HomeMy WebLinkAboutBuilding Permit #359-2016 - 40 WOODBRIDGE ROAD 9/21/2015 �'��gNnrtr 0
BUILDING PERMIT oFtpOR&ORT►i
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION 70
Permit No#: Tot/ Date Received
ITS US
Date Issued:
IMPORTANT:Applicant must complete all items on this page
LOCATION O 1'1✓(x46r f c Rod, (
PROPERTY OWNER
C/ Pnnt_ _100 Year Structure yesOno
MAPA 0< PARCELS ZONING DISTRICT: Historic District. yeMachine Shop Village ye
TYPE OF IMPROVEMENT PROPOSED USE
Resi ntial Non- Residential
❑ New Building V One family
❑Addition ❑ Two or more family ❑ Industrial
teration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
❑ Septic ❑Well ❑ Floodplain LIVVetlarids; ❑ Watershed District
❑Water/Sewer
DESCRIPTION OF WORK TO BE PERFORMED:
n e tar '1 'n CA n�i
/ Identification- P ease Type or Print Clearly
OWNER: Name: Sae ¢ �y�I� Phone:
Address: ivo
Contractor Name: Phone:
Email:
.Address:/'? VPC&o f j- No,
Supervisor's Construction License: CS 'a77-y87 Exp: Date: 2ele
'Home Improvement License: Exp. Date:
ARCHITECT/ENGINEER f Phone:
Address: Reg. No.
FEE SCHEDULE:BU DINGPERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: l 'r1o.011 FEE: $
Check No.: Receipt No.:
NOTE: Persons contracting dith unregistered contractors do not have access to the gu fund
Signature of Agent/Owner �ature of contractor
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer lel Tanning/Massage/Body Art ❑ Swi n ring 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 Siqnature
I'
COMMENTS
l 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:
Lo ed 384 Osgood Street
FIREVEPAR?TMENT - Temp.-Dumpster on=site eyes.__ _ no.,
Located;at 12.4+MainxStreet
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)
❑ Notified for pickup Call Email
Date Time Contact Name
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
❑ Building Permit Application
❑ Workers Comp Affidavit
o Photo Copy Of H.I.C. And/Or C.S.L. Licenses
Li 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
o Building Permit Application
o Certified Surveyed Plot Plan
o Workers Comp Affidavit
Li Photo Copy of H.I.C. And C.S.L. Licenses
o Copy Of Contract
o Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
o 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)
o Building Permit Application
o Certified Proposed Plot Plan
❑ Photo of H.I.C. And C.S.L. Licenses
❑ Workers Comp Affidavit
o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
o Copy of Contract
o Mass check Energy Compliance Report
o 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
Doe:Building Permit Revised 2014
Location ^7
No. r �� 'L OI�f Date Z �S
. . TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $ ""
Foundation Permit Fee $
Other Permit Fee $
ATED XV
TOTAL $
i Check#��,
-^ Building Inspector
� 17uJ
- NORTH
Town of = . t E ndover
0
No. 2A
-
?,, h ver, Mass, C?_
L 64
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coc"Ic NlWKM y1.
�,4 gDRgTED ►`PP�,�S
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BOARD OF HEALTH
Food/Kitchen
PER..MIT T D Septic System
THIS CERTIFIES THAT ..... ......� •`'; e,. ,�.1 �- .... BUILDING INSPECTOR
has permission to erect .......................... buildings on
e . ,, • . Foundation
.. .....................
. Jon..... .......� ..........�..
1 .` ` � Rough
to be occupied as ...........��ka�.....Q�.��i��ect Sr1�.l. .... ...................................... Chimney
provided that the person accepting this permit shall in every conform to a 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 CONSTRUCT191 S S Rough
Service
............... ..... ............................................... Final
BUILDING 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.
Dxes on Constru t�lon I .
zg 'Z- G *'qps w.w.•aa�'q�.!ao.a-"r w nc.� .�
Date:09/13/2015
Proposal
Stephen Noone
40 Woodbridge Road
North Andover, MA 01845
PROPOSAL—Installation of New Vinyl Siding
Remove existing wood siding.
Al debris to be removed off site via dumpster. Crescio Trucking to haul off.
Install Tyvek house wrap and ice and water shield as needed. Install main
house body with gray siding, 7" reveal. Install white corner boards, electric box pads, exterior
light blocks, electric meter wrap.All to be the same color of siding. Install P.V.0 trim,to receive
J-channel as needed. Install attic soffit venting.
Total $ 14,350.00
All material is guaranteed to be as specified,and above 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$ 14,350.00.
50%upon signing $7,175.00
50%upon completion of project $7,175.00
An interest charge of 1.5 % per month will be applied to any balance due 30 days after
completion of this project.Any alteration or deviation from above specifications involving extra
cost will be executed only upon written orders and will become an extra charge over and above
the estimate.All agreements contingent upon strikes, accidents or delays beyond our control.
Desmond Construction,Inc.,P.O. Box 41,North Andover,MA 01845 Phone:978-582-2279/FAX.978-682-2279
bm-desmond(@comcost.net
IJPoge
' I
Desmono-d Construction Ince
mak,,:4� � .-. � 'xG���� ss .rw✓
Owner to carry fire,tornado and other necessary insurance upon above work. Workmen's
Compensation and Public Liability Insurance on the above work to be taken out by Desmond
Construction, Inc.
Respectfully submitted
per Matthew Desmond
NOTE:This proposal may be withdrawn by us if not
accepted within days.
ACCEPTANCE OF PROPOSAL
The above prices, specification and conditions are satisfactory and are hereby accepted. You
are authorized to do the work as specified. Payment will be made as outlined above.
Signature: Date:
Signature: Date: ." Il
Desmond Construction,Inc.,P.O. Box 41,North Andover,MA 01845 Phone:978-582-2279/FAX.978-682-2279
bm-desmond@comcast.net
21 Page
The Commonwealth of Massqchuseffs
Department oflndfusiWalAceidents
1 Congress Street,Suite 100
Boston,Al 02114--2017
www.mass.gov/dla,
Workers°Compensation Insurance Affidavit:Builders/Contractors/EIectrieians/Plumbers.
TO BE FILED WITH THE FE1dIV.r ITNG AUTHOR1TY.
Applicant Information Please Print Ledbly
Name(Business/Orgauization/lndividual): J(,V-
Y
Address: /F V1.1 4.,
City/State/Zip: yG Phone#: -10f
Axeyon an employer?Checkthe appropriate box: Type of project(required):
1.❑I am a employer withj:.. : employees(full and/or par-time).-* 7. ❑New construction
2.❑I am a sole proprietor or partnership and have no employees working forme in 8. d Remo deliAg
any capacity.[No workers'comp.insurance required.]
9. ❑Demolition
3-❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]i
10 0 Building addition
4.❑lam a homeowner andwill be hiring contractors to conduct all work on my property. I will
ensure tbat all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions
proprietors with no employees. 12..Q plumbing repairs or additions
5.❑I am a general contactor and I have hired the sub-contractors listed on the attached sheet. 13. ROOFTepatrS
These sub-contractors have employees and haveworkorscomp.insuraace.t
&Q We are a corporation and its officers have exercised their right o£exemption perMOL G.
14.F1 Other
152,§1(4),and we have na empIoyees.[No-workers'comp.insurance required.]
*Any applicant that checks box*1 must also fill out the section below showing their workers'compensation policy information.
fi 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 checkthis box must-attachad 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 workeis'comp.policy number.
am an employer t/iat is providing workers'compensations lasurance for my employees'.below is the policy artd job site
�� inforntatian.
Insurance Company Name:�,�/!�tJG�d L'� S �✓jf✓/���' ��� z —
Policy or Self ins.Lie.#: 7/fg I-- ExpirationDate: 7�7`2Q�6
Job Site Address: City/State/Zip:
Attach a copy of the workers'compensation-policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MOL 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.
X do hereby certi and tri paints andpenaldes ofpetjury that the information provided above is true and correct.
Si nature: Date:
Phone#• S'tJ,F-�� 3 7�
Official use only. Do not write in this area,to be completed by city on town official.
City or'Town: Permit/License 4
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical inspector 5.PIurnbing inspector
6.Other
Contact Person: Phone#:
I �
Information and Instructions - .
Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees.
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."
Art employer is defined as"aa 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 representatives of 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 completely,by checking le-boxes that apply to your situation and,if
necessary,supply sub=contractors)name(s),address(es)and•phonenumber(s)along with their certificate(s)of
insurance. Limited Liability Companies(LLC)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. B e advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the aha-davit. The affidavit should
be retained 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 or ifyou'are required to obtain a workers'
compensation policy,please call the Department-at the number listed below. Self-insured companies shouldenter-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 pennit/license number which will be used as a reference number. In addition,an applicant
that must submit multiple permii/license applications in any given year,need only submit one affidavit indicating current
policy information(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 Erle for future permits or licenses. Anew 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 burn 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-MASSAFE
Fax#617-727-7749
Revised 02-23-15 www.mass.gov/dia
ACC>R& CERTIFICATE OF LIABILITY INSURANCE DAi�eizoisrn
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: R 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(s).
PpOOUCFAE?Cr victoria Howes, CIBR
MTM Insurance Associates - PHONE _ (978)681-5700 PAX (978)681-5777
1320 Osgood Street L .Iickiel@mtminsure.com
INSURER AFFORDING COVERAGE RAID 8
North Andover MA 01845 INSURERAMravelers Casualty ins Cc of 19046
INSURED muRpRe:Travelers indemnity Company of 25682
Desmond Construction Inc INSURERC:
19 Upland St INSURERD:
INSURERE:
North Andover MA 01845 WBURERF:
COVERAGES CERTIFICATE NUMBER:15-16 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.
INBR ADOL LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFP PO ODY EXP u1111179
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 3 1,000,00o
CLAIMS-MADE ®OCCURPREMISES DAMAGE TO RF.RrMr— 300,000A a rt ce $
4803AS233671542 7/7/7015 7/7/3016 MED EXP(Any oneperson) 3 5,000
PERSONAL A ADV INJURY $ 1,000,000
GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
X POLICY❑JET 7 LOC PRODUCTS-COMPIOP AGG 3 2,000,000
OTHER: BIM Add Ins Contractors 3
AUTOMOBILE LIABILMYOe IN NG U $
4_.
ANY AUTO BODILY INJURY(Per person) 3
�
OOWNED SCHEDULED BODILY INJURY(Per accident) $
AUTOS
NON-OWNED PROPERTY DAMAGE $
HIRED AUTOS AUTOS tPe,a e
$
UMBRELLA LIA9 OCCUR EACH OCCURRENCE 3
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DEO RETENTION Sf
WORKERS COMPENSATION Beatrice and Matthew X O
AND EMPLOYERS'UABILRYER
ANY PROPRIETORMARTNERIEXECUTIVE Y/N Oas�d are eioluded EL.EACH ACCIDENT 3 1,000,000
R OFFICER/MEMBER EXCLUDED? y N/A ,
L (Mandatary In NH) IEVB3A83186515 8/23/2015 8/23/2016 E.L.DISEASE-EA EMPLOYE $ 11000,000
If S6descrihe under
SCRIPTI OF OPE TIONS I E.L.DISEASE-POLICY LIMIT 3 11000,000
DESCRW nON OF OPERATIONS/LOOATIONS/VEHICLES(AOORD 201,AddtWnal Re r s ScheW le,may IK adacred H Tae space Is required)
This certificate of insurance represents coverage currently in effect and may or may not be in compliance
with any written contract.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
1600 Osgood St. ACCORDANCE WITH THE POLICY PROVISIONS.
N Andover, KA 01845
AUTHORIZED REPRESENTATIVE
L Mancinelli, CIC/SAM
®1988-2014 ACORD CORPORATION.All rights reserved.
ACORD 26(2014/01) The ACORD name and logo are registered marks of ACORD
INS026 nmuln
From: Samantha Gillen Samanthag@mtminsure.com
Subject: Desmond Construction Inc,COI for Town of NA
Date: September 18,2015 at 10:18 AM
To: bm-desmond@comcast.net
Hello,
Please see attached certificate, per your request.
Thank You,
Samantha
Samantha Gillen
Assistant Commercial Executive
MTM Insurance Associates, LLC
1320 Osgood Street -
North Andover, MA 01845
978-681-5700(phone)
978-681-5777 (fax)
samanthagOmtminsure.com
Visit us online: www.mtminsure.com
MI ��T1 m
ANSURANCE
•0
Office Hours: Monday-Thursday 8:30 to 5:00, Friday, 8:30 to 4:00.
Please forward Certificate of Insurance Requests to: certifiicateso-mtminsure.com
Please be advised that we cannot bind or alter coverage via voicemail, fax or email.
****LIKE US ON FACEBOOK****
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Office of Consumer Affairs and Business Regulation
10 Park Plaza - Suite 5170
w Boston, Massachusetts 02116
Home Improvement Contractor Registration
Registration: 143109
Type: Private Corporation
Expiration: 6/18/2016 Tr# 254059
DESMOND CONST. INC.
MATTHEW DESMOND
19 UPLAND ST
N. ANDOVER, MA 01845
Update Address and return card.Mark reason for change.
Address �j Renewal Employment Lost Card
SCA 1 Co 20M-05111
e errAffa�rs&Bu ifif ss Regulation
lis License or registration valid for individul use only
_�__Office of Consumer Affairs&Busifiess Regulation g Y
pj OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
i egistration: 143109 Type: Office of Consumer Affairs and Business Regulation
xpiradow,. 6/18/2016 Private Corporation 10 Park Plaza-Suite 5170
Boston,MA 02116
DESMOND CONST:INC.
MATTHEW DESMOND
19 UPLAND ST 4 ,moo
N.ANDOVER,MA 01845 Undersecretary NotvaY without signature