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HomeMy WebLinkAboutBuilding Permit #814-13 - 55 FOXWOOD DRIVE 5/29/2013Permit NO Date Issue BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received IMPORTANT: Applicant must complete all items on this page LOCATION `Print PROPERTY OWNER Print MAP NO: PARCEL: ZONING DISTRICT: Historic District ye no Machine Shop Village ve t no TYPE OF IMPROVEMENT PROP SED USE Res' ential Non- Residential ❑ New puilding YOne family ❑ Add' ion ❑ Two or more family ❑ Industrial ❑ AltQtation No. of units: ❑ Commercial .. air, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic. 0 Well ❑ Floodplain = -❑ Wetlands ❑ Watershed'District ❑ Water/Sewer - Identification Please Type or Print Clearly) OWNER: Name: /Cfl1Tr 4 /`tU1Zt> ./a- Phone: -% Address: $ , c4,v00 L7Vc4-L CONTRACTOR Name: Phone: 5� Address: µ a 1961 -Yo Supervisor's Construction License: { , Exp. Date: t r Home_ Improvement License: Exp: Date: .P 5`/9'7' I 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: $ /3 FEE: $ LO I .,bv Check No.: IC Receipt No.: NOTE: Persons contracting)lh unregistered contractors do not have access to the eu r r. 1 Permit NO: Date Issued: 21 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received TYPE OF IMPROVEMENT IMPORTANT: Applicant must complete all items on this page Residential s+ ❑ New Building ❑ Addition ❑ Alteration - ❑ One family ❑ Two or more family No. of units: ❑ Industrial ❑ Commercial • LO AST OON °,..�� .... t ® `Sept Well ' �"' ®�1Nater/Sewer,�o r . x r 1P, o � I 'PROPE TY OWNER ; '. ;. �, Print 100JYg' �jQId Structure _ r, , RC=EL'Z®NING ®ISTRICT..Hstoric'District yes yes, nom : i®ate�� F'iome Im rovement LI ense ino� TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ Addition ❑ Alteration - ❑ One family ❑ Two or more family No. of units: ❑ Industrial ❑ Commercial ❑ Repair, replacement ❑ Demolition ❑ Assessory Bldg ❑ Other ❑ Others: ® `Sept Well ' �"' ®�1Nater/Sewer,�o Floodplain ®IWetland - ®{Wat sed ®istrict `; - DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) OWNER: Name: Add ress: Phone: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE: BOLDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. 'total Project Cost: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund 'Signature of:Agent/Ower_:',,..,.,:_r_.a'. m,. :fitSig�ature of contractorw.,.-K. . �_ Plans Submitted- _ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans El t *C�ON�TRACT®RName�Phone Address' pF 1 ce Arm lsor"'s Con structon�YLinN�Exp i®ate�� F'iome Im rovement LI ense x Dated - ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE: BOLDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. 'total Project Cost: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund 'Signature of:Agent/Ower_:',,..,.,:_r_.a'. m,. :fitSig�ature of contractorw.,.-K. . �_ Plans Submitted- _ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans El t ;M -J. :�. ... mow- � T • .-Jt�^'� _. � "." .. . e"�'�� .. .. .. - t - Location V V No. 1 _ a Date . kep� 1 -J Check # 1 vJ 26446 TOWN OF NORTH ANDOVER, Certificate of Occupancy $ Building/Frame Permit Fee $ kal.bD Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Building Ind ector f I Plans Submitted ❑ f Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE.DISPOSAL Public Sewer ❑ Tanning/Massage/BodyArt ❑ .. ,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 PLANNING & DEVELOPMENT ❑ COMMENTS CONSERVATION COMMENTS HEALTH COMMENTS DATE APPROVED Reviewed on _ Signature Reviewed on Signature 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 f DPW Toiva! ]Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT -Te Dumpster on site yes no Located at -124 Main Street Fire Departmefit si O ture/date COMMENTS y 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 ® Notified for pickup - Date Doc.Building Permit Revised 2010 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 o 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 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 o 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 appy al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording roust be submitted with the building application Doc: Doc.Builkiing permit Revised 2012 NO ~D: W _.. 0 Q cu u u +' \ O LL vy Ln u O0 a)_ Ln 0 W N z Z J a7 C O m "O 7 LOL L � w C U LL 0 a Z Z m C. t to d' LL Q a Z U W L to3 O w uL i. N m LL WLL Z IA Q : cr LL WJ U w W 0 W w C .m z v {% " 0) 0 v O N V, _ I � O 2 r f1 �• .Q Cc it C' m CDM. a E c y 0 r S m CL CC. < NChCL_ � J i S CD w c CDN o o r c _-C t O o o CL 0) — c c m �. A a� . c > H tO Lo ED0 = = c QC'. cv -v .o �. F- o 2 rn pip a) � t W = w O O v �� ,� O Z LLI w1- — �, -W W .L- v ami — = H • V 41 O-0 y: Q �i N �n .0 •p Lo p F�CL t CL 0o > 4 cn 2 z z w w CL W H W a. O W :a U) Z 0 in co Q O U O U N J v v O 9 i E pe. O O d z N Co C a � Q � U) .EGOOm ao� c o� _ccCL O �Q O v_ J O �0-O =z V N CL U) LLI cl U) W 19W W 19 W CA it fAZ7 r Z r L1 LU = LL Q m tav+ a+ o LL `?r, u O. U) a N z z m v 7 LL s N t4 W >. c E U '° LL D F - a z z d s j w co LL O a Z J v mr LU w s 7 O_' u N _ LL � LLI N Z tw w _ LL z m Q a LU 0 uimLn LL .m z ( j +-' _ p O (n _ O cc o _ V m L a �+ _ O CL ca y ca m � E v. O rIf CL M o N J L: L m �� S: > _ Cc L c=U)m O _ °' o U) - o = `•:boa as z CL c O o > O = o� IL �• _ • m 0 •N (`� C CY) v O r _ \ a L cc 2 Q �- 1— O to C0 w O m W_ _ M— O O N rn Lu umlE 0 CDC L CL U) > '� c = O O L. = O CL OV Z m CDZ cnW w CL w H W CL O W U) Z CO H Q c O U CO O U U J M v v O w ti f 'D W W 19 W U) The Commonwealth of Massachusetts Department oflndustriglAccidents Office of Investigations 600 Washington Street Boston, MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/ElectriciansfPlwmbers Applicant Information Please Print Legibly Name (Business/Organization/lndividual): SVZ— Ul 2C -a.L t� Q?pp�_ C M4;Kr � ITTt tS7V �C.�1 T,�z bY Address: awl -oF^RK-5 5-t City/State/Zip: Lu vwt_ ryAA v ( -b';-q Phone #: ec `6 5� -_q6c�,/ Are you an employer? Check he appropriate box: Type of project (required): 1. � employer with 4. ❑ I am a general contractor and I 6. ❑ New construction employees (full and/or part-time) * 2. ❑ I am a sole proprietor or partner- have hiredthe sub -contractors listed on the attached sheet. 7• ❑Remodeling ship and'have no employees These sub -contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. g, D Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its 10.E] Electrical repairs or additions required.] 3. ❑ I am a homeowner doing all work officers have exercised their right of exemption per MGL 1 LE] Plumbing repairs or additions myself. [No workers' comp. c.152, § 1(4), and we have no 12, E�Reof repairs insurance required.] i employees. [No workers' 13.1] Other comp. insurance required.] '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 Ere 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. lam an employer that 1s providing workers' compensation insurance for my ,employees. Below is the policy and job site information. Insurance Company Policy # or Self -ins. Lie. #: QA-- ab - DO o 16? `ZS - U 1 _ _ Expiration Job Site Address: `7 iCn-�.�tNz�e�y'7 City/State/Zip: N • ny�2�'1Tz Attach a copy of the workers' compensation -policy tleclaration page (showing the policy number and expiration dote). Failure to secure coverage as requiredunder 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. X do herebyrtafv under i ON00 that Official use only. Do not write in this area, to be completed by city or town official true and correct. 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 InstructRon­8 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 ofhire, 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 employee, 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 ofpublic 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 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. Anew 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 NOTrequired 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 Cor- monwoalfli of Massachusetts Dop.afteut of fadusttia.1 Accidents offi`ice of Iayestigati<o.ns 604 Washiugto>a Stxeet Boston} MA. 02111 TQL # 617-72,.7-4900 ext 406 or X-S77�11�'.ASS.A.F,, Revised 5-26-05 Fax 4 6X7"727-7 749 AcoRo®CERTIFICATE OF LIABILITY INSURANCE ° 04/10/20 YYY'. 04/10/2013 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 - G.B. NICKERSON INSURANCE AGENCY 321 BOSTON POST ROAD, SUITE 4C MILL BROOK II SUDBURY, MA. 01776 CONTACT NAME: PHONE978-443-3332 FAX AIC,No): 978-443-7527 E-MAIL PRODUCER CUSTOMER 10 INSURERS AFFORDING COVERAGE NAIC# INSURED PAUL J. TRISCHITTA JR. DBA CONSTITUTION CONTRACTING 231 SPARKS STREET LOW ELL, MA 01854 INSURER A: WESTERN WORLD INSURANCE CO INSURER B: ACADIA INSURANCE COMPANY INSURER C: INSURER D: INSURER E: INSURER F: L1UVtKAL3tS-GFNTIFICATF NIIMRFR- 17FVICIfIN NIIMCCD. - 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 ADDLSUBR POLICY NUMBER POLICY EFF MMI IYY POLICY EXP MM/DD/YY Y LIMITS - A GENERALLIABILITY NPP8081998 08/04/12 08/04/13 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL &ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ - 1,,000,000- - _ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -.COMP/OP AGG $ -1 0001000 - POLICY 7 PRO LOC $ - AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT $ - (Ea accident) - BODILY INJURY (Per person) $ _ - ALL OWNED AUTOS - BODILY INJURY (Per accident) $ - SCHEDULED AUTOS HIRED AUTOS _ PROPERTY DAMAGE $ (Per accident) $ NON -OWNED AUTOS $ UMBRELLA LIAB HCLAIMS-MADE OCCUR - EACH OCCURRENCE $ EXCESS LIAR AGGREGATE $ DEDUCTIBLE $ $ - RETENTION $ B WORKERS COMPENSATION ANDEMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVEE.L. OFFICER/MEMBER EXCLUDED? F—] N / A WC -20-20-001678-0411/8/12 - 11/8/13 X WC STATU- OTH- - EACH ACCIDENT $ 100,000 E.L. DISEASE - EA EMPLOYEE. $ 100,000 (Mandatory In NH) If yes, describe under E.L. DISEASE - POLICY LIMIT $- 500,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I. LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) - - - VAIV I.CLLA I IVIV - KEYSTONE DEVELOPEMENT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 910 BOSTON POST RD ACCORDANCE WITH THE POLICY PROVISIONS. MARLBORO, MA 01752 AUTHORIZED REPRESENTATIVE MIKESAITI anKEYSTONEDEV NET A It V I WOO-LIJUy At3UKU GUKFUKATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and loco are reaistered marks of ACORD Massachusetts --Department of Public Safety y Board of Building. Regulations and Standards Ci mstructian SuperN icor Specialt•' License: CSSL-101112 PAUL) TRIS TA-_ 231 SPARKS-STREET z LOWELL * 01854 -1i � Commissioner 01/08/2014 i L/ � �4i77A7?.Oil2LU6lXA.(.fL 0��/�OCi,GiL�bE�b �. Office of Consumer Affairs & Business Regulation DOME IMPROVEMENT CONTRACTOR- egistration: 1.51273 Type:, xpiration 5/26%2Q14; DBA CONSTITUTION CONTRACTING- . PAUL TRISCHITTA' 231 SPARKS ST. LOWELL, MA 01854 -' Undersecretary HIC 151273 CSSL101112 5/24/13 Professional Roofing Services ROOF REPLACEMENT CONTRACT FOR RANDY MURDZA, 55 FOXWOOD DR. NORTH ANDOVER, MA: 1. Present owner with all permits for work to be performed 2. Tear off and de -nail existing roof down to bare wood, hanging heavy duty mesh tarps from eaves of roof to protect house, yard and plantings from debris 3. Clean all debris on a daily basis into onsite dumpster to be removed at completion of project 4. Inspect all wood roof sheathing, re -fasten any loose wood and replace any damaged or rotting wood at no additional cost up to 100 sq. feet ( Additional wood replaced at $52 per sheet or $5 per linear foot) 5. Install GAF Stormguard ice and water shield 6' up from eaves of roof, in all valleys, around all chimneys, skylights and pipes, on all low sloped sections and against all side and vertical walls 6. Install GAF Deckarmor, premium, breathable underlayment to remainder of roof 7. Install 8" aluminum drip edge flashing to perimeter of roof 8. Install GAF Prostart starter strip shingles to perimeter of roof 9. Install GAF Timberline HD, lifetime shingles to roof using six 1 %" round head, galvanized roofing Nails per shingle for 130 MPH wind coverage (Charcoal) 10. Cut 13/4" gap on each side of main ridge beam 11. Install GAF Snowcountry, externally baffled ridge vent continuously to roof ridge 12. Cover all hips and ridges with matching GAF enhanced hip and ridge cap shingles 13. Replace flashing around all pipes, vents and skylights 14. Replace flashing around all chimneys ( aluminum step flashing and lead counter flashing ) 15. Replace flashing at side and vertical walls as needed 16. All workmanship guaranteed 10 years 17. Includes GAF Systems Plus Weather Stopper Warranty ( 50 year non prorated coverage on entire roof system ) TOTAL COST OF INVESTMENT. $13,897 PAYMENT DUPNZILL.UPON COMPLETION OF PROJECT 14.3 231 Sparks St. • Lowell, MA 01854 • 978-502-9601 Fax: 978-453-5989 • paul@constitutioncontracting.com