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HomeMy WebLinkAboutBuilding Permit #800-15 - 380 WINTER STREET 4/14/2015f I�yt� PAW � � BUILDING PERMIT TOWN OF NORTH ANDOVER /' APPLICATION FOR PLAN EXAMINATION Permit NO: '� Date Received Date Issued: LL41j I PORTANT: ADDlicant must complete all items on this Dane LOCATION No l n Iyi' C5 7�`• Print PROPERTY OWNER _ {� .. _ forint MAP NO: v PARCEL:ZONING DISTRICT: Historic District y s Machine Shop Villaqe v s no no 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_ 11 Other _❑ Septic - Well - - y-- ❑ Floodplain i Wetlands Watershed District Water/Sewer S+a �Q r s-h'v i ,/-c4 . d r,' edg e . ` �-h1 hd.�(c�J"A -J I �- r40 e- Ven Li Pe fl'mz acct, --ecf vrc, ( s A;,,, (es o S-�-a_� (cc loaY G( ca. n un a h at d'i s106 &a( - Identification Please Type or Print Clearly) OWNER: Name: &'j.; s Cr Phone: I -N - 69 } 09 Address: Wl�+eir �- • N • l�ih ciovu CONTRACTOR Name:, Phone: 1�6 -,16,5a - 99.�,3- Address: d� -' Supervisor's Construction License: Exp. Date: 0 15-A 3 OL - I h 1 � Home Improvement License:Exp. Date:. 13q Taq c �• 1� 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: $A 4 a S FEE: $_ a J 3 Check No.: MI -1 IL Receipt No.:_go`� T NOTE: Persons c6tracting with unregistered ontractors do not have access to the guaranty fund Signature of Agent/Owner ,� L nature of contractor N C Plans Submitted Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swinnning Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc. ❑ Pennanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: Commen Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT Temp Dempster on site yes _ H _. _ - Located at 124 'Main Sheet _ Fire, Departmentsignatureldate __ m� COWOENTS --- 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 No MGL Chapter 166 Section 21A -F and G min.$100-$1000 fine IVU 1 tJ ana UA I A - wor department use ❑ Notified for pickup Call Ema Date Time Contact Name Doc.Building Pennit Revised 2014 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 o 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/Cross Section/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: Building Permit Revised 2014 Location G )1 ✓1 —� Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $�! Foundation Permit Fee $ Other Permit Fee $ TOTAL Check # Building Inspector < 0 O ag -1 O O - _ r- N -; � COD' N —Di =CD•�0 m Zp ? S� �• to O O UVA) CD 'r1 O. O Q m Cl)CD N W cD. o CD 2 c� D O c, @ cD �. o 0 to co 1J (1'O� 00 m c CD 5' O < to cQ --CD -� C oos(n} , oo CD - a (n 0 = • � < O. O cn o O . _- CL �Q�cn CD 'S -v CD cD N 0 00 as D NCD O i p V1 '+ (D K O W O m m ZI T :3 D) y> H z m n O 70 T :3 D1 0 a ca m m D Z cn n 0 m = ° O .D C W c Z H n O M 1 sr O cn O wx 1 C p in vZi M � 0 • T O O 3 (D=r cD p x 'C O C ND �� C J � CD CD 'V � rt O O N C7 n CD Z y A C D O •O Z r- r m aU am ��� (� cam. n--� O o M ai (� /`°V - v CD Cl)// T ; /� m cD o cn cr SU CD CD O CD f� O CD Z OCD /_/^� Vn CM CD ' — v U)W CD O � � Z 0 C Z O m CD --I O < 0 O ag -1 O O - _ r- N -; � COD' N —Di =CD•�0 m Zp ? S� �• to O O UVA) CD 'r1 O. O Q m Cl)CD N W cD. o CD 2 c� D O c, @ cD �. o 0 to co 1J (1'O� 00 m c CD 5' O < to cQ --CD -� C oos(n} , oo CD - a (n 0 = • � < O. O cn o O . _- CL �Q�cn CD 'S -v CD cD N 0 00 as D NCD O i p V1 '+ (D K O W O m m ZI T :3 D) y> H z m n O 70 T :3 D1 0 a ca m m D Z cn n 0 m = ° O .D C W c Z H n O M 1 sr O T1 O C S O wx 1 C p in vZi M � 0 Ln fD 'O ft 3 T O O 3 (D=r cD p x 'C O C ND �� J CD n N CD CD 'V � rt O O w 3 O N r' V1 '+ (D K O W O m m ZI T :3 D) 7a O C S H z m n O 70 T :3 D1 N fD z Z7 O C S m m D Z cn n 0 m T O' OJ :7 O C S .D C W c Z H n O M T O pl n S 7 T1 O C S T O C O- =$ C p in vZi M � 0 Ln fD 'O ft 3 T O O 3 2 m q 2 V Gs PAGE # of PAGES We hereby submit specifications and estimates for: / 1 �f CI to _. _ ir6 Apt— do uJYl ' � 1 n S i 1 or TSL/FVt �t A4 ri doe njeen far Iltn !a,44 Ilei, e d d r,`o 9 -dr to -ft"p- fore An or al'ailL I�e,'piacv��>9 cel (�r'S. I✓2,�T�a(I< 8" t�G1r`1'e drr°p PdVe to t Aer,w,e�l-pr_ install 62/(Qcp ice Q ci WU ter sk,*e (d fin Pates. Va((eu s aytol r�b,IlS. InSfgfl )P J✓1dQfladvvtPni- t� -tGlo rew.atnder ©� �►e rda�- d-P'c-k- r s f+J ` Ir I` I Q ILII F(a+ Coo ir\SfiaIt ,'In'jIot-HAin lddotrCt 3crewe& d.'0', WA 3'I d1a�pS. (hs+all .n4ai cobb•er w►Pt46a2aeEkitlu adb,o.,-PIt, Sw4-i,+1 ib .n ri „.► P. e r FIG ll P d ;v i is tkoe j b ber uiA 0 Pea( 4 s%' c.k rvl-em bryw- L-{oU.se 010.4 4nuy),A tared ,arbfir----4- Prom delop-I s•- dQrajvid4 rasKed Clea., 1204 5-PJerot wi`16 wotnneWc 6V-60MC r�• 5 - All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to standar practices. Any alteration or deviation from specifications below involving extra costs will be executed only upon written orders, and will become an extra charge over and above the estimate. Not responsible for recalibration of satellite dishes. Customer should cover attic space, a small amount of debris may fall into space. All agreements contingent upon strikes, accidents or delays beyond our control. We are fully insured for Workman's Comp and Liability Coverage. We propose hereby to furnish material and labor - complete in accordance with the above specifications for the sum of: $ .Seye.l j]e&4 -7�nl j sc;h al Sey>°n qu-k lred. -Tir, N E -Le ollars Wctu Q2�^�o Jbrrvt cew„nIP avr with payments to be made as follows: Any alteration or deviation from above specifications involving Respectfully extra costs will be executed only upon written order, and will Submitted become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents, or delays Note - this pro a withdrawn by us beyond our control. if not accepted within 10 days. Seven year workmanship guarantee Ac"pW ICe J o1 os / �1 •:. s: t V/�N Final Payment due upon completion_ The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work ;�natulj&- as specified. Payments will be made as outlined above. Date of Acceptance: ` 16 . Signature rKvrva�►� 20 Pichowicz Rd. Tim DarCey Billerica, MA 01821 &� License # 077587 Tel: (978) 262-9955O o IfEWQ # 139724 Fax: (978) 262-9955H.I.C. GENERAL!!ITRA1N3 www.darceygc.com "ROOFING SPECIALIST" Proposal Submitted to: Job Name: Job # I Ra,, I's Address Job Location: ' Date Plans M ot 7T6;7e7 Phone # Fax # Architect fi - 9 -6q07 We hereby submit specifications and estimates for: / 1 �f CI to _. _ ir6 Apt— do uJYl ' � 1 n S i 1 or TSL/FVt �t A4 ri doe njeen far Iltn !a,44 Ilei, e d d r,`o 9 -dr to -ft"p- fore An or al'ailL I�e,'piacv��>9 cel (�r'S. I✓2,�T�a(I< 8" t�G1r`1'e drr°p PdVe to t Aer,w,e�l-pr_ install 62/(Qcp ice Q ci WU ter sk,*e (d fin Pates. Va((eu s aytol r�b,IlS. InSfgfl )P J✓1dQfladvvtPni- t� -tGlo rew.atnder ©� �►e rda�- d-P'c-k- r s f+J ` Ir I` I Q ILII F(a+ Coo ir\SfiaIt ,'In'jIot-HAin lddotrCt 3crewe& d.'0', WA 3'I d1a�pS. (hs+all .n4ai cobb•er w►Pt46a2aeEkitlu adb,o.,-PIt, Sw4-i,+1 ib .n ri „.► P. e r FIG ll P d ;v i is tkoe j b ber uiA 0 Pea( 4 s%' c.k rvl-em bryw- L-{oU.se 010.4 4nuy),A tared ,arbfir----4- Prom delop-I s•- dQrajvid4 rasKed Clea., 1204 5-PJerot wi`16 wotnneWc 6V-60MC r�• 5 - All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to standar practices. Any alteration or deviation from specifications below involving extra costs will be executed only upon written orders, and will become an extra charge over and above the estimate. Not responsible for recalibration of satellite dishes. Customer should cover attic space, a small amount of debris may fall into space. All agreements contingent upon strikes, accidents or delays beyond our control. We are fully insured for Workman's Comp and Liability Coverage. We propose hereby to furnish material and labor - complete in accordance with the above specifications for the sum of: $ .Seye.l j]e&4 -7�nl j sc;h al Sey>°n qu-k lred. -Tir, N E -Le ollars Wctu Q2�^�o Jbrrvt cew„nIP avr with payments to be made as follows: Any alteration or deviation from above specifications involving Respectfully extra costs will be executed only upon written order, and will Submitted become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents, or delays Note - this pro a withdrawn by us beyond our control. if not accepted within 10 days. Seven year workmanship guarantee Ac"pW ICe J o1 os / �1 •:. s: t V/�N Final Payment due upon completion_ The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work ;�natulj&- as specified. Payments will be made as outlined above. Date of Acceptance: ` 16 . Signature The Commonwealth of Massachusetts Department of IndustrialAccidents a 1 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. Aimlicant Information Please Print Leeibly Name (Business/Organization/Individual): (J naregq ( rq Cgli? Address: City/State/Zip: 73)'J l e v ' C.�, IM a • O 1 Jrj1 Phone #: 7 7� ' d- 6 -::t - Y`�� Are you an�em toyer? Check the approprlate box: 1.��am a employer with semployees (&U and/or part-time).* 2.❑ lam a sole proprietor or partnership and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3. ❑ I am a homeowner doing all work myself [No workers' comp. insurance required.] t 4.E] 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 employees. 5.❑ I 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.t 6.0 We are a corporation and its officers have exercised their right of'exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 7. ❑ New construction 8. E] Remodeling 9. ❑ Demolition 10E] Building addition ILL] Electrical repairs or additions 12.E] Plumbing repairs or additions 13. Roof repairs 14. ❑ 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• t/:at isproviding iporkers' compensation insurance for my employees Below is thepolicy and job site information. Insurance Company Name: PTGe— IqM e 1'i Cat / , J Policy # or Self -ins. Lie. #: Expiration Date: Jok • l Job Site Address: 380 Win k. c City/State/Zip: lJ 1/'f Yt i / IiGr Attach a copy of the workers' compensation policy declaration page (showing the policy number and expirte). 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 cert{jy under the pains and penalties of perjury that the information provided above is trite and correct Phone #•,� rb d QI 1 Offlcial 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 #• „� ' //„ 1` ...,��., �,.,•,,./// ,� ^ //..:..../..�.-iii . Office of Consumer Affairs & Business RC -elation 'HOME IMPROVEMENT CONTRACTOR (^' Registration: 139724 Type: xpiration: 8x/2015 DBA DARCEY GENERAL CONTRACTING TIM DARCEY 20 PICHOWICZ RD BILLERICA, MA 01821 LindersccrcL•try tU Massachusetts - Department of Public Safety Board of Building Regulations and Standards Construction Supcniwr License: CS -077587 TIMOTHY P. DARCEY 20 PICHOWICZ RD. - Billerica MA 01811 - Expiration Commissioner 02/11/2016 -......-.-- au. i1- 4.1 wwc. 1 -RA UC'il VGl �< CERTIFICATE OF LIABILITY INSURANCE 1 DATE(MM/D0/YYY`n 1019719014 TA&CRATIFICATE 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. HIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE no nonnnnrn w.rn - --- IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(tes) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require and endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsemen s . PRODUCER 1CONTACT DESANCTIS INS AGCY INC 100 UNICORN PARK DRIVE WOBURN, MA 01801 28GBS INSURED TIMOTHY DARCEY CONTRACTING INC PHONE FAX (A1C, No, Ext): (A/C, No): E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE INSURER A: ACH AMERICAN INSURANCE COMPANY INSURER B: INSURER C: INSURER D• MAIC It 20 PICHOWICZ ROAD INSURER E: BILLERICA, MA 01821 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: rG FY 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 M SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS MADE F-1 OCCUR. GEN'L AGGREGATE LIMIT APPLIES PER: 7 POLICY M PROJECT ❑ LOC AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULE AUTOS HIRED AUTOS NON -OWNED AUTOS UMBRELLA LIAB H OCCUR EXCESS LIAR CLAIMS -MADE POLICY EFF DATE POLICY EXP DATE POLICYNUMBER IMMIDDtYYYY) (MMMMYYYY) LIMITS (OCCURRENCE $ 4GE TO RENTED $ MISES (Ea occurrence) EXP (Any one person) $ TONAL & ADV INJURY $ :RAL AGGREGATE Is )UCTS -COMP/OP AGG 1 $ BWEDSINGLE 1$ LIMIT (Ea accident) BODILY INJURY $ (Per person) BODILY INJURY $ (Per accident) PROPERTY DAMAGE $ (Per accident) OCCURRENCE 1=rATr . RETENTION $ $ A WORKER'S COMPENSATION AND WC STATUTORY OTHER EMPLOYER'S LIABILITY YN UB -2E411683-14 08PY1J2014 08/22/2013 I LIMITS ANY PROPERITORiPARTNER/EXECUTIVE a WA E. L EACH ACCIDENT $ 100,000 OFFICERIMEMBER EXCLUDED? (Mandatory in WH) E.L. DISEASE - EA EMPLOYEE $ 100,000 If yes, desedbe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ $00,000 DESCRIPTION OF OPERATIONS!LOCATIONSNEHICLES/RESTRICTIONS/SPECIAL ITEMS THIS REPLACES ANYPRIOR CERTIFICATE ISSUED TO THE CERnRCATE,HOLDER AFFECTING WORKERS COMP COVERAGE. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION DATE THEREOF, NOTICE WILL BE DEUV IN ACCORDANCE WITH THE POLICY PRO AUTHORIZED REPRESENTATIVE m of ACORD