HomeMy WebLinkAboutBuilding Permit #233-2017 - 46 FOSTER STREET 9/1/2016 {
i NORTH. w-
BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION * ,
Date Received ADRATED 4`�
Permit No#: � ��ssACHus�c
j�
Date Issued:
MPORTANT: Applicant must complete all items on this page
CATION `� �► u ��t
LO Print
PROPERTY OWNER 10o Year Structure Yes °
Print
(a ']_PARCEL:& ZONING DISTRICT: Historic District yes no
MAP
`�� Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE Non- Residential
Re idential
❑ New Building ne family
El Two or more family ❑ Industrial
❑Addition ❑ Commercial
[IAlteration No. of units:
-,Repair, eplac n
Assessory Bldg ❑ Others:
[I
Demolition ❑ Other -- �� �� ❑ Watershed�District
Septic ❑Well p Floodplain; ❑Wetlands
❑Water/Sewer
DESCRIPTION OF WORK TO BE PERFORMED:
kA- U a J-
1 '
Identification- Please Type or P-rint Clearly Phone:
OWNER: Name:
:L ----)tA Cy
Address:
(� f`mak lS,°`,5 �`► hone:
Contractor ame: �`— �
Email A
Address: /
Exp. Date:
Supervisor's Construction License: t" S
d Exp. Date:�(
Gl `
Home Improvement License:
�o
ARCHITECT/ENGINEER
Phone:
Reg. No.
'i Address:
M FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
FEE: $
Total Project Cost: $_�_
Receipt No.:
Check No.:
NOTE: Persons contracting with unregisteredinpr
of
contractors do not have ac the guaranty fund
--
-ti
Location -�
No. r �" ,t i Date `t
t r
• TOWN OF NORTH ANDOVER`
i,3 , � •.
Certificate of Occupancy $ 4
Building/Frame Permit Fee $ �
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Ile
Check
- t O 3 it
Building Inspector /
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
F
WERAGE DISPOSAL
❑ Tanning/1VIassageBody Art ❑ SwimmingPools❑ Tobacco Sales ❑
Food Packaging/Sales ❑
Private(septic tank, etc. ❑ Permanent Dmnpster 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
COMMENTS
HEALTH Reviewed on Signature
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
b
Conservation Decision: Comments
Water& Sewer Connection/Signature& Date Driveway Permit
DPW Town Engineer: Signature:
rE DEP Located 384 Osgood Street
_M'TET� ►71p Dumpster=on;site �yes �i ; `�"EX
IMIR
o ated
r+^ '+s^+.,�:rX is"a" ;,k'7 2 ��j s�trY'i t�}w. * �3`l M •r +Ifx�:! �i x'+'" -w..�. ...
#
• FiretDepartmentisi nature/date
^:k��i--•--�s-°' -•°��9.'�,;Y ..7. ;�..,a.�cr..:��....�..�....ex.ra�..5.�......FTI...d,...._„•.....:..,..:i'..._.�,,,� 3. ..J �'
��k � s�:.� ti,_ Q� > Sf�t„i �� � i�3.. F�'-L`r '�'.�,K�✓'�.�E"°s�"',�"!."";�� -a� , --?rT'--,--^a.=-_-„ :.. ,1
r.>K.yc. .3;t..w.®}��+..y � ”.. e t s i c i ' r .r_`-' "'t '�r �f�'r �, r r ��r ^{•
COMMENT^S` r7 tF' +l'�3 P x.,r, '�¥'`• Y� •, � ?.. +G i 3+ �i r�°f�� .y'i��+°� rt r� z7F%1 3'?:7 �.�a � .f�'i�
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 I
MGL Chapter 166 Section 21A-F and G min.$1oo-$1o0o fine
NOTES and DATA— (For department use)
® Notified for pickup Call Email
Date Time
Contact Name
Doc.Building Permit Revised 2014
Building Department
in is a list of the required forms to be filled out for the appropriate permit to be obtained.
FRoofing,
following
Siding, Interior Rehabilitation Permits
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
prior to issuance of Bldg Permit
g art p
De
OTE: All dumpster permits require sign off from Fire p
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 S
ection/Elevation Plan Of Proposed Work With Sprinkler Plan And
�. Flo
Hydraulic Calculations (If Applicable) licable
Mass check Energy Compliance Report (If App )
Engineering Affidavits for Engineereproducts Fd a Department prior to issuance of Bldg Permit
OTE: All dumpster permits require sign o
ff fromNew 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
of Building Plans (One To Be Returned) to Include Sprinkler Plan An
Two Sets
' ' Hydraulic Calculations (If Applicable)
Copy of Contract
46 2012 IECC Energy code
-41 Engineering Affidavits for Engineered productsPermit
OTE: All dumpster
� um ster permits require sign off from Fire Department prior to issuance of Bldg.
. stamp peals
IFand roof of Appeals
cases if a variance or special permit was required the Town corded at the Registry of Deeds. one copy from the Board of p
ordin
� In all applicant must then get this
that the appeal period is over. The app
must be submitted with the building application
T Cy Doc:Building Permit Revised 2014
r 'I NORTH
,.. q :. -c . : ve: �
No. o16 1 *
n0 h ver, Mass, 6fAalobv
[
�
CO ./KNl K WKAo a%�
s U
BOARD OF HEALTH
Food/Kitchen
P.ERMIT T LD Septic System
THIS CERTIFIES THAT BUILDING INSPECTOR
..................... . .... .................�a....... . .........................
Foundation
has permission to erect ...... ................... buildings on ...... . ......... ...... .. ... •
.. . .. .........................
Rough
to be occupied as ..... ..... ... Chimney
p c ................. .. .: .. ' . ................................�...
provided that the person accepting this permit shall In every reslct conform to the terms of tl iplicati
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 MO S ELECTRICAL INSPECTOR
UNLESS CONST I T Rough
Service
... ... .... ... ... .......... ........ Final
G INSPE TOR
GASINSPECTOR
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.
i
RED TAIL CONSTRUCTION CONTRACT#81316
733 Turnpike Street Unit 192
13North Andover, MA 01845 DATE:8/30/16
Phone: 978-273-4397
E-mail:rdtail@comcast.net www.rdtail.com
Scope of Work Address:
Jerry and Jacque Margolcyz
46 Foster St
North Andover,MA 01845
Thank ou for choosing Red Tail Construction---Scope of Work Agreement:
Item Item Description
Scope of work:
1 Front fascade of garage: remove existing trims, install new AZEK trims at corner boards,,around $7,430.00
garage doors and around upper window;remove damaged clapboards and install new hardi-plank
clapboard siding.Weather seal all; all debris removed from site. Ve.w w AHdow I'54 s"ve
S f 4,QRS �ik
We Appreciate Your Business.
Total All Segments : $7,430.00
Payments:
Upon Start: $2,100.00
Upon Substantial Completion: $2,600.00
Upon Completion of punch-list/project: $2,730.00
Red Tail Construction, Inc.
733 Turnpike st unit 192 North Andover, MA. 01845; CS License # CS-094338; HIC
#155649;
Contract begin scope of work on 8-30-16; completion by 9-8-16
Approved by:
Jerry Margolcyz Steve McCullouyh Red Tail Construction Inc
_ The Commoyzwealth ofMasstrchusetts
z .
Department ofindustrialAccidents
1 Congress Sheet,Suite 100
- j Boston,MA.02114-2017
.�� ww�v.rnrx go-PMa
W,a kers'Compe'nsationlumrauceAffidavit:Builders/Con--tractors/Eleetricia�nslPlm�bers.
TO BE FILED WITH TBE pnMTMG AUTHORITY.
A licant Wor mation Please Print Le ' I
Name (Ensiness/Organizafion/InC 1nal):
Address: 9
City/StateLzip: tjL (r��J.9•�
Are you au employer?Chatiie appropriate box: Type of project(Tenured):
I. I am a employerv&h employees(full and/or part time).* 7. [[New coristraltion
2. I am a sole propiietor cr partaersbip and have no employees wozldng for me in 8. RBrrio deli]ig
any capacity.[No workers'comp.insurance required] 9, Demolition
3.Qlam ahomeownerdoingallworkmysel;INoworkers'comp.-insmancerequred]t 10❑Euilc�ingaddition
4.0 I am a homeo-mmand will be hiring contractors to conduct all work onmy property. Iwill
ensure that all contractors either have workers'compensation in sumee or are sole I ❑Electrical repairs or additions
proprietors withno employees. 12:0 Plumbing repairs or additions
5.n I am ageneral contractor and Ihave hired the sub-contractors listed on the attached sheet. 13.0 Roof x'epairs
These sub-coniractorsliave employees andhave workers'comp.incrm,nce-1 14.❑Other
6.[]We are a cozpration zndits of gers have exercisedtheirrigbt of exemption perMGL c.
152,§1(4),andw-ehaveno-employees.jNoworkers'comp.ins�sancerequred.]
j
*Any applicaotthatchecksb&41 must also''Elloutthesectionbelow shov>herworkers'compensationpolicy i0fomiaiion.
i Homeowners alio shj if k a affidavit indicating they are doing all work and then hire outside contractors must submit a neve affidavit indicating such
?Contractors_#bat checkthis box mnsta taclsect an additional sheet showing the name of the sab-contractors and state whether ornotthose entities have
employees. Ifthe sub-conIraciors Save employees,IdLey must pravidetheir workers'comp.policy number.
I ani an erriployer tli at zs pYoviding-workers'compennsad on insurance for any employees.'Beloit/is thepoliey arid job site
-
Insurance Company Name: ']
Policy#orSelf-ins.Zi .#: S S l '( � I Expiration Date: \6
Job Site Address: '1 � `�` - City/State/Zip:
AttachacopyoftheWOKkers' cornpensationpolicy declaration page(showing the polleynumberand expiration date).
Failure to secure coverage as required under MOL 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 SWOP WORK ORDER and a fine of up to$250.00 a
day against the violator.A,copy of this statem t may be forwarded to the Office of Investigations of the DIA for insurance
coverage verif oation.
1 d hereby certify uaader t9hepai - en aides of perjury that the informaiionprovided ab ve is o �d eori eek
Si afore: Date: `
Phone#: Ci
Official use only. JIo not-write in this area,to be completed by city or town o iiciax.
City or Town: Permit/License#
Issuing Authorfty-(circle one): i
1.Board of Health 2.BuilditngDepartment 3.City/Town Clerk. 4.B+lectrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
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 bf hire,
express or implied,oral or written."
Au 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-ail 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 anotherwho 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 bean employer."
MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the ismance or
renewal of a license or permit to operate a business or to construct buildings in the cornmonwealtlt for any
applicant wJao lias not pro duced 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 fiTl•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•phonenumber(s)alongwiththeir certificate(s)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)withno employees'otherthan the
members orpartaers,arenotregairedto 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•7n.dustrial
t
Accidens for confirmation ofinsurance coverage. Also be sure to sign and date the affidavit. no 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 gaestions regarding the law ox if you•are required to obtain a workers'
compensation policy,please call the Department at the number listed below. Self-iusur6d companies should'enter their
self-insuraace 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 areference 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"lob 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 maybe provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. Anew affidavit must be filled out each
year.where a home owner or citizen is obtaining a license or p ermit 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
DATE IMMmDIYYYYI
CERTIFICATE OF LIABILITY INSURANCE
' TWQ.CE1qTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. S
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
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 and endorsement. A statement on this certificate does not confer rights to
the certificate holder in lieu of such endorsement(s).
PRODUCER CONTACT
NAME:
S"TARKWEATHER&SHEPLE-Y PHONE FAX
60 CATAMORE BLVD (A/C,No,Ext): (A/C,No):
E-MAIL
EAST PROVIDE-"NCE.RI 02914 ADDRESS:
22111-IX INSURER(S)AFFORDING COVERAGE NAIC#
INSURED INSURER A: TRAVELERS INDEMNITY COMPANY OF AMERICA
RED TAIL.CONSTRUCTION INC INSURER 8:
INSURER C:
733'TURNPIKE ST UNIT 192 INSURER o:
INSURER E:
NORTH ANDOVER,MA 01845 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 ADD SUB POLICY EFF DATE POLICY EXP DATE
LTR TYPE OF INSURANCE L R POLICY NUMBER (MMIDDIYYYY) (MMIDDIYYYY) LIMITS
GENERAL LIABILITY EACH OCCURRENCE Is
COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED !$
CLAIMS MADE 0 OCCUR. REMISES(Ea occurrence)
ED EXP(Any one person) Is
GEN'L AGGREGATE LIMIT APPLIES PER: ERSONAL&ADV INJURY is
ENERAL AGGREGATE I$
POLICY PROJECT LOC RODUCTS-COMP/OP AGG Is
AUTOMOBILE LIABILITY
COMBINED SINGLE $
ANY AUTO LIMIT(Ea accident) I
ALL OWNED AUTOS BODILY INJURY j$
SCHEDULE AUTOS (Per person)
HIRED AUTOS BODILY INJURY �$
NON-OWNED AUTOS (Per accident)
PROPERTY DAMAGE 1$
(Per accident)
I
UMBRELLA LIAR OCCUR EACH OCCURRENCE is
EXCESS LIAR CLAIMS-MADE AGGREGATE Is
DEDUCTIBLE 1$
RETENTION S $
A WORKER'S COMPENSATION AND X WC STATUTORY OTHER
EMPLOYER'S LIABILITY YIN UB-9F557812-16 03/19/2016 03/19/2017 LIMITS
ANY CEPIME BERIPARTNDED) CUTIVE � NIA E.L.EACH ACCIDENT S 500,000
OFFICER/MEMBER EXCLUDED?
(Mandatory In NH) E.L.DISEASE-EA EMPLOYEE($ 500,000
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT is 500,000
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/RESTRICTIONSISPECIAL ITEMS
THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE_.
CERTIFICATE HOLDER CANCELLATION
Jerry Margolcyz SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED
46 Foster St IN ACCORDANCE WITH THE POLICY PROVISIONS.
North Andover, MA 01845 AUTHORIZED REPRESEn
�/�
ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD 1988-2010 ACORD CORPORATION. All rights reserved.
r,psefls vepaUrnent of Public y
a, , cr of Suiici.in safe
g Regulations and Standards
Llce6se: t5-094338
,. rucAon Sirpervitor
STEPHEN A'NICCULLOUGH
733 TURNPIKE ST U-1,92 r
NORTH ANDOVER MA p� 45{`
y
Comm, fssi_'oner Expiration:
09/08/2017
T J7
^ (91e �»L�»antccal�aC�/�ao��ic�uteGtsi
Office of Consumer Affairs&Business Regulation
i OME IMPROVEMENT CONTRACTOR
egistration: ;195649 Type: i
- xpiration -4/3012'017, Individual
STEPHEN MC CULLpt-G
lit
STEPHEN MC dJU4-UGC
733 TURNPIKE STREET,�
f .PrNDOVER;MA 018 8
Undersecretary
,a
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