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
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Salem Vinyl Siding & Windows LLC
46 Herrick Circle, Pelham, NH 03076
603-893-8043 < * > Glenn C. 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