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HomeMy WebLinkAboutBuilding Permit #1077-16 - 439 WINTER STREET 4/15/2016 6/?✓I� " I� 1� r10RTF� AA4 9 � °o�tten„°• NO BUILDING PERMIT 3� �.._�. . . .6 ° TOWN OF NORTH ANDOVER ° w APPLICATION FOR PLAN EXAMINATION • - Permit NO: 10 -77 -16 Date Received 0 Ca;1.1 /IE / 1 (n �SSACHus Date Issued: fff l' IMPORTANT:Applicant must complete all items on this page LOCATION i J dAgt,�-- Print PROPERTY OWNER ''S Q Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Re 'dentia) Non- Residential ❑ New Building One family ❑Addition ❑Two or more family ❑ Industrial ❑AI ration No. of units: ❑ Commercial 1 epair, replacement ❑Assessory Bldg ❑ Others: ' ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑ Water/Sewer --� AL 2 ``�', 642256 yzzts 1,4 o ow/ Identification Please Type or Print Clearly) OWNER: Name: ���n� � /�/ � Phone: r Address: � — CONTRACTOR Name #c CA-Q-(,, Phone: 5JS62-2 Address: �' S� 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: $ FEE: $ /�`�� Check No.: t Receipt No.: NOTE: Persons contracting 'th n gistered contractors do not have access to the guaran fund signature of Agent/lOwner _ Signature of contractor Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. fit.: ELECTRICAL: Movement of Meter location, rust 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) I LI Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 1 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 Dempster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF m U FORM PLANNING DEVELOPMENT Reviewed On Signature COMMENTS CONSERVATION Reviewed on Signature i COMMENTS HEAL THe R viewed ori Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Ranning Board Decision: Comments Conservation Decision: Comments �Vzter-& Sewer Connection/signature ®ate Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DE=PARTMEIV1' QTernp Duster Located at 124 Main Street " fi,p A' Fire Departmen sign 11 r.w Minh 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 4, Photo Copy Of H.I.C. And/Or C.S.L. Licenses �6 Copy of Contract 4a Floor Plan Or Proposed Interior Work ,t. 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) 4. 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) 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 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 Doc:Building Permit Revised 2014 f Location r No. J Date • TOWN OF NORTH ANDOVER � k = Certificate of Occupancy $ "' Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check#Lf-, tf3L 6Building Inspector NORT11 Town of p to No. bl' T t 2o AILs oh , ver, Mass, COCMICNlWICK 1' A°RAreo �Pa���S s � - BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System _502 l rre", L BUILDING INSPECTOR THISCERTIFIES THAT ............................................................................................................................ `j Foundation has permission to erect .......................... buildings on . ..... ........ .......::........................................ 7 Rough to be occupied as G r r"o�' ................................................................. Chimney .........................5�... ...... .............le- 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit'. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough Service �s-� ....................�... .. ....... .......................................... 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. RA CARLO ROOFING .COM Home Improvement Lic. 106052 Construction Lic. Cs02O350 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 SAAIFRANK 10/10/15 )��nn��Address 439 WINTET NORTH OVER MA 01845 k4hone 603-365-855967 -557-5417--1. k� �03�t v, �9,D Contact We hereby submit specifications and estimates for: Strip existing roof Install TITANIUM UNDERLAYMENT �s Install new metal dripedge. 1 �-l�_ 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$3.75 a ft. INSTALL 1/2" INSULATION BOARD INSTALL NEW RUBBER ROOF RA CARLO BETTER BUSINESS BUREAU ACCREDITED A+RATING LIMITED LIFE TIME Guarantee for Materials add 15 Year Guarantee for Labor We propose hereby to furnish material and labor, complete in a co e with above specifications, for the sum of_$ 14,500.00 .Authorized Signature Note: This proposal may be withdrawn by us if not accepted within da Acceptance of Proposal: The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment will be made 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 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 SAAIFRANK 10/10/15 Address 439 WINTER ST NORTH A OVER M 01 45 Phone 603-365-8559 978-557-547 ' on act 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$3.75 a ft. INSTALL 1/2" INSULATION BOARD INSTALL NEW RUBBER ROOF RA CARLO BETTER BUSINESS BUREAU ACCREDITED A+RATING LIMITED LIFE TIME Guarantee for Materials add 15 Year Guarantee for Labor We propose hereby to furnish material and labor, comp et in c rd c wZ o e specifications, for the sum of_$ 14,500.00 .Authorized Signature Note: This proposal may be withdrawn by us if not accepted within days. Acceptance of Proposal: The above prices, specifications and conditio s are satisfactory a are hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above. 1/3 at start of job balance upon completion Start Date Completion Dat Customer and RA Carlo wil rmine start date at signing of contract. PLEASE COVER STORED THINGS IN AT,T�IIC SOME DEBRIS MAY FALL IN RA CARLO ROOFING .COM Home Improvement Lie. 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 SAAIFRANK 10/10/15 Address 439WINTE ST NORTH OVER MA 01845 jwhone 603-365-8559 78-557-54. .6 Ai �o3�6v, �9,D Contact We hereby submit specifications and estimates for: Strip existing roof Install TITANIUM UNDERLAYMENT Install new metal dripedge. �-f�_. 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$3.75 a ft. INSTALL 1/2" INSULATION BOARD INSTALL NEW RUBBER ROOF RA CARLO BETTER BUSINESS BUREAU ACCREDITED A+RATING LIMITED LIFE TIME Guarantee for Materials add 15 Year Guarantee for Labor We propose hereby to furnish material and labor, complete in a o e with above specifications, for the sum of_$ 14,500.00 .Authorized Signature Note: This proposal may be withdrawn by us if not accepted within da Acceptance of Proposal: The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment will be made 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 RA CARLO ROOFING .COM Home Improvement Lic. 106052 Construction Lie. 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 SAAIFRANK 10/10/15 Address 439 WINTER ST NORTH ANDOVER OVER M g45 Phone 603-365-8559 978-557-547 \101C on act 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$3.75 a ft. INSTALL 1/2" INSULATION BOARD INSTALL NEW RUBBER ROOF RA CARLO BETTER BUSINESS BUREAU ACCREDITED A+RATING LIMITED LIFE TIME Guarantee for Materials add 15 Year Guarantee for Labor We propose hereby to furnishmaterial and labor, comp et in c rd c w o e specifications, for the sum of_$ 14,500.00 .Authorized Signature Note: This proposal may be withdrawn by us if not accepted within days. Acceptance of Proposal: The above prices, specifications and conditio s are satisfactory a are hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above. 1/3 at start of job balance upon completion Start Date Completion Dat Customer and RA Carlo wilt rmine start date at signing of contract. ``•. PLEASE COVER STORED THINGS IN ATTIC SOME DEBRIS MAY FALL IN J The Commonwealth of Massachusetts Department of IndustrialAccidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PEPJvffr ING AUTHORITY. ARylicant Information Please Print Legib Name(Business/Organization/Individual): Address: ,b)A-)STzrZ City/State/Zip: Phone#: l(OL;7 Are you an employer?Check the appropriate box: Type of project(required): 1.❑d-fim a employer with employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 f-1 Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.t 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other 152,§1(4),and we have no employees.[No workers'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 ?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. Iam an employer that isproviding workers'compensation insurance for my employees. Below is the policy andjob site information. �(� Insurance Company Name: Policy#or Self-ins.Lie.#: �n V�,2 C-5 7 Expiration Date: Job Site Address: � ll �! ZT 2 ST City/State/Zip: G` Attach a copy of the kers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL 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. Ido hereby certi �n er the pains andpenalties ofperjury that the informationprovided above is true and correct Si ature: Date: l5z( Phone#• 1'��7 �/�ISt Q�Fc 7 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#: DATE(MMIDD/YYYII) ACOORV CERTIFICATE OF LIABILITY INSURANCE 04/14/2016 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: annle lukas T. EDMUND GARRITY&CO., INC. ac°N,;Ed: (617)354-4640 AI Ne: E-MAIL @9 ADDRESS: annle aRt Insurance.com 545 CONCORD AVENUE INSURER(S)AFFORDING COVERAGE NAICff CAMBRIDGE MA 02138 INSURERA: TRAVELERS INDEMNITY CO OF AMERICA(THE) 25666 INSURED INSURER 8: RA CARLO INC INSURERC: INSURER D: 65 DUNSTER RD INSURER E: BEDFORD MA 01730 INSURER F: COVERAGES CERTIFICATE NUMBER: 44929 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. INSR TYPE OF INSURANCE ADDL SUER POLICY NUMBER MNOLICY IIDD EFF POLICY MMIDD EXP LIMITS LTR2=JIM COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ _ CLAIMS-MADE I OCCUR PREMISES GE ToEa occurrence $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY❑PR - LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED N/A BODILY INJURY(Per accident) $ AUTOS NON-OWNED PROPERTY DAMAGE $ HIREDAUTOS AUTOS UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE N/A AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION X STATUTE ER AND EMPLOYERS'LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT $ 100,000 A OFFICERIMEMBEREXCLUDED? NIA WA NIA 6HUB2E92734915 10/27/2015 10/27/2016 (Mandatory in NH) E.L DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If 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.mass.gov/lwd/workers-compensabonfinvestigabons/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of N Andover ACCORDANCE WITH THE POLICY PROVISIONS. 384 Osgood St AUTHORIZED REPRESENTATIVE North Andover MA 01845 Daniel M.Cr y,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD s> Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-020350 I i s JJj� 8 ROBERT A CARIfi ` 65 DUNSTER RD: s Bedford MA 01730 Expiration Commissioner 04112/2016 Office 6f Business Redeitnrio". %OME 1MPROVEMEt T CO%TRACTOR Tye ~ Registration. 9=F 52 DBA Expiration 71212{f96 R.A.CARLO CO Robert Carlo i 76rister Road — I�'v>-3-,73'6 i