HomeMy WebLinkAboutBuilding Permit #937-14 - 21 PERRY STREET 6/24/2014PermitNo#:
BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Date Issued: ex
I " IMPORTANT: ADDlicant must comDlete all items on this Me
Date Received
LOCATION
PROPE'RT)
MAP
Print 100 Year Structure
PAIRCEL:16,/5- ZONING DISTRICT:- --- Historic District
Machine Shor) Vil
e
yes
yes
yes
no
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
0 New Building
El One family
0 Addition
[I Two or more family
0 industrial
El Alteration
No. of units:
El Commercial
11 Repair, replacement
El Assessory Bldg
D Others:
11 Demolition
D Other
El Septic 0 Well-
0 Floodplain El Wetlands
0 Watershed District.
OW6ter/Sewer
DESCRIPTION OF WORK TO BE PERFORMED:
Izz-- — _AZ 1P,
,Z�ZZ,felf Z)J�J 6— �IAM L wll4oa—1 _ZkJ_374114'110A) 7a Ig
Identification - Please Type or Print Clearly
OWNER: Name: -Selo 71— tO AU�SoIJ Phone: V -7 Jel 71
Address: /Y (�ORW,�5A)
Contractor Name-.
Address: ___ li &J Z
. - - = � &)
FJJ
Supervisor's Construction License: Exp. Date-.
Home Improvement License:
ARCH ITECT/ENG I NEER
Address:
Date:,.-.
Phone:
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: $ FEE: $
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have accqs to the gqoantyfq�
3ignature of Agent/Owner Sianature
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
• 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
u Building Permit Application
Ei Certified Surveyed Plot Plan
Li Workers Comp Affidavit
Li Photo Copy of H. 1. C. And C. S. L. Licenses
Lj 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
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
Ej 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 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
A
Plans Submitted 11 Plans Waived [I Certified Plot Plan E Stamped Plans El
TYPE OF SEWERAGE DISPOSAL
Public Sewer
TanningIN4assage/Body Art E]
Swimming Pools 11
Well
Tobacco Sales El
Food Packaging/Sales 0
Private (septic tank, etc. El
Permanent Durnpster on Site 11
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
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
'Ra'n.ning Board Decision:
Conservation Decision:
Comme
Comments
Water & Sewer Connection/signature & Date Driveway Permit
DPW Town Engineer: Signa
Located 384 Osaood Street
FIRE DEPARTMENT - Temp 'Dumpster on site yes no
Located at 124 Main Street
Fire Department signature/date
L COMMENTS
Dimension
Number of Stories:
Total land area, sq. ft.:
Total square feet of floor area, based on Exterior dimensions.
ELECTRICAL: Movement of Meter location, mast or service drop requires approval of
Electrical Inspector Yes No
DANGER ZONE LITERATURE: Yes
MGL Chapter 166 Section 21 A —F and G min.$100-$l 000 fine
NOTES and DATA — (For department use)
LJ Notified for pickup Call —Email
Date Time Contact Name
Doc.Building Permit Revised 2014
No
Location :�// ,, � /- -
No. Date (;/A;?
Check #
1
27710
TOWN OF NORTH ANDOVER
Certificate of Occupancy $-
Building/Frame Permit Fee $
Foundation Permit Fee
Other Permit Fee
TOTAL $
building Inspector
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GIN
SCOTT AULSON
14 CURWEN ROAD
PEABODY, MA 01960
(978) 423-3472
December 18, 2013
Heather Zikrnanis
Avatar Properties
163 Main Street, Unit 201
Salem, NH 03079
RE: 21 Perry Street, W. Lawrence, MA
I
Dear Heather,
BY EMAIL ONLY
h.zikmanis@avatqMroperties.net
I am pleased to quote to you the following price to perform deleading work at the above -
referenced address, according to the lead inspection report of Cary Marcrello, License
No. M-3169, dated 10/26/13
Scope of Work:
• Doors containing lead based paint to be scraped, feathered and sanded to meet
compliance.
• All leaded door & window casings to be stripped to bare wood or replaced with
new and to full header height.
• Abate doo�ambs that contain lead by scraping to bare wood and to full header
height.
Door thresholds to be scraped in place where needed.
Windowsills and aprons to be scraped to compliance.
All exterior windows that contain lead are to be brought to compliance.
Remove and replace all windows found to have lead paint with vinyl replacement
windows Harvey Brand Classic Low -E glass or equal.
All interior trim containing lead will be made intact.
Baseboards to be capped or scraped back on outside comers to meet compliance.
Shelves/supports in closets that contain lead to be abated.
Walls that contain lead based paint to be made intact; outside comers to be
covered.
Ceilings/closet ceilings listed as containing lead based paint on report to be abated
to all state and federal regulations.
Exterior upper trim to be brought into compliance by making intact any loose or
peeling paint.
Exterior of house will be abated until compliance is achieved.
Loose and Raking pa, int to be made intact.
All other components listed as containing lead based paint on report to be
deleaded to all state and federal regulations.
• All exterior lead to be brought to full compliance with 105 CMR 460.000 (delead
regulation) lead poisoning prevention and control regulation.
• Prime and finish paint of the. interior/exterior to be done by others.
Scope of Supply: I will provide the following:
• Materials and labor warranty, effective for one year from the date of the project
completion.
• Trained and licensed supervision.
• Trained and licensed workers.
• All necessary precautions taken to protect personnel.
• Materials, supplies and equipment for lead abatement.
• Man lifts and other equipment necessary to access the work area.
Conditions and Qualifications: It is expected that Avatar Property to provide the
following:
• Water, lighting and power.
• Unencumbered access, at all times, to the work area.
• All obstructions to be removed prior to our work beginning.
• Storage area for materials and small equipment, if necessary.
I will ensure the following:
• All dust samples will comply with state requirements for lead in dust.
• All notification requirements for local and state agencies are met.
• All insurances are carried by said contractor.
• All material is guaranteed as specified.
• All work to be completed in a professional competent manner.
Anticipate the following:
• No guarantees are made on time scheduling due to inclement weather, which may
hinder the progress of work.
• This project is being approached as a lead abatement project.
• All work methodology shall comply with government regulations.
• There have been no assumptions made towards the existence of any unidentified
materials.
• I am responsible for proper cleanup of the work area only. Any request for larger or
additional cleanup outside the work area is not included in the contract price.
This proposal does not cover the following:
Removal not listed in the report, cost of initial inspection or re -inspection, painting or
carpentry, unless noted above.
If waste is determined to be hazardous by TCLP testing, additional cost will be paid
by the client.
PRICE: $169750.00
Payment terms: 1/3 deposit, 1/3 at start, and balance upon substantial completion.
I look forward to working with you on this project. If you have any questions or require
any additional information, please feel free to contact me at (978) 423-3472.
Thank you,
-15--coott Aulson
Project Manager
Acceptance of the proposal, the above prices, specifications and conditions are
satisfactory, you are hereby authorized to do the work. Payment will be made as
specified above.
Date of Acceptance: Signature:
Department of Public Health & Department of Labor
60 NOTIFICATION OF DELEADING WORK
'0
All sections of this form must be completed in order to comply with
AR,
the notification requirements of M.G.L. C. 111§197,
454 CMR 22.00 and 105 CMR 460.000, as most recently amended
Contractor performing project Scoft Aulson License# DC001 480
E,p. Date 05/20/15
Lead Paint Inspector Gary Marciello Date of Inspection 10/26/13 License # M3169 Exp. Date
ADDRESS OF PROJECT:
Street Address 21 Perry Street
City No. Andover
Property Owner Richard & Marcelle Hamel Addri
Telephone Number (603) 894-6300
Deleading Method:E] Wct[Dry Scraping E] Heat Gun
E]Demolition Caustics
E]Covering Other
if "Other" selected, please explain
Check one: Dwelling is multi -family=
Start Date 06/25/14
Apt. Number
,.- 01845
183 Pillsbury Rd., Londonderry, NH 03053
[]Liquid Encapsulant
[Z] Replacement
Single-family Other_E__:���
Completion Date 06127114
When will work be done: Am 8 pm 4 (Specify times on site) Weekends? NO
Project Supervisor.Name Li(
Worker's Compensation Policy Number
In case of emergency contact Tel.
(Contractor's Representative)
DELEADING CONTRACTOR
Carrier
Exp. Date.
The undersigned hereby states, under the pains and penalties of perjury, that he/she has read and understood the Commonwealth of
Massachusetts Deleading Regulations, 454 CMR 22.00, and the Lead Poisoning P evention and Control Regulations, 105 CMR 460.000, and
that the information contained in this notification is true and correct to the b -of his/her nowle nd ef.
Date June 16, 2014 Signed 11z, W_;Ji
Company Name SCOTT AULSON
Address 14 CURWEN ROAD, PEABODY, MA 01960
Telephone Number (978) 423-3472
OVER -4
Certificate No: A043021
THE COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF LABOR AND WORKFORCE DEVELOPMENT
DEPARTMENT OF LABOR STANDARDS
19 STANIFORD STREET, BOSTON, MASSACHUSETTS 02114
DELEADER CONTRACTOR LICENSE
SCOTT AULSON CONTRACTING & ABATEMENT
14 CURWEN RD
PEABODY MA 01960
LICENSE: DC001480 EXPIRES: Wednesday, May 20, 2015
IN ACCORDANCE WITH M.G.L. CH. I 11, § 19713(b) AND 454 CMR 22.03, THIS LICENSE IS ISSUED BY
THE DEPARTMENT OF LABOR STANDARDS TO THE CONTRACTOR ABOVE FOR THE PURPOSE OF
ENTERING INTO OR ENGAGING IN DELEADING WORK.
THIS LICENSE IS VALID FOR A PERIOD OF ONE YEAR.
THIS LICENSE MUST BE MAINTAINED BY THE CONTRACTOR WHEN ENGAGED IN DELEADfNG
WORK IN ACCORDANCE WITH M.G.L. CH. I I I § 19713(b)(2) AND 454 CMR 22.03.
HEATHER E. RoWE, DIRECTOR
Please detach this mailing tab and keep your license certificate in an accessible location. A copy
of this license must be maintained at each worksite.
SCOTT AULSON CONTRACTING & ABATEMENT
14 CURWEN RD
PEABODY, MA 01960
11%� RD CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)
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.
IPAPOKIANP If the certificate holder is an ADDITIONAL INSUR D, the p011cy(les) must be endorsed. If SUBROGATION I �WAJVIED, �subject to
the tems; and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer eights to the
certificate holder in lieu of such endorsemengs).
PRODUCER CONTACT
NAME,
Prestige Insurance Agency, Inc PHONE
14 North Main Street fAtc. NQ Ed). 978) 750-4474 50-6606
c -m L
M:Lddleton, MA 01949 ADIZESS: Prestigeins@comeast. net
NAIC #
INSURED
Scott Aulson Commercial
14 Curwen Rd
Peabody, MA 01960
COVERAGES CIPIPTIFICATE NUMBER:
THIS I REVISION NUMBER:
S 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 A14Y 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 RAVE BEEN REDUCED BY PAID CLAIMS.
�SR A–DD—L . POLICYEFF POUCYEXP
TR TYPEOFINSURANCE POLICY. NUM13ER (MMIDDIYYYY) JnL/DD1YYYY)
A GENERALLIABIUTY L081001137 8/27/13 8/27/14 EAC OC LIMITS
H CURRENCE
X CQrWERCISAL GENERAL LIABILITY --ffA—MAGETORENTED 1 1000,00C
CLAM _M –1 OCCUR LEMNISES fEa occurrencel $ 100100C
X CLAIMS -MACE F -ME D EXP (" Ong person) 5, OOC
PERSONAL& ADV INJURY 3 1 (inn nnr
I AGGREGATE L UIT APPLIES PER
GENERAL AGGREGATE $
PRODUCTS-COMP/OPAGG $
tGEN'L
' POLICY r–].PRO- _–] LOC
C -JECT r
I—
AUTOMOBILE LIABILITY
ANYAUTO
ALLOWNED SCHEDULED
AUTOS AUTOS
NON -OWNED
HIREDAUTOS AUTOS
I
COMBIN I_N9L_ff_LU_r_ $
(Eaaccidart) — $
BODILY INJURY (Per person) s
BODILY INJURY (Per acciclent) S
_FiIR_0_fff;V
—DAW
PE GE
(Eeraocident) $
$
UMBRELLA LIAB
OCCUR
EXCESS LIAB
CLAIMS -MADE
EACH OCCURRENCE $
DED RETENTION $
AGGREGATE
MRKERS COMPENSATION
$
AND EMPLOYERS'LIABILITY
ANY PROPR IETOR/PARTNER/EXECUTIVE YiN
OFFICE RAAE MBER EXCL UD ED?
(Mandatory In NH)
WC OTH-
FIR
E.L. EACH ACCIDENr
E.L. DISEASE -EA EMPLOYEE $
"Xe
D S�RdlesTrnbNeu der
P 'o & OPERATIONS below
E.L. CIS EASE - POLICY L im IT I s
DESCRIPTION OF OPERATIONS I LOCATIONS IVEHICLES (Attach ACORD 101, Additional Re ma*s Schedule, if mom space is re qU md)
k1l coverages are subject to Policy terms, conditions, requirements and exclus±ons.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBEE) POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, TICi WILL BE DELIVERED IN
Client copy ACCORDANCEW17H POLICY PRJIONS.
AUTHORIZED REPRESENTANT15k. ff Ir A
7D6R-
@ 198V 20'0 ACO CORPORATION. All rights reserved.
ACOR D 25 (2010105) The ACORD name and logo are registered marks of ACORD
Phone: Fax: E -Mail:
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09/09/2013
Scott Aulson
14 Curwen Road
Peabody, MA 01960
Re: Workers Compensation Insurance
Policy Number: AWC-400-7029619-2013A
Policy Period: 09/04/2013 to 09/04/2014
Dear: Scott Aulson
A.I.M. Mutual Insurance Company
Massachusetts Employers Insurance Company
New Hampshire Employers insurance Company
Associated Employers Insurance Company
Welcome to the A.I.M. Mutual Insurance Company. Your workers compensation policy with us is currently
being processed, and your policy number is noted above.
I am a member of the customer service team assigned to your policy. If you have any questions or
requests, please feel free to call or email me. If you prefer, you may contact any of these areas directly.
Certificates of Insurance
Fax: 781-270-5690
Email: dcox@aimmutual.com
Phone: 781-270-8740 or 781-270-8935
Credit Department
Kathleen Murphy: (781) 270-8870
John MacDougall, Manager: 781-270-8846
Claim
Online: www.aimmutual.com
Phone: 866-270-3354
Fax: 781-270-5599
We look forward to being of service to you.
Sincerely,
Sheila Bindman
7812708710
sbindman@aimmutual.com
cc: Prestige Insurance Agency Inc
14 North Main Street
Middleton, MA 01949
54 Third Avenue - P.O. Box 4070 a Burlington, MA 01803-0970 * Tel: 781.221.1600 / 800.876.2765 * Fax: 781.270.5599
BRIDGEWATER - BURLINGTON * CONCORD, NH * HOLYOKE - MARLBOROUGH
sponsored byAssociated Industries ofMa5sachu5etts
Department of Public Health & Department of Labor
NOTIFICATION OF DELEADING WORK
All sections of this form must be completed in order to comply with
�11101
the notification requirements of M.G.L. C. 111§197,
454 CMR 22.00 and 105 CMR 460.000, as most recently amended
Contractor performing project Scoff Aulson
Lead Paint Inspector Gary Marciello
ADDRESS OF PROJECT:
Street Address 21 Perry Street
City No. Andover
License# DC001480_Exp. Date 05/20/15
Date of Inspection 10/26/13 License # M3169 Exp. Date
—Apt. Number
Zip 01845
Property Owner Richard & Marcelle Hamel Address 183 Pillsbury Rd., Londonderry, NH 03053
Telephone Number (603) 894-6300
Deleading Method:E] Wet[Dry Scraping E] Heat Gun [] Liquid Encapsulant
E]Demolition E] Caustics E] Replacement
[]Covering [] Other
If "Othee' selected, please explain
Checkone: Dwelling is multi -family
Start Date 06/25/14
When will work be done: Am 8 pm 4
Project Supervisor
Worker's Compensation Policy Number.
Single-family Other F__1
Completion Date 06/27/14
(Specify times on site) Weekends? NO
License # Exp. Date
In case of emergency contact Tel. U
(Contractor's Representative)
DELEADING CONTRACTOR
Carrier
The undersigned hereby states, under the pains and penalties of perjury, that he/she has read and understood the Commonwealth of
Massachusetts Deleading Regulations, 454 CMR 22.00, and the Lead Poisoning RE evention and Control Regulation's, 105 CMR 460.000, and
that the information contained in this notification is true and correct to the Zbof his/her- nowle nd ef.
Date June 16, 2014 Si2ned
Company Name SCOTT AULSON
14 CURWEN ROAD, PEABODY, MA 01960
Telephone Number (978) 423-3472
OVER4
4-1, Page I of I
THE COMMONWEALTH OF
MM!q)kip*jV§h*fn Standards
Homepa- ,vvw-mass.jzov/doIs
Thank you for your submission. Your confirmation number is: 9683283.
A confirmation email has been sent to: cginas@aulson.com.
http://ewr.detma.org/Confirmation.aspx 6/16/2014
Cathv Ginas
From:
DoNotReply@dos. state. ma. us
Sent:
Monday, June 16, 2014 1:53 PM
To:
cginas@aulson.com
Cc:
h.zikmanis@avatarproperties.net
Subject:
DELEADING NOTIFICATION FORM DELEADING CONTRACTOR
Thank you for submitting your Deleading Notification Form DELEADING CONTRACTOR, Please retain
this email for your records and post a copy at your work site.
Confirmation #: 9683283
Submission Date: 06/16/2014 01:53 PIVI
NOTIFICATION OF DELEADING WORK
The Notification is: Routine Notification
DLS Waiver Number:
House Number: 21
Street Name: Perry
Street Type: St
Unit/Apt Number:
City: North Andover
Zip Code: 01845
Property Owner/Agent: Richard & Marcelle Hamel
Phone :6038946300
Owner Address: 183 Pillsbury Rd., Londonderry, NH
Email: h.zikmanis@avatarproperties.net
Name of Licensed Lead Inspector/Risk: Gary Marciello
Inspector/Risk Assessor License Number: M3169
Date of Inspection: 10/26/13
Expiration Date:
1
CONTRACTOR INFORMATION
Contractor Name: Scott Aulson
Contractor Address: 14 Curwen Road
City: Peabody
State MA
Zip Code: 01960
Contractor Contact Person: Scott Aulson
Office Phone: 9784233472
Cell Phone: 9784233472
Email: cginas@aulson.com
Contractor License Number: DC
Six digit Number: 001480
Expiration Date: 05/20/15
LR/LW Name:
License/Authorization Number : MR
DS/MR six digit Number:
Expiration Date:
TYPE OF DELEADING WORK TO BE PERFORMED:
Class I Deleading Methods Selected
Making Intact,Replacement,Wet/Dry scraping or wire brushing,
Moderate Risk Deleading Methods Selected:
Low Risk Deleading Methods Selected:
2
N/A.1
WORK SCHEDULE:
Project Start Date: 06/25/2014
Project Completion Date: 06/27/2014
Project Start time: 8 am
Project End Time: 4 pm
End of email
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