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HomeMy WebLinkAboutBuilding Permit #001-2016 - 34 WILD ROSE DRIVE 6/29/2015 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: ORTANT:Applicant must complete all items on this page 1 LOCATION �T` ZA !Gt a-y", PROPERTY OWNER � � 2--1 e o* ✓s�� _ Print MAP NO:b ?—PARCELJZO Y ZONING DISTRICT: Historic District yes c� Machine Shop Village yes d1u) 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 1i Septic 0 Well' 0 Floodplain D Wetlands 11 Watershed District D Water/Sewer D FTION OF WORK TO E PERF E CRI ORMI;D. Identification Please Type or Print Clearly) /� r 9 ' 7 5'393 OWNER: Name: G� h S�i Phone: Address: lId 126 u �� CONTRACTOR Name: 1 L /'�l1Qi� Phone: 7�a�� d333 ,, i Address: JQ164J �- �� c� Supervisor's Construction License: Exp. Date: Home Improvement License: ` ®�/�(� Exp. Date: / ARCHITECT/ENGINEER Phone: �. Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.MOO PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ V/ J/ FEE: $ Check No.: ���3y Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to th guaranty fund ;Signature of Agent/Ovvner _ ._ Signature of contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ElSwimming Pools El 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 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 F P lanr.,.ing Board'Decision: Comments Conslrvation Decision: Comments Water& Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date 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 Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— For department use LI Notified for pickup - Date I Doc:.Building Permit Revised 2008mi 1 Building Department 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 ❑ 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) ❑ 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) ❑ 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 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 2008mi Location 2Y1.j,I w 2I S �,I _ No. a 6�� Date (,L'911,., • - n TOWN OF NORTH ANDOVER � Certificate of Occupancy $ Building/Frame Permit Fee $ 3 dD';. Foundation Permit Fee $ - Other Permit Fee TOTAL $ Y Check#4!S??2- GtJ i � `I Buildingiinspector NORTH Town Of . ? Andover o 10 No. 2-o h ver, Mass 2615 ADR^TED ' 5 lS V BOARD OF HEALTH Food/Kitchen PER T L D Septic System 4 THIS CERTIFIES THAT y BUILDING INSPECTOR ..................... ...... .......... .... ....... s .... ........... ................. ....... .... .. .. . .. .. . .... 3- 4 has permission to erect ....... buildings on ... . �.. ,..... R..4114 Foundation �e Ir" Rough to be occupied as ........ p� ........ ..........................................:..................................................... 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough .........;:. Service .............. ..... .... ...... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz 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. t ESTABLISHED 1985 PROPOSAL DATE OF PROPOSAL 6121!2015 14 LOOK UP TO" www.expressrooter.com mike .expressroofer.com HOME IMPROVEMENT CONTRACTORS LICENSE#108126 P.O.Box 542,Chelmsford,MA 01824 CONSTRUCTION SUPERVISOR LICENCE#99497 Phone:978.256-23331 Fax:978-251-2907 • • PROPOSAL SUBMITTED TO: • • WORK TO BE PERFORMED AT: STAN ZIENTARSKI 34 WILD ROSE DR NORTH ANDOVER 978-273-5395 We hereby propose to furnish materials and perform the labor necessary for the completion of: STRIP UP TO 1 LAYER OF ASPHALT SHINGLES OFF HOUSE-WINDOW-GARAGE ROOFS CLEAN UP AND HAUL AWAY TARP OFF HOUSE TO HELP PREVENT DAMAGE TO HOUSE AND LAWN AREA COMPLETELY DE-NAIL OLD ROOFING NAILS AND RE-NAIL ROOFING BOARDS AS NEEDED WITH 8D RING SHANK NAILS ALL WALL FLASHING WILL BE INSPECTED AND REPLACED AS NEEDED Install:IKO Storm Shield 6'u from the bottom eaves IKO Storm Shield under chimney lead and 3'down on roof IKO Storm Shield in valleys Felt paper over roof boards IKO Storm Shield 3'on roof where roof buts into walls IKO Leading Edge Plus Starter strip on all roof decking edges IKO Cambridge Architectural shingles We install 6 nails per shingle for a 130 mph IKO wind warranty) Cut in 1 1/2"opening on peak of roof and install Roof Saver ridge vent along all ridge surfaces All ridge vent is Hand Nailed IKO ridge cap shingles 8"Drip edge on all outside roof edges white All shingles will be fastened using 1 '/"-1 1/2"roe in nails BLOW OFF ENTIRE ROOF AND CLEAN GUTTERS AND DOWNSPOUTS ROLL 3 FOOT MAGNETS OUT TO PICK NAILS OFF LAWN AREA FOR FINAL CLEANUP ABOVEALL LISTED ROOFING •r• OF ROOFING INCLUDES: ALL LABOR AND MATERIALS FOR THE ABOVE AND ROOFING PERMIT ALL ROOFING MATERIALS STRIPPED OFF YOUR ROOF WILL BE RECYCLED AT ROOF TOP RECYCLING 15 YEAR WORKMANSHIP LIMITED AND A LIMITED LIFE TIME IKO SHINGLE WARRANTY CLEAN UP AND HAUL AWAY ALL SHINGLES Note:No warranty on problems and/or damaged caused by ice backups No warranty on old skylights All material is guaranteed to be as specified,and the work to be performed in accordance with the drawings and specifications submitted for above work and completed in a substantial workmanlike manner for the sum of. $12,394.00 $NO MONEY DOWNS PAYMENT IN FULL AT COMPLETION OF JOB WITH K MADE OUT IN THE NAME OF Express Roofing INC. ♦ Call Toll Free Respectfully submitted -- .:- BBEI 1-888-210-ROOF ••. Note-This proposal maybe withdrawn by us it not accepted by: 612512015 All workers fully insure ACCEPTANCE OF PROPOSAL The above prices,specifications and conditions are satisiectory and are hereby accepted.You are authorized to do the work as specified. Payments will be made as outlined above.Any additional work than the above will be an extra charge. UPGRADE TO OWENS CORNING DURATION ARCHITECURAL SHINGLES WHICH INCLUDES A LIMITED 50 YEAR NON-PRORATED COVERAGE ON MATERIALS AND LABOR . 4 �•_1� yam- Signature + } Date �/K/ LG f 2� SHINGLE COLOR 4 04?, , Homeowner Is responsible for protecting and cleaning content of attic from possible dust and debris during your roofing project. Not responsible for any Issues caused by mold Any 112 in.Plywood Installation will be an additional charge of$60.00 per sheet Labor and materials We recommend new chimney lead with all new roofs for an extra charge of$495.00 per chimney y'78 69 COM _ / Doo 18 (D�xovM'� C , q�8 2-73 ij 39� "' The Commonwealth of Massachusetts Department of IndustrialAccidents I Congress Street, Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organization/Individual): Address: J b na c. City/State/Zip: �&)Q 5*rorA �, Dlf f(o Phone#: Ca �� d5(p - a�,33 Are you an employer?Check the appropriate box: Type of project(required): 1.F1 I am a employer with employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. E] Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑ Demolition 3.F-1. l am a homeowner doing all work myself.[No workers'comp.insurance required.]t 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 ❑ Building addition ensure that all contractors either have workers'compensation insurance or are sole I I.E] Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.[?([am a general contractor and I have hired the sub-contractors listed on the attached sheet. These sub-contractors have employees and have workers'comp.insurance..' 13.Yoof repairs 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other 152,§1(4),and we have no employees.[No workers'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 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: Ano4i uor,4 'Tl.sy rClhce CO . Policy#or Self-ins.Lic. gCX #:���C�fba 314513 Expiration Date:_�i tp Job Site Address:y l L/ W1 I j�Foi e— City/State/Zip: Al, /gy 1d(j il C- Attach a copy of the workers' compensation policy declaration 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 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify r e pains and penalties of perjury that the information provided /abov is tr and correct. Si nater Date: Phone#: b `� 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#: ACORQ CERTIFICATE OF LIABILITY INSURANCE DATE(MMrot1JYYYY) o4ro3/2o15 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 endorsemengs). PRODUCER NCONTACT AME: ANDRE SILVA Rapo & ]epsen Financial and Insurance Services P No,Exq: S08-87S--5600-- (� No 0 87S-588S -ADDRESS:, DDRE 1103 Commonwealth Ave - ADDRESS: Boston, MA 02215 _ INSURER(S)AFFORDING COVERAGE NAIC tr INSURER A: Essex Insurance Company INSURED ECUAUSA CONSTRUCTION INC INSURER B: AMGUARD INSURANCE CO 153 ARLINGTON ST APT 2 INSURER C: FRAMINGHAM, MA 01702 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: EXPRESS ROOFER REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED AB VE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR 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. INSR r - µ 'ADDL SUBR' i POLICY EFF— -POLICY EXP TYPE OF INSURANCE LTR I INSR.WVD POLICY NUMBER MMIDDIYYYY I MMIDD/YYYY LIMITS GENERAL LIABILITY ! TBA 0$112/2015 03112120161 EACH OCCURRENCE S 1,OOO, DAhIAGETO KE1�T«D Ow X COMMERCIAL GENERAL LIABILITY PREMISES{Ea oxurence) 1$ _ i-00-1-0-04 CLAIMS-MADE X OCCUR MED EXP(Any one person)l $ 5,000 A y _ PERSONAL 8 ADV INJURY $ 1,000,000 _ GENERAL AGGREGATE I$ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMPlOP AGG I$ 2,000,000 ~X POLICY, PRO- JECT LOC AUTOMOBILE LIABILITY (Ea awdenl) S _ ANY AUTO BODILY INJURY(Per person) ,S ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY{Per aCcadeMj±$ ` 4 NON-OWNED 1�ROPEFITY01%X11AGE �— HIRED AUTOS _ AUTOS (Per accidenlZ S UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS LJAS CLAIMS-MADE AGGREGATE I S DED RETENTIONS $ WORKERS EMPLOY RS!LI COMPENSATION R2WC6234S3 01/16/20W 01116/2016 X I TORY LIMITS I ER WC STATU- AND EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNERlEXECUTN��Y-�-/�N� E L EACH ACCIDENT i$ 1#0000000 B OFFICERIMEMBER EXCLUDED? I N I N I A , _ _ (Mandatory In NH) E L DISEASE-EA EMPLOYEE,,S 1,000,000 DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT 13 1,000,00 { DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 104,Additional Remarks Schedule,N more spikes is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CELLED BEFO THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELI ED IN ACCORDANCE WITH THE POLICY PROVISIONS. EXPRESS ROOFER mike@expressroc)fer.com AUTHORIZED REPRESENTATIVE 16 70NAS RD WESTFORD, MA 01886 01988.2010 A4,01RD4ORPOTOWN. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction SuperNi+or Specialt% License: CSSL-099497 MICHAEL L C04-TNER 16 Jonas Road ' r" Westford MA 01886 Expiration Commissioner 04/24/2016 �/fr �arru�miuu�p/ff r'I�llriura��a�c/1� Office of Consumer Affairs&Busidess Regulation OM IMPROVEMENT CONTRACTOR egistration: 108126 Type' expiration: 8113/2016 DBA MICHAEL L.CORTNER-EXPRESS ROOFING Michael Cortner 16 JONAS RD WESTFORD,MA 01886 Undersecretary