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HomeMy WebLinkAboutBuilding Permit #421-16 - 458 JOHNSON STREET 10/5/2015 �CptvnrE� ��//f NORTH BUILDING PERMIT °� ED 161 % TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION * ,� K 1. Permit No#: Date Received �1Rp°aAreo gSSACHUs�� Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION �� n n �►� S f l/1 civ R f� � -� Print PROPERTY OWNER � cZLL Print100 Year Structure yes no MAP S PARCEL: Af ZONING DISTRICT.— Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ne family 11 Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ,,repRepair, replacement [IAssessory Bldg ❑ Others: air, ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: f CoY�'1 ���� �D or— �z� �e tin.,t= 6S c, Identification- Dylge Type or Print Clearly OWNER: �Name: I C± 11Y l 6 K Phone: J Address: �i S 2 L1SDL'� Contract r Name:CA KC0 ?r 1�C Rrr Phone: ��'3 �S Email Address: c�'� c - oh1opr V'/' L Li Supervisor's Construction Licenser 5`1063q Exp. Date: �1 Jam ° Home improvement License: )3 1 —Exp. Date: 1 � p p ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.•$$112.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ ?, 00 FEE: $ Check No.: 7 Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access he gu -a fund 5 nature of Agent/Owner �� �� Signature of contractor--- 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 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 c Planning 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 T FIG Located at 124 Main Street Fire Department signature/date COMMENTS �L V , e U Y O E'- t� Dimension Number of Stories: 'Z- 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 Doc.Building Pennit 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 o Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work o 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 ❑ 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 o 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 • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ • #Q , Building/Frame Permit Fee $_, 0, Foundation Permit Fee $ a Other Permit Fee $ TOTAL $_ 9 ti Check# �� - B 'ding Inspector r 7 NORTI� . : :. .c . ve" '* ver, Mass, COCHICHEWICK S U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT ..................0 .... .. ................................................ BUILDING INSPECTOR has permission to erect .......................... buildings on .. r�....., . ................................. ..................... Foundation Rough to be occupied as — �''�� 60;; f,a„ .................... .. . f .. .. ....... ....... ... ..... f../. SIR:... .. .. �2................... 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough Service ` �. .................... ...... . ,�;�2n�:G��.. .............................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz 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. QUOTE BLUE ROOF CONTRACTING 81 Bailey Rd INVOICE NO. XXXX00162 Somerville,MA 02145 DATE July 27,2015 781-267-6771 CUSTOMER ID Mat BLUEROOFCONTRACTING.COM EXPIRATION DATE 9/30/2015 BLUEROOFCONTRACTINGna GMAIL.COM TO Mat Carpanter 458 Johnson Street N.ANDOVER,MA 01845 781-710-9063 SALESPERSON JOB PAYMENT TERMS DUE DATE ROOFING/GUTTERS/RAFTE �' Carlos Pereira RS 1/3 Signing; 1/3 Mid-paint;1/3 Canhplefion QUANTITY DESCRIPTION UNIT PRICE LINE TOTAL DEMO: Remove asphalt shingles to roofing deck(33 Squares). Replace rotted roofing boards,up to 32 Sq.Ft included.DEMO entire 40X15 main roofing section including all boards and rafters.Extra boards will be additional charge*1 Install 8 Inch white dripe edge through-out roofing perimeter. Install step flashing on all chimneys and walls. Install pipe flanges on all pipes Re-frame 40X15 roofing section,both sides that were demoed. Install plywood as decking.All framing and materials to be used need to be up to code Install Ice+Water shield on all valleys and roofing perimeters(Grave or Equivalent in quality It price) Flash all pipes and protruding elements,Skylights Install LIFETIME rated architectual asphalt shingles of owners choice of color,based on color board provided Install ridge vent and terminate with caps Replace all gutters and add gutter by porch and main roof that are missing gutters Dispose of all debris to local dump site Not to touch rubber roofing 1185SgFt RE-FRAMING ROOFING $7.75 9,183.75 163ft $10.00 1,630.00 33.00 ASPHAL SHINGLE ROOFING $475.00 14,850.00 3.20 DISPOSAL $540.00 1,728.00 ALL WORK CARRY 5 YRS WORKMANSHIP WARRANTY FROM START DATE Quotation prepared by: _Carlos Pereira 11 This is a quotation on the goods named,subject o the onditions noted below: SUBTOTAL $ 27,391.75 (Price subject to increase due to unforseen occurances.If extra work is added to this estimate after start of project. SALES TAX '1 price based on max 2 layers if additional layer is found extra nd disposal will incur. 80 extra per ton,$20 per square,per layer) AL $ 27,391.75 To accept this quotation,sign here and return: THANK YOU FOR YOUR BUSINESS! 6LVvi,e ms, �`�r�. /V3 J /M,- cc ts, /t y 9 (2, l5 � AcG : The Commonwealth of Massa chusetts M Department of IndustrialAceldents .F d 1 Congress Street,Suite 100 µ- Boston,MA 02114-2017 Wt www mass.gov1dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legib NaMe(Business/Organizationdndividual): G em V o. ] l7 o Address: b 1 3 CC7t I e V KJ City/State/Zip: LOHerV t 1 t e VZ1�, hone Are you an employer?Check the appropriate box: Type of project(Tequired): 1.'pr am.a employer with _employees(full and/or part-time).* 7. E]New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. EIRemodeling any capacity.[No workers'comp.insurance required.] 9. F1 Demolition 3..Q I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10E]Building addition 4.F1I 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 I L E]Electrical repairs or additions proprietors with no employees. - 12.E]Plumbing repairs or additions 5.❑1 am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13 Woof repairs These sub-contractors have employees and have workers'comp.insurance.t 6.FJWe are a corporation and its officers have exercised their right of exemption per MGL c. 14.E]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 flus affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors 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,&y 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: Policy#or Self-ins.Lie.9:1/✓GG 5-00-SO. Expiration Date: l ` Job Site Address: S 4 [ 0��1 f 00 5/• 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 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. I do hereby cerj+under epain ndpenalties ofper jury that the informationprovided ahoa is tri and correct. Si ature. � Date. (2— Phone#: ��� Official use only. Do not write in this area,to he 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#: at A� CERTIFICATE OF LIABILITY INSURANCE �o;oi;2o15 °' ' 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 POLICIE 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 WANED, 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 CAONTME: ACT N Insurance Center Special Risks, Ltd. PHONE 888-773-7475 No: 413-781-0050 20 Gold Street ADDRESS: info@ specialrisksltd.com P.O. Box 1250 Agawam, MA 01001 INSURER(S) AFFORDING COVERAGE NAIL# INSURER A: ESSEX INSURANCE COMPANY INSURED INSURER B: BRC RENOVATIONS INSURER C 81 BAILEY ROAD SOMERVILLE, MA 02145 INSURER D: 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 PERIO 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 TERM EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE ADDL SUER POLICY NUMBER MM/DDY EFF NYM M�/LDIpY EXP LIMITS A GENERAL LIABILITY 3DY6862 04/03/2015 04/03/2016 EACH OCCURRENCE $ 11000,000 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 50,000 CLAIMS-MADE FIOCCUR MED EXP(Any oneperson) $ 1,000 X $500 DEDUCTIBLEDeductible PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1,000,000 JECT X POLICY PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANYAUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident UMBRELLA UAB OCCUR EACH_OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION $ WORKERS COMPENSATION WC STATU• I 10TH- AND EMPLOYERS'LIABILITY Y/N TORY L IMITS ER_ ANY PROPRIETOR/PARTNERIEXECUTIVrI NIA E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLO 0 yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) REMODELER CERTIFICATE HOLDER CANCELLATION Town of North Andover SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 36 Bartlett street ACCORDANCE WITH THE POLICY PROVISIONS. Andover, Ma 01810 AUTHORIZE EP��RES++E..NTATN 1 A, ©19 -2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD DS#2395645 DATE(MNUDD/YYYY) ►co a CERTIFICATE OF LIABILITY INSURANCE 10/1 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( must be endorsed. If SUBROGATION IS WAIVED,subject the the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to th certificate holder in lieu of such endomement(s). N CT 20DUCER NAME: AL PONTE INSURANCE AGENCY INC PHONE Exc: (617)492-7600 aC,No:(617)354-0401 819 Cambridge Street ADDREss:ciaudia•victoria@thepontegroup.com Cambridge, MA 02141 INSURER(S) AFFORDING COVERAGE NAICN INSURER A: JSURED BRC RENOVATIONS INSURER B: 81 BAILEY RD INSURER C: SOMERVILLE, MA 02145 INSURER D.AEIC INSURER E INSURER f: I REVISION NUMBER: ,OVERAGES CERTIFICATE NUMBER; N ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEE 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. YE LLIMITS NSR A D su POLICY NUMBER MM/DD MMfDDPrM any TYPE OF INSURANCE INSR WVD EACH OCCURRENCE $ GENERAL LIABILITY PREMISES Ea occurrenceL_ COMMERCIAL GENERAL LABILITY MED EXP(Any one person) $ CLAIMS-MADE EI OCCUR PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS-COMPIOP AGG $ GEN'L AGGREGATE LIMIT APPLIES PER. $ POLICY PECT LOC AUTOMOBILE LABILITY O accident $ BODILY INJURY(Per person) $ ANYAUTO SCHEDULED BODILY INJURY(Per accident) $ ALL OWNED AUTOS AUTOS NON-OWNED $ Per accident) HIRED AUTOS AUTOS $ EACH OCCURRENCE $ UMBRELLA LIAB OCCUR AGGREGATE $ EXCESS LAB CLAIMS-MADE $ I OED RETENTION$ WCSTATU- OTH- WORKERS COMPENSATION TORY LIMITS ER AND EMPLOYERS'LIABILITY Y/N4/17/5100,000 ANY PROPRIETORfPARTNERIEXECUTIVE Y WCC50 0-5014 518-15 4/17/16 E.L.EACH ACCIDENT $ D OFFICERIMEMBER EXCLUDED? CI NIA E.L.DISEASE-EA EMPLOYE $ 100,000 (Mandatory in NH) des If cribunder E.L.DISEASE-POLICY LIMIT $ 500 ,000 yes,dese DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 36 BARTLETT STREET THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ANDOVER, MA 01510 ACCORDAr ITH THE POLICY PROVISIONS. /T AUTHORizE6 R P SENTATIVE ° 1988-2010 ACORD CORPORATION. All rights reserved. ACORD25(2010/05) The ACORD name and logo are registered marks of ACORD ��e�panv»2oouaecc��,a�UliGcrd9�u�eail Office of Consumer Affairs&Business Regulation License or registration valid for individul use only -(NOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: '173394 Type: Office of Consumer Affairs and Business Regulation .� 5 1.6 IndividalEx Expiration:-' u 10 Park Plaza-Suite 5170 =a, —=• Boston,MA 02116 CARLOS A.PEREIRA=..__ „7 � r , CARLOS PEREIRA 81 BAILEY RD SOMERVILLE, MA 02145 l Undersecretary Not valid without signature Massachusetts-Department of Public Safety Board of Building Regulations and Standards 1.111111/ullll'/ll OII SIC/Y11111 ' License: CS406349 CARLOS A PERE-14"A� 81 Bailey Road Somerville MA 0Z-145 "s ♦ 9 .t/e Expiration Commissioner 07/15/2017