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HomeMy WebLinkAboutBuilding Permit #829-14 - 21 WILSON ROAD 5/14/2014Permit Date Issued TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION LOCATION PROPERTY OWNER MAP NO:PARCEL Date Received TANT: Applicant must complete all items on this page Print 100 Year Old Structure yes no - ZONING DISTRICT: Historic District yes no Machine Shop Village yes no .TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building NS)ne family ElAddition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial epair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic []Well ❑ Floodplain ❑ Wetlands ❑ Watershed District ❑ Water/Sewer PTION OF WORK TO BE PEKi-UKmtu: OWNER: Name: A, Ar^nn- q-- � —,Iqq Wnl--� /"lIAUIGJJ. �r y� A TOR Name: X �V I1� P CONTRACTOR hone: C Supervisor's Construction License: 0 l Exp. Date: 4-t-7 ^ �� Home Improvement License: 10 U r✓ Exp. Date: 0 `" I 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: $ �_✓ rr MC) FEE: $ i 5Lt i�TD Check No.: Z Receipt No.: 21� NOTE: Persons con racting with unregistered contractors do not have acqStped Warad Si nature of A ent/Owner Siggature of contract ._.g _ _ ._ . .g ... _ _ Plans Submitted �� Plans Waived ❑ Certified Plot Plan ❑ Plans ❑ Plans Submitted ❑ Plans-Hl/aived - - ❑: Certified Plot Plan ❑ Stamped Plans ❑ -TYPE OF::SEWERACEDISPOSAL" Public Sewer ❑ Tanning/Massage/Body Art ❑ . Swimming Pools ❑ well ❑ Tobacco.Sales ❑ Food Packaging/Sales ❑ -Private: (septic tank, etc:_ . ❑ .: _ _:.: permanent D aupster 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 r, Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes - Planning Board Decision: Com Conservation Decision: :Comments Water & Sewer Connection/siignature & Date Driveway Permit r DPW Tow;! Engineer: Signature: Located 384 Osgood Street FIRE DEPARTM,L`NT - Temp Durnp.ster on site yes no .Located -at 124 Mair. Street -Fire Departinerit signature/date-" - 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 No MGL-.Chapter.166.Sectlon 21A -F and G min.$100-$1000:fine NU I ES and DA IA - (For d LJ Notified for pickup - Date Doc.Building Permit Revised 2010 ent use Building Department The foh.owing is -a list of the required.forms to be filled oufforAhe appropriatepermit tube obtained. Roofir° g, Siding, Interior Rehabilitation Permits ❑ Bluilding Permit Application ❑ Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.LLicenses o 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) a 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 o 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 cans if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the apu•?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.+ted with the building application Doc: Doc.Building Permit Revised 2012 Location No. G�— Check #la Date h� 1 - TOWN OF NORTH ANDOVER d Certificate of Occupancy $ Building/Frame Permit Fee $ted Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Buildin Inspector 4mo 0 J Q S LL O cr.D O CC t _>.O "a O L0 EJ +�+ N •�„ Q LO O W H ? z —' m a+ C 7 LCL C9 CC A U LL O d of Z Z m t to 3C d' — LL 0 d N Z U u W W L OD 3 d' U Lo I c1c 0 U a Z Q C7 t 00 3 d' — LL Z - LLIG F. °C Q W W w N, . N L'- L Co O z OJ v Lo +-; N D Y O N n F-1 O O V � IA ,•1 Q, cL to rd N O F•Q h w c a 114c° O d (� L ++ U1 O.* a : 3• C J y LLI >Cc� as -a C rn • a� z - Ln o m N 3 � CL Q(� CD T 0 ca � y ..�. occ _ CD . CL 5 ~as .v m ujco = 'a - O O LL '0EL E m y C ,= t O y = � .2 V V W E • U m 0-0 O ., N Q, O'� �j y o O F-1 H t L. a 0 � CLOU i z O m CD z W W N W CL O W :a p 0 J M m '^ vI H 0n U I— z U U) J M E � O O Z N ti O 0 CA m m O O a~� o � — A CL cc Q az O O � O v U cn i N 0 The Commonwealth of Massachusetts Department of Industrial Accidents y� Office of Investigations 1 Congress Street, Suite 100 Boston, MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers palicant Information Plpacp Print I,Paihl Name (Business/Organization/Individual): Address: Phone #: Are you an employer? Check the appropriate x: 1. El am a employer with 4. I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. ship and have no employees working for me in any capacity. [No workers' comp. insurance required.] ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t These sub -contractors have employees and have workers' comp. insurance.1 5. Q 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' comp. insurance required.] Type of project (required): 6. Q New construction 7. Q Remodeling 8. Q Demolition 9. Q Building addition 10. ❑ Electrical repairs or additions 11. ❑ Plumbing repairs or additions 12.Q Roof repairs 13. ❑ Other *Any applicant that checks box #1 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 and state whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. Iam an employer that is providing workers' compensation insurance for my employees. Below is the policy andjob site information. Insurance Company Name: Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address: City/State/Zip: 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 insurance coverage verification. I do hereby cer fy nder th �1,9711 ins and penalties ofperjury.that the information provided above is true and correct Signature: I Pit Date: lq- Z, _ i 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. Other Contact Person: Phone #: i1 } Massachusetts - Department of Public Safety Board of Building Regulations and Standards Construction Supervisor SpecialtN License: CSSL-099497 _, 1 I ♦ !. MICHAEL L COgtn,, ' 16 Jonas Road s Westford MA 01$86 ; Expiration Commissioner 04/24/2016 71, iammonwsaa .:, Office of Consumer Affairs & B mess Regulation HOME IMPROVEMENT CONTRACTOR a Registration: 108126 Type: Expiration: 8/13/2014 DBA MICHAEL L. CORTNER-EXPRESS ROOFING Michael Cortner 16 JONAS RD WESTFORD, MA 01886 Undersecretary d CERTIFICATE OF LIABILITY INSURANCEDATE(MM/DDI 3/ /)14 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(ies) 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 rights to the certificate holder in lieu of such endorsement(s). PRODUCER A -Costa Insurance Agency, IncPHONE 2 Franklin Commons Framingham, MA 01702 CONTACT NAME: FAX ' (508) 875-3488 / No, (508) 875-9388 E-0/IaL ADDRESS: ]on@a-costains.com NPP8183801 8/15/13 INSURE S AFFORDING COVERAGE NAIC # INSURER A: Travelers Insurance Com an DAMAGE TO RENTED PREMISES Ea occurrence) $ 50,000 INSURED INSURER B: Western World Insurance JD GENERAL CONSTRUCTION INC INSURERC:Ace American Insurance Co. 1001 WAVERLY STREET INSURER D: FRAMINGHAM, MA 01702 INSURER E: 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 INSR SUBR WVD POLICY NUMBER POLICY EFF M/DD/Y POLICY EXP MM/DD/YYYY LIMITS B GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR DEBRA DALLA COSTA NPP8183801 8/15/13 8/15/14 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence) $ 50,000 MED EXP (Anyone person) $ 5,000 PERSONAL& ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATE LIMITAPPLIES PER 1-1 POLICY PRCT LOC PRODUCTS -COMP/OP AGG $ 10,000,000 $ AUTOMOBILE LIABILITY ANY AUTO ALL O WNED SCHEDULED AUTOS AUTOS NON -OWNED HIREDAUTOS _ AUTOS CONE WED�SINGLE LIMIT accident)$ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PReOPPERdTY DAMAGE $ $ UMBRELLA LIAR EXCESS LIAB F OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ C WORKERS COMPENSATION ANDEMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICE RIMEMBER EXCLUDED?N (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below / A 9972L68813 9/25/13 9/25/14 WC STATU- DTH- E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE -EA EMPLOYEE $ 100,000 E.L. DISEASE -POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is requred) CERTIFICATE HOLDER CANCELLATION © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD Phone: Fax: E -Mail: SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN MICHAEL CORTNER ACCORDANCE WITH THE POLICY PROVISIONS. DBA EXPRESS ROOFING AUTHORIZED REPRESENTATIVE 16 JONAS RD DEBRA DALLA COSTA © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD Phone: Fax: E -Mail: This lamp t satisfies all basic 're uirr C� q ments of the state's Hame imprriv'me>tzt`Contrnctor Law (1vIGl; chapter 142 to protect homeowner;, Seek legal advice Ifneeessar , Ap r isotts consumer191101110 p A), but tial s not fnelude standard guide to home imprpvemertV before agr eing't p y wo p��y arm improvementsaoshout II h� COIn abca Consumer Affairs and Business Regulatinn's Consumerinformtttion Hotline at 617-973-876'7 or pY in a t Ila meowv�ier fl Pt�?m.ation ,.. 1 888-2a3-3757, PY ycallingtIre . +�oniracfor informa>Ixmm City/Town Daytitite Pbone •,- The Jbm S F t` � t7,. f__ce s <On(' . Hs�.ay�� ui ut�aten s o a e �x� eI Q � W_&1;. zgriired,'Zsermits - The follow r in�:i,criIdiirgpetmits are required Proposed Start and Com la Sche dale - The foIIewin schedule and tiI be secured bX the contractor as the homeowner's agent, be adhered to unless circa (0 Hers who secure their o1= permits wffl be instances beyond the contractor`s oo duIc will ! from ntrol arise excl'ided the G.ua�raat.1; Fund provisions' of MGL chapter x42A,) ' .� ate when contractor will begin contracted ' Akohte wwhen contracted work will be substantially Total Coatrnct I''rice'and Pnymprt Schedule Y completed. The Contractor Agree!- to perform the wormy frirnish the materia! and labor• specified above for the fatal sum of pf 5 PaynJenis will be made according to wing schedule: the f°IIn `�' i*) upon signing'conszzct (not to exceed 1" of . the'total eoniractprice or the cdst: of'special order items, whichever is greater) ' by »: or uponcompletion•of 5 by f—�� or upon completion of l upon completion of the con ( tract (Law forbids demanding full pay mentuntil contract is completed to both a Tho follow]ng inateU10quipmeat must be special p p try's satisfaction) ordered before the contracted wml begins in order a—'—`---- to meet the completion schpdulc.(•*) NOTES: M Including all finance ch «+ ) Law requires th�t any not exceed the greater or (a) one-third of the ots] tttm�asit or down- whichmust bespecial ordm0d:jn advance to meet the completion schedule, ayment required by the contractor before work begins may rt price or (b) the actuaf cost of any special equipment or custom made materia! E rass Wa rranf,! -1(s an express tan Subebniraetor _ 3berna tmavlded b the con actor?_ s 7 hE contractor ngr_ s to be solely responsible for corinpde tion f tthh� W r j_ aes� bed enrrao patty%subcontractor utilized by the contrpctar must bo attae ed o the cantmat n terials and laborunderthis• aeree�nent The contractor further agrees to be solely'responsible far regardless of the action o fany mrd Con hrt shall notimpl - Upon signing, this documentbecorries a binding ce,n�et under law. Unless Otherwise Yments to al! subcontractors for contract shall not imply that any lien or other security intcreytlras been placed on the res{dencc, carefully before signing this contract, rwise noted within this document, the . ]review the following cautions and notices • Don't be pressured ' P d into signing the contract; Take time to read and fullyunders • ' lee sur a contractor h s Obcantmetors to v ti 1:7ome Improvement Co understand it, Aslc questions if something be registered - iifih the Dhuctor ofIimtte Im royror R_aaratrattox� g is unclear, regi'tmtion b g r ctor at One Ashburton Place Roc The law requires most home improytrnent contractors and by -writing to the Diu P ,cmentGontractorRe ' ] 800=223-0933. , nl 1301 $osto grsfration. You may Inquire about contractor • Does the.contractnr have insurances MA 02108 or by calling 617.-727-320p or ' Know your rights and re : ara tp see thaty°nr contractor is properly ]nsured, Guide to the Rome•Impro em n r Contrao�ardl-awmp,°rtant Infarmaliota on the reperso side °f this form and get a co Py of the Consumer You may cancel this agreement if it has been signed at a �ilaee atirer• than the contractor's. norm conttactorin writing at his/hermain office orbranch otirce b third business day folIowirr , Y ardina normal Place ofbnsiness g the srgnizag nt this agreement, See the attryacm�anoe o�ance].Iation form for an providedyou he the gram sent arby delide ll0 NO Si �. �0'�l]�� re ��y �•� ry, not later than midnight of the Two identical ca cnntractmu,t6c CONTRACT end signed.� C 1 � TIu Z L'+ explanation of this right. piesofthe. �����y'� y�� (��y [��y ( t� _�- On copyst„a:�?d;�c to tnc jwtncoLynt�.lif Y �lrt�,l`(.L1. -rhe ea1ercopy9bncidbekept by the contractor. Homeowner's Signatu Data ontractor's Signature Date .' PROPOSAL www.expressroofer.com HOME IMPROVEMENT CONTRACTORS LICENSE # 108126 CONSTRUCTION SUPERVISOR LICENCE #99497 • • • PROPOSAL SUBMITTED TO: NAME ADDRESS PHONE# GROGORY AND LANA 21 WILSON FARM RD N ANDOVER ESTABLISHED 1985 DATE OF PROPOSAL 51212014 m ike(o)expressroofer. com 16 Jonas, Westford, MA 01886 Phone: 978-256-2333/Fax: 978-251-2907 • • WORK TO BE PERFORMED AT: ADDRESS 21 WILSON FARM RD N ANDOVER We hereby propose to furnish materials and perform the labor necessary for the completion of: STRIP UP TO 2 LAYER OF ASPHAULT SHINGLES OFF HOUSE ROOF CLEAN UP AND HAUL AWAY TARP OFF HOUSE TO HELP PREVENT DAMAGE TO HOUSE AND LAWN AREA COMPLETELY DE -NAIL ROOF AND RE -NAIL ROOFING BOARDS AS NEEDED WITH 8D RING SHANK NAILS ALL WALL FLASHING WILL BE INSPECTED AND REPLACED AS NEEDED Install: IKO Storm Shield 9'up from the bottom eaves IKO Storm Shield around vent pipes, IKO Storm Shield 3' around skylight ' k IKO Storm Shield on roof where roof meets house IKO Storm Shield under chimney lead and 3' down on roof Y I'" WL" fflz- Felt paper over roof boards IKO Leading Edge Plus Starter strip on all roof decking edges IKO Cambridge Architectural shingles' We install 6 nails per shingle for a 130 mph IKO wind warranty) Roof Saver ridge vent along all ridge surfaces IKO ridge cap shingles 8" Drip edge along all outer roof edges white New pipe flange's over vent pipes 2°4" Pipes) All shingles will be fastened using 1 %" - 1 '/" roofing nails ROLL MAGNETS OUT TO PICK NAILS OFF LAWN AREA FOR FINAL CLEANUP ALL ABOVE LISTED ROOFING MATERIALS ARE PROPERTY OF EXPRESS ROOFING INCLUDES: ALL LABOR AND MATERIALS FOR THE ABOVE AND ROOFING PERMIT 15 YEAR WORKMANSHIP LIMITED AND A LIMITED LIFE TIME IKO SHINGLE WARRANTY CLEAN UP AND HAUL AWAY ALL SHINGLES I Note: No warranty on problems and l ordamaged caused by ice backups No Warranty on old skylights All material is guaranteed to be as specified, and the work to be performed in accordance with the drawings and specifications �� submitted for above work and completed in a substantial workmanlike manner for the sum of. $a,, 9A� 5.00 $ NO MONEY DOWN $ PAYMENT IN FULL AT COMPLETION OF JOB WITH CASH OR BANK CHECK 1 0 MADE OUT IN THE NAME OF Michael L. Cortner Call Toll Free Respectfully submitted Ma 1 -888 -210 -ROOF • • • Note -This proposal maybe withdrawn by us if not accepted by: 5/9/2014 All workers fully insured ACCEPTANCE OF PROPOSAL The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payments will be made as outlined above. Any additional work than the above will be an extra charge. Signature ` 61A , 'SHINGLE Datet%� COLOR (�/ . Homeowner is responsib for protecting and cleaning content of attic from possible dust and debris during your roofing project. Not responsible torany issues caused by mold **Note any plywood replacement will be an extra INM per 4x8 by half inch sheet - labor & materials included Note any roof board replace ment will be an extra charge of $4.00 per linear ft 1"x 8" boards WE RECOMMEND REPLACING 6 SKYLIGHTS WITH 6 NEW FIXED VELUX SKYLIGHTS FOR AN EXTRA CHARGE $3795.00WE RECOMMEND NEW CHIMNEY LEAD WITH ALL NEW.ROOFS FOR AN EXTRA HARGE 011 $395.00 PER CHIMNEY Wit 4--r) i a i