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HomeMy WebLinkAboutBuilding Permit #117-15 - 45 BUCKLIN ROAD 7/31/2014 O� NORT" q `�t�eo •6• ti� BUILDING PERMIT TOWN OF NORTH ANDOVER ° t o APPLICATION FOR PLAN EXAMINATION Permit NO: _ Date Received �9 . .`� Argo Date Issued: I �9SSACNUS t� IMPORTANT: Applicant must com Tete all items on this page ��'� LOCATION , ys 80C �61A) 44 t Printf,,-,,. PROPERTY OWNER. l�A UM&2 - . " Pring MAP NO: �� PARCEL I C3ZONING DISTRICT: Histone District' yes no ti a,cF- '- •',Machine ShopkVillage yes no° t° TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ItOne family ❑Addition ❑Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial 'WRepair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Septic ❑,Well "Floodplain []WetlandsR'[7 WatershedDistrict El Water/Sewer F . 5r21P E)CISTI K �SP/"Y SHIM-e;6 EJ ,9 NO /Ztcf C4l'E W/rf/ AAW 3O- VEA)ie /CE ANo 4grep Identification Please Type or Print Clearly) OWNER: Name: JZ -74 y ,LVA-44,e Phone: ��� 6'DS� -?6-?v Address: y5- 86Ct1,/N A0 Al N4e)J1F l M 0/e y7 CONTRACTOR Name A. ­ ._ one Address: ; E D CUA / S �E � * Supervisor's Construction License:" x E57 xp {D`ate ' r i I j Homemprovement License: Ex 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 c Proj1et Cost: $ .522 a ,j�—�' FEE: $ Check No.: I ' °1 Receipt No.: Z1 tq— NOTE: Persons contracting with unregistered contractors do not have access to t uar my fund Signature of Agent/Owner Sign�atuie of contractor r — �_�_ BUILDING PERMIT 01 tIORTH TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION 0 en k coc Permit No#: Date Received A ED 0' �SSACHU Date Issued: IMPORTANT: Applicant must complete all items on this page A'51 n 4- - ;_ 4-t £ �F,� r- - —.0 _J SZL.e t!I A,-AffilON . .................. n ft E RJ W RZ ;��®RRR @7. W. pP RIOT Az Yar-,,8 ru7efflr7F `MAPPAK,QL- ONINdW MJf 1RbISI1ff F Qyes ........... ...................... TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential 0 New Building 0 One family El Addition El Two or more family El Industrial 0 Alteration No. of units: El Commercial El Repair, replacement 0 Assessory Bldg [I Others: 0 Demolition 11 Other 13�',l=Watersheds M7ft Other - +n— SepticT, nd U.'q, 1"aterghe AQWic-N A DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: W k 6� a - tftb(� M— r. q Tp� -W9 ............ ;r7 ff�j 1 1� 5 J,0-A .0 A e AM 181 �,.d4 &4 M2 77��= -�J tat . an -tion#P %,Q--b,n,sttiJc' licerf V zY , - - ---. �T_s.-,- 1011.t v I K�- ,E_f7 r da 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.: Receipt No.,: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature WOW mesal.'t- h:.t!Y�"sT+ -'S�,vw .'a-+r" .�+ ..._.^rr:sN,u.. _ .s. �_._..__-• . . �,-.,.a.. •�7• ."s".. ,-:} Location _ell ° 1 t�.s t N is No. 1 J Date e TOWN OF NORTH ANDOVER • DI4e _ Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# I b u �fi � building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ S�'ll�ing Pools 11Well ❑ 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 Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/signature& r)ate Driveway Permit i DPW Town Engineer: Signature: FjRE - Located 384 Osgood Street DEPAR}TIVI t sF- .r ".L""'r ^`A ' ".' -gyp` ENT �aTernp ®urn steon site ,� Y LocaCetl a P eyes ,�� _ t 124 WinAStreet L y �� x� -k - ilf3ire De artment epR signature/date , 1 . .o,+?vat^:. y.,�...�-�--,.aR"-«Yr*„�" 3i�,;�� 6R.���• "moi �i`r g3 Z''Kx,�� 'N � �- �}..,,'rt ��t;,� ' �.a .£�' ��"`j�+:, r .. 'b s¢' .� 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 I 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 o 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 o 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 ❑ 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 ?_ An-dover G /r J_ 'J� "n No. „ �` .. h ver, Mass, 2.H2bN � o cocNic«ewic« �1' �a p�R.4rap 'Cot C? S u, BOARD OF HEALTH Food/Kitchen PERMIT LD Septic System THIS CERTIFIES THAT ........... ..1. �. ... BUILDING INSPECTOR .. ......... ........ ....... Foundation has permission to erect .......................... buildings on ...4. 4S...3 1.VA4.....U............. Rough to be occupied as .......��6M. % ..... .....4...re rbaf.................................................................. Chimney provided that the person accepting his 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 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough Service BUILDING INSPECTOR. Final 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. NORTH ANDOVER BUILDING.DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit at: 4Xfi 1AJ is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150 A. - Also, note Permits are required under Fire Prevention laws Chapter 148 Section I 0A. The debris will be disposed of in: NOV 7'/9*All FE/1 S r TjUU (Location of Facility) Sign e of Pe pplicant 7 j� Date hlgs lv i SS V - N4V 4 rPe- The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations �w I Congress Street, Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information pPlease Print Legibly /� Name (Business/Organization/Individual): E 7'7_67436110' zw e tp)elscr LG C Address: 661M"/A 16Y 6FA)IT12 ,SVI rC 226 6' '76ArCity/State/Zip: //�/Z1 Y 114 0/f/5- Phone#: '?76- Are e you an employer? Check the appropriate box: Type of project(required): 1.9 I am a employer with 5 4. ❑ I am a general contractor and I employees(full and/or part-time). * have hired the sub-contractors 6. E]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' [No workers' comp. insurance comp. insurance.: 9. E] Building addition required.] 5. ❑ We are a corporation and its 10.El Electrical repairs or additions 3.❑ I 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 13.❑ Other 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. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Twif e ews, Policy#or Self-ins. Lic. #: 6H08,513 9 V570 4 — /7 Expiration Date: y >/s Job Site Address: 1/5 /3X&IA,) 12D City/state/Zip: /19 0/6VS 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 certify under the pa i n ties 7e7l?e that the information provided above is true and correct. Si ature: 3/ 20/y Date: Phone#: — q/?1/75/ 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#: Illi '`� �, "TER'b Contractor License#CS 094612 �M 6 HIC#160616 !' ice �M e S:i=die=2wrr::tl.is Vijay Kumar 45 Bucklin ltd: -North_Ando✓e.,_NIA 0144- _ Ph:781-605-3634 ' ....• �_.. . .__. ._ .. Email:vkwnami@liotmail.corri June 10,2014 Dear Vijay, The following estinttite is for the roof installation for tete prop�_rty located at the above address. The following paragraphs describe the work that wi!I be performed. Roof l"stja 1eion Ploeedure: Strip existing roof on the entire house Inspect decking["Or any rotten or damaged areas _ `Replace any,rotted or broken.tooting boards,ata os'o; ,5 00/1.,F fir ledger hoard or 570.00/sheet for iz"plywood Install 6-fect.0di-co&water or all leading cdgee vailcy,'&'or liatisitions Install 15 p hind r°elt pap:r to cover rest ot'robf Install an 8-inch drip edge on all•eave and rake edges.Colo,,':�'v'iiit:Y Install new,vent pipe flanges Install new 30 year Architectural shingles,fastened by nails Install a ridge vent systema on the main peak of,the hoose Paint Chimney cap Replace piece of metal wrap on right side,of ho se,, .,m Home owner to,choose calor-of,stringles 1.rrlcn _ A€iditiona9 >eceitcate�ris: Dumpster to be placed next to house or garage All work will tie :lone in a professional manner,and timely basis A Please cover aii items in attic to protect from fall;nr dust atad debris ` ca We are not responsible for any of the cracks t1 at riiay wrise in.&.y walis'or ceilings 44; We vv,,ill remove wl of the job related debris 'FI) -o gl?Burly.jobs to cleating and upon rob co nrletion Dur p..rce itu liddcs the co t of the builds pe.rn ii obtain t a at tl;e'6ftfi A«lover Building Department Cost for tailor& M-,!.aerial to Install New Roof: $5,225.00 Additional carpentry will be billed at an hourly rate of S45ihr plus any riecessary material Pavviont'rerms: 30'% deposit,30%work in progress and. 0'% upo -ompletion Warranty: ,r3atter• h rt.rp;ses L.C",nuc:raAtt«s all work pert,-rued joY a period of ro e rs. .If piny problems occur we .will cover&,ow, %l�or to correct ihie;proh.,lern and meet the civaomer's satisfaction.A !z i erase#160616 DenniVijay k:utnarBetterion. homeowner ACC?RV CERTIFICATE OF LIABILITY INSURANCEFDATE(MMIDDIYYYY) 4/22/14 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(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 endorsemen s). PRODUCER CONTACT NAME: Carmen Cocca Cocca Insurance Associates Inc PHONE 781 245-0888 �jx No; (781) 246-3926 dba Water Street Insurance Age E-MAILADDRESS: carmen@cjetinsurancehere.com 27 Water Street INSURERS)AFFORDING COVERAGE NAIC# Wakefield, MA 01880 INSURER A:Essex INSURED INSURER B:Travelers Betterbuilt Enterprises LLC INSURER c:Evanston 100 Cummings Ctr Ste 226-G INSURER D: Beverly, MA 01915 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INRR VVVD POLICY NUMBER (MM/DONYYY) (MMIDD/YYYY11 LIMITS A GENERALLIABILITY 3DS5526 1/11/14 1/11/15 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTEDES(Ea occurren ce) $ 50,000 CLAIMS-MADE FXI OCCUR MED EXP(Anyone person) $ 5,000 PERSONAL&ADVINJURY $ 11000,000 GENERAL AGGREGATE S 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY PRO- LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT a accident $ ANYAUTO BODILY INJURY(Per person) $ ALLOWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIREDAUTOS NON-OWNED PROPERTY DAMAGE AUTOS er acc dent) $ C UMBRELLA LIAB X OCCUR XONJ451413 1/11/14 1/11/15 EACH OCCURRENCE $ 1,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,000 DED RETENTION$ $ B WORKERS COMPENSATION AND EMPLOYERS'LIABILITY Y/N 6HiJB5894898—A-14 4/25/14 4/25/15 WCSTATUOT - H- ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLLDED? N/A E.L.EACH ACO CENT $ 1,000,000 (Mandatory in NH)and E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yyes describe under DESt RIPTION OF OPERATIONS below F.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Rernaft Schedule,if more space is regui red) The Workers Compensation policy does not provide coverage for DENNIS DROGGITIS & EVANGELOS LIAPIS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CERTIFICATE ISSUED FOR YOUR ACCORDANCE WITH THE POLICY PROVISIONS. COMPANY UPON REQUEST FOR BIDDING PURPOSES ONLY AUTHORIZED REPRESENTATIVE Carmen Cocca ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The AC ORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: I' Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supen isor License:'CS-084795 EVANGELUS LIA tS 12 STONE STREETs DANVERS MA 0192 r �,•��,,-"qw,. Expiration Commissioner 05/11312415. Vfie�panvnzan�ueczll e s W0-dU`�&J License or registration valid for individul use only Office of Consumer Affairs&BusidesRegulation before the expiration date. If found return to: - lation ME IMPROVEMENT CONTRACTOR office of Consumer Affairs and Re u Type: r,eigistration: 160616 10 Park Plaza-Suite 5170 piration: ._81f3'!'201`6- Ltd Liability Corporati Boston,MA 02116 BETTER BUILT EN .B PRIS S-_L'-LC EVANGELOS LIAPIS 100 CUMMINGS.CENTER SlJ4TE'2' ft ERLY,MA 01915 Undersecretary slid w' ut signature I }