HomeMy WebLinkAboutBuilding Permit #1235-2016 - 490 MAIN STREET 5/25/2016 I I BUILD NORTH BUILDING PERMIT of q TOWN OF NORTH ANDOVERh6=61,0 o = ;, APPLICATION FOR PLAN EXAMINATION -- Per No#: GN ' T Z h Date Received �, �iq A rPP q9 Date Issued: !i SSgCHUSS� IM ORTANT:Applicant must complete all items on this page _ _ LOCATIONS - — Print PROPERTY OWNER ,x p�� P_nnt 100 Year structure MAP P�_ Yes no PARCEL:W ZONING DISTRICT. Historic.District ye no Machine Shop.Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building El One family ❑Addition ❑Two or more family ❑,Kustrial ❑Alteration No. of units: Z Commercial ❑ Repair, replacement ❑Assessory Bldg Others: ❑ Demolition ❑ Other u;, pSe tic UVell p ❑ Floodplain ❑ Wetlands. © Watershed District ❑.Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: Contractor Name: 1W►ad L Address' Supervisor's Construction License T Exp. Date: Home Improvement License ....... Exp. Date: l3 /Jo -- ARCHITECT/ENGINEER Phone: Ji Address: Reg. No. FEE SCHEDULE.BULDING PERMIT:,$p12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST ASED ON$125.00 PER S.F. Total Project Cost: $ �d FEE: $ Check No.: Receipt No.: NOTE: Persons contracting w unre istered contractors do not have access to the guaranty fund Lgnature of Agent/Owne. `` Signature of contractor Building Department I 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 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/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 NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) i ❑ 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 ❑ 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:Building Permit Revised 2014 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 ❑ j Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ f THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS y 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/dote C0MMEN TS. - - Dimension f I jNumber of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: f 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-$1000 fine i NOTES and DATA— (For department use) i f ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 -— — -- r NORTH Town of �� LAndover O 0 No. Z h � ver, Mass a a6aCA11*# O L/wNt 1, COC NIG NE WICK V �•9 A S l! BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System � �... , THIS CERTIFIES THAT BUILDING INSPECTOR ............... ....... .v...e............ ...........�.......... ............. Foundation has permission to erect .......................... buildings on .. ... .... :I..N.Z .ve ......... ® Rough tobe occupied as ........... . ... .. ....... ..... ..................................................................... Chimney provided that the person acce tin tMs permit shall in eve respect conform to the terms of the application p p p g p every 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 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION TARTS Rough // Service ............ f..... .......... .. ........................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Roi,gh 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. EXPRESS ROOFING PROPOSAL DATE OF PROPOSAL: 512112016 ESTABLISHED 1985 Gualiry Rooanp SlneeA999 mike@expressroofer.com EMUS ROOFING, P.O.Box 542,Chelmsford,MA 01824 Quality You Can Look Up To Phone:978-256-2333/Fax:978-251-2907 www.ext)ressroofer.com PROPOSAL SUBMITTED TO: CONSTRUCTION SUPERVISOR LICENCE#99497 SALS PIZZA ROOF COMPLETION DATE- 490 MAIN ST so- NORTH ANDOVER YEAR HOUSE BUILT- HOME IMPROVEMENT CONTRACTORS LICENSE#108126 We hereby propose to furnish materials and perform the labor necessary for the completion of.• STRIP ALL ASPHALT SHINGLES OFF ROOF CLEAN UP AND HAUL AWAY TARP OFF HOUSE TO HELP PREVENT DAMAGE TO HOUSE, PLANTS, DECKS,WALK WAYS AND LAWN AREA RE-NAIL ROOFING BOARDS AS NEEDED WITH 8D RING SHANK NAILS TO ENSURE SECURE BASE FOR NEW SHINGLES ALL WALL FLASHING WILL BE INSPECTED AND REPLACED AS REQUIRED Install: Owens Corning Weather Lock G Prograde 6' up from the bottom eaves Owens Corning Weather Lock G Prograde under chimney lead and 3'down on roof Owens Corning Weather Lock G Prograde in valleys Owens Corning Weather Lock G Prograde around skylights Owens Corning Weather Lock G Prograde around vent pipes on roof Owens Corning Weather Lock G Pro rade on roof where roof butts into walls Rhino Synthetic Roofing Underla ment over roof boards Owens Corning Starter strip on all roof decking edges Owens Corning Duration Architectural shingles We install 6 nails per shingle for a 130 mph OC wind warranty) Cut in 1 1/2"opening on peak of roof and install Roof Saver ridge vent along all ridge surfaces All ridge vent is Hand Nailed Owens Corning ridge cap shingles 8" Drip edge on all outside roof edges white New pipe flanges over vent pipes 2"-4" All shingles will be fastened using 1 %"- 1 '/2'roofing nails electro plated roofing nails BLOW OFF ENTIRE ROOF AND CLEAN GUTTERS AND DOWNSPOUTS ROLL 3 FOOT MAGNETS OUT TO PICK NAILS OFF LAWN AREA FOR FINAL CLEANUP INCLUDES: ALL LABOR AND MATERIALS FOR THE ABOVE ALL ROOFING PERMITS ARE IN INCLUDED ALL ROOFING MATERIALS STRIPPED OFF YOUR ROOF WILL BE RECYCLED AT ROOF TOP RECYCLING • il 3 X1e e -e- • • o :o- INA o- CLEAN UP AND HAUL AWAY ALL SHINGLES Note:No warranty on problems and/or damaged caused by ice backups No warranty on old skylights All material is guaranteed to be as specified,and the work to be performed in accordance with the drawings and specifications submitted for above work and completed in a substantial workmanlike manner for the sum of. $7,984.00 $ NO MONEY®OWN $ PAYMENT IN FULL AT COMPLETION OF JOB WITH CASH OR BANK CHECK MADE OUT/N THE NAME OF Express Roofing INC. �y Call Toll Free Respectfully submitted ��� B138 1-888-210-ROOF ••• Note-This proposal maybe withdrawn by us if not accepted by: 5/20/2016 All workers fully insured ACCEPTANCE OF PROPOSAL The above prices,specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified.Payments will be made as outlined above.Any additional work than the above will be an extra charge. f Signature Date .51-V 0'J. SHINGLE COLOR Homeowner is responsible for protecting and cleaning content of attic from possible dust and debris during your roofing project. Not responsible for any issues caused by mold ANY ROOF BOARDS THAT NEED TO BE REPLACED WILL BE AN EXTRA CHARGE OF$4.00 PER BOARD FOOT WE RECOMMEND NEW CHIMNEY LEAD WITH ALL NEW ROOFS FOR AN EXTRA CHARGE OF$595.00 EXTRA PER CHIMNEY WE RECOMMEND TO REPLACE ALL OLD SKYLIGHTS WITH NEW VELUX SKYLIGHTS WITH ALL NEW ROOFS FOR AN EXTRA CHARGE Any 112 in.Plywood installation for roof will be an additional charge of$55.00 PER SHEET Labor and materials included The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations w 1 Congress Street, Suite 100 �= Boston, MA 02114-2017 5' www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lg ibl Name (Business/Organization/Individual): Address: HCl S 8 City/State/Zip: Phone#: Are you an employer? Check the appropriate box: Type of project(required): L I a 4. E �am/a general contractor and I ❑ m a employer with L'� 6. ❑ New construction employees (full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition working for me in any capacity: employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance. 1 required.] 5. F1 We are a corporation and its ME] Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ P bing repairs or additions myself. [No workers' comp. right of exemption per MGL 12. Roof repairs insurance required.] t 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 1.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: �- ArGhL� Policy#or Self-ins. Lie. #:_ 0 f - Expiration Date:' (l(eh- Job Site Address: V AiM City/State/Zip: ?4()U eC 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 tl 'is and penalties ofperjury that the information provided abov is time and correct. Si ature: Date: Phone#: Official use only. Do not write in this area,to be 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#: ,aft 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 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 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 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-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 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 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 Office of Investigations would like 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: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel, # 617-727-4900 ext 7406 or 1-877-MASSAFE Revised 7-2013 Fax # 617-727-7749 www.mass.gov/dia 4 � AC Re CERTIFICATE OF LIABILITY INSURANCEo4l,8DAT / I 118122016016 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 INSUPER(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 certificate holder in lieu of such endorsement(s). PRODUCER NAVE ANDRE SILVA RAPD 8 JEPSEN INSURANCE SERVICES INC PHONE FAX M FRAMINGHAM MAA 0,702 NP.Ext!; 508.875-5M wc,holy 508-875-5885 191 CONCORD ADDRESS ANDREORAPOANDJEPSEN.COM ! INSURER(SIAFFORONiGCOVERAGE NAIC0 INSURER A ENDURANCE INSURANCE INSURED FIVE STAR GENERAL CONSTRUCTION CORP INSURER B: LIBERTY MUTUAL FIRE INS CO 153 ARLINGTON ST APT 2 INSURER c FRAMINGHAM,MA 01702 INSURER D INSURER E' INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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 SHOM MAY HAVE BEEN REDUCED BY PAID CLAIMS INSR' TYPE OF INSURANCE AODC&UBA POEEGY EFF'laOLiCY EftP POLICY NUMBER O M LIMITS GENERAL LIA8 ITY LAC"OCCURRENCE S 1,000.000 X ;CMMERCi-LCENFRAIL1AdWTr A ETI)YE TED ( PREMISES(Es IcAl .S 100,000 %th VS-MADE: X 4JGC'UA MED EXP fAny arta Dtwsmi S 5.000 A CBC20001273700 04/06/2016 04AW017 PERSONAL&ADV INJURY s 1,000.000 GENERAL AGGPEGATE s 2400,000 Whl,.A15GAEGAIEOVT:W-i3.E8°F;; PRODUCTS-COMPrQPAGG 52.000,000 X P LIC* D 5 AUTOMOD"LIA TYIii., G UM;f .1�>f iCG'WsMa* � An,ALIO, Kay.NJORY IPer pM») S A„L CV.WZ SCrfEDU11D WTOS 0(x70:Y iNJURY fpw oawoM1PI.8 atszEOAUT.JS t(7WticE. F}RR',5IEl�*r SAMA�a. s �a1T r Prr aaxd�nBl S UMBRELLA LIAR OCC4JR EACH OCCURRENCE S EXCESS LUIS CLAN AGGREGATE S DED . PETENT0"3 rt S WORKERS PENSATIOH WG A'SLF AND EMPLOYERS LIAWTY YINX ANY ETMPARTNERI FEC'+t`Vf B OFFXXVEUDER EXCtIn'YIr NIA TBA 04/1512016 04/15/2017 E,, EA H AGC CF:KT s 1,000,000 (Mla*fttory m NMI E DISEASE-EA EMPLOYCE S 1.000,000 C L fXSEA,SE•P6A.,C+,,jKT S 1.000.000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attafxl ACORD 101,Ada+UonU Asmar4s sch*dt",It claws space Is mownd) CERTIFICATE HOLDER CANCELLATION \ __e'MICHAEL L CORTNER SHOULD ANY OF THE ABOVE DESCRIBED LES CA CEL FARE THE EXPIRATION DATE THEREOF, NOTICE L B ED IN 16 JONAS RD ACCORDANCE WITH THE POLICY PROVISIONS. WESTFORD MA AU7HOfMED REPRESENTAT" MIKE@EXPRESSROOFER.COM I 0 1988-2010ACORORATION. All rights nese ACORD 26(2010105) The ACORD name and logo are registered marks of ACORO Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CSSL-099497 Construction Supervisor Specialty MICHAEL L CORTNER ' 16 JONAS ROAD F WESTFORD MA 01886 (� lam.— Expiration: Commissioner 04/24/2018 � �Jlrr �nnrrirrnrncvi�/�c�C fln,;,;rrr�rr.te//' Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration: 185252 Type: 31 Expiration: 5/16/2018 Corporation EXPRESS ROOFING INC. MICHAEL CORNTER 16 JONAS RD. WESTFORD, MA 01886 Undersecretary Location 4rl No. 'z' Date L---) �ZS � r • TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $-9L* Foundation Permit Fee $ - Other Permit Fee $T TOTAL $ _ Check#'-� n f1 i 3 C 4.2 7 Buildiirig Inspector