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HomeMy WebLinkAboutBuilding Permit #821-13 - 595 MASSACHUSETTS AVENUE 5/30/2013Permit NO: Date Issued: TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received I IMPORTANT: Applicant must complete all items on this -page I TYPE OF IMPROVEMENT PROPOSED USE Residpntial Non- Residential El New Building One family 11 Addition El Two or more family 0 Industrial 0 AI ration No. of units: El Commercial epair, replacement [I Assessory Bldg El Others: 0 Demolition El Other ❑- - – , :®Weir -,-- - 161F,,Ib0qP)bi W W bi DESCRIPTION OF WORK TO 6E FEM-UKIVItU: !90J 0\& Identification Please Type or Print Clearly) OWNER: Name:—'-ri:t!9 A o -T- -I 'k, Phone: (_Q36E5r30(Lf Address: qperv_ 011iften, A. 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: $ 57 q<") FEE: $ Check No.: La--- Receipt No.: ;26 47-�� NOTE: Persons contracting with unregistered contractors do not have access t the gu"antyfund `Signature _of .,Ag_6rJtJ6 n'er':..-.,,,�--:,'.,.",i.." �.Sia..-leitureof.cbhtractbr.,. _., Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan El amped Plans El 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 HEALTH Reviewed on Siqnature 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 DPW Towp- Engineer: Signature: Located 384 Osgood Street FTEDEPA-T- M'E �T - Temp Dumpster on site yes no Located at ,124 Main Street Fire Dep ariinett-sigriature/date COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions Total land area, sq. ft.: ELECTRICAL: Movement of Dieter 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 B Notified for pickup - Date Doe.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. R.00firig, Siding, Interior Rehabilitation Permits Building Permit Application Li Workers Comp Affidavit u Photo Copy Of H.I.C. And/Or C.S.L: Licenses o Copy of Contract u Floor Plan Or Proposed Interior Work u Engineering Affidavits for Engineered products NOTE: All dumpster.permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks u Building Permit Application o Certified Surveyed Plot Plan o Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) o 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) o Building Permit Application o Certified Proposed Plot Plan u Photo of H.I.C. And C.S.L. Licenses D Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And -Hydraulic Calculations (If Applicable) o Copy of Contract u Mass check Energy Compliance Report u Engineering Affidavits for Engineered products DOTE: 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 app, 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.Building permit Revised 2012 Location 6 6 �SS• 2 f rl-No. t 2 ��� Date Check #1�/� 26455 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $_72 , Foundation Permit Fee $ Other Permit Fee $ TOTAL $ �A Building Inspector '" 4 a LU LL o Q m C O U \ "O O O LL E N N U +� Q 'N /n 0 a Z z Z m C O ''Z (p "O C 7 O LL -C bybA 3 O O✓' ? N C t U C LL o a LA Z z m J a t O O d' — C LL 0 u N Z u UL7 W .0 by O O d' u N (A C LL a Z Q t bA 7 O C z W cc o. W W 5 LL C 7 z y.+ 41 N �`+ N p�j o i O E {n rM� H =coram _ O O L Q. m Q E Q. L � 1 0 E cm O = V H C� cn J V� C > V U) m = G1 0 _ 0 E L o O CL = O o N me � o0 L Q CL �0 . ..: _ tm Q L LN. is CL H o N 2 m W ui LL W V I— O O .2 N C •� t� � .� L Cl) O Q. O 0 0 a Z Z m Cl) = (00 z Cf) Wcn GC a. Z w0 � U cn W a Z ■v L" - L W N _- 0:2 FOREMAN CELL Name: JANA OLENIO Phone: (978).361-5394 Address: 695 MASS AVE. City: NORTH ANDOVER State: MA Contact: BARRY Date of Pronosal: 05-15-2013 Proposal#: 1012927 WE HEREBY SUBMIT SPECIFICATIONS AND ESTIMATES FOR STRIP AND RE -ROOF HOUSE DETAILED DESCRIPTION: MAIN HOUSE FRONT AND REAR -MOVE AND DISPLACE ALL PERSONAL BELONGINGS AND OTHER ITEMS IN FALL AREA OF ROOF SYSTEM TO ENSUR NO PROPERTY DAMAGE DUE TO FALLING DEBRIS -TARP AREA, SECURE AREA BELOW WORK AREA AND PREP AS NEEDED TO ENSURE NO DAMAGE POSSIBLE BY FALLING PRODUCTS - CLEAN AND PREP., AND DE -NAIL ROOFING DECK .REMOVE SKYLIGHT FLASHING KITS FROM SKYLIGHTS AS APPLIACBLE -INSTALL 8" WHITE GALVALUME DRIP EDGE TO PERIMETER -INSTALL GAF WEATHERWATCHICE AND WATER SHIELD (BITUTHANE LEAK BARRIER) MINIMUM 6 FEET FROM ROOF -TO -WALL JUNCTURE, EVES, AND VALLEYS, TUCK UNDER FLASHING KIT, AND MINIMUM 6, FEET FROM AROUND CHIMNEY OR ANY OTHER ROOF PENETRATIONS -INSTALL GAF #30 FELT PAPER UNDERLAYMENT TO OPEN FACE AREA -INSTALL NEW 6" GALVALUME STEP FLASHING TO ROOF TO WALL JUNCTURES AND CHIMNEY BASE AS APPLICABLE -INSTALL STARTER COURSE SHINGLES UP RAKE EDGES -SHINGLE TO COVER WITH GAF TIMBERLINE PRESQUEH.D. ARCHITECTURAL SHINGLES BY ALL N.R.C.A. AND GAF SPECIFICATIONS AND PROCEDURES. (OWNERS CHOICE OF COLOR TO FOLLOW) WITH -- LIFETIME MANUFACTURERS WARRANTY ** -WEAVE SHINGLES INTO SKYLIGHT FLASHING KITS AND RE -SECURE -INSTALL NEW PIPE FLANGES AS NEEDED FOR ROOF PENETRATIONS -LIFT CHIMNEY LEAD AND INSPECT BASE -REPLACE ALUMINUM FLASHING AROUND CHIMNEY BASE -CAP PEAKS WITH GAFHIP AND RIDGE CAP -INCLUDES REMOVAL OF ALL WASTE MATERIAL, OLD ROOF SYSTEM, AND DEBRIS FROM PREMISES. WE MAINTAIN AND REMOVE DUMPSTER AND DO A FINAL WALK THROUGH WITH A ROLLING MAGNET AS PART OF STANDARD CLEAN UP OPTION: CUT IN PEAK AND INSTALL RIDGE VENT SYSTEM OPTION: RE -LEAD CHIMNEY (EA) 5475.00 $550.00 PAYMENT TO BE MADE FOR ALL LABOR AND MATERIALS 1/3 UPON SCHEDULING AND 1/23UPON COMPLETION AND 113 WITHIN 14 DAYS OF COMPLETION AT THE TOTAL ESTIMATE PRICE OF $5,950.00 REMOVAL OF OL.D ROOF SYS� MCLUDES UP TO MAXMIUM LAYERS AS ALLOWED BY LAW. BMG TWO LAYERS. ANY ADDITIONAL LAYER (EACH) WELL CODISPOSE OR ALL MA713UAL IS GUARANTEED AS SPECIFIED. AND THE ABOVE WORK IS TO BE COMPLETEDM A Y O THE SPECMATIONS AS LISTED AND M SUBSTANTIAL. WORKMANLIKE MANNER FOR THE AM. FI SUM OF VE THOUSAND. NINE HUNDRED D LLARS SIGNED 14ALDATE -27-0 HOME- R / HIRIN PAR EPRESENTATION THERE OF SIGNED DATE 27 CON CTOR. REPRE NTA RRIMACK VALLEY ROOFING AND GUTTERS SERVINOVERRIMACK VALLEY AREA OVER 27 YEARS * CERTIFIED MASTER SHINGLERS * FULLY INSURED * FULLY LICENSED * MEMBER B.T.A. * 14 YEAR WORKMANSHIP WARRANTEE 30+ YR MANUFACTURERS WARRANTY * ' MEMBER B.B.B. * MEMBER N.R.C.A. * VISIT US ON THE WEB AT W W W.MERRIMACKVALLEYROOFING.COM * $50.00 REFERRAL REBATE MERR. VALLEY R&G LLC. * HIC #163227 * MATTHEW INGHAM * CSL # 32707 * 522 MERRIMACK ST. METHUEN MA 01841 0 Office of Consumer Affairs & Business Regulation OMEIMPROVEMENT CONTRACTOR T pe: ;j xpiration: 5126%2015 Individual JOSEPH DEMARCO JOSEPH DEMARCO 2 PARK ST HAVERHILL, MA 01830 Undersecretary Massachusetts - Department of Public Safeh Board of Building Regulations and Standards Construction Supervisor License License: CS 23707 JOHN P SHANAHAN 66 CHERYL LEE LN LOWELL, MA 01854 ('ununisiuncr M Expiration: 10/6/2013 Trt#: 5645 a CERTIFICATE OF LIABILITY INSURANCE °"TEDsro712WAl2arafMMYYI 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 Ileu of such endorsement(s). Producer Cloutier insurance 87 Pleasant street Boston, MA 02201 CONTACTMERY ROCHA .PHONE M$92roa2sac Na • ronutrozlr POt.ICY EXP MMIDD INSURERS AFFORDING COVERAGE NAIC 0 INSU NAUTILUS INSURANCE COMPANY.- _ _ _ ... _._ 17370 INSURED Merrimack valley Roofing and Gutters LLC 122 Merrimack street Methuen, MA 01844 msuRERB: NATIONAL CONTINENTAL INS CO 10243 INSURER 1: LIBERTY MUTUAL INSURANCE CO 23043 - INSURERO: - 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 LTR TYPE Of INSURANCE ADDL UHR POUCY NUMB POLICY EFF MMIDD POt.ICY EXP MMIDD LIMITS A GENERAL LIABILITY COWERCIAL GENERAL LIABILITY GEMMS -MADE M OCCUR ES�FNTA NN246727 06/04/2012 06/04/2013 EACH OCCURRENCE 5 1,000,000 PRFMISES a 50,000 _S MEDL"XP M one ersan S 5,000 PERSONALdADV INJURY S 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENIAGGREGATE LIMIT APPLIES PEW POLICY % LOc _ PRODUCTS •COMPIOPAGG $ 2,000,000 $ B AUTOMOBILE LtABILITY ANYAUTO ALL OWNED SCHEDULED AUTOS AUTOS NON4y4VNEO HIRED AUTOS AUTOS COMBINED SIN ! LIMIT IE&OAderl BODRYINJURY (Par pmm) $ BODILY INJURY (Per accident) S PROPERTY DAMAGE $ nccr $ UMBRELLA LIAB EXCESSUAR HCLAIMS.MADE OCCUR EACH OCCURRENCE S AGGREGATE S DED I I RETENTION S$ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORMARTNEWEY.ECUTIVE OFFICERIMEMRER EXCLUDED?FN� (Mandatory In NH) Ifymdesabeunder DESCRRIPTION OF OPERATIONS bolow NIA LB5199652 /04/2012 06/04/2013VYG sTATU- oTk- E.L EACH ACCIDENT $ E.I.. DISEASE - EA EMPLOYEE S `— E.L DISEASE • POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, AdcMn2i Ramarkc Schodtft it mom taxa In required) Cawmp eXdudes aww. Jeremy Cdto CERTIFICATE HOLDER CANCELLATION -,--/ ©1988.201? ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of AC RD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MERRIMACK VALLEY ROOFING AND GUTTER THE EXPI TION DATE: THEREOF, NOTICE WILL BE DELIVERED IN P.O. Box 1214 ACCORDANf WITH THE POLICY PROVISIONS. NeWburyport, MA01950 AUTHORIZED REP ES�FNTA -,--/ ©1988.201? ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of AC RD The Commonwealth of Massachusetts Department of lndustrid Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Buil.dens/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organi'zatiorAndividual) ^h, LA4` 3 G C Are you an employer? Check the appropriate box: - Typp of project (required): 1. ❑ I am a employer with 4. ❑ I am a general contractor and I 6. New construction employees (full and/or part-time) * 2. El am o. sole proprietor orpariner- have hired the sub -contractors listed on the attached sheet. 7• Remodeling ship and'have no employees These sub -contractors have 8. ❑ Demolition working for we in any capacity. workers' comp. insurance. 5. ❑ We are a corporation and its g, [l Building addition [No workers' comp. insurance required.) officers have exercised their 10.❑Electrical repairs or additions 3. ElI 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.Q Roof repairs insurance . re uired required.] employees. [No workers' 13.0 Other comp. insurance required.] ,Any applicant that checks box#1 must also filloutthesectionbelbwshowingtheirworkers'compensationpolicyinformation. T Homeowners who submit this affidavit indicating they tie 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 their workers' comp. policy information. X am an employer that is providing workers' cJlmpensation insurance for my employees. Below is the,policy and job site information. A , . Insurance Company Policy # or Self -ins. Lic. #: L 6 Expiration Date: L-0/46 Job Site Address: �,K- / k -u 2cr< City/State/Zip: Attach a copy of the workers' compensation policy $eclaration page (showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A ofMGL o. 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 hereby cer i ,under the jains and penalties ofperjury that the information provided above is true and correct. fab - 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 - - - Phone#: