HomeMy WebLinkAboutBuilding Permit #446-16 - 47 PETERS STREET 10/8/2015 4oRTIJ
BUILDING PERMIT O& 4LED Sao
TOWN OF NORTH ANDOVER �
APPLICATION FOR PLAN EXAMINATION _ n
UO`
Permit No#: Date Received ��ssacwuDate Issued:
ANT:Applicant must complete all items on this page
LOCATION
PROPERTY OWNER Fivs 1 (J���d ple,40� fir 6� OJ-' Amoy-ee
Print 100 Year Structure yes no
MAP PARCEL: ZONING DISTRICT: Historic District ye no
C�_>C3� Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building ❑ One family
❑Addition 0 Two or more family El Industrial
❑Alteration No. of units: ❑ Commercial
Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
® Sept c .' 11�lell A ' ® Flo®dplai`n� . IM`®,11Uatershed ®'st i`ct�A, }
Water/Sewer g i _ ;A
DES RIPTION QF WORK TO BE PE FPRME
oil
4 LS
Identification- Please Type or Print Cie rl
OWNER: Name: s g a/o - neo " �� 1 Gv�-t"Do Phone:
Address: I`rl✓I � .-
P A�V,
Contractor Name: b5v :nne' �ts�wv�lon ��/ V1 Phone ���P— L/29 �� r
Email: ,
Address: rw ;Voy<ml�°T— d✓� l /�`��
LS
upervisor's Construction License:/Ya&/t �- Exp. Date:ome Improvement License: 13,5y Exp. Date: I '20 /Cv
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE.BULDING PERMIT:$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F.
Total Project Cost: $ FEE: $ �
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not ha ac s to tke g ran and
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑ Tanniug/Massage/Sody Art ❑ Swimming Pools ❑
Well ❑ Tobacco Sales 11
Food Packaging/Sales ❑
Private(septic tank, etc. ❑ Permanent Dumpster on Site ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY i
INTERDEPART'MENT'AL SIGN OFF m D FORM
PLANNING DEVELOPMENT Reviewed On Signature_
COMMENTS
CONSER'V'ATION 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
q'
on.�ervation Decision: Comments
Fater& Sewer Connection/Si naturo ®ate Driveway Permit
]DPW Town Engineer: Signature:
Located 384 Osgood Street
�FIRE
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s$eron;sit-� enp�Dump
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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
i
Electrical lns Inspector Yes
p N®
DANGER ZONE LITERATURE: Yes No
MGL.Chapter 166 Section 21A—F and G min.$1oo-$1000 fine
I
NOTES and DATA— (For department use)
® Notified for pickup Call Email
DateTime Contact Name
Doc.Building Permit Revised 2014
Building Department T
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
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
OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
Addition Or Decks
t 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
OTE: 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
2012 IECC Energy code
Engineering Affidavits for Engineered products
®TE: 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
-h
Location 4&1*a /
No. Date 1D
! IV }
• - TOWN OF NORTH ANDOVER
e Certificate of Occupancy $
4 Building/Frame Permit Fee
Foundation Permit Fee $
Other Permit Fee
TM
TOTAL $ I
4
Check#
Building Inspector
29488 r
NORT#i
Town of
t E 11. ndover
o
4. In
No. 4+�_
2z I
h ver, Mass, I O
T O LAN! 1
COCNICNEWICK V
S U
BOARD OF HEALTH
Food/Kitchen
PERMIT T LD Septic System
( ' f BUILDING INSPECTOR
THIS CERTIFIES THAT ......... ... .�..:..1�..... ..........��!:�..............................
has permission to erect .. g Foundation
............�.......... buildings ....�.�......�G. . . ........�1.............................. R ugh
to be occupied as ...... ......... ......� ......1,.1�►m ...... ...... .4... ...L.l1.(.!`a!��....�14�.l.�C/ C mney
provided that the person accepting this permit shall in every respect c nform to the sof the application 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
M PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
UNLESSC0 S UC N TR TI S RTS Rough
Service
............... ... ..... .................................................. Final
BUILDING INSPECTOR
GAS INSPECTOR
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.
PRIME COMMERCIAL CONTRACT
This form complies with professional standards in effect January 1-December 31.2010
Errnna Construction Services THIS CONTRACT IS
License. CS 066182 ENTERED INTO
583 North Broadway THIS DATE:
Haverhill. MA 01832 &O
PHONE(978)178-8215 FAX(978)374-9130 C�
NAME
First United Methodist Church of North Andover-Paul Carlotto is church representative
BUYER/ PROJECT ADDRESS CITY STATE/ZIP PHONE
OWNER IV7 Peters Street North Andover MA 978.994.3631
ALTERNATE ADDRESS(IF ANY) CITY STATE/ZIP PHONE
N/A
LENDER: ('IfAny):
N/A
(Name/Branch/Address of Lender)
We hereby propose to perform the following work:
See estimate dated September 28,2015
We will begin on or about October 12,2015
Work performed at Church in N.Andover at 57 Peters Street North Andover;MA
(Street Address And Legal Description If known)
TIME FOR COMPLETION:The.work to be performed by Contractor pursuant to this Agreement shall be substantially completed
within ninety(90)days or approximately on 1-42016. s.&�f,ee �
INTEREST:Overdue payments will bear in4e'st d�of 1'/2%per month.
PAYMEN caner a s to pay Contractor a total price of. Seventeen Thousands four hundred fifty three dollars and thirty one
cents Doll ($17,45331}
Down pay
me� 81.31 is the down payment
with any payments to be made as follows:$5,236.00 after.the drywall is installed,followed by 3,236.00 after painting is done,and
$/2,000.00 is the final payment after substantial completion.
L/
e
c OWNER/BUYER SIGNATURE DATE
X
CONTRACTOR SIGNATURE OWNER/BUYER SIGNATURE DATE
C)2010 ABCAForms
J
TERMS AND CONDITIONS
I. CHANGES IN THE WORK. Should the owner,construction of construction, theft, vandalism and malicious mischief
lender,or any public body or inspector direct any modification or endorsements attached,the insurance to be in a sum at least equal
addition to the work covered by this contract, the contract price to the contract price. The insurance shall name the Contractor and
shall be adjusted accordingly. any subcontractors as additional insured's,and will be written to
Modification or addition to the work shall be executed only protect owner,Contractor and subcontractors as their interests may
when both the Owner and the Contractor have signed a contract appear.
Change Order. The change in the contract price caused by such Should Owner fail to procure such insurance,Contractor may do
contract Change Order shall be as agreed to in writing, or if the so at the expense of Owner,but is not required to do so. Owner
parties are not in agreement as to the change in contract price,the and Contractor waive rights of subrogation against each other to
Contractor's actual cost of all labor,equipment,subcontracts and the extent that any loss is covered by valid and collectible
materials,plus a Contractor's fee of 30% shall be the change in insurance. If the project is destroyed or damaged by accident,
contract price. The Change Order may also increase the time disaster, or calamity such as fire, storm, flood, landslide,
within which the contract is to be completed. subsidence or earthquake,owner as extra work shall pay for work
Contractor shall promptly notify the Owner of(a)latent physical done by Contractor in rebuilding or restoring the project.
conditions at the site differing materially from those indicated in
the contract, or (b) unknown physical conditions differing VII. RIGHT TO STOP WORK. Contractor shall have the right
materially from those ordinarily encountered and generally to stop work if any payment shall not be made, when due, to
recognized as inherent in work of the character provided for in this Contractor under this Agreement;Contractor may keep the job idle
contract. Owner as added work shall pay for any expenses incurred until all payments due are received. Failure to make payment,
due to such conditions. within five(5) days of the due date, is a material breach of this
Agreement and shall entitle contractor to cease any further work.
11. OWNER'S RESPONSIBILITIES. Owner agrees to allow
and provide Contractor and his/her equipment access to the VIII. CLEAN UP. Contractor will remove from Owner's
property, property debris and surplus material created by the operation and
leave it in a neat and broom clean condition.
III. DELAYS. Contractor agrees to start and diligently pursue
work through to completion,but shall not be responsible for delays IX. COMPLIANCE WITH LAWS. In connection with the
for any of the following reasons: failure of the issuance of all performance by Contractor of duties pursuant to this Agreement,
necessary building permits within a reasonable length of time, Contractor shall obtain and pay for all permits and comply with all
funding of loans, disbursement of funds into funding control or federal,state,county and local laws,ordinances and regulations.
escrow, acts of neglect or omission of Owner or Owner's
employees or Owner's agent, acts of God, stormy or inclement X. ARBITRATION, VALIDITY AND DAMAGES. Any
weather,strikes,lockouts,boycotts,or other labor union activities, controversy or claim arising out of or related to this contract,or the
extra work ordered by Owner,acts of public enemy,riots or civil breach thereof, shall be settled by arbitration in accordance with
commotion,inability to secure material through regular recognized the Construction Industry Arbitration Rules of the American
channels, imposition of Government priority or allocation of Arbitration Association,and judgment upon the award rendered by
materials,failure of Owner to make payments when due,or delays the Arbitrator(s)may be entered in any court having jurisdiction
caused by inspection or changes ordered by the inspectors of thereof.
authorized governmental bodies, or for acts of independent
contractors, or holidays, or other causes beyond Contractor's XI. ASBESTOS AND HAZARDOUS WASTE. Unless the
reasonable control. contract specifically calls for the removal, disturbance, or
transportation of asbestos or other hazardous substances,the parties
IV. SUBCONTRACTS. The Contractor may subcontract acknowledge that such work requires special procedures,
portions of this work to properly licensed and qualified precautions, and/or licenses. Therefore, unless the contract
subcontractors. specifically calls for same, if Contractor encounters such
substances,Contractor shall immediately p sto work and allow the
V. TAXES AND ASSESMENTS. Owner will pay for taxes and Owner to obtain a duly qualified asbestos and/or hazardous
assessments of all descriptions. material contractor to perform the work or do the work at
contractor's option. Said work shall be treated as an extra under
VI. INSURANCE AND DEPOSITS. Contractor shall carry the contract.
Worker's Compensation Insurance for the protection of
Contractor's employees during the progress of the work. XII. ATTORNEY FEES. In the event legal action or arbitration
Contractor shall carry liability insurance to cover any damages to instituted for the enforcement of any term or condition of this
Owner's property resulting out of the acts of Contractor. Owner contract, the prevailing party shall be entitled to an award of
shall obtain and pay for insurance against injury to his own reasonable attorneys fees in said action or arbitration,in addition to
employees and persons under persons on the job site at Owner's costs and reasonable expenses incurred in the prosecution or
invitation. defense of said action or arbitration.
Owner shall also procure at own expense and before the
commencement of work hereunder"all-risk"insurance with course
The Commonwealth of Massachusetts
z Department of Industrial Accidents
1 Congress Street,Suite 100
f< Boston,MA.02114-2017
yV;y�t www mass.gov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Ledb
I
Name(Business/Organization/Individual): Y! fl
Address: 4)2�< AvalkdV
/4
City/State/Zip: 3d-Phone �-
Are you an employer?Check the appropriate box: Type of project(required):
1. I am.a.employer with employees(full and/or part-time).* 7. 0 New construction
I am a sole proprietor or partnership and have no employees workingfor me in
8. El Remodeling
any capacity.[No workers'comp.insurance required.]
3.F]I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. El Demolition
❑4.F]I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 Building addition
ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions
proprietors with no employees.
12.[]Plumbing repairs or additions
5.FJ I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.Q Roof repairs
These sub-contractors have employees and have workers'comp.insurance.$
6.Q We are a corporation and its officers have exercised their right of exemption per MGL C. 14.Q Other
152,§1(4),and we have no,employees.[No workers'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.
tContractors 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,'tliey 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 joh site
information.
Insurance Company Name:
Policy#or Self-ins.Lie.#: 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 MGL 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 STOP WORK ORDER and a fine of up to$250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
1 do hereby certif r the pains and penalties ofXerjury that the information provided above is true and correct.
a f�
Si ature: Date:
Phone#:
Official use only. Do not write in this area,to he completed by city or town official..
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#:
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 o:�liire,
express or implied,oral or written."
An 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 an 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 another who 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 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
applicant who has not produced 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 fill-out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)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 an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents foi•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 Accidents. Should you have any questions regarding the law or if you'are required to obtain a workers'
compensation 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
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 a reference 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"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 future 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 burn 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-DAASSAFE
Fax#617-727-7749
Revised 02-23-15 www.mass.gov/dia
Date Prepared: 03/10/15
COMMERCIAL LINES POLICY
BUSINESSOWNERS POLICY DECLARATIONS
Merchants Mutual Insurance Company
Buffalo, New York
Policy Number: BOP 1083845 Transaction Type: New Bus i ness
Previous Policy Number: Billing Type: DIRECT BILL
Your Agent: 40478/NERO61033
Named Insured and Mailing Address: Agent Name and Mailing Address:
RAMON ERINNA DBA M P ROBERTS INSURANCE AGY INC
ERINNA CONSTRUCTION SERVICES 1060 OSGOOD STREET
583 NORTH BROADWAY NORTH ANDOVER, MA 01845
HAVERHILL, MA 01832-1221 (978)683-8073
Policy Period: From 03/01/15 to 03/01/16 12:01 a.m. Standard Time at location of designated premises.
Exceptions: 12:00 noon in Michigan.
The Named Insured is: I ND I V I DUAL
IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF THIS POLICY, WE AGREE
WITH YOU TO PROVIDE THE INSURANCE AS STATED IN THIS POLICY.
I
Policy may be Subject to Audit
TOTAL POLICY PREMIUM: $ 1 ,001 .00
Includes Terrorism Risk Insurance Act Premium Of: $ 12.00
Policy Subject to $150.00 Minimum Retained Premium
Countersigned: Authorized Representative:
— 9Z.
MU 8382 (09/07) THESE DECLARATIONS TOGETHER WITH THE COMMON POLICY CONDITIONS, COVERAGE PART DECLARATIONS, COVERAGE PART
FORM(S)AND FORMS AND ENDORSEMENTS,IF ANY,ISSUED TO FORM A PART THEREOF,COMPLETE THE ABOVE NUMBERED POLICY.
INSURED COPY
/J
September, 2014
Dear Customer,
Below is a listingof our material rates and hours of operation. If you
p
have any questions please call our Administrative Office, Monday-
Friday 8am - Spm at (603) 894-9800.
Other Bulky Waste (OBW) $130.00 per ton
Shingles $128.00 per ton
CRT* $ 22.00 each
Propane tanks $ 11.00 each
Tires $ 6.00 each
CFC** $ 17.00 each
Fluorescent Bulbs $ 5.00 each
Mattress $ 10.50 each
* CRT includes computer monitors and all size Televisions.
**CFC includes air conditioners, refrigerators, freezers and
dehumidifiers.
Minimum charge of$75 for loads under 1200 pounds. All rates
subject to fuel surcharge based on the weekly US Department of
Energy Index. Prices subject to change
Scale Hours of Operation
Mon - Fri 7:30am - 4:30pm
Saturday 7:30am - 12:00pm
Sunday Closed
Thank you,
LL&S, Inc.
87 Lowell Road
Salem NH 03079
I
�G c �rynw�uuerx�G °
Reg"" oa
Office of Consumer Affairs&Business
ENT CONTRACTOR Type:
MEIMPROVEM
gistration: 1355p3 pgA
xpiration.
41912016
ERINNAC
ONSTRUCTION `
on Erinna ?, g
Ram WAY .,.�. i .•
583 NORTH BROAD ;.- Undersecretary
HAVERV ILL,MA 01832
Massachusetts -Department of Public Safety
Board of Building Regulations and Standards
VHII�LI Ul�l fl 11 JU�1GI V 1\lll ,
License: CS-066182
a
RAMON M ERIN1A
583 N BROADW ABY
HAVERHII-.L
MSF
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Expiration
J,�.•��� 04/16/2017
` Commissioner