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HomeMy WebLinkAboutBuilding Permit #218-2017 - 267 CHICKERING ROAD 8/31/2016 BUILDING PERMIT {�ORTy T� �� del ( vo TOWN OF NORTH AND04 2R APPLICATION FOR PLAN EXAMINATION Permit No#: `� t `�I Date Received �gssAc►Dus���5 Date Issued: � I�� IMPORTANT: Applicant must complete all items on this page LOCATION 6-7 C C go f i' /(' R o a d ,13rint PROPERTY OWNER q Rf-ma- dd1 e4 " L L� ,� Print 100 Year Structure yes n MAP PARCEL: yU l ZONING DISTRICT: Historic District yes T Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family El Addition El Two or more family El Industrial El Alteration No. of units: iommercial 9`1�epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: 5-�-',P a�� EXis�,>� A501.A1T sl,,..rrle rs� , 7►as�zl/ G e� I'c�� wrt�e!' 19-A Identification- Please Type or Print Clearly OWNER: Name:iq QemA„gder Ti-, L.L_ Phone:78/`73A-5-)63 Address: &,IL S; Wollivr-rimf) 01601 Contractor Name: Lovt-, Phone:~7 Email: QW cit,sw 2� c Act_. y1 r Address: 11!% Achdet; i Aum dile(moj'T4% , fA'9 x2-188 Supervisor's Construction License: Q`?,"?3 Exp. Date: 10-Zc t$ Home Improvement License: tJ/n Exp. Date: ARCHITECT/ENGINEER rVI)q 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. qq 00 Total Project Cost: $ ;c � , Q D , FEE: $ >4 Check No.: Receipt No.: � NOTE: Persons contracting with unregistered contractors do not have access to the guara ty fund Location 01 t v i t 6 Lf No. ✓ Date r • - TOWN OF NORTH ANDOVER r . Certificate of Occupancy $ ,/ Building/Frame Permit Fee $ _`- c� Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# Building Inspector �' Plans Submitted ❑ Plans Waived .❑I.• Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanuiag/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ ❑ 7 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 PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature • COMMENTS HEALTH Reviewed on Signature COMMENTS • '' Zoning Board of Appeals: Variance, Petition No: 7oning'Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Wafter & Sewer Connection/Si nature & Date Driveway Permit DPW Town Engineer: Signature: ,FIR DEP Located 384 05good Street ,} ARaTMENT - TempDumpster onsite;.tiyes M, no r � "i i Locatedjat`s1241MaincSt�eet• � - - - t �. 4N epartmentsignature/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) ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 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 OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks 4, 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/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 OTE: 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 2012 I ECC Energy code 4, Engineering Affidavits for Engineered products 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 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:Building Permit Revised 2014 NORT11 q Town of f 6 ndover p ..�... go No. 2I 1 Z n h ver, Mass 3 �� O COCNICNlWKK gD44TED S U i BOARD OF HEALTH Food/Kitchen PERMI T L D Septic System THIS CERTIFIES THAT .........`� . . BUILDING INSPECTOR .....T�nnAn►. ... .>,. LL .... ................ Foundation- ............... has permission to erect .......................... buildings on .... I.�r. . �... ....... Rough to be occupied as ......... "tin� .. ....M�......................................................................... Chimney provided that the person accs permit shall in every respect conform to the terms of the application Final on file in 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 CONST TION Rough 1 Service .. .. .. . .... .... ........ " Fina J BUILDIN I PECT R 1 GAS INSPECTOR Occupancy Permit Required to Occupy Building 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. Smoke Det. WELLS ROOFING COMPANY 112 Academy Avenue Weymouth,Massachusetts 02188 August 30, 2016 t: 781-331-3104 f: 781-331-5666 Ninety-Nine Restaurants 14 A Gill Street Woburn, MA 01801 Re: 267 Chickering Rd. North Andover, MA -reroof proposal Gentlemen: Wells Roofing Co. proposes to furnish all materials and labor necessary to perform the following work, on the property indi- cated above, for the sum of $29, 000. : 1 ) Obtain building permit. 2) Strip off all existing asphalt shingle roofing. 3) Install 6 ' of ice & water shield membrane along eaves. 4) Cover remainder of roof with underlayment. 5) Install aluminum drip edging along all roof edges. 6) Reroof with GAF Timberline 30-year architectural style roof shingles, color Charcoal. 7) Install a Cobra ridge vent with shingle cap. 8) Clean out gutters. 9) Promptly remove all debris. jopectf ly submitted, Accepted by: , t4f -O" e�60Date:uis Wells Residential • Commercial • Industrial The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): ) �., Address: [ ) City/State/Zip: Kik CZl 6__ Phone #: 78) -33i-310 Are you an employer?Check the appropriate box: Type of project(required): 1.[&I am a employer with J 4. ❑ I am a general contractor and I employees(full and/or part-time). * have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g. ❑Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance. 9. ❑Building addition required.] 5. ❑ We are a corporation and its 10.[1 Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.R Roof repairs insurance required.]t c. 152, §1(4),and we have no 131-1 Other employees. [No workers' comp. insurance required.] *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. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. ff� Insurance Company Name: tV 1� Policy#or Self-ins.Lic.#: Q, en tn9 Q Z)O Expiration Date:_ 2 3 ^ Job Site Address:7 b �� �ctLEs,,./( �� City/State/Zip: rlddoer VA A 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. Ido hereby certify nder the pains and penal ies of perjury that the information provided above is true and correct. Signature: e 11V��/, Date: 4 �t Phone#: 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#: A�® CERTIFICATE OF LIABILITY INSURANCE DATE 0166 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 CONTACT Select Department NAME: P Eastern Insurance Group LLC PHONE _,,,. (800)333-7234 x66807 AAIC No:(701)586-8244 233 West Central Street E-MAILADDRESS. selectwork@easterninsurance.com INSURERS AFFORDING COVERAGE • NAIC# Natick MA 01760 INSURER AAdmiral Insurance Company 4856 INSURED INSURERB:WFRE Commerce Insurance 34754 Wells Roofing Company INSURERC:Star Insurance Co 18023 112 Academy Avenue INSURERDNational Union Fire Ins Co 19445 INSURER E: Weymouth MA 02188 INSURER F: COVERAGES CERTIFICATE NUMBER-CGL 15-16 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. INSRLTR TYPE OF INSURANCE A POLICY NUMBER MM%DDY/YYYI POLICY EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAREMIMAGESES(Ea occurreRENTEDnce $ r 5O 000 P A CLAIMS-MADE X❑OCCUR CA00001222609 2/8/2015 2/8/2016 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICYFX]PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea..dent 1,000,000 ANY AUTO BODILY INJURY(Per person) $ B ALL OWNED SCHEDULED BDTXKN 2/8/2015 2/8/2016 BODILY INJURY(Per accident) $ AUTOS AUTOS XHIRED AUTOS X NON-OWNED 1 PROPERTY DAMAGE $ AUTOS Per acddent $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 EXCESS LIAB 7 6/23/2016 2/8 2016 D CLAIMS-MADE BU023013 24 / AGGREGATE $ 5,000,000 DED I X RETENTION$ 0 $ C WORKERS COMPENSATIONX WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/NLIM ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1 000,000 OFFICER/MEMBER EXCLUDED? Y❑ NIA (Mandatory in NH) C0690401 2/31/2015 2/31/2016 E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space Is required) Roofing Contractor. Lou Wells is excluded on the Workers Compensation policy. CERTIFICATE HOLDER CANCELLATION (978)688-9542 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. BUILDING DEPARTMENT 1600 OSGOOD ST, STE 2035 AUTHORIZED REPRESENTATIVE NORTH ANDOVER, MA 01845 John Hoegel/CMH2 �-�— ACORD 25(2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. INS1)25 r7n1nn51 nt Tho ArnRrl name and Inn^aro w iafamrl marka of Al-nRn i u+ Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-037338 a Construction Supervisor LOUIS M WELLS w 112 ACADEMY AVE WEYMOUTH MA 02188 9 Expiration: Commissioner 01/10/2018 t