGER ZONE LITERATURE: Yes M G L C h a p t e—,—1 —66—S—e c —tj-0 n —1W " No an; � Min -$10 ()-$1 0-00—fi—ne---- DOC.Building Pen -nit 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, Siding5 Interior Rehabilitation Permits 4, Building Permit Application 4, Workers Comp Affidavit , Photo Copy Of H.I.C. And/Or C.S.L. Licenses 4, 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 4, Building Permit Application �6 Certified Surveyed Plot Plan 14, Workers Comp Affidavit 4,, Photo Copy of H.I.C. And C.S.L. Licenses copy Of Contract sed Work With Sprinkler Plan And Floor/Cross Section/Elevation Plan Of Propo Hydraulic Calculations (if Applicable) Mass check Energy Compliance Report (if Applicable) 4, - Eng . in . eer . ing A , ff - i . d . avi . t . s - for - E - ng - ineered products OTE: Ail 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 HJ.C. And C.S.L. Licenses Workers Comp Affidavit Two Sets of Building Plans (One o Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (if Applicable) Copy of Contract 66 2012 IECC Energy code 4� Engineering Affidavits for Engineered products :)TE: 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 Doe: Building Permit Revised 2014 CN rA rA < 0 0 co cu j_- u -a 0 0 E CL a) V) 0 u LLI z z n co .2 _0 c :3 0 LL to :3 0 E = u Cc 0 0 u LLI z D -i -C uo =3 o -Fa Lj- 0 LU z u LU tio 0 Ln c U- 0 LLI Ln z bD =3 0 a .— U- z LLI ui LU CU =) co 6 W t5 (n cu cu 0 E V) do :7 L E L_ 4) CL Ln U) .2 cc 'S tm ca 0 0 N CD 0 z 0 P 5-W os. 0 uj CL co Z CD Z C3 _j M CO cf) LU CL U) x z LLJ 0 U) Cf) uj LU —j a- z 0 z 55 0 E 0 z 0 a. 0 0 0 CL w w S.: 0 0 0 0 o CL CL M< E 0 Z CL U) L r_ C 0 cc Cc 0 cc CD cc t E E co VVE 00 CL Cc cn a) 0 r > M 4: :4) U) 0) > cn tm .:=,.o 0 0 -0 :2 CL 0 > 0 CL (D C.L w C-) 0 cc 0 4) 0 a E- cc -0 0 CO) CL -a) C'm 0 .2 0 u) r 0-M E (D 0 CD :2 CL (D > cc 0 0 -W CL 0 0 E L_ 4) CL Ln U) .2 cc 'S tm ca 0 0 N CD 0 z 0 P 5-W os. 0 uj CL co Z CD Z C3 _j M CO cf) LU CL U) x z LLJ 0 U) Cf) uj LU —j a- z 0 z 55 0 E 0 z 0 a. 0 0 0 CL w w S.: 0 0 0 0 o CL CL M< E 0 Z CL U) Serving Greater Boston for Over 25 Years! HALLMARK Dave Tomolillo HAUMARK HOMES REMODELING CSL#:064063 HIC#:158936 Standards & Quality are out Priority! SolarCity Quote — Re -Roof February 25, 2016 John Gorman 203 Boxford St North Andover, MA 01845 (508) 265-7695 jjgorman2l@verizon.net Roofing Specification: MP1 & MP2 Only-. Remove old comp shingles down to the existing roof sheathing Remove all nails and replace up to 32 square ft. of plywood, if needed N Additional plywood will be charged at $55.00 per sheet Apply 6'of Water Shield along the lower eaves Apply 3'of Water Shield along the valleys Install new vent pipe water diverters where needed Apply 15 lb. felt underlayment as protective base Install 8" aluminum drip edge along entire roofline perimeter Includes 57'] color matching caps Includes 2 ] 12" roof vents Removal of roofing debris by dumpster Total number of roof squares [ 11 ] Owens CorningT" TruDefinition@ Duration@ 30 -year Architectural shingles. Providing all Insurances, Licenses and Permits Materials and Labor: $4840.00 Permits & Admin: $120.00 1: $4960.0 Hallmark Homes Associates, Inc. * P.O. Box 885, Medford, MA 02155 0 (781) 838-0789 * www.HallmarkHomesRemodeling.com ter 00sto" for over 2S Years! Serving Grea Dave -romobllo VIIC#. HALLMARK CSL*1'064063 .11-;8936 ,,t% 14t,%fr% St, 110p, I I'M. Quality are out PrIorityl OWNER'S AUTHORIZATION FORM For Building Permit Application(s) - ates, Inc - form is to provide Hallmark liomes Assoc' - The sole purpose of this from the Owner to file Building Pernlit with the necessary permission as agreed upon between the Owner and Applicati0n(s) for such Project work the Owner's Authorized Company and its designated subcontractOrs- Fmnt Of House mpi Hallmark Homes Associates, Inc. * P.O. Box 885, Medford, MA 02155 0 (781) 838-0789 - www.HallmarkHomesRemodeling.com 71e Comnionwealth of Massachusetts D2 Departinent ofIndustrialAccidents I Congress Street, Suite 100 twl Boston, MA 02114-2017 www.mass.govIdia Workers' Compensation Insurance Affidavit: BuflderstContractors/Electricians/Plumbers- TO BE FTLED WITII THE PERWITING AUTHORM. . Apiplicant Information Please Print Le6b Name (Business/orgar&aflon/Individual): Hallmark Homes Associates, Inc. Address: 56 Wilson Street city/state/zip: Medford, MA 02155 Phone#: (781) 838-0789 An you an employer9 Check the appropriate box: Type of project (required): I -[Z I am a employer with --?--eWfoyee, (full and/or pt-tm.).- 7. New construction 2. 1 am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity. (No workers' comp. insurance required.) 9. El Demolition 3. 1 am a homeowner doing an work myself. [No worker . s, comp. insurance required.] t 10E] Building addition 4. 1 am' a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers' compensation insurance or am sole 1 IJ -1 Electrical repairs or additions . . with no employees. 12.E] Plumbing repairs or additions 5.n I am a general contractor and I have hired the sub -contractors listed on the attached sheet. 13. Roof repairs These sub-contracturs have employees and have workers' comp insurance.: 6.n We are a corporation and its officers have.exercised their right of exemption per MGL c. 14. Other 152, § 1(4), and we have no employees. [No workers' oomp. 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 now affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-coniracturs and state whether or not those entities have employees. If the sub-oontractors have employees, they must provide their workers' comp. policy number lam an employer that isprovhfing workers' conWnsadon Insurancefor my enVloyees. Below Is thepollcy andiob site Informadom Insurance company Name. The Travelers Policy #or Self -ins. Lic. #: 6KUB-5B29684-3-14 ExpirationDate: 03/17/2016 Job Site Address L r4 City/state/zip: A-4 4V�r 12V9 0 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 statement may be forwarded to the Office of Investigations of the DIA for insurance I do hereby cerflft un#r the pa#ts andpiNaZfes ofperjury that the information provided above Is true and correct Phone #: (781) 838-0789 Offidal use oni ,y. Do not write in this area, to be conVieted by city or town official City or Town: Permit/License # 9/17/2015 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#: CERTIFICATE OF LIABILITY INSURANCE (MMIDDIYYYY) 17�/16/2015 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 tights to the certificate holder in lieu of such endorsement(s). PRODUCER Peter A. Rossetti Ins. Agcy. 436 Lincoln Avenue CONTACT -NAME: Peter A. Rossetti Ins. Agey- PH �NC 1FAX _fAIC No. E,,.. 781-233-1855 AIC. No): 781-231-3752 E-MAIL ADDRESS: pnickerson@rosseftiinsurance.com Saugus, MA 01906 Peter A. Rossetti Ins. Agcy. INSURER(S) AFFORDI G COVERAGE NAIC # INSURER A: Western World EACH OCCURRENCE $ 1,000,000 INSURED Hallmark Homes Associates Inc INSURER B: Pilgrim Insurance PO Box 885 Medford, MA 02155 INSURER C: Travelers -GENERAL AGGREGATE S 2,000,000 PRODUCTS - COMPIOP AGG $ 2,000,000 INSURER 0: INSURER E: AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS S NON -OWNED X HIRED AUTO AUTOS 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 LTR TYPE OF INSURANCE ADDL INSO SUBR WVO POLICY NUMBER POLICY EFF (MMIDDfYYYY) POLICY EXP (MMIDDfYYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY r_V_1 CLAIMS -MADE OCCUR NPP1349917 06111/2015 06111/2016 EACH OCCURRENCE $ 1,000,000 -U) PREMISES (Ea occurrence) $ 50,000 MED EXP (Any one person) $ 1,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO. F-1 LOC OTHER: 0 JECT -GENERAL AGGREGATE S 2,000,000 PRODUCTS - COMPIOP AGG $ 2,000,000 Emp Ben. $ NA B AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS S NON -OWNED X HIRED AUTO AUTOS PRCOOOOIO01303 04/2312015 04/2312016 COMBINED SINGLE LIMIT $ 1,000,000 (Ea a ident) BODILY INJURY (Per person) S BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAWS -MADE EACH OCCURRENCE $ AGGREGATE $ IDE I I RETENTIONS $ C WORKERS COMPENSATION AND EMPLOYERS* LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION -OF OPERATIONS below NIA 6KUB-SB29684-3-14 03/1712015 0311712016 X I OTH- IPSTEARTUTE I ER E.L. EACH ACCIDENT $ 1,000,000 E. L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT 1 $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) Carpentry Operations. CERTIFICATF HOLDFR rANrFI I ATInPJ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Inspectional Services THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Hallmark Homes Associates, Inc. — David Tomolillo CHUSETTS DRI t VER LICENS? "IR 92 END 4d NUMM 02-24-20i� NONE S82535027 ir W34 �'06 3-15-1961 0, 15 SEX M 11�-W'&00 D NE ToMOLILL0 DAVID F 56 Wilson Street Medford, MA 02155 Massachusetts - Department of Publi; Safety Board of Building Regulations and Standards Construction Supen-isor License: CS -064063 IN. DAVID F TOMOL)ILO I) �12 56WILSONST MEDFORD MA 62155 Expiration Commissioner 0311512016 C--)iX-1 ffrr-�'arl"" ""., Vfficeof ConsurnerAffairs & Business Regulation 10 Uj, ,AOME IMPROVEMENT CONTRACTOR I I Expiration: 3/1812016 Private Corporati, egistration: 158936 TypQ: 4 Q HALLMARK HOMES ASSOCIATES INC. DAVID TOMOLILLO I STONEHILL DR. IF STONEHAM, MA 02180 Undersceret.—ly MA www,mass.rv/rmv 2� MA 02, , 3 03.15.196, CLASS - SmIl.tWel.666-26dool ft'...Pt set -1 bo. EN00RSEMENrS- RESTMCTIONS- NONE NONE F7777� CHANGE OF ADDRESS. PRINT BELOW. PERMANENT INK I - Unrestricted - Buildings of any use group which contain less than 35,000 cubic feet (991m') of enclosed space. Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For DPS Licensing information vWt: www.Mass.Gov/DPS License or registration valid for individul use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, MA 02116 Not valid wi out signature