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Home My WebLink AboutBuilding Permit #676-14 - 55 BLUE RIDGE ROAD 4/2/2014TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received AL I , . �. Date Issued: IVI U= IMPORTANT: Applicant must complete all items on this page LOCATION _25,57 d d4 e ed - Print PROPERTY OWNERS _ j 1-- Prinf 100 Year old Structure yes'nno MAP NO: PARCEL: ZONING DISTRICT: Historic District yes Machine Shop Village yes TYPE OF IMPROVEMENT. PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial epair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Septic ❑ Well ❑ Floodplain ❑ Wetlands ❑ Watershed District iEl Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Type or Print Clearly) OWNER: Name: Orlrlracc• 1- 24 CONTRACTOR Name: Ajaldo,C T . Phone: 3 2 -10 -2 - Address: .0-2_Address: q dou,&&d21 64:�I, I 1i Supervisor's Construction License&-.1�� Exp. Date: _ Home Improvement License: 12 Exp. Date:V3 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: $ q F FEE: $ 10 Check No.: Yb Receipt No.: r7 -•_>S 14. a NOTE: Persons contracting with u egistered contractors do not have access to the aranty fund ignatureaof Agent/Owner Slgpature of contracto . Plans Submitted 1J 6n4s . aived ❑ Certified Plot Plan 11 CSta ped ans ❑ I Location No. Lo —' Date �[ Check # TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ 1 V D'bt Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Building Inspector Plans Submitted ❑ 'Plans Waived ❑ . :.-Certified Plot Plan ❑ Stamped Plans ❑ 'TWeEE'OF::SEWERA:GE.D1SP-C)SAL Public Sewer ❑ Tanning/Massage/Body Art ❑ . Swimming Pools ❑ Well ❑ Tobacco -Sales .. Food Packaging/Sales ❑ Pxivate (septic tank, etc._ - Permanent Di inpster on.Site ❑ .-THE. FOLLOWING SECTIONS FOR -OFFICE USE ONLY INTERDEPARTMENTAL SIGN _OFF - U FORM _:-,__,DATE REJECTED . DATE: APPROVED PLANNING & DEVELOPMENTS ❑ ❑ COMMENTS CONSERVATION COMMENTS HEALTH COMMENTS Reviewed on Signature Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes . Planning Board Decision: Conservation Decision: Comments Comments Water & Sewer Con nection/S_i_gnature & Date Driveway Permit DPW Tows Engineer: Signature: Located 384 Osgood Street FIRE DEPAIRTM NT- Temp Dumps#er onsite yes_ no Located of :124 Mair Street. Fire'Departme►it s'ignature7date COMMENTS ' "" -Dimension Number of Stories: :Total land -area; sq. ft.: Total square feet of floor area, based on Exterior dimensions. ELECTRICAL: Movement of. Meter, Iodation, n ast or service drop requires approval of '.Electrical Inspector Yes No DANGER ZONE LITERATURE: -Yes No MGL.Chapter•166.Secdon 21A=F and G min.$100=$1000.fine IVU I tS and UA1 A — (t -or department use ® Notified for pickup - Date Doe.Building Permit Revised 2010 Building Department -`rhe fol owing i- ' a -list of the required forms to be filled ouffor:the appropriate. permit to be obtained. Roofivg, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/OrC: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/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 ❑ 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 cans .if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the apt)•?al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm-tted with the building application Doc: Doc.Bui?ding Permit Revised 2012 ACC)RO® CERTIFICATE OF LIABILITY INSURANCEDATE(NM/DD/YYYY) INSR LTR TYPEOFINSURANCE 2/12/14 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(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 NAME: DEBRA DALLA COSTA A -Costa Insurance Agency, Inc PHONE FAX 2 Franklin Commons Fxtll 508 875-3488 No; (508) 875-9388 mta ADDRESS:on@a-costains.com Framingham, MA 01702 INSURER(S) AFFORDING COVERAGE NAIC # INSURERA:ESSEX INSURANCE COMPANY INSURED INSURERB:Acadia Insurance PROS HOME BUSINESS SERVICES IN 164 CHESTNUT STREET STE1 INSURER C: MARLBOROUGH, MA 01752 INSURER D: INSURER E: INSURER F: %.VVCR/ ur-0 GtK I1FICA IF NIIMRF R• DC\/ICIMI KIIHIRADCD. 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 LTR TYPEOFINSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF MIDDY POLICY EXP M41/DD/YYYY LIMITS A GENERALLIABILITY 3DL2114 5/10/13 5/10/14 EACHOCCURRENCE $ 1,000,000 COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR DAMAGE TO RENTED E I E aoocuce $ 100 000 MED EXP (Anyone person) $ 5,000 PERSONAL&ADVINJURY $ 11000,000 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATE LIMITAPPLIES PER 7X POLICY PE 4 LOC -PRODUCTS $ 1,000,000 $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT a accident $ BODILY INJURY (Per person) $ ANYAUTO ALLOWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident ) $ NON -OWNED HIRED AUTOS _ AUTOS PROPERTY DAMAGE $ eraccdent UMBRELLALIAB F OCCUR EACH OCCURRENCE $ E(CESSLIAB CLAIMS -MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY PROPRIETOR/PARTNER/EXECUTNy / NE OFFICER/MEMBEREXCLUDED? 7 NIA WC2020005043 9/7/13 9/7/14 X WCSTATU- OTH- "RyANY E.L. EACH ACCIDENT $ 100 ,000 E.L. DISEASE - EA EMPLOYEE $ 100,000 (Mandatory in NH) If yes, describN OF er DESCRIPTION OF OPERATIONS below O E.L. DISEASE -POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/ LOCATIONS I VEHICLES (Attach ACORD 101, Additional Rerrarks Schedule, if more space is required) Lt \ r`ANrFI I ATIr1N U 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD Phone: Fax: E -Mail: SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE PROS HOME SERVICE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE DEBRA DALLA COSTA U 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD Phone: Fax: E -Mail: V/ze �arrunzaruueall�i olVv`aQaadwel �. Office of Consumer Affairs & Business Regulation. MEJIMPROVEMENT CONTRACTOR o egistration: ;1.38167 Type: .re 3(4/20.1+5;: Individual IVALDO VENTURIN IVALDO VENTURIN 41 BRADFORD ST. QUINCY, MA 02169 Undersecretary ------------ t�t Massachusetts - Department of Public Safety c Board of Building Regulations and Standards Construction Superl icor v3 License: CS -083117 WALDO A VENTURIN. 41 BRADFORD ST QUINCY MA 02169 ' 954, Expiratl00 CK #381 PD 02/05/2014 $60.00 MARISA G. VENTURIN wonhn 382 IVALDO A. VENTURIN 41 nnnoronosr. � 4 QUINCY,,77M{ 0]169-iR11 1 �_ ,,, /� 11 �IItt 1""To LANA J �I•'-ia \1110. Soc4•..uc.i•1 i' 100.00 utuacucrary I'�,.' . ? ®EastemBank , �,tta�s-t7 � 1 l� 1\'x:0 1 1 30 1 4981: 04 0000544„ 03 2 CK #382 PD 02/05/2014 $100.00 1 lu U 4mo 0 J W x LL 0 O m N u 0 LL N ? N y it Gi In O d z z m .2 (p 0 LL t O d' ? U Cc C t U LL O d z z coN 4. t O OC LL cc O W N z V u W W t 0 Q' U •bn ` N VI LL O U a Z O L 0 d' LL LLI cc CL p 5 LL i '�- Co Z +-' a ++ l/1 cu N Q GC N CN lC p .Q �I dr a) y mQ c o N V r S a L �: �y 2� ` • � = O J v O E cn = •/• O �NGo �/ V L O F. w v v 0 r -ml 00 O CL C. CD Q r J � O Z 0 N The Commonwealth of Massachusetts , - Departmint of Industrial Accidats Office of Invesfigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly t Dame (Busyness/Orizanizaiion/individuai):_?—K o �,flp,� ��i vtR?-� fLy l CSLJI i Address: MJ -220 '--30.S Z6 4 6 Are you an employer? Checkt e appropriate box: Type of project (required): 1. ❑ I am a employer with0 4. ❑ I am a general contractor and I 6. ❑ New construction employees (full and/or pari -time).* 2. ❑ I am a sole proprietor or partner- have hired the sub -contractors listed on the attached sheet. 7. ❑ Remodeling ship and1ave no employees These sub -contractors have 8. ❑ Demolition worldng forme in any capacity. workers' comp. insurance. 5. F1 We are a corporation and its 9, F1 Building addition [No workers' comp. insurance required.] officers have exercised their 10Electrical repairs or additions 3. ElI am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself. [No workers' comp. c.152, §I(4), and we have no 12. Ki0of repairs insurancere ed.] employees. [No workers' 13.❑ Other comp. insurance required.] xAny applicant that checks box#1 must also fill outthe secfion bel6w showingtheir workers' compensation policy information. i -Homeowners who submit this affidavit indicating they dre doing all work and then hire outside contractors must submit anew affidavit indicating such. 1Contractors that cheAthis box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. X am an employer that is providing workers' compensation insurance for my employees Below is the policy and job site information. .1 l Insurance Company Name:�� ►WJ l.0 Policy # or Self ins. Lie. #: 01i Expiration Date: q- — Ci /State/Zi IV I �{1(/l�7 Job Site Address: ty p� Attach a copy of the workers' compensation olley declaration page (showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL o.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 rine of up to $250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. X do hereby cerin under a pains and penalties of perjury that the information provided/above is true and correct. - Sianature: ��, � Z— \ / f 3 2 i s-� Phone #• �/ l 7 S Oficial 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 6. Other - Contact Person: 4. EIectrical Inspector 5. Plumbing inspector 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 -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 maybe 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 he. 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. Pleas e be -sure to fill. in the permit/license number which will be used as a reference number, k addition, an applicant that must submit multiple permit/license applications in any given year, need only submit oneaffYdavit 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 CQmmonmaxthof Massac�hu�Pt�s Dopaftent of ZndusWal Accidents Me Q AVestfgatim 600 Washiog(:on Stxoei Boston, MA 02111 TO, # 61.x`-7.27-4900 at 406 ox 1-877- MASSAFB Revised 5-26-05 Bay, # 617-727-7749 wwwaass,gov7dia 449 Boston Post Rd East State 10,M►drlborough,Ma 01752 Main: (508)-305-2656 Toll free:(877)902 2175 Fox:(508)-305-2657 Emoil.info@proshomeservices.com "Your Exterior Home solutions" www roshomeserViCe5.COM Painting .Siding .Roofing .Carpentry .Decks Proposal Submitted to:lustin Perry Blue Ridne Rd City State a Zip Code;North Andover, Name: Roofing Replacement Estimate Number:75 Sales Name:Sander A.1ves We propose hereby to fumlah material and labor—complete In accordance with speciflog s below, for the 9Urn of Dollars:$9,000.00 7 7 PeyMent to be made as follows: All mate( Is Buarenteed to be Be sped76ed. All work to 110 eompleiad in e workmanlike monncrapwrdingtostandxdpractices. Any oneratlonofdeMationfrom speoMc:loons Authorized balaw involving extra coats will be eloecuted only upon wMBn orders cord will become an Signature //40^ addtt(oml change overand above the egtjmele. All agreenteute contingent upon atri fts, YMf A &—B aceiderha or delwys beyond our aar&ol.Ovawr to oxsy fire, comedo, and other neovw:arY insurance. Our workers are tuly covered by wort m cuml)"sadOrl insurance Nae: This�A�blh*-w by us !fact acoepted within 6 days. We hereby submit specifications and estimates for. Scope of Work: 1)prepare site for work,protect structure,protect landscaping as needed. Contractor agrees to supply the labor and materials. 2)Removal,replacement and/or disposal of existing roof. 3)lnspect all plywood fior damage upon removal of existing roof. 4)lf plywood Is needed,there will be an additional cost of S6b.00 per 4"' x S sheet. 5)Install drip edge around entire perimeter of roof. $)Install 6 feet" ice and watershleid in all necessary areas including roof to wall junctions,valleys,along all eaves,around chimneys,around skylights and all other high risk areas. 7)Instalt a premium underlayment on all remaining sections of roof deck where there will be no ice and water shield. 8)Replace flashing around all soil pipes. 9)Install an architectural shingle to factory specification. 10)r®work flashing at roof to wail junctions,chimneys and skylights as needed. 11)Grounds to be cleaned daily Including a magnetic sweep. Final detailing upon completion. 12)Removal of all job related debris. 14)Price includes all labor and materials. 15) All labor Mkrranty for a period of 2 years from the completion date work. 16)AJi materials Life Time Warranty By GAF . yes Install.a ridge ventilation system. No Install counterflashing on chimney/s House Total sq feet:2,800 permits: pros Home Services Inc obtain and pay for all necessary permits. Shingle type: Gat Tmberline H.D. Life Time Warranty Shingle Color Choice: j Notice of cancellation; This is a ccntraat.-rvu may cancei this trawaation aw terns prior to midnight of the thixd busineas day aftee the date of t2da trasaotion.Yoa Ma3F o=MI ` this transaction without penalty Of Obligation its aanceled Whithin the. UM frame allowed. 1: Payments Terms:509d Down 50% Upon Completion acceptance of Proposal The above pries, specifica"na. terms and corditioas am aat(sWory and aro hereby accepted. You are authorLed to do the work as specified. Payment A be made or. outMned above. Print M1lame 1 Aem of Acceptatnce: �� I 8ignatws 11 VA AjLA