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HomeMy WebLinkAboutBuilding Permit #646-13 - 31 SUGARCANE LANE 4/5/2013BUILDING PERMIT TOWN OF NORTH ANDOVER ' APPLICATION FOR PLAN EXAMINAT4 N Permit NO: Date Received Date Issued: 7 / �►ORT1/ O��t�an eaq�0 i 1L b i 0o':� eta i TOP ACul, +fit TYPE OF IMPROVEMENT PROPOSED USE ' Residential Non- Residential ❑ New Building "ne family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial C&Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑ Wel1 ElFloodplain Cl W, etl4hds ❑ Watershed District ❑ Water/Sewer sal `el � �.� o� �-.�- � .�,� a�,� ► Ttz r�.�, l � � o ��e C Identification Please Type or Print Clearly) OWNER: Name: 6-pt-qy 06 le ( (v Phone: Address: 31 uz� rlt_� CAS CONTRACTOR Name:: i.. _ l Phone: 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: $ ,��15� v.o FEE: $ 1V - Check No.: I �� Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the gugranty fr4d TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued', IMPORTANT: Applicant must complete all items on this page CA) MhPNOV,NT Q198 -E xO �xi-aTi 41,5 - 0 urq, 1 7 H" i r jQis rlbV i t 1 24' TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential 0 New Building 11 One family El Addition El Two or more family [I Industrial El Alteration No. of units: [I Commercial 0 Repair, replacement 0 Assessory Bldg El Others: El Demolition El Other J� Floodplain N, 0 1 W. i'� I iw, qirlto 6 - DESCRIPTION OF WORK TO BE PtX1-UKMtU: Identification Please Type or Print Clearly) 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: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Lb.ignaiu e.toTi egxquwnetj 7_ Plans Submitted ❑ F3',ans Waived El Certified Plot Plan El Stamped Plans El r ._. Plans Submitted ❑ Plans 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 - U FORM PLANNING & DEVELOPMENT COMMEN DATE REJECTED DATE APPROVED ❑ ❑ CONSERVATION Reviewed on Signature COMMENTS HEALTH. Reviewed on Signature COMMEWI"S Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Commen Water & Sewer Connection/Signature & Date Driveway Permit DPW Tow IEngineer: Signa Located 384 Osqood Street FIRE DEPARTQkWt- Temp Durrlpsfer on site yes no Located at 124 Mai Street r$Ew.x '� Fire. Department=signature/date, COMMENTS `` Dimension Number of Stories:_ Total land area, sq. ft.: Total square feet of floor area, based on Exterior dimensions. ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine NOTES and DATA — deeartrnent use ® Notified for pickup - Date Doc.Building Permit Revised 2010 No Building Department The folpwing 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 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 ❑ Workers Comp Affidavit ❑ 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) a Mass check Energy Compliance Report (If Applicable) a 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) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ 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 casks if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the app: 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''stted with the building application Doc: Doc.Building Permit Revised 2012 Location No. lq-�- Check #iq?r- 26255 Date TOWN OF NORTH ANDOVER Certificate of Occupancy Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $- TOTAL $ K�' 4e -I BuMinilnspe�tor ACORD CERTIFICATE OF LIABILITY INSURANCEDATE(MM/DD/YYY1� 03/27/2013 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 policy(les) must be endorsed. If SUBROGATION IS WANED, 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). CONTACT PRODUCER NAME Rapo & ]epsen Financial and Insurance Services PHONE F�d; 617.783.1160 Arc, N,):617.783.2062 1103 Commonwealth Ave ADDRESS: Boston, MA 02215 INSURER(S) AFFORDING COVERAGE NAIC # 36 FAIRMONT STREET #1 MALDEN, MA 02148 „,SURERA: Nautilus Insurance CO INSURER 0: INSURER C: INSURER D: I { INSURER F RFVISIC)N 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. TYPE OF INSURANCE ADUL INSR 5UUH WVD POLICY NUMBER MM/D POLICY EXP MMlDD1YYYY) LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F, OCCUR NN229179 03/23/2013 03123!2014 EACH OCCURRENCE 1,000,0001 _$ PREMISES Ea occurrence) $ 100,00 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,00 GEML AGGREGATE LIMIT APPLIES PER POLICY jEC LOC PRODUCTS - COMP/OP AGG $ 2, OOO , OO $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOSNON-OWNED HIRED AUTOS AUTOS LIMIT Ea accident $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ $ Per acciderd $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ _ F _., .. WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y 7 N ANY PROPRIETORIPARTNER/EXECUTNE FIICER/MEMN ER EXCLUDED? u (Mandatory in If yes describe under DESCRIPTION OF OPERATIONS below NIA TORY LIMITS ER EL EACH ACCIDENT $ EL DISEASE = EA EMPLOYEE$ EL DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS r VEHICLES (Attach ACORD lei. Additional Remarks Schedule, If more space Is required) CERTIFICATE HOLDER r 9%0111 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE NOEL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ]OHN RAID ©198&2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) , The ACORD name and logo are registered marks of ACORD WINTE-2 OP ID: JJ r oW CERTIFICATE OF LIABILITY INSURANCE DA03127/2013Y) 03/27/2013 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 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 endomemen s . PRODUCER Phone: 617-924-1100 Bradly S. Michals Insurance Fax: 617-926-2162 A encs, Inc. 19 Main Street Watertown, MA 02472 Crown Insurance Agency, Inc. CONTACT NAME: PHONE FAX AIC No Ext): AIC No): EMAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A:Arbella Insurance Co. 17000 INSURED Winter Hill General Contractor Claudio Mcuhna Araujo 170 Main St North Reading, MA 01864 INSURER B: Acadia Insurance Company INSURER C: 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. I LTR LTR TYPE OF INSURANCE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN POLICY NUMBER MM/uDDI EFF MPIMfDnf EXP LIMITS AUTHORIZED REPRESENTATIVE GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE El OCCUR FOR BIDDING ONLY FOR BIDDIN EACH OCCURRENCE $ PREMISES Ea occurrence $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMITAPPLIES PER: 17 POLICY PRO LOC PRODUCTS - COMP/OP AGG $ $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOSIx X HIRED AUTOS NON -OWNED AUTOS 1020001551 04/0912013 0410912014 COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ 50,00 BODILY INJURY (Per accident) $ 100,00 PROPERTY DAMAGE $ 100,000 PeracadeM UMBRELLA LIAB EXCESS UAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $ Is B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? N (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A C-20-20-003174-01 03/26/2013 03126/2014 X WC STATU- OTH- RY LIMITS I I ER _ E.L. EACH ACCIDENT $ 100,00 --' '--'— E.L. DISEASE - EA EMPLOYEE $ 100,00 E.L. DISEASE - POLICY LIMIT $ 500,00 Commercial Applica DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) RE: Operations of The Named Insured CERTIFICATE HOLDER CANCELLATION XXXXXXX SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE FOR BIDDING ONLY THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. FOR BIDDING ONLY . FOR BIDDING ONLY AUTHORIZED REPRESENTATIVE FOR BIDDING ONLY FOR BIDDING ONLY FOR BIDDIN ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD —� - - - C��e �rnwr�aareuea�� a���asaaclurelld- .QAffice of Consumer Affairs & Business Regulation ME IMPROVEMENT CONTRACTOR gistration: 1168583 Type: - xpiration =:3/8/2015°., Corporation WINTER HILL GENERAL_CONTRACTOR, INC. CLAUDIO ARAUJO 170 MAIN ST �76c- NORTH READING, MA 01889' 'Undersecretary Vlassachca�Utts - Dep ai-tment oaf Public SafetN Board of Buildin4l .Refgulations and Standards Construction Supervisor License License: CS _105185 CLAUDIO ARAUJO; 163 HANCOCKST NO -1 EVERETT, MA 02149 n Expiration: 7/136GS I ('anal nc mci. 7T#: 10518 rY Print Form . The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations I Congress Street, Suite 100 Boston, MA 02114-2017 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leeibly Name (Business/Organization/Individual): (Ail N-T-C--fZ i'(6,Ap.Y-Qj Address: `_)-0 t�A�I A. S i ity/State/Zip: " , 1�7 A/A Phone #: _'r?l - . 3d 1 - I Are you an employer? Check the appropriate box: I am a employer with 4. ❑ I am a general contractor and I _ employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub -contractors have working for me in any capacity. employees and have workers' [No workers' comp. insurance required.] comp. insurance.: 5. ❑ We are a corporation and its ❑ I am a homeowner doing all work officers have exercised their myself [No workers' comp. right of exemption per MGL insurance required.] t c. 152, § 1(4), and we have no employees. [No workers' coma. insurance reauired.l Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. ❑ Electrical repairs or additions 11. ❑ Plumbing repairs or additions 12. ❑ Roof repairs 13. ❑ Other *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 insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy # or Self -ins. Lic. #: k k>C_ D/ Expiration Dat Job Site Address: b 1 9 v6 !tR_lAl,1 l-e� L J,-) City/State/Zip: 0. A 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 $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penallies of perjury that the information provided above is true and correct Phone #: -YT b - — I'M Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: .VINTER HILL PROPOSAUESTIMATE 170 Main St, Worth Reading, M& 01854 791-M-1991 Claudio Araujo—License CS 105185 www.vAnterhglgc.com Email: &T CD/e //0(O -j V :5/v. C.OA,\ "J) S v C'" -C A ^.-e. o(N _ Phone: l j 2 0 9 Date: Tice following paragraphs describe the work that will be perfommd. • Remove existing shingle mof on the entire House • MM an 8 inch drip edge on all lading edges (Color. �++� �•I K 1 • • Install if feet of ice & water shield on front ming edges & valleys HU leafle NO$ 611alls per ship0le • Insall slitter strip on all Wdq edges. • Install shingle mate fell paper on all arra not covered by ice & water shield • dhamu new rage vent • hill new vent pipe flanges • • Replace any rotten or damaged roof decking plywood ( we allow 32SSF at no charge, $ 45.00t9hes theraltee • Replace arty rotten or damaged roof d=Mng ledger board-( wee allow 30 ft, at_no charge, $&OWR thereafter) • • Replace any rotten or damaged feeds or rake boards at $10.5018 • Insall GAF Timberland High deflMtion Architectural Shingles • • Remove existing bad flashing on dhknney, build kw & water shield, step flashing and grind new lad flashing into chimney • IV ;tI—Trarnslion wall; remove vinyl 910g, Insall koe & _water shknkl;;step flashing and m4notail oft" vbtyl siding • • System. Pius, weather stopper warramty.1ndudel len contrad • Shingle Color=fit w �j(a/a�' • Cos for tabor & Material for New Shingle Roof: $ f I� S .oma • �� Poymertt Terms: 113 deposit due upon slgnMg contract E 1/3 payment due upon start of job: E-�—�, .� 113 paymett due upon completion of job:. I Tates Amount Agreed To Be Pail: $ Work Scheduled to Begin: TBD Job expelled to be completed within 60 days of actual start date. Warranty: Winter Hill General Contractor Inc. guarantees all work performed for a period of (10) years. Nary problem occur we will cmrer the cos of all labor and material to domed the problem and mat the customer's mon. gaud - PMW 1111111WOF'Ry cRo e whor bill General Contractor Inc. Date MWVAer Date I C, M rA E = W Z O a m N v O LCL N N Q In ocp O r d H Z C7 G �_ m C O O LL O O w L U L: LL �. 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