Loading...
HomeMy WebLinkAboutBuilding Permit #141-13 - 55 BRIGHTWOOD AVENUE 8/20/2012 VaORTH BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: HI — o Date Received l — � Arim �SSgcHus���y Date Issued: Z IMPORTANT:Applicant must complete all items on this page LOCATION 5 r Pint-f PROPERTY'OWNER'. 1. r-� V—+CGh I,✓� 5 MAP NO: QPARGEL ZONING DISTRICT Histonc.District yes. no Villa'Sho ... o ey TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration No. of units: Commercial 4 , Repair, replacement Assessory Bldg Others: ' Demolition Other Septic - Well ' Floodplain. . Wetlands; Waterstied,Disf�ict` Water/Sewer I DESCRIPTION OF WORK TO BE PREFORMED: S� ACcs i��d ��� ri �(� ✓��C/ 5 Ide�}tification ease T or Print Clearly) OWNER: Name: ` ( \ � Phone: - Address: CONTRAGY,0R Name: f Phone:. Address: r/ Supervisor's,Construction License:C,'-�>, -®5 `I Exp H_ _ - Exp Date: ome,Improvement License: _ ARCHITECT/ENGINEER Phone: a Address: Reg. No. FEE SCHEDULE.BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. 7pCheTotal Project Cost: $ 6a4 FEE: $-7p- Check ck No.: 13 -:*-6 Receipt No.: �` T NOTE: Persons contracting with unre 'st red contractors do not have acce to h a u d Signature of Agent/Owner 1 nature of contracto Location 5- y C/ No. Dateo • • TOWN OF NORTH ANDOVER �r Certificate of Occupancy $ Building/Frame Permit Fee $� y Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check#� 25627 Building Inspector 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 ' 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 MainStreet " Fire�Departmenf signature/date COMMENTS :, t 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) 0 Notified for pickup - Date Doc.Building Permit Revised 2008 1 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 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 MOTE: 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 MOTE: 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:INSPECTIONAL SERVICES DEPARTIVIENT:BPFORM07 Revised 2.2008 JAORTH own of s � : 1. ndover No. h 13Z % 40 ILI • o h ver, Mass, A_ COCKIC Kl WICK 01* 7S U BOARD OF HEALTH PERMIT LD Food/Kitchen Septic System THIS CERTIFIES THAT . . . ....... .. BUILDING INSPECTOR . Foundation has permission to erect .......................... buildings on .... ..........Ad.7toe k ......,. Rough tobe occupied as ..................... .. .. ..... ....'........�.. .� .. .:..,................ Chimney provided that the person a'c' this per it shall in every respect conformrms 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 EXPIRESIN- NT ELECTRICAL INSPECTOR UNLESS CONSTRU TIO TA Rough Service' ............ ..... ...................................................... 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 The Commonwealth of Massachusetts Department of Industrial Accidents Office 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): lr Address: City/State/Zip: Phone#: Are you an employer?Check the appropriate box: Type of project(required): 4. F1 am a general contractor and I g New construction 1.Vam a employer with ❑ employees full and/or part-time).* have hired the sub-contractors ( p ) 7. Remodeling 2.❑ I am a sole proprietor or partner- listed on the attached sheet. # ❑ 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 10.El Electrical repairs or additions officers have exercised their required.] 11.❑Plumbing repairs airs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL mself. [No workers' comp. c. 152,§1(4),and we have no 12.[:]Roof repairs y insurance required.] 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. i 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.#: Expiration Date: 2 Job Site Address: ` w City/State/Zip: Attach a copy of the workers' compens ion 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 of Investigations of the DIA for insurance coverage verification. (do hereby ce tii er the . s a d ens f perjicry that the information provided abov trite correct. Si nature: Date: Official nese 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 evised 5-26-05 Fax# 617-727-7749 t:nin--- --"IA:- WOOST-1 OP ID: DN A`O�RO' CERTIFICATE OF LIABILITY INSURANCE DAT02110D/YYYY) 02110!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 ACT PRODUCER 781-848-8600 NAME: McSweeney&Ricci Ins Ag Inc PHONE FAX 420 Washington Street 781-843-8807 c No.Ert: (A1C No): P.O. BOX 850984 E-MAIL Braintree, MA 02185 ADDRESS: PMarks mkt INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:Acadia Insurance Company 31325 INSURED Charles J Wooster dba Wooster INSURER B:Star Insurance Company Rooting PO Box 8051 INSURER C Lowell,MA 01853 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. INSR TYPE OF INSURANCE SU POLICY EFF POLICY EXP LTR IN POLICY NUMBER MMIDDIYYYY MMIDDIYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 AMAGETO RENTED A X COMMERCIAL GENERAL LIABILITY CPAD083583 10/17/11 10/17112 PREM SES Ea occurrence $ 250,00 CLAIMS-MADE r_X1 OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,00 X Per Project Aggre GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: -PRODUCTS-COMP/Op AGG $ 2,000,00 POLICY X PROi L1 LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,00 A ANY AUTO MAAM79734 10/17/11 10/17/12 BODILY INJURY(Perperson) $ ALL OWNED SCHEDULED AUTOS AUTOS AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Pera.c dent X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,00 A EXCESS LIAB CLAIMS-MADE CUA0383967 10117/11 10/17/12 AGGREGATE $ 1,000,00 DED X RETENTION 0 $ WORKERS COMPENSATION X WC STATU- OTH- AND EMPLOYERS'LIABILITY I TS B ANY PROPRIETORIPARTNEREXECUTIVE F N 00720669 02/06/12 10/17/12 E.L.EACH ACCIDENT $ 1,000,00 OFFICER/MEMBER EXCLUDED? N I A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,00 If ibe under DESCRIPTION PTION OF OPERATIONS below E_L.DISEASE-POLICY LIMIT $ 1,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION EVIDENI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Evidence Of Coverage ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD WOOSTER ROOFING PROPOSAL ALL TYPES OF ROOFS DATE: 6/28/12 o0S &ROOF RELATED SERVICES Always Hand Nailed License Numbers: Charlie and Steve Wooster Construction Supervisors 54268 • - 1-888 ROOFIN-1 (766-3461) Home Improvement Contractor Main: 978 251-7181 Registration 100712 Serving MA&NH since 1984 Fag: 978 251-0159 Call For Our References Proposal Submitted To Work To Be Performed At Name Bill Hutchins Name Company Name Company Name Street 55 Brightwood Ave. Street City No.Andover State MA Zip Code 0 4� City State Zip Code Home# q ' '' `' Mobile# � G� GPS`>` Work# Fax# We hereby propose to furnish the materials and perform the labor necessary for the completion of the following job. Strip the entire upper main roof and right rear step cover roof to the roof deck. I. Renail any loose decking and replace any rotted at$2.00 per foot. 2. Install 8"white aluminum dripedge. 3. Instal 16' of Grace ice and water barrier on all eaves. 4. Paper remainder of roof with Grace Tri-Flex roofing underlayment. S. Install Certainteed Landmark Lifetime shingles,hand nailed. 6. Install new lead flashings on chimney. 7. Install new vent pipe flange. 8. Install new hood vents. 9. Clean and dispose of all debris. Workmanship guaranteed for 10 years.We are fully insured with workers'com enation as well as liability insurance. Please return copy of proposal: All material is guaranteed to be as specified,and the above work to be performed in accordance with the specifications submitted.All.work will be completed in a substantial workmanlike manner for the sum of Dollars($6,350.00), with payments to be made as lows:Job p 'd upon completion. Respectfully submitted Note-This proposal may be with wn by Wiif not accepted within 30 days. ACCEPTANCE OF PROPOSAL The above prices,specifications and conditions are satisfactory and are hereby accepted.You are authorized to do the work as specified. J Payment will be made as o dined above -. Date S / r Signature Mailing Address: P.O. Box 8051 -Lowell, MA 01853 Location: 525 Woburn Street-Tewksbury, MA 01876 E-Mail:Info Wooster-Roofin .com Website:www.Wooster-Roofinq.com \ 77—Y CZ 2 �'7�' r/!/U'!li 0 01�,jacJ'uia(%l/lii. r 1 �• Office of airs and e f CAffd BiRegulation .= 10 Park Plaza - Suite 5170 Boston, Massachusetts 021-16 Home Improvement Contractor Registration Registration: 100712 Type: DBA Expiration: 6123/2014 Tr# 227218 CHARLES J_ WOOSTER ROOFING Charles Wooster P.O. BOX 8051 — LOWELL, MA 01853 Update Address and return card.Mark reason for change. Address f-I Renewal ❑ Employment Lost Card SCA 1 .n 20M-05111 / ;i L\ Office of Consumer Affairs&Business Regulation License or registration valid for individul use only T� 1 . ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: N _ i `10 egistration: 100712 Type: Office of Consumer Affairs and Business Regulation xpira6on: 6/23/2014 DBA 10 Park Plaza-Suite 5170 Boston,MA 02116 CHARLES.J.WOOSTER ROOFING Chanes Wooster s E-11K—SURY,MA 01,876 Undrrs&retary -— - - Not valid witho ignature Massach- usetts -Depart r.er!t f P:jbiic Sa4e'y Board of Building Regulat;uns and Standards Construction Supervisor License: CS-054268 - CHARLES J WO06TER PO BOX 8051 LOWELLMA Of853 cr�rr;� io„a� 05/11/2014