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HomeMy WebLinkAboutBuilding Permit #427 - 211 SUTTON HILL ROAD 11/18/2010 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: d IMPORTANT:Applicant must complete all items on this page LOCATION Print PROPERTY OWNER 1'\S, Ny_�a,- ) � L- b V� Print MAP NO: 40 PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT P OPO USE R si ial Non- Residential ❑ NeVBuilding a family ❑ dition ElTwo or more family ElIndustrial Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition El Other iO.Sephc ��kWell ��tFloodplain Wetlands- D WatershedDi`strlct , DESCRIPTION OF WORK TO BE PERFORMED: Id ntification Please Type or Print Clearly) OWNER: Name: �_ f1 Phone: '135L Ii5s "3S (0% Address: 'D1 SJ4\A CONTRACTOR Name: wwwyA�s G e,vw� �'-�-� Phone: i�O3- -j�C,5-713 z Address: I Six- V-V\ �.W1a0S NN O3�`1 Supervisor's Construction License: /6�/7Z`2 Exp. Date: �UZ Z/ Home Improvement License: /S 5 0 2-dd Exp. Date: TcZ/Z. ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ c/-7 J_/ O FEE: $ �_ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to a guar ty, n I Sigriature'of�Agent/Qwner ;� : ,r .. ._;` _ ;Signature ofscontrac Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans F1 TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster 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 J COMMENTS HEALTH Reviewed on Siqnature 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 DPW Town Engineer: Signature: Located 384 Osgood St r t FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS 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 LI Notified for pickup - Date Doc:.Building Permit Revised 2008 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 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 I Addition Or Decks o Building Permit Application o 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) o 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) o Building Permit Application ❑ Certified Proposed Plot Plan o 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 o 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 thea appeal period is over. PP P 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: Doc.Building Permit Revised 2008mi Location 0( ' No. Date �L,v 001MI TOWN OF NORTH ANDOVER 1 p Certificate of Occupancy $ Building/Frame Permit Fee $ �- Foundation Permit Fee $ Other Permit Fee $ ` TOTAL $ Check # 23716 Building Inspector ORTH Town of OAndover . No. '�- LAKE o dover, Mass., COCHICHEWICK V QRATED P'?�,t�� S BOARD OF HEALTH Food/Kitchen PERM IT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT......... •••• • •••••• Foundation hasermission to • p erect..............:....................... buildings on�.l�...... .. .. . . ............�. .......�i .�s..... Rough to be occupied as......"�c Chimney ........ .............. ........... !!! /....................................................................... provided that the perg this permit shall in every re ct conform to the terms of the application 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 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRU �ST Rough 01 Service BUILDING INSPECTOR Final Occupancy Permit Required to 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. Burner Street No. SEE REVERSE SIDE Smoke Det. Fully Licensed and Insured • Member of MA Better Business BureauL O lIJG a�� Member of NH Better Business Bureau � �Q5 GAF-ELK Cert.ME16226 HIC Reg#159028 General Contracting 1005 Boylston St. #363• Newton, MA 02461 •(617)527-7663 PROPOSAL SUBMITTED TO PHONE DATE STREET E-MAIL CITY,STATE,AND ZIP CODE 1 JOB LOCATION ((�`` '' ) 1 1 Completely protect home with tarps to catch falling debris.Respect and protect shrubbery and flower beds. Strip off existing roofing material down to the bare roof deck. Inspect roof deck for structural defects and to determine the condition of underlying plywood or boards.Repair and replace as necessary*. Inspect roof ridge for proper 1 1/2"spacing on either side of ridge for maximum exhaust ventilation.Cut in if necessary. Install 6'of Q) ,< f'.J° ` Ice and Water Shield at roof eaves. Install 3'of 1 Ice and Water Shield centered in all roof valleys. Install Ice and Water Shield around all existing skylights. Install Ice and Water Shield around chimney base. Carefully remove existing siding from cheek walls.Inspect sidewall deck for structural defects and to determine the condition of underlying plywood or boards.Repair and replace as necessary*. Install I.j e e.. Ice and Water Shield 11k'from roof deck and 1 Y2'up sidewall. Install a 2'x2'collar of ice and water shield around all existing vent pipe penetrations. Install new r> _ - vent pipe penetration boots to all existing vent pipe penetration. Install r breathable roof deck protection to remainder of the roof deck. Install new 8"L and R 24 mm heavy gauge(color) A - drip edge at roof eaves and gable rakes. Install starter strip at roof eaves and gable rakes. //� C �� Install'37"'a ( r• _ ).desired color. ` (color) `. Install new aluminum step flashings and apron flashings.Counter flash chimney. Install 1(n (feet)of GAFELK Cobra r:)t ,k, C•, �r, � ridge vent at roof ridge for maximum exhaust ventilation.Hand nail to ensure proper fastening. Install)QL► (feet)of t, lI+1� distinctive hip and ridge cap.Hand nail to ensure proper fastening. Thoroughly clean up and dispose of all roofing debris on property.Magnetically sweep property for nails. 1 Notes:.V.,..�` 1; v 1 ' C..., i/`i� a: C\ Y'. .�n/ �� l .. S ,) t t J •( 1 �r p �a .J �` I 7 s X� J' L _ - .1— �.9 C_lJti". 1 'ter ll' 1s.1( s \ .c>. Q.t !<..s Edmunds General Contracting will: l"; ~Jf- r' r k: •Obtain all necessary permits to complete roof replacement work. •Furnish and install all necessary materials to complete roof replacement •Perform work as efficiently as possible without sacrificing quality •Provide a thorough clean up and disposal of all debris generated during roof replacement •Remove all roofing debris generated daily using our own dump trucks.NO LARGE CONTAINERS will be used •Recycle all asphalt roofing debris generated during roof replacement. •Thoroughly clean existing gutters of roofing debris. ' Edmunds General Contracting guarantees all workmanship performed for the life of the roof system.We will include an exclusive GAF-ELK year Weather Stopper System Plus factory enhanced warranty. ADDITIONAL NOTES:Edmunds General Contracting prohibits smoking on customer's property.Offers hand nail roofing services at no additional Argo.(Yes/No) 'Edmunds General Contracting evili replace up to 2 sheets of COX roof decking and 20'of fascia al no additional cost to the customer.Any additional replacement or repairs will be brought to the attention of the customer and additional arrangemeds will be made to address repairs. Ask me about Srnart Money financing. "Roof Now Pay Later.° Thank you for the opportunity to bid on your roof replacement work. IVC 'Propoge hereby to furnish material and labor- complete in accordance with above specifications, for the sum of: �� C 1y. �� �� :f �'U! i /ruy dollars ( Payment to be made as follows: v r t 1 t t C. 1 s All material is guaranteed to be as specified.All work to be completed in a workmanlike manner Authorized Signature: / according to standard practices.Any alteration or deviation from above specifications involving — extra costs will be executed only upon written orders,and will become an extra charge over and p above the estimate.All agreements contingent upon strikes,accidents or delays beyond our Note:This proposal may be withdrawn control.Owner to carry fire,tornado and other necessary insurance.Our workers are fully covered by us if not accepted within , r days. by Workmen's Compensation Insurance. 4CCeptanre of lropomil - The above prices,specifications and conditions are satisfactory and are hereby accepted. You are authorized toi '' �Jj//�✓ do the work as specified.Payment will be made as outlined above. Authorized Signature• Date of acceptance: ��� L... r_^��o Authorized Signature: —--- - The Commonwealth of Massachusetts Department oflndustrial Accidents IR Office of Investigations 600 Washington Street Nall �` Boston,MA 02111 .�M www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please PrintLegibly Name (Business/Organization/Individual): tay A G UA"n�, U—C Address: l � , City/State/Zip: e� 0`)Sgl I Phone#: Gy�, - 3 Cos -773z ArA�yop employer?Check the appropriate box: Type of project(required): 1. a employer with a — 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.E] I am a sole proprietor or partner- listed on the attached sheet. E] 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 S. ❑ 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.❑ Plu •ng repairs or additions myself. [No workers'comp. c. 152, §1(4),and we have no 12. oof repairs insurance required.]i employees. [No workers' comp.insurance required.] 13.0 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 acid their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: L,'6,r b4 Aa 4r- f Policy#or Self-ins. Lic.#: (N – 5I S-z©z 0 Expiration Date: /�zC/l/ Job Site Address: Z11 S,Roo H,71 {'LeiCity/State/Zip: k)r„r/i7 &Jcyte- � C�(8y5- Attach a copy of the workers' compensation policy declaration page(showing the policy number aid 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 DI or' sur _ce•co ag verification. Ido hereby certify nder t e pains a penaltie of perjury that the information provided above is true and correct.' Signature: Date: f/ /,5- /D Phone#: C, 3 C_5---77 3 Z Official use only. Do not wri.e to this area,to be completed by city or town of 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-contractors)name(s),address(es)and phone numbers)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 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 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 sure 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 pen-nit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications inany given year,need only submit one affidavit indicating current polio 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 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 www.mass.gov/dia 3/25/2010 7:49:12 AM PST (GMT-8) FROM: insurancevisions.com-T0: 19786889542 Page: 2 of 2 �� �-.r® DATE(MMIDD/YYYY) � CERTIFICATE OF LIABILITY INSURANCE 8/25/2010 PRODUCER PLANRIGHT INSURANCE & FINANCIAL LLC THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 224 MAIN STREET STE 3C ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE SALEM, NH 03079 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 603 912-5646 603 912-5647 INSURERS AFFORDING COVERAGE NAIC# INSURED EDMUNDS GENERAL CONTRACTING LLC INSURER A: Liberty Mutual Grou PO BOX 2214 INSURER B: SALEM NH 03079 INSURER C: INSURERD: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TOTHE 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 DD'L POLICY EFFECTIVE POLICY EXPIRATION LTR NSRD1 TYPE OF INSURANCE POLICY NUMBER LIMITS GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ CLAIMS MADE F-1 OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ . GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY JECT PRO LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANYAUTO (Ea accident) $ ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Peraccident) GE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR FICLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ A WORKERS COMPENSATION WC2-31 S-369752-020 1/26/2010 1/26/2011 WOC STATRY ITS OTRH- AND EMPLOYERS'LIABILITY YIN' ANY PROPRIETOR/PARTNER/EXECUTIVEE.L.EACH ACCIDENT $ 100000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Workers Compensation Insurance: Part One of the policy applies only to the Workers Compensation Law of the State of MA. PHYSICAL ADDRESS: 114 OLD VILLAGE ROAD, NORTH ANDOVER, MA 01845 CERTIFICATE HOLDER CANCELLATION SHOULD ANYOFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION TOWN OF NORTH ANDOVER DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN BUILDING INSPECTOR NOTICE TO THE CERTIFICATE HOLDER NAM ED TO THE LEFT,BUT FAILURE TO DO SO SHALL 1600 OSGOOD STREET1 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR BUILDING #20, SUITE 2-36 REPRESENTATIVES. NORTH ANDOVER MA 01845 AUTHORIZED REPRESENTATIVE s ( Jeff Eldridge �j v ACORD 25(2009/01) ©1988-2009 ACORD CORPORATION. All rights reserved. CERT NO.: 8109390 CLIENT CODE: 1338660 Anne Chandler 8/25/2010 7:47:13 AM Page 1 of 1 i i I ✓ - oa�� Office off Conn sumer Affairs&B4siness Regulat ga ion _ HOME IMPROVEM Registration: ENT CONTRACTOR -;x,159028 Expiration: =3/26/2012 . Type: °' ___ ------ Individual E UNDS GENERAL CONTRACTING DAVID EDMUNDSi ==: k, 1 SHAKER LANE 1 P � I HAMPSTEAD, NH - Undersecretary j �� tss,t�.btrs guard of ctts- p�lt.rr i Bui4lin,f 'trttertf of i Constr Rt: