HomeMy WebLinkAboutBuilding Permit #435-13 - 562 SALEM STREET 11/29/2012 TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received
Date Issued:
IMPORTANT:Applicant must complete all items on this page
LOCATIONi 1_
P(int,
9 Y
PROP.ERTiY(OWNER�.. _ ' _I' ��/ _
Print] 100 iYeari Old�structuro� yes) no)
MAP NO PARCEL OM7 -ZONING'DISTRICT Hstoric;Dlstrict yes no)
M_
achine'S,ho _Villa a es,
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building XOne family
i ❑Addition ❑Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
FRepair, replacement Assessory Bldg Others:
Demolition 11El❑ Other
❑.Septle: ❑W,ell Floodplain ❑Wetlands, ❑ Watershed;Distrito
n°"Water/S:ewer -
DESCRIPTION OF.WORK TO BE PERFORMED:
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Identification Please Type or Print Clearly)
OWNER: Name: roti e _2?yu,e-A-1 'e Phone:l;7X",g� ZW3
Address:
CONTRACTOR' Name .�1 D _ _ _ Plione 5p
!I04
S
Address:: ` / D-. L� �✓ . ...__ �� f% i �
Su 'ervlsgrFs,Construction Licens ✓ Date
# a a f
P
Home,lm.proVement,�_L_icense; Exp Date< 230 _ I
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: $ .,��5—�� FEE: $ / � �—
f/ ,
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty unci
SignatureofaA`gent/Owner ,Signature of contractor
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan Stamped Plans ❑
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
o 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
o 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
❑ 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: Doc.Bui Wing Permit Revised 2012
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
i
HEALTH Reviewed on Signature
CCT,NIIMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments f
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.Mairi Street
Fire De partmentsignatu a/date
COMMENTS .;,
Dimension
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
land area, . ft.:q
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
Location �� "
No. Date. 90t f
a
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.3
M
e • TOWN OF NORTH ANDOVER
e
Certificate of Occupancy $_4
Building/Frame Permit Fee $ s
a Foundation Permit Fee $
;N Other Permit Fee $
TOTAL $
Check# �
s
25996 uilding Inspector f
NORTH
own of
t . IF ndover
No. 4 -
h ver, Mass, ' •
LWOW-
C00041c"twt
_T T
S V
BOARD OF HEALTH.
Food/Kitchen
.. PERMj- L D Septic System
THIS CERTIFIES THAT � �......... .. ! !
BUILDING INSPECTOR
............... .... ..... .. .............................
Foundation
has permission to erect ... ....:............ buildings on .s. .......... Ab...
Rough
to be occupied as ........ .... .l.t........ .. ...�...... ....... .................. :::::........ Chimney
provided that the person accepting this permit sh4ll in every respect confo 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
Rough
VIOLATION of the Zoning or Building Regulations Voids this Permit.
Final
PERMIT EXPIRES IN 6 MONTS ELECTRICAL INSPECTOR
UNLESS CONSTC ON TS
Rough
Service-
.... . .. ...........................UIL..........ING............INSPEC......R.... Final
B.U.-
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
It'fiy'y,'�[Jle 14.40 rAl 018 0d.`. zL1; I.KUaa 1.V7lBtY:'i4t: wiVul
A`CO�� DATE(MWODKYYY)�
CERTIFICATE OF LIABILITY INSURANCE 7/24/2012
THIS CERTIFICATE IS ISSUED A:i A MATTER OF WFORMATION 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 PRODUC82,AND THE CERTIFICATE HOLDER.
IMPORTANT: it the certificate holder is an ADDMONAL INSURED,the policy(ies)must be endorsed. IF SUBROGATION IS WAIVED,subject to
the rarms and conditions of the policy,cettdin pc{irieB may require an endorsement. A statement on:his certificate does not confer rights t®the
cei ificm holder in lieu of such eridorsernen 5.
P>r,DucER � (:oasacT iausea G®ld
NAME'
�,xpFjP3 Tri8t7tY8lfC®—F(aabcCly PHONE (978)532-5445 FC n.(978)5s2-2217
139 Lynn£ield Street lgoldman@croesagency.a� �_
INSURER(9)AFFDROINGCOWIERYGE_ NAICS
Peabody MA 01960 INSURFRAMain Street America Assur. 9939
D SURE.0 T INSURER B;Nat10na1 Gram_Mutual- Ins Co 14788
milvexia Conzt:ructiorx Inc, iNsumelravPelFare Casualty and SuretX
F 48 WOB'JRN ST INS R D:
�al&aWGTON MA 01997-3440 (N UR M. F_
COVERAGES CERTIFICATE NUMBER-CL2272469589 REVISION NUMBER: _
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO TME(INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTVNTHSTANDiNG ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT MTN RESPECT TO WHICH THIS
CERTIFICATE MAY 8E ISSUED OR K0 PERTAIN, THE (INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
FXCLUSIGNS AND CONDITIONS OF SUCH POLICIES.LIMITS SROM MAY HAVE BEEN REDUCED BY PAID CLAIMS-
IN..� --- — -- POLJCY F PO(,PeT ern
t, TYPE OF OXWRANCE Policy NUMBER MkyDt? MPIIDD ilrR79
(ANERAL.UAENUTY .� EACH OCCURRENCE $ 1,000,000
I I4ERCWL GENERAL LIABILITY 500,000
DAMAGE TO RENT:O
X COM
k /31/2012 /31/Tort --�
1 L Lf.IMS-M1MDE OCCUR 58958 MED EAP(Any ene Pusan) F 10,000
PERSONAL&ADV INJURY_ S 1,000,000
GENERALAGGREGATE s 2:000,000
(GEM' AtIGREGATTELNITAPPLIES PER!+ PRODUCTS-COMPIOPAOe S 2,000,000
POL><V[]12T- n LOC $
ALIT —
OMOER.E UABIUTY IED eBe ercCitleM 6nvGl5 InAIT
IED
gl L- "'t AUTO BpDI'_YINJURY(Par pmsanj t 250.000
I` ALLcWNEa X I nc1G6�E0 FS8558 /31/2012 /314013 SOUgLYNNwRY(per socm;jt) 5 500,000
'4014.OWNEn PROPERTY DAMAGE E
?t KRED AUTOS ��AUTOS Per : _-- 2501000
�---- Ivvaw GdecAw.Dcaudtols $
IVRfILA 16LAt �._ OCCUR TT EACH OCCURRP.NCE f
EXCE�S"S"Lb418 '� GLAIM;I4ADE � AGGREGATE b
DEORC7 ELATION
(„• WORKERS COMPENSATION STArT_ CrrH-
AND EMPLOYERS'UMMY
FR
pti'Y PROPRIVORJPARTNERlc.1,ECUTIVE T'� NIA E.L.EACHACC IDENT S 500,000
OFFIGERMENWRD(GLUDED iJ Qti35Y93?12 /31/2'012 713112013
t(Manducsrr in NN) E.L.DISEASE-EA EMPLOYE 5 500 000
I it yee,aea«tt a lmaer
C!E5C1.111ON OF OPERATIONSCelow E.L.DiSEASE•POLICY LIMIT b 500,000
D SCR)PTIONOFOPERATIONS ILOCATIONS IVENICLLS(AdechACORD 101,AddidonelRemeftschmdy1e,Rmom lapsteIsinaum)
Re£er to policy for eacluaionary endorsements and special proi:isions_
C ERTIFIGATE FIOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCEL!ED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL 81; DELIVERED IN
F Or EalXa xredf3 Puzpo,ce ACCORDANCE 1MTN THE POLICY PROVISIONS.
AUT140ft O REPRESENTATrvg �..� y
TimDthy Tramont�e/b= vr;v' +GSL. .L
A CORD 25("10105) 01988.2010 ACORD. CORPORATION. Ad rights reserved.
fl lst)25(�alae5),al The ACORD name and logo are registered marks of ACORD
,
F!assachusetts -Department 4f PU do Say .'/
zmdardls
4_ `d 4Y,•.i k"..f Efi '4 fitly :[:'dr e, '1111N
ucerse.CSM5387
JOHN L S LVE90 �s r
845 WOBUP5 ST
WUMWGTf)N MA 011887
t
��;13 e;1�1ss�3s,F� 04i0812a14
Office of Consumer Affairs and Business Regulation
10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Registration: 106478
Type: Private Corporation
Expiration: 7/23/2014 Tr# 226131
SILVERIO CONSTRUCTION CO., INC.,
John Silverio
845 WORBURN STREET #5
WILMINGTON, MA 01887
Update Address and return card.Mark reason for change.
❑ Address [:] Renewal ❑ Employment E] Lost Card
SCA 1 :a 20M-05/11
845 Woburn Street ® Wilmington, Massachusetts 01887
978-694-4064 • 781-944-3219 ■ Fax: 978-694-4067 a www.silverioconstruction.com
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/Elects icians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Orgmization/Indi`ndual): SILVERIO CONSTRUCTI()N845 WOBURN _
WILMINGTON, Mq STREET
Address: -
4-4464
City/State/Zip: Phone #:
Arg'you an employer? Check he appropriate boa: Type of project(required):
1. I am a employer with 4. ❑ I am a general contractor and I 6 New construction
❑
employees (full and/or pa -time).* have hired the sub-contractors i
2.❑ I am a sole proprietor or partner-
listed on the attached sheet. z ?• Remodeling
ship and have no employees These sub-contractors have 8. ❑ Demolition
working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition
workers comp. insurance
5. ❑ We are a corporation and its j
[No10. Electrical repairs or additions
required.] officers have exercised their
3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions
myself. [No workers' comp. c. 152, §1(4), and we have no 12.0 Roof repairs
insurance required.] t employees. [No workers'
13.❑ Other
comp. insurance required.] 11
'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information:
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
iContractors 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: �JQh Q �1'42,20
Policy#or Self-ins. Lic. #: L Expiration D
Job Site Address:� �r� 02- ��c�a1 City/State/Zip: I
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
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.
1 do hereby certify under the pains andallies of perjury that the information provided above is true and correct
Signature: Date: `1A� !�---
Phone#:
Oficial use only. Do not write in this area,to be completed by city or town official.
City or Town: Permit/License#
Issuing Authority (circle one):
1. Board of Health 2. Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6. Other
Contact Person: Phone#:
SILVERN
Registration #106478
PROPOSAL
TO OWNER: Ms. Irene Bourne DATE: 11/8/12
STREET: 562 Salem Street TEL: 978-685-3963
CITY/STATE/ZIP: No. Andover, MA JOB: Strip siding and reinstall new siding
We herebv submit specifications and estimates for work to be dome at:
and shown as recorded at Book , Page
Existing Split Level:
-Strip existing siding front exterior of(rouse & remove gutter and downspout
-lnstal.l-house wrap to entire house
-Cover all windows, door trim, Gabel trim and facia with custom bent white metal
-Cover all soffits with white vinyl vented soffet parcels
-Install Harvey Industries,double S"monogram gray color vinyl siding to /rouse
-Install new white gutters and downspouts
-Install torte sets of strutters to house
Quote does not include cost of trash,permit,paint, electric and radiant/teat in floor the flooring, water, ledge,fill
trucked in or out, machinery to dig footings(if needed), driveways, any underlying decayed wood on house or blue
prints, cabinetry, ceiling farts, light fixtures,tile adhesive, tile,grout, installation of glass or marble tile, appliances,
underground utilities,finish landscape,surveyors,pump truck,steel in footings or walls, moving hidden wiring and/or
pipes, and the handling of any hazardous materials,such as asbestos or lead.
Silverio Construction will obtain the permit(s) necessary to complete the above proposed work. If the Owner secures
any and all building p fmits;.then.the,work is excluded from the guaranty fund provisions from MGL Ch. 142A.
Due to the large selectiomt of options.and materials;prices may vary between general contractors. If you receive an
offer for a lower price,please give us the opportunity to compare proposals. This will ensure you that both companies
arepticing,out thesamestyie products,options,`and materials. Contractor reserves the right to select quality of
material on all unspecified products.
1
S �
`t{845 Woburn Street0.Wilmington, Massachusetts 01887
978-694-4064 . 781-944-3219 ■ Fax: 978-694-4067 ■ www.silverioconstruction.com
F6 iLVERIO CONSTRUCTION CO.,INC. Z
.. K. - f 4
$S'
3
2-YEAR SATISFACTION GUARANTEE
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WE PROPOSE hereby to furnish material and labor—complete in accordance with above specifications for the sum
of Sixteen Thousand, Five Hundred and Ninety& 00/100-------------$16, 590.00
i =
Work to commence on or about: 11/20/12
With the majority of the work to be completed on or about: 12/11/12
Please sign and return yellow copy with a deposit as outlined below.
CHANGE ORDERS ARE TO BE SIGNED AND PAID PRIOR TO COMMENCEMENT OF WORK.
PAYMENTS to be made as follows:
25%-deposit, 35%-when 2 sides are complete, 35%-when 3rd side complete, 5%-on substantially complete
All material is guaranteed to be as specified All work to be completed in a substantial workmanlike manner according to specifications
submitted per standard practices. Any aheration or deviation from above specifications involving extra costs will be executed only upon written
orders,and will become an extra charge over and above the estimate,to be pgvable at completion of said extras. All agreements contingent upon
strikes, accidents or delays beyond our control. such as weather,back orders of materials,or lack of payment. Owner to carryfire,tornado,and
other necessary insurance. Our workers are frilly covered by Worker's Compensation Insurance. One and one half percent (1-112%)per
month, eighteen percent(18%)annual finance charge will be assessed on all balances over thirty days. In addition,the Owner shall pay all
costs of collection,including all reasonable attorneys'fees in the event of default.
We may file a mechanics lien against your property and have the same recorded at the applicable Registry of Deeds.
Your signature to this agreement indicates your assent to such a lien.
We mm• withdraw this proposal if not accepted within 20 days.
AUTHORIZED SIGNATURE:
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S IERIO CONSTRUCTION CO., INC.
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it �.�y�l.`3s'�
VERIO CONSTRUCTION CO.,INC. 3
ACCEPTANCE OF PROPOSAL: The above prices, specifications and conditions are satisfaetory and are hereby
accepted You(ere authorized to do the work as specified Prr)hnent will be made as outlined above.
Do not sign this contract if there are any blank spaces
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DATE OF ACCEPTANCE: SIGNATURE:
SIGNATURE:
You have a three(3) dad,right to cancel this contract after it has been signed,pursuant to MGL Chapter 93 (48), Chapter 255D
(14), or Chapter 140D (10) as may be applicable.
WE ACCEPT MAJOR CREDIT CARDS
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