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HomeMy WebLinkAboutBuilding Permit #1037-15 - 41 COPLEY CIRCLE 6/11/2015 BUILDING PERMIT "O oT"�ti TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION * _ u / Date Received Permit No#•. �gSSACHu`����y Date Issued: I IMPORTANT:Applicant must complete all items on this page LOCATION Print PROPERTY OWNER Print 100 Year Structure yfyesno MAP�PARCEL: �ZONING DISTRICT: Historic District o Machine Shop Village 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 ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: S 0(.- x-);\\\'-S Phone: Address: (4� C ft( C\WC-us. Contractor NameT-A,,, hone: �l�� ��'�� " 7 s'3 l Address: '10 :[C�4"t>t- L)a `m/wSS • Supervisor's Construction License: LY-cl Exp. Date: ! 2-1 Home Improvement License: Exp. Date: 1 e ( Z ( 2 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: $ /s. �CIO 00 FEE: $ Check No.: �Gs Receipt No.: ` o� NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contractor Location ' C a p'e, CA4QQ,%.- No. t b 1� (� Date . - TOWN OF NORTH ANDOVER • c 1 FI)j ' • Certificate of Occupancy $ � � Building/Frame Permit Fee $� . r Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# � uilding Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE'OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/MassageBody Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ permanent 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 .Tanning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signatureldate 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 I 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 ❑ 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 o 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 F NORTH Town of It T..", �� Andover O i. ' 1 No. A ?7, Z o h ver, Mass tAACP 2A15 A- COC KICK�WICK 7d p�R�TEO \,`�5 1S U BOARD OF HEALTH Food/Kitchen PER IT T LD Septic System THIS CERTIFIES THAT ,&....�41314 BUILDING INSPECTOR .............. ................................................................. has permission to erect Foundation g . ........................... bulldin son ...4.1 ... � .... �r..�.. .�.. ....�.......... Rough to be occupied as ......�• .�....�............ ..... er OF................................................................ Chimney provided that the person accepting 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 6URNTHHAS ELECTRICAL INSPECTOR UNLESS CONSTRUCTI Rough Service .............. ................... .ill.......................... Fina 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. ,..fa"i , , ` cllflimnnoeys Residential & Commercial (Roofing CHIMNEYS POINTED -CAPPED All Types Of Siding _ Expert Masonry Work Mass Toll Free 4 Rotor`Leak CwtLt4 r': Licensed& Insured 1-800-WAIT-4-USalis;ch�i&o..r et&d smce i97s VcLicense#034200 (924-8487) w6r, Caele lAaz sa 47CqVAV I � We Work Year Round •5 it ? i- ;s, "> s r` vs*" d+ -'t+�- ...q. +�+_ 'LT' iky } , � k -;c - � "� S°•" �° '".�'i;v',X,,,b ,�;. f'' �/r�'a"� .# t- y�.s :� .�'` ��s-r-:.,m ,,Y ,r'-�'c� y � n-. .t:i .,.. _;, j, .•.. 3',1_�,Ix;a� .r`.. .}.� r.2�d7'�w''...-s. +Sx+«tk+adn. -+..�, -:..�' � s.. �,..Ls3 - t!, S..,t° � � r Proposal To: Sue Willis Date 5l O14 Street: 41 Copley Circle N.Andover,MA 978-974-0167 L Roof proposal cassielmarie@comcast.net Certainteed Landmark 1. Extm aution will be taken to protect house and 12. Removal of all work related debris. Planks will be landscaping as best as possible.(tarps etc.) placed under dumpster to prevent any damage to Magnets run at final clean up. driveway. 2. Remove all shingles from entire house... 13.Building permit included, 3. Inspect and re-nail any loose or lifted plywood 14.No painting or staining included in proposal Any compromised plywood will be replaced at an 15.Contractor workmanship warranty: 10 years under additional cost of$70.00 per sheet of 1/2"CDX normal wind and rain conditi 4. Install'heavy gauge 8"white aluminum drip edge Total roof cost: 15,200.00 to all eaves and rakes. 5. Install 6'of Certainteed Winter Guard ice and Upgrade to Pro's: $ 19,200.00 water'shield along all eaves and top to bottom in Option:Install(1)new Vehix SOb FS Fined all valleys. Full coverage on all rear low slope skylight and flashing kit.$800.,00 additional roofs. . Option:Install(1)new Velux MOS FS Fixed 6. Install Certainteed Diamond Deck synthetic skyligbt and flashing kit.$700.00 aaditional underlayment to remaining sheathing up to ridge. cost~ 7. Install all new pipe boots. 0 Option:Manual filtered light single pleated ` 8. Install Certainteed Swift Start starter shingles to blind and operating handle: S 375.00 per all eaves. . Option:Solar powered double pleated room 9. install Certainteed Landmark Limited Lifetime darkening blind with tempered LOW/E glass: architectural shingles to entire house. 10 year S 550.00 per material MFG. warranty.(See extended (Qualifies for 30% federal tax rebate) warranty)All shingles will be installed and (5 standard color choices) fastened according to mfg.specs. Certainteed 4Star extended direct MFG warranty 10. Install new CAF Cobra ridge vent and cap with A fully transferable 100%coverage against color matched Certainteed Shadow hip and ridge material defect for a fully non pro rated period of F shingles.n$ 50 year.Please refer to pamphlet tent in estimate 1 I. Counterflash existing chimney lead,skylights and folder.Offered to our local referrals and included all roof protrusions with ice and water shield,tie in this proposal at no additional cost. into new shingles and seal. ` .. 12. Over garage welt connection: Remove Balance due upon eomaletion approximately(15 )courses of siding.install ice 1119h1y rated member of the accredited BBB and and watr shield to entire removed area and roof Artzie's List sa connection. Install new aluminum step flashing. Thank you! Install all new pre-primed cedar(rough)siding. The Commonwealth of Massachusetts - Department of IndustriqlAccidoiks Office of Investigations 600 Washington Street .Boston,MA 02111 UV www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information n �- Please Print Legibly Name(Business/organizatiorAndividual): Al l/4 0-r_/, 6 1 r- Address: Jt �( <.�, �Jl t aR,y�- City/State/Zip: ✓►n el S S Phone#: Are you an employer?Check the appropriate b Type of project(required): 1.❑ I am a employer with 4. am a general contractor and I ' _ - 6. New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. ❑Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. g F1 Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.El Electrical repairs or additions 3111 am a homeowner doing all work right of exemption per MGL 1 L❑Plumbing repairs or additions myself. [Ido workers' comp. c. 152,§1(4),and we have no 12.0 Roof repairs insurance required.]t employees.[No workers' 13.EJ'0ther J�? C, comp.insurance required.] *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 a're doing all work and then hire outside contractors must submit anew affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name% Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: e-V9_k I C t"�Q Le 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 requiredunder Section 25A of MGL c: 152 can lead to the imposition of criminal penalties of 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. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DLA.for insurance coverage verification. I do hereby certify under tl pains and penalties of perjury that the information provided above is true and correct. Signature: Date: ` at Phone# q1 VAY _1%--'7571( Official 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 M. 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 ofhire,• 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 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 producedacceptable 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 the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(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. Be advised that this affidavit maybe submitted to the Department 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 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 if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should 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/license 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 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 file for future permits 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 burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Dep.artm.ent ofJ radustdal.Accidents Office ofIavestigations 6.Q0 Washington,Stxeot Boston,MA 021.11 Tod.#61.7-72.7-4900 oat 406 or 1-877:MASSAFE Revised 5-26-05 Fax,##617-727-7749 wwwma.sa,gov/cla cr CERTIFICATE OF LIABILITY INSURANCE Q%TE0.nOMYYY, 5128/2015 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: If the aertifcate holder Is an ADDITIONAL INSURED,the pabcy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the tetmis 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). R CONTACT Assigned Risk Services Universal Insurance Agency fnc PIPIONE 634-4589 Ii G No.: 866 215-8118 374 Belmont St F air ester MA 01604 ADDRESS, PobcySer&es®berkleyrWcom f 6SURER ARFORDMG COVERAGE NAICS iNsuRER A; Acadia Ingurarme Ca 31325 INSURED INSURER E &M Construction Inc �y Congress c . `03 Congress St INSURER D tlAilford,MA 01757 INSURER E IL POURER G VERAGES CERTIFICATE M)MBER, REVISION NUMBER: TWIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD C=CATED. NOTWITHSTANDING ANY REQUIREMENT.TERRA OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE WAY BE ISSUED OR WAY 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 C LAIMS. INSR I A S POLiC POLICYP LTR TYPE OF INSURANCE INSR MWD POU CY NUMBER IggIpD1YYY (k=IDDIYYri) LIMITS G ENERAL LIA84.1TY Auto MO ELLE.LIA131U TY $ WORKERS COMPENSATION X WC STAT U- ETH- AND EMPLOYERS'LIABILITY YIN TORY L.T._ ER ANY PROPRIeTORR+ARTNERIEXECUTtVE © EL EACH ACCIDENT s 1.,000,000 lM A DIFFICEEM6Si EXCLUDED? ww WC-20-20-005 %mW OWWA15 05/2012016 (ilaadataryin NNJ Et DISEASE-EA SIPLOYEE $ 1.0 •000 H yes.describe.under DESCRIPTON OF OPERATIONSbelow _._ . . __.._. _..__. _...._ ._. -POUCY LIMIT 1,$ 11000,000 DESCRIPT IDN OF OPERATIONS 1 LO CAT IONS I VEHICLES(Attach ACO RD 101,Additional Ranarks Schaduk,M more apace is required) EIM.tbn Category Elect.Status Name States) orth r Itsdm3e Maria 6uanun KA MW Qlastruction Inc —_-- 93 congress St Milford,MA 01757 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POU CIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN //.�����Under WITH THE POLICY PROVISIONS_ AD Under One Roofing AUTHORIZED REPRESENTA NE 30 Temple St MeMuen,MA 01844 �� �"► f ignature -- �` 4CORD 25(2010105) RRAC 3134 x CERTI�'�CME OF LIABUTY INSURANCE °"'E"'°arc - • Q2i24t2�?i S CERUWATE 0 OWED ASA■ATTM OF ZM OW AIBP CARS 110 iMrMTS UPON THE CERAFWAYE BOLDER THis CMR-YM� Tw�atr�► Eir.A�T+�cT�e�m� form� a: �Is�i�to po�as�lr+�gan���it� t�t66 endwis& i+e.. i i�c c+�c i:;: 02051-Tat b%swItswe Agamy LLC (9 f8}59S 2690 ; (9T4168T Gid9 %gthickedna F4 93 125 , ' U�dor One Ito-DIE C. John Lanzat- 2' Talo ftivo TE - _ hiRS ss ro CERT!#T TW C1 TteL '�attc�s Cf F L1Siffi SES e��a ro OiRY83 AkSOVE roa POLICY PER 100 UICATEfl. I Yit911i,11h G ANY TiB QC IiGm EiF IC�GI'�f UA Oistiffit ODtX4lSdT iRit7ii RESPECT TO Wk cM N,': CER.T147GA« toav @TC [ED C]AC 14AY T TIlE dti i11E P01 7ES O SC D i{ 1 IS $tt1!►ECT t0 ALL THE TERN t}�Ci,t�E[Gd'C�Mfg? �ffAlC#t Q�Ip:�3 tib i4�PtY £ 11r 8 �'a t ' Trrs GF D PfA�t1r i I i tsSYTf f�EtE,f3xALt�►t'I _— � r;p*•_ r:.ri_____.....�..5_ . .__ i ' r '!&f-AH'1kFr't'-.ix t l9t mot zs:.x i Y ,stsa 1i+VM4 t/ 5 :SF-- ` c OXOPMAIU d$i[.00AttOtC'S!WZNMLM •SzO=wt A 'duamdowoogsvaftaw&O+.ro*me" +r . �onel�s cngA�o�s wiu+cy 4xess� e �1� Lacr� TE LAMM _ ? XNKYAWAda OF TM^saw GESCIMM POLE as C&AX:i:1.LEG Rw 1 Massachusetts-Department of public Safety Board of.Building Regulations and Standards license;CS-068720 JOHN W 30 TEMPLE DR METHUEN MA 61 i „��„��11�6tgc. 'r"'�• Expiration Conwriissioner 84103120'17 ..ruw Zip - --- City/Town ) � �V code — Search Registrants Click on the registration number to view complaint history,You can also view arbitration and.Guaranty Fund history. The list is current as of'Wednesday, October 8, 2014. Search Results REGISTRANT RESPONSIBLE REGISTRATION ADDRESS EXPIRATION STATUS NAME INDIVIDUAL NUMBER DATE ALL UNDER ONE ROOF LANZAFAME, 137057 166 A MERRIMACK ST 10/02/2016 Current JOHN METHEUN,_MA 01844 ®2012 Commonwealth of Massachusetts. Mass.Gov®is a registered service mark of the Commonwealth of Massachusetts. fnin"Al 14