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HomeMy WebLinkAboutBuilding Permit #1282-2016 - 39 WEYLAND CIRCLE 6/9/2014 V►ORTI1 `ED6BUILDING PERMIT o 0I?JT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: �2Date Received ' 41 Date Issued: �cHu IMPORTANT:Applicant must complete all items on this page LOCATION �� w�uy►J' C/�- Print PROPERTY OWNER /W Print MAP NO: PARCEL:2]?S( ZONING DISTRICT: Historic District yesno Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Resi ential Non- Residential ❑ New Building ne family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial pair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other I 1 Septic Li Well ? Floodplain Wetlands L Watershed District Water/Sewer / � i�jgzw/U�r, �JIv i,{sm J�_t b,,L,/' -4-rAA ,.Z Identification Please Type or Print Clearly) OWNER: Name: k t AFEW Phone: Address: CONTRACTOR Name: Phone: Address: Supervisor's Construction License: nExp. Date: C s ���s� Home Improvement License: /040 Exp. Date: ( �/ r ARCHITECT/ENGINEER Phone: ti Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:MOO PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. 490 otk7��jal Project Cost: i �d FEE: $ heck No.: Receipt No.: " NOTE: Persons contracting with unregistered cactors do not have acces to a ty fund Signature of Agent/Owner ignature of contractor ' F %AORTy A BUILDING PERMIT -- O q-[LED1. TOWN OF NORTH ANDOVER ,6 O a APPLICATION FOR PLAN EXAMINATION * ,� y h Permit No#: Date Received °°RrED `" '1 y gSSACHUs��� Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION Print PROPERTY OWNER Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes 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 ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District p Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: Contractor Name: Phone: Email: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: S 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: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund 9` f Signature of contractor, a Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Pennauent Dumpster on Site ❑ i THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF m U FORM PLANNING DEVELOPMENT Reviewed On Signature_ COMMENTS i 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: Comments Conservation Decision: Comments Water& Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: _ _� .__-._ . . _Located � MERIT Te oca e 3$�Osgood Street � EPART ,, mpDumpsterontsitey�es: .. no $,Locateat 12;4Min e , partmerirsi - i Frinatur e/date+ {COMMENTyyrS I t 4 r _1 i N 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) ® Notified for pickup Call Email Date Time Contact Name Doc.Building Pennit Revised 2014 i Building Department i 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 OTE: 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 OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ,;6 Building Permit Application 4 Certified Proposed Plot Plan 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) Copy of Contract 2012 IECC Energy code Engineering Affidavits for Engineered products OTE: 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 Location No.l � �•tJ Date d)b0 r � • TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ 170 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Y C' Check# 'n Building Inspector �/ s10RTH Town of Andover 0 y• No. --t h ver, Mass,AIL �i V6.00, �� 1 9A Co[NIc"a WICK y1' x.45°R�rEo �Q���S U BOARD OF HEALTH PERMIT Z='jl D Food/Kitchen Septic System THIS CERTIFIES THAT ............. �w14S ��t ........................................................ BUILDING INSPECTOR ........... . .... has permission to erect ........................ buildings on �' `,,,�� „�„ ;, �('�pp Foundation .... .... ....� ....�........4:....................... to be occupied as Rough ,, I��f�p .. . . . .... ..... Chimney provided that the person accep Ing this permit shall in every respect conform to the terms of.the. .a. . lication. on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Final 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 CON TION Rough Service woo • •• Final BOUUILDIN NSP TOR Occupancy Permit Required to Occupy Building Rough GAS INSPECTOR 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. RA CARLO ROOFING .COM Home Improvement Lic. 106052 Construction Lic. 0020350 R.A.Carlo Company Vinyl Siding*Roofing*Windows 65'Dunster Road Bedford, Massachusetts 01730 Phone (781) 275-7310 Fax (781) 275-9775 Proposal Submitted To://Name MR JAMES WHIFFEN 5/13/15 Address 39 WEYLAND CIR NORTH ANDOVER MA Phone 617-909-7000 Contact We hereby submit specifications and estimates for: Strip existing roof Install TITANIUM UNDERLAYMENT Install new metal dripedge. Install new ventcollar flashing and new flashing in chimney. INSTALL RIDGEVENT ALONG PEAK OF ROOF Install ice and water shield along roof edges and in all valleys.6' Apply newCertainteed LANDMARK LIMITED LIFETIME asphalt fiberglass self- sealing shingles to all roofing areas Cover house with tarps Clean and truck all debris away. Any rotted wood to be replaced at$3.75 a ft. RA CARLO BETTER BUSINESS BUREAU ACCREDITED A+RATING r LIMITED LIFE TIME Guarantee for Materials add 15 Year Guarantee for Labor We propose hereby to furnish material and labor, complete in ac d1k e th above specifications, for the sum of_$10,000.00 .Authorized Signature Note: This proposal may be withdrawn by us if not accepted within da Acceptance of Proposal: The above prices, specifications and conditions An sate actory and are hereby accepted. You are authorized to do the work as specified. Payment a e as outlined above. 1/3 at start of job balance upon completion Start Date Completion Date Customer and RA Carlo will determine start date at signing of contract. PLEASE COVER STORED THINGS IN ATTIC SOME DEBRIS MAY FALL IN The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Please Print Name: rM4 E7'`J w Location: Cl2 CiPhone am a homeowner performing all work myself. 0 I am a sole proprietor and have no one working in any capacity I ; --m an employer providing workers'compensation for my employees working on this job. Company name: Address I� 50 y v1-.S c 52 City: !E7 t? O M45,(�() Phone#: U 2 i2SO12kZ Insurance Co. Policy# �27 t3� Company name: Address i Cily: Phone#: Insurance Co. Policy# Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of($100.00)a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. 1 do herby certify r the p s ndftc f perjury that the information provided above is true and correct. Signature Date do Print name Phone# (p C 2—047&0 Official use only do not write in this area to be completed by city or town official' ❑ Building Dept 171 Check if immediate response is required Building Dept ❑ Licensing Board ❑ Selectman's Office Contact person: Phone#: ❑ Health Department ❑ Other FORM WORKMAN'S COMPENSATION I i To: Page 3 of 4 08/06/2016 10:17:30 EST 1 61 781 281 91 From: Adrienne Monks CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDtYYYY) 6/8/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY Q NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURAK . 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 endorsement(s). PRODUCER CONTACT Anna Lukas NAME: T. Edmund Garrity & Co. , Inc. PHONE (617)354-4640(617)354-4640 AIC No;(617)359-5828 545 Concord Ave. E-MAIL ADDRESS:annie@garrity insurance.com INSURERS AFFORDING COVERAGE NAIC A Cambridge MA 02138 INSURERA-.Endurance Insurance INSURED INSURER 8 RA Carlo Inc INSURER C: 65 Dunster Rd INSURER 0: INSURER E: Bedford MA 01730 INSURER F: COVERAGES CERTIFICATE NUMBER-aster COI 2016 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, 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 IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR POLICY NUMBER POLICY POLICY 7h LDD/Y YY LIMITS TYPE OF INSURANCE x COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 500,000 A CLAIMS-MADEOCCUR DAMAGE'r0 RENTED S 100,000 PREMISES Ea Occurrence CBC20001177400 3/8/2016 3/8/2017 MED EXP(Any one person) S 5,000 PERSONAL BADV INJURY S 500,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 1,000,000 POLICY ❑PRO- _ S F , JECT , LOC PRODUCTS-COMP/OP AGG S 1,000,000 ..._.._._._... ._...........------ --------'--....-...._ O AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S Ea accident ANY AUTO BODILY INJURY(Per person) S ALLOWNED SCHEDULED BODILY INJURY(Per accident) S AUTOS AUTOS NON-OWNED PROPERTY DAMAGE S HIRED AUTOS AUTOS Per accident S UMBRELLA UAB OCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS-MADE AGGREGATE S GED I I RETENTIONS S WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR%PARTNER/EXECUTIVEE.L.EACH ACCIDENT S OFFICERYMEMBER EXCLUDED? ❑ N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYE 5 If yes,describe'under _._........_ _�....._._..._, DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) CERTIFICATE HOLDER CANCELLATION (978)688-9542 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of N Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 384 Osgood St ACCORDANCE WITH THE POLICY PROVISIONS. North Andover, MA 01845 AUTHORIZED REPRESENTATIVE W GarritY/SPORT ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025imiwi% To: Page 4 of 4 08/06/2016 10:17:30 EST 16178128191 From: Adrienne Monks ��®� r ATE(MIWDDIYYYY) A� CERTIFICATE OF LIABILITY INSURANCE 06/0812016 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 endorsement(s). PRODUCER CONTACT NAME: annie lukas T. EDMUND GARRITY& CO-, INC. AICNNo Ext): (617)354.4640 FAX No: E-MAIL ADDRESS: annle@garrlty-Insurance.Com 545 CONCORD AVENUE INSURERS AFFORDING COVERAGE NAICf# CAMBRIDGE MA 02138 INSURER A: TRAVELERS INDEMNITY CO OF AMERICA 25666 INSURED .. .._.—..------... INSURER B: RA CARLO INC INSURERC: INSURER D; 65 DUNSTER RD INSURER E: BEDFORD MA 01730 INSURER F: COVERAGES CERTIFICATE NUMBER: 59484 REVISION NUMBER: THIS IS TO CERTIFY THA"[ 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 IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IPOLICY EXP LTR ADDL TYPE OF INSURANCE IVSD WVD SUER POLICY NUMBER MMLDDNYYY MWD IYYYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE s CLAIMS-MADE J OCCUR DAMAGE T RENTED L PREMIS�S,(EaocWrreng*1_ a MED ECP(Any one person' S NIA PERSONAL 8 ADV INJURY S GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S PRO- POLICY JECT n LOC PRODUCTS-COMPIOP AGG S OTHER: S AUTOMOBILE LIABILITYCOMBINED SINGLE LIMIT S Ea accide t' ANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED AUTOS AUTOS N/A BODILY INJURY(Per accident) S HIRED AUTOS NON-OWNED PROPERTY DAMAGE S AUTOS Per accid. S UMBRELLALIAB H OCCUR EACH OCCURRENCE s EXCESS LIAB CLAJMS-MADE NIA AGGREGATE s DED RETENTIONS S WORKERS COMPENSATION �/ PER 0TH- AND EMPLOYERS'LJABILITY Y/N X STATUTE ER ANYPROPRIETORIPARTNER.IEXECUTIVCE.L.EACH ACCIDENT S 100,000 A OFFICERIMEMBEREXCLUDED? NIA N/A NIA 6HUB2E92734915 10/27/2015 10/27/2016 (Mandatory in NH) E.L.DISEASE-E A EMPLOYEE S 100,000 II Yes.describe under �............_..._. DESCRIPTION OF OPERATIONS bel mr E.L.DISEASE-POLICY LIMIT S 500,000 NIA DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Romekrs Schedule,may be attached N more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(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 www.rnass.gov/lwdlworkers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Andover ACCORDANCE WITH THE POLICY PROVISIONS. 384 Osgood St AUTHORIZED REPRESENTATIVE Andover MA 01845 Daniel M.Crg4ay,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD Cl/eanr•�na�zcaeall�• �__Office of Consumer Affairs&Business Regulation - HOME IMPROVEMENT CONTRACTOR — Registration:.-,-- 6052 Type: Expiration ;�/2,18 DBA R.A.CARLO CO Robert Carlo " 65 Dunster Road Bedford,MA 01730 Undersecretary Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-020350 Construction Supervisor ROBERT A CARLO ;.. _ 65 DUNSTER ROAD BEDFORD MA 01730 Expiration: Commissioner 0411212018 I I