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HomeMy WebLinkAboutBuilding Permit #715-13 - 23 OLD FARM ROAD 4/30/2013, a BUILDING PERMIT TOWN OF NORTH ANDOVER ° —7)51—J 3 APPLICATION FOR PLAN EXAMINATION ; ~ Permit NO. T Date Received Date Issued: 91 13. 0 IMPORTANT: Applicant must complete all items on this page LOCATION ,� Z, � �..�..� One family Address: ;Z� o-z.����i,�.�1,:�� 0 Addition ` PR£3PERTY t3 W�JEl u.. Print .o s No. of units: . -� MAP NCS` 'ARCEL � ZONING DISTRICT, Histanc Distri f ,y yep` 5 ..: ..� r Machin Shop Villa a <�, yes, no TYPE OF IMPROVEMENT PROPOSED USE Please Type or Print Clearly) Residential Non- Residential 0 New Building � �..�..� One family Address: ;Z� o-z.����i,�.�1,:�� 0 Addition 1i Two or more family Industrial D Alteration No. of units: Commercial E.1-Kepair, replacement ] Assessory Bldg D Others: ;y Demolition € i Other - Septic Well Floodplain r" Wetland's Watershed District "Water/Sevier,- F yr_ 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: $ FEE: $ Check No.: !2) (pt) Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to th juaranty fund Signature of Agent/Owner— ignature of contractor, y Identification Please Type or Print Clearly) OWNER: Name: f�l ( ( ,J �_ Phone: �' / �5 2KF Address: ;Z� o-z.����i,�.�1,:�� c r -r1 ib'OIITRACTOR. Name:-11 phone. Address: � < - 1 Supervisor's.to�hst'ruction License,, Exp. -Date: Home improvement License. Exp. Date. 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: $ FEE: $ Check No.: !2) (pt) Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to th juaranty fund Signature of Agent/Owner— ignature of contractor, y TOWN OF V40RTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: Date Received Date Issued: IMPORTANT• Applicant must complete all items on this page `D •>.� •x% y. ; 100YearsQld`Struct_ure .yes'tS no -MA 0; -PARCEL: ' _ P,rrnt' ZONIN,01DIST;RICT:. Histonc�Distnct� yes; no I- ,�Macfime Sfiop7Village� .yes• .. no;:. TYPE OF IMPROVEMENT ❑ New Building ❑ Addition ❑ Alteration ❑ Repair, replacement ❑ Demolition 11.`SeII, fic;; ,pWeII �,Wate�/Sewer PROPOSED USE Residential ❑ One family ❑ Two or more family No. of units: ❑ Assessory Bldg ❑ Other .b'Eloodplain, ❑_ •Wetlands Non- Residential ❑ Industrial ❑ Commercial ❑ Others: n .Watershed District,: DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: <CbNTRAic Name: _Rhone: - } . ell Supervisor s Gonstrdction LicenseExp: - t,. ��• ! • • t • [ .. .•'Y is � t � - - _ ., r a , _ Home Improvement License; Exp: Dater ARCHITECT/ENGINEER Phone: Address: Reg. No FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $925.00 PER S.F. Total Project Cost: $ EE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund :Signature of Agent/Owrier Si nature of contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plai.s r --- Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ 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 COMMENTS HEALTH 'Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes_._ Planning Board Decision: Comm Conservation Decision: Comments Water & Severer Connection/Signature & Date Drivewav Permit y DPW Town Engineer: Signature: Located 384 Osgood Street ��IRE ®EPARTitlli NT -Temp Dumpster on site yes no Located at'124 MainStreet Fire DepaKmert 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 )oc.Building Permit Revised 2010 Building Department The folawing 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 gOTE: 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 COTE: 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 e OTE: 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 app; 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 ated with the building application Doc: Doc.Building Permit Revised 2012 Location 23 v' No. 3 Date Check # 9(0-0 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $� Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 26337 Building Inspector CA m m m cn m mm CD 0 z CD o Cr j CL �. > cc O CDQ E� �. as CD O CD Qv C. CD CD O Jw� O. 0 CA �' 0 U) 91)CD CD CD C. U) v z a CD O D O z o• CD N co O W CL to CD 0 0. U) CD 0 —% 0 __Mu U) CD N I CD•� 0 CD C7 o � - -a = m cn 0; C -n .ten 0 m co CD .a CA N 0 C. CD CD a1 y O O O r0�► CQ Q' 0 N 0CD Cs 0 CD -0 0 to , � U) O �o U) n�N CL O C0W C.0 — CD CD a,CD CL CD CD rN fl, -a O O ca 0CD 0 :5 S 3 CD CD N CD �D N 0 aCD CD -0 O � _rt p1 O � O Q .0, z J p - r v (n 3 O �0 (D .t to 1 N rr Z O C 'n m M 3 -zi T O O Otl S H y T N fD0 0 A A S r m � y C � m i T 3 n S 3 7 fD It T 0 3 Q fu 0 0 m;a N v rf fl N N 3 T O D_ 7q n W D m D S C oM z cn a �v ;a m �z O � --i* z D c cn N �• C v z Z a O D O z o• CD N co O W CL to CD 0 0. U) CD 0 —% 0 __Mu U) CD N I CD•� 0 CD C7 o � - -a = m cn 0; C -n .ten 0 m co CD .a CA N 0 C. CD CD a1 y O O O r0�► CQ Q' 0 N 0CD Cs 0 CD -0 0 to , � U) O �o U) n�N CL O C0W C.0 — CD CD a,CD CL CD CD rN fl, -a O O ca 0CD 0 :5 S 3 CD CD N CD �D N 0 aCD CD -0 O � _rt p1 O � O Q .0, z J p - r v (n 3 O �0 (D .t to 1 N rr Z O W 0 O 'n m M 3 -zi T O O Otl S H y T N fD0 0 A A S m m � A rO M T 3' : 0 Otl 3 y C � m i T 3 n S 3 7 fD A O Qq S T 0 3 Q fu 0 0 C p Z m 0 N v rf fl N N 3 T O D_ 7q n W D m D S * b� II The Commonwealth of Massachusetts Print i orm Department of Industrial Accidents i� Office of Investigations 1 Congress Street, Suite 100 Boston, MSA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/PIumbers Applicant Information Please Print Legibly Name(BusinessrOrganizationrhtdividual): WinWin Properties, LLC. Address: 165 Hancock St. /State/'Lip: Braintree, MA 02184 Phone #: 781-843-7253 Are you an employer? Check the appropriate box: 1.0 I am a employer with 5 4. ❑ I am a general contractor and I employees (full and/or part-time).' have hired the sub -contractors 2. ❑ 1 am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub -contractors have working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.+ required.] 5. ❑ We are a corporation and its 3. ❑ I atn a homeowner doing all work officers have exercised their myself. [No workers' comp. right of exemption per MGL insurance required.]` c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 4. ❑ Building addition 10.0 Electrical repairs or additions 1 I .❑ zoof bing repairs or additions 1.2. repairs 13.❑ Other *Any applicant that checks box #1 must also till out the section bolow showing their workers' compensation policy information. ` 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. I ant an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Wells Fargo Inc. Policy # or Self -ins. Lic. #: 20 WEC RT8776 Expiration Date: 3112/14 3t J Job Site Address:_ _.....__________..........�_ ---------- City/State/"Lip: /�1 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 viola r. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurancroverage verification. Ido hereby certif under the pains /t d enalties of )er'u that thein ormation provided above is true and correct. 7 Sit nature: Date l� 6' r,t,,,„„ 4. 508-245-0460 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 Ilealth 2. Building .Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: Jeremy Gavin MA CSL # 100388 4 Kestrel Way Carver, MA 02330 508-245-0460 Contract for Repairs 23 Old Farm Rd. North Andover, MA After inspection of the roof it is determined that there are 2 layers of roofing material that needs to be removed. Work to be performed; O Strip 2 layers of existing shingles, existing underlayment and drip edge o Install new white drip edge, ice and water shield, felt paper, reflash chimney, new vent boots and Certainteed 30 year Architectural shingles. (color is determined by you) Our pricetfor performing this work is $7,500. As soon as we have your approval, & deposit Or .1/3 of total cost, we can begin work on the project for you. Gavin sor Mike Katz T.he'CO m6nwealth ofMas's'achusetts Department of Fire Services Office' of the Stale. Fire Marshal. ' =� P: 0. Box.I025 SLiteRcad, Stow -M -A 0I775 . APPLICATION FOR PERMIT e Date: A n:d o v e r�' ermitNo ( Cibj ar Town) (4Applicable) =afeIn accordanccwith the provisions ofNLG_L. Chapter 10 as provided in Section 5.:2 % CMR 3!+ applicatioa is hereby made '(FuII,namc.ofpersoo, Fimi or Corporation) 'State clearly Address purpose for - which peonit (Street oc P.O. Bax Cityor Towa) • isrequcsted For pcanissioato, locate .dumpster' for construe t nn.r-+• /rjPmnI t;n of buildine•. Comments: dumpster' must be .25'' from structure or 'covere when Ent' in ns,e at ( Give location by street and no., or dace cin suchmanncr as. to provied adequate identification oflocation) Name of competentoperator Cert Na, (If AppLicablc ) Datelssucd-rejected ey (Signature of -Applicant) Date of e:,psation V -/ xev $ 50 .00 Paid Due The C®.mmon Baa -dt.h Of NlaSSachusetts Department of Fire S6rvice-s Office of the State Fire Varsha.l ' P. 0. Box 1025 S4ite Road, Stow,ltiL4 01775 PERMIT Date: North Andover TermitNo (Citrj of Tovm) Di Safe Number (If Applicable.) g In accord -c": with the provisions of L G L.l 4$ Chapter* _L Iasprovided in sectiaa 577 (MR 3 4 Startt Date This Permit is granted to: I'Yl1dn 1 9.-FC�njr1L 1�� � t -I L Full name ofpersoa, Firm'or Corporation Pcrrnissionto locate dumpster for construction/renovation/demolition of building. Coraments:, dumpster must be, 25' from structure if unablwith rewired Ratrictioos:ce tolace learance dumpster must be covered with 1 wood or tarp end of -work day at ( Give locution by street and no., or describe in such manner as to provied adequate identification of location ) FecPaid .S 50.0.0 ` t j�jire Chief ire P Si This Pcrrait will cx <3 () f ' -� (gnature of ofucal Vantin rmit) Offical man g perritit ( Tide ) ,�tlr•�G'�' CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORD -ED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, 02-26-2013 THIS CERTIFICATEIS 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 SUBROGATIONIS 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 WELLS FARGO INS/PHS CONWT NAME: PA/C, Ne Ext): (860467-8730 ( (AIXC No): (877) 538-8526 260482 P:(866)467-8730 F:(877)538-8526 PO BOX 29611 ADDRESS: INSURER4S) AFFORDING COVERAGE MAIC x CHARLOTTE SC 28229 INSURER A :'Twin City Fire ins Co INSURED INSURER B INSURER C WIN WIN PROPERTIES, LLC CLAIMS -MADE L OCCUR 165 HANCOCK ST INSURER INSURER E E BRAINTREE MA 02184 INSURER F I, I 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 AFFORD -ED 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. NS LTR TYPE OF INSURANCE D iINSR SO'BR WVD �'POLICY POLICY NUMBER EFF I (MM1DD/YYYY) ICY EXP j (MMlDD/YYYYI LIMITS ' GENERAL LIABILITY _— € i OCCURRENCE $ COMMERCIAL GENERAL LIABILITY I _EACH i PREN� �IS"tSa eeneel $ CLAIMS -MADE L OCCUR ' ! a I € MED _XP (Any one person) $ _ u _ 1 t Ij PERSONAL 8, ADV INJURY S GENERAL AGGREGATE $ GFN'L AGGREGATE LIMIT APPLIES PER:€ PRODUCTS - COMP/OP AGG S ._.__J POLICY U PECTRO- LJ LOC J ( S AUTOMOBILE LIABILITY [ ' ! I ':. COMBINED SINGLE LIMIT $ j I j i ill I (Ea accident) BO ILb Y INJURY (Per ANY AUTO person) S S BODILY INJURY (Per accident) $ ALL OWNEDSCHEDULED Ui I AUTOS L AUTOS HIRED AUTOS NON -OWNED ! l PROPERTY DAMAGE S (Per accident) dent) AUTOS I$ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR j CLAIMSWADE i _ U _AGGREGATE i $ j OED3IIi RETENTION S I ? $ I WORKERS COMPENSATION l V WC STATU- OTH- AND EMPLOYERS' LIABILITY YIN : _ TORY 11 TORY LIMITS I ER — A ANY PROPRIETOR/PARTNERIEXECUTIVE"'"— 1 OFFICER/MEMBER EXCLUOEDl I I E (Mandatory (Mandatory In NHS "'�" N!A: �� ( 20 WEC RTS776 03/i2/2013 111 03/12/2019 ( E.L. EACH ACCIDENT $ 500,000 '500 !f yes, describe under I I �—L E.L.' $ DISEASE - EA EMPLOYEq' 000 DESCRIPTION OF OPERATIONS below II E.L. DISEASE •POLICY LIMIT $ 500 , 000 I DESCRIPTION OF OPERATIONS I LOCATIONS i VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is rettuired) Those usual to the Insured's Operations. Frank Maranelli is an Additional Insured per the Business Liability Coverage Form SS0008, attached to this policy. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE Frank Maranelli DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 439 WASHINGTON ST FL 1 AUTHORIZE R PRES£NTATiVE - BRAINTREE, MA, 02184��ad���^� r' 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD n A m ge > In meso ;a oD D C v w s w <Z Z w amA nom; �� •C;- w co � w ° fy co 0 Polk n O ? A , C1 t 1