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HomeMy WebLinkAboutBuilding Permit #845 - 215 HICKORY HILL ROAD 5/29/2012BUILDING PERMIT A!4N,, TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION 1_ PermitDate Receivedrap Date Issued: :AT, � IMPORTANT: Applicant must complete all items on this Dave vn i�bw&G_Atl N t ii nn I TYPE OF IMPROVEMENT PROPOSED USE OWNER: Name: '-tcy l rL- Residential Non- Residential New Building One family c Addition Two or more family Industrial n No. of units: Commercial epair, replacement Assessory Bldg Others: Demolition Other �-_4 N �:, , 'i C , 'Floodplain W, af6r§he 'dQi§tfic AZT. JV W/96WOT I UL5t;KIPUIUNPFWORK TOBEPREFORAPED: qeiTtificati n Please Type or Print Clearly) OWNER: Name: '-tcy l rL- Phone: c VAddress: Q kc 'Name;�-J;�� .hone . Address,_. ---�,_,A_?s A 7 2 �i/, & �PEAS�- -11 'OaK" _lz ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE: BUL DING PERMIT. $92.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $925.00 PER S. F. Total Project Cost: $ FEE: $ 11 () Check No.: H Z-4 Receipt No.:,) ;3 4,oe NOTE: Persons contracting with unregistered contractors do not have access to the" antyfund nYOVvnbr Si nature df -A66-1... Signature of lconira66-_ _­­_ ­ . ­ - .. i .... 1. .. v . — I Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL HEALTH Reviewed on 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 PLANNING & DEVELOPMENT COMMENTS DATE APPROVED CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature 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 Street FIRE DEPARTMENT TempD4umpster on. site ,yes no Located of 1 M -"" St' t 24 ''. � ' Y *" � t l i fi a re- Department#signature/date. Ltd � c > .00MMENTS s S 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.$10041000 fine NOTES and DATA — (For department use) ® 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 ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products (VOTE: 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) ❑ 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 ❑ 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 MOTE: 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 Doc: INSPECTIONAL SERVICES DEPARTMENTMFORM07 Revised 2.2008 Location No. Date� Check 4A��( TOWN OF NORTH ANDOVER Certificate of Occupancy $- Building/Frame Permit Fee $ Foundation Permit Fee $- Other Permit Fee $ TOTAL e-� 25336 Building Inspector Fully Licensed and Insured • Member of MA Better Business Bureau Propagal Member of NH Better Business Bureau GAF Cert. ME # 20212 HIC Reg # 166661 5 EIN # 26-1081508 1---,1^r---MA CSL # 104728 LBBB—` General Contracting, LLC �-��- MfiI1flC 51 S. Broadway #2214 �SalemNH79 (603) 890-0084 1 10 Stevens Street #141 • Andover, MA 01810 (978) 475.0095 PROP SAL SUBMITTED TO PHONE �f 7-71 DATE STREET U j E-MAIL CITY, STATE, AND ZIP CODE,, JOB LOCATION Completely protect the home with tarps to catch falling debris. Respect and protect shrubbery and flower beds. Strip off -]— layers of roofing material down to the bare roof deck. Inspect the roof deck for structural defects. Determine the condition of the underlying plywood or boards, and repair and replace as necessary*. Inspect roof ridge for proper 112" qpacing on either side of ridge for maximum exhaust ventilation. Cut in if necessary, Install new heavy gauge 11.� `� (color) ApUM;e-J%�'M drip edge at roof eaves. Install 4-0e_C46S'4344da ice and water shield to meet manufacturer's specifications (i.e. 6 feet from roof edge, 3 feet centered in valle s, around a I skylights, chimney bases, roof penetrations and at all sidewall transitions). Install NBLL breathable roof deck protection to remainder of the roof deck. Install new heavy gauge e ��t (color) A QYL'1,0J(Y% drip edge at roof rakes. Install ®' - , ZSr'' starter strip at roof eaves and r <es. �— `' Install i �f �i.%+� �ii�i _��� desired cololt &/ (color / Install new flashings to meet manufacturer's specifications. (i.e. sidewalls, chlmn s and roof penetrations). Install (feet) of �� Skn ne� I`_t'��ridge vent at roof ridge to allow maximum ventilation. Hand nail to ensure proper fastening. Install Z/!E�L (feet) of t• j'X 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. Notes: C G\ CC, ^R c ) Edmunds General Contracting will: • Obtain all necessary construction -related permits to complete this project. • Perform work as efficiently as possible without sacrificing quality. • Furnish and install all necessary materials to complete the project. • Provide a thorough clean-up and disposal of all debris generated during project. - Edmunds General Contracting LLC agrees to commence work on/or about _1-z / and described work will be completed in about , days. -y Product Upgrade Product Upgrade 2: Contractor's employees are fully covered by workmen's compensation and liability insurance. Upon completion of the above work, all undersigned agree to execute and deliver to the contractor, their joint note in accordance with his (their) above obligations as requested by contractor. Upon refusal to do so, contractor may at its option declare the entire contract price or so much as then remains unpaid, immediately due and payable. It is agreed that, if permitted by law, contractor shall be paid by the owner(s) all reasonable costs, attorney fees, and expenses, in addition to the amount due and unpaid, that shall be incurred in enforcing the terms and conditions of the contract and/or any lien in connection herewith. MA It is further agreed that this contract may be assigned by the contractor, and also that the obligations hereof shall bind and apply to their heirs, successors or estates of the parties. munds General Contracting LLC guarantees all workmanship performed for years. q We will register&4400- i—�— fa ory enharfced warranty providing .S_6. years of material defect coverage and years of workmanship defect coverage through GAF Materials Corporation for: no charge. _ the additional cost of 'Edmunds General Contracting LLC will provide the materials, labor and disposal to replace up to 64 sq. ft. o r of decking and 20 ft of fascia at no additional cost. Any additional materials including labor and disposal will be replaced at per sheet or r % linear fool. Edmunds General Contracting, LLC agrees to furnish the material and All material is guaranteed as specified. All work to be completed in a workmanlike manner according to standard N practice. Any alteration or deviation from above specifications involving extra costs will be executed only upon written labori complete in accordance with the above specifications, for the sum orders, and will becomeanextra charge over and above the stated contract price. Contractor is not responsible for damage due to high winds, tornadoes, hurricanes, fire or other. hazards. Owner(s) agree to carry fire tomado and other of 1' _. A-0 dollars ($�) necessary insurance. Contractor is considerate of owner's landscaping and but due to the nature of the roofing r installations a damage may occur. We attempt to minimize any damage, and will not be held responsible if any vdr-fs' d age occ �ntr for is not responsible for any damage to the interior of property, including pre-existing Pa ment Terms: t -, i. q �t c It n (i. water �fa�itns Og plaster, exposed nails or conditions resultingfrom application of materials as y 54� 1 �r-(� w`epd ie a . Itertas o f attli ay need to be covered by the owner. Contractor is not responsible for damage l caused b Ice dam Guild -u All agreements are c ntin ent upon strikes, accidents, or delays beyond our control. • A deposit of (not to exceed 1/3 of the total contract) is y p' g V g p - y y due upon start of work. The balanceis due when work is completed to the satisfaction of all parties.. .4t Z C:> • A finance charge of 1.5% per month (18% per year) will be charged on past due accounts over 30 days Rcceptance of Proposal - The conditions are satisfactory and are hereby i the work as specified. Payment will be rtlad Date of acceptance: Authorized Signature: (, kdmunds General Contracting -LLC Note: This proposal may be withdrawn by us if not accepted within 4� days. ces, specifications, and DO OT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. You are authorized to do i a v Ore Signature: uthorized Signature: All home improvement contractors shall be registered. Any inquiries about a contractor or subcontrac r relating to a reg ralion should be directed to: Office of Consumer Affairs and Business Regulation, 10 Park Plaza, Suite 5170, Boston, MA 02116 (Phone: 617-973-8700). Owners who secure their own construction -related permits or deal with unregistered contractors be ex lu tl from cess to the Guarantee Fund provisions of MGL.c.142A The owner will receive a signed copy of this contract before work will commence. The owner has three (3) business days to cancel this contract and incur no penalty. Correspondence should be directed to Edmunds General Contracting LLC at the above address. Rev. 04/11 17 1. . From:Julie Dortona FaxID: Page 2 of 5 Date:5/29/2012 12:35 PM Page:2 of 5 OP ID: JD '`SII R�� CERTIFICATE OF LIABILITY INSURANCE D 051291/2 Y) 05/29112 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 rights to the certificate holder in lieu of such endorsement(s). PRODUCER 603-890-6439 PlanrightInsurance-SalemPHONE 224 Main Street Suite 3C 603-890-6521 Salem, NH 03079 James A Santo CONTACT NAME: FAX AIC Ea Ext : AIC No): E-MAIL ADDRESS: PRODUCER CUSTOMERIDp: EDMUNA INSURERS AFFORDING COVERAGE NAIC A INSURED Edmunds General Contractor LLC PO Box 2214 INSURER A:St Paul Surplus Lines Ins Co INSURER B: Riverport Insurance Company EACH OCCURRENCE $ 1,000,000 Salem, N H 03079 INSURER C: INSURER D: INSURER E: 11/11/11 INSURER F: MED EXP (Any one person) $ 5,000 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 MAYHAVE BEEN REDUCED BY PAID CLAIMS. ILCY TR TYPE OF INSURANCE POLICY NUMBER MMIDDIYEYYY FF EXP MMID YYYV LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FX] OCCUR CP572203 11/11/10 11/11/11 DAMAGE TO RENTED- - PREMISES (Ea occurrence) $ 50,000 MED EXP (Any one person) $ 5,000 PERSONAL &ADV INJURY $ 1,000,000 WS091261-(RENEWAL) 11/11/11 11/11/12 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS- COMP/OP AGG $ 2,000,000 X POLICY PRO LOC JECT $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accideno ANY AUTO BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ SCHEDULED AUTOS HIRED AUTOS PROPERTY DAMAGE $ (Per accident) NON -OWNED AUTOS $ UMBRELLA LIAB HCLAIMS-MADE OCCUR EACH OCCURRENCE $ EXCESS LIAB AGGREGATE $ DEDUCTIBLE $ $ RETENTION $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNERXECUTIVE Y / N /E OFFICER/MEMBER EXCLUDED? �Y (Mandatory In NH) N 1 A C288300042503 - NH WC288300042503 04/03/11 04/03/12 04/03/12 04/03/13 X NCSTATU- OTH- TORY LIMITS ER E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE - EA EMPLOYEE $ 100,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE- POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) C: 3A:NH & MA / David Edmunds has elected to be excluded from coverage on the NH policy. t.ct[ t Iri%.H I t MULUtI( I:ANI:t_LLAI IUN TOWNNOA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN TOWN OF NORTH ANDOVER ACCORDANCE WITH THE POLICY PROVISIONS. 1600 OSGOOD STREET NO ANDOVER, MA 01845 AUTHORIZED REPRESENTATIVE O 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD The Commonwealth ofMassachusetts Department oflndustriglAccidents D, face oflnvestigations 600 Washington Street .Boston, MA 02111 www.massgovMa Workers' Compensation Insurance Affidavit: Builders/Contractor6/ElectriciansfPlumbers Applicant Information Please Print Legibly Name (Business/Orgadrzation/individual): City/State/zip: Phone #: C C)?j -K-5 —77-73Z_ Are y an employer? Check the appropriate box: 1.02 I am a employer with ` S 4. ❑ I am a general contractor and I employees (full and/orpart-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor orpartner- ship and: have no employees working for mein any capacity. [No workers' comp. insurance required.] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] i listed on the attached sheet. x These sub -contractors have workers' comp. insurance. 5. ❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 152, §1(4), and wehave no employees. [No workers' comp, insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ EIectrical repairs or additions I LD Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other 'Any applicant that checks box#1 must also fill out the section below showingtheir workers' compensation polieyinformation. I Homeowners who submit this affidavit indicating they tie 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 their workers' comp. policy information. X am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company f v "o4 Policy # or S elf -ins. Lic. #:-yW Z'� 1 S� Co Sa! Z 02b Expiration Date: 2 e> 7— Job Job Site Address: (x City/State/Zip: 1N ,%j o t�; q� Attach a copy of the workers' compensa ionpoliey declaration page (showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A ofMGL c. 1.52 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 galnst t lator. Be advised that a copy of this statement may be forwarded to the Office of for j4pf `a3/d� coverage verification. X do Izer4by cei0*Ytrle4t0gra enc hies ofperfury that the information provided above is true and correct. i!P Official use on4,.190 nokw4lon this area, to he completed by city or town official. City or Town: Permit0cense # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. CitylTown Clerk 4. Electrical Inspector 5. Numbing Inspector 6. Other - - - Contact Person: Phone Information and -Instruction*8 Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...everyperson in the service of another under any contract ofhim,- 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 o£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 employes " MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or p ermit 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 ofpublic 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) andphonenumber(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 maybe submitted to the Depart mentofIndustrial Accidents for confirmation 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' compensationpolicy, please call the Department at the number listed below. Self-insured companies should enter theirself-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 rill out in the event the Office of Investigations has to contact you regarding the applicant, PIease be sure to fill in the permit/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 (ifnecessary) and under "Job Site Address" the applicant shouldwrite "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. More a home owner or citizen is obtaining a license or permit not related to any business or commercial venture 0.e. a dog license or permit to bum 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: Tho Commonwoalthofmbmachu.:sottq - Depaziment of Jadust&d ,A.cclaouls t?fte o IU estzgat�iga 60G Waftgtoa Street Boston? MA 02111 Tel, # 617 727,4900 ext406 ox 1-87WASS.A.F,� Revised 5-26-05 Faze 617"727-7749 D C/) > < u U) Z-40 C::' --4 M, M PCD. M > U) m ;0�C),=�;c Q x (D .,- Z rn N) 0) tz P —y. 01 M - Nh ssachusetts - Department of Pul)Iie.Safeh Board of 8uildin(y Regulations and St<indxrds Construction'Supervisor License License: CS 104728 DAVID EDMUNDS P.O. BOX 2214 SALEM, NH 03079 J' mss' Expiration: 10/3/2013 ('umn�isciuner Tr#: 104728 W W RS ao F U v 0 V ti � U v N C cm to O r'� WFyl U cn c � m � o rJ cm C �C N m Z _ O Z � O O 0 U 0 O 2' I' O O Z CD CL O CO) G C CO � V/ CD Q �FE m m CD 0 CD CD LO O d S .o o cc CL C Z � V h C C C C cc O. Y/ Y♦ W W kv W U) C G CPQ w2 U w 0 a°' u. O W � CO w Q U cz w F W w H cn a U) . 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