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HomeMy WebLinkAboutBuilding Permit #443 - 534 BOSTON STREET 12/10/2009 'I TOWN OF NORTH ANDOVER / ,/, APPLICATION FOR PLAN EXAMINATION Permit NO: `�`� Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION t-3 o S4ov\ Sr e.e Print PROPERTY OWNER eh f� < ML C.a.t^4,Ef 101 Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building <gne famil Addition Two or more family Industrial Alteration No. of units: Commercial e air, replacement Assessory Bldg Others: Demo i ion Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: 1S cerocd , 101)SP 4.7,�N, 30 Ueg, - 4510 crS✓J�r� � � �h Identification Please Type or Print Clearly) OWNER: Name: C1-�r; .� iMc C�r�1^�t Phone: 40 - 711- op(.v Address: 5`t 3 Sosiov\ Si CONTRACTOR Name: S'v� �`I 1h Phone: 978 857- 91,78 Address: VA 60very D1- pet000j y tai fs11,er;cc, SMA oi- a 1 Supervisor's Construction License: 97 9 3-7 Exp. Date: (,`acl- Xo'i l Home Improvement License: �(oa38`7 Exp. Date: aw a3- 1D ll ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT: 1000.PER 12.00 $ $ 00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. oti Total Project Cost: $ �4`1a. FEE: $_��Q .© ° 3Q Check No.. %1 7 Gl No..Receipt � 2 �� NOTE: Persons contracting with unregistered contractors do not have access to theuaran and g t1' .f Si' nature of Agent/Owner Signature of contractor �.. Location No. �� �z . Date �Z o NORTH TOWN OF NORTH ANDOVER F R 9 Certificate of Occupancy $ ,SSACMUSEt� Building/Frame Permit Fee $ /92� Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 23U 7 r 22692 r 13ilding Inspector i 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 I DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on _ Signature COMMENTS n Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes ,r 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 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 i NOTES and DATA— (For department use I ❑ Notified for pickup - Date Doc:.Building Permit Revised 2008 T 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 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 ❑ Certified Surveyed Plot Plan o Workers Comp Affidavit u Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract L3 Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) L3 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) E3 Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ 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: Doc.Building Permit Revised 2008 XAORT Town of Andover 'k VO No. ?4 43 -r7 WO 7 IL AKE dover, Mass.,0 L COCHICHEWICK ��S RATED BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT......................................................... Foundation 'r ................................................................................................. has permission to erect........................................ buildings on ........ ....spr�&Y..j�......................................... Rough tobe occupied as.................... eo'4.....................................................I............................... Chimney 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 ELECTRICAL INSPECTOR UNLESS CONSTRUCTION. TARTS Rough Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR 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. SEE REVERSE SIDE Smoke Det. '. Proh?ssional.Roofing Contractors 14 Governor Peabody Road Billerica,MA 01821 978-815-1486 978-857-9278 MA CSL#057937 HIC Registration#162387 Chris McCarthy November18, 2009 543 Boston Street PROPOSAL North Andover MA 617-799-0060 ✓• First we will start by protecting the house plants andthe lawn with tarps. Vo Then strip roof down to the sheathing and put debris into a dump trailer that will be on site. ✓• We will remove all the old roofing nails and re-nail the roof boards. • If necessary we will replace any broken or rotted plywood at no cost up to 64 square feet. Additional plywood replacement will cost $2.00 per square foot for %2 inch plywood. ✓• Next we will remove the siding were it meets the roof. • We will install new 8 inch aluminum drip edge over a 12 inch strip of Certainteed HT ice and watershield that will be folded down onto the fascia board. ✓ • Then apply 6 feet of Certainteed premium HT ice and watershield at eaves, 18 inches were roof and siding meet. ,�• Next we will install Certainteed roofers select underlayment over remaining roof deck. J • Then we will chalk lines at ten inch increments to ensure straight shingle installation. �/• We will next install Certainteed Woodscape/Landmark 30 year shingles color of choice. • Around the chimney we will fold the ice and watershield up and behind the lead flashing. We will also install new counter flashing and seal the lead flashing with geocel sealant. • All plumbing stacks will receive new pipe flashings. ✓• We will install a new black rain dive rter over the front door. • Then we will install Shinglevent 2 baffled ridgevent. • The job site will be cleaned on a daily basis and swept with a magnet to collect any nails. • The cost of the job includes all materials, labor and removal of debris. Attention Home Owners Please cover all personal belongings in your attic and storage area. There is always a chance of small roofing debris falling through spaces in your roof deck. Please make sure items hanging on the walls are secure to prevent them from falling. Visit us on the web at www.snsmoreyinc.com Total $8,442.00 Deposit $2,800.00 Due upon completion $5,642.00 Acceptance of contract The above pric s, specifications and conditions are accepted. You are authorized to complete the w�rk . Payment willbp made as outlined above. Homeowner Av- Date ly)\J , Z�`', zoo Proposal may bd withdrawn by SNSorey Inc. if not accepted within 21 days Conditions All materials guaranteed to be as specified.All work is to be completed in a workmanlike manner according to standard practices.Any alterations or deviation from specifications involving extra cost will be executed only upon written orders and will become and extra charge above and beyond our control.Owner to carry fire and other necessary insurance.Our workers are fully covered by workmans compensation insurance. i NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGLc 40 S 54, a condition of Building Permit at: s3a �� , S�- is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150 A. Also, note Permits are required under Fire Prevention laws Chapter 148 Section 10A. The debris will be disposed of in: p '(Location of Facility) Signature of Permit Applicant la-1 0-05 Date The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Uf 600 Washington Street Boston, AM 02111 www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Sn S my(ee V zoc- Address: 14 6c1- I0EY%010Y RJ f72:����e/;cy V►'tA yI aI City/State/Zip: 't3, ��.eric s M4 O1%a k Phone#: 4_7�- 16 S7-cc a-)9 Are you an employer?Check the appropriate box: Type of project(required): 1.E5'11 am a employer with a- 4. ❑ I am a general contractor and I 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. 1 7. ❑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 required.] officers have exercised their 10.El Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.Q-Ttoof repairs insurance required.] t 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. 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 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: , (� Policy#or Self-ins.Lic.#: TA a 3;141 Expiration Date: a 0 10 Job Site Address: E 3- 20S�Ov, S� . City/State/Zip:_V) Py17 -e/ MA .pf.ey5- 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 o Y f Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Sienature• _L�y/cam_ Date 10-1 10 d!1 Phone#: 7_7L 857-7- c?a 7 f) 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 p g p for Contact Person: Phone#: i 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 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. 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 or 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 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 600 Washington Street Boston,MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 5-26-05 www.mass.govldia PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Northwest Insurance Agency HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 238 Bedford St ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW Lexington,MA 2420 COMPANIES AFFORDING INSURANCE COMPANY A GRANITE STATE INSURANCE COMPANY INSURED Sns Morey Inc 14 Governor Peabody Rd Blllemla,MA 01821-0000 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOT WITHSTANDING 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 THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALLTHE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, 00 1 LTR TYPE OF 91SURANOB POLICY NUMBER FOUCYIIFFEWM DA7B POLICYLVII1ATION DAT! A DEMPLOYERS'LL4BLITY LIMITS E PROPRIETOR/ ARTNERWEMECUTIVE OFFICERS ARE: NCL❑E%CL❑ 7423241 2/13/2009 2/13/2010 ATUTORY LIMITS OTHER amaga Applle.to MA Operations Only. CH ACCIDENT $ 100,00 ISEASE POLICY LIMIT $ $00,00 ISEASE-EACH EMPLOYEE $ 100,00 DE8CRIPTION OF OPERATIONMEHICLMSPECIAL ITEMS CERTIFICATE HOLDER CANCELLATION TOWN OF GRAFTON SHOULD ANY OF THE ABOVE DESCRIBED POL(CIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,TNI ISSUNG COMPANY WILL ENDEAVOR TO MAIL 14 30 PROVIDENCE RD DAYS WRITTEN NOTICE TO THE CERTIFICATE MOLDER NAMED TO THE LEFT,BUT GRAFTON, MA 01819 FAILURE TO MAIL SUCH NOTICE SMALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ' � . ... F' _ , t �} � � _� ' '. � 'y t., •Y .. fig,. � -ti � , 1 Ac®O® CERTIFICATE OF LIABILITY INSURANCE DATE 12/8NYDDIYY9 �,...� 12i8/2oo PRODUCER (781)861-1800 FAX: (781)861-1804 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Torry Insurance Group ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 238 Bedford Street HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Lexington MA 02420 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A:MGM Insurance Company 14788 SNS Morey, Inc. INSURER B:Commerce Insurance 34754 14 Governor Peabody Road INSURER C: INSURER 0: Billeri a MA 01821 INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS TYPE OF INSURANCEDATE(MM/DDIYYYY) DATE(MMfDOIYYYY1 GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES a occurrence $ 500,000 A CLAIMS MADE OCCUR KPP3296L 1/29/2009 1/29/2010 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 11000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $ 1,000,000 X POLICY SEPT- LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ S ALL OWNED AUTOS LT2024 2/4/2009 2/4/2010 BODILY INJURY $ 100,000 X SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ 300,000 NON-OWNEDAUTOS (Per accident) PROPERTY DAMAGE $ 100,000 (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO EA ACC $ OTHER THAN AUTO ONLY: AGG $ EXCESS!UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR EICLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATIONVuC STATU- OTH. AND EMPLOYERS'LIABILITY Y/N OR LIMITS ANY PROPRIETOR/PARTNER/EXECUTIVE❑ E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If es,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Operations usual to a site contractor. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Chris McCarthy DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN 543 Boston Street North Andover, MA 01845 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE LOuiS Tonry ACORD 25(2009/01) ©1988-2009 ACORD CORPORATION. All rights reserved. INS025(200901) The ACORD name and logo are registered marks of ACORD Massachusetts- Department of Public Safetj Board of Building Rehuliitions and Standards j Construction Supervisor License a V License: CS 57937 Restricted to,; 1 G ISTEPHEN D MOREY 14 GOVERNOR PEABODY RD j BILLERICA, MA 01821 I Expiration: 6/29/2011 ('ununissiuner --- --- ------ Tr#: 18765 � � ,✓/ae �amirno�ruaP.as/,I� a�.�avaac�uoeCZa Board of Building Regulations and Standards — HOME IMPROVEMENT CONTRACTOR Registration: 162387 Expiration.'2/23/2011 Tr# 280717 Type: Private Corporation SNS MOREY INC STEPHEN MOREY'. - - 14 GOVERNOR PEABODYRD` i. BILLERICA, MA 01821 Administrator b