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HomeMy WebLinkAboutBuilding Permit #553 - 505 GREAT POND ROAD 1/17/2012 BUILDING PERMITf NORTil o "Eo TOWN OF NORTH ANDOVER s� b`;F'. - =6 0 APPLICATION FOR PLAN EXAMINATION W Permit NO: �, Date Received 9 �' 4L � ��SSACHUSE��� Date Issued: IMPORTANT:Applicant must complete all items on this s k a 7� WE 41�- ` eIP 7 .=-, tcy�i,.—AT�IQ r yC'� A - L .-Y�- .f' -.k: r S 1- --y-*N' �? •r"' .4 f M-� �c` 1 p,_�:.�• .•s rte+ > - .c. rn �fx�,•.,�r�-2'`''-3.c._ .a, --f'`E ,t",C' -fC-+'+�• 1A. + --"_•3. 4�c._ any t - ti..• �, v0-`�� �� r ..s& f eYx'©�I r �,� y `t _nar tV� ,�+' 's� ,.r,r.,f1 -`^�-rRL•�> Y r'- .i�: k.r - 7 �2 r,� r•7,`A-�, t'F.i ry£a-itrt''�r tr'r ax==1'•� tr t, ,. G i t~ti b'-')ec i 1111"S t?IL - r '_' �r .vi.4 �rc - L } -lin'` I'"3rr . 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J�,y�ri '43 &�s T-�v7'.r�'i-i �.�.�.�� '$7 n';;�rL-,_ �''�� $ - _ A �c-� �:'.S_�•'+.. ,&�H.41�:r � ..:�:*i+4�`4h}r.1L.}2'�P� :,i���r.�vY•�i_,,t'�'.,N.j11���j.'�.l'YI��:C`_-�rl1�,F..k�4�C2�.IL.fh- �St DESCRIPTION OF WORK TO BE PREFORMED: SG,w►e /G CCS �la�i Identification PIease Type or Print Clearly) OWNER: Name: ,n Phone: 9'1 85- Address• M wL - MIL ^ - .r�•R��"..�.-�-C..-�i..p`^�"-�-'"e1�•-tr ��-�.,7,Sr..�ar�soccdF��--.A••w•�*'h-+�v--'^'-.�i'r'�'a�'+- u.. � rte• �.1�.•"�.ry. ¢•�� �1.� �-_� � �"_a�u ,� ...a Fl r P��'>T~�,,, .t� � �•b.,. � r*.r N' ti .•o�..d� "Fi--t�,w.�'�-�%�:"-,=�,c�s.;3:r��kP,` �t �'` � �".�,�•. - � __'�`ii'.`•h.�-3 r"'��:�`?�,�* -,°i`•��� �r"'a •.��t��F�.�`r llf�.'t ',�� r•r�-_>�.",3-' { � +e- �`,-ay; �' -sem .}>� ,�^� ��s 1•r.- - �,'. 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FEE: $_ J� ------- Check No.: " g J d Receipt No.: NOTE:NOTE: Persons contracting with unregistered contractors do not have access to the b-u ranty fu Si naEur�xaf�A en�/OuuneT t�. �__ J Building Department ' The following is a list of the required forms to be filled out for theappropriate 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 nt 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 ❑ Cer li:ieU d Proposed Plot Pian ❑ 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 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 d THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature %C0Nil I MEN TJ HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments M1 Conservation Decision: Comments Wafer & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: ` Located -384 Osgood Street �Fd��2E A� lE#N ` :'ferpDrpter�� � e "�� `LLocatedfi411alntr�et j 'x a �j 1 s Muvefda t*e 7 i.. •4 a, .S + S I I �5 s r L 4 i Y 'COi/JVJ�Y I•.7. C c f 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-$1000 fine NOTES and DATA— (For department use) i ❑ Notified for pickup - Date Doc.Building Permit Revised 2010 i � �R Location Q� �� ��� �Y� No. Date �ORTh TOWN OF NORTH ANDOVER 9 4 , :�� Certificate of Occupancy $ _,._. ,>' AC)4US<� Building/Frame Permit Fee $ Foundation Permit Fee $ ------ Other Permit Fee $ -TOTAL $ Check # 1 24998 Building Inspector NORTH Town of zAndover' .. o! , dover, Mass.,LAKE � • l"�' 1 'L COCMICKEWICK RATED BOARD OF HEALTH PERMIT T Food/Kitchen Septic System - BUILDING INSPECTOR THISCERTIFIES THAT...............0.................. .................................. ............................................................... ............ _ anon a has. permission to erect..... .................................. buildings on .�.....�.......�....................P....�.............�. ..... Farxid .. -- Rough to be occupied as... .....4....................................... -........................:.................................... Chimney y provided that the person accepting this permit shall in every respect conform 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 PERMIT EXPIRES IN 6 MONTHS UNLESS �TT ELECTRICAL INSPECTOR V 1�I LESS CONSTRUC Q 11VTSRough - .................................................................................. ........................... 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 RE,DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE smoke Det. TORRA-1 OP ID: LT ,4`oRo� CERTIFICATE OF LIABILITY INSURANCE P�o'MMIDD/YYYY) 1/17/12 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(ies) 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 781-944-1245 NAME:CONTACT David A Cole CIC Cole Insurance Agency,Inc. 194 Haven Street 781-942-1797 (AICr PHONE Exr):781-944-1245 aC No):781-942-1797 Reading,MA 01867 E-MAIL ADDRESS:davidcole@coleins.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Harleysville Worcester Ins Co 26182 INSURED Anthony Torra INSURER B:Harleysville Insurance Group dba Tomar Construction 21 Juniper Circle INSURER c:Hartford Insurance Co Reading, MA 01867 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 SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILS TYPE OF INSURANCE NR ADDL UBR INS&MDPOLICY NUMBER MM DDY EFF MYm M/DDY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A COMMERCIAL GENERAL LIABILITY SPP00000035049J 04/07/11 04/07/12 DAMAGEPREMISESS( RENTED 100 000 Ea occurrence , $ CLAIMS-MADE F—I OCCUR MED EXP(Any one person) $ 5,000 X Business Owners PERSONAL&ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GENTA REGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY JECT PRO LOC $ AUTOMOBILE LIABILITYO(Ea aBINEDtSINGLE LIMIT $ X ANY AUTO BA 00000083229E 05/07/11 05/07/12 BODILY INJURY(Per person) $ 250,00 ALL OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS AUTOS ( ) 500,00 HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ 100 OO AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I RETENTION$ $ WORKERS COMPENSATION X WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE 12WECLS4140 05/07/11 05/07/12 E.L.EACH ACCIDENT $ 100,00 OFFICER/MEMBEREXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1 $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Renovation Construction/Carpentry CERTIFICATE HOLDER CANCELLATION TNANDOV SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town Of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. Building Inspector 1600 Psgood Street AUTHORIZED REPRESENTATIVE North Andover,MA 01845L_ ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD OMAR CONTRACTING T MA 01867 21 Juniper Cr., Reading, 781-944-0278 Office TOMARCON@verizon.net TING & CONSULTING GREEMENT TOMAR CONTRAC � �a.. �� ,2012 between TOMAR CONTRAoCmeNG with an improvement This Agreement is made on M an nd telephone#781-944-0278. H Cr.,Reading, address at 21 juniperConstruction Supervisors License#050275 hereinafter Calle Contractor# 143932, and MassK l til ,�)�„�n address at "contractor"and p�- in is a detailed description of the work to be done and the 1.WORK:The following see attached) materials to be used. ION F WK: Work is scheduleto begin 2012. 2.COMMENCEMENT&COMPLETto beOubstan ally completed on on � `�'_ 0=2011 and scheduled aid for the work to that the price to be p noted). agree t as a e hereby 9 ials. (except ctor and owner 29'.��,� • clusiv f mater Contra clusivelm 3. PRICE .� be performed on the Contract is$ --eX Owner to Contractor payments shall be paid by 4. TIME SCHEDULE FOR PAYMENTS:S e attached under terms). Owner to the following schedule:( consecutive days, according aid for five(5) In the event a payment is due and remainsw th seven(7)days written notice to Owner, and Contractor agree that contractor may, a ment for all work done to date and for terminate this Agreement and recover from owner p Profit- all supplied to date,including reasonable overhead and p all materials and equip incorporated into NTY Contractor guarantees to Owner t Contractot all ealso guarantees that 5. EXPRESS WARRP` specified or agreed. the work will be new unless otherwise sp manlike manner,free from defects and in conformance with any work will be done in a work rah 1. defects in materials or specifications mentioned in Paragraph for one (1)year. If any Agreement is g )yr repair such defects and to bring the Work under this Ag Contractor agrees Workmanship arises within this time, Agreement at no additional expense to Owner. to the standards required under the A9 other remedy under the laws available Work up limits or supercedes any This guarantee in no way to the owner in the event of defective work. g. NOTICE OF OWNERS RIGHTS 'on should re directed to: ent Contractors and subcontractors shall be registered an any (a) All Home Improvem relatingtractor to registration inquiries about a contractor or su bcon Home improvementContractor Registration One Ashburton Place, Room 1301, Boston, MA 02108 Phone#617-727-8595 (b)The contractor's registration number must be on the first page of this Contract. (c) Owner's three(3) cancellation rights under Massachusetts General Laws, Chapter 93, section 498, Massachusetts General Laws, Chapter 140 (d) Section 10 or Massachusetts General Laws Chapter 255, Section(d)shall be stated. 7. PERMITS (a) It is the obligation of the Contractor to obtain required permits, as the owner's agent, as shall be necessary for construction. (b)That Owners who secure their own construction-related permits or deal with unregistered contractors will be excluded from access to the guarantee fund. 8. INSURANCE See Certificate of Insurance(attached hereto and made a part hereof). 9. MODIFICATION This agreement, including the provisions related to price and time of performance and time for payment cannot be changed except by a written statement(change order)signed by both contractor and Owner. All hidden,concealed, or unforeseeable conditions, including, but not limited to code violations,that must be repaired, corrected or otherwise remedied shall result in a change order. A change order fee of$35.00, per change order will apply unless otherwise specified. 10. NOTICE OF CANCELLATION Owner may cancel this Agreement if signed at the place other than the Contractor's address, if owner notifies contractor in writing of his/her intention to do so no later than midnight of the third business day following the signing of the Agreement. The following language addressed to Owner regarding notice of cancellation is required by statute: YOU MAY CANCEL THIS AGREEMENT IF IT HAS BEEN CONSUMMATED BY PARTY THERETO AT A PLACE OTHER THAN AN ADDRESS OF THE SELLER, WHICH MAY BE HIS MAIN OFFICE OR BRANCH THEREOF, PROIVDED YOU NOTIFY THE SELLER IN WRITING AT THIS MAIN OFFICE OR BRANCH BY ORDINARY MAIL, POSTED BY TELEGRAM SENT, OR BY DELIVERY, NO LATER THAN MIDNIGHT OF THE THIRD BUSINESS DAY FROM THE SIGNING OF THE AGREEMENT. SEETHE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. CONTRACTOR OR OWNER HERBY AGREE TO THE ABOVE TER S: o i DATE OWNER'S SIGNATURE, 1116 Aw DATE W"RACTOR'S SIGNATURE The Commonwealth ofMassachusetts Department of-Ind'ustrialAccidents Office of Investigations, 60013 Washington Street UV Boston,MA 0211- www.massgov/ilia 'workers' Compensation Insurance Affidavit: Builders/Contractors/EIectricians/PIumbers A licant Information • �'Iease Print Le ibI Nidlne,(Business/Organization/Individual): Address: -City/State/Zip: Phone#: [01 an employer?Check the appropriate box: 9474 a employer with�� 4. ❑I am a general contractor and IrMEI project(required): loyees(full and/or part time).* have hired the subcontractorsew construction a sole proprietor or partner- listed on the attached sh5ot.1emodeling and have no employees These sub-contractors have ing for me in any capacity, workers'comp,insurance. emblition workers'comp,insurance 5. ❑ We are a corporation and its ilding additionred.] officers have exercised their ectrical repairs or additionsa homeowner Join ag 11 work nght of exemption perIVIGL umbing repairs or additionslf [No workers'comp, c.152, §1(4),and we have nonce required.]t em to employees. 12.E31of repairs p Y [No workers comp,insurance required] her Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors on actors that check this box must attached an additional sheet showing the name of the sub-contractors must submit anew affidavit indicating such and thea workers'comp,policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the otic an ' information. p y andjob site Insurance Company Name: �-�e Policy#or Self-ins.Lic.#: /3 `e C L2 lq4 Expiratlon Date: �.. Job Site Address: Oyi f Attach a copy of the workers'co City/State/Zip: ,Apffd mpensation policy declaration page(showing the policy number irat' i t7 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 certif under tlt nd e - ` P ofperjury that the information Pro Vided above is true anti correct. Si ature: • _ Date: f' Shone Official use only. Do not write in this area,to be completed by city or town offcial. City or Town: Permit/License# Issuing Authority(circle one): I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical inspector 5.Plumbing 6.Other - - g Inspector 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 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 " pp p d p able 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 certificates)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 notrelated 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. Ue COMMORw-Wh of Massachusetts Depaf eat of kdustrial Accidents Office of Investigatlons 600 Washhoon Street Boston;MSA,02111 TO.#617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fay,#617-727-7749 www.mass.gov/dia 1 i C��e�paazvr�zo�eea z °enc zccaeGt� ' re or License registration valid for individul use only Office of Consumer Affairs&Business Regulation ? g OME IMPROVEMENT CONTRACTOR. before the expiration date. If found return to: egistration: ;1'43932 Type: Office of Consumer Affairs and Business Regulation xpiration: ;;_ 012, DBA 10 Park Plaza-Suite 5170 8/16/2 Y ' i Boston,MA 02116 lug .-�,�:== fes=: ai :a.':-�. - . TOMAR CONTRACTING, ANTHONY TORRA w I ,, 21 JUNIPER CIR. READING,MA 01.$67 `'- Undersecretary Not va without signature Massachusetts- Department of Public SafetN Board of Building Regulations and Standards Construction Supervisor License , p ''License: CS 50275 "' N SUPEKVtSOR i_ • ( 1 ANTHONY,N TORRA {' 21 JUNIPER CIR READING,"MA 01867 �--�-- Expiration: 5/2/2012 d'unna�ixgiurtcr Tr#: 3864 a:; f, AS D A