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HomeMy WebLinkAboutBuilding Permit #493-14 - 31 CARTY CIRCLE 12/11/2013TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: / DateReceived Date Issued: - IMPORTANT: LOCATION PROPERTY /OWNER _ MAP NO: Y- .PARC must complete all items on this Print 100 Year Old Structure yes;no. ZONING=DISTRICT: Historic District yes no Machine Shop Village yes n _ .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 ❑ Septic ❑ Well ❑ Floodplain ❑ Wetlands ❑ Watershed District ❑ Water/Sewer �"d 0 - DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or OWNER: Name: — . C]FZ7�7y a�Gc. W Orqr1reee- Clearly) CONTRACTOR Name: c� _ Phone:. Address:.. Supervisor's Construction License: (2,5-453.5/--5-Exp. Date: Home Improvement License: _ Exp. Date: 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: $ <37 FEE: $ Check No.: 1 I O h lr NOTE: Persons contracting with unregistered Signature,Of Agent/Own'err. Plans Submitted E Plans Waived ❑ ir)t No.: ntracto t lave chguarantyfund -LIignature of contractor_ . -I' Certified Plot Plan ❑ Stamped Plans ❑ r Location ::� _ G / No. Date 4 / 4 ? Check # ) 10 �V 27172 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ . 9-t�� Building Inspector w Plans Submitted-❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ :TYPErOR SEWERAGEDiSPOSAL . Public Sewer ❑ Tanning/Massage/BodyArt ❑ .. Swimming Pools ❑ Well ❑ Tobacco.Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc.- ❑ - - . _ Permanent Dempster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED: PLANNING & DEVELOPMENT' ❑ COMMENTS CONSERVATION COMMENTS HEALTH COMMENTS A DATE:APPROVED Reviewed on Signature Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comm Conservation Decision: :Comments Y Water & Sewer Connection/Signature & Date Driveway Permit DPW Tow;2 ]Engineer: Signature: Located 384 Osgood Street FIRE DEPARTM*,'ENT =•Temp Dumpster onsite yes no Located-at-124,Mair�tStreet. Departmdri _ ..._ Fire nt'signatu'r'e/elate 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 1.Yes No DANGER ZONE LITERATURE: Yes No MGL -Chapter 166 Section 21A -F and G min.$100-$1000 fine NU 1 1=5 and UA I A — (t -or department use El Notified for pickup - Date Doc.Building Permit Revised 2010 Building Department •: The foltowing'is�a-list of the required forms to be filled out for the appropriate. permit to be obtained. Roofivg, Siding, Interior Rehabilitation Permits o ` Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.-L Licenses o Copy of Contract Li Floor Plan Or Proposed Interior Work o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks o Building Permit Application a Certified Surveyed Plot Plan o Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses Li Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) o 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 o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cas<-,s if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the apo,al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm.tted with the building application Doc: Doc.Building Permit Revised 2012 Dec 11 13 01:39p Pappathan Insurance 6036351328 p.2 �1 A� o CERTIFICATE OF LIABILITY INSURANCE DATE(1WDDfMi, " GENERAL UAeILm X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR 72111/2013 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 pollcy(Ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions the of 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 Pappathan Insurance Agency, Inc PO BOX STH NAM � Rob Bertini AHIM EVE (603)635-1099 NC Noj; (603)635-1328 E-MAIL @P aoDREss: rob a nn athaninsurance.com Pelham, NH 03076 INSURER(Sl AFFORDING COVERAGE NAIC iJ INSURERA: C - erative Insurgrice Companies. 118686 INSURER B. Co -Operative Insurance Com a iL:S INSURED Glenn Cote INSURER c: Travelers Indernrifty Company DBA: Salem Vinyl Siding INSURER D: 46 Herrick Circle INSURERE: Pelham, NH 03076 INSURER F: — — — -- RCVIalUN NUMtitK: 1 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTNITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE JNSURANCE 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----FAD—DL 903A LTR TYPE OF INSURANCE POLICY NUMBER MMIDOYA1YYFY ryPj�jp Y EXP LMITS A " GENERAL UAeILm X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR BPO169234 05/1912013 06/1912014 1 EACH CCCURRENCE S 1 00O 000 ED - PREMISES Ea oo n S 60.000 MED EXP (An one person) $ 5,000 PERSONA_&ADVJNJURY 3 GENERAL AGGREGATE $ ZOOO.000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PIF 17-RO LOC PRODUCTS - COMolOP AGG S 2 000 000 3 B AUTOMOBILE LIABILITY CA0169203 05/17/2013 05/17/2014 COMBINED SINGLE LIMIT 1.000.000 Ea acddenf ANY AUTO ALL OWNED' 1^ SCHEDULED AJTOS x AUTOS H RED AUTOS NODI-O1tiNED AUTOS BOCdLY INJURY (Perpersoni $ BODILY INJURY(Peraccident) $ PROPERTY DAMAGE Per accident S 3 B �( UMBRELJIILJAB X OCCUR EXCESSLIAB - CLARAS-MACE UC0769467 05/19/2013 OSM912014 EACH OCCURRENCE $ 7,000 000 AGGREGA—E $ DED I X RETENTION S 10000 WORKERS COMPENSATION C AND EMPLOYERS' LIABILITY Y 1 N ANY PROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMBER EXCLUOED? y (Mandadscsib ) Ifyyes, desrribeunder DESCR1PThJNOFOPERATIONSWm- N J A ' Ti 6KUB• SB905782-A-13 03128/2013 03/24/2014 L X ^� STATU- OTH E.L. EACH ACCIDENT S 100,000 E_LDISEASE-EAEMPLAYE $ 100 000 ELL, DISEASE -POLICY LIMIT $ SOOOOO DESCRIPTION OF OPERATIONS ILOCATIONS f VEHICLES (ALtach ACORD 101, Additional Remarks Schedule, if more space is raquiredl CERTIFICnTFII nPio Jane 81 Jeff Duboff 31 Carty Circle North Andover, MA 01645 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRA77ON DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS_ AUTHORIZED O 1988-2�197.�Cr1Rl'1 CARP(!l?ATIAIu nil .:s.a.. AL:UKLJ Z5 (1010105) The ACORD name and logo are registered marks of ACORD- — , _- Printed by RLB on December 11, 2013 at 01:04PM The Commonwealth of Massachusetts Department of IndustrialAccidiks 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 Addre: City/State/Zip: 49e_� Phone #:- 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 I 6. F1New construction employees (full and/or part-time).* 2. ❑ I am a sole proprietor or partner- have lured the sub -contractors listed on the attached sheet. 7• ❑ Remodeling ship and'have no employees These sub -contractors have 8. ❑ Demolition working for me in any capacity. [No workers' comp. insurance workers' comp. insurance. 5. We are a corporation and its 9. ❑Building addition required.] officers have exercised their 10. ❑ 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.] i employees. [No workers' nn `- comp. insurance required.] 13 Otherid�i *Any applicant that checks box #I must also fill out the section below showing their workers' compensation policy information. 7 Homeowners who submit this affidavit indicating they a're 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 their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy anal job site information. Insurance Company Policy # or Self -ins. Lic. #: Expiration Date: /i Job Site Address: '3/ C . Allidle City/State/Zip: /V a1:7Ufll- Attach a copy of the workers' comp sationpolicy 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 certo und��07.ep#fns air rip 9altip ofperjury that the information provided above is true and correct 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. PIumbing Inspector 6. Other - - - Contact Person: Phone Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, • express 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 another who 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 -contractors) 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 or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured 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 "Job Site Address" the applicant should write "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 Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Mossacl?useatts Department of Industdal .Accidents Office of Investigations 6.04 Washington Street Boston, MA. 02111 Tel, # 617-727-4900 emt 406 or 1-877-MASSAFE Revised 5-26-05 Fax # 617-727;7749 www-mass,govaa CO) m m m y m U) F 1-1 _v, C O 5 w U)0 0 O 0 zN � o� �± _• CL2:c co U' -v �a �0�, CD CD o � 2) C _ CD CD 0 CD CD 0 y. CO C 5 v 0 U) z 0 .�•f O CDa O Z. O z m cn 0 cn CCS m -v m z cn O a 0 z o, CD 0 ca 0 O co CD 0 2. 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Cote -' Name of Purchaser: Jeff & Jane Duboff Date: 11-26-2013 Address: 31 Carty Circle Phone: 978-258-0668 hm.. 617-549-0525 cell City: North Andover State: Mass Zip Code:01845 Project: Alcoa/Mastic Discovery 7" Shingles vinyl siding 1. Inspect and prepare walls for sheathing or siding installation. 2. Strip labor for removal of existing wood shingles and clean up.......... requested ■ 15 yd dumpster container fee allowance ($ 800.00) included 3. Furnish and install insulation sheathing.... Green Guard ... P-38... R -Value 1.5 4. Furnish and install Alcoa/Mastic Discovery traditional 7" vinyl shakes...... Color ... Scottish Thistle........... entire house 3,200 sq. ft ...... *Manufacturer Life Time Warranty* 5. Corner Post Treatment: Custom PVC smooth 5/4" x 5 %2", j -pocket , _color White 6. Remove fascia board and install PVC 3/4 x 20" boards. ■ 5/4 material is additional ... $ 1.50/lin. ft....?? 7. Gable rake boards, install 5/4"x 8" PVC smooth with j -pocket board ■ square fascia and shadow board overlay style. 8. Cover all soffit area with White solid vinyl full vented panels. ■ increase additional venting by knocking out between holes, if necessary. 9. Remove all window casing, install 5/4"x 3-1/2" PVC smooth with j -pocket, ■ 4 pieces casings... white. ■ inspect for existing proper weather taping 10. Cover all door casings with: Same as windows including garage doors. ■ garage door jamb capping with aluminum coil material, install new ■ PVC white Thermal weather-stripping ( 3 pieces/ door) ....included 11. Furnish and install 2 Anderson #400 windows... install in garage wall. ■ no inside finish trim or paint included. 12. Furnish and install one custom Therma-Tru Smooth Star ■ S-608 ( 6 lite) + 607 ( 4 lite) SL fiberglass entrance door. ■ includes composite jamb material with 3 1/2 casing with j pocket included. ■ Set up of door is left hinge in -swing with side -light on right ■ Framing necessary to reduce opening is included. • Handle set and dead bolt is additional 13. PVC moldings to be install with plug fasteners and stainless steel nails (filled) ■ create a display sample for owner so they can decide. 14. Fixture polystyrene J -blocks to be same color as siding ...Scottish Thistle. (included) 15. Ridge -vent system ($ 200.00) on dormers to be determined after inspection of insulation. 16. Do not block or cover 2 rectangular gable vents, whole house fan exists. 17. Clean job site of scrap and debris deposit into trailer cage on site . 18. All Building Permits and Recycling Dump Fees. << $ 380.00.00 est. additional $ 800.00 allowance 19. Extra work........ requested or required: a. b. C. Scope of Project a) Strip removal and clean up of all cedar shingles .....................................$ 2,400.00 b) Dumpster allowance...............................................................................$ 800.00 c) Furnish & install 3/8" polystyrene backer insulation .................. ........... $ 2,240.00 d) Furnish & install Discovery shingles .................................................$ 17,600.00 e) Furnish & install PVC 5/4 with j -pocket factory assembled comers ....... $ 1,200.00 f) Furnish & install PVC 5/4 with j -pocket and shadow board style ............ $ 5,390.00 g) Furnish & install vinyl Soffit coverage.....................................................$ 1,330.00 h) Furnish & install PVC 5/4" with j -pocket window casing ........................$ 4,500.00 i) Furnish & install Therma-Tru Door S 608 with SL6070 ...........................$ 2,400.00 D Furnish & install 2 Anderson #400 windows ............................................$ 800.00 TotalProject Cost......................................................................................_ $ 38,660.00 Quantity Discount ............. ............................................................................ $ 1,000.00 Total Project amount......................................................................................$ 37,660.00 We agree to pay for the aforementioned materials and labor the sum of $...37,660.00... Dollars, in the following manner: Deposit herewith, $...7,660.00..... and the balance of $...30,000.00.... to be divided into .... (5) installments of $6,000.00 upon siding start, $6,000.00 middle of progress, $6,000.00 middle of progress, $6,000.00 middle of progress, final payment $6,000.00.... as deemed appropriate by thr, seller. This order is subject to acceptance by the seller. The seller shall not be liable for delays caused by strikes, shortage of material or any other causes beyond his control. THE SELLER WARRANTS THAT IT WILL PERFORM THE TERMS OF THIS CONTRACT IN A GOOD AND WORKMANLIKE MANNER AND MAKES NO OTHER WARRANTIES EXPRESSED OR IMPLIED OTHER THAN THOSE WRITTEN WARRANTIES OF THE MANUFACTURER AND FURNISHED TO THE BUYER BY THE SELLER OF ANY GOODS OR MATERIALS SUPPLIED BY THE SELLER. Title to all the materials shall remain with the seller until this contract is paid for in full and according to the terms stated previously. The seller may at his election remove the materials without liability for damage or otherwise unless payment is made within the time herein specified and retain payments made as liquidated damages without legal process. The y materials covered hereby shall remain. personal property even though affixed or attached to the building in which it may be contained. You may cancel this agreement by a written notice directed to the seller at his main 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. This constitutes the entire agreement, and not other agreement, oral or written, expressed or implied shall qualify the terms herein. Amount overdue subject to 2% interest and any legal reasonable fees necessary to collect thereof. Mass Lie; # CS 0351.52 Mass H.I.C. # 114134 Ins. Co -Operative Travelers C7� Accepted Date ... 11-27-2013............ Glenn C. Cote .................................. Accepting Purchaser.....beff- �'` . or Jane Dubo