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HomeMy WebLinkAboutBuilding Permit #251-13 - 55 BLUE RIDGE ROAD 10/1/2012 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: , � 7 Date Received Date Issued: ID I �v IMPORTANT: Applicant must complete all items on this page LOCATION a PROPERTY OWNER Print 1 100 Year Old Structure yesno MAP NO: M, PARCEL:0ZONING DISTRICT: Historic District yes no Machine Shop Village yes no Nte- TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family El Addition El Two or more family El Industrial ❑Alteration No. of units: ❑ Commercial Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic 0 Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer D SCRIPTION SOF WORK TO E PE FORMED:; L zi I� C0-NAr r V lf � ,� ` - �- rZ \ �'� w , de ti01io le a Type or Print Clearly) OWNER: Name: r Phone: 1-2 c ZZ`1 Address: SS v-e Widm = ,l,vcg 14- 01 NT CONTRACTOR Name: OS Phone: \ Address: 00 Supervisor's Construction License: a76 -7Exp. Date: � /,�O)l Ll Home Improvement License: Exp. Date: 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: $ FEE: $to 6 ,n Check No.: Receipt No.: 29 NOTE: Persons contracting with unregistered contractors do not have access to th uaranty fun Signature of Agent/Owner Signature of contractor , Plans Submitted ❑ Plans Waived ElCertified Plot Plan ❑ (Stamped Plans ❑ m Location x �/�2- �1 J Q P� No. r�^ Date 1 �2 • ' TOWN OF NORTH ANDOVER O Certificate of Occupancy $ Building/Frame Permit Fee stpoo '- Foundation Permit Fee $ � Other Permit Fee $ TOTAL $ Check#Z u 25766 / Building 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 DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments G Conservation Decision: Comments L 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 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.$10041000 fine NOTES and DATA— (For department use LJ Notified for pickup - Date Doc.Building Permit Revised 2010 ---- .••,,,u I IUL Tian u d,Ibtampdd Plans U - 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 o 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 Li Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks Li Building Permit Application Li Certified Surveyed Plot Plan o Workers Comp Affidavit Li Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) o 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 a Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit Li Two Sets of Building Plans (One To Be Returned) to. Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o 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 2012 NORTfi Town of s ndover 0 - . r No. � o h ver, Mass, &6Aze"e- COCHIC"t WICK y1. RATED J'Pa,`'�y U BOARD OF HEALTH - T T LD Food/Kitchen PERMI Septic System THIS CERTIFIES THAT .....`—�. ��:`'. .���:� :�'........................................................................ BUILDING INSPECTOR .... ....... .,. . ..... - � ��. c „ 5 ^ + Foundation has permission to erect .......................... buildings on ..55.. ....................... `.............. � ................ Rough to be occupied as ......:t: J.311: ' :, � yQ � l Chimney.. . ....... . provided that the person accepting this permit shall in every respect conform 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough Service .................... ........ .... ... .�.s�.......r.......... 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. SEE REVERSE SIDE - Vlll;nCtLlly nullCy I'dAILJ; J10111"13IliY Lld,LC: IU/ 1/ LV1L Uzi; Uzi Hm YdgC : L VI J MODER-1 OP ID: KH CERTIFICATE OF LIABILITY INSURANCE D 10101112 Y) 10/01/12 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 978-777-9394 NAME: Dan Hurley Dan Hurley Insurance Agency 978-777-3306 AICC.N Ext:978-777-9394 AIc No: 978-777-3306 Chestnut Green,Suite 24 Seven Federal Street AAREss:dan@hurleyinsurance.com Danvers, MA 01923-3620 Daniel J Hurley INSURER(S)AFFORDING COVERAGE NAIC p INSURERA:Preferred Mutual 15024 INSURED Modern Time Construction INSURERB:ACE Insurance Joseph Meola DBA 85 Abington Road INSURER C: Danvers, MA 01923 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 MAYHAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE POLICY EFF PO EXP LIMITS LTR INSR WVD POLICY NUMBER MMIDDIYYYY MMIDDIYYYY GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY CPP0120599641 12/30/11 12/30/12 PREMISES Ea O TEDence $ 100,000 CLAIMS-MADE a OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERALAGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY PES LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ ff $ WORKERS COMPENSATION X WC STATU- OTH- AND EMPLOYERS'LIABILITYTORY LIMITS ER B ANY PROPRIETOR/PARTNER/EXECUTIVE Y❑ NIA 4507P266-12 03/16/12 03/16/13 E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? SEE NOTES (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS 1 VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) s per policies: Joseph Meola is exempted from workers compensation policy. CERTIFICATE HOLDER CANCELLATION TOWNNOA 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. 1600 Osgood Street N.Andover, MA 01845 AUTHORIZED REPRESENTATIVE Daniel J Hurley ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Modern Time Construction 35 Longwood Avenue Saugus MA, 01906 (781)640-2993 modem Time Construction May 21,2012 Justin Perry Tel(781)249-2229 JobSite: 55Blue Ridge St Andover,MA Proposal Foundation $100.00 Seal all cracks around front and rear of house Roof $700.00 Power wash all debris and mold off roof Siding(5000 sq.ftj $38,000.00 To remove all clap board and dispose of debris Install insulation and House wrap on exterior of home Install new vinyl siding on exterior Remove and re-install gutters and down spouts Remove wood trim around all windows, doors and corners Install new Azec exterior trim around windows, doors and corners Windows and doors $2,800.00 To remove exterior sliding door and 1 window in kitchen Purchase and install new double hung window and exterior French door Sand,prime and paint all window sashes Deck $12,000.00 To demo existing deck because of safety issues l To install new deck with composite flooring and PVC railing . . . . . . . . . . . . . . . . . . . . . . . . . . . . Carpet Flooring $800.00 Shampoo and Vac all carpet floor Paint walls $2,500 1"floor bath 2nd floor bath Kitchen Master bedroom 32 d floor bedrooms Total Cost ............................$55,100.00 1 fuw � Office o onsumery�s B smess Regutatioa7"- HOME IMPROVEMENT CONTRACTOR Registration:, 166480 Type: Expiration: k612014 Individual Jw` EOLA... -_ ---- JOE MEOLA 35 LONGWOOD AVE SAUGUS,MA 01906 Undersecretary Massachusetts- Department or'1'ublic'+S rPetN Board of Building Regulations and Stalloa•ds Construction Supervisor Licerise-' License: CS 88767 r JOSEPH MEOLA 35 LONGVVOOD AVE .:�.,,:•.c L'.:,.: s ... ......... SAUGUS, MA 01906 Expiration: 9/20/2013 ('ununissiuncr Tr#: 1115 G r. 1 1 f Vill.-ndLt'lly 17u11Cy raALL.1:1-3/O/ / / V:1: V:J HL7 I-agu ; 3 VI 3 MODER-1 PAGE 2 NOTEPAD INSURED-SNAME Modern Time Construction OP ID: KH DATE 10/01/12 As required by Massachusetts Workers Compensation Rating and Inspection Bureau: All requests for (workers compensation) Certificates of Insurance must be submitted to the servicing carrier or voluntary direct asignment carrier. A request has been faxed to Insurer B named on page 1. The Commonwealth of Massachusetts Department of Industrial Accidents BJJOffice of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): MP(- AQ Tz& Address: 3 � �{ City/State/Zip: Phone#: (]Q', r q 0 "'�qq 3 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and 1 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2. 1 am a sole proprietor or partner- listed on the attached sheet.$ ❑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.❑Electrical repairs or additions 3.❑ 1 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.❑Roof repairs insurance required.] employees. [No workers' comp.insurance required.] 13.❑ Other *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: Policy#or Self-ins.Lic. 6 Expiration Date: r lob Site Address: 56 Nue- S City/State/Zip: CXIP'� 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 :tne 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 if 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. !do hereby certify un er the pains and pen ties of perjury that the information provided above is true and correct. ii nature: Date: I 'hone#: 7 k a 3 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#: 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 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 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 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 Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. # 617-7274900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 revised 5-26-05 www,mass.gov/dia