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Home My WebLink AboutBuilding Permit #917-15 - 46 STONINGTON STREET 5/14/2015BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: IMPORTANT: LOCATION J . -Ad N 1-1 mustcomplete all items on this x/ SV— .r v Print PROPERTY OWNER i� ' _ irl � Print/00 K 0 MAP NO: r PARCELP 46 ZONING DISTRICT: Historic DistrictTve no _ Machine Shop Villagec no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building 9,dne family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial epair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑ Well ❑ Floodplain ❑ Wetlands ❑ Watershed District ❑ Water/Sewer Identification Please Type or Print Clearly) OWNER: Name: ,�,9//i d //� Phone: Address: CONTRACTOR Name: L/¢ lij�Bti'LP, Phone: '7d l7efI e // ./�6�n Address: Supervisor's Construction License: 9Dyl?9 Exp. Date: Home Improvement License: /7G 761 9 Exp. 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 Project Cost: $ �� Sr4 FEE: $ I �� Check No.: Z Receipt No.: 28'7`7 3 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund ,/ pignaiure or Hgenvuwner 4V,6, c.)' /,,f �— Signature of contractor C -zew _� r �. L� ti Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ "W'u"ning 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 e U FORM PLANNING & DEVELOPMENT COMMENTS CONSERVATION COMMENTS HEALTH COMMENTS Reviewed On Signature. Reviewed on Signature Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes 1 Planning Board Decision: Comments Conservation Decision: Comments Wafter & Seaver Connection/signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPAR+TMENT -Tern Dum�'ster on_' situ '"Y p `' p_ yes no Located at 1r24 Main Street Fire DepartmeignaMure/date R. MMEN, I T� , Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.:, ELECTRICALS Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes N® DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$10o-$1000 fine NOTES and DATA -- (For department rise) ® Notified for pickup Call Email Date Time Contact Name Doc.Buildinb 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 4. Building Permit Application Workers Comp Affidavit 4. Photo Copy Of H.I.C. And/Or C.S.L. Licenses �6 Copy of Contract Floor flan Or Proposed Interior Work Engineering Affidavits for Engineered products TOTE: 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 TE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) Building Permit Application 4. 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 2012 IECC Energy code Engineering Affidavits for Engineered products TOTE: 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 Doe: Building Permit Revised 2014 7 �O Location No. bate '""(vq7 Check #0116 28773 TOWN OF -NORTH ANDOVER Certificate of Occijpancy $ Building/Frame Permit Fee $ Foundation Permit Fee $- Other Permit Fee $ TOTAL $ Buli ding inspector L� J WCA LL O O m N u Y �O O O LL J Ln Q N N 0 Z Z J� m c O m : 7 O LL �M 7 O N C L U _ 70 LL 0 a Z 0 z J d � O 2' _ C LL 0 a Z U V J W t 0= d' U N N LL O w z Q .0 00 2' LL W H W W W i : co O z N L N a+ N -11 O E V) 0 W �a z Z m CO z Cl) � l ' T z ' 1 tq W I.L o is Z LLJ O F V W J a z m O a� c 0 N d 0 • O Z a J 0 E CD I.L � 0 G� z Q cn � 0 .� CD0 U) •AE, m m W Cl- 0 w 0 0 0 Q 0 .CL 0 . rz v CL w CL U) zA bLARRY ,......r_,...,�.....y. _ - - - 30 Sheridan Stree -`� Wobum , MA 0180, 781.789.9711 CS09038S larryhildebrand@a verizon.nel �� Quality Roofing by Laity Hildebrand, hereinafter referred t0 as "Contractor", here r above premises in a good, workmanlr7ce and substantial manner according m the following terms, ash to Owner all materials and labor necessary to roof and/or improve the a. Description of the work and the materials to be used: g pecrficat ons and provisions: New Shingle roof as per the attachment "A" Project details. New Shingle Roof Total $ 11 6 &� .. Options[; ! PA46.004 L cy�Z-.e4 Standard Shingle warranty included 10 yr & Lifetime System Pius warranty 20 yr & Lifetime $240.80 up b. Desai ��- Description of any areas that will NOT be worked on: Jur Q,& $ �. This list of specifications subsequentpages (see page number below) - Total Contractor proposes to Perform the above work, (subject two rainy 8�dons and/or deductions Pursuant to authorized change orders) , for the Total Sum of;�_3, Down Payment (if any)AMOU ; P.9YMENT Dl) WH at t PAYMENTS TO BE MADE IN iN3TA LME c ec cti 1. Balance upon Completion i By check upon receipt of invoice for draws as 2. _ described under "Payment Due When" to the left 3• column. 4. —` d. Commencement and Completion of Work: Substantial commencement of the job shall mean either the physical delivery Performance of any labor and shall be subject to any permissible delays as per provision (3) on the reverse side of this proposal/contract. of materials onto the premises or the ex.. Approximate Start Date: e. Acte Approximate Completion Date: Acceptance: This proposal is approved and accepted. I (we) understand there are no oral tam, Provisions, Pians (if any) and specifications inthisproposal/�ntract is the Mire 0. menta or understandings between the parties of this agreement The writ0en order only and with the express approval of both parties. Changes may incur additional c t between the perces. Charges in this agreement shall be done by written change Additional Provisions Of This ProposaUConbW Are On The Reverse Side And May Be Notice To Owner on page two (2) before signing. Read "Arbitration of Disputes" Provisionn ed a two (21 ro pages {seepage number below). Read Ign in the same place on Provision. Nyou agree to arbitration, sign on the Cine below the NOTICE where indicated. P two (2j, Pt+ovision 10 and the NOTICE fotbwig this DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES cancel this agreement if it has been signed bCH COPY of this Contract a You may at a place other than an address of the seller, which may be Jhis main office or branch thereof, provided you noir the seller in 4.� writing at his main office or branch by ordinary mail posted, by 8PPMedn telegram sent or by delivery, not later than midnight of the third business day following the signing of the agreement See attached Garret Hudlow I notice of cancellation for an explanation of this right appro+eu (conuz3dor) -"`( NOTE; This proposal may be withdrawn atterr 30 days from o► Form RPC C CopyriSht ®19�-2008 ACT Contractors Forms N not approved and signed by both parties. �) $�� tvww:cai€orrit'corrt Page one Of -2_ Total Pages The Commonwealth of Massachusetts , Pant Form Department of Industrial Accidents Office of Investigations I Congress Street, Suite 100 t Boston, MA 02114-2017 www. mass.gov/dia Workers' ^Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Name (Business/Organization/Individual): Address: z GC Phone #: Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4.a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2.E] I am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub -contractors have working for me in any capacity. employees and have workers' [No workers' comp. insurance comp, insurance.+ required.] 5. [] We are a corporation and its 3.0 I am a homeowner doing all work officers have exercised their myself. [No workers' comp. right of exemption per MGL insurance required.] t c. 152, §1(4), and we have no employees. [No workers' insurance required. Prin Type of project (required): 6. ❑ New construction 7. El Remodeling 8. 0 Demolition 9. (] Building addition 10.❑ EIectrical repairs or additions 11 -[1 Plumbing repairs or additions 12.0 Roof repairs 13,❑ Other __ (&Z "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 arc 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: Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address: 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 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 cerci under the pains and penalties of p!rLu2 that the information provided above is true and correct. ir— Official use only. Do not write in this area, to be completed by city or town of 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 #: ..+D. �+�-.. �+ .+ au• +... uv.a.+ .+. ......,.., ... ww.w a aavu a.• vvu ♦ aw.a� uva ♦va CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYYI TASMOITIFICATE 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.CERTIFICATE HOLDER. IMPORTANT: if the certificate holder Is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the arms 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: PHONE FAX UNIVERSAL INS AGENCY 374 BELMONT STREET (AIC, No, Ext): (AIC, No): E-MAIL ADDRESS: WORCESTER, MA 01604 7726B INSURER(S) AFFORDING COVERAGE NAIC 9 INSURED INSURER A: ACE AMERICAN INSURANCE COMPANY AMERICAN CONSTRUCTION & SIDING INC INSURER B: INSURER C: 04 SENATE RD APT C INSURER D: INSURER E: MILFORD, MA 01757 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS 8 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 MAYBE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMBS SHOWN MAY HAVE BEEN REDUCED BY PAD CLAIMS. INSR LTR TYPE OF INSURANCE ADD L SUB R POLICY NUMBER POLICYEFFDATE (MMd)DIYYYY) POLICYEXPDATE (MNhDDIYYYY) LIMITS GENERAL LIABILITY CH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY CLAIMS MADE M OCCUR. AMAGETO RENTED $ REMISES (Ea o=urreirce) ED EXP (Any one person) $ GEN'L AGGREGATE LIMB APPLIES PER; POLICY PROTECT LOC ERSONAL & ADV INJURY $ ENERAL AGGREGATE $ RODUGTS-COMP/OP AGG $ AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE $ LIMIT (Ea accHert) ALL OWNED AUTOS BODILY INJURY $ SCHEDULE AUTOS (Per person) BODILY INJURY $ HIRED AUTOS NON OWNEDAl1TOS (Per aoddert) PROPERTYDAMAGE $ 71 (Per accident) UMBRELLA LIAR 0 OCCUR EACH OCCURRENCE $ EXCESS L1AB CLAIM&MADE AGGREGATE $ DEDUCTIBLE $ $ RETENTION $ A WORKER'S COMPENSATION AND EMPLOYER'S LIABILITY YIN UB-BD861692-14 12/0712014 12!07!2015 X I WC STATUTORY OTHER LIMITS ANY PROPERITOMPARTNER/EXECUTIVE OFMCERIMUMER EXCLUDED? NIA E. L EACH ACCIDENT $ 100,000 E.L. DISEASE - EA EMPLOYEE $ 100,000 (Mandatory In NH) Ityes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCA11ONSNEHICLESIRESTRICMONSISPECIAL ITEMS THIS REPLACES ANYPRIOR CERTIFICATE ISSUED TO TRE CERIMCATEHOLDER AFFECTING WORKERS COMP COVERAGE. CERTIFICATE HOLDER CANCELLATION LAWRENCE HI:LDEBRAND LLC DBA QUALITY ROOFING AND SOLAR SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL B DEUV IN ACCORDANCE VATH THE POLICY PRO 30 SHERIDAN ST AUTHORIZED REPRESENTATIVE WOBURN, MA 01801 ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD 1988-2010 ACORD CORP6RATIOW.- A-11 Tights reserved. Y ffice of Cqnsumer Affairs & Business Regulation ME IMPROVEMENT CONTRACTOR egistration: 176769 Type: Xpiration: 9/25/2015 LLC LAWRENCE HILDEBRAND, LLC. LAWRENCE HILDEBRAND 30 SHERIDAN ST WOBURN, MA 01801 Undersecretary Massachusetts -.Department of Public Safety Board of Building Regulations and Standards Construction Supeii i%or License: CS -090389 LAWRENCE BILJ)EBRAND.. 30 SMI[MA.N Sr WOBURN MA 01801 Expiration Commissioner 05/2412016