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HomeMy WebLinkAboutBuilding Permit #239-2017 - 55 LYMAN ROAD 9/7/2016 i� S p10RTN w- 0�,.(iED F6 qfY� 16 TOWN OF NORTH ANDOVER 32 hey:'. o APPLICATION FOR PLAN EXAMINATION ` 70 CDC . K 1 Permit No#: Date Received �fyssq2;9 �HUs��(`� Date Issued: l0 1 IMPORTANT: Applicant must complete all items on this page LOCATION Print PROPERTY OWNER Ca. v etl fi Print 100 ear Structure yes no MAP -�Z"/ PARCEL: Q�ZONING DISTRICT: Historic District ye no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial VAlteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑:Well ❑ Floodplain [],WetlandsWatershed.,District D.Water/Sewer _ DESCRIPTION OF WORK TO BE PERFORMED: , C ,f"�c„ '�, S �4 �r` rcJt�v»S Identification- Please Type or Print Clearly OWNER: Name:�a ,�c��1�;p �f- Phone: Address: -- • Contractor Name: Ac-bro rn JGc�f' �O Phone- G 0 (2 -? Email: c,en ti ' Address: Supervisor's Construction License: Exp. Date: 48 Home Improvement License: /S'3 �J � Exp. Date: ARCHITECT/ENGINEER lVor Mp.-v� Sc. Qg Phone: 603 - *10 - AQ �„k�� t7es-r9✓I Address: h�0 [B nx �30 5���•� �/ 4307 _Reg. No. 3eti0 FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $1Jro--JW0o�'' 0 FEE: $ - &4 Check No.: LW5 Receipt No.:3� NOTE: Persons contracting with registered ontractors do not have access to th guaranty f d 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 � g g OTE: 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/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 OTE: 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 2012 I ECC Energy code Engineering Affidavits for Engineered products OTE: 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 Doe:Building Permit Revised 2014 a 1 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL, Public Sewer Tanuing/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank, etc. ❑ Pennanent Dmnpster on Site ❑ THE FOLLOWING SECTIONS FOR-OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF m U FORM PLANNING & DEVELOPMENT Reviewed Ong & Signature_ a_5t,__k_ COMMENTS 'v CONSERVATION Reviewed on_ Signature a COMMENTS HEALTH Reviewed on Signature COMMENTS f/y-) C> Ap_2 T. 4 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 Permif DPW Town Engineer: Signature: ocated84 Osgood 3 O od Street *FIRE DEPARTQf 11 fTemp D'u_mpster,ori site eyes ;y no ! Lcatgat'%2,4 t t Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: I ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector yes Ido 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 Penroit Revised 2014 Location r _ No. Date Date j1r r • - TOWN OF NORTH ANDOVER �Y Certificate of Occupancy 4 Building/Frame Permit Fee $ �- Foundation Permit Fee $ Other Permit Fee �- TOTAL $ Check Building Inspector / U 4 4 Enter construction cost for fee cal - North Andover Fee Cakulatlon Construction Cost 52,000.00 m $ - $ 624.00 Plumbing Fee $ 78.00 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 78.00 Total fees collected $ 880.00 55L man Road 239-2017 on 9/7/16 Dormer to rear of house, expand bedrooms add bathroom r 1 NORTH - O `1, ` •� No. h ver, Mass, coc.ucNew�c.. v1• GATED PPa��S U BOARD OF HEALTH Food/Kitchen PERNSeptic System THIS CERTIFIES THAT .............. . :r.... ...IT .... .1 C ,�,,,L' '�„ LD....................... BUILDING INSPECTOR Foundation has permission to erect ............... .......... buildings on ... ...�.. !!�....................................... Rough to be occupied as . .. . 1��qW..capoic..... . . .�.. v.. 5.....�...... Chimney provided that the person accepting this permit shall in every respect confZfim to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws re ti g o th sectio Alteration and Construction of Buildings in the Town of North Andover. � qi PLUMBING INSPECTOR Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONS TIO T Rough Service ... ... ..... .............. .... .......... Final BUILDIN INS CTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz 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. 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 Dmmpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE VSE ONLY INTERDEPARTMENTAL SIGN OFF m U FORM PLANNING & DEVELOPMENT Reviewed On(j -1 � ��D Signature_ COMMENTS-L CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board,ofAppeals:Variance, Petition No: Zoning Decision/receipt submitted yes i Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Signature& Date ` n DriveWaV Permif DPW Town Engineer: Signature: ocated 384 Osgood Street 1FIRE,DEPARTMENT}Y= Tem'° . rk t.� g Locate915t 1. 4 Main Str e ' +r: pr'°� ,.IF;,i Department si(ynature/dafe_ . f i ..... COMMENTS. ./fly ANIS P-A Capachiett proposal 5/19/16 Rear Dormer Parties Aaron M. Scarpello Home Improvements, LLC the "Contractor" Full Identification, The TAX ID of principal is 20-3306885 Contractor address: 2 Magnolia Ave Salem NH, 03079 The Contractor's Massachusetts HIC registration number is 153859 The Contractor's Massachusetts Construction Supervisor's number is CSFA-096462 The Contractor hereby proposes to perform the work described below for: Capachiett Family located at 55 Lyman Rd. North Andover, Massachusetts. 1. The Rear Dormer project at 55 Lyman Rd. North Andover, Massachusetts Address, consisting of the following: The said parties, for the considerations hereinafter mentioned, hereby agree to the following: o Addition to be built in rear of current residence ■ Approximate floor space 32'x 20' (dimensions to be confirmed prior to signing contracts) ■ Use of additional space is to create an additional bedroom and attached full bathroom. o Work to be done: ■ Beam sizing and plans • If an engineer's stamp/approval is required, the engineers fee will be extra ■ Permits ■ Preparation to 2ND level of existing structure for new addition: ■ Stripping away of any roofing or siding that may interfere with placement of new structure ■ Demolition of existing interior walls, flooring etc. ■ Excavation and footings: • None required ■ Framing • All framing lumber will meet or exceed current code requirements (see plans) ■ Insulation • Rolled fiberglass to all wall floor and ceiling cavities as is required by Massachusetts code and any interpretation by North Andover officials. (see plans) o Roofing ■ Rolled rubber roofing in the rear 2°°level of the home. Asphalt architectural shingles in the front, rear breezeway and garage ■ Ridge vent and/or other types of non-mechanical roof venting added where possible. • Maximum cost of additional vents and installation $250.00 1Page dL. - 6I I' o Any additional electrical work not required to satisfy building code for the receptacles and fixtures added for the addition o Any additional plumbing work not required to satisfy building code for the plumbing fixtures added for the addition 1. Any additional costs will be built to the homeowner at my costs plus ten percent. (note: my labor is built out at$50.00/ hour per man) • Construction and Jobsite Details: o Existing lawn &driveway may suffer some damage due to construction trucking; every attempt is made to minimize the damage, however the homeowner shall not hold the contractors liable for the extra cost if damage situations appear. o Any unforeseen discoveries that may affect the construction costs are they responsibilities of the homeowner. For example: asbestos, mold, ledge, high water table etc. 1. Any additional costs will be built to the homeowner at my costs plus ten percent. (note: my labor is built out at$50.00/ hour per man) • Reference to incorporated documents: o Full drawings to be supplied after contract is signed but at least 2 weeks prior to start date. • More fully described in the sketch/plan attached, prepared by TBD and dated TBD and by the attached list of specifications of even date, both incorporated by reference. Estimated Price$52,500.00 SUBJECT TO CHANGE IF WORK IS MODIFIED AND AGREED CHANGES ARE SIGNED BY BOTH PARTIES 2. Payment Schedule The Owner hereby agrees to pay the Contractor, for the aforesaid materials and labor, the estimated sum of$52,500.00 in the following manner: . •$5000.00 down payment and materials expensesenses CV, 142- -$15000.00 start date •$10000.00 upon completion of all rough framing •$10000.00 upon completion of roofing and siding •$10000.00 upon completion of wall board, insulation, rough plumbing, rough electric, •$ Remainder upon completion of project Payments for extra work done will be paid with the next scheduled payment. (example- extra work is required to repair rot in the floor framing $100.00 due at the start date) Finish Materials approx. $(This amount is subject to change based on actual choices of finished materials made by the homeowner) 100%due at time of order(finished materials will be ordered and purchased at various times during the duration of the job) 3T' age Some finished materials may not be able to be returned or cancelled once the order is placed and some may be subject to a 20% restocking fee. These charges will be the responsibility of the homeowner if it is the homeowner requests the exchange or return. 3.This remodel is scheduled to begin Fall 2016, both parties understand that an exact start date or completion date cannot be determined at this time because the contractor has several jobs ahead of the Capachiett project. 4. The Contractor agrees to provide and pay for all materials,tools and equipment required for the prosecution and timely completion of the work. Unless otherwise specified All materials shall be new and of good quality. There is a one year warranty on materials and craftsmanship, if manufactures warranty does not apply. 5. In the prosecution of the work,the Contractor shall employ a sufficient number of workers skilled in their trades to suitably perform the work. 6.All changes and deviations in the work ordered by the Owner should be presented to the Contractor, by the homeowner in writing, the contract sum being increased or decreased accordingly by the Contractor. 7.The Owner, Owner's representative and public authorities shall at all times have access to the work. 8. Construction and Jobsite Details: Existing lawn&driveway may suffer some damage due to construction trucking; every attempt is made to minimize the damage, however the homeowner shall not hold the contractors liable for the extra cost if damage situations appear. Any unforeseen discoveries that may affect the construction costs are they responsibilities of the homeowner. For example: asbestos, mold, ledge, high water table etc. 9. In the event the Contractor is delayed in the prosecution of the work by acts of God,fire,flood or any other unavoidable casualties; or by labor strikes, late delivery of materials; or by neglect of the Owner;the time for completion of the work shall be extended for the same period as the delay occasioned by any of the aforementioned causes. 10.The Contractor agrees to obtain insurance to protect himself, his workers and subcontractors against claims for property damage, bodily injury or death due to his performance of this agreement. 11.This agreement shall be interpreted under laws of the State of Massachusetts. 12.Attorney's fees and court costs shall be paid by the defendant in the event that judgment must be,and is, obtained to enforce this agreement or any breach thereof. 13. Insurance: Liability Insurance certificate available upon request. 14. NOTICE to Homeowner:All contractors must be registered and display the contractor's registration number.You have the right to rescind this contract within three days of signing.The Home Improvement Contractor Regulation Statute, M.G.L.A. c. 142A gives you certain warranties and homeowner's rights under the act. In the event of a dispute,your or the contractor have the right to request non-binding arbitration. NOTICE: DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. IN WITNESS WHEREOF,the parties hereto set their hands and seals the day and year written above. OWNER'S NAMEE ' S NATURE DATE 41Pagc OWNER'S NAME OWNER'S SIGNATURE DATE OWNER'S ADDRESS _Aaron ScarP ello ��6 CONTRACTOR'S NAME CONTRACTOR'S SIGNATURE DATE 2 Magnolia Ave Salem ,NH 03079 CONTRACTOR'S ADDRESS 51Fage ®BolasOncade Triple 1-314" x 16" VERSA-LAM@ 2.0 3100 SP Roof Beam1RB01 BC GALC®Design ReportCm Dry 2 spans I No cantilevers 0/12 slope August 22,2016 08:28:20 Build 4516 File Name: Capuchietti.bcc Job Name: Capuchietti Description:Designs1RB01 Address: 55 Lyman Rd Specifier: City,State,Zip:N.Andover,MA Designer: Kimberly Hankey Customer: Company: Cyr Lumber Co.,39 Rockingham Rd,Windham,NH Code reports: ESR-1040 Misc: Q° 12 1 21-0400 13-00-00 BO 81 B2 Total Horizontal Product Length-34-04-00 Reaction Summary(Down/Uplift) (Ibe) Bearing_ Live Dead Snow Wlnd Roof Live B0,3-1/2' 1,119/45 2,363/0 6,034/0 B1,11" 2,727/0 5,996/0 15,000/0 B2,3-1/2" 737/333 888/0 3,136/0 Live Dead Snow Wind Roof Live Trib. Load Summary Tag Description Load Type Ref. Start End 100% 90% 115% 150% 125% 1 cathedral ceiling&r... Unf.Area(lb/ft^2) L 00-00-00 3404-00 10 20 55 12-03-00 Controls Summary value %Allowable Duration Case Location Pos.Moment 35,481 ft-lbs 55% 115% 10 08-11-04 Neg.Moment -39,958 ft4bs 620/6 115% 12 21-04-00 Neg.Moment -39,958 ft-lbs 62% 115% 12 21-04-00 End Shear 6,864 lbs 37.40/a 115% 10 01-07-08 Cont.Shear 10,155 lbs 55.3% 115% 12 19-06-08 Total Load Defl. U372(0.68") 64.5% n/a 10 09-11-10 Live Load Defl. U511 (0.496") 70.5% n/a 25 09-11-10 Total Neg.Defl. U999(-0.093") n/a n/a 10 25-07-07 Max Deft. 0.68" 68% n/a 10 09-11-10 Span/Depth 15.8 n/a n/a 0 00-00-00 %Allow %Allow Bearing Supports Dim.(L x M Value Support Member Material BO Post 3-1/2"x 5-1/4" 8,397 lbs n/a 60.9% Unspecified B1 Post 11"x 5-1/4" 20,996 lbs n/a 48.5% Unspecified B2 Post 3-1/2"x 5-1/4" 4,024 lbs n/a 29.2% Unspecified Cautions For roof members with slope(1/4)/12 or less final design must ensure that ponding instability 1 will not occur. For roof members with slope(1/2)112 or less final design must account for Rain-on-Snow surcharge load. Notes CH N � No.30044 0 X040 �Q#OTC, 1 , 4 nnF�� ' Page 1 of 2 ®SolseCascade Triple 1-3/4" x 16" VERSA-LAM®2.0 3100 SP Roof Beam\111301 BC CALCI Design Report Dry 12 spans I No cantilevers 10/12 slope August 22,2016 08:28:20 Build 4516 File Name: Capuchietti.bcc Job Name: Capuchietti Description:Designs\RB01 Address: 55 Lyman Rd Specifier: City,State,Zip:N.Andover,MA Designer: Kimberly Hankey Customer: Company: Cyr Lumber Co.,39 Rockingham Rd,Windham,NH Code reports: ESR-1040 Misc: Design meets User specified(U240)Total load deflection criteria. Disclosure Design meets User specified(U360)Live load deflection criteria. Completeness and accuracy of input must Design meets arbitrary(1")Maximum total load deflection criteria. be verified by anyone who would rely on Calculations assume Member is Fully Braced. output as evidence of suitability for particular application.Output here based Design based on Dry Service Condition, on building code-accepted design Deflections less than 1/8"were ignored in the results. properties and analysis methods. Fastener Manufacturer:Simpson Strong-Tie,Inc. Installation of Boise Cascade engineered wood products must be In accordance with current Installation Guide and applicable User Notes building codes.To obtain Installation Guide CC064SDS2.5 COLUMN CAP BEARING 131 or ask questions,please call (800)232-0788 before installation. BC CALCO,BC FRAMERS,AJS-, Connection Diagram ALUOIST®,BC RIM BOARDTm,BCIS, �{ b d BOISE GLULAM-,SIMPLE FRAMING LI SYSTEMS,VERSA-LAM®,VERSA-RIM a PLUS®,VERSA-RIMG, c VERSA-STRANDS,VERSA-STUDS are trademarks of Boise Cascade Wood Products L.L.C. a minimum=1-1/2"c=6-1/2" b minimum=6" d=12" e minimum=1" Calculated Side Load=1,041.3 Ib/ft Install Screws with screw heads in the loaded ply. Connectors are:SDW22600 i I t� The Commonwealth of.Mass�chusetts z.. .Depaxt eent of XndastrialAccidents -- _ 1 Congress Sheet,Suite 100 J#d .goston,MA 02114-2017 WWW- iasssgov/dia Parkers'CompensationlnsuranceAffidavit:Builders/Contractors/EleetriciamTI-Rmbers. TO BE Wl:IffTEE pER11dXTTJTTG•AUTR012T1.'Y. Applicant 7nfoxination . Please Print Le�zb� Name,qSa ess/Organizationllndividual): Ael/1o✓1 Y'l n�c J f G ���//C7 ✓17� .-+�—✓►��/J� �jCa�/s�. Ad&ess: -Phone Areyou an employer? Checkfe appropriate box: Type of project(xegrdrec rm�a:olcpropii-tc):�orpaTtaBrSMP mployerv&h ! employees(fffiandlorpart-fine).* 7.• QNeW corisiniction andhaveno employees Working forme in 8. []Remodelltig any capacity.[No workers'Comp.insurance required.] 9, ❑Demolition 3.❑I am a homeowner doing all work myself INo workers'comp.insurance required.]t 10�;'�g addition 4.E]I am a hom .Teowneand will.be hiring contractors to conduct all work on my property. I VM LI ensure an contactors either have workers'compensation insurance or are sole 11:�]ElEleectrical repairs or.additions that proprietors wino employees. 12:0 Plumbing repairs or additions 5.❑I am a general contactor and Ihage hired the sub-contractors listed on the attached sheet. 13: ]Roof repairs These sub contactorshave en�koyees andhaveworkers'comp.insurancO 14.E]Other 6.n We.are acorporada pad ifs officers have exereised.theii right of exemption perMGT c. 152,§1(4),andwefiaveno.einployees.jNoworkers,comp.insmanceregmredj Any applicantthat checksbox41 must also fU outthe seetionbelow showiugtherworkers'compensationpolicyinfonnaiion T 13omeowners wh,sH9ii#ff affidavitindicatrugthey are doing allworkandthenhire outside contractors mustsiibmit anew affidavr'tindicatmg SW ?Contractors_that checktlus box mast.4p!bsd an additional sheet showing the name of the sub-contractors and state whether ornotthose entities have employees. Ifthe sub-con3rac(Ors trove employees,&y must provide their workers'Comp.policy number. I abn an erriployer fiz at a Tjoviaingworkers'cornpenEation hzsurance for MYernylayees'BeloV is the pokey and site infor7natian. Insurance Company Name: policy or Self-ins.Ila.#: Expiration Date: // lob Site Addxess: City/State/Zip: A alo c� Attach a copy of the workers' comensationpolicydeclarationpage(showingtbepolicynumbexandexpirationdate). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a tine 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 fma of up to$250.00 a day against the-violator.A,copy of this statement may be forwarded to the Office of Investigations of the DIA for inmrance coverage verification._ I do hereby cer u�d pains and penalties ofpeijitry tlzat the information provided above is fie and correct ify S7mature pp Date: Phone# Official z se only. Do not-write in this area,to he completed by city or torwn official. City or Town: PermibUcense# Issuing Authority(circle one): i I.Board of Healtya 2.BuildingDepartment 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 bf hire, express or implied,oral or written" An employer is defined as"an iridividugl,partnersbip,asso ciation,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enf6xpri.se,and including the legal representatives of a deceased employer,or the receiver-or trustee of au 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 b 6 deemed to be au.employer." MGL chapter 152,§25C(6)also states that"every state or local licemsiug agency shall withhold the issuance or renewal of a license orpermit to operate a business or to construct buildings in the commonwealth for any applicant who lias not produced acceptable evidence of compliance with the iusurance coverage r*equired." 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 ofthis chapter have been presented to the contracting authority." Applicants PIe-as a fil1'out-the workers' compensation affidavit completely,by checking=he boxes that apply to your situation and,if necessary,supply sub=contractoi(s)name(s),addresses)and•phone mumber(s)along with their certificates)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)withno employees'olherthan 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-Industrrial Accidents foi:con-9mmation ofinsurance 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 ox if yotn'are xequixed to obtain a workers' compensation policy,please call the Department at the number listed below. self-insur6d companies should'enter their self-insurazice license number on the appropriate line. City or Town.Officials Please be sure that the a£f'idavitis 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 areference number. la 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"lob 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 maybe provided to the applicant as proof that a valid affidavit is on file fox 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 NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth.of Massachusetts - Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,Na 02114-2017 TeL# 617-727-4900 exE.7406 or 1-877--MAS8AFE Fax#617•-7277749 Revised 02-23-15 www.mass.gov/dia 09-07—'16 07:48 FROM- 9785572130 T-302 P0002/0.003 F-296 � aD/YYYY) TE(MMr '--- CERTIFICATE OF LIABILITY INSURANCE DATE 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 endorsemen s. PRODUCER GO NTA GT Mark S.Rowe,CIC 1 Michaud,Rowe And Ruscak Ins. PHONE 978 888 8829 ' P.O.Box 188 A/c No: 978 557 2130 North Andover,MA 01845 ADDRESS: Mark S.Row®,CIC INSURERS AFFORDING COVERAGE I NAIC 8 INSURERA:Essex Insurance Company 39020 INSURED Aaron Scarpello Home Imp,LLC INSURERB: 1 2 Magnolia Ave. INSURERC: 1 Salem,NH 03079 1 INSURERD: 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. 1 LTR TYPE OF INSURANCE OC POLICY NUIa9ER MM/DO MM/D Y ExP LIMITS A X COMMERCUU GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS-MADE T OCCUR 3EC8512 12/10/2015 12/10/2016 DAMAGE IBES EaoecurD 1 $ 100,00 MED Q(P Wj one person) S 5,00 PERSONAL&ADVINJURYI $ 11000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 1 $ 2,000,00 X POLICY PRO- LOC JECT PRODUCTS-COMP/OP AGI;G $ 1,000,00 OTHER I S AUYOMOBILE LIABILITY COMBINED SINGLE LIMIT i $ ccident 9 ANY AUTO BODILY INJURY(Per persor� $ ALL AUTOS OWNED AU70SULED BODILY INJURY(Pergccdeitt) $ NON-OWNED P11OFEffTYDAMAGE I HIRED AUTOS AUTOS Per acodem 1 $ 1 $ UMBRELLA LIAR OCCUR EACH OCCURRENCE I $ EXCESS LIAB CLAIMS-MADE AGGREGATE � $ DEDRETENTION$ S WORKERS COMPENSATION X POTFI� AND EMPLOYERS LIABILITY Y/N STATUTE ER 4 B ANY-PROPaiETORIPARTNER/EXECUTIVE 'SWC CERT TO COME E.L.EACH ACCIDENT OFFICEFWEMBER EXCLUDED? F7N/A I $ (Mandatory in NN) DIRECTLY FROM INS CARRIER E.L DISEASE-EA EMPLOY S IF yes,describe undo DESCRIPTION OF OPERATIONS below E.L.DISEASE-110,-CyLIMIT $ DESCRt"ON OF OPERATIONS/LOCATIONS/VEMCLES(ACORD 101,Additional Remarks Scneduie,May be aitaehed It more space is requiroM nte Nor carpentry and residential remodeling ZE: 55 Lyman Road North Andover, MA 01846 1 a CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL; BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood Street North Andover,MA 01845 AUTHORIZED REPRESENTATIVE 01988-2014 ACORD CORPORATION. All rights reserved. 4CORD 25(2014101) The ACORD name and logo are registered marks ofACORD 09-07--'16 07:49 FROM- 9785572130 T-302 P0003/0003 F-296 ACORb® J DATE(MM/DD/YYY1) �� CERTIFICATE OF LIABILITY INSURANCE 08/07/2016 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 REPRFSENTAnVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the poliey(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 NONV CT Krista McMahon AX MICHAUD, ROWE AND RUSCAK INSURANCE ASSOCIATES, INC. PHONE (978)'6884829 Fa/C ao E-MAIL v I DD Ess: kmCmdhon mninsurance.0om 9 P.O.BOX 188 INSURER(S)AFFORDING COVERAGE j NAIC N NORTH ANDOVER MA 01845 INSURERA: LIBERTY MUTUAL FIRE INS CO 23035 INSURED INSURER B: AARON SCARPELLO HOME IMP LLC INSURERC: INSURER D: 2 MAGNOLIA AVE INSURER E: SALEM NH 03079 1 INSURER F: COVERAGES CERTIFICATE NUMBER' 82653 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. INTR TYPE OFINSURANCE ADDLSUBR POUCYNUMBFR MM1LEFFDD Pip EXP UMM COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS.MADE OCCUR DAMA ET RENT PREMtSr nce $ MED qCP qn one pen3on)� $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY❑JET F]LOC PRODUCTS-COMP/OP AGG $ OTHER: I 1 $ AUTOMOBILE LIABILITY COMBINED SI G L MITI $ Ea accident d ANY AUTO BODILY INJURY(Per person) $ ALL OWNEDSCHEDULED AUTOS AUTOS ) N/A BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTYDAMAGE $ AUTOS Per accident I a Is UMBRFILAUAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE N/A AGGREGATE $ DED RErENION$ Ty� $ WORKERS COMPENSATION X STATUTE E 1 AND EMPLOYERS'LIABILITY Y I N ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100.000 A OFFICEWMEMBEREXCLUDED? N/A N/A N/A WC231S380493026 04/19/2016 04/19/2017 (Mandatory in NH) E.L.DISEASE•EA EMPLOYE $ 100,000 If be under DESCRIPTION OF OPERATIONS below E•l-DISEASE-POLICY LIMIT $ 500,000 N/A DMORIPT11ON OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,nW be attached if more space Is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those ernployees outside of Massa lchusetts- This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage Can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/twdfworkers-componsationfinvestigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE cANCELLt U BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood Street AUTHORREDREPR6SBNTATIVE { North Andover MA 01845 Daniel M.Cr y,CPCU,Vice President—Residual Market—WGRISMA ©1988.2014 ACORD CORPORATIO'. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD W V) 0 zt, r j W U' s 00 o 12 1 12 Q z a8 �- o LLull I I -:I-, aaaa = EXISTING EXISTING U ::2ii o aooa EXISTING Q � Q F Ln . aooa NEW RIGHT VIEW � THESE PLANS ARE DIAGRAMATICAL ONLY DATE: 8/22/16 ALL CONSTRUCTION PRACTICES TO FOLLOW IRC 2009 THIS PLAN DOES NOT COVER ALL ASPECTS OF BUILDING THIS BUILDING THE GENERAL CONTRACTOR IS RESPONSIBLE FOR VERIFYING ALL BUILDING CODES AND MEMBER SIZING 1/4"SCALE THE GENERAL CONTRACTOR SHALL RESEARCH ZONING AND SITE LIMITATIONS PRIOR TO START OF CONSTRUCTION ALL DIMENSIONS TO BE FIELD VERIFIED AND CHANGES MADE ACCORDINGLY THE GENERAL CONTRACTOR(OR PURCHASER OF PLANS IF NO G.C.)ASSUMES FULL RESPONSIBILITY FOR USE OF THIS PLAN OR ANY PART THERE OF LAJ0 cn cc z 0 v� w o IF NECESSARY o0 RAISE CHIMNEY .�..� 12 c 1 ■� CRICKET a �. 12 Q8+/ R ICE&WATER SHIELD MIN. 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11 LAJ J r � NEW PLY 16" LVL BAD TO I I TING RIDGE C11 I ISI L �-J LLJ Q Ln Q U z ROOF EXISTING RAFTERS > FRAMING THESE PLANS ARE DIAGRAMATICAL ONLY DATE: 8/22/16 ALL CONSTRUCTION PRACTICES TO FOLLOW IRC 2009 THIS PLAN DOES NOT COVER ALL ASPECTS OF BUILDING THIS BUILDING THE GENERAL CONTRACTOR IS RESPONSIBLE FOR VERIFYING ALL BUILDING CODES AND MEMBER SIZING 1/4"SCALE THE GENERAL CONTRACTOR SHALL RESEARCH ZONING AND SITE LIMITATIONS PRIOR TO START OF CONSTRUCTION S - 1 ALL DIMENSIONS TO BE FIELD VERIFIED AND CHANGES MADE ACCORDINGLY THE GENERAL CONTRACTOR(OR PURCHASER OF PLANS IF NO G.C.)ASSUMES FULL RESPONSIBILITY FOR USE OF THIS PLAN OR ANY PART THERE OF W Q D V) - z 0 . cn w V1 eel Q4 t�' 00 rA .r M z � 12 3'-0" ao 14'-1 3/17 io 11'-4" Q 12'-4 1/2- 0 EXISTING W z rz EXISTING C-) ME o 24'-6" J D Q_ Ln Q Q DC7 EXISTING U z EXISTING CROSS SECTION THESE PLANS ARE DIAGRAMATICAL ONLY DATE: 8/22/16 ALL CONSTRUCTION PRACTICES TO FOLLOW IRC 2009 THIS PLAN DOES NOT COVER ALL ASPECTS OF BUILDING THIS BUILDING THE GENERAL CONTRACTOR IS RESPONSIBLE FOR VERIFYING ALL BUILDING CODES AND MEMBER SIZING S - 2 1/4"SCALE THE GENERAL CONTRACTOR SHALL RESEARCH ZONING AND SITE LIMITATIONS PRIOR TO START OF CONSTRUCTION ALL DIMENSIONS TO BE FIELD VERIFIED AND CHANGES MADE ACCORDINGLY THE GENERAL CONTRACTOR(OR PURCHASER OF PLANS IF NO G.C.)ASSUMES FULL RESPONSIBILITY FOR USE OF THIS PLAN OR ANY PART THERE OF Lijcn z O V) W 12'-3" 12'-3" 3 PLY 16"LVL RIDGE 5/8"ROOF SHEATHINGS N BOLT TO SIDE OF EXISTING RIDGE 12 3 PLY 16 LVL RIDGE �z 16"O/C —1 NEW SHED DORMER ROOF BOLTED TO EXISTING RIDGE 2 X 10 SPF RAFTERS 16110/C EXISTING ROOF 1 X 3 STRAPPING 16"0/C A z $ CC064SDS2 5 I I MIN. 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R-20 INSULATION W/VAPOR BARRIER I` ;• � \ 1/2"G.W.B. 2 X 6 SPF SILL PLATE Q 12'-9" W rill, EXISTING EXISTING = Q U � Q � � o n —' z Q LQ REPLACE EXISTING LALLY COLUMN V z WITH NEW 4"LALLY COLUMN NEW 24'-6" CROSS SECTION THESE PLANS ARE DIAGRAMATICAL ONLY DATE: 8/22/16 ALL CONSTRUCTION PRACTICES TO FOLLOW IRC 2009 THIS PLAN DOES NOT COVER ALL ASPECTS OF BUILDING THIS BUILDING THE GENERAL CONTRACTOR IS RESPONSIBLE FOR VERIFYING ALL BUILDING CODES AND MEMBER SIZING 1/4"SCALE THE GENERAL CONTRACTOR SHALL RESEARCH ZONING AND SITE LIMITATIONS PRIOR TO START OF CONSTRUCTION S- 3 ALL DIMENSIONS TO BE FIELD VERIFIED AND CHANGES MADE ACCORDINGLY THE GENERAL CONTRACTOR(OR PURCHASER OF PLANS IF NO G.C.)ASSUMES FULL RESPONSIBILITY FOR USE OF THIS PLAN OR ANY PART THERE OF v Massachuseft, _ Board o{Suii^�in Department rntcttcf ns g 4egul - �r blic Safety o 1 S-uperosor 1& mils Sian s CSFA -Fa -096462 AARONMs �sr_r'r5 GNp A A s MN$ ! �- y CarmtissiOner pir4on 07/07/2016 Office ore , _ OIISUIIlC1' ' 7 HOME lMPiZpV Affairs&$nsiness`/ Regisf t►o EIVil NTCpIyT�C �ahU n:,��- � TOR 1 ExPing! c,� 88g n14AW2017 --YY—e: Aq N M.SCA Deq i H�N! A�1 z AARON SC. is r C.' 2 MAGNOLIq SALEM. A M 0307 . —3 Vader._ secr0ary s Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CSFA-096462 Construction Supervisor 1 & 2 Family , f AARON M SCARPELLO , 2 MAGNOLIA AVENUES SALEM NH 03079 P � Expiration: Commissioner 07!0712018