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HomeMy WebLinkAboutBuilding Permit #672-2017 - 46 COPLEY CIRCLE 12/28/2016�/Z)7%�tY W -e-4 Ao Lt - BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION" permit No#: 7 2- }0 f7 Date Received 1 Date Issued: o r 6 IMPORTANT: Applicant must complete all items on this page d,ot,1 A` 018 LOCATION �� �IYC,�� PR R E: RT YY OWN_ER__.- MAP' L ZONING DISTRICRT- Yes yes 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 0 Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Septic. `01Nell 0 Floodplain D Wetlands- 1Nafersned Di"sfric '! , , _Water/Sewer-. - DESCRIPIIUN UI- VVUI- M I U 01= 1 r-MrUM1w1cv. Identification - Please Type or Print Ulearly OWNER: Name:, }�yevn s ecr-o Phone ���� -- '� Address: L-�4 \ YCAP- 00\_ + ftA4A IV`�' Contractor Name l tdZ? Phone: GG3- W.- �`t? Address: ��}r✓1!y.1-�' �. �U"�!�� a ���• ���. _� - ---. . u ervsoc's CoristYuction cense r Datwer Sup p" Date Home Iri .ovement License .... - ��0- . Exp, - -.-- - - ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE. BULDING PERMIT: $92.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. '-. _,Total Project Cost: $ to ,cm FEE: $ v i Check No.:—"3 S79 3_G Receipt No, -3 ! 3F;` NOTE- Persons co tracting with unregistered contractors do not have. access to the guaranty fund �f,AnPnf �nlr,Pr (an re of eo ractar Location f/ ( ( 1.1: 1 t No. (0 i' -U1 5 Check # ? ` r . � Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 1 C Building Inspector Plans Submitted ❑ Plans Waived Certified Plot Plan ❑ Stamped Plans ❑ F-' F 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 a U FORM PLANNING & DEVELOPMENT Reviewed On COMMENTS Signature, CONSERVATION Reviewed on Signature COMMENTS HEALTH COMMENTS Reviewed Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes t Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street -- --- - 1.11IN "U111POLM vii ILC yC5 no Located at 124 Main Street Fire Department signature/date COMMENTS -Nmension 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.sloo-siodo fine Doc.BOding 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. r Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application/ ❑ Workers Comp Affidavit ❑ Photo Copy Of H.1. C. And/Or C. S. L. License ❑ Copy of Contraot/- ❑ 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/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 (1f Applicable) ❑ Copy of Contract act ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products COTE: 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 0 CDn a O CD CDo� CL �• N O vCD C = cr -CD CD O CD C O CD CO CD � v O 0 Z 0 �- o CD 3 CD Z 0 m v cn z O Cl) O D O z o, CD N O CQ O cm X CD U3 0 N 0 U) U) CD o c O 2 = � N CD, CD n 0 � =- C7 m o O o Q. 0 m 0 -qL m 0 c D m x S O con CD C'1 to CL O '" U)� O OCD CCD ,L ��� ;3 � 00 t m CD O � a r: V.- CD (n O n CL 00 COL o N cn ��< CLCD �y CD U) a 0 o c :vf CDC CD yrt CD10 CD N CD- 7 rt s N O O O Q C3 Ln 3 O O � to (D Z 0 W C O T v D m -' TZ7 j O d4 Z m 0 T j N O0 O A DQ rm- m AD r m 0 T O' W O DQ a C Z O .0 T j n s rD W O Dq T O 7 a) oN 3 W C L o m O EA (D �. N (D 3 T O O_ r m W � O O m D O qb a Owens Corning Platinum Protection Certification Number- 217736 Sentry Roofing K/A LMPH HOLDINGS 40 King St. Suite 2 Auburn, NH. 03032 PROPOSAL Steven Seero 46 Copley Circle North Andover, MA. 01845 December 22, 2016 Re: We propose to replace all roof areas at the above address except areas Job/Site Preparation - All work is to be performed within accepted OSHA guidelines - Work area is to be kept clean at all times - Care is to be taken to protect all landscaping and personal property Removal - Tarp house and grounds prior to stripping the existing roof, house is to be protected from leaks at all times. - Remove all the existing roofing material to wood sheathing, re nail any loose sheathing - Replacement of any sheathing if needed will be done at a cost of $ 42.00 per sheet - Remove and dispose of any and all job related debris per state and federal requirements - Magnetic sweep all affected areas - The two existing skylights Roofing Installation Page 1 of 3 Owens Corning Platinum Protection Certification Number- 217736 - Install new .018 white 8" aluminum drip edge to all roof edges. Install Owens Corning Weather Loc G Self-sealing Ice and water protection as follows: 9' at all eaves, and 3'at all valleys, rakes and penetrations Install Owens Corning Pro Armor high performance roof underlayment to all areas not covered by ice and water protection Install Owens Corning Starter Plus starter shingle to all eve and rake edges Install Owens Corning TruDefinition Duration lifetime roof shingle, color choice Is Onyx Black Install Owens Corning Vent Sure Ridge Vent to all ridges needing to be vented Install Owens Corning ProEdge hip and ridge shingle to all ridges - All shingles are to be installed with six nails - Check and replace all metal flashings as needed Replace plumbing vent pipe boot, install clear sealant where neoprene rubber meets plumbing pipe Install two new Velux fixed Velux skylights of matching size. The smaller unit is FS size A06, the larger size is S08. New flashing kits will also be installed. Interior finish trim is to be installed as needed General - Contractor is to warranty any labor issues including leaks for ten years - Provide owner with an Owens Corning Platinum Warranty if requested - Contractor is to provide insurance certificate prior to start of work - All work is to be done in a neat and workmanlike manner - If you have a satellite dish: We are not responsible for any service charges to reconnect your dish service, should it be necessary, after we re -install the dish to your new roof. You may want to schedule a reconnection date ahead of time to reconnect your services once we have completed your roof. Job Cost / Payments Cost of materials, labor, and disposal ------------------------------------ $ 10,900.00 Cost of Building permit ( I will obtain for you ) TBD Platinum Protection Roofing System Warranty ( If wanted )------ $ 450.00 Page 2 of 3 ^ The Commonwealth of Massaehusetts Department ofIndldstrialA.ccidents „ - r I Congress Sheet, Suite 100 Boston, MA. 02114-2017 www mass.gov/dia WCompensationlnsurance Affidavit- Builders/Contractors/Electricians/Plumbers. alkers' BE MED WrH TRE PER�JUTIl� Cx AUTgORI i'. 'bl TO please Prins Le A •' licant Information h� -PH HOldly<5 Nalue (Business/Orgariiz,timadiviaual): LM Address: 4U S�reek Phone #: (o t'3 - 7-7N City/State/Zip: Axe y an employer? Check the appropriate box: Type of project (required); em to ees(full and/or part-time).' 1. I am a employer with P y 7. ❑ NeVi' d6wlril6iion 2.0 I am a sole proprietor or partnership and have no employees brorking forme in insurance required.] 8. Q Remo deluig 9. ❑ Demolition any capacity. [NO Workers' comp. insurancerequired] 3.Q I am ahomeowner doing all workmysel£ [No workers' comp. 10 [] Building addition 4.[]T am a homeowner andwill be hiring contractors to conduct all work on my property. I will insurance or are sole 11. [] Electrical repairs or additions ensure that all contradbrs either have workers' compensation 12. Gj-Plumbing repairs or additions proprietors with no employees. 5.Q I am a general contractor end Ihave hiredthe sub -contractors listed onthe attached sheet employees have workers' comp. insurance 13,Rb6f repairs These sub -contractors have and 14.r] other 6. ❑We area corporation and its, officers have exercised their right of exemption per MGL c. comp. insurance required] 152 §1(4) and vac have no empldyees. [No workers' 'Any applicant that check§ box#1 must also fill out the section below showing their workers' compensation policy information: i Homeowners who su... v hvs affidavit mnc�ating they are doing all work andthen 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 notthose pntig-e - have employees. If the sub -contractors have employees, they must provide their workers' comp. policy nuutber. I am an employer that isproviding�workers' compensation insurancefor° my employees. Belo7v is tliepolicy aradjob site information. �s Insurance Company Name: 0 � trCJl7 ExpirationDate^ I Z8 11� Policy ## or Self ins. Lie. n/M�1.� /YI/� ilgy�� ,Y� City/State/Zip: / K lob Site Address: Attach a copy of the vvoxkers' co. pensation policy declaration page (showing the policy number and expiration date ) - lob Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a filie up to $1,500.00 and/or one-year imprisonment, as well as civil penalties be fothe foxm of a ST ed to the £ii e op O Invo�E�� of � DIA for insurance 0 a day against the violator. A copy of-tbis statement may coverage verification. tizepains andpmalues ofpeYlarY I do hereby CIO exts undert7iat the information provided above is true and correct - ON- / Of use only- Do not-WTite in this area, to be completed by city or town offieial. City or Toyvn- permit/License # Issuing Authority (circle one): 1. Board of F(ealth 2. Building Department 3. Cityllown Clerk 4. Electxicallnspectox 5. plumbing Inspector 6. Other Phone #: Contact Pern so• 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 hire, express or implied, oral or written." An employe-ris defined as "an individual; partnership, association, corporation or other legal entity, or any two or more ofthe foregoing engaged in a joint enferprho, and including the legal representatives of a deceased employer, or the receivef'oz trustee of an individual, partnership, association or other legal entity, employing emplbyees..However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant ofthe' dwelling house of another who employs persons to do maintenance, construction or repair work on such dowelling house or on the grounds or building appurtenant thereto shall not because of such employment b6 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 applzcantwho has not produced -acceptable evidence of compliance with the insurance coverage xequiked." 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=contractors) name(s), address(es) and phone number(s) along with their certificates) 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 au LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for 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•Accidenis. Should you have any questions regarding the law or if you are required to obtain a w' orkers' compensatiori 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 ofthe affidavit for you to fill out in the event the Office ofInvestigations 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 thai must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necess ary) 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 fixture 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 bum 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 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax ## 617.727-7749 Revised 02-23-15 www.mass.gov/dia KNAPTON READE & WOODS Fax 6034644066 Dec 28 2016 09:20am P001/001 r LnllrnnlJL.-VL t51V1t KK 111 A�ORL7` CERTIFICATE OF LIABILITY INSURANCE DATE 12123/20 6 12/28/2016 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 j BELOW. THIS CER rIFICATF_ OF INSURANCE DOCK NOT CONG-TITUTC A CONTRACT BETWECN THE ISSUING INSURER($), AU I HUKILtU REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or 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). PRO13UGER INME CT Knapton Reade, & woods Agency, Inc. PHONE — - I prc, N0003) 464�t066 22 School Street IAIC, No, Eli: (603) 464-3422 Hillsboro, INSURED LMPH Holdings LLC dba Sentry Roofing 40 King St Auburn, NH 03032 E -MAI ADDR __• •. -_ INSURER,(Z) AFFORDING COVERAGE NAIC 0 INSURER A: Nautilus Insurance Co 17370 INSURER e: Proaressive Insurance Group 24252 INSURER C,: Berkley Risk Administrators INSURER D: INSURER E INSURER F: UUVt -ts CERTIFICATE NUMBER: REVISIO N NUMBED. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN I$SUED 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._ ... — TYDE OF INSURANCE ADDL SUER POLICY NUMBER FOUCYEFF POLICY EXP MIDDIYYYY MM LIMITS A X COMMERCIAL GENERAL LIABILITY AUTHOR12Eo R^EPR/E-SEENTTATIvE EACH OCCURRENCE 1,-000,000 s_ CLAIMS -MADE CLAIMS -MADE F I OCCUR NN7362$8 DAMAGE TO RENTED PR€MISES (Fa occurrcnDq — - 100,000 11/0412016 11/04/2017 MED. EXP (qnY On@ [B�BOn) g 5,000 - •—�_- -- PERSONAL BADV INiuRY $ __ 1,000,°°D N'L AGGREGATE LIMIT APPLES PER: GENERALAGgREGATE $ 2,000,000 -. POLICY JEL'T �� LOC 2,000,000 PRppUCTS•COIeOlOPAGG S _ OTHER- S B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT accidenn _ $ 500,000 _- ANY AUTO _ O'nT1ED 15CHEDULED 025644011 07/09/2016 07109/2017 BODILY INJURY (Per ersan 5 —•• - AUTOS ONLY X AUT05 BODILY IN RY (P@r @��Id@nt $ •AMAGE _ RE� Q p _ .. AUTOS ONLY AVOTOS 0V 1 PROPERTY (P@r 8cci0Bn1 ..... .._ •_ UMBRELLALIAB OCCUR EACNOCCURRENCE„ 5 EXCESS LIAR CLAIMS -MADE _ A R AT DED RETENTION $ C WORKERS COMPENSATION 5 pp _ PTRT AND EMPLOYERS'LIABILITY YIN : ERH ANY PROPRIETowPc.RTNER EXECUTIVE r� 0288300658601 05/28/2016 05/2812017 100,000 OFFICER/MEMSER FxCLUDED? Y..:N/Ai E S, EaG� ACCIDENT — $ an glory In NH) 11 yes, deacnbe undo E.L. DISEASE- EAEMPLOY= $ 100'000 !, E.L DI - POLICY LIMIT Is 5001040 SCRIPTION OF OPGRATION5 WOWOPERATION i I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORO 101• Additional Remarks Schedul=, Toy be attached It more spam Is rQq.I(,d) 'Workers Comp Info: Excluded Officer (NH): Paul Modzelaeki Ra: 5teven Seero, 46 Copley Clrele, North Andover, MA 01845 /'1VVrrV LJ 1LV I O/VIII ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 120 Main St ACCORDANCE: WITH THE POLICY PROVISIONS. North Andover, MA 01845 AUTHOR12Eo R^EPR/E-SEENTTATIvE /'1VVrrV LJ 1LV I O/VIII ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Massachusetts Department of Public Safety ® Board of Building Regulations and Standards License: CS -109956 Construction Supervisor PAUL MODZELESKI 280 STARK HIGHWAY SOUTH DUNBARTON NH 03046 Expiration: Commissioner 05/23/2020 I r�le �3crr...,�rrraerr�/� a�P�l�a.r.Tcrc�rcJe/, ... Office of Consumer -Affairs & Business Regulation r HONE iMPROVl MENT CONTRACTOR Registration =178126 Type: �f.•P Expiration: = 8/£12018 LLC LMPH HOLDING, LLC. _ DBA SENTRY ROOFING PAUL MODZELESKI 40 KING ST. . AUBURN, NH.,03032 Undersecretary