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Home My WebLink AboutBuilding Permit #589 - 47 MARBLEHEAD STREET 4/2/2010 NORT1l BUILDING PERMIT o�tt,.o ,6Ati TOWN OF NORTH ANDOVER FO APPLICATI N FOR PLAN EXAMINATION ?L bE OM ' +f C _ Permit N05;_� Date Received Q� �SSACHUS�� Date Issued: o IMPORTANT:Applicant must complete all items on this page LOCATION rint PROPERTY OWNER a —CXR Print MAP NO: PARCEL: ZONING DISTRICT: Historic District , yes no Machine Shop Village yes no 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 Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: II� Identification Please Type or Print Clearly) q OWNER: Name: Ui 4 Phone: / �� 5 M0 3 Address: 4/ -? OA 1 CONTRACTOR Name: Phone: QQ�� Address: In &3_7 /O/t N-A Q le 4�y Supervisor's Construction License: Exp. Date: 8 d`' + Home Improvement License: �� /d � exp. Dater:... 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: $ 7P7J� FEE: $ Check No.: _ Receipt No.: Zed i / NOTE: on contracting with unreg ste ed contractors do not have access to the guaranty fund Signature of Agent/Ow 'signature of contractor_ ; i i 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 L3 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 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/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) ❑ 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 o Mass check Energy Compliance Report ❑ 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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 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 DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS i CONSERVATION Reviewed on Signature R COMMENTS HEALTH Reviewed on Signature COMMENTS S Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes 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 no Located at 124 Main Street Fire Department signature/date COMMENTS 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 i DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— For department use s E k ❑ Notified for pickup - Date Doc.Building Permit Revised 2008 Location /17 No. Date �2 MORTIS TOWN OF NORTH ANDOVER Fewi + : ; , Certificate of Occupancy $ S C►NS CHC Building/Frame Permit Fee $ 1 �S 4 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 22696 Building Inspector lt.Lr'll 1.1"Q.A 1NJ-4. '21 Gl GV1V Lj L . 1V fuA rrf]ljL' Gf VVG 1'G-X s)C.A VGA ACORD. CERTIFICATE OF INSURANCE DATE(M"MYY) 04.02-10 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE GILBERT INS AGCY HOLDER. THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 137 MAIN ST ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. READING,MA 01867 COMPANIES AFFORDING COVERAGE COMPANY 73MCG A TRAVELERS DIRECT ASSIGNMENT INSURED ` COMPANY B DUVAL ROOFING LLC COMPANY P O BOX 637 C NORTH READING,MA 01864 COMPANY D COVERAGES THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVEBEENISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOTWTINSTANDING 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 SUB2ECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LffdM SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER DATE(MMkDDIYY) DATE(MMOMYY) UMITS GENERAL LIASIUTY GENERAL AGGREGATE $ COMMERCIAL GENERAL LIABILITY PRODUCTSCOMPIOP AGO. $ CLAIMS MADE OCCUR. PERSONAL&&ADV.INJURY $ OWNER'S&&CONTRACTOR'S PROT. EACH OCCURRENCE $ FIRE DAMAGE(Any one fire) $ MED.EXPENSE(Any one person) $ AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT $ ALL OWNED AUTOS BODILY INJURY(Per Person) $ SCHEDULE AUTOS BODILY INJURY(Per Accident) $ HIRED AUTOS PROPERTY DAMAGE $ NON-OWNED AUTOS GARAGE LIABILITY ANY AUTOS AUTO ONLY-EA ACCIDENT $ OTHER THAN AUTO ONLY: EACH ACCIDENT $ AGREGATE $ EXCESS LIABILITY UMBRELLA FORM EACH OCCURRENCE $ OTHER THAN UMBRELLA FORM AGGREGATE $ WORKER'S COMPENSATION AND A EMPOLYER'S LIABILITY UB-0230N919-10 03-11-10 03-11-11 STATUTORY LIMITS X THE PROPRIETOR( EACH ACCIDENT $ 1001000 PARTNERS/EXECUTIVE X INCL DISEASE-POLICY LIMIT $ 500,000 OFFICERS ARE: EXCL DISEASE-EACH EMPLOYEE $ 100,000 OTHER I DESCRIPTION OF OPERATIONS!LOCATIONSIVEHK:LESIRESTRICTiONS1SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTU'1CATE HOLDER AFPE,=G WORKERS COMP COVERAGE I CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION TOWN OF NORTH ANDOVER,MASSACHUSETTS DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THELEFT,BUT FAILURE TO MAIL SUCH NOTICE 1600 OSGOOD STREET SHALL IMPOSE NO OBUGAT10N OR LIABILITY OF ANY KIND UPON THE COMPANY.ITS AGENTS OR REPRESENTATIVES. N.ANDOVER,MA 01845 AUTHORIZED REPRESENTATIVE ACORD 25-5(3/93) Charles J Clark NH ORT T0 0 4Andover . TIL7 A K E y dover, Mass., 4, COC HIC Hr ORATED `S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT �. "r. s .. .... ............ "�i...........................................:.......... ........... ................................ Foundation has permission to erect........................................ bu- ings on... '............. ►.I... . .. ..�..... Rough to be occupied as...... . ... ..... . 0 Chimney ........... .... ............... ............................ provided that the per acce ng this permit shall in every respec nform to the terms of the application on file in Final 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 go PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR. UNLESS CONSTRUT ARTS Rough .......... . .... ..................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Ocatpy Building GAS INSPECTOR 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. SEE REVERSE SIDE smoke Det. Page No. of Pages Builders License # 58443 Home Construction Reg. # 109288 � o � �o (781)944-1994 (978)664-2557 "The Areas Oldest Roofing Company" x P.O. Box 637, North Reading, MA 01864 PROP O AL /WITTTEDTO ��- DATE, ,^ ET LJ / /V1 4 f j' C� J JOB NAME CITY,STATEAND IP ODE JOB LOCATION rC We hereby submit specifications and stimates for: Recommended Optional El f Ire A d / (Included in price) (Not included in price) Rip&Remove all shingle debris from roof&job site: E 1 layer ❑2 layers ❑3 layers or more Repair/or Replace any roof decking; not to exceed 50sq.ft. (additional at$1.70 per ft.) Install 8"aluminum drip-edge/and rake-edge along entire perimeter. Choice of mill,white 2GR Install ICE&WATER underlayment along Horizontal eaves,valleys,sidewalls, sky-lights and chimneys Install premium base sheet underlayment between roof deck and roofing shingles t// Install 30yr CertainTeed/GAFfTamko or IKO architectural roof shifigles ❑40 year ❑50 year ,. ��3 0 ❑60 year ❑Lifetime See manufacturer warranty policy for more details Install new aluminum vent-pipe flange(s) � / ✓ Chimney(s)-counter-flash and re-step existing flashing LJCut& Install new lead flashing " ✓ Ridge-vent/exhaust vent with low profile design, hidden by shingle caps. ❑Soffit-ventilation ❑ Roof louver-vents Seamless style aluminum gutters-custom fabricated at job site by our own gutter machine ❑Downspouts ❑Leaf gutter guards Other e late 6 4V Mj f;1 or Cftir;sc7 ♦� sljf' L i1 / a *Please Note:All items in roof attic should be removed or covered due to falling roof particles,at time of roof tear-off Price includes all items above that are checked only/others may be priced separately upon request. Pe JJrapose hy to fu erebnish material and labor-complete in accordance with above specifications,for the sum of: CIsoo "�.. d Total price not including options. dollars($ Payment to be made as follows: - 30%deposit required before ordering materials.Balance due in full upon day of completion. Please make all payments out to Kenneth Duval, mailed to: P.O. Box 637, No. Reading, MA 01864 Late charges of$50 per week for all outstanding bills due upon day of Authorized completion. Signature -Accepting proposal means agreeing to the terms of the enclosed binder Note:This proposal may be contract. Please sign contract&return top copy(white)with deposit: withdrawn by us if not accepted within `�a days RightFax N3-2 4/2/2010 6:41: 16 AM PAGE 2/002 Fax Server ACORQ. CERTIFICATE OF INSURANCE DATE(MM\MYY) 04-02-10 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE GILBERT INS AGCY HOLDER. THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 137 MAIN ST ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE READING,MA 01867 COMPANY 73MCG A TRAVELERS DIRECT ASSIGNMENT INSURED COMPANY B DUVAL ROOFING LLC COMPANY P O BOX 637 C NORTH READING MA 01864 COMPANY D COVERAGES THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE ENSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOTW ITHSTANOM ANY REOUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCLMIT 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, LUMTS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, CO POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER DATE(MMIDDIYY) DATE(MMOMYY) LIMITS GENERAL LIABILITY GENERAL AGGREGATE $ COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG. $ CLAIMS MADE OCCUR. PERSONAL&&ADV.INJURY $ OWNER'S&&CONTRACTORS PROT. EACH OCCURRENCE $ FIRE DAMAGE(Any one fire) $ MED.EXPENSE(Any one person) $ AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT $ ALL OWNED AUTOS BODILY INJURY(Per Person) $ SCHEDULE AUTOS BODILY INJURY(Per Accident) $ HIRED AUTOS PROPERTY DAMAGE $ NON-OWNED AUTOS GARAGE LIABILITY ANY AUTOS AUTO ONLY-EA ACCIDENT $ OTHER THAN AUTO ONLY: EACH ACCIDENT $ AGREGATE $ EXCESS LIABILITY UMBRELLA FORM EACH OCCURRENCE $ OTHER THAN UMBRELLA FORM AGGREGATE $ WORKER'S COMPENSATION AND A EMPOLYER'S LIABILITY UB-0230N919-10 03-11-10 03-11-11 STATUTORY LIMITS X THE PROPRIETOR( EACH ACCIDENT $ 1001000 PARTNERS/EXECUTIVE X INCL DISEASE-POLICY LIMIT $ 500,000 OFFK:ERS ARE: EXCL DISEASE-EACH EMPLOYEE $ 100,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLESIRESTRICTKTNSISPEC1AL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTTPICATE HOLDER AFFECTING WORKERS COMP COVERAGE CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED SEFORETHE EXPIRATION TOWN OF NORTH ANDOVER,MASSACHUSETTS DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO MAIL SUCH NOTICE 1600 OSGOOD STREET SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY.ITS AGENTS OR REPRESENTATIVES. N.ANDOVER,MA 01845 AUTHORIZED REPRESENTATIVE ACORD 25-5(3193) Charles J Clark I The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street - ? Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Duval Roofing, LLCm,-rOp�„� s c� _ Address: No. Reading, MA 01864 City/State/Zip: Phone #: o � Areappropriate box: Type of project(required): an employer? Check t 1. I am a employer with 4. E] I am a general contractor and I 6. ❑ New construction � employees (full and/or'part-time). have hired the sub contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g• ❑ Demolition workingfor me in an capacity. employees and have workers' Y9. ❑ Building addition [No workers' comp. insurance comp. insurance. We are a corporation and its 10.❑ Electrical repairs or additions 5. required.] ❑ � 3.❑ 1 am a homeowner doing all work officers have exercised their 11. Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.[U'rf repairs insurance required.] fi c. 152, §1(4), and we have no employees. [No workers' 13.❑ Other 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 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: /-11 Policy#or Self-ins. Lic. #: P S C) 3 O/U�/J/(� Expiration Date: 3h, 1 Job Site Address: "7 City/State/Zip:/)O 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 certify under the pains and penalties of perjury that the information provided above is true and correct. Signatu _ Date: Phone#:� Official use only. Do not write in this area, to be completed by city or town official I 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#: ,per T� i�arnmzo�zueal,� �✓�� Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 109288 Expiration: 9/9/2010 Tr# 273490 Type: D3A DUVAL ROOFING Kenneth Duval •J urvti 72 NORTH ST N.READING,MA 01864"" Administrator s Massachusetts- Depat-tment of Public Safe" Board of Building Regulations and Standards Construction Supervisor License License: CS 58443 Restricted to: 00 KENNETH P DUVAL PO BOX 190172 NORTH ST N READING, MA 01864 Expiration: 12/10/2011 (' nunis.i mer Tr#: 10475 I I NOTICE z NOTICE TO o TO EMPLOYEES �= EMPLOYEES 09 v�v M S The Commonwealth of Massachusetts DEPARTMENT OF INDUSTRIAL ACCIDENTS 600 Washington Street, Boston, Massachusetts 02111 617-727-4900 — http://www.mass.gov/dia As required by Massachusetts General Law, Chapter 152, Sections 21, 22&30, this will give you notice that I (we) have provided for payment to our injured employees under the above mentioned chapter by insuring with: THE TRAVELERS INSURANCE COMPANIES NAME OF INSURANCE COMPANY P .O. BOX 1450 MIDDLEBORO, MA 02344-1450 ADDRESS OF INSURANCE COMPANY (7PJUB-023ON91 -9-10) 03-11 -lo TO 03-11 -11 POLICY NUMBER EFFECTIVE DATES GILBERT INS AGCY 137 MAIN ST READING MA 01 867 NAME OF INSURANCE AGENT ADDRESS PHONE# o DUVAL ROOFING LLC 184 PARK STREET 0 NORTH READING MA 01 864 EMPLOYER ADDRESS EMPLOYER'S WORKERS COMPENSATION OFFICER (IF ANY) DATE ^ MEDICAL TREATMENT The above named insurer is required in cases of personal injuries arising out of and in the course of employment to furnish adequate and reasonable hospital and medical services in accordance with the provisions of the Workers' Compensation Act. A copy of the First Report of Injury must be given to the injured employee. The employee may select his or her own physician. The reasonable cost of the services provided by the treating physician will be paid by the insurer, if the treatment is necessary and reasonably connected to the work related injury. In cases requiring hospital attention, employees are hereby notified that the insurer has arranged for such attention at the NAME OF HOSPITAL ADDRESS 002991 V1120PiG02 TO BE POSTED BY EMPLOYER