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'�
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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