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Home My WebLink AboutBuilding Permit #121-14 - 415 MASSACHUSETTS AVENUE 8/5/2013 BUILDING PERMIT pORT11 ww-- rO,�TLlD.'6tq_rO TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: — — �D e Date Received R Date Issued: I ��SSAGHUS�� r _ IMPORTANT Applicant must complete all items on thisp age (OCAT-1001' nn{PETY OWNER'_ MAP NQ' ARCEL:i� ZONING DISTRICT 71-00�Historic District yes rio _Maclaine Shop.Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building ane family Addition Two or more family Industrial Alteration No. of units: Commercial ✓Repair, replacement Assessory Bldg Others: Demolition Other Septic Well p r Flood Iain = Wetlands `" Watershed Distra Water/Sewer, ct' DESCRIPTION OF WORK TO BE PREFORMED Identifi tion Pleas Type or Print Clearly) OWNER: Name:�_Oz �- � Phone: Address: /10� °CONTRACTOR, Name: Address :O C-_ �^� Supervisor's Constructon1icense EX . .D - - _ P ate. _ Home Improvement License: . _ - j1 Exp Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULD/NG PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125 00 PER S.F. Total Project Cost: $ XC) av FEE: $ Check No.: Receipt No.: NOTE: Persons contracts with registered contractors do not have access the gu my fund Si nature of<q 9 ent/Own _.. ._9 _. _w� __ _gnature,of contractor I Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, iding, Interior Rehabilitation Permits 11 'ng Permit Application �mers Comp Affidavit 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/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And l 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 ❑ 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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 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. Permanent Dumpster on Site THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Sionature COMMENTS HEALTH Reviewed on Signature COMMENTS 0 Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes I Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer ConneCtion/Signature&Date Driveway Permit DPW Town Engineer: Signature: Located 384 Os ood Street FIREDEPARTMENT: Temp Dempster on " site Located at�124 MainStreet i _ . .�' Fire Department signaturefdatef 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 No Electrical Inspector Yes � 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 - Date I ....... --........................._......._._...._._... _..........._......_..__.._....-- Doc.Building Permit Revised 2008 7 Location No. Date • - TOWN OF NORTH ANDOVER t Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL _ $ Check# + ` 26702 Building Inspector oORTH Town of t E : I� ndover No. 2 I Z • Y O � LAN• h , ver, Mass, COC NIC NlWCK RArEo fpkv L) BOARD OF HEALTH Food/Kitchen PERMITLD fi�rr.. Septic System THIS CERTIFIES THAT ;3.0.f.......A .......C!.i�ss ................... BUILDING INSPECTOR Foundation has permission to erect .......................... buildings on .......41C.... . ....&ft.............. _ Rough AQ ago to be occupied as ........... .....•. ........ ..... ..............41MA. ... ... ............................... Chimney provided that the person accepting this permit shall in every respect c rm 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 grew UNLESS CONSTRUCT ST Rough Service ................ .... .......................................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Reguired 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. SEE REVERSE SIDE The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' ` 1 Congress Street, Suite 100 Boston,MA 02114-2017 5° www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Ryan and Son Roofing Inc. / Peter S. Ryan Address: 383(Rear) Lowell Street-Suite 2G Wakefield, MA 01880 617-571-9056 City/State/Zip: Phone #: Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. K?I am a general contractor and I 6. New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. C]Remodeling ship and have no employees These sub-contractors have g• E] Demolition working for me in any capacity. employees and have workers' 9. []Building addition [No workers' comp. insurance comp. insurance.+ required.] 5. ❑ We are a corporation and its 10.[3 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I LE]Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.E]Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other 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 are doing all work and then hire outside contractors must submit a new affidavit indicating such. 1Contractors 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-contractors have employees,they must provide their worker;'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name: Policy#or Self-ins. Lie. #: Expiration Date: 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 Section 25A of MGL c. 152 can lead to the imposition qof 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 DIA for insurance coverage verification. I do hereby i er tl f, ins and penalties of perjury that the information provided above is true and correct. Si e: Phone#: 617-571956 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#• .5 t .. '' � .. Ate. � i 4,�'' .. � ,, - .. '. t� •!',� f ., i �.�l�. .:J.. ,i� . .. i4 ,..t s ��tV+... . f i :�.. .,t ? a � .y;:.- (. . iii. � G:..f� t . .. ., 6 r �`�,J .3,. . r .7 .r.�i . �..... ., ...y' ... ...... ... .. ..._ .... .. ... .. ..'S.� � ,.. i _, t a}.e ... . � .. e i ( � � .. V � t � r. � i r i .. � � 1 ., 1 ..,. i t . i . .. a.....L .. � .� ..._ . ... .. ...,.w- .. . .� ..n .: ...... '.. .. . v. r..�'.n .c. ....... F. �. ..•t e . .., _.r«a. ..� r... .... • s.. u,..t.... u..... ... ..- r v. ...... . .,. t ra .. .x.. �,: .V5 l,. a1i.' � . �7 al . .. ' . taa. Y% ,. y v J ♦. j,.�,n. ..w. a... .. ... .. r .. v .. .. ... .. .. .... ♦ .�,.,a..... i.. .... .. .. . � � •"� a (: a .. ... � t. .. ., ..._ ..., __.... .. ., �r f� .. The Commonwealth of Massachusetts Department of IndustrialAccidents n Office of Investigations a ' I Congress Street, Suite 100 V Boston, MA 02114-2017 www mass.gov/diu Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant information Please Print Le ig bly Name (Business/Organization/Individual): Empirel Home Improvements, Inc. / Clinton A. Galvin Address: 95 Audubon Road -#315 City/State/Zip:Wakefield, MA 01880 Phone#: 1-845-269-2015 Are you an employer? Check the appropriate box: Type of project(required): ll_ X I am a employer with 2 4. ❑ I am a general contractor and I employees(full and/or part-time). have hired the sub-contractors 6. F]New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. ❑Demolition working for me in any capacity. employees and have workers' 9 ❑Building addition [No workers' comp, insurance comp. insurance.= required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.0 Other comp. insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. 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 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-contractors have employees,they must provide their workers'comp.policy number. I am an employer that isproviding workers'compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name: Travelers Casualty Co. Policy#or Self-ins. Lic. #: 7PJUB-5B85550-4-13 Expiration Date: 03-02-2014 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 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 DIA for insurance coverage verification. I do hereby certi to pains and penalties of perjury that the information provided above is true and correct. SiMature: Date: ✓ S--/ l Phone#: 8452692015 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#• ACORQ CERTIFICATE OF LIABILITY INSURANCE osiza�2o 3) THIS CERTIFICATE IS ISSUED AS A MA''TER 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 older is an ADDITIONAL ED,t e Dollcy(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 endorac ment(a). PRODUCER CONTACT NAME: _ Duffy Insurance Agency, Inc. PHONE ExD: 781.593.1200 No:781.593.7260 317 Broadway ADDRESS: Wyoma Square INSURER(S)AFFORDINO COVERAGE _ NAIC a Lynn, MA 01904-2602 INSURER Seneca Specialty Insurance Co --- --... ._.. -- ---.. --- - --- .._ _ -----. ._ .. .- --- .... -. . ...._ INSURED Empire I Home Improvements Inc. INSURER B: Travelers CasualtyIns_ Co of A 95 Audubon Road INSURER C: Apt. 315 INSURER Cl: �— Wakefield, MA 01880 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: Ryan And Son Roofing 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDE')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. TNSRI---- ---._.._........--- ___ _....__ DIIC FDLICVEFF --....._......--..............—..._. — LTR TYPE OF INSURANCE INSR POLICY NUMBER MMIDD MMIDDIYYYY LIMITS GENERAL LIABILITY BAG-]021911-05/21/2013!05/21/2014 EACH OCCURRENCE f__ 1,- 000,00 j—- E'U'EN" -t ..—. 100 00 X COMMERCIAL GENERAL LIABILITY I PREMISES EA dccurtance) S _I J CLAIMS-MADE ,�^OCCUR MED EXP(Any one person) E 1,00( PERSONAL 8 ADV INJURY A I ._......._. ...............--...__..._._._....i..S_. 1,000,00( ...._I.... ....._......_...-.._...._......................................_ ,— ! GENERAL AGGREGATE S 2,000.00( GEN'L AGGREGATE LIMIT APPLIES PER, ! PRODUCTS-COMPIOP AGG E 1,000,0O —. POLICY I�E� j LOC i i S AUTOMOBILE LIABILITY Es accident) ANY AU)O I i BODILY INJURY(Per person) f ALL OWNED SCHEDULED ---" AUTOS AUTOS I BODILY INJURY(Per accldontl,$ NON-OWNED ! .PKUVr K I T UAMAUL_.___.... HIRED AUTO S AUTOS I Per accident 1 L.._—_...._i_....__......._....._..._._.(...a._ I I t I-... UMBRELLA LIAR .OCCUR EACH OCCURRENCE f ...—._ EXCESS LIAB CLAIMS-MADE I AGGREGATE E OEO L RETENTIONS S WO RXERSCOMPENSATION 7PJUB-5685550-4-1103/02/2019�03/O2/2014 I WCSTTORY TU- I ER AND EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNERIEXECUTIV Y/N E.L.EACH ACCIDENT f 100,000 B OFFICER/MEMBER EXCLUDED? hIA -- -- — (Mandatory In NH) I I E.L.DEASE-EA EMPLOYEE E If yes.descn order IS DESCRIPTION OF OPERATIONS below I I E.L.DISEASE POLICY LIMIT E S00,0010 I I � DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLE:i(Attach ACORD 101,Additional Ramarkr Schadula,H more spa"Is nqulrad) roofing, carpentry, FOR BIDDING PURPOSES PROOF OF 1k ORKER"S C;F)P,IPENSA I I()N f; GENERAL LIAB11-I Y ItiSURANC:E CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Ryan and Son Roofing 383 (rear) Lowell St. AUTHORIZED REPRESENTATIVE Suite 2g Wakefield, MA 01880 01888.2010 ACORD CORPORATION, All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD X-P, if:) R5 3 al mds 1� Sm 0S ------------- -,�, !<J�c• Zrr'7ir/ilcitcircri�/�c�� ;�lr ac�r%:el(': Office of Consumer Affairs&Business Regulation._ �� tfOME IMPROVEMENT CONTRACTOR -4egistration: 175213 Type: `;Expiration: 5/1/2015 �:• - Corporation EMPIRE 1 HOME IMPROVEMENTS CLINTON GALVIN 95 AUDUBON RD#315: _ WAKEFIELD,MA 01880 _ --.._-- _- _ Undersecretary Wi I S -BJ �Jti nt'Build:J) IZC�i,k�iit)tt� tn� S J-, _ CilSr 1Ci?GTi - 'ser ° kens.. . nse:'CS 104865 CLINTON GALVIN. 1:02 DELMONT AVE APT 2 c LOWELL, MA 01852 Exptr<:iicn: 4 7/1/201 Vis: __ 1� � I`/JL�tr��rr.1��t'� f �ft � .j.!<r.€l�rr;1<�� f „ r--(=� f Consumer ! `=t Office oAffairs and I3tlsincss 1Zgul�Ation 40 10 Park Plaza - Suite 51.70 Boston, MasScichuSCUS 02116 Home ImProvelnertt Contractor Registration 3. Registration: 159797 Type Private Corporation Expiration 5129/2014 TO 159797 RYAN AND SON ROOFING INC. PETER RYAN 93 NEW SALEM ST WAKEFIELD, MA 01880 Update Address and return card.Marts reason for change. I sCAi t5 2otvt•o5tii C Address I Renewal ^� Employment Lost Caret 1 GJ/u lro/ioa/rr-rru,eul(�o "'�ltrJnc�ai('l./J E �\. Office of Consumer Afbirs 8 Business Regulation License or registration valid for individul use only P OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: � ? egistration: 159797 Type: Office of Consumer Affairs anti Business Regulation ` CIWyLpiration: .5129/2014 Private Corporation 10 Park Plaza-Suite 3170 t _ Y Boston.n'IA 02116 j RYAN AND SON ROOFING INC. PETER RYAN �re 93 NEViI SALEM STWAKEFIELD MA 01880� Not valid without s f p 1� Submifted To: Job Location: Joe Hicks 415 Massachusetts Avenue 383t1C_1I.0well Sweet Suite 2G, Val of eld,XIA 01880': 415 Massachusetts Avenue North Andover, MA wr+-w.1kyanAmdSonRoofing.c0m North Andover,MA T&'617-571-9056 F3araiil:.tit�ttAndS4nK ifl�, nes Proposal date: August 5,2013 We are pleased to hereby submit this proposal to furnish materials and labor,completeiy in accordance with the below specifications: (Additional charges may apply for any change's not included below in proposal either by request of owner,or if Ryan and Son Roofing f nds unforeseen circumstances that will affect the performance,quality or integrity of this job).In the event legal action is taken to enforce any provision of this agreement,the prevailing party shall be entitled to all its reasonable costs,including reasonable in-house or outside attorney's fees.Not responsible for debris in attic. - t - X Strip roof tobare weal and fe-sldnule:S6,980A0 • Strip existing shingles down to bare wood • Check for rotted wood and replace as needed • Nail down any loose wood • histall ice&water shield to fust 6-feet,and in all valleys and around any protrusions • install premium synthetic underlayment(in place of standard 301b.felt paper) ,. • Install all new 8"white drip edge on perimeter and step flashing,where needed BBR • Install manufacturer suggested starter course of shingles • Install IKO Lifetime/architectural shingles in color of your choice • Install ridge vent • Cap ridge vent properly with manufacturers suggested cap(IKO Hip&Ridge 12) • Properly flash any protrusions and all new pipe flanges,if any on roof Chimney:Reaead and repoint chimney where needed:Inducted Clean Up: • Will cover area with tarps to minimize debris and remove debris related to work • NOTE: Please cover any belongings in the attic,as they will get dusty,if applicable Cost details: (Includes cost of ermit,Iabor,dump&material) Payment Scbedule: ist payment due upon signing: $1,480.00 Total Cost 6 8 Total balance due upon completion: $5,500.00 ,,,,,K-i1 !ly remit payment to "Peter Ryan". Thank you! Respectfully Submitted bll: ' _�_ Accepted •� . All work is 100%guaranteed for'10-yearslon all craft'smanshirAll other warrantees are through th manufacturer.All warrantees will be null&void if job is not paid in full:Thank�,f�etting us serve you!!!Ryan and Son R g,Inc. License#159797 CC: Lou/Peter