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HomeMy WebLinkAboutBuilding Permit #733-2016 - 507 SALEM STREET 12/15/2015A z> 0 YA BUILDING PERMIT 3 oF<=LE NORTH quo ` TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION �y T h Permit No#: Date Received �qs R,TEo SACHUS� Date Issued: IMPORTANT: ADDlicant must complete all items on this pane LOCATION s a q PROPERTY OWNER Pq MAP b_'�'A PARCEL: 0 101 S lj,f -e, � S,7' /,//-I In G Print 100 Year Structure yes no ZONING DISTRICT: Historic District ye no Machine Shop Village ye � no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ''One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Septic ❑ Well ❑ Floodplain ❑ Wetlands ❑ Watershed 'District El Water./Sewer DESCRIPTION OF WORK TO BE PERFORMED: so f): ?,v, � , /,-), r-- Identification / Identifiication - Please Type or Print Clearly OWNER: Name: /W/q/zv2 ,Qeoel2,y Phone: Address: -� S �'r�., S� /i/q, 5;?sJ-C-1 Contractor Name:J ,ket G�� Phone: g4,Y Email C,&4�0 Address: Supervisor's Construction License- 06�L'�� Exp. Date: Zai Home Improvement License: y 5,% Exp. Date: ARCHITECT/ENGINEER Phone: 9 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: $ FEE: $ [ Check No.: Receipt No.: NOTE: Persons contracting W46 unregistered contractors do not have access to the guaranty fund 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 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 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 TOTE: 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 m U FORM Reviewed On COMMENTS Signature CONSERVATION Reviewed on Sionature COMMENTS HEALTH COMMENTS Reviewed on Siqnature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments F %tater & Sewer Connection/signature & Date Driveway Permit DPW Town Engineer: Signature: Locatea X504 Loeated at 124 MainStreett 1t Fire aDDep ent signa u / to 4 •� � 191MMENTjS r .)sgooa Street s3 . jjj 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: lies No MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine NU I Lb and DA I A — I I -or department use ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 Location No. r ' 2,C) Date )z— Check # TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ '?/— Foundation Permit Fee Other Permit Fee $ TOTAL $ Building Inspector v C � y 0 p CD CD �o CL co N •a 0 o <vCD C = c 0 — CD CD o � Im (ID CD Q O CD N• CC C � v 10 z CD 0 70 (D a CD O 0 O n ti mm �� nm O� z -� m c cn n— .� z IWC n 0 z O h 5 CD N O• CQ O W Q. O to CD ca rt 0 2. cn -0 CD oO = 2 T .Z7 CD 'a N o, o c0,) 0 CL 3 m C) O S $ N. T N -n 0 CL 0 m cn "0 _° CD - c CD C _ Com@ 3 O a -I O cm Q O rt y, O O S 5 rt S •* �D S O CD O < �. . C' O O• C �U y C z CD O O Cr C C nCID (on C: 0 = - v QQ_ co S O - < N O N CD U) S CL CC 01 \ (p FL - 11D y C O 7 S O A O -s CO O C..-P0 CD CD U) C3 CD N 0 y C'1 N T DCD CDV a, -v 0 N a� o � v n tt N L W T .Z7 T N W T x T (� %o T V7 -n Y C (D S N OJ . C' d C y C y C C '6 O 7r�• - S S S \ (p N N 7 S O- A z (D N N T N O A S m ,O 0' 3 C C W n m c n z Hr Ci) �° m m m m D -4 O 2 M 70 0 0 °� Y ��� m �rz a Proposal To: Marc Perry Street: 507 Salem St. North Andover, MA Date 9/17/2015 978-975-8237 Roof proposal I nes 'e uaq &-, onirnercia1 oco Ni All Types Of C y C9,R11,, MHEYS4��� E pert Masonry Mork 2. Strip all shingles from entire main house. n = k 3. Inspect and re– nail any loose or lifted plywood. Lu,cr 5cA & Insured Pti�+ass "Cris Free -or, ll), Ow ed x�.�<.:i� , ,<._.� � � t �.r�.��Jfs �� License #034200 1 -800 -WAIT -4 -US _. eaves and rakes. W. �Ic�g>(c Yeark�c�tarnafi (924-8487) shield along all eaves and top to bottom in all Proposal To: Marc Perry Street: 507 Salem St. North Andover, MA Date 9/17/2015 978-975-8237 Roof proposal I marc@perryins.com I 1. Protect house exterior and landscaping as best as 16 IKO Shield Pro Plus Extended mfg. warranty: 100% coverage, fully transferable, on material, possible. (tarps etc.) 2. Strip all shingles from entire main house. labor, tear off and debris removal for a full non 3. Inspect and re– nail any loose or lifted plywood. pro -rated period of 20 years. Offered to our 4. Any compromised plywood will be replaced at an referred customers and included in this proposal at additional cost of $65.00 per sheet of 1/2" cdx fir. no additional cost. 5. Install heavy gauge 8" aluminum drip edge to all eaves and rakes. Total cost: $ 5,900.00 6. Install 6' of IKO Armourguard ice and water shield along all eaves and top to bottom in all Notes: Please be advised, valuables in the attic valleys.. 6'MA state code. should be moved or covered due to minor debris, 7. Install all new pipe boots. dust and asphalt particles that will accumulate 8. Above the ice and water shield, install IKO cool during the stripping process. All Under One Roof roof guard synthetic underlayment to the not responsible for any damage or clean up that remaining sheathing up to the ridge. may occur in attic. 9. Install IKO Leading Edge shingles to all eaves.. 10. Install IKO Cambridge AR(algae resistant) Limited Lifetime architectural shingles to entire Balance due upon completion roof. 15 year non pro -rated warranty by IKO mfg. 11. Install new Cobra ridge vent. Referrals available upon request 12. Counter -flash chimney and all roof protrusions with ice and water shield, seal and tie into new Highly rated member of the accredited BBB and Angies' List roof. 13. Building permit included. 14. Removal of all work related debris. Thank you! 15. Contractor workmanship warranty =10 years under normal wind and rain conditions. Acceptance of Proposal—The above prices, specif cepted. You are authorized to do the work as specifi Date of Acceptance: ions and condi ion are satisfactory and are herby ac - Payment will b ade outlined above. Signa ur �\ The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Sheet, Suite 100 Boston, MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Leeibly Name (Business/Organization/Individual):.. 411 olo:5A C3 f*?66/" Address: J° T -01-t. t /,' R j (-' City/State/Zip: 1- a vw A-sS Phone #: 17, `t'7r -7J-:5 / Are you an employer? Check the appropriate box: Type of project (required): L[] I am a employer with employees (full and/or part-time).* 7. ❑ New construction 2.E] I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity. [No workers' comp. insurance required.] 3.[:]] am a homeowner doing all work myself. [No workers' comp. insurance required.) t 1 El Demolition 10 Q Building addition 40 1 am a homeowner and will be hiring contractors to conduct all work on my property. 1 will ensure that all contractors either have workers' compensation insurance or are sok 11.0 Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 501 am a general contractor and I havi hired the subcontractors listed on the attached sheet. These sub -contractors have employees and have workers' comp. inswance.t 13.DRoof repairs ni 6.E] We We aa corporation and its officers have exercised their right of exemption per MGL c. 14. Q Othef 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. ' Homeowners who submit this affidavit indicating they are doing all work and thea 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 subcontractors and state whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' eompensadon insurance for my employees Bdow is the policy and job site informadom Insurance Company Name: Policy # or Self -ins. Lic. #:, Expiration Date: Job Site Address: �r� r7 �� t 5 C /`1 /* City/State/Zip: i✓/ ���`t'� 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 S 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. I do hereby certify under the pains andenaid/ess of�perjury that the information provided above is true and correct Civnahrre- �4 40_/ " Date: Phone #: %'7Y - q175 - O,lcial use only. Do not write in this area, to be completed by city or town o,()'ieiai 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 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 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 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 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. # 617-7274900 ext. 7406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 02-23-15 www.mass.gov/dia 11/18/2015 CUED 11:55 FAX 781 598 6430 DAVID ZELLER INSURANCE U001/001 ACCMD CERTIFICATE OF LIABILITY INSURANCE FDATEIMMIDOfYYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER01THIS 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 endorsement(s). PRODUCER CONTACT NAME: Maryellen Goodwin DAVID E. ZELLER INSURANCE AGENCY INC I PHONE . , 17R11 FoF_9n7i FAX 370 LYNNWAY - INSURERS AFFORDING COVERAGE NAIC0 LYNN INSURED MA 01901 INSURER A: ACE AMERICAN INSURANCE CO 22667 BERRY FRANK & BERRY JAMES DBA FRANK & SONS INSUR RC: 45 WINBROOK DRIVE INSURER D : mouncn r COVERAGES CERTIFICATE NUMBER: 13141 REVISION NUMBER: THIS tS 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 ADD[ SUe POLICY EFF LTR TYPE OF POLICYNUMBER MMIDD MIDprYYYYI P LIMITS COMMERCIAL GENERAL LIABILITY EACHOCCURRENE $ CLAIMS MADE 0 OCCUR IJAMAo PREMISES Ea ommencel S NIA MED EXP (Anyoneperson) S GEN'[ AGGREGATE LIMIT APPLIES PER: PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ POLICY JET 0 LOO PRODUCTS -COMP/OPAOG $ OTHER AUTOMOBILE LIABILITY bCOMBINED SINGLE LIMr ANYAUTO Ea accident $ ALL OWNED SCHEDULED BODILY INJURY (Per person) S AUTOS AUTOS N/A BODILY INJURY(Peracddent) S HIREDAUTOS NON -OWNED AUTOS PROPERTYDAMA E Per accident $ $ UMBRELLALIAS OCCUR EACHOCCURRENCE $ EXCESS LIAB CLAIMS -MADE N/A AGGREGATE $ DED RETENTIONS WORKERS COMPENSATION S AND EMPLOYERS'LIABILITY YIN X T STATUTEANYPRERH- A OFFI EORfMEMBERPEXCW0ED4ECUTIVE WA NIA NIA E.L. EACH ACCIDENT S 100,000 (Mandatory in NH) 6S62UB9998L43415 11/05/2015 11/05/2016 It yes, describe under E.L. DISEASE -EA EMPLOYEE S 100,000 DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY umrr $ 500,000 NIA DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached If more space is required) Workers' CompensaWn benefits will be paid to Massachusetts employees only. Pursuant to Endorsement WC 20 03 06 B. no authorization is given to pay claims for benefits to employees in states otherthan Massachusetts if the insured hires, or has hired those employees outside of Massachusetts. This Certificate of insurance shows the policy in force on the dale that this certificate was issued (unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored dally by accessing the Proof of Coverage - Coverage Verification Search tool at www. mass.govAwd/workers-Compensation/investiga tions/. No partners have elected coverage. CERTIFICATE HOLDER s //_ l %,MTV%.aLLAIlUN O L/l� ( SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ALL UNDER ONE ROOF ACCORDANCE WITH THE POLICY PROVISIONS. 30 TEMPLE DRIVE AUTHORIZED REPRESENTATIVE METHUEN MA 01844 Daniel M. Crc W, CPCU, Vice President—Residual Market —WCRIBMA ©1988-2014 ACORD CIDRPCIRATit'im aD .ink#n .e ­..,.r AGURU 25 (2014101) The ACORD name and logo are registered marks of ACORD �U { a� Massachusetts . Depa0went of Public Safety Board of Building Reguiat3ons and Standards Construefi-on �i rtiraar License: CS -069120 rj{ { 303'E;Sit LEDR- MVHM MMA ISyV Cern�¢tissianer C3dJIi�f�Ot7 oya{t:cr r�cy{at{a,ta� Click on Ute registration number to view complaint history, You can also Ly fund history. The fist i&'�current as of Wednesday, October 8, 2014. RE1G' .. T NT RESPONSIBLE a pNDIVOUAOL ALL. UUMIt ONE ROOl= L.ANZAFAME, JOHN Search Results REGISTRATION ADDRESS EXPIRATION NUMBER DATE STATW 137057 166 A MERRIMACK ST 10102/2016 Current METHEUN. MA 01844 ©2012 Commonweattn of Massachusetts. M9$s.G0v4D Is 8 registered service mark of the Cortinjonweatth of Massachusetts.