HomeMy WebLinkAboutBuilding Permit #998-2016 - 39 HIGH STREET 3/24/2016k
BUILDING PERMIT
TOWN OF NORTH ANDOVER
AV&-�-VLXPPLICATION FOR PLAN EXAMINATION
6i%-2-�I� Date Received
Permit No#: I I r --
Date Issued:
IMPORTANT: Applicant must c(
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TYPE OF IMPROVEMff-N--T
PROPOSED USE
Resi Te—ntial
idential
0 New Building
0 One family
0 Addition
0 Two or more family
0 Industrial
0 Alteration
No. of units:
0 commercial
epair, replacement
0 Assessory Bldg
El Others:
El Demolition
0 Other
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UtbUK1r 1 IV114 Vr vvurxrx I %J LJL- r- L- IRA--
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OWNER: Narne:- & I
Address:
r)ntract6r Nan)6: f i-�-fAt&nvo\
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ARCH ITECT/ENGI NEER
Phone:
Address: Reg. No.
FEESCHEDULE. BULDING PERMIT.- MOO PER $1000-00 OF THE TOTAL ESTIMATED COSTBASED ON $125.00 PER S.F.
Total Project Cost: $ FEE:
Check No.: Receipt No.:
NOTE: Persons contraYing7w-ith Aregistered contractors do not have access to the guarantyfund
. Plans Submitted. [I Plans Waived 11 Certified Plot Plan El Stamped Plans
TYPE OF SEWERAGE DISPOSAL
Public Sewer El
Tanuing/Massage/Body Art E]
Swimming Pools
Well 1:1
Tobacco Sales El
Food Packaging/Sales El
Private (septic tank etc. El
Permanent Dumpster on Site El
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING & DEVELOPMENT
COMMENTS
CONSERVATION
COMMENTS
HEALTH
COMMENTS,
Reviewed On Signature
Reviewed on Signature
Reviewed on' Signature
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
,'Planning Board Decision:
Comments
'Conservation Decision: Comments
Water & Sewer Connection/ Drivewav Permit
DPW Town Engineer: Signature:
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 approlfal of
Electrical Inspector Yes No
DANGER ZONE LITERATURE: Yes
MGL Chapter 166 Section 21A —F and G Min.$100-$1 000 fine
No
Doc.Building Permit 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
4� 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
E: 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)
46 Mass check Energy Compliance Report (If Applicable)
�& Engineering Affidavits for Engineered products
OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
New Construction (Single and Two Family)
4� Building Permit Application
;6 Certified Proposed Plot Plan
4. Photo of H.I.C. And C.S.L. Licenses
,& Workers Comp Affidavit
4� Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (if Applicable)
.;6 Copy of Contract
2012 IECC Energy code
Engineering Affidavits for Engineered products
10TE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit
lin 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
0 j
-7
Location I
No. Date 61
Check#
TOWN OF NORTH ANDOVER
Certificate of Occupancy
Building/Frame Permit Fee
Foundation Permit Fee
Other Permit Fee $
TOTAL $-
Building Inspector
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CONTRACT
AGREEMENT made as of the I'S
I. CONTRACTING PARTIES _�L day of 2016.
Owner:
RCCj LLC, 17.lvalooSt, Suite 100, Somerville. MA 0214-3
Trade Subcontractor:
Portanova Roofing, Inc. Tax ID#
148 Minot Street, Dorchester, MA 02122
11. PROJECT
Roofing Work — #47, 445 and 439 High Street, North Andover, MA 01845
III. WORK TO BE PERFORMED
SuPplyand install all labor, material, and equipment to perform the following work:
47 High "Darby Scott lower" (First roof)
- We will rernove and replace existingrubber roof system with 3" of rigid insulation and
new rubber roof system.
- R oof will col-ne with 20yr manufacturers warranty
- We will terminate rubber under windows with termination bar. Then we will install new
alUrninurij flashing under windows and down over r , ubber. A1.1 old caulking will be cut out
under windows and new 40yr. bronze colored caulk will be applied.
under windows* 42 windows total *includes only
Roof will conic with new large copper drip edge to cover fascia. Gutter will be reused
Includes all termination bar and bronzereglet at front wall
Includes all debris removal via durripster
First roof to start upon deposit of $2 1,622-22 (1/3 of total cost)
Second Payment of $21.,622.22 at halfway point
Portanova Roofilig, 111c,, 148 MinOt Street, Dorchester, MA 01122 T: 617-33 1-5815 ww1v-P0rtan0vaRoofh)g.c0M
i,mai payment of $21.622.22
due upon completion (Estimated 3 weeks)
Total cost of $64,867.67
45 High "Ballast roofs" (Second roof)
- Remove existing rubber roof and insulation than install new 3" rigid insulation and new
rubber roof system. This is a concrete deck roof so we will use harnmer drills and
masonry fasteners. There may be debris falling from ceiling. We will coordinate with
Keiran. We are not responsible for concrete deck in anyway
Roof comes with 20yr manufacturers warranty
We will install new large copper drip edge where needed
All debris will be removed via dumpster
We will install new termination bar and new reglet where needed
Second roof to start upon deposit of $26,222-22 (1/3 of total coso
Second Payment of $26,222.22 at halfway point
Final,payment of $26,222.22 due upon completion (Estirnatcd 5 weeks)
Total cost of $78,666.67
39 High "Horse shoe shaped roof'fThird roof)
- Remove existing rubber roof and insulation than install new 3" ridgid insulation and
new rubber roof systern
- Roof will come with 20yr manufacturers warranty
- We will terminate rubber under windows with termination bar, Then we will install new
aluminum flashing -under windows and down over rubber, All old caulking wi - cut out
under windows and new 40y.r 11 bo
- bronze colored caulk will be applied. *includes only
under windows* 418'of windows total
- Includes new large copper edge metal
- Includes all new 4" drains
Portitnova Rooting, Inc., 148 Minot Street, Dorchester, MA 02122 T: 617-33 1-5815 www-PortanovaRoofingxorn
- All debris will be removed via dumpster
- Includes all new termination bar and reglet where needed
Third roof to start upon deposit of $31,722.22 (1/3 of total cost)
Second Payment of $31,722.22 at halfway point
Final payment of $31,722.22 due upon completion (Estimated 5 weeks)
Total cost of $95,166.67
t
vo�iz�j
IV. INSURANCE PROVISIONS
Portanova Roofing Inc. shall maintain in effect industry standard Workmen's
Compensation Insurance for all of its employees and General Liability Insurance for the
duration. of the Work of this Contract.
V. MANNER OF EXECUTION
All Work shall be performed and completed in co'mplia'nce with all federal, state, city,
and local codes and ordinances.
All Work shall be performed in compliance with OSHA rules and regulations. All OSHA
violations and fines related to the Work of this Contract shall be the responsibility of the
Trade Subcontractor performing the Work.
All Work shall be performed in a first class workmanlike fashion consistent with die
highest standards in the construction industry
AGREED: 7
te
En -b�� Vi:>
RCG West Mill NA LLC
Trade Subcontractor
Date
Ken Portanova, t5--�
Portanova Roofing, In
Portanova Roofing.. Inc., 148 Minot Street, Dorchester, MA 02122 T: 617-331-5815 wwwTortanovaRoofing.com
N The Commonwealth of Massachusetts
Department of IndustrialAccidents
I Congress Street, Suite 100
Boston, AM 02114-2017
www.mass.gov1dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/FIectricians/Plumbers.
TO BE FILED WITH THE PERNUTTING AUTHORITY.
Ap-plicant Information Please Print LeLrib
NaMe (Business/Organization/Individtial): PO C4-cktA c2fic, ILA C -
Address:—
City/State/Zip: 0�1 3? (
Phone #: 1-7 �S S_
Are you an employer? Check t6appropriate box:
Type of proj pet (T�quired):
1.)Q I am.a employer with employees (fall and/or part-time).* 7. [jNew construction
2. F] I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling
any capacity. [No workers' comp. insurance required.]
9. F1 Demolition
3. R I am a homeowner doing all work myself [No workers' compAnsurance required.] t
4. F1 I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 Fj Building addition
ensure that all contractors either have workers' compensation insurance or are sole 11. Electrical repairs or additions
proprietors with no employees.
Plumbing repairs or additions
5. F1 I am a general contractor and I have hired the sub -contractors listed on the attached sheet. 13. E] Roof repairs
These s�b-contractors' ha4� er�ploye.es and have workers' comp. insurance.1
6. n We are a corporation and its office . rs have exercised their right of 'exemption per MGL c. 14. Fj Other
152, § 1(4), and we have no. e loyc�s. [No workers' comp. insurance required.]
*Any applicant that checks box #1 mustalso fill out the section below showing their workers' compensation policy information.
f Homeowners who submit �his affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
tContractors 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-co'niractors have e'rnploy*ees, ffie� must provide their workers' comp. policy number.
I am an employer th at is providing workers -' compensation insuran cefor my employees.' Below is th e policy andjob site
information.
Insurance Company Name: In 1-0, &n Ce S+ -C) r C
Policy # or Self -ins. Lic. Huilfteov� Expiration Date:
fob Site Address: q3 0 g(I 3q 14 1-1 k City/State/Zip: N /4"hyf/,
Attach a copy of the wdkersi—Itompensation 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 $1,5 00.00
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 under thepqins andpenalties ofpeijuiy that the information provided above is true andcorrect.
0fj1cial use only. Do not write in this area, to be completed by city or town official.
City or Town: Permit/License 9
Issuing Authority (circle one): i
1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: Phone#:
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation fo the e
r i� ipployees.
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 representativesof a deceased employer, or the
receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the
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 be 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
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
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 oompletely, by checking - the boxes that apply to your situation and, if
necessary, supply sub-contractor(s) name(s), address(es) and -phone number(s) along with their certificate(s) of
insurance. Limited Liability Companies (LLQ 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 Depaitment 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 pr 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 reiqui�ired to obtain a workers'
compensatiod'policy, please call the Department at the number listed below. Self-insur6d companies sh,ould'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/ficense number which will be used as a reference number. In addition, an applicant
that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current
policy infortuation (if necessary) and under "Job Site Address" the applicant should write "all locations in _(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 pen -nits or licenses. A new affidavit must be filled out each
year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i -e. a dog license or permit to bum 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
I Congress Street, Suite 100
Boston, MA 02114-2017
Tel. # 617-727-4900 ext. 7406 or 1-877-NUSSAFE
Fax # 617-727-7749
Revised 02-23-15 www.mass.gov/dia
Mar 24 16 04:12p p.2
DATE (MM)DWYYYY)
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CERTIFICATE OF LIABILITY INSURANCE
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711.11.E. 325 '71392
PRODUCER r 325 - 8952 INC -.0): - -- -- -- ---
THE INSURANCE STORE (NIC. No, Extl:.
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ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD
0 ATE(MWODNYYY)
CERTIFICATE OF LIABILITY INSURANCE
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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
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IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ie5) 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 endorsement�s;).
C CT
PRODUCER No .11'er Ann Gallagher
PHONE, -8952 FAX 01:
THE INSURANCE STORE INC, No EXI)w (617) 325 (AiC. N
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1 D6 SPRING ST. INSURER )AFFORDING COVERAGE NAIC It
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INSURED INSURER B
PORTANOVA ROOFING INC INSU RER C
50 ELM COURT INSURER E:
COHASSET MA 02025 INSURER F:
COVERAGES CERTIFICATE NUMBER: 39650 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BEL40W HAVE BEEN ISSUED TO TO=- INSURED NAMED ABOVE FOR THE POLICY PERIOD
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IAEC SXR (Anyone :wson) $
PERSONAL&ADV INJURY $
N/A
13&�Irl- AGGREGATE LIMIT APPLIES PER:
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PRODUCTS - COMP!OP AGG
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$
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VVORKERS COMPENSATION
AND EMPLOYERS'LIABILITY YIN
ANYPROPRIETORIPARTNER)EXECU
CFFICER/MEMBEREXCLUE)ED? NfAl
(Mandatory In NH)
NIA
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6.HUBBD80784115
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E.i-. EACH ACCIDENT S 500,000
10126/2015 10126/201 6
E.L. !�:SEASE - EA EMPLOYEE $ 500,000
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0 RIPTION OF OPERATIONS below
i
E.L. D'SEASE - P01 50n 000
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DESCRIPTION OF OPERATIONS J LOCATIONS /VEHICLES (ACORD 101, Addilional Remarks Schedule, maybe attached If more space is required)
Workers' Compe nsatior benefits will be paid to Massachusetts employees orly. Pursuant to Endorsement INC 20 03 06 B, no authorization is given to pay
claims for benefits to employees in states other than Massachusetts if the insured I-ires, or has hired those employees outside of Massachusetts.
This certificate of Insurance shows the policy in force on the date that this certificate was issuet (unless the expiration date on the above policy precedes the
issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage - Coverage Verification
Search tool at wvvw.mass.gov;lwdhvorkers-com.oensa�ion/investigations/.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRrBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
TOWN OF ANDOVER BUILDLING DEPT ACCORDANCE WITH THE POUCY PROVFSIONS.
1600 OSGOOD ST AUTHORIZED REPRESENTATIVE
ANDOVER MA D1845
Daniel Cr.�,Iy, CPCU. Vice President — Residual Market — WCRIBMA
(D 1988-2014 ACORD CORPORATION. All rights rese
ACORD 25 (2014101) The ACORD name and logo are registered marks of AGORD
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Office of Consumer Affairs & Business Regulation
ME IMPROVEMENT CONTRACTOR
Type:
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Private
xpirati6n: 4/23�12016
PORTANOVX ROOFING INC.,
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KENNETH PORTANOVA
148MINOTSTREET
A02122t'�
DORCHESTER, M Undersecretary