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HomeMy WebLinkAboutBuilding Permit #335-15 - 50 LOST POND LANE 10/3/2013 BUILDING PERMIT Q* NORT{i�t LED 1 �Q TOWN OF NORTH ANDOVER 02. 6. om APPLICATION FOR PLAN EXAMINATION e« o � Permit No#: ' , Date Received �y ORATED�Pp ki SS US Date Issued: 3 IMPORTANT: Applicant must complete all items on this page LOCATION. _ �. O_S - - L {� Prin 'PROPERTY OWNER .:t'r ot S� a I+ skl_aA I/l�a Print 100 Year Structure yes no MAP - .,.,PARCEL: - _ ZONING DISTRICT .- -Historic District yes n0 Machine Shop Village yes no_ TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial Iteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands b Watershed .District Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Roar G� , r Ident'fication- Pleas Type or Print Clearly OWNER: Name: 4 J Phone: '6S'6-S Y�7 Address: 0 S bur Contractor Name:V,Co�a�{e� Phone: q7g-65-G-7 $qg7_ Address:_ _ 31 GSo� Supervisor's Construction License. 2J S__q Z(3 Ex Date: Home1mprovement'License �..a Exp. Date:_ it (y'AS'' 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: $ C� A °Q FEE: $ Al Check No.: �� 0 Receipt No.: �d U 5 NOTE: Persons contracting with unregistered contractors do not have acces 1 uar ty fund Signature of Agent/Owner _ Signature of contract. 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 Li Building Permit Application o Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract o Floor Plan Or Proposed Interior Work o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks o Building Permit Application o Certified Surveyed Plot Plan o Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses IIS ❑ Copy Of Contract Li Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) a 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) o Building Permit Application o Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses u Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) Li Copy of Contract o Mass check Energy Compliance Report o 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 ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS e 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 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 i I 1 Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: i 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 � I NOTES and DATA— (For department use) I ,4 I i it ❑ Notified for pickup Call Email 3 Date Time Contact Name Doc.Building Permit Revised 2014 i Location 6 U &ST Aolv71,11 er Date e - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee s-14: ' Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# 2805; 8 Building Inspector NORT1l Town of t ndover No. * T - hver, Mass, 16 coc"Ic"aw.cu �1' ��A�p'�TEO ►'P�,�'(5 S V BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System f� L 1 BUILDING INSPECTOR THIS CERTIFIES THAT ...........,/;,,r.�1..�..^.a1.h... ............... ..�.1��.4!�.A�... ..................... has permission to erect buildings on04• Foundation .......................... • Rough to be occupied as ..........alcceptinngt ...... .. ....... ...- ....................... Chimney provided that the person sepermii-!a-ii in every respect confo 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 MONTHS ELECTRICAL INSPECTOR • UNLESS CONSTRUC NST S 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. i Office of Consumer Affairs&Business Regulation i ME IMPROVEMENT CONTRACTOR E; egistration: ;170575 Type: - xpiration Al DBA r^ CD ROOFING i VINCENT COLANGEL, ; 3 HODGSON ST `' a 1 TEWKSBURY,MA 01876 Undersecretary I L i Massachusetts-Department of'Public Safety fBgard of Building Regulations end Standards ' C'utritr"ctiu$3 Sui-pcisur Spccioilt� . License: CSSL-105943 t'.I IN f VINCENT COL-ANGELO ��C, t' 3 HODGSONTREET Tewksbury MA 01876 J.• woe "�} t` Expiration,,{ 03/09/2016 CD Roofing Vincent Colangelo 3 Hodgson St. #0, Roof in Tewksbury, Ma 01876 THERE'S NO .OOF WE T COVER - 978-656-8497 97 vincentcolangelo@sbcglobal.net 8-656-48497 HIC Llc# 170575 CSSL Lic# 105943 i Customer: /05f OWENS CORNING '50AiXxJover 177-( 17-734, PREFERRED CONTRACTOR Description of work Performed: r Obtain required town permits& provide certificates of insurance&workers compensation (Provide Dumpster set on planks*for contractors use only(materials all recycled) Attach Large Tarps to protect adjacent finishes, landscaping, and property. ,�4-Strip-off( I)existing layers of roofing on complete house S re-nail any loose decking 44 Install 8inch ;tl p Aluminum Drip edging/Owens Corning Starter Shingles ),Install Owens Corning Ice S Water shield Eft at eaves, 3ft in valleys, around all penetrations X Install Synthetic felt paper to entire roof De C�, he �P ( ( Install Owens Corning LifeTime warranty TruDefinition Duration shingles '919 Install new neoprene vent pipe flashings on all plumbing pipes (Install Oweris Corning VentSure ridge venting with moisture guard Install Owens Corning ProEdge hip& ridge cap shingles )( ) Completely r&-IJash-c.himn.ey--with-lead k p kle've J (y'Owens Corning Preferred contractor installation with full warranty All work will be completed according to state and manufacturing codes and specifications. Every day we will have the roof water tight, clean gutters, completely clean the job site, and use a magnet roller to collect scattered nails. Additional work to be performed r ' All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices. Any alteration or deviation from the above specifications must be made in writing on an Add-on/Modification of Contract form and may become an extra charge over and above the amount stated herein. This agreement is contingent upon delays beyond our control.Owners to carry fire,tornado and other necessary insurance. Our workers are fully covered by Worker's Compensation Insurance. Homeowner agrees to pay for all work as set forth below. If the homeowner defaults, homeowner agrees to pay all cots of collection, including reasonable attorneys fees,in addition to other damages incurred by contractor.Full Payment is due upon completion of work. We propose hereby to furnish material and labor - complete in accordance with the above specifications, for the sum of: dollars($ ). Said amount shall be paid as follows:' Note:This proposal may be withdrawn by us if not accepted within days. YOU, THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION. SEE THE ATTACHED NOTICE OF CANCELLATION FOR AN EXPLANATION OF THIS RIGHT. THIS SALE IS SUBJECT TO .THE PROVISIONS OF THE HOME SOLICITATION SALES ACT AND THE HOME IMPROVEMENT ACT THIS INSTRUMENT IS NOT NEGOTIABLE. Work will not begin until your right to cancel has expired and you-have,r ai a epo it of dollars($ ), unless this agreement provides herwYYs �,/ Signature of Contractor or authorized representative: lrr` fASOF *(IMe)have read the terms stated he —)they have been plained to(me/us),and(I/Vlle)find them to be satisfactory and hereby accept them. Signature of Homeowner(s): K 'A � I A� CERTIFICATE OF LIABILITY INSURANCE F �TE(�" '14 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 certificate holder In lieu of such endorse men PRODUCER CONTACT Angela Westen Insurance Agency NAME:PHONE FAX 557 Central Street E-MAIL 978 735-4094 N (9�e) 735-4095 ADDRESS: an ela@awesten.com Lowell, MA 01852 INSURE S AFFORDING COVERAGE NAIC# INSURERA:ATLANTIC CASUALTY INSURANCE CO INSURED INSURER B:HARTFORD UNDERWRITERS INS COMP FO CONSTRUCTION CORP. INSURER C: 40 READ ST. INSURER D: LOWELL, MA 01850 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 SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER M/DD/Y MMIDDIYYYY LIMITS A GENERAL LIABILITY L021008696 3/18/14 3/18/15 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GE NE RAL LIABILITY DAMAGE TO RENTED $ 100 OOO CLAIMS-MADE OCCUR PREMISES(Ea occurren e)MED EXP(Anyone person) $ 5 000 PERSONALBADV INJURY $ 11000,000 GENERAL AGGREGATE $ 2.000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OPAGG $ 1,000,000 POLICY PRO LOC $ AUTOMOBILE LIABILITY Co%1NEd.rtSINGLELIMIT $ ANY AUTO BODILY INJURY(Per person) $ ALLOWNED SCHEDULED BODILY INJURY Per accident $ AUTOS AUTOS ( ) NON-OWNED PROPERTY DAMAGE HIRED AUTOS _AUTOS eraccident $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESSLIAB CLAIMS-MADE AGGREGATE $ DED RETENTION B WORKERS COMPENSATION AND EMPLOYERS'LIABILITY 2E112O68 3/30/14 3/30/15 WC STATU- OTH- ANY PROPRIETOR/PARTNER/EXECUTNYIN E E.L.EACHACgDENT $ ZOO OOO OFFICERIMEMBER EXCLUDED? N i A (MardatDry in NH) EL.DISEASE-EA EMPLOYEE 1 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below EL.DISEASE-POLICY LIMIT I s 100,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CD ROOFING ACCORDANCE WITH THE POLICY PROVISIONS. VINCENT COLANGELO 3 HODGSON ST. AUTHORIZED REPRESENTATIVE TEWKSBURY, MA 01876 r: ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: VINCENTCOLANGELO@SBCGLOBAL.NET The Commonwealth of Massachusetts Department ofIndustrigl Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information PIease Print Legibly Name(Business/Organization/Individual): 6Q" / Address: ILA 5:0--n Sf" City/State/Zip: 12w r S:Lc n Phone#: 7 Are you an employer?Check the appropriax: Type of project(required): 1.❑ I am a employer with 4•4V7 am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.El am a sole proprietor or partner- listed on the attached sheet. ❑Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition workingfor me in an capacity. workers'comp.insurance. Y p tY• 9. E]Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their ME]Electrical repairs or additions 3111 am a homeowner doing all work right of exemption per MGL I L[]Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees.[No workers' 13.[i 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 is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:. Q Policy#or Self-ins.Lie.#: boa r o0 8 6�� Expiration Date: Job Site Address: 5,0 Pyn Cf City/State/Zip:_N. A,d(D(g�� 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. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby cer ' un tl pa' s d penalties ofperjuty thatthe information provided above is true and correct. Signature: Date: 013/ Phone#• 4° T n— ro �G 'Phone g�-2 - 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#: i 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 repairr 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,thapter,f52;§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 ofpublic 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. 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 n 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 bum 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 Common :eah to .1�oflklassa c�u .s e tts Department of T.ndustrial.Accidents Office ofJaVestigations 604 Washington.Street Boston,HIAA,0.2111 Tel,#617-727-4900 oxt 406 or 1-87TMASSAFE Revised 5-26-05 Fax#617-727-7749 www.mass,govldia