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HomeMy WebLinkAboutBuilding Permit #345-14 - 476 GREAT POND ROAD 10/10/2013 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: J Date Received Date Issued: I PO 'TANT:Applicankmust complete 411 items on this page LOCATION_ P int PROPERTY OWNER } Print 100 Year Old Structure yes no MAP NO: �`'1� PARCELZONING DISTRICT: Historic District yes Ino Maehme Shop Village yes' _ TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family El Addition El Two or more family El Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Septic ElWell 0 Floodplain ElWetlands Watershed District ❑Water/Sewer . _ DESCRIPTION OF WORK TO BE PERFORMED: Identifica ion Plea*e Typ or ri t Clearly) ��``//� OWNER: Name: l iS Phone: .S—W3-7q Address: CONTRACTOR Name: _ /' - Phone: Address: v ° < �� r Supervisor's Construction License: _ Exp: Date: Home Improvement License: .__ _ __ Exp. Date: v'2 /4 _ 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: $ j�/ ��G FEE: $ L/ Check No.: Receipt No.: C f� NOTE: Persons contracting with unregistered contractors do not have access to i a fu Signature of AgentlOwner Signature,of contract Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ St ped Plans 0 Building Department The fol(swing is`a list of the required forms to be filled out for the appropriate.permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits o Building Permit Application Li Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract o 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 o Certified Surveyed Plot Plan o Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) o 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 o Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract ❑ 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 cas<s if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the apw-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.Buiiding Permit Revised 2012 E Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE_0YSEWERAGEDiSP_OSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ well ❑ . Tobacco Sales 0 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 ❑ 0 COMMENTS j _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 Conservation Decision: Comments Water & Sewer Connection/Signature Date Driveway Permit DPW Tow;! Engineer- Signature: Located 384 Osgood Street FIRE DEPARTMEN1` -Termp Dumpster on site yes no Located'at 124 Mair Street ` Fire Departiriertt signature/date 4 r 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 DANGER ZONE LITERATURE: Yes No MGL-Chapter-166 Section 21A-F and G min.$100-$100o.fine NOTES and DATA— (For department use ® Notified for pickup - Date t Doc.Building Permit Revised 2010 Location No. Date1 • TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $w v Foundation Permit Fee $ ' � Other Permit Fee $ TOTAL $ Check# .. Building Inspector NORTfy - T .- wv . uc . . ve" . o � - No. , - ti h ver, Mass, b Ito I toc Nlc"t—OCK y1' �d A0, �TEO s V BOARD OF HEALTH PERMIT T LD Food/Kitchen Septic System THIS CERTIFIES THAT .............................NQil... ........ .................................................................... BUILDING INSPECTOR /� � � � Foundation has permission to erect.......................... buildings on ........... ......�N�:!a..nd...�..•...... Rough S1 �.JL�• `"Y.K. ..................c- .......... ...... Chimney to be occupied as ................. .............................. .. .....:....... ..... provided that the person accepting this permit shall in every respe conform to the terms of 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHSELECTRICAL INSPECTOR UNLESS CONSTRUCTIO STARS Rough Service ................... . ...................................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildink - 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. SEE REVERSE SIDE The Commonwealth of Massachusetts Department of lndustrigl Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electriicians/Plumberg Applicant Information Please Print Ledb Name(Business/Organization/Individual): Address: City/State/Zip:- Phone#: 2S Are you an employer?Check the appropriate box: Type of project(required): 1. am ap Y em to er with� — 4. ❑ 1 am a general contractor and 1 6. ❑ ` New construction employees(full and/or part-tim e).z have hired the sub-contractors 2111 am a sole proprietor or partner- listed on the attached sheet.? �• ❑Remodeling ship and'have no employees These sub-contractors have 8, ❑Demolition working for me in any capacity. workers'comp.insurance. 9• ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its 10.(]Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all work night of exemption per MGL I Q]Plumbing repairs or additions myself.[No workers'comp. c.152,§1(4),and we have no 12f jRm)ftepairs insurance required.]t employees.[No workers' 1311 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. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that 1s providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name:. J� Policy#or S elf-ins.Lic.#: �� Expiration Date: l 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 requiredunder 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$250.00 a day against the violator. B e advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certlo un r i ins p a ies of t_the information pro/vid abo eeiis true and correct. - Signature: Date✓ l7 Phone 4: Z� Of ccial use only. Do not write in this area,to be completed by city or town official. City or Town: PermitMeense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.CitylTown CIerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other - - - Contact Person: Phone M. Information %nd bs$rlU[ed®I�l 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 of hire,• 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 au 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 be 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-contractors)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. Do advised that this affidavit may be submitted to the Department of Industrial Accidents for 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-andprintedlegibly. 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 bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would no to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: `rho Cox MOJIwealtl of M_a ssarl?v=ats Da-parbent ofladustdat Accidents 0*e ofWeNtigatiom. 600 Wasbbgtoa Street Boston}M&02111 TO,#617-7274900 ext 406 ox 1-877MASSAFF, Revised 5-26-05 Fay,#617-727-7749 WOOSTER ROOFING PROPOSAL ALL TYPES OF ROOFS DATE: 10/9/13 oOS &ROOF RELATED SERVICES Q Always Hand Nailed License Numbers: Charlie and Steve Wooster Construction Supervisors 54268 One - 1-888 ROOFIN-1 (766-3461) Home Improvement Contractor Main:978 251-7181 Registration 100712 Serving MA&NH since 1984 Fax:978 251-0159 Call For Our References Proposal Submitted To Work To Be Performed At Name Gayle Nieburger Name Company Name Company Name Street 2 Stirling St. Street 476 Great Pond Rd. City Andover State MA. Zip Code 01810 City No.Andover State MA Zip Code 01 45 Home#475-8437 Mobile#475-2396 Work# Fax# We hereby propose to furnish the materials and perform the labor necessary for the completion of the following'ob. Strip the entire barn roof to the roof deck. 1. Renail any loose decking and replace any rotted at$2.00 per foot. 2. Wrap facias and rakes in white aluminum trim coil. 3. Perform any miscellaneous carpentry at$75/man/hour+materials. 4. Install 8"white aluminum dripedge. 5. Paper the roof with Grace Tri-Flex roofing underlayment. 6. Install Certainteed XT-30 Moire Black shingles,hand nailed. 7. Paint cupola. 8. Clean and dispose of all debris. Workmanship guaranteed for 10 years.We are fully insured with workers'compensation as well as liability insurance. Please return copy of proposal: All material is guaranteed to be as specified,and the above work to be performed in accordance with the specifications submitted.All work will be completed in a substantial workmanlike manner for the sum of Dollars($17,900.00),minus Angies List 6.25%discount,-$1,118.75,($16,781.25). with payments to be made as follows: 1/3 down arW remainder paid upon completion. Respectfully submitted Note-This proposal may be with wny us if n ac ted within 30 days. ACCEPTANCE OF PROPOSAL The above prices,specifications and conditions are satisfactory and are hereby accepted.You are authorized to do the work as specified. Payment will be made as outlined above. -, Date 0 >, 1 �3 Signature d/ Mailing Address: P.O. Box 8051 -Lowell MA 01853 Location: 525 Wobum Street-Tewksburv. MA 01876 04W 01 E Office of Consumer Affairs d Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 100712 Type: Supplement Card CHARLES J. WOOSTER ROOFING Expiration: 6/23/2014 STEPHEN WOOSTER 525 WOBURN ST TEWKSBURY, MA 01876 Update Address and return card.Mark reason for change. i 0 zoM-osn i Address ❑ Renewal ❑ Employment E] Lost Card > F/1'Ie z 1z uueaj��, a CiG cr��ac�z e j Office of Consumer Affairs and Busines Regulation 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 100712 Type: DBA Expiration: 6/23/2014 Tr# 227218 CHARLES J. WOOSTER ROOFING Charles Wooster --P.O. BOX 8051 -- LOWELL, MA 01853 Update Address and return card.Mark reason for change. E] Address ❑ Renewal ❑ Employment n Lost Card JaTvYy Soarci Or Bud-d,e.0 `^ :u > &.^,.'',c Standards �ll?2cft'llt'tlf)?3 3U1}�F'eIS!); .. t `_'.cense: CS-054268 CHARLES J WOUsTER PO BOX 8051 LOWELLMA OM3 ; mmissio e, 05/14/2014 �r"1 WOOST-1 OP ID:GM ACRD" DATE IMMIDDNM � CERTIFICATE OF LIABILITY INSURANCE 1011611.2 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(SI AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER IMPORTANT: if the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subjectto the terms and.conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 781-848-8600 CONTACT Gerry McDonald McSweeney&Ricci Ins Ag Inc 781-843-8807'PHONE 781.952 143 P/tX 420 Washington Street c N Ext: arc No).-781-843-8807 P.O.Box 850984 E-NAILS Braintree,MA 02185 Paul Marks INSURERS)AFFORDING COVERAGE MC* wsuRERA:Acadia Insurance Company 31325 INSURED Charles Wooster dba Wooster ,NSURERB:Star Insurance Company Roofing PO Box 8051 INSURER C Lowell,MA 01853 INSURER o: INSURER E: INSURER F- COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED T0.1-HE 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 MAYHAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE INSR WVO POLICY NUMBER POLICY EFF PM UA EXP LIMITS GENERALLUIBIUW EACH OOCURRENCE $ 1,00D,00 A X COMMERCIAL GENERAL LIABILITY CPA0083583 10/17112 10/17/13 PREMISES Es occwmce $ 250,00 CLAWS-MADE r7OCCUR MED EXP(Any one Person) S 5100 PERSONAL&AOV 94JJRY $ 1,000,00 X Per Project Aggre GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOPAGG $ 2,DDD,00 POLICY X JECT LOC $ AUTOMOBILE LIABILITY ICEOM"45SING1:ELIMrr S 1,000,00 A ANY AUTO MAA0379734 10/17112 10/17/13 BODILY INJURY(Perperson) $ ALL OWNED F-v-1 SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X HIREDAUTOS )( NON-OWNED PROPERTYDAMAGE $ AUTOS Per aocideM X uMeREta LUIS X occuR FJ1CH OCCURRENCE $ 1,000,000 A EXCESSLL48 ri CLAnIS4AADE CUA03M967 1(1/17112 10/17/13 AGGREGATE $ 1,000,00 DED I X I RETENTION 0 $ WORKERS COMPENSATION X I WCSTATU- O � TH- AAD.EMPLOYERS'LNABll1iY T Y !M B ANY PROPRIErORIPYIN WCD720M 10117/12 10117113 E.I..EACWACCIDHIT $ 1,OOD, OFRC6tNM8QM EXCLUDED? NIA (Mandatory in NH) F-L OiSERSE-EA EMPLOYEd$ 1,000,00 If yes.desrnbe under DESCRIPTION OF OPERATIONS below E.LDISEASE-POLICY LIMIT $ 1,000,00 Q Property CPA0083583 10/17112 10/17/13 A Equipment CPA0083583 10117/12 10/17/13 DESCRIPTION OF OPHRATIONS I LOCATIONS I VEHICLES Ntach ACORD I(H AddidonW Remarks Scheduf if more is IA e, space rogtdred) CERTIFICATE HOLDER CANCELLATION EVIDENI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCEI.i.ED BEFORE Evidence Of Coverage ACCORDANCE WITH TH PO�EPRQVISIONS VLqLL BE DELIVERED IN AUTHORRED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. " ACORD 25(2(1110105) The ACORD name and logo are registered marks of ACORD