HomeMy WebLinkAboutBuilding Permit #524-2017 - 337 MARBLERIDGE ROAD 11/16/2016Permit No#: 6o2
Date Issued: //A�
-- ^ - 1- n.-- a.%
LOCATION,,.
Y
P'R G) P ERT' . OWNE
t MAP ,.
BUILDING PERMIT ✓ORT
TOWN OF NORTH ANDOVER
APPLICATION FORPLAN EXAMINATION'--
Date Received
LWORTANT: Applicant must complete all items on this page
Pri
-7
W&
yes
r I
nt ho
44,
is
CEL Historic 11)[9trib
s no
MachinaY
9h6pVqla e ye n
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
0 New Building
KOne family
0 Addition
El Two or more family
0 Industrial
IkAIteration
No. of units:
0 Commercial
0 Repair, replacement
El Assessory Bldg
[I Others:
0 Demolition
0 Other
Septic Ee
EPl.b 0 t amQWetlan s
. -a f -_ , StH6
DESCRIPTION OF WORK TO BE PERFURIVIED:
ge54c%A (L R,,4
Identification - Please Type or Print Clearly'
OWNER: Name: Phone:
Address:
C11age
C
Contractor Nd P.hbr)e;..._
V.7
Supefvisors T_f q n L i de F1 S .9
i=xnm
0* ;-
H: Mp 1mpicense
JI-
xJDDate
ARCHITECT/ENGINEER Phone:
Address: Req. No.
FEE SCHEDULE. BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Total ProjOGt COSI: $ -FEE:
Check No.: and
cess the arantyf
NOTE: Persons contracting
witiz unregistered con FS
n r
Building Department
The following is a list of the required forms to be filled out for the appropriate permit to be obtained.
r
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
o Copy Of Contract
❑ Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (if Applicable)
o Mass check Energy Compliance Report (If Applicable)
❑ 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)
Ei 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
DOTE: 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
Doe: Building Permit Revised 2014
Plans Submitted ❑
Plans Waived 11. Certified Plot Plan ❑ Stamped Plans ❑
Ti'PE 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 v U FORM
PLANNING & DEVELOPMENT Reviewed On
COMMENTS
Signature.
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH
COMMENTS
Reviewed on
Sianature
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
0
Planning Board Decision: Comments
Conservation Decision:
Comments
Water & Sewer Connection/Signature & Date Driveway Permit
--
'Engineer: Signature:
FIRE DEPART jUj, ,� Located 384 Osgood Street
Located at 124. Main Street —no—Dumpster on site yes no
Fire Department si jnature/date
COMMENTS
-imension
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
®ANGER ZONE LITERATURE: Yes No
MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine
Doc.Buildang Pemit Revised 2014
Location
No. i7 Z — 20(7 r _ Date 1v � lG � k("
I
Check #2 0 7
3`197
TOWN OF NORTH ANDOVER
Certificate of Occupancy
Building/Frame Permit Fee
Foundation Permit Fee
Other Permit Fee
TOTAL
i
i
U Building Inspector
{i.
lJ
3
0
H
! J 16.
o �
�o
0 cc
CL
c�
a• y O Q
o '00,
E Q
U)
A N O
E
02
Z= o =
0 Cc
ca
V y
O Cc
N J
C1 �
o' >
Cc
y °'
.__ -0 o
cm U) O =
_ ,ova
'a N N
EO C
J- C z
- N o 0
CM > o
= o�
Q CL
� O o = c
= m .
Q a�
F— p w.2 m
ujW = -0cn w O O
LL N d y =
N •CL =
w E
W
U CD O
U) CL ;� _
2 R o OL = O
H s - CL 0 U
ti
N
W
O
DC
z
0
.E
L
CL
ccs
CL
O
.CL
U
to
CL
U)
w
L
O
V
U)
O �c
mm
mo
o
�a
C -a
Cc cc
J -0
O 42)
z 0
CLU)
r_
J
2
LL
O
O
fd
c
L
Y
y�
-D
O
O
LL
ate+
T
N
Y
O.
D)
N
O
Z
Z
�m
C
O
Y
ra
C
3
O
LL
wG
3
O
K
>
v
E
S
U
m
c
LL
O
CL
LM
Z
Z
m
J
n'
OD
3
O
2'
—
cD
LL
0
Vaf
Z
u
~
W
W
b4
3
O
ar
Z
DJ
N
m.
S
LL
O
LLIC
Z
CA
c7
l7D
3
O
(if
iD
C
LL
W
Q
W
0
LU
5
LL
O
c
3
LD
O
Z
N
W
Y
N
�+
N
Q
D1
Y
O
N
0 cc
CL
c�
a• y O Q
o '00,
E Q
U)
A N O
E
02
Z= o =
0 Cc
ca
V y
O Cc
N J
C1 �
o' >
Cc
y °'
.__ -0 o
cm U) O =
_ ,ova
'a N N
EO C
J- C z
- N o 0
CM > o
= o�
Q CL
� O o = c
= m .
Q a�
F— p w.2 m
ujW = -0cn w O O
LL N d y =
N •CL =
w E
W
U CD O
U) CL ;� _
2 R o OL = O
H s - CL 0 U
ti
N
W
O
DC
z
0
.E
L
CL
ccs
CL
O
.CL
U
to
CL
U)
w
L
O
V
U)
O �c
mm
mo
o
�a
C -a
Cc cc
J -0
O 42)
z 0
CLU)
r_
CD Roofing.
Vincent Colangelo
3 Hodgson St.
• Tewksbury, Ma 01876
978-656-8497
00 i vincentcolongelo@sbcglobal.net
HIC Llc# 170575
CSSL Lic # 105943
Nlgs K X12 r
Customer: 337 AAei4kr'•'C RA OWENS CORNING
Iv . nv�,. w zl 15-7S
PREF ERRED CONTRACTOR
Description of work Performed:
(tObtain required town permits & provide certificates of insurance & workers compensation
Provide Dumpster set on planks 'for contractors use only (materials all recycled)
Attach Large Tarps to protect adjacent finishes,.landscaping, and property.
Strip -off (f) existing layers of roofing on complete house & re -nail any loose decking
Install flinch � Aluminum Drip edging I Owens Coming Starter Shingles
14 Install Owens Corning Ice 8r Water shield 6ft at eaves, 3ft in valleys, around all penetrations
7(*Install Synthetic felt paper to entire roof
Install Owens Corning LifeTime warranty Tru Definition Duration shingles
Install new neoprene vent pipe flashings on all plumbing pipes
Install Owens Corning VentSure ridge venting with moisture guard L,
Install Owens Corning ProEdge hip & ridge cap shingles
Completely re -flash chimney with lead d. c. tl, ne Y S
(Owens Corning Preferred contractor. installation with full warranty
All work will be completed according to state and manufacturing codes and specifications. Every day.we will have the
.roof water tight, clean gutters; completely clean the job site, and use a magnet roller to collect scattered nails.
Additional work to be performed . d Ro t furl -tom I rid l v(ie
E?_T'r�
e �-' 1XI Pvc D
All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according 10 standard practices. Any alteration or deviation from the above
specifications must be made in writing on an Add-orirModification of Contracttorn and may become an extra charge over and above the amount stated herein. This
agreement is contingent upon delays beyond our control. Owners to carry fire, tomado and other necessary insurance. Our workers are fully covered by Worker's Compensation
Insurance: Homeowner, agrees to pay for all work as set forth below_ If the homeowner defaults. homeowner agrees to pay all costs of collection. Including reasonable
attorneys fees: in addition to other damages incurred by contractor. Full payment is due upon completion of work:
We propose hereby to furnish material and labor -.complete in accordance with the above specifications, for the sum of:
dollars ($ ( f UQ 6,0 ). Said amount shall be paid as follows:
k
Note: This proposal may be withdrawn by us if not accepted within C3 days.
YOU, THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS
DAY AFTER THE DATE OF THIS TRANSACTION. SEE THE ATTACHED NOTICE OF CANCELLATION FOR AN
EXPLANATION OF THIS RIGHT. THIS SALE IS SUBJECT TO THE PROVISIONS OF THE HOME SOLICITATION SALES
ACT AND THE HOME IMPROVEMENT ACT THIS INSTRUMENT IS NOT NEGOTIABLE:
Work will not begin until your right to cancel has expired andyo' id posit of
dollars ($ ), unless this agreement prowl oth e.
Signature of Contractor or authorized representative:
`(I/We) have read the terms stated herein to h beer
and hereby accept them. -- -�
Signature of Homeowner(s): __..
k
to (melus), and (ItWe) find them to be satisfactory
j'he Commonwealth of Massachusetts
_ Department of IndustrialAccidents
X Congress Street, Suite 100
Boston, MA 02114-2017
www mass.gov/dia
-r aRM 5y'y
VPa kers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Iwnbers.
TO BE FILED WITH TRE PERMITTING .A.UTHORTTx'.
Alypucajut. it, xux—u..x.,r
Name (Business/Oigabization&dividual): C
Address: 4 S0'� S�
City/State/Zip•�f PA..� C�
Axe you an employer? Check the appropriate box:
Gj,&e' b
Phone #:
I.F] I am a employer with employees (full and/or part-time)-`
2.❑ I am a sole proprietor or partnership and have no employees Working for me in
any capacity. [No workers' comp. insurance required.]
3.E] I am ahomeowner doing all Workmyseli iNo workers' comp. insurance required.] t
4.❑I am a homeowner and will be Hiring contractors to conduct all work on my property. I will
ensure that all contractors either have workers' compensation insurance or are sole
proprietors with no engloyees.
5.am a general contractor. and Ihave hired ft sub -contractors listed on the attached sheet.
These sub -contractors have employees and have workers' comp. insurance.,
6. QWe are a corporation and its. officers have exercised their right of'exemption per MGL c.
152 RIM and W have no employees. [No workers' comp. insurance required-]
vl ? � — V s:�?t / I
Type of project (required):
7. ❑ Nevi'd6nsiri'diion
8. [] RRemodelidk
9. ❑ Demolition
10 [] Building addition
11.0 Electrical repairs or. additiops
12T[]'Plumbing repairs or additions
13% n Roof repairs
14.n Other
*Any applicant that checlt box #1 must also fill out the section below showing their workers' compensation policy information:'
Homeowners who submii•th.1 affidavit indicating they are doing all work andthen 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 ave
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 thepolicy and jo% site
information.
Insurance Company Name: 11- /
�� ExpirationDate: / %� (( 7
Policy # or Self -ins. Lic. #: �
(� City/State/Zip: • L
Job Site Address:
.Attach a copy of the workers' compensation policy decl ation page (showing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a foie 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. A cog�91this statement may be forwarded to the Office of Investigations of the DIA for hasurance
coverage veru.,
Ido
pains andpenalties of perjury that the information provided above zS true Ina GUM:: C:11.
Phone #: r c — �J 1
Of use only. Do not write in this area, to be completed by city or town officiax
City or Town:
permit/License #
Issuing AuthoxR (circle one):i
1. Board of Health 2- Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Phone
Contact Person:
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their ernpl6yees.
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
receivbfor trustee of an individual, partnership, association or other legal entity, employing emplbyees..However the
owner of a dwelling house having not more than three apartments and who resides therein, or the occupant ofthe
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 b6 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
applicaiit who has not produced -acceptable evidence of compliance with the insurance coverage ieq'ufred."
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 certificates) 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'
compensatiori 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
thai 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 is (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 notrelated 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 Department's address, telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street, Suite 100
Boston, MA 02114-2017
Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE
Fax # 617-727-7749
Revised 02-23-15 www.mass.gov/dia
DATE(MMIDD'YYYY)
A� V CERTIFICATE OF LIABILITY INSURANCE 13/18/16
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 terns 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 endorsemengs).
PRODUCER _ _ - NTACT
NAME--.1-1--
Angela
AME-__ -'
Angela Westen Insurance "Agency PHONE FAC (976) 735-4095
557 Central Street EMaL (97p) 735-4094 FACc,,);
ADDRESSngela@awes ten. com
Lowell, MA 01852 _: aINSURE S AFFOROinK'r COVERAGE r. NAIC rl
INSURER A: ATLANTIC CASUALTY INSURANCE CO
INSURED INSURER a: HARTFORD UNDERWRITERS INS COMP
F O CONSTRUCTION CORPORATION
INSURER C:
_ - -- J--
4 ASTOR ST AP. 4A INSURER O:
LOWELL, MA 01852 INSURER E:
INSURERF:
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, TERMOR 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 1S SUBJECT TO ALL THE TERMS,
EXCLUSIONS ANDCONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED.BY PAID CLAIMS.
INSR' IADOLISUBR
POLICY EFF POLICY EXP i
LTR( TYPE OF INSURANCE I1 POLICY NUMBER
M/00lY MldlDDIYYYY.- LIMITS
A I GENERAL LIABILITY I L021008696-2
3/18/16 3/18/17 EACH OCCURRENCE
C,5 1_,000 000
}
}i CO(JAAERC4ALGENERALtIABF_ITY I ;
t DAMAGE TO RENTEDPREMISESP):a.CSGXr�I'_6
S 100,Q0 —0—
S
CLAIMS -MADE OCCUR { f MED EAP (Any w -a eason)
5 l_'00.0_'_00'0
PERSONAL& ADV INJURY
1
GENERAL AGGR_OATE
S 2,000,000
GEN'LAGGREGATE. LLiMIT APPLIES PER
---
PRODUCTS CO MPIOP AGG
I S. 1 r QOO., OQ(j
PRO- ! LOC
- POLICY
AUTOMOBILE LIABILITY
BINED SINGLELIMIT
£aacetderl)
}
s I - _.. ._.
ANYAUTO -�
BODILY INJURY (Per aorsony
$
.AL L SCHEDULED
(.•BOOIL Y INJURY[ Per xpdenl)
$.
AUTOS AUTOS
• NON -OWNED
PRORe RTY DAMAGE
$
HIRED AUTOS AUTOS -
i
I
t
,z'Potacco").-,..
$
t UMBRELLA LIAR OCCUR -
EACH OCCURRENCE
�
~.�
_i EXCESSLIAB CLAIMS-NMDE I -
._�.
- f AGGRI-GA'TE -
i S .... .. .
DED RETENTION S t
_
$
WORKERSCOMFENSATION ! I '2E11206B-16
I 3/30/161 3/30/17 'WCSTATU- OTH-
_
ANDEMPLOYERS'UABIUTY YIN -
I TORYLIFAIIS ER
ANY PROPRIETORIPARTNERIEXECUT'NE
t EACHrtCClpCNt[-
I " 100, 000
a..-...-..-._
OFFICERVEMBEREXCLUDEO� N!A.
_E.t _
_ _.._.. -.
(Mandatory in NH)
[ L DIS FRSE -EA. FMP WY EFtnS 100,000
I I yes d escr.be under
-
. DESCRIPTION OF OPERATIONS below
E DISEASE -POLICY LIMIT,
$ 500,000
I
1
I
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (AttachACORO101,AdditionalRenmeksSchedule.itrhoresMceIsregtiredI
SHOANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE E TION DAff THEREOF, NOTICE WILL BE DELIVERED IN
TOWN OF NORTH ANDOVER ACC(VONITH THY, POLICY PROVISIONS.
1600 OSGOOD STREET SUITE 2035 Ir1__
NORTH ANDOVER, MA 0184.5 1 AUTHORIZHU REPRESENTATIVE
1
C 1988.2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
Phone: (978) 656-8497 Fax: E -Mail: vincentcolangelo@sbcalobal.net
��ie �araa�aearaioecclG� o��aQaac�iccaeCtt �`
Office of Consumer Affairs & Business. Regulation
OME.IMPROVEMENT CONTRACTOR
Registration 170575 Type:
J Expiration 11/10/2017 DBA
,rte
CD ROOFING
VINCENT COLANG4--
O`==1cV'
3 HODGSON STS .
TEWKSBURY, MA 01876 ' Undersecretary
Massachusetts Department of Public Safety
Board of Building -Regulations and Standards
License: CSSL-105943 l
Construction Supervisor Specialty
VINCENT COLANGELO �-
3 HOUGSON STREET
TEWKSBURY MA 01876
i
Expiration:
Commissioner 03/09/2018