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HomeMy WebLinkAboutBuilding Permit #1234-2016 - 270 BRENTWOOD CIRCLE 5/25/2016 l 1� to LfNORTF� BUILDING PERMIT OF,tLED ,6Aao TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION i � 1• Permit No#: � `� Date Received �qs q�TEo�P �cy SHCHUS Date Issued: I ORTANT:Applicant must complete all items on this page LOCATION d pe&J-1�00 d C � - L Print PROPERTY OWNERc�0 Print 100 Year Structure yes o MAP _PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes: no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other p pt�c Welll: = Fl plain WetlAM g V�/atersfied D strict I` .pIWAA er/Sewer DESCRIPTION OF�WWK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: C-eT7r, )Jo Phone:(,! 9- ?97-10--( Address: ' Contractor Name: Se-71Z C Phone: G��� 38�'' sc 11 Email• JPti Address: Supervisor's Construction License: Exp. Date: g-'3-2°°6 Home Improvement License: Z pi�2 Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BUL NG PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 4 �U FEE: $ 2 Check No.: �-u Receipt No.: NOTE: Persons contracting with unregistered contra(-Ws do not av cces e guaranty fund . - ---_. _ - - =c= - Location 1 i No. �� ` — 2at ' Dated • • TOWN OF NORTH ANDOVER • Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ _ TOTAL $ _ L Check# f L� 30426 Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWER-AGE 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 PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMM S HEALTH Re 'ewed on Si mat COMMENTS -Zoning Board of Appeals:Va ' ce, Petition No: Zoning Decision/receipt submitted yes Planning Board D ision: Comments Conservation Decision: Comments- Water omments4"dater& Sewed'Connection/Signature& Date Driveway Permit DPW Town]Engineer: Signature: Located 384 Osgood Street FIRE DEPAR�4,'zM., E ' m�sp�stet ra-o3r n s1U:.N es,!�i Located at 124 Main Street ` 4 Fine Department signature/date: :;YM - C®MMENT;S rY , Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICALMovement®f 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 ease ❑ 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 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 IECC Energy code Engineering Affidavits for Engineered products IN 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 Doe:Building Permit Revised 2014 F NORTH own of . 4 ndover 0 . No. a 3 _ caG , 4m"-W- .* *" Z � o h ver, Mass, a Q' COCKICKl WICK y1' RATED 00p��S U BOARD OF HEALTH PER NII! T T L Food/Kitchen Septic System THIS CERTIFIES THAT �. BUILDING INSPECTOR 4 has permission to erect .. buildings on 41alTo... .. ...... Foundation Rough to be occupied as .........Sl�iji � ........ .... ................................................................. Chimney provided that the person acceis 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 CONSTRUCTIO RT Rough Service ..............I..... .. ............ ........ .�............................' Final BUILDING INSPECTOR 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. DiPierro & Sons Corp. 62 High Street Everett, MA 02149 (617)-389-5611 License #CS-083324 Reg. # 182002 Job Site: Kyle Cataldo 270 Brentwood Cir North Andover, MA Terms: Estimate for strip and re-roof. 1. Strip entire roof down to wood decking. 2. Re-nail all roof boards as needed. 3. Replace all rotted roof boards as needed, up to 100 lineal feet is included in contract price any additional footage will be additional charge of$2.50 per foot. 4. Provide and install six feet of ice and Water shield. 5. Provide and install 8-inch aluminum drip edge around entire perimeter. 6. Provide and install new synthetic roofing underlayment paper per code. 7. Provide and install new pipe boots. 8. Provide and install new ridge vent. 9. All flashing of chimneys,vents, and walls to comply with roof system. 10. Provide and install new lifetime architectural shingles. 11. Remove all lead flashing around chimney.and provide and install new. 12. Pull all necessary permits. 13. Clean up and remove all job related debris. For the total amount of: $19,400. Contractor's signature: U� The Commonwealth of'Massachusetts F Department of'IndustrialAecidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/E4E lectricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY, Applicant Information Please Print Legibly Name(Business/Orgauization&dividual): < (ro Sd) ') S Address: (: � �— City/State/Zip: 5,.W2P Phone#: 12Areloyex?Clrecktlio ajppioprlate box: Type of project(required)' loyer with employees(fall and/or part-time).` 7. [l New construction 2.❑lam a sole proprietor or partnership and have no employees Working for me in 8. E]Remo delhig any capacity.[No workers'comp.insurance required.] 9. ❑Demolition Irl I am a homeowner doing all work myself[No workers'comp..insmance required.]t 10 n Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole I L❑Electrical repairs or additions propiietors-with no employees. 12.[]Plumbing repairs or additions 5.❑lam a general contractor and I have hired the sub-contractors listed on the attached sheet. 13. oof repairs These sub-contractors Have employees and have workers'comp.instrance.t 6.F1 We are a corporation and ifs officers have exercised their right of exemption per MGL c. 14.[]'Other 152,§1(4),and we have no.employees.[No workers'comp.insurance required.] *Any applicantthat checks box4l must also fill out the section below showing their workers'compensation policy information. t Homeowners who snbinif'this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors 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. Ifthe sub-corilractors have employees,[liey must provide their woflceFs'comp.po4cy number. X awn an employer that is p'iovidiing workersp compensation insurance for my employees.'.below is the policy and job site information. , Insurance Company Name; T�_VyUr? �Policy#or Self-ins,Lie.#: S D-1 �L �Job Site Address: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL o. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. X do hereby ce pains andpenalties ofpelju at the information provided above is true and correct. Si tore: Date' s � Official use only. Do not write in this area,to be completed by city or town offzciaz 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 a iployers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as ...overy person in the service of another under any contract of hire, expxess 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 anotherwho 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=contractoi(s)name(s),address(es)and-phone number(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 may be submitted to the Department of Industrial 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 oz if you'are required to obtain a workers' compensation policy,please call the Department•at the number listed below. Self-in"sured 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 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(if necessary)and under"fob Site Address"the applicant should-w ite"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 permit 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 Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 Tel.#617-727-4900 ext.7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia ACORO® CERTIFICATE OF LIABILITY INSURANCE 77YYYY ) 10/16 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 endorsemengs). PRODUCER CONTACT NAME: Sabatino Insurance Agency PHONE Fax(617) 387-7466 (617) 381-9186 IAICN. / No: 564 Broadway E-MAIL ADDRESS: Everett, MA 02149 INSURE S AFFORDING COVERAGE NAIC# INSURERA:PENN AMERICA INS CO INSURED INSURER B:Safety Insurance Dipierro & Sons Corp INSURER C:American Zurich 62 High Street INSURER D: Everett, MA 02149 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 ADDL SUBR POLICY EFF POUCY EXP LTR TYPEOFINSURANCE INSR WVD POLICY NUMBER M/DDIY MM/DDVYYYY LIMITS A GENERAL LIABILITY PAV0053526 5/14/16 5/14/17 EACH OCCURRENCE $ 1,000,000 O R COMMERCIAL GENERAL LIABILITY DPREMISES AMAGE (EaaEoNCTED $ _100,000 CLAIMS-MADE 1-1 OCCUR MED EXP(Anyone Person) $ 51000 PERSONAL&ADVINJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER PRODUCTS-COMPIOP AGG $ 2,000,000 POLICY PRO LOC $ ,ECT F B AUTOMOBILE LIABILITY 6232564 2/25/16 2/25/17 Ceaocide�DitSINGLELiMfi $ ANYAUTO BODILY INJURY(Per person) $ 100.000 ALLOWNED SCHEDULED BODILY INJURY(Per accident) S 300,000 AUTOS AUTOS HIREDAUTOS _AUTOS NON-OWNED erracccide tDAMAGE $ P 100,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ C. WORKERS COMPENSATION 6ZZUB—00O2960 5/14/16 5/14/17 I TORY LIMITS WCSTATU- OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 100,000 OFFICERMIEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yyes describe under DESlRIPTIONOFOPERATIONS 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 regri red) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED TAiNE _ - © 1988-20 10 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: C�/✓ze�poara��u ruaeaf�o��Qoae��t�nit. Office of Consumer Affairs&Business Regulation t HOME IMPROVEMENT CONTRACTOR Type: Registration 182002 i1`�`` Corporation Expiration 59.812017 A - DIPIERRO&SONS CORP. CIRIACO DIPIERROi---i , 51 SYCAMORE EVERETT,MA 02149 Undersecretary t Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-083324 JERRY C DIPIERRtp 'r 51'Sycamore Strut o,ti Everett MA 0214 ( , i Expiration Commissioner 08/13/2016