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Home My WebLink AboutBuilding Permit #219-2017 - 57 COTUIT STREET 8/31/2016 �tORTF/ gUILDING PERMIT TOWN OF NORTH ANDOVER o APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received `p Tap Date Issued: 1 I `HU MPO TANT: Applicant must complete all items on this page LOCATION S:1- S c, C o l v. k 5)r PROPERTY OWNER 0 Print Print MAP NO: PARCEL: %lL/ ZONING DISTRICT: 1-- 'I Historic District yesno Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition Atwo or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial "epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well CI Floodplain ❑Wetlands C 1 Watershed District ❑ Water/Sewer Cxr-, �_ r-94Vkc-C sig _e (11—OQ 431C.9 k-.., 11� S�v"� '`(��•��"�\ 1 ops�1�.\� Sh y Identification Please Type or Print Clearly) OWNER: Name: Do,� �,'; �\ ZDA),cez Pe 1 i c,�o Phone: Address: CONTRACTOR Name: c- 1 Phone: -7?k`tRA- %512 Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date- ARCH ITECT/ENGI NEER ate:114 ARCHITECT/ENGINEER Phone-.— Address: hone: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-. $ )( ISd b FEE: $ Check No.: lOj l Lu Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Taming/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 ❑ ❑ COMENTS CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature&Date Driveway Permit Located at 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 - Date Doc.Building Permit Revised 2012 Location ) No.G 1 J C�J� Date t!5;i >f • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ _ r-• Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ ` TOTAL $ Check# t Building Inspector OORTH Town of 1, a ndover . O - 0 No. a Dh ver, Mass, C0C"1C"1WICM � _0 ADRATED r'Pa,�'�� S U BOARD OF HEALTH Food/Kitchen PERMIT.. T D Septic System THIS CERTIFIES THAT � /4`..:....�j?O. Q�f.. .. .. .. . . AK0 BUILDING INSPECTOR r ... Foundation has permission to erect .......................... buildings on ... .. .....'. . ....C'....T..�.��:�... . Rough tobe occupied as .. � ... ........................................................................ Chimney provided that the person accepting this permit shall in every respect conform 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 MONTHS ELECTRICAL INSPECTOR UNLESS CONST LN T Rough Service ....... ........... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. Page 2 of 8 PROPOSAL Proposal submitted To: Phone: Date: Dan Hill&Dolores DePiano 978-697-9824 8-23-2016 Street Address: Salesman: Contact Person: 57-59 Cotuit st Steven Balsavich Dan City,State and Zip Code Email: North Andover,MA 01845 qsryche9l@yahoo.com We hereby propose to furpish labor and Materials to*stA new sbingle roof to Manufacturer's specifications by the following: This estimate covers toe following roof areas: • All Shingle RoofAreas Preparation: • Remove the existing asphalt shingles and felt down to the wood sheathing. • Leave any existing ice and water shield in place. • Cut a new ope*g i}}�he e?}sfMg sheathing for the new ridge vent. • Inspect for and replace any broken,rotted,or missing roof sheathing. Any sheathing replacement cost depends on the type of sheathing. • The building wig be timid ding#ic rpatoval process. Protect all shrubbery as required. Installation: • Install new aluminum drip edge along all rakes • Install vented drip edge on all eaves. • Install Ice&Water Shield 6 feet along the eaves of the roof. • Install Ice&Water Shield 18 inches around all penetrations. • Cover the balance of the roof with Synthetic Felt. • The shingles that will be used are: Owens Corning Your choice of standard manufacturer colors:Customers Choice • Install a new Ridge Vent to be covered with Seal A Ridge shingles at the existing and new ridge openings. • Install new vent pipe flashing up to 4 inches. Any larger will be properly sealed. • Re-use and seal the existing sidewall flashing. lent Initia .A Page 4 of 8 Y Contract Acceptance-Upon signing,this document becomes a binding contract under law.Unless otherwise noted within this document,the contract shall not imply that any lien or other security interest has been placed on the residence.Review the following cautions and notices carefiilly before signing this contract. Estimated Start Date: Estimated Completion Date: The Start Dates Given Are Weather Dependant And Will Be Decided Upon Acceptance Of The Proposal. We propose h to furnish mouiah and labor,conriele in accordance with above for the suns o Ten Thousand Five Hundred Dollars ($10,500.00) Payment terms are to be as follows: *1/3 Deposit $3,500.00 *1/3 At Start $3,500.00 *Balance Upon Completion $3,500.00 *Total Payments $10,500.00 DO NOT SIGN THIS PROPOSAL IF THERE ARE ANY BLANK SPACES Contractor's Authorized Signature: Date: ck ci. ACCEPTANCE OF PROPOSAL—The above prices,specifications,conditions and additional terms are satisfactory and are hereby accepted. You are authorized tp4Q the work 4 specified ayment will be made as outlined abov . / Date of Acceptance Signature: - Signature: Contract Arbitration The contractor and the homeowner hereby mutually agree in advance that in the event the contractor has a dispute concerning this contract,the contractor may submit the dispute to a private arbitration firm which has been approved by the Secretary of the Executive Office of Consumer Affairs and Business Regulation and the consumer shall be required to submit to such arbitration as provided in assachus :4 General ,chapter 142A. 'c er's Signature Contractor's Signature NOTICE:The signatures of the parties above apply only to the agreement of the parties to alternative dispute resolution initiated by the contractor.The homeowner may initiate alternative dispute resolution even where this section is not separately signed by the parties. IrJient Initial W* The Commonwealth of Massachusetts Department of Industrial Accidents s I Congress Street,Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Le¢ibly Name (Business/Organization/Individual): Address: 5,;t %"K-e(+ s City/State/Zip: O S Phone#: � 7� �RCl`l- c5--J Are you an employer?Check the appropriate box: Type of project(required): I.E]I am a employer with employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in $. Remodeling any capacity.[No workers'comp,insurance required.] 9. Demolition 3.❑I am a homeowner doing all Nvork myself.[No workers'comp.insurance required.]t ❑ 10 Building addition 4,❑I am a homeowner and will be hiring contractors to conduct alt work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12. Plumbing repairs or additions 5.(x{'1 am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.Q'Roof repairs These sub-contractors have employees and have workers'comp.insurance.- 6.0 We are a corporation and its officers have exercised their right of exemption per MGL a 14•❑Other 152,$1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#I must also fill out the section bclokv showing their workers'compensation policy information. +Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. if the sub-contractors have employees,they must provide their workers'comp,policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. nn Insurance Company Name: Policy#or Self-ins.Lic.#: �S Expiration Date: I o y� Job Site Address: S co�to: � ,S� City/State/Zip: W A nAt Pr, n')Ps Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cerd&under the Gins and rtalties of perjury that the information provided above is true and correct , Si nature: --11 Date: Phone#: Official 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#: a D /DDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 05117/51171 0216 �r 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 have ADDITIONAL INSURED provisions or 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). ONTA T PRODUCER NAME ISABELE CORDEIRO _ Brazway Insurance PHONE 978.455-5991 MC—_1 No:978-455-9934 --- -WC. JW �I— — 345 Main St Unit 131 E-MAIL S:brYazwa usa@yahoo com ADDRES _.—. Ste,—__ _ __— - - -- Tewksburt MA 01876 _INSURER(S)AFFORDING COVERAGE N_AIC# INSURER A:WESTERN WORLD INSURED AM CARPENTRY INC wsURERB:THE HARTFORD 110 DELMONT AVE.#11 1 SURERC: LOWELL MA 01852 INSURER D INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. MSR -- -Ab-6l �-Bk-- -- POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE 1 I POLICY NUMBER MMIDD _.MWDDNYYYI COMMERCIAL GENERAL LIABILITY i EACH OCCURRENCE S 1,000.--000 ^ bAMA��REI�TE�` -- CLAIMS-MADE 0 OCCURI If PREMISES(Ea occurrence 5100,000 A NPP8314993 10412612016 04/2612017 1 MED EXP(Any one person) $5,000 PERSONAL 6 ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE_.5 2,000,000 POLICY❑PRO LOC PRODUCTS-COMP/OP AGG 5 2,000,000 JECT ---- S OTHER: COM INED INGLE LIMIT AUTOMOBILE LIABILITY .(Ea Npon�-- S ANY AUTO I BODILY INJURY(Per person OWNED SCHEDULED ODILY INJURY(Per Zc denl) $ AUTOS ONLY AUTOS PROPERTY DAMAGE HIRED NON-OWNED JPereeadeo)_ AUTOS ONLY AUTOS ONLY $ UMBRELLA LAAO OCCUR _ EACH OCCURRENCE {S _ I EXCESSLIAB CLAIMS-MADE I � IAGGREG ATE $ DED M RETENTIONS S WORKERS COMPENSATION STATUTE ERH AND EMPLOYERS'LIABILITY YIN I j - (6S60UB0G36388515 101141201511011412016 EL._EACH ACCIDENT _ S 100x000 _ IANYPROPRIETORIPARTNERIEXECUTIVE Q NIA OFFICERAAEMBEREXCLUDED9 I L E.L.DISEASE-EA EMPLOYEE_S 100,000 B (Mandatory in NH) — `� 500,000 (If yes,describe under ( I _ E.L.DISEASE-POLICY LIMIT 5 DESCRIPTION OF OPERATIONS below f i � t DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES(ACORD 101,Additional Remarks Schedule,may be aRached if more space is required) CARPENTRY,ROOFING,SIDING CE ATE HOLDER CANCELLATION 1-11 STELLA CONSTRUCTION 8,HOME SERVICES SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 82 PINKER?ST THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. MEDFORD MA 02155 AUTHORIZED REPRESENTATIVE p 1988-2015 ACORD CORPORATION. All rights reserved. Stella Construction HIC & CSL License's ♦, � liijsincsa Regulstien P'oPROVEMENT CONTRACTOR 183440 Type :13'2017 LLC Y HOME SERVICES, LLC s aha` k: t t`nderset CS-108729 ERIK KORTZ sr PLNKERT STREET Medford M. A 02155