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HomeMy WebLinkAboutBuilding Permit #254-13 - 31 BRADFORD STREET 10/1/2012 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page - LOCATION -_ - - - -_ Print? , PRQPERTY�QWNER Print', 771OO�Year pldastructure yes4 MAP'N` O 3 ' i 1 ,._e.FARCEL�._. ZONLNG DIST�RIC_T, W toric}District,, yes MachlrieShop:Villager yes, no;° TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ane family ❑Addition El Two or more family El Industrial ❑Alteration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other - - r ❑ Septic; 1Nell ❑:°Floodplain: ❑Wetlantls Watersheds©istnct _ ❑aWaterlSeweri_ _ . DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) OWNER: Name: Vr-m ,A U\ S wo Phone: Address: 31 r c korA s yT CONTRACTOR Name: A�,t5 rCc S . Plone ` ^?$'�:�J - a ,Address: . - _ - ,Supervisor's;Construction License: "� Exp' Date Homerlmprovement.License . _ ) �-� _ Exp Date° I ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ cy5'o 0 FEE: $ � Check No.: Receipt No.: ;2 5 99 6 ' NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Sign ure oaf Agent/OwnerA Signature of.contracto Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ tamped Plans ❑ I Location Date /�/ l 2-- • ' TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ g wa TOTAL $ Check# Y 25769 Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ M Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ El ? 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: Comments tconservation Decision: Comments Nater & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTM' ` Temp Dumpster on site yes no Located 6t:1244Main Strdet. Fire Department signatltrbfdate COMMENTS , i Dimension 4 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 DANCER ZONE LITERATURE: Yes Pio MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— For department use U Notified for pickup - Date Doc.Building Permit Revised 2010 i Building Department j 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 P Building Permit Application o Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work a Engineering Affidavits for Engineered products NOTE: 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 I ❑ Workers Comp Affidavit I ❑ 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 j MOTE: 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 Li 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 NOTE: 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: Doc.Building Permit Revised 2012 NORTH own o s ndover No. - t - -now ver, Mass, j� �F o �.K. 1. COCHIC N.WICK V AERATED rP5 ` S V - BOARD OF HEALTH PERMIT T LD Food/Kitchen Septic System THIS CERTIFIES THAT V J� BUILDING INSPECTOR ..................... ............... ....................... ......................................................... Foundation has permission to erect .. buildings on ..................•• Rough to be 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough ...•...... Service li .............. ... .�.................. 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. SEE REVERSE SIDE I 10/01/2012 10:02 9786819002 R W TESTA INSURANCE PAGE 01/01 ® CERTIFICATE OF LIABILITY INSURANCE ••2012 30/01/2012 milm 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.certif(cate 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 NAME: R.W. Testa Insurance Agency, Inc. AIC,N Nn, Evil: (978) 685-1150 "� N.1;078) 681-9002 855 Turnpike Street ADORE88; Ti�DI[CER CUSTOMER ID d: North Andover MA, 01845 _ INSURER(S)AFFORDING COVERAGE _ NAICS _ INSURED INSURER A :COMMerCe Insurance Company JAMES M TESTA dba INSUR¢R 8 ; TESTA BUILDING AND REMODELING INSURER C 5 APPLETON INSURER D INSURER E N ANDOVER MA 01845-3119 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. I TR RADD 99W 1D TYPE OF INSURANCE INSR WVDD POLICY NUMBER (MM�IDOMM) (MMIDDIYYYY) LIMRB A GENERAL LIABILITY 16388 6/01/2012 6/01/2013 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY / / "bw(3,9y0 R'>✓NTE6 " PREMISES Ea occurrence $ 100,000 CLAIMS MADE OCCUR / / / / MED EXP(Any one person) $ 5,0()0 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: / / / / PRODUCTS-COMP/OP AGG $ 11000,000 POLICY PRO LOC / / / / $ AUTOMOBILE LIABILITY / / / / COMBINED SINGLE LIMIT $ ANY AUTO / (Ea accident) BODILY INJURY(Per person) $ ALL OWNED AUTOS / / / / SCHEDULED AUTOS BODILY INJURY(Poraccident) 8 — HIRED AUTOS / / / / PROPERTY DAMAGE $ (Per accident) NON.OWNEDAUTOS / / / / $ UMBRELLA LIAR OCCUR / / / / EACH OCCURRENCE $ EXCESS LIAa CLAIMS-MADE / / / / AGGREGATE $ DEDUCTIBLE RETENTION $ $ WORKERS COMPENSATION / / I WO TATU- OTH- AND EMPLOYERS' UABIUTY Ey_LI QI(T_S- � ANY PROPRIErOR1PARfNER EXECUTIVE Y/N E.L.EACH ACCIDENT OFFICERIMEMBER EXCLUDED? N/A $ (Mandatory In NMI E.L.DISEASE-EA EMPLOYE $ re yes describe under / / / bESldRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS r VEHICLES (Attach ACORD 101, AddlUnaol Ramertl 8Ek-dule. 8 mom ePaee le reQulmdl RE. 31 BRADFORD ST., NORTH ANDOVER, MA 01$4$ 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 ANDOVERACCORDANCE WITH THE POLICY PROVISIONS. 1600 OSGOOD ST AUTHORIZED A2PRE3ENTATIVE NORTH ANDOVER, MA 01845 ACORD 25(2009/09) ®1988-2009 ACORD CORPORATION. All rights reserved- INS025(2ooeo9) The ACORD name and logo are registered marks of ACORD TES TA Building and Remodeling Start date 9/20/12 5 APPLETON STREET Finish date 9/30/12 NORTH ANDOVER , MA 01845 HIC Lic. 120296 Expires 11/19/13 (978) 682 2023 CSL Lic. CS 54718 Expires 6/8/14 Proposal Sept 17,2012 Proposal Submitted To: Address of work to be done Paula Travers Emma Uliano 500 Chadwick Road 31 Bradford Street Bradford ,Ma 01835 North Andover, MA 01845 Job: Re roof Obtain building permit Complete removal of all demolition and construction materials generated by Testa Building and Remodeling and its subcontractors. CONSTRUCTION : Strip the entire roof down to the sheathing Install 3' of water and ice shield. Install a 30 year Architectural roof shingle Afmance charge of 1!/2%per month(18%per year)will apply to all accounts over 30 days past due. In the event collection activity is required the customer shall be responsible for all costs associated with collection,including reasonable attorney's fees. I propose hereby to furnish material and labor complete in accordance with above specifications, for the sum of. $9,500.00 Nine Thousand Five jHundrM Dollars One- third to start,one-third after half done,one- third upon completion. r _.i Authorized signature I reserve the right to cancel this contract if of accepted in 30_days f Signature Signature DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES This form satisfies all basic requirements of the state's Home Improvement Contractor Law(MGL chapter 142A),but does not include standard language to protect homeowners.Seek legal advice if necessary.Any person planning home improvements should first obtain a copy of"A Massachusetts Consumer Guide to Home Improvement"before agreeing to any work on your residence.You may obtain a free copy by calling the Office of Consumer Affairs and Business Regulation's Consumer Information Hotline at 617-973-8787 or 1-888-283-3757 or on our website. (Owners who secure their own permits will be excluded from the Guaranty Fund provisions of Date when contractor will begin contracted work. MGL chapter 142A.) Express Warranty-Is an express warranty being provided by the contractor? No 11 Yes(all terms of the warranty must be attached to the contract) Subcontractors-The contractor agrees to be solely responsible for completion of the work described regardless of the actions of any third party/subcontractor utilized by the contractor.The contractor further agrees to be solely responsible for all payments to all subcontractors for materials and labor under this agreement. Contract Acceptance-Upon signing,this document becomes a binding contract under law.Unless otherwise noted within this document,the contract shall not imply that any lien or other security interest has been placed on the residence.Review the following cautions and notices carefully before signing this contract. •Don't be pressured into signing the contract.Take time to read and fully understand it.Ask questions if something is unclear. •Make sure the contractor has a valid Home Improvement Contractor Registration.The law requires most home improvement contractors and subcontractors to be registered with the Director of Home Improvement Contractor Registration.You may inquire about contractor registration by writing to the Director at 10 Park Plaza,Room 5170,Boston,MA 02116 or by calling 617-973-8787 or 888-283-3757. •Does the contractor have insurance?Ask the Contractor for his insurance company information so that you can confirm coverage,or ask to see:a copy of a"proof of insurance"document. •Know your rights and responsibilities.Read the Important Information on the reverse side of this form and get a copy of the Consumer Guide to the Home Improvement Contractor Law You may cancel this agreement if it has been signed at a place other than the contractor's normal place of business,provided you notify the contractor in writing at his/her main office or branch office by ordinary mail posted,by telegram sent or by delivery,not later than midnight of the third business day following the signing of this agreement.See the attached notice of cancellation form for an explanation of this right. DO NO)T SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES!!! Two iden 1 opies o the contract roust be completed and signed.One copy should go to the homeowner.The other copy should be kept by the contractor. Homeowner's Vn/ture C e/ ctor's Signature Date Date Contractor Arbitration The Home Improvement Contractor Law provides homeowners with the right to initiate an arbitration action(as an alternative to court action)if they have a dispute with a contractor. The same right is not automatically afforded to a contractor,however. The contractor would have to resolve any dispute he/she has with a homeowner in court unless both parties agree to the optional clause provided below.This clause would give the contractor the same right to arbitration as is afforded to the homeowner by the Home Improvement Contractor Law. 'The contractor and the homeowner hereby mutually agree in advance that in the event the contractor has a dispute concerning this contract,the contractor may submit the dispute to a private arbitration firm which has been approved by the Secretary of the Executive Office of Consumer Affairs and Business Regulation and the consumer shall equired to submi o such arbitration as provided In Massachusetts General Laws, chapter 142A. Homeowner's Signature Contractor's Signature For assistance with informal mediation of disputes or to register formal complaints against a business,call: Consumer Complaint Section Office of the Attorney General 617-727-8400 AND/OR Better Business Bureau 508-652-4800, 508-755-2548 or 413-734-3114 Version 2.1-11/22/201 NOTICE OF CANCELLATION YOU MAY CANCEL THIS TRANSACTION, WITHOUT PENALTY OR OBLIGATION, WITHIN THREE BUSINESS DAYS FROM THE ABOVE DATE. IF YOU CANCEL,ANY PROPERTY TRADED IN,ANY PAYMENTS MADE BY YOU UNDER THE CONTRACT OR SALE,AND ANY NEGOTIABLE INSTRUMENTS EXECUTED BY YOU WILL BE RETURNED WITHIN TEN BUSINESS DAYS FOLLOWING RECEIPT BY THE SELLER OF YOU CANCELLATION NOTICE,AND ANY SECURITY INTEREST ARISING OUT OF THE TRANSACTION WILL BE CANCELED. IF YOU CANCEL, YOU MUST MAKE AVAILABLE TO THE SELLER AT YOUR RESIDENCE, IN SUBSTANTIALLY AS GOOD CONDITION AS WHEN RECEIVED,ANY GOODS DELIVERED TO YOU UNDER THIS CONTRACT OR SALE; OR YOU MAY, IF YOU WISH, COMPLY WITH THE INSTRUCTIONS OF THE SELLER REGARDING THE RETURN SHIPMENT OF THE GOODS AT THE SELLER'S EXPENSE AND RISK. IF YOU DO MAKE THE GOODS AVAILABLE TO THE SELLER AND THE SELLER DOES NOT PICK THEM UP WITHIN TWENTY DAYS OF THE DATE OF CANCELLATION, YOU MAY RETAIN OR DISPOSE OF THE GOODS WITHOUT ANY FURTHER OBLIGATION. IF YOU FAIL TO MAKE THE GOODS AVAILABLE TO THE SELLER, OR IF YOU AGREE TO RETURN THE GOODS TO THE SELLER AND FAIL TO DO SO, THEN YOU REMAIN LIABLE FOR PERFORMANCE OF ALL OBLIGATIONS UNDER THE CONTRACT. TO CANCEL THIS TRANSACTION, MAIL OR DELIVER A SIGNED AND DATED COPY OF THIS CANCELLATION NOTICE OR ANY OTHER WRITTEN NOTICE, OR SEND A TELEGRAM TO [Name of Seller],AT [Address of Seller's Place of Business]NOT LATER THAN MIDNIGHT OFdate). I HEREBY C C L THIS TRANSACTION. Date: Buyer's Signature: alaov-j 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): -Te S 4',A, c7' Address: S Pp k-2 �-o,`, S fi o%-a\4 City/State/Zip: IV, A/J d of Lf' /A A Phone#: °� ?�!- G � �i- a-oa Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and 1 6. ❑New construction pmployees(full and/or part-time).* have hired the sub-contractors I---- 2. I am a sole proprietor or partner- listed on the attached sheet. 1 7•. [EJ Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9. ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.[1 Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑Roof repairs insurance required.] t 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 their workers'comp.policy information. ram an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: ?olicy#or Self-ins.Lic.#: Expiration Date: lob Site Address: City/State/Zip: k.ttach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). a ailure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a ine 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 if up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of nvestigations of the DIA for insurance coverage verification. do hereby cerci under the pains and penalties of perjury that the information provided above is true and correct. .i nature: Qi� f r 17 Date: 'hone 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#• Massachusetts Department of Public Safety Board of Building Regulations ulations and Standards _ Construction Supervisor License: CS-054718 JAMES M TESTA 5-APPLETON ST ° { N ANDOVER MSC 01845 a Expiration Commissioner 06/08/2014 ✓f/w t�arn�reovuuec� i o�./�aaacze�ivaeh`a Office'of Consumer Affairs&Busmess Regulafion HOME;IMPROVEMENT CONTRACTOR _ ;Registration ��120296 Type: 'Expiration 91119/2013 DBA TESTA'-BUILDINQIWREMODELfNG.4 JAMES TESTA 5 APPLETON STREE.T•�,�:Y.= N.ANDOVER,MA 01845 :: _^'` Undersecretary a; Unrestricted Buildings of any use group which contain less than 35,000 cubic feet(991m)of enclosed space. Failure to possess a current edition of the Massachusetts state'Building code is use for revocation of this license. For DPS Licensing information visit: www.Mass.Gov/DPS a - r ' License'or registration valid for individul use only before the expiration date. If found return to: " 1. Office of Consumer Affairs and Business°Regulation 1 10'Park Plaza-Suite 5170 Boston,MA 02116 4 ' Not valid without signature f 4 ii f ii p ' I