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HomeMy WebLinkAboutBuilding Permit #128-15 - 55 FARNUM STREET 8/5/2014 BUILDING PERMITo "O�T"Atio TOWN OF NORTH ANDOVER 02 y - -° '° °� APPLICATION FOR PLAN EXAMINATION t ' ^ h JF nOM 10 Permit Nod &' Date Received 21E CHU`�'�Date Issued: I ORTANT: Applicant must complete all items on this page LOCATION r-S Sf Print PROPERTY OWNER ���, t. 0s-n4 Print 1 100 Year Structure yes o MAP =- PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑ Two or more family ❑ Industrial Iteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identificatio Please Type or Print Clearly OWNER: Name: ne e- raG Phone: Address: U M �f Urn �Cu^ eb Contractor Name: Phone: Address: ,Son s� �L� kS�c.�.f Supervisor's Construction License: 3 Exp. Date: (q�/5 Home Improvement License: J 7b 57 -5- Exp. Date: (1 /10 //S- ARCH ITECT/ENG I NEER /o /S- ARCHITECT/ENGINEER Phone: J Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.•$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. t Total Project Cost: $ l �t q00 FEE: $ Check No.: �O 5-r Receipt No.: NOTE: Persons contracting with unregistered contractors do not have acce o th gu ty fund ,Signature of Agent/Owner Signature of contract Location �' �_� 6 rhyvy-, —c, No. "' Dat . - TOWN OF NORTH ANDOVERM • 1 aa Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ w Check# a Jam, ,�. i.; J V 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 PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature S COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments j Water & Sewer Connection/Signature & Date Driveway Permit r 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 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) ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Pen-nit Revised 2014 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 o 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 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 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 I r - NORTH ve- 0 No. soh ver, Mass, ) 14 1 GOC MICMl WICK 1 V I �.9 p�R'�TEO I►P��,�S S U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT ........V.P1.44MASW............. � .. .�iw�s.. ..I . BUILDING INSPECTOR Foundation has permission to erect .......................... buildings on .T......... ...... �1!l..V.!!1, ........... .. ...... Rough to be occupied as ......... ... . �� ................................... Chimney ....... ...... .. .......... ........................ provided that the person accepti this permit shall in every resp onform 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 MO S ELECTRICAL INSPECTOR UNLESS CONSTRU N TS Rough Service w ........ ........ ..... ................................................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough 1 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. i CD Roofing Vincent Colangelo 3 Hodgson St. ` oof in • Tewksbury,Mo 01876 1HERE'S 110 ROOF WE CAN T COVER • 978-656-8497 • vincentcolongelo@sbcglobal.net 48-656-49497 HIC Llc# 170575 /— CSSL Lic# 105943 lT 2�1Q ! Customer: �'�� �` �r"� OWENS CORNING N a ,v��' s �7$ '`l's die® PREFERRED CONTRACTOR Description of work Performed: KObtain required town permits&provide certificates of insurance&workers compensation ,,Provide Dumpster set on planks*for contractors use only(materials all recycled) Attach Large Tarps to protect adjacent finishes,landscaping,and property. A4Strip-off(y)existing layers of roofing on complete house&re-nail any loose decking -Install 8inch'A�t-&Aluminum Drip edging/Owens Corning Starter Shingles Kinstall Owens Corning Ice&Water shield Eft at eaves,3ft in valleys,around all penetrations KInstall Synthetic felt paper to entire roof (*Install Owens Corning LifeTime warranty TruDefinition Duration shingles otinstall new neoprene vent pipe flashings on all plumbing pipes K Install Owens Corning VentSure ridge venting with moisture guard P1.Install Owens Corning ProEdge hip&ridge cap shingles Acompletely re-flash chimney with lead ;)Owens Corning Preferred contractor installation with full warranty All work will be completed according to state and manufacturing codes and specifications.Every day we will have the roof water tight,clean gutters,completely clean the job site,and use a magnet roller to collect scattered nails. Additional work to be performed ko n kit 5 K��,9�-�- W �, V e l vx ,/Vo v F/X e d n1 O 4pfc1 e- &l`M4el Gro w 4 c47d, r�rf;i- 10 asp gr"`c Ks _ C r✓ "� r�&J o� all JOrtiJ�S f 4Pf I� New ar a•s��f 6&6ect n-,�r 6r gYat l io:.0-:s, All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices.Any alteration or deviation from the above specifications must be made in writing on an Add-on/Modification of Contract form and may become an extra charge over and above the amount stated herein. This agreement is contingent upon delays beyond our control.Owners to carry fire,tomado and other necessary insurance.Our workers are fully covered by Worker's Compensation Insurance. Homeowner agrees to pay for all work as set forth below. If the homeowner defaults, homeowner agrees to pay all costs of collection, including reasonable attorneys fees,in addition to other damages incurred by contractor.Full Payment is due upon completion of work. We propose hereby to furnish material and labor - complete in accordance ith the ab ,e specifications, for the sum of: dollars($ j 900 , •� ). Said amount shall be paid as follows: Note:This proposal may be withdrawn by us if not accepted within 90 days. YOU, THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION. SEE THE ATTACHED NOTICE OF CANCELLATION FOR AN EXPLANATION OF THIS RIGHT. THIS SALE IS SUBJECT TO THE PROVISIONS OF THE HOME SOLICITATION SALES ACT AND THE HOME IMPROVEMENT ACT THIS INSTRUMENT IS NOT NEG (ABLE. Work will not begin until your right to cancel has expired and yo p ' a dep si f dollars($ ),unless this agreement provid o erw Signature of Contractor or authorized representative: *(IfWe)have read the terms stated herein,they have been explained to(me/us),and(I/We)find them to be satisfactory and hereby accept them. Signature of Homeowner(s): A� CERTIFICATE OF LIABILITY INSURANCE DATE YM ii 2 ,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(es) 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 Angela Westen Insurance Agency PHONE FAX (978 735-4094A/CN (978) 735-4095 557 Central Street E-MAIL : an Ela@awesten.co Dz Lowell, MA 01852 ADDRESSINSURE S AFFORDING COVERAGE NAIC# INSURER A:ATLANTIC CASUALTY INSURANCE CO INSURED INWRERB:HARTFORD UNDERWRITERS INS COMP FO CONSTRUCTION CORP. INSURER C: 40 READ ST. INSURER D: LOWELL, MA 01850 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MIDDIYYYYI (MMfDDIYYYYI LIMITS A GENERALLIABILITY L021008696 3/18/14 3/18/15 EACH OCCURRENCE $ 1,000,000 �( COMMERCIALGEMEPAL LIABILITY DAMAGE TO RENTED $ 100,000 CLAIMS-MADE EJOOCUR MED EXP(Arty one person) $ 5,000 PERSO NA L&ADV INJURY $ 11000,000 GENERALAGGREGATE $ 'Z 000 000 GEN'LAGGREGATE LIMITAPPLIES PER PRODUCTS-COMP/OPAGG $ 1,000,000 POLICYFI PRO F LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT aaccidert $ ANYAUTO BODILY INJURY(Per person) $ ALLOWNED SCHEDULED BODILY INJURY Per accident $ AUTOS AUTOS ( ) NON-OWNED PROPERTY DAMAGE HIRED AUTOS _AUTOS aracoident $ UMBRELLA LIAR [_OCCUR EACH OCCURRENCE $ EXCESS UAB AB AGGREGATE $ DED RETENTION $ B MRKERS COMPENSATION 2E112068 3/30/14 3/30/15 WCSTATU- OTH- AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE I FR EL.EACHACgDENT $ 100 000 OFFICER/MEMBER EXCLUDED? NIA (Mandatory in NH) Ifyyes,describe E.L.DISEASE-EA EMPLOYEE $ 500,000 under DESCRIPTION OFOPERATIONS below EL.DISEASE-POLICYLIMff $ 100,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEUVERED W CD ROOFING ACCORDANCE WITH THE POLICY PROVISIONS. VINCENT COLANGELO 3 HODGSON ST. AUTHORIZED REPRESENTATIVE TEWKSBURY, MA 01876 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The AC ORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: VINCENTCOLANGELO@ SBCGLOBAL.NET l .__�_ .- -.—.-•a.-- �2e Q'�runw�ruaecc�t/a o����czclai��elt�� �. Office of Consumer Affairs&Business Regulation. ME IMPROVEMENT CONTRACTOR Type. I Wxegistrati 11on: 170575 piration: „ 11012015 DBA CD ROOFING t.' VINCENT COLANGELO 3 HODGSON ST "' TEWKSBURY,MA 01876 Undersecretary i logMassachusetts -Department of Public Safety Board of.Building Regulptions grid Standards f: Cun�trti ktiiyl Supervisor Speciali� . License: CSSL-105943 I IS VINCENT COLANGELO Cp --� 3 HODGSONSTREET ,. Tewksbury MA 01876 Expiration; Commissioner 03/09/2016'; Ike ComnionwoOk aft assaeiaasetts �e,�r�Y€a�entof.�nc����rcclAccic�e��� ' Office offAvestzgations 600 Wasftgton S'tteet .Boston,MA 02111 www.mass govIdia Wqr keTs,Com.pewation Inswance Af i'idaviit:BuRdersICoyt°actors/ElecfrexezanslPXii pex,o ppi:cant Wor�nation Please plain Legibly Name(Businesslorganization/XnWduaD . Address: City/S tatemp: S �c✓rn4 Phone t: 4 713 S�S`6"S C19 Z, .Are you an employer?Check the appropriate box: Type of project(required): I.Q T am a employer with 4. 91 am a general contractor and I 6• ❑New contraction employees(full and/or parttime)* havelairedthe sub-contractors 2.Q S am a sole proprietor or Partner- listed on the attached sheet.T 7. ❑P-emodeliug slop and'havena•employees These sub-contractors have S. E]Demolition working forme in.any capacity. workers'comp.insurance. 9• ❑Building addition IN'o workers'comp.insurance 5, ❑We axe a corporation and its ME]Electrical repairs or additions quired.I officers have exercised.their Ie3.[] am a homeowner doing all right of exemption per MCIL ll.[]Plumbingrepairs or additions myself LNO workers'comp. c.1.52,§1(4),andwehaveno 12.P Roofxepairs insmancere ed. employees.[No workers' comp.insurancerequired.] I3.[]Other � applicautthatchecks box#1 must also filloutthe sectionbelowshowingtheirworkers'compensaionpolicyinformation. Someowners wha submit this affidavit indicatingthey 9e doing ailworXand then iure outside contractors mustsubmit anew afddavitindicatingsuch. TContractors that cheAthis box must attached an additional sheet showingthe name of the sub-contractors and their workers'comp.policy marination. Icernareernployejthatis,providing-workersleomyeiisationitisurime,-forri2yerrWIoyees BeMegistliepalicyanc�j0 site information. Insurance y Com an Mame;_( Company Policy#or Selz ins.Bic.#: O (enn 84 Expiration Date: C /State4), � 't�O tx-l� lob Site Address-,— �� rA LIM , i t3' m •p� • .Attach,a copy of fte workers'camp ensatiowp olicy declaration page(shov&g.the policy mmber and expixatiou date). Failure to secure covexago.as xequiredunder Section 25.A ofMGL o.152 can lead to the imposition of criai alpenalties of a e t e as c' ' enables in the form.ofa STOP WORK ORDER and a fine fine up to$I,50O.00 and/or one-year iraprisoum n,as w 11 zvzl p of up to$250.00 a day against the viaZator. Be,advised that a copy ofthis statement maybe foxwarded to the Office o£ Investigations of the DIUoaiustax ca coverage verification. that tree in o mention rovidecl'abo a is true and correct, ai amid enarties o er' ri r v .�do Hereby cert, der tr p .� .fp .�� .l� ,P 8 s� Date: Phone#• L77S.— � B K7 Offl,eial use gnfy, vo not write in 61s area,to be coxgreted by city or toxin official: City or Town: Permit/License# Issuing Authority(circle one): 1.Board of health 2.BuildingXDepartment I City/Town Clerk 4.Electrical Inspector 5.PlumbingEmpector f.Other - - - Information and Instructions� Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees, Pursuant to this statute,an eq ployee is defined as`°..-every person in the service of another under any contract ofhixe,• express orimplied,oral orwritten." Atz eVlorye�is defined as"an.individnal,partnership,association,corporation or other legal entity,or any two Or More ofthe oxegoingengaged inajointenterprise, and including the,legal repxesentafivesofadeceasedem to ex.orthe TO ceiver OX tt�istee ofaa individual,partnership,ash elation or other legal entity,employing employees owevex the owner of a dwelling house having Wetmore than three apartments and who resides therein,or the occupant ofthe dwelling h.0use of another wh.o em los exsons to1 IL p*WO&on such dwelling h or orf the grounds or building appurtenant thereto shall notbecause of such employment be deemed to be an employexse MGL chapter 152,§25C(6)also states that"every state or local Heensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings zn-the commonwealth for any applicant who has not produced-acceptable evidence of compliance with.the insurance coveragerequired." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions sha11 enter into any contract for the performance ofpublic woxkuntzl acceptable evidence of compliance with the insurance requirements of this chapterhave beenpresented to the cQutracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checldng the boxes that apply to our situation and,if ziecessary,supplysub_confraetox(s)name(s),addresses)andphonenumber(s)along with their certificate(s)of insurance. LimitedUability'Companies(LLC)orLimitedLiabilitypartaerships(LLP)withno employees otherthanthe members orpartaers,arenotrequiredto canyworkers'compensationinsurame. if mLLC orLLP doeshave employees,apolicyis required. Be advisedthatthis affidavit maybe submitted to the Department of Industrial Accidents for coniixtnation of insurance coverage. Also be Me to sign and date the affidavit The affidavit should be returned to the city or town that the application for thepermit or license,is being requested,not the Department of IndustrialAcoldents. Shouldyou have any questions regarding the law or ifyou axe xequired to obtain ayPoxkexs' compensatlonpolicy,please call the Department atthe umber listedbelow. Self-Insured companies seuldenter their selfinsuranceh ce nse number on the appropriate line I City or Town Officials Please be luxe thatthe affidavit is complete andpxinted legibly. The Department has provided a space at the bottom ofthe affidavitforyouto fill outiuthe eventtha office Please be sure oflnvestigationshas ta contact you regarding the app]icant. to JM inthe permit/license numbex whichwill be used as a reference number. 7n addition,an applicant thatxnust submitmultiple permit/Iicouso applications is any givenyear,need only submit one affidavit indicating canrent policy information(ifnecessaty)and under"M Site Address"the applicant shouldwrite"all locations in (city or town)"A:copy otlie affidavit that has been ofixcially stamp ed ox marked by the city ox town may be provided to the applicant as Proof that a valid affidavit-is on file fox future p exmits or licenses. A nevi affxdavitxnust be filled out each year.Where a home owner or citizen is obtaining a license ox permit not related to any business or commercial venture (i.e.a doglicense orimmitto burn leaves etc.)saidperson is N'OTxequiredto complete this affidavit. The Office of luvest gatfons would line to thank you in advance for your cooperation and should you have any ctuestions, please do not;hesitate to give us a calf. The Department's address,telephone and fax number; Th Q 0P-W. dL o MTW.S.9a7,v&Pfte . .PVaxment QfZxtdu�Gxla1Acoldqt� . • t?f�cc o�'Tn.���cg�.-�Qxt� • 6,04 V1 Aington. re TO, 617.72',4900 W-�406 qx 1-87 Revised 5-26-05 Fad WWW— angQvIch'a