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HomeMy WebLinkAboutBuilding Permit #274-2017 - 40 BELMONT STREET 9/14/2016 BUILDING PERMIT OF NORTk( Hw_ �t.LEU TOWN OF NORTH ANDOVER 10 3 APPLICATION FOR PLAN EXAMINATION ~ Permit No#: Date Received SSACHUSfc Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION i Print PROPERTY OWNER c // 100 Year Structure yes no MAP I PARCEL: O?cl7-,- ZONING (STRICT: Historic District yes no Machine Shop Village ye no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building 9-erne family ❑Addition ❑ Two or more family ❑ Industrial A-Alteration No. of units: ❑ Commercial Z Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other � >j�,Sep#i,�� ❑W{e 1, �� � �1FIoo` p aid�1N�1anc]s�; ��;� `1IU_a�shed,�Distri�t� _ r+WaterSewer - DE RIPTION OF VQRK TO BE PERFORMED: _ �- - Identification- Please T or Print Clearly ���� ���� OWNER: Name: Phone://` Address: JCl� Contractor Name: Ph ne: � Email: 6' Address: P ' Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: �- 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: $ � c�- - FEE: $ Check No.: %(;, Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access t guarqnty_funfl k T. s 40 Location •&410'--A No. nC C ` 2pt ! Date E a • - TOWN OF NORTH ANDOVER > Certificate of Occupancy $ Building/Frame Permit Fee $ 7`6'0 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check#P 4 30889 Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL I Public Sewer ❑ Tauning/Massage/Body Art ❑ Swumning Pools ❑ Well11 ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank, etc. ❑ permanent Dumpster on Site ❑ i �II THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS I CONSERVATION Reviewed on Signature y t r - 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 384 Osgood Street EIREjDEPAR iVIE(VTj,Tempn ,Dumpster osite -yes,.,-,,,,. no �� Located at;�1{24 eiiniSt[eet ;" i # Fire Depaftent signature/date it i t-��wr COMMENTS ^'` {- � •t � ,a l i Dimension i 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.$1oo-si000 fine NOTES and DATA— (For department use) LI Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 I 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 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) A 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) 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 2012 I ECC Energy code Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit Inallcas es if a variance orspecial permit was required the Town clerks office must stamp the decision from the Board of Appeals i 1 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 I i i I r 7 NORT1y w. .. . . t .c . . ve' 'o 1. ry p •^'.' •Y� X11 1 � z oh ver, Mass, COCNIC NtWKN �1. �d ADRATED S U BOARD OF HEALTH Food/Kitchen PERR T D Septic System THIS CERTIFIES THAT .. 4�.. ... BUILDING INSPECTOR 4�....... . .1. . U ......... Foundation has permission to erect ....... ................. buildings on ........ ....... . . �� Rough tobe occupied as ............ ...................................................................... chimney provided that the person acceptin 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 CONSTRUCTIO Rough Service . ... ... .. ...... ........ ............... Final BUI ING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building 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. WOOSTER ROOFING PROPOSAL ALL TYPES OF ROOFS DATE: 9/12/16 &ROOF RELATED SERVICES Always Hand Nailed! �O License Numbers: Charlie and Steve Wooster Construction Supervisors 978-851-ROOF (7663) 54268 Fax: 978 251-0159 we.1-11-Va, Home Improvement Contractor 2015 OFFER: Serving MA&NH since 1984 Registration 100712 10% off up to$300 if proposal is Call For Our References accepted within 10 days! Proposal Submitted To Work To Be Performed At Name Denise "_goott Name Company Name Company Name Street 195 Florence Rd Street 40 Belmont St City Lowell State MA Zip Code 01851 City No.Andover State MA Zip Code 01845 Home# 978 937-0718 Mobile# 978660-3220 Work#978 656-5568 . Fax# We hereby propose to furnish the materials and perform the labor nece.ssary for the completion of the following'ob. Strip the entire main shingle roof to the roof deck. 1. Renail any loose decking and replace any rotted or sheath over at$2.00 per foot. 2. Install 8"white aluminum dripedge. 3. Install 6' of Grace ice and water barrier on all eaves. 4. Paper remainder of roof with Grace Tri-Flex roofing underiayment. 5. Install Certainteed Landmark Lifetime shingles,hand nailed. 6. Flash chimney to roof. 7. Install ShingleVent 11 ridge vent. 8. Replace soffit vents. 9. Install vent to receive bathroom exhaust. 10. Clean and dispose of all debris. Workrnanshi2 guaranteed for 10 years.We are fully insured with workers'compensation as well as liability insurance. Please return copy of proposal: All material is guaranteed to be as specified,and the above work to be performed in accordance with the specifications submitted.All work will be completed in a substantial workmanlike manner for the sum of Dollars,($7,275.00), with payments to be made as follows:lob paid, 1/3 down and balance upon completion. Respectfully submitted_Stephen Wooster._,-,ff Note-This proposal may be withdrawn b us if not acct ted',tiithiri da s. ACCEPTANCE OF PROPOSAL The above prices,specifications and conditions are satisfactory and are hereby accepted.You are authorized to do the work as specified. Payment will be made as outlined above. ,T/ Date �3� � Signature . Mailing Address: P.O.Box 8051 -Lowell,MA 01005 LOedtltttic 926 Woburn 8troot-Towkcbury,MA 01876€-Mail:Info(@Wooster- Roofing.com Website:www.Wooster-Roofing.com The Cori mon-wealth of Massy ehusetts Depca-Ftment ofindusirialAceldents _ 1 Coag—sass street,suite 100 $os'ton,MA 02114 2017 t �v�vrna,��gavfdira " �©�kers'CoxapeazsaL..ioz�In�urance.A��cia�vzt:Baildexs/Cozy.:Exac-�ors/Z+`•Ieeixzciax�slPZmnbexs. TO BE,MYD-fM IM RERZHr NGAVEHORM. A :cant 7u oxmation Please Print Zepibl Namapusmesd().ganizatiomffndividual): Address: r,19 I Citylstate%zip: Areyou an employer ClceeIr 3ie ap�iropriatebox: Type of project(req==d): 1 � Ilia•employer pith employees(fM and(arparttime).* 7: ❑New coz7:sftMGti()n - '' "Lor $. Remodeag ees Wo _ e o ein 1 rkrng am asoIe o etororpazinersh%p and have n pay ❑ 2.�I pr Pm any capacity.ENC,Workers'comp_insurance required_] 9_ ❑Demolition in Iam ahomeawnerdaingall Workmyse1f ENO Workers'comp.jngm-anceraquired.]t 10 ❑Building addition 4.❑IamahnmeoWnerandWllbebirmgcoutactorstoconduct all-wodconmypropet3r IWC. ensure Viet an contractors either have Workers'compensation insi=ce or are sole 11:❑Electrical repairs or.additions proprieinrs nc employees. Y2 [[Plumbing repairs or additions 5.❑I am ageneral coniraciar and lhaye hiredthe sab-eontaetors listed on the a;#ached sheet. 13• oQix ep airs 'These sab-conractorshave eir�loyees andhaveworkers'comp_insur�ce 1A.❑Other 6_❑We areacorpor pti#s of�eershave exercised heirlight of eaemptioaperMGZ a. 152,§1(4),and webaveno.employees.jNoWorkers'comp.insurancereq�ed] '.Anyapplicaut batehec7csboxiglnmstalso,:Mouttheseatoubelowshawingtheiiworkas'compensationpolicybilmation. iSomouwnerswhosUbffi,�X.16davritia icet�gtheyaredomgaI1�°rkandhenbireoutsidecontraerorsmustsiImitanewaffidavit dicatmgsuch_ Conixaciorshatcheck�usbe�mnscaifaeheclanaddilionalsheetsbav�mgth�nameoffihesab-coaaaciorsaD.dsLataWhefiherornot�oseentitiesbave employees.Ifthesub-conlracto Aaveemployees,�ieymnstpresvdethen Workers'comp.poIicynumbez. I a ye an ev proyeY ffz at aspfoviding�or•kers'coynpensadon insr�rancefor•719 ernprayees,Bero�zs theporicy acid jog szte Insurance Company 2Tame: Policy#or Self-ins.3ic.#: / ExpiradonDate: lob Site Address: D r ��� Czty/State/dip: au � C Attach a copy OfthBv7orkers' coxnpep4ationpolicy declaxationpage(show-bagthepolicynumbex and exppkafioxi date). Failu e to secure coverage as zequired under MGL c. 152, §25A is a criminal violation punishable by a fine up to$1,50 0.00 and/or one-year imprdsonm-ent,as well as civil penalties inthe form of a STOP WORK ORDER.and afine of up to$250-00 a day against the-violator_A,copy of this statement may be forwarded to ib.e OMGa of Investigations of the DIA for insura-nce coverage verttic n- do herehy c ti tr , ' s and-p ides ofPeery Azat the information provaded ani,ve s i e c� eon�eet Si afore: d Date: Phone#: Offidal'ase orzrY -DOTzot-turite in this arrear to he cotnpreted by city or town officiax City or Town: ??erxnit/License# Issuing Antlioxit4y-(circle one): i I.Board ofHealtla 2.Buildi)agDepartment 3.City/Town Clerk 4.Electrical Inspector 5.)?lambing Inspector 6.Other Contact person: Phone#: I Information and Instructions Massachusetts General Laws chapter X52 requires all employers to provide workers'compensation for their employees. r•� z Pursuant to this statute,an eYnployee is defined as"...every person m the service of another under any contract bf hire, express or implied,oral or written." Aq employer is defned as"an individual,partnexsllip,association,corporation or other Iegal entity,or any two or more of the foregoing engaged is a joint enterprise,and including the legal representatives of a deceased employer,or the receiver-or trustee of-an individual,partnership,association or other legal entity,employing employees. Ho-wever 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 b6 deemed to be an employer.". MGL chapter 152,§25C(6)also states that"every state or Io cal licensing agency shall withhold the issuance or renewal of a.license or permit to operate a business or to construct buildings in the comraonwealtlx dor any applicantwbo Sias not pro doted acceptable evidence of coznpliauce with the insuxartee coverage required" Additionally,MGL chapter 152,§25C(7)states"Neifhex 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 in requirements of this chapter have been presented to the contracting authority." -A.pplicauts PIease fdl-out-the workers' compensation affidavit completely,by checking=he boxes that apply to your situation and,if necessary, supply sub=corttractoi(s)name(s),address(es)and•phone m nber(s)alougwith their certificates) of insurance. Limited Liability Companies (LLC)or Limited Liability Partnerships(LLP)wif a no amployges*other than the, members orpatuors,arenotreguiredto canyworkers' compensationinsurance. If an LLC or LLP doeshave employees, a policy is required. Be advised that this affidavit maybe submitted to the Department of•Industrial Accidents fb=conf=afion ofiasorance coverage_ Also be sure to sign and date the aiffdavit. Tho affidavit should be retarn:ed to the city or 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 ox if you'are.requ7red to obtain a workers' compensation policy,please call the Department at the number listed below. Self-instrred companies sbould'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 fillinihe permit/license number which will be used as areference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Tob 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 maybe provided to the applicant as proof that a valid affidavit is on fle fox future p ennits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or per mit notrelated 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 1 Congress Street, Suite 100 Boston,MA.02114-2017 Tel_# 617-727-4900 ext_7406 or 1•-877-MA.SS.AFE Fax#617•-727•-7749 Revised 02-23-15 www.mass.gov/dia ji I ACC">RO CERTIFICATE OF LIABILITY INSURANCE DATE(MMtDDtYYYY) 10/16/2015 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: N the certificate holder is an ADDITIONAL INSURED,the policy(les)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(a PRODUCER ]AmE �rly McDonald McSweeney&Ricci Insurance Agency, Inc. PHONE �No)-781-843-8807 420 Washington StreetDADA DRESS : e P.O.Box 850984 Braintree MA 02185 INSURER AFFORDING COVERAGE MAIC# INSURER AA-cadia In surance Company 31325 INSURED WOOST 1 INSURER B:Star Insurance Company Charles J Wooster dba Wooster Roofing INSURER C: PO BOX 8051 INSURER D: Lowell MA 01853 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER:814527104 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 REOUIREMENT,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.LWITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR A POLICY EFF POLICY EXP TYPEOFINSURANCE POUCYNUMBER NWOD ODt LIMITS LTR INS A_ GENERALLIABiuTy CPA0083583 10/17/2015 10/17/2016 EACH OCCURRENCE $1,000,000 X COMMERCiALGENERNLL1ABTIJ Y PREMISES aocameam $250000 CLAIMS-MADE a OCCUR MED EXP(Any one son) $5,000 PERSONAL&ADO INJURY $1,000,000 GENERAL AGGREGATE $2000 000 GENtAGGREGATEUMITAPPLIESPER: PRODUCTS-COMPIOPAGG $2,000,000 POLICY PRO LOC $ A AUTOMOBILE LIABILITY MAA0379734 10/1712015 10117/2016 Em acididem) $1,000,000 ANYAUTO BODILY INJURY(Per person) $ ALLOWNED SCHEDULED BODLY INJURY(Peat) $ AUTOS AUTOS �WAD PROD DAMAGE HREDAUTOS Awer $ S A X I UMBRELLA UAB X SUR CUA0383967 10/1712015 1011712016 EACH OCCURRENCE $11000,0110 EXCESS UAB. CLAMS-MADE AGGREGATE $ DED I X I RETENTION 0 I $ B WORKERS COMPENSATION WC0720669 10117/2015 10/17/2016 X MSTATU- OTH- AND EMPLOYERS'LIABILITY YIN ANY PROPRIETOMPARTNER1EXECUTIVE E.L.EACH ACCIDENT $2,000,000 OFRC EXCLUOE7d � M-!A (Mandatory In NH) E.L DISEASE-EA EMPLOYE $2,000,000 R yar,ds=ihe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT S2,000,000 A Properly CPA0083583 10117/2015 10/17/2016 Equipment `DESCRIPTION OF OPERATIONSI LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required). sample CERTIEU&Tet2h&ER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Clampie ACCORDANCE WITH THE POLICY PROVISIONS. i AUTHORRED flEPRESENTATIVE 0 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and i Vie registered marks of ACORD m -- Office of Consumer Affairsin Business Regulation - 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 ontract or Registration - Home Improvem,__ Registration: 100712 Type: Supplement Card 6/23/201'8 CHARLES Expiration: 6 CHARLES J. WOOSTER ROOFING� STEPHEN WOOSTER P-0. BOX 8051 { LOWELL, MA 01853 1j! Update Address and return card.Mark reason for change. -"` E] Address ❑ Renewal Employment Lost Card SCA 1 0 20M-05/11 Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-054268 Construction Supervisor CHARLES J WOOSTER P.O BOX#8051 , LOWELL MA 01853 Expiration: Commissioner 05/11/2018 Office of Consumer Affairs and Business Regulation 10 Park Plaza Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration �- Registration: 100712 Type: DBA 4 f� Vii, Expiration: .6/23/2018 Tr# 289129 CHARLES J. WOOSTER ROOFING Charles Wooster my P.O. BOX 8051 3 LOWELL, MA 01853 /f Update Address and return card.Mark reason for change. –_. Address Renewal Employment Lost Card