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HomeMy WebLinkAboutBuilding Permit #1313-2016 - 28 SOUTH BRADFORD STREET 6/16/2016 00RT11 q BUILDING PERMIT TOWN OF NORTH �,PIrDbVER ° t � APPLICATION FOR PLAN EXAMINATION Permit NO: — Date Received A�'Pq<ocw,cww 1 7 �pATlD'PP y'(� Date Issued:• l6 � 9SSACHus�� IMPORTANT: Applicant must complete all items on this page „ i/,o;�✓ /�,/ i„ �:„ .., o / ,/ ..rii ✓i ,� ,dam%i i./„9 0 //% //////r mai �//MINIMIZE TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building J] One family ❑ Addition ❑Two or more family ❑ Industrial I ❑Alteration No. of units: ❑ Commercial ® Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other %/c/. i// 11/00/10104 ./,05, /%WINE ///%i strip and re-roof .+a.sphalt shingles- 20 sq I, I i Identification Please Type or Print Clearly) I OWNER: Name: Jeremy Young Phone: Address: 29 south Bradford St. North Andover, 01845 //m/seffir// %'�of/a/'%.%/j//� iii/ ✓/////�%/%/,/G/ %��i////%/%l%i .� �i.�r�,�� /„�///%//, All, ii tea/ Al /c /ice..,.,///.. ,.e..,,. �/O,/i„✓/,,�.�.,, ,, i �i�' /,. //,/ / � !o// /. //%//// /� .,% / /� s, /lei ,/ ///,//, f 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: $ 8000 FEE: $ 1�reo Check No.: 5'3 I Receipt No.: O NOTE: Persons contracting with unregistered contractors do not"have access to the guaranty fund DntuSigned by: �„” i,T/µ, irn/moi//ilii i ;:.� D�%/. i.i �'1.,/% '//'//Z�i/iji, /.,//�� ./ ,,,,.///�/,, ,,///�/,/r., / /,%l/�/"�%/i�i ✓/O.�/r�///'/i e ''�y i.?lIgi/Gtir % i } I 50212AA3A48A4C5... t - yr Plans Suvnitt-d ❑ Plans Waived,[] Certified Plot Plan ❑ Stamped Plans ❑ t- 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 m U FORM PLANNING & DEVELOPMENT Reviewed On / Signature COMMENTS fly !\ j(� f WWf. VONA QTY CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes it Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: ;iFIRE A. p T TernD rrm ster oni e sh� M 4 Located 38 Osgood Street t 00-2ed dV,124 I I �tDepartme14,S-i i I i 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 E Doc.Building Pennit Revised 2014 I 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 E Engineering Affidavits for Engineered products f OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks Building Permit Application I 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) :r 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) 4, Building Permit Application 4. Certified Proposed Plot Plan 4. 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 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 thea appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording PP must be submitted with the building application Doc:Building Permit Revised 2014 NORTH Town of 3�' - ` _ Andover O 0 No. 17)1Vz h ver, Mass o� COC NIc"IWICK �qs RATED PP�`�.(5 U BOARD OF HEALTH PERMIT T LD Food/Kitchen Septic System THIS CERTIFIES THAT ........ ,,,,,,,,,,,,,,,,,,,,,,,,,,,,, BUILDING INSPECTOR ..R �'!, ........ ... ... . ..rte................ has permission to erect ....... buildings on .29 .. ... rD�.� , ...�► Foundation ................... ........ Rough ,-�.P ft..JLW P� tobe occupied as ... .. .. ... . ........ ....... . .. ................................................................... Chimney provided that the person accepting this 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 ION Rough Service 10040 ... .. .. .. .. .............. .... .... Final BUILDING IN EC R � GAS INSPECTOR Occupancy Permit Recruited 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. Certified Safe Electric, Inc. Proposal June 14, 2016 pot"11 these,r W, home C-71 Cviif"Smart New Roof Scope of Work certifa S.I., To: From: Jeremy Young Bruce A. Davis 29 South Bradford St 50 Tower Avenue !No Andover, MA 01845 Marshfield,MA 02050 License#CS-104740 781-500-9358 Roofing Supe of Work - Approximately 20 Square X Strip, remove and dispose of existing roofing shingles and materials up to 21ayers X New Owens Coming Lifetime Shingles Duration Estate Gray Galvanized nails installed per hurricane requirements Owens ComingWeatherLock!G Granulated Self-Sealing Ice and Water Barrier entire roof X ADE34817 Cream drip edge on horizontal edges X Ventsure RidgeCat Rolled Ridge vent and caps New pipe boots for all vent pipes Includes all labor, material,clean up and disposal of rubbish Blood underlayment replacement additional, if required. dding of Soffit'Vents additional,if required. Total Installation Cost $8000.00 61tomer ACJtante V ® DATE(MM/DD/YYYY) AC� AC� CERTIFICATE OF LIABILITY INSURANCE 01/14/2016 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 CONTANAME:CT Darlene Mulcahy MALCOLM & PARSONS INSURANCE AGENCY INC AIc°No Ext: (781)344-3200 FAX No: ADDRESS: dm@malcolmandparsons.com 6 FREEMAN ST. INSURERS)AFFORDING COVERAGE NAIC# STOUGHTON MA 02072 INSURER A: TRAVELERS PROPERTY CAS CO OF AM 25674 INSURED INSURER B CERTIFIED SAFE ELECTRIC INC INSURER C: INSURER D: 50 TOWER AVENUE INSURER E: MARSHFIELD MA 02050 INSURER F COVERAGES CERTIFICATE NUMBER: 24268 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 LICY EXP LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER MM/DDIIYYYY MLICY EFF MI D// YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE 1:1 OCCUR DAMAGETO PREMISESSEa occurrence) $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO- LOC - PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINEDSINGLELIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS N/A BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE $ HIREDAUTOS AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 4 EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION X1 SPER I TATUTE OERH AND EMPLOYERS'LIABILITY Y I N ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 A OFFICER/MEMBER EXCLUDED? NIA N/A NIA 7PJUBOG17773815 08/01/2015 08/01/2016 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/lwd/workers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION 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 St Bldg 20 STE 2035 AUTHORIZED REPRESENTATIVE North Andover MA 01845 Daniel M.Crowy,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD DATE(MM/DDIYYYY) A�D® CERTIFICATE OF LIABILITY INSURANCE 6/10/2016 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 Jaime Gonsalves NAME: Malcolm & Parsons Insurance Agency HCNE Ex (781)344-3200 A(AltNo: (781)344-1425 713 Washington Street ADDRESS:jll@malcolmandparsons.com P.O. Box 527 INSURER(S)AFFORDING COVERAGE NAIC# Stoughton MA 02072 INSURERA:Northland Insurance Company INSURED INSURERB:Sentinel Insurance Company Ltd 39098 Certified Safe Electric, Inc. INSURER C:Nautilus Insurance Company 50 Tower Avenue INSURER D: INSURER E: Marshfield MA 02050-5131 INSURER F: COVERAGES CERTIFICATE NUMBER-CL1632803667 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 ADDLTYPE OF INSURANCE JUM SUER POLICY NUMBER MM DDY/YYYY MMIEFF DDIY XP LTR LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTE A CLAIMS-MADE FJ{ OCCUR PREMISES Ea occurrence $ 100,000 WS256559 7/15/2015 7/15/2016 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X PRO ❑ LOC PRODUCTS-COMP/OPAGG $ 2,000,000 POLICY❑ JECT OTHER: General Aggregate $ 5,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 B ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED 08UECZJ8251 3/7/2016 3/7/2017 BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS Per accident $ PIP-Basic $ 8,000 UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,0 0 000 C X EXCESS LIAB CLAIMS-MADE AGGREGATE $ 2,000,000 DED I I RETENTION$ AN021275 7/15/2015 7/15/2016 $ WORKERS COMPENSATIONPER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE I I ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ N/A` E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS 1 LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Electrician, Solar, Roofing Contractor CERTIFICATE HOLDER CANCELLATION certifiedsafeoffice@gmail. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 120 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. North Andover, MA 01845 AUTHORIZED REPRESENTATIVE Amne Parsons/DARL �^ — ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INSn2s/901401) The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600,Washington Street. Boston,MA 02111 www.mass.gov1dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Orgaiiiyationlindividual): certified Safe Electric, Inc Address: 50 Tower Ave. City/State/Zip: Marshfield, MA 02050 Pbone#: 781-626-4258 Are you an employer?Check the appropriate box- Type of project(required): LB I am a employer with 84. [1 1 am a general contractor and 1 6. New construction employees(full and/or p—ail--time—).* have hired the sub-contractors 7. Remodeling 2.n I am a sole proprietor or partner- tilted on the attached sheet..t ship and have no employees These sub-contractors have 8. El Demolition working for me in any capacity. workers'comp. insurance. 9, F1 Building addition tNo workers'comp. insurance 5. El We are a corporation and its required,] of10,[XI Electrical repairs or additions officers have exercised their 3,Fl I am a homeowner doing all work right of exemption per MGL 11.Q Plumbing repairs or additions myself. [No workers'comp. c. 152,§1(4),and we have no 12. x Roof repairs insurance required.]t employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box 111 tnus(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 him outside contractors must submit a now affidavit indicating such. *Contractors that check this box must attached an additional sheet showing the name offt sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'contpensittion insurancefor my employees. Below is the policy andjoh site information. Insurance Company Name: Traveler's Insurance Policy 4 or Self-ins, Lic.9: UB-OG177738-15 Expiration Date: 08/01/2016 Job Site Address: 29 South Bradford st City/State/Zip:_No.rth Andover, MA 01845 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. I do hereby certify under lite pains and penalties of perjury that the information provided above is true and correct. Signature: Date: 6/13/2016 phgLqe#.. 781-626-4258 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.CityiTown Clerk 4. Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: an 06parwt of Publfc S 'y Board of Building Ro fa"'na arAStandards I iturto ; M10474() ,- t BRUCE A DAVIS MAR$14FIEL A 0m, i's sic e 0l11��1III / ## �✓ Iw INC �,NN eqg O 71 XT / { / V ar u g ', / 3 s �r s / y mv iT ✓ / 'r;�,r3zrirr3trt n ' - z3 rrr. z+ull3 Lk-enm or regWrntion valid for iadividuai use only . office of Co nmer Affil1ra& isdO'Abefore the expfrstiot�date. 1t found return to: ,- HOME IIAPROVEMENT OONTRACTOR Office of Const Affotrs and Bminem Reguiatiou Asaw"Alow 160104 Type- 1U 1' �'�-Suite 5170 Expiration." 12'�#1Pr rate CorporationBostog,MA 02116 CER"t'IFIED SAFE ELtCtRlCAC-" BRUCE DAMS ✓ So TOWER AVE MARSHFIELD,MA 02050 underseavory Not valid ut signature i I Location.2 64 / No.j 3 / 3 '' l� Date e,,l • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ _ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ ~ Check#y-) �� w ,� 10 ., � a Building Inspector