HomeMy WebLinkAboutBuilding Permit #113-2017 - 305 WINTER STREET 8/4/2016 ®� )�y BUILDING PERMIT V,oRvH p 4SS,ED '616 Vo �� 6�}`•� ry,86 AL TOWN OF NORTH ANDOVER 0 � APPLICATION FOR PLAN EXAMINATION m Permit No#: ,3 Date Received �s RHT9D S4ONUS Date Issued: ORTANT: Applicant must complete all items on this page DATION A • AROP,�ER�T�Y ®1NNFRZx V C F TOR-n10©Year Structure yyes n� -. (MAPS JPP�RCEL� Z®NING DISTRI,CTHistonc District �y s tno ,t< { d , Mach ne Sho= Vilra ee TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ^ne family [I Addition ❑Two or more family [I Industrial Jb-Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other p ptic3 L®.1Nell7 ," � Floodplain 1 lWetlands a - Se ed ®istriet¢ DESCRIPTION OF WORK TO DE PERFORMED: 4- P� Identification- Please Type or Print Clearly OWNER: Name: v cp, IS YypAl v L —oL 1 Phone: Address: 3®S w i ST 9- 1 t : ' •' Phone .��.�ervizsor s Cons cefion License= �o _ . po entLicense [Home Irnprw ou�e-m - - - - •l:.,St:—.YRt'K'1S9f�Ce-ffi'SS'L',•••• a1f.3 5r_'-w.Pl=OMAY2IM.. ARCHITECT/ENGINEER Phone: - 1 Address: Reg. No. FEE SCHEDULE.BULDING PERMIT:$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ �' �� FEE: $ (� Check No.: 00 a l / Receipt No.: © �/ NOTE: e ®�a e®�at�aeta�ag tiv�th uaar�egistered contractorado not cave a �s to the guaranty fund Si enaWre of,coti gnat_e_of Agent/Owner __ �_A� _ __ Plans Submitted ❑ Flans 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 a 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: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments 01 Watef.& Sewer Connection Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street EPFIREDARTVET �Dumser on=sife yesNT F xi Located afti124,Main+Street f ' 1 t•a rt �� Fi FeaDepartment'signatureLdate . .., rTsi }:.9 .rF- �.�°t f:�+...E, - t _ ..`h•Ya w :'h. : s.,. i=� .�..,.. r,7 COMMENTS; . rn Dimension Number of Stories: Total square feet of floor area, based on (Exterior dimensions. Total land area, sq. ft.: } , ELECTRICAL: Movement of deter 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) IJ Notified for pickup Call Email Date Time Contact Name Doc.Building Peiinit 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 ❑ Engineering Affidavits for Engineered products DTE: 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 o 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 )TE: 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 o 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 )TE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit n all cases if a variance or special permit was required the Town Clerics office must stamp the decision from the Board of Appeals hat the appeal period is over. The applicant must then get this recorded at the registry of Deeds. One copy and proof of recording oust be submitted with the building application Doe:Building Permit Revised 2014 I Location �✓'� � ,7 No. 1 '��I Date '� � . - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ ` Other Permit Fee TOTAL $ Check# !/ Building Inspector NORTH oven Of � t sAndover o No. Ah ver,ver, MaSS, Zd CoC ��«eW'c « « �1 �.A ARRA TED I•Pa�`� BOARD OF HEALTH Food/Kitchen PERMIT LD Septic System THIS CERTIFIES THAT ....... �` BUILDING INSPECTOR Foundation has permission to erect .......................... buildings on ...3.0, .....jib/././.V7m...., � � � Rough 1 to be occupied as ... .. . ..... .... �......................................................................... Chimney provided that the person accepting his 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 CONSTR ON ... . Rough Service .... . . ... ...... ..... ' Final BUILDING IN CT 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. PROPOSAL/ESTIMATE 170 Main St,North Reading,MA,01864 — 781-321-1991 Claudio Araujo—License INTER HIL TC ( L www.winterhillgc.com C ONTRACTOQ. INC. BRUCE SIIAINWAL > Email 305 WINTER S1'—NORTI-I ANDOVER-MA Phone: 978-387-3065 Date: 07/28/16 Job Location: Shingle Roof Tear Off: The following paragraphs describe the work that will be performed. • Protect wall,decks,patio,plants using tarps(winter hill is not responsible to protect any belongs into de attic and clean up) • Remove existing shingle roof on the entire house • Install an 8 inch drip edge on all leading edges(Color: ) • Install 6 feet of ice&water shield on front leading edges&valleys • Hurricane Nailing:6 Nails per Shingle • Install starter strip on all leading edges. • Install DECK ARMOR on all areas not covered by ice&water shield • Install New Ridge Vent • Install new vent pipe flanges • Replace any rotten or damaged roof decking plywood(we allow 32SF at no charge,$65.00/sheet thereafter) • Replace any rotten or damaged roof decking ledger board(we allow 32 ft.at no charge,$3.501ft.thereafter). • Install new GAF Timberline High Definition Architecture Shingles Remove existing lead flashing on chimney,install Ice&Water Shield,step flashing,and grind New Lead Flashing into Chimncy • Warranty included in contract -( ,) System Plus (X) golden pledge • Shingle Color= 61.1e al�`-' fe-0(- L. • All debris will be removed from the property Cost for Labor&Material for New Shingle Roof: $ 7,987.00 Payment Terms: 113 deposit due upon signing contract: $ Pa — f 113 payment due upon start of job: $ _ 113 payment due upon completion of job: $ Total Amount Agreed To Be Paid: $ Work Scheduled to Begin: TBD Warranty:GAF.guarantees all material for lifetime and work performed for a period of fifteen(15)years.If any problems occur we will cover the cost of all labor and material to correct the problem and meet the customer's satisfaction. Claudio Araujo,Project Manager BRUCE SHAINW b f Winter Hill General Contractor,Inc. Date Home Owner Date 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 A lit Information on Please Print Legibly Name (Business/Organization/Individual): 1 ✓ IT,,`{- 44, 1—L, �► Address: 1 � ern+ ti S r City/State/Zip: : ��r-of I ­6 Phone#: `� pL I C( Ar you an employer?Check the appropriate box: general contractor and I Type of project(required): 1. I m a employer with4._ ❑ I am a g 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 8. ❑Demolition working for me in any capacity. employees and have workers' insurance.t 9. F1 Building addition comp.[No workers' comp.insurance p• required.] 5. [] We are a corporation and its 10.F1 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 1 I.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.❑ ,Other 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 insurgence for my employees. Below is the policy and job site Information. Insurance Company Name: -t /`- co 14 70 Policy#or Self-ins.Lic.#: wC- 2c7- LO- UO 31 +q - 0 Expiration Date: Job Site.A ddress: W7 VTt-- 1 City/State/Zip: kr-^' �' 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 criminalP enalties 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 under tl�and penalties of petjuey that the information provided above is true and correct. Signature: j Date: 1 I Z. -- 11 -C 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#: WINTE-2 OP ID: JJ A�oRo CERTIFICATE OF LIABILITY INSURANCE FDA05/17/201 Y) 05/17/2016 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 Bradly S.Michals Insurance NAME: Crown Insurance Agency, Inc. _ _ _ _._-,.- .__--____...._- _ , _ PHONE aC No 617-926-2162 Agency,Inc. A/c No Exa:617-924-1100 -�� �-^ � �_ 85 Main Street E-MAIL -` Watertown,MA 02472 ADDRESS: T� Crown Insurance Agency,Inc. INSURER(S)AFFORDING COVERAGE mmT NAIC# INSURER A:Acadia Insurance Company INSURED Winter Hill General Contractor INSURER 8:Ncirthland Insurance Claudio Mcuhna Araujo 170 Main St INSURER C:Arbella Insurance Co. 17000 North Reading,MA 01864 INSURER D 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 TYPE OF INSURANCE D UB -..-- POLICY EFF POLICY EXP ------ - --- -_.._ LTR POLICY NUMBER MMIDD/YYYY MMIDDIYYYY LIMITS B X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,00 CLAIMS-MADE �OCCUR WS274235 02/13/2016 02/13/2017 DAMAGE TO ER7E6` ------"""'------__.--_. _. PREMISES(Ea occurrence $ 100,00( MED EXP(Any one person) $ 5,00 PERSONAL&ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 X POLICY PRO LOC __...._..- _....._...._ JECTPRODUCTS-COMP/OP AGG $ 2,000,00 OTHER: _-_.�____._.._.-........_-_._._..�__............ .. AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ �- 1,000,00 Ea accident _ . _ C . ANY AUTO 1020001551 04/09/2016 04/09/2017 BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED .---.- ______...__._,_._..._.........._._....._,._�..,.,,._,_,.,___......._._. AUTOS AUI OS BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE-AUT $ OS Per accWent UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ SS LIAB CLAIMS-MADE -`---GA-.- AGG_REAfE $ OED RETENTION$ $ — WORKERS COMPENSATION PER OTI- AND EMPLOYERS'LIABILITY YIN X STATUTE ANY PROPRIETOR/PARTNER/EXECUTIVEa N/A WC-20-20-003174-03 03/26/2016 03/26/2017 E.L.EACH ACCIDENT $ 500,00 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,00 If yes,describe under .---____.-..__...___..._.____.__._...._.._........ DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Operations of The Named Insured CERTIFICATE HOLDER CANCELLATION 7xxxxx SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE OR BIDDING ONLY THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. FOR BIDDING ONLY FOR BIDDING ONLY FOR BIDDING ONLY AUTHORIZED REPRESENTATIVE FOR BIDDING ONLY FOR BIDDIN U 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD -�;,�� —��e rpo�na��xa�rraeccll,�a o�G�-�liryJ�rc�rrrselli POffice of Consumer Affairs_&Business Regulation 01`.9E IMPROVEMENT CONTRACTOR ,u Massachusetts -Department of Public Safety - egistration: -16858 3•:.: Type' ' Board of Building Regulations and Standards Cor oration -- i ;=3181201`7`" p ( �..____.•___ r "WExpiration:, I •- L VII IIILI UL.LIII II)UIICI Y1�111 .. r_ -•. ' License: CS-105185 WINTER HILL GENERAL CONTRACTOR, INC.,,_ Claudio M Araujo;T f CLAUDIO ARAUJO 163HancockSt"-Am-F 170 MAIN ST' Everett MA 021' NORTH READING,MA 0,1889 -Undersecretary- ` Expiration "�.......�• - `J.�� �' 07!1312017 —� Commissioner h.. a? I