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HomeMy WebLinkAboutBuilding Permit #394-16 - 44 PHILLIPS COMMON 9/29/2015 c�uw� Xti �a�'S' BUILDING PERMIT o�"L°T b,6 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: 1 Date Received �` / � 0AATED / gSSAC Date Issued: c f` IMPORTANT: Applicant must complete all items on this page LOCATION _ Pnrt PROPERTY OWNER - �- - - Print 100 Year Structure yep �` no MAP. PARCELT_ ZONING ISTRICT Nistorc�Disfnct yes. no Ye - Machine Shop VillageS no 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 C Septic 0,Nell © Floodpl�a:n� 0 Wetlands D 'Watershed Dstnct _Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: Contractor am e.. ..� Phone J `7 . -=- - _ Address . J _ Supervisors Construction! License. � � Exp Date _- _ s Horne4lmpr©yerrmentLicense Exp spate _ ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BOLDING PERMIT.•$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. c U Total Project Cost: $ CA lS FEE: $1.f 'n _ '^ Check No.: Receipt No.: )jq ) � NOTE: Persons contracting with unregistered contractors do not have a cess to the guarantyfund Sig.nattare of Agent/Own.er ..__ - ° .__ _ Signature.of Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swi nmmg 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 I HEALTH Reviewed on Signature COMMENTS i 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 F.IR�E D`EPAR€TMEll Ternp ®umpsteronsite= yest�. 4 Located at124,gfMain Sf�eet t J ,FireDepartmen ,signature/date h 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 Doe.Building Pennit Revised 2014 +1 1 I Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. t Roofing, Siding, Interior Rehabilitation Permits ` o 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 { 9 ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit 1 ❑ 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) Li Mass check Energy Compliance Report (if Applicable) o 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 i ❑ 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 j ❑ 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 Location No. Date Aq . • TOWN OF NORTH ANDOVER Certificate of Occupancy $ A Building/Frame Permit Fees Foundation Permit Fee $ . Other Permit Fee $ TOTAL $ � 33 � Check# 1 Building Inspector 29423 A NORTH Town of rY.4, Andover h h ver, Mass, I S _ - q COCNICHI WICK 1' ' 9S DRATED Oki? U BOARD OF HEALTH PERM Food/Kitchen Septic System T LD THIS CERTIFIES THAT e /e,so% ...... BUILDING INSPECTOR . ... . .. . .. . �.���. P,,....�r. f7 .......�� Foundation 'has permission to erect .......................... buildings on .. ... ........ LLLL �1�. � c Rough to be occupied as .......�„�t .......jr ...... ......... V ..... Chimney provided that the person accepting this permit shall in every res ect 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 p� Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO TA Rough Service Final BUILDING INSPECTOR W, GAS INSPECTOR 3 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. 1 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 lure, 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 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 the boxes that apply to your situation and,if necessary,supply sub-contractor(s)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 may be submitted to the Department of Industrial Accidents foi 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 Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-20.17 Tel. #617-727-4900 ext. 7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia Fully Licensed and Insured Member of MA Better Business Bureau. r''' n }� Member of NH Better Business Bureau ,� . . GAF,Cert",ME#•20212 S�1C� ``� HIC Reg#166661, Owens Corning Preferred Contractor42.12828 MA CSL#104728 . r °•e . OSHA 30'.Hour Construction Safety Training �._ f EPA Lead Safe Certified. 4,r •�; .:General:�Contiracting; Lcc.,ARM " 51 S. Broadway#2214 Salem, NH 03079 (603) 890-0084 1 10 Stevens Street#141 Andover, MA 01810 (978)475-0095 PROPOSAL SUBMITTED TO PHONE DATE a 67eCG -c 617 633 '-idea '/I / jam STREET E-MAIL Y4-1 l;)s 6G^ � CITY,STATE,AND ZIP CODE ! JOB LOCATION 'Completely protect the home with-tarps to catch falling debris Respect and protect slir.`ubberynd flowervbeds. Strip off layers of roofing material down to the bare roof deck. Inspect the roof deck for structural defects. Determine the condition of the underlying plywood or boards, and repair and replace as necessary*. Inspect roof ridge for proper 11/2" spacing on either side of ridge for maximum exhaust ventilation. Cut in if necessary. Install new heavy gauge "i�:+(f , (color) Alum;lt,t.Yt drip edge at roof eaves. Install (VCC,+6rL44-C ice and water shield to rY eet manufacturer's specifications (i.e. 6 feet from roof edge, 3 feet centered in valleys,.around all skylights,chimney basQ,s, roof penetrations and at all sidewall transitions). Install becA 4cirlr breathable roof deck protection to remainder of the roof deck.. Install new,heavy gauge I� -a'�. (color) .d#fu t�^i/+Dt d". drl edge roof rakes. P 9 w a Install .. starter:stnp f at rdof eaves and rakes r Install r ftn. ;" tt.r.-r tS S :. . �� '1C desired color.: (colgr) 7 ' Install riew flashings to meet m anufacturor's'specifica ons, (i.e. sidewalls, chimneys skyl ghts,arid'roof penetra$ons) Install (feet) of �c�yt e•�. � UGQc J•f 1 ridge vent at roof ridge to•allovv maximum ventilation. ' Hand nail to ensure proper fastening', r Install Bt fir' (feet) of —7—mbtc—Vk� distinctive hip and ridge cap. Hand nail to ensure proper fastening. Thoroughly clean up and dispose of all roofing debris on/property. Magnetically sweep property for nails. ;. I Notes: w lec b c Ck-ri Y W ( �4 f E ,r Edmunds General Contracting will: > • Obtain all necessary construction-related permits to complete this project. • Perform work as efficiently as possible without sacrificing quality. • Furnish and install all necessary materials to complete the project. • Provide a thorough clean-up and disposal of all debris generated during project. Edmunds General Contracting LLC agrees to commence work on/or about and described work will be completed in about days. Product Upgrade 1: Product Upgrade 2: 4 Contractor's employees are fully covered by workmen's compensation and liability It is further agreed that this contract may be assigned by the contractor,and also insurance. that the obligations hereof shall bind and apply to their heirs,successors or estates of the parties. Upon completion of the above work,all undersigned agree to execute and deliver to the contractor,their joint note in accordance with his(their)above obligations as Edmunds General Contracting LLC guarantees all workmanship performed for requested by contractor.Upon refusal to do so,contractor may at its option declare -45-,years. the entire contract price or so much as then remains unpaid,immediately due and e �` / payable.It is agreed that,if permitted by law,contractor shall be paid by the We will register S, Pe'l't E/"s factory enhanced warranty owner(s)all reasonable costs,attorney fees,and expenses,in addition to the providing Q; years of material defect coverage and 7 years of amount due and unpaid,that shall be incurred in enforcing the terms and conditions workmanship defect coverage through e,>,�F for: of the contract and/or any lien in connection herewith. T154 no charge —the additional cost of Edmunds General i Contracting LLC will provide the materials,labor and disposal to replace up to 64 sq.ft.of roof decking and 20 ft of fascia at no additional cost. Any additional materials including labor and disposal will be replaced at, / per sheet or �Q�linear foot. Edmunds General Contracting, LLC agrees to furnish the material and All material is guaranteed as specified.All work to be completed in a workmanlike manner according to standard practice.Any alteration or deviation from above specifications Involving extra costs will be executed only upon written labor complete in accordance with the above speJfications,for the sum orders,and will become an extra charge over and above the stated contract price.contractor is not responsible for damage due to high winds,tornadoes,hurricanes,fire or other hazards.Owner(s)agree to carry fire tornado and other of r 174220 etib };�,C dollars($ ,tX� In insurance.Contractor is considerate of owner's landscaping and but due to the nature Of the roofing ,r'flC,�, jxj installation some damage may occur.We attempt to minimize any damage,and will not be held responsible if any c / 7 _rte �� �(�(� damage occurs. Contractor is not responsible for any damage to the interior of property,including pre-existing Payment Terms: conditions(i.e.water stains,crumbling plaster,exposed nails)or conditions resulting from application of materials as specified above.Items in the attic may need to be covered by the owner.Contractor is not responsible for damage • A deposit of _(not to exceed 1/3 of the total contract)is caused by ice dam build-up.All agreements are cont'ngant upon strikes,accidents,or delays beyond our control. due upon start of work.The balance ofr-FIs due when work Authorized Signature* _ ---••* � is completed to the satisfaction of all parties. '< `Edmunds General Contracting LLC • A finance charge of 1.5% per month (18% per year)will be charged on Note: This proposal may be withdrawn by us if not accepted within past due accounts over 30 days days. �LCepta!nte Of V1'Ot1onl -The above prices,specifications,and 00 aNOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. conditions are satisfactory a are hereby accepted.You are authorized to do the work as specified.Pay a will be made asXoutline"bgve. !Authorized Signature: bate of acceptance: Authorized Sigl ature: All home improvement contractors shall be registered.Any Inquiries about a contractor or subcontractor relating to a registration should be directed to:Office of Consumer Affairs and Business Regulation,10 Park Plaza,Suite 5170,Boston,MA 02116(Phone:617-973-8700). Owners who secure their own construction—related permits or deal with unregistered contractors shall be excluded from access to the Guarantee Fund provisions of MGL.c.142A , The owner•will receive a signed copy of this contract before work will commence.The owner has three(3)business days to cancel this contract and incur no penalty.Correspondence should be directed to Edmunds General Contracting LLC at the above address. Rev.01/13 ' ���® DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 9/18/2015 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 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 PLANRIGHT INSURANCE& FINANCIAL LLC NCONTACT AME: 224 MAIN STREET STE 3C PHONE FAX SALEM, NH 03079 E MAIL Ext AIC No ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: LM Insurance Corporation 33600 INSURED INSURER B t EDMUNDS GENERAL CONTRACTING LLC P 0 BOX 2214 INSURER C: SALEM NH 03079 wsURERD: INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: 26473324 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 SUBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM/DD/YYYY MMIDD/YYYY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO CLAIMS-MADE OCCUR PREM SES(E.Occurrence $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY 0 JECTPRO ❑LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIREDAUTOS AUTOS $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION$ I $ A WORKERS COMPENSATION WC5-31S-369752-025 1/26/2015 1/26/2016 �/ STATUTE EERH AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT $ 500000 OFFICER/MEMBER EXCLUDED? ❑Y N 1 A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 500000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Workers compensation insurance coverage applies only to the workers compensation laws of the state of MA. This certificate cancels and supersedes all previously issued certificates,only as they relate to workers compensation coverage. CERTIFICATE HOLDER CANCELLATION TOWN OF NORTH ANDOVER, MA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE EXPIRATIONTHE DATE THEREOF, 120 MAIN STREET ACCORDANCE WITH POLICY PROVISIONS.IEWILL BE DELIVERED IN NORTH ANDOVER MA 01845 AUTHORIZED REPRESENTATIVE �1 LM Insurance Corporation ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD 26473324 1 1-369752 1 15-16 WC I Ashish Eorgaonkar 19/18/2015 10:41:30 AM (EDT) I Page 1 of 1 �+ Massachusetts -Department of Public Safety ' Board of Building Regu'latio�s and Standards 'Construction'Supen icor License: CS-104728 rte' sum ' DAVID C EDMUNDS -Q P.O.BOX 2214 SALEM NH 03019 Expiration .54— 10/0312015 • ; ' Commissioner ` �12��QO71�//720iIZCI{�dGL1L d���(/(�40CGCSZt//re�i Office of Consumer Affairs&Business Regulation OME IMPROVEMENT CONTRACTOR egistration: ;1%6661 Type: Expiration:4 r:6 2-112 1:6� Corporation n t = EDMUNDS GENERAL TR-CTING,LLC. �. .3 `?S\ DAVID EDMUNDS Y ., g - '�- '. 18 ASHFORD RD HAMPSTEAD,NH 03841;' . . Undersecretary I I, 1