HomeMy WebLinkAboutBuilding Permit #844-15 - 60 RUSSELL STREET 4/23/2015BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION /
Permit NO: Date Received l
Date Issued:
TANT: Applicant must complete all items on this
LOCATION
PROPERTY
-'1 Print
MAP NO: 6 10 PARCEL � ZONING DISTRICT: Historic District yes no
Machine Shop Villaqe yes (no
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
A One family
❑ Addition
❑ Two or more family
❑ Industrial
❑ Alteration
No. of units:
❑ Commercial
Repair, replacement
❑ Assessory Bldg
❑ Others:
Demolition
❑ Other
❑ Septic ❑ Well
❑ Floodplain ❑ Wetlands
❑ Watershed District
❑ Water/Sewer
`CIL V, k� -- �—o c
Identification Please Type or Print Clearly)
OWNER: Name:
Address:
\,50'� -2(Q 6- 1 63
CONTRACTOR Name: ?S Phone: (9 -(OZ-,J
Address: A ^ t
Supervisor's Construction License:Exp. Date: l o � Ii ( 2 '` c� I b
Home Improvement License: Exp. Date: l
�?,� 2�1� 2 I Q [ 20 l Uo
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: $ %0 '560o . cxp FEE: $ � —
Check No.: U0 Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Signature of Agent/Owner �f contractor \�baoi_/V\C,*^ '`
V6-
i e
Plans �"Llhh :ted [I Plans Waived ❑ Certified Plot Plan . Stamped Plans ❑
TYPE..' F SEWERAGE DISPOSAL
public Sewer ❑
Tallning/MassageBody 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
PLANNING & DEVELOPMENT Reviewed On Signature.
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on Signature
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
a Planning Board Decision: Comments
Conservation Decision: Comments
Water & Sewer Connection/Signature & Date Driveway Permit
DPW Town Engineer: Signature:
-
Located 384 Osgood Street_
+FIRE iDEPARTMENT -Temp i®umpster�on site eyes
Locatetl,at 124.(Main
Fire,Depai'ment signatureldaYe_-
�C
,:o
Dimension:,:,:
Number of Stories: Total square feet of floor area, based on Exterior:;,dimensions.
:_ X3
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
MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine
No
Doc.Building Penn it Revised 2014
Building Department
The following is a list of the required forms to be filled out for the appropriate permit to be obtained.
r
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
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/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
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: Building Permit Revised 2014
Location �o
No. Date 1-1�
Check #
2 6
TOWN OF NORTH ANDOVER
Certificate of Occupancy. $-
Building/Frame Permit Fee s
Foundation Permit Fee
Other Permit Fee
TOTAL
Building Inspector
v
N n
0
n Z y
CD
CL
su
�• U)
to V
0 CD
< o
Q�=
c SU
CD
CD 0
Im CD
C o CD
CQ CMD
� v
0
0 O
o
CD
SCD
0
m
m
Cl)
Z
O
Cl)
O
D
O
z
h
CD
N
O
t0
W
Q
to
CD
co
rt
O
O
N
0.
cn
N
CD
rt
on 0 23 x
U < CD N
�D C o CD 0
o m
N
O co rt CD T_
O O .� CL 0 177
W a N p
CDC DQ N N
O O n
co Q O rt
� O N
S n
� (D CD
S
CD 'a 7
� O O
0 to
S
z CD
rr
CD
rt
D
0=:
O. �
C O 2 to
<CL _ N
CD �' O
��CD
CL
CD
te0 'I
rCD
:
0
O
P—* *
49tC-7 a
o
O
C C
CD =CD
Co
CD
0 U)
on
CD
CD
CL
� S
oLn
fD(D
rD
1
.+
O
W
3
fD
T
m
z{
3
°
a
S
N
n
-�
j
d
m
a
3
m
m
n
N
0
°—
o
S
C
N
m
0
°—
s
3
7
M
o
0�0
=r
o
C
pr)
:3=r
C
p
Z
N
M
m
O
m
�.
fl
Ln
3
o
a
=3
O
>
p
O
2
m
D
2
y
0
0
O ti
O
fD
01
The Commonwealth of Massachusetts
Department of Industrial Accidents
a , d I Congress Street, Suite 100
Boston, MA 02114-2017
.J' www. mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Name (Business/Organization/Individual):
C l 1) �� ��o
Address: \2U eP.w Fq Q,- A'
City/State/Zip:,�� Wn kP- Qr� LO-0Phone #: �l Cpm IVZ-Z�,
Are you an employer? Check the appropriate box:
1. dam a employer with employees (full and/or part-time).*
2. ❑ I am a sole proprietor or partnership and have no employees working for me in
any capacity. [No workers' comp. insurance required.]
3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t
4.F-] I am a homeowner and will be hiring contractors to conduct all work on my property. I will
ensure that all contractors either have workers' compensation insurance or are sole
proprietors with no employees.
5.F-] I am a general contractor and I have hired the sub -contractors listed on the attached sheet.
These sub -contractors have employees and have workers' comp. insuranceJ
6. ❑ We are a corporation and its officers have exercised their right of exemption per MGL C.
152, § 1(4), and we have no employees. [No workers' comp. insurance required.]
Type of project (required):
7. ❑ New construction
8. ❑ Remodeling
9. ❑ Demolition
10 ❑ Building addition
11.Electrical repairs or additions
12. ❑ Plumbing repairs or additions
13. Roof repairs
14. ❑ Other
*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.
tContractors 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.
Insurance Company Name:
Policy # or Self -ins. Lic. #: \ r I t Expiration Date:
Job Site Address: U S`p J� City/State/Zip:
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 cer tfy under thepains land penalti-els oofperjury that the information provided above is true and correct.
Signature: (� \A /it SIS• UW Date: `� ( 2;-�> 1 Z b A
Phone #: U 61 -�' � Co 3S'(� 23
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 #:
PRECI-5 OP ID- FS
�4 " CERTIFICATE OF LIABILITY INSURANCE
FDATE
THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT
04/23/DO/Yl5
04/23/2015
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
Westford Insurance Agency
PO Box 308
Westford, MA 01886
Eric Semple
CONTACT
NAME: Eric Semple
PHONE
A/c No Ext: a
c No): 978-692-0429
E-MAIL
ADDRESS: Eric Westfordlnsurance.com
INSURERS AFFORDING COVERAGE NAIC #
EACH OCCURRENCE $ 1,000,000
INSURER A: Western World Insurance Co
INSURED Precision Roofing ,LLC
PO Box 653
INSURER B:
INSURER C :
Acton, MA 01720
INSURER D:
GEN'L AGGREGATE LIMIT APPLIES PER:
INSURER E:
POLICY PRO- ❑
D LOC
INSURER F:
11"(1VFQArCC
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO
KtVIZHUNNUMBER:
THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED
WITH RESPECT TO WHICH THIS
HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR ADDL SUB
LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF POLICY EXP
INSDWVD MM/DD/YYYY MM/DD/YYYY
LIMITS
A X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE � OCCUR NPP8115189
EACH OCCURRENCE $ 1,000,000
06/07/2014 06/07/2015
PREMISES Ea occurrence) $ 50,000
MED EXP (Any one person) $ 5,000
PERSONAL & ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY PRO- ❑
D LOC
GENERAL AGGREGATE $ 2,000,000
JECT
PRODUCTS - COMP/OPAGG $ 1,000,00
OTHER:
$
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT
Ea accident $
ANY AUTO
BODILY INJURY (Per person) $
ALL OWNED SCHEDULED
BODILY INJURY (Per accident) $
AUTOS AUTOS
HIRED AUTOS NON -OWNED
AUTOS
PROPERTY DAMAGE
$
Per accident
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE $
EXCESS LIAB
CLAIMS -MADE
AGGREGATE
DED RETENTION $
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
PER OTH-
STATUTE ER
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? F
N / A
E.L. EACH ACCIDENT $
(Mandatory in NH)
If yes, describe under
E.L. DISEASE - EA EMPLOYEE $
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT $
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required)
CFRTICIL`ATC unl Mon _
Town of North Andover
1600 Osgood Street
North Andover, MA 01845
ACORD 25 (2014/01)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
w'I"o-LUl4 ACUKU CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
Massachusetts - Department of Public Safety
Board of Building Regulations and Standards
Construction Supenisor Specialty
License: CSSL-099691
ERIIC B HAMMAR` '
PO BOX 653
ACTON MA 01730
m Expiration
Commissioner 10/17/2015
a �
�7J/zn. U'cz�mnzt��u+eail� afn-��Ci.Jd�e�ltiJrlls I;
Office of Cousumer Affairs &
Business Regulation
ME IMPROVEMENT CONTRACTOR Type
egistration: 130275 di
Corpc:
xpiration: 2/912016
Ltd;Uability
PRECISION ROOFING LLC..
Erik Hamman
126 NEW ESTATE RD
LITTLETON, MA 01460
f--
Uudersecretary
License or registration valid for individul use only
before the expiration date. If found return to:
Office of Consumer Affairs and Business Regulation
10 Park Plaza - Suite 5170
Boston, MA 02116
i of valid without signature
Customer/Homeowner Name
Company Name
Albert 'Taylor
Precision Roofing, LLC
MA HIC # 130275, exp. 2/9/2016
Street .A.ddress/Jobsite
Contractor/Business Owner Name
60 Russell St.
Erik Hammar
MA CSL # 99691 (RF, WS), exp. 10/17/2015
City/Town State Zip
Business Address
126 New Estate Rd- Littleton, MA 01460
North Andover MA 01450
PAyfigle, Phone 508-265•-1853
Mailing Address
Evening Phone
P.O. Box 653, Acton, MA 01720
Kptaylor219@comcast.net
Business Phone
978.63 5.1023
Federal Employer ID
20-2820250
WORK TO BE PERFORMED AND MATERIALS TO BE USED
Contractor agrees to do the work, and to furnish the materials, described below for Homeowner:
• Acquire all necessary permits.
• Install tarps prior to shingle removal to protect the house, landscaping, decks and A/C units.
• Strip off all old shingles from roof, de -nail substrate and repair/replace rotted boards.
• Nail off any loose substrate sheathing.
• Install F remium .018, 8 -inch mill finish aluminum drip edging along all roof side (rake) edges.
• Install new mill finish aluminum vent pipe flanges.
• Leave in place and re -use existing aluminum step flashing where rooflines join vertical walls.
• Install new aluminum flashing around chimney under/behind existing lead flashing.
• Inspect existing lead chimney flashing for adequacy with Contractor's 10 -year Warranty.
• Install Air Vent,-Inc.'s ShingleVent° II ridge vent at all ridgelires, per manufacturer
specifications.
• Apply a 6 -foot width of Grace Construction Products' Ice and Water Shield' underlayment as
follows: along roof bottom edges; up valleys; around skylights, chimney and vent pipes.
Application will extend under existing step flashing.
• Install Manufacturers Synthetic underlayment over remaining exposed sheathing. Installation will
extend under existing step flashing.
• ; Install CertainTeed Landmark / Owens Corning Duration Limited Lifetime architectural roof
shingles of select color, following manufacturer's application specifications.
• Install CertainTeed / Owens Corning factory enhanced starter strips along eves and rakes and
factory enhanced Ridge cap. Increasing wind warrantee to 130mph.
• Fasten roof shingles with six nails per shingle following manufacturer's nailing pattern. Nails are
galvanized steel 1'/a" by 1/8" smooth shank with 3/8" diameter head. No staples will be used.
• Clean and sweep jobsite daily with a magnet.
• Remove old shingles and related debris from job site.
• Clean jobsite grounds upon completion of all work described.
• Leave two bundles for home owner when job is complete.
Homeowner's Initials / I of 2 Contractor's Initials
OTHER CONDITIONS, WARRANTIES/GUARANTIES, WORK SCHEDULE
• Work area to be completed is the entire main roof and garage. Exposed areas will be protected from
inclement weather.
• Total Contract Price includes replacement of two(2) 1" x 8" rough cut spruce barn board.
Additional board replacement will be $3.00 per liner foot, installed.
• Price to replace rotted or broken trim boards will be $5.00 per linear foot, installed. Replacement
primed pine board dimensions will match existing trim boards.
• Total Contract Price includes disposal fee for old shingles and related debris.
0,:' CertainTeed's Limited Lifetime Warranty on shingle materials is per Homeowner's registration
J available online at www.Certainteed.com.
• Total Contract Price includes Contractor's 10 -year Warranty on labor covering any leaks associated
with poor workmanship: clumney-roof flashing joints, loose sheathing, raised nails, low nails,
sunken nails, bent nails, improperly installed ice and water, paper, or shingles.
• Precision Roofing, LLC is not responsible for existing hidden damage, excessive rotting etc., and if
discovered will cause all work to cease until there is an agreeable solution between both parties.
• Permit cost vary greatly from town to town, permit cost will be additional to the final bill
based on your towns rate.
• The following schedule will be adhered to unless circumstances beyond contractor's control arise:
Work Scheduled To Begin: 1/12/2015 Work Scheduled To End: 1/13/2015
The dates above are ballpark time frames. An exact date will be given upon the return of this contract.
PRICE AND PAYMENT SCHEDULE
Contractor agrees to perform and warrantee the work, plus furnish the materials and labor, as specified
above, for the SUM of. $10,800.00
Homeowner agrees to make payments according to the following SCHEDULE (Cash, Check, Visa,
MasterC-cu-d, American Express and Discover are accepted): (American Express will be subject to 1.5% surcharge)
1/3 upon signing the contract.
2/3 upon completion satisfactory to all parties of all work described herein.
All home improvement contractors and subcontractors shall be registered in Massachusetts. Inquiries about registration
should be directed to: Office of Consumer Affairs and Business Regulation
Suite 5170, Ten Park Plaza, Boston, MA 02116; 617.973.8700
Homeowners who secure their own construction -related permits or deal with unregistered contractors shall be excluded
from access to the Guarantee Fund.
A copy of this contract will be kept by the Company and should also be kept by the Homeowner.
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY .BLANK SPACES
Homeowner's Signatures'` D to Contractor's Signature Date
Homeowner may cancel this agreement if it has been signed by a party thereto at a place other than an address of
the seller, which may be his main office or branch thereof, provided Homeowner notifies the seller in writing at
his main office or branch by ordinary mail posted, by telegram sent or by delivery, no later than midnight of the
third business day following the signing of the agreement.
Precision Roofing, LLC www.precisionroofing-lle.com
2 of 2