HomeMy WebLinkAboutBuilding Permit #667-14 - 46 WINTERGREEN DRIVE 3/31/20141 BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINAT
Permit NO: 6. _� Date Received �?
Date Issued: 2 14
RTANT: Applicant must complete all items on this
LOCATION `T
Print
PROPERTY OWNER F�41 h
Print
MAP N0: IN -PARCEL: ZONING'DISTRICT: Historic District yes no
Machine Shop Village yes no
TYPE OF IMPROVEMENT
PROPOSED USE
Residenti
Non- Residential
New Building
One fa
Addition
Two or more family
Industrial
Alteration
No. of units:
Commercial
Repair, replacement
Assessory Bldg
Others:
Demolition
Other
Septic Well
Floodplain Wetlands
Watershed District
Water/Sewer
(( F(xCt
Ih Se-frM! LC6f�to0
Identification Please Type or Print Clearly)
OWNER: Name: —plc k C� LscV�G Phone: �-7k
Address:
CONTRACTOR Name:
one:
Address:
v4&/ rc k (P
Supervisor's Construction License: O Exp. Date: 5�
.50
7 l
Home Improvement License: Exp. Date:
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE: BOLDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Total Project Cost: $ _FEE: $ I Lf 3
Check No.: Receipt No.: r—
NOTE: Persons contlacting1with unregistered contractors do not have acceiglo the guar fund
Signature of Agent/Owne -- �gnatpre of contracto a
u
t:
- Plans -Submitted ❑ PlansWaived, El
, 4
ay
_.Certified Plot Plan ❑
Stamped Plans ❑
WP)✓ OPWERAGEDISPD AL
Public Sewer ❑
Tanning/Massage/Body Art ❑
Swimming Pools ❑
Well ❑ .
Tobacco.Sales ❑
•Too_dPackaging/Sales ❑
Private (septic tank, etc:_ ❑ -:.=
-Perinaiient Dtunpster. on Site ❑
THE_ FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
'DATE REJECTED DATE:APPR.OVED
PLANNING & DEVELOPMENT` ❑ ❑
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:
Conservation Decision:
Comme
Comments
Water & Sewer Con nectioniS_ignature & Date Driveway Permit
DPW Tow;; Engineer: Signature:
Located 384 Osgood Street
'FIRE DEPARTMOT.. Temp Dumpster on site no
Located at 124V-1
Fire De
pa me'
COMMENTS . .
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
Total land -area, sq. ft.:
ELECTRICAL: Movementof Dieter location; niast-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
NU I t5 and UA I A — (For department use
__- i (V 61— T� (), I �' 4
® Notified for pickup - Date
Docluilding Permit Revised 2010
Building Department
The fol,)wing is'a Ii'st of=tho.eequired=forms to be filled outfocthe appropriate. permit to`.be obtained.
Roofirr.g, Siding, Interior Rehabilitation Permits
❑ Building Permit Application
❑ Workers Comp Affidavit
o Photo Copy Of H.I.C. And/Or°G.S.-L- Licenses
❑ Copy of Contract
Li 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
u Floor/Crossection/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)
NOTE:
❑ Building Permit Application
o Certified Proposed Plot Plan
❑ Photo of H.I.C. And C.S.L. Licenses
o 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
All dumpster permits require sign off from Fire Department prior to Issuance o -Rkdg Perm
In all cases if a variance or special permit was required the Town Clerks office must stamp & decision from the Board of Appeals
that the apu•,al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
must be submAted with the building application
Doc: Doc.Bui?ding Permit Revised 2012
Location qY U),
No. V01- Iq-
Check #
27391
Date � , � 4
TOWN OF NORTHA��P%'—.,
s
Certificate of Occupancy
Building/Frame Permit Fee
Foundation Permit Fee
Other Permit Fee
TOTAL
1�-r --'
ding Inspector"-
I'IHK— �l—CL914 14:14 r rom: (bi—J4cf-1 (J( Hase: 1/1
TORRA-1 OP ID: DC
�;;L CERTIFICATE OF LIABILITY INSURANCE DATIY
033/31/231120144
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
cortlfleate holder In Ilau of such endorsement(s).
PRODUCER NAME; David A Cole GIC
Cole Insurance Agency, Inc. PHONE
194 Haven Street IC No Ex :781-944-1245 AIC No; 781-942-1797__
Reading, MA 01867 AODREss.:.davldcole@coleins.com
INSURER(S) AFFORDING COVERAGE NAIC 1
INSURERA: Harleysville Worcester Ins Co 26182
INSURED Anthony Torra INSURER_ B:_ Harleys_vlI1e Insurance_G_3_%_up 23582
dba TOMar Construction
21 Juniper Circle INSURER C: Hartford Insurance Co
Road ing, MA 01867 INSURER D:
INSURER E
INSURER F
CAVFRAGFR PRI2TIFIrATC All IMGCG- oevlelnu ullaseee.
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.
/NSR — -- ADDL SUB _..._
'�POLICVfiFF—•—POLICYfiXP'. _:_..._..__.__.......,._.. _.._.....,..._..........
LTR TYPE OF INSURANCE POLICY NUMBER MMIDDIYYYY MMIODIYYW LIMITS
OENERAL LIABILITY
EACHOCCURROJCE S 1,000,000
A
X C0_MMENCIALGENhRALUAL+ILl1Y
CLAIM; -MADE 51OCCUR
SPPODO00035049J
04/07/2014
04107/201$
pR[MI;CSj[,O;rUrrar,,;q _ 100,000
MED EXP (Any ono P-mmi) S 5,000
PERSONAL & ADV INJU12Y $ 1,000,000
6ENlzkALAG0kl:(Wt $ 2,000,000
GENT AGGREGATE LIMIT APPLIES PER
--
PRODUCTS- COMPIOP AGC $ 2,000,000
P01 Icy PRO. I OC
$
AUTOMOBILE
LIABILITY
Ca eccider ' d
A
ANY AUTO
RTX792
05107/2013
05/07/2014
BODILY INJURY (I)erper3onl $ 250,00
ALL OWNED
Al.rrODULtU
AUTOSX
BODILY INJURY (Per accldentl $ 500,000
NON -AUTOS
HiNtu AUIUS AUTOS
kx
PER ACCJDENT A` B 100,000
UMBRELLA LIAR
OCCUR
EACH OCCURRENCE S
EXCESS LIAB
CLAIMS -MADE
AGGREGATE $
DED RETENTION $
$
B
WORKERS COMPENSATION
AND EMPLDYERS LIABILITYTORY
ANY PROPRIETORIPARTNERIE)CECUnuE YIN
OFFICERM17MDCR CKLUDCO� El
N 1 A
12WECLS414D
05/0712013
05107/2014
X VY l7. ., A U- 0 H-
LIMITS
E L EACH ACCIDENT $ 100,000
E L DISEAS..........
E L DISEASE - POLICY LIMIT $ 5001000
(Mandatory In NH)
OF OPERATIONS below
DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEWCLES (Attach ACORD 101, AddlHDnal Remarks Schedule; If mora space In required)
WcM rrrr�^rc nWwr=r` l_OAN%_MLLA 119011
TNANDOV
SMOULD ANY OF TME ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Town Of North Andover ACCORDANCE WITH THE POLICY PROVISIONS,
Building Inspector
1600 Osgood Street AUT HO RIZED REPRESENTATIVE
North Andover, MA 01645
6 088.2010 ACORD CORPORATION. All rights ronorvod_
ACORD 25 (2010/05) The ACORD name and logo are registered marks ofACORD
'h C.' manonwealth ot-Massachusetts
1 111'1ti VI i'11' 'I
1 e o
Department of Industrial Accidents
�-- Office of Investigations
1 Congress Street, Suite 100
Boston, MA 02114-2017
www.anass.gov/dia
tractors/Electricians/plumbers
Workers' Compensation Insurance Affidavit: Builders/Conilbd
Name (BusinesslorganizationlInndividual):
Address:
A ec,'If y,a A � / n7 phone #.
Are yo n employer? Check the appropriate box:
4. [] I am a general contractor and I
I. -El am a employer with �—
have hired the sub -contractors
employees (full and/or part-time).*
listed on the attached sheet.
2. ❑ I am a sole proprietor or partner-
These sub -contractors have
ship and have no employees
employees and have workers'
working for me in any capacity.
comp. insurance.
[No workers' comp. insurance
5.0 We are a corporation and its
required.]
3. ❑ I am a homeowner doing all work
officers have exercised their
right of exemption per MGL
myself. [No workers' comp.
insurance required.] t
c. 152, § 1(4), and we have no
employees. [No workers'
comp. insurance required.]
q LK (v;7Y7 S_
Type of project (required):
6. ❑ New construction
7. ❑ Remodeling
8. ❑ Demolition
9. ❑ Building addition
10.0 Electrical repairs or additions
11.[] Plumbing repairs or additions
12.0 Roof repairs
13. ❑ Other
*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:
Policy # or Self -ins. Lic. #: � � Expiration Date:d
/ / T�
City/State/Zip: �d A, t f� �
Job Site Address:_ �_
17
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 imprionment, as well as civil s Be advised that a copy of thistes in the form of a STP stat statement may be forwOrdedOto he Offic and a fine
of up to $250.00 a day against the violator
Investigations of the DIA for insurance coverage verification.
I do hereby certify u the pains and p�i//t��' that the information provided above is true and correct.
Y7
official use only. Do not write in this area, to be completed by city or town o f cial.
City or Town:
Permit/License #
Issuing Authority (circle one):
City/Town
Clerk 4. Electrical Inspector 5. Plumbing Inspector
1. Board of Health 2. Building Department 3. C
6. Other
Revi 11 Contact Person:
Phone
'ST
Office Coo A—ffhi,, & Bdsin
HOME7MPR'OVEMENT CONTRACTOR
Registration:2;043932 Type: �
Expiration: c81:a..61U14 DBA
T idi R CONTRfiCTlf Gr;l
ANTHONY TORRA
21 JISNIPER CIR..t'
READING, MA 01867;, — 1
Undersecretary
a�ment of Publics afety '
Massachusetts De - Re Mations and Standards
j Board of Building g
1 Construction supervisor
License-. Cg_050275`, r
ANTHONY N TO
2i JUNIPER CUR
867JpEADINGMA
�y BXpiration
05102J2014
Commissioner
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TOMAR CONTRACTING
21 Juniper Cr., Reading, MA 01867
781-944-0278 Office
TOMARCON@verizon.net
TOMAR CONTRACTING & CONSULTING AGREEMENT
This Agreement is made on q{�h 3� , 2014 between TOMAR CONTRACTING with an address at 21
Juniper Cr., Reading, MA and telephone # 781-944-0278. Home Improvement Contractor # 143932, and
Mass. Construction Supervisors License #050275 hereinafter called"co tractor" and
r'e—h
/t ith an address at (,✓� h �s�i�ey . �� ✓e j�LXt 4 ,6¢i, cOve %` A
1. WORK: The following is a detailed description of the work to be done and the "
materials to be used. (see attached)
2. COMMENCEMENT & COMPLETION OF WORK: Work is scheduled to begin on2014
and scheduled to be substantially completed on ,( 2014.
3. PRICE: Contractor and owner hereby agree that the price to be paid for the work to
be performed on the Contract is $ ! !e�fQ3 exclusive/inclusive of materials. (except as noted).
4. TIME SCHEDULE FOR PAYMENTS: Payments shall be paid by Owner to Contractor
according to the following schedule: (See attached under terms).
In the event a payment is due and remains unpaid for five (5) consecutive days, Owner
and Contractor agree that contractor may, with seven (7) days written notice to Owner,
terminate this Agreement and recover from owner payment for all work done to date and for
all materials and equipment supplied to date, including reasonable overhead and profit.
5. EXPRESS WARRANTY Contractor guarantees to Owner that all materials incorporated into
the work will be new unless otherwise specified or agreed. Contractor also guarantees that
work will be done in a workmanlike manner, free from defects and in conformance with any
specifications mentioned in Paragraph 1.
Work under this Agreement is guaranteed for one (1) year. If any defects in materials or
Workmanship arises within this time, Contractor agrees to repair such defects and to bring the
Work up to the standards required under the Agreement at no additional expense to Owner.
This guarantee in no way limits or supercedes any other remedy under the laws available
to the owner in the event of defective work.
6. NOTICE OF OWNERS RIGHTS
(a) All Home Improvement Contractors and subcontractors shall be registered and any
inquiries about a contractor or subcontractor relating to registration should be directed to:
Home Improvement Contractor Registration
One Ashburton Place, Room 1301, Boston, MA 02108
Phone # 617-727-8595
(b) The contractor's registration number must be on the first page of this Contract.
(c) Owner's three (3) cancellation rights under Massachusetts General Laws, Chapter 93,
section 498, Massachusetts General Laws, Chapter 140 (d) Section 10 or Massachusetts
General Laws Chapter 255, Section (d) shall be stated.
7. PERMITS
(a) It is the obligation of the Contractor to obtain required permits, as the owner's agent, as shall be
necessary for construction.
(b) That Owners who secure their own construction -related permits or deal with unregistered
contractors will be excluded from access to the guarantee fund.
8. INSURANCE See Certificate of Insurance (attached hereto and made a part hereof)
9. MODIFICATION This agreement, including the provisions related to price and time of performance
and time for payment cannot be changed except by a written statement (change order) signed by both
contractor and Owner. All hidden, concealed, or unforeseeable conditions, including, but not limited to
code violations, that must be repaired, corrected or otherwise remedied shall result in a change order. A
change order fee of $35.00, per change order will apply unless otherwise specified.
10. NOTICE OF CANCELLATION Owner may cancel this Agreement if signed at the place other than
the Contractor's address, if owner notifies contractor in writing of his/her intention to do so no later than
midnight of the third business day following the signing of the Agreement. The following language
addressed to Owner regarding notice of cancellation is required by statute:
YOU MAY CANCEL THIS AGREEMENT IF IT HAS BEEN CONSUMMATED BY PARTY
THERETO AT A PLACE OTHER THAN AN ADDRESS OF THE SELLER, WHICH MAY BE HIS
MAIN OFFICE OR BRANCH THEREOF, PROWDED YOU NOTIFY THE SELLER IN WRITING AT
THIS MAIN OFFICE OR BRANCH BY ORDINARY MAIL, POSTED BY TELEGRAM SENT, OR BY
DELIVERY, NO LATER THAN MIDNIGHT OF THE THIRD BUSINESS DAY FROM THE SIGNING
OF THE AGREEMENT. SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN
EXPLANATION OF THIS RIGHT.
CON RA TOR OR OWNER HERBY AGREE TO THE ABO
2 If
DA E / ;7CRA
' IGNA
DAT CTOR'S SIGNATURE