Loading...
HomeMy WebLinkAboutBuilding Permit #100 - 623 TURNPIKE STREET 8/8/2007 taORTFi i, 0 BUILDING PERMIT .,Lao 6 0 TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received 3 ACHU Date Issued: —0 IMPORTANT:Applicant must complete all items on this page OCATION o T . ' w Pi n RFTY-OV4ER ,PVrJKrx $ x rPrint MAP '' ' NO PARCEL Z0 NING DISTRICT Ye ,-no Mkfi "Iggg, yes o J TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential 0 New Building P16ne family 0 Addition El Two or more family El Industrial _E1 Alteration No. of units: El Commercial epair, replacement El Assessory Bldg El Others: _E1 Demolition El Other I i0l'P 11 Floodplain MCMA istr, a go�ptid, J 6,dplairy 4�'it]Va" "080 '�W'''- . ,r a g, Ma DESCRIPTION OF WORK TO BE PREFORMED: Sky 1 0 r&w'� '6 VL A)L'.L AA'a %A V_e>r_1 Identification Please Type or Print Clearly) OWNER: Name: Lkla 11 �4 AMtg PhoneS7&-(oa&-35-3-7 Address: rx' CONTRACTOR e 4 T R Name hone, Add'e' ss: "W1 Np­ 'Y n,,L'iicense., uoervisor' "6nstructi6 " Date: X, 4 �Home,ln proyehlihfi`bh"se- Exp. Date: 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: $ FEE: $ 7a Check No. -4 Receipt No.: '004a94 NOTE: Persons cont acting w-#h-r nregistered contractors do not have access to the guarantyfund r%+/ Signature Own r 5ig,naure of Agent/T 9 or, No"IM BUILDING PERMIT TOWN OF NORTH ANDOVER F i -. • . A APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received SAc U`� 0 Date Issued IMPORTANT Applicant must complete all items on this page �I'll, Ai �� r �� a � �'" � ll It -f - TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family [I Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other lads DESCRIPTION OF WORK TO BE PREFORMED: Identification Please Type or Print Clearly) OWNER: Name: Phone: Address ift AM- u m 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: $ FEE: $ Check No.: Receipt No.: {: NOTE: Persons contracting with unregistered contractors do not have access to the guaran ty fand a 5 S gtUe � � Slgnattare of Agett/O�uner- M.. . ,..w. a rt � a ��.�_ i Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ 9 Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ t THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED 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 Dri ewa Permit Located at 384 Osgood Street �R PA TM NT l ernp L)uMT s erlbn sit es �' r . �. 455��'` of I Dimension II 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 droprequires Electrical Inspector Yes No q approval of I E DANGER ZONE LITERATURE: Yes No � MGL Chapter 166 section 21A—F and G min.s100-s1000 fine I i NOTES and DATA— (For department use i I i II I I ❑ Notified for pickup - Date ..._..._......._._..........._........_....._..._....................._.........__._.....---...._..............._._................... Doc.Building Permit Revised 2007 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 NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application o Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ 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 j ❑ 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 u 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: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 I Location�od3 / ilf, q No. Date NORTh TOWN OF NORTH ANDOVER ` f 9 3 Certificate of Occupancy $ �sNUsE<�' Building/Frame Permit Fee $ Foundation Permit Fee $ _ Other Permit Fee $ TOTAL $ Check # 20472 Building Inspector NO R TI-� Town of And No. o 0 .:. ,.r,. 0 LAK o �` dover, 1VIaSS., COCHICHEWICK 7�AoRATED PP�t-`C7 BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System • BUILDING INSPECTOR THIS CERTIFIES THAT......... ... ..�... ......... Foundation � has permission to erect.......... � �............................ buildings on ... 2.3.......�..........4L.......... .�....'..�......441.r Rough to be occupied as......5 .........�....A&$....L. Chimney .......... provided that the person acce �this permit shall in eve ii ~- ,t coform to the terms of thea lication on file inP P P g P rYPP Final 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 CONSTRU T Rough .................... ....... ................................................:.....INSPE..... Service BUILDING Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. Burner FlRE DEPARTMENT Street No. SEE REVERSE SIDE Smoke Det. Wally&Maureen Amigo �2 $�__0 623 Turnpike St. Roofing • Siding 7 North Andover,MA 01845 (978)688-3537 —------------- - -- ---- . -----_-- ----- Dear Wally&Maureen Amigo, ----- --------- The following estimate is for the roof installation for the property locat work that will be performed. In addition to installing your roof, I woulc from GAF or CertainTeed. We, as GAF Master Elite Certified Installer you with a 25-30 year labor warranty directly from the manufacturer.To please visit our website @ www.olympicroofing.com Installation Pre ------ Strip existing roof on the main roof&garage or back part of main roof(upper portion) -k Install an 8 inch drip edge on all leading edges(rakes&fascia) 4 Install ice&water on all leading edges&valleys 4� Transitional walls are optional and incur an additional cost for the siding repair 4 Install new vent pipe flanges Replace any rotten or damaged decking(we allow 32SF @ no charge,$60.00/sheet thereafter) 4L Replace any rotten or damaged ledger board(we allow 30ft.at no charge,$3.00/ft.thereafter) 4 Install 15 pound felt paper on all areas that is not covered by ice&water shield ak Install new GAF 3-TAB shingles 4 Install new Cobra ridge vent system 4 Option 1(Chimney): Strip existing lead around the base of the chimney. Install ice&water shield around the base of the chimney. Install step flashing around the base of the chimney. Install new lead flashing around the base of the chimney. Option 2: If we can leave an Olympic sign in front of house for(3)weeks after job is completed,the price of the roof will be discounted as shown below. Additional Specifications Homeowner to choose color of shingles COLOR:S C a/Eg� 4 Our dumpsters are sent to a recycling facility;therefore no additional trash may be placed in them. The transfer station will charge us a fee for additional trash which will be passed on to the homeowner. 46 Transition walls are an option,and if the existing flashing is in good shape,usually do not require replacement 4- During a roof job,it is not common for the nails to break the sheathing during the nailing of the shingles 4 We are not responsible for any of the cracks that may arise in any walls or ceilings 4 Please cover all your floors in your attic to protect from dust and debris We will remove all of the job related debris Permit costs vary from town to town and are not included in this bid Initial the options you are choosine below: Cost for Labor&Material for Entire Roof&Garage: $5,500.00 Cost for Labor&Material for Main House only: $3,900.00 c Cost for Labor&Material for Entire Roof&Garage(Option 2): $4,995.00 Cost for Labor&Material for Back Upper Part of Main Roof- $1,500.00 Cost for Labor&Material for Chimney Option: $ 495.00 Cost for GAF Smart Choice Warranty: $ 250.00 Payment Terms: 1/3 deposit$��p0 _,1/3 work in progress$ and 113 upon completion$ Please make payments to Alpine Property Services and Inc. Total Amount Agreed To Be Paid: $ ss-c)c 2 Warranty: Olympic Painting and Roofing guarantees all work performed for a period of one year. If any problems occur we will cover the cost of all labor and material to correct the problem and meet the customer's satisfaction. o not sign this contract if there are any blank spaces. onal provisions follow and are incorporated herein by this reference) David Hodge,Sales Manager Wally,6'r N45ur-een'Purigb Alpine Property Services Company Inc., Homeowner Tel: (800) 535-4312 • Fax: (978) 535-2008 • 515 Lowell Street • Peabody, MA 01960 1-888-5 OLYMPIC • www.OlympicContractors.com 15 Tanguay Avenue 117 South Killingly Road The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.g ov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): U Cg V,-, �— Address: City/State/Zip: `P Cx�h LA int(a( Phone #:560 3� Are you ployer?Check the appropriate box: Type of project(required): 1. am a employer with ©2--2> 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7• ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 1 I.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12. oof repairs insurance required.] t employees. [No workers' I31-1 Other comp. insurance required.] *Any applicant that checks boz#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. $Contractors 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: Nom.✓l+� �[ Y�� T_7n_su� Policy#or Self-ins. Lic.#: VJC_VC�`7:>1'7a-� Expiration Date: I 1 �' c3 Job Site Address: (!:t X3 U i'v�, q— 5� City/State/Zip: <A�,A�-M�- 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. BVeverification.dvised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance ove I do hereby certify under the p ins a nalties of perjury that the information provided above is true and correct. 1 a ure: Date: CS-7 Phone#: r0-0 — 3-.;-- Official .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#: 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 of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or.more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an 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 be deemed to be an employer." r l MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." 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 of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s), address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than 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 may be submitted to the Department of Industrial Accidents for confirmation of insurance 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 or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials J , J Please be sure that the affidavit is 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 a reference number. In 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"Job 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 may be provided to the applicant as proof that a valid affidavit is on file for future pen-nits or licenses. A new 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 burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts , Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-7274900 ext 406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 5-26-05 www.mass.gov/dia ACORD os/14/2007 CERTIFICATE OF LIABILITY INSURANCE DATE T""' ,a/zoo7 PRODUCER Pf ( 7-5110 Fax: (817)857 KNIGHT INTERNATIONAL THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ATIONTIONAL INSURANCE GROUP UP ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 500 VICTORY ROAD HOLDER_ THIS CERTIFICATE DOES NOT AMEND, EXTEND OR MARINA BAY ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. QUINCY MA 02171 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Clarendon America Insurance Company ALPINE PROPERTY SERVICES CO.,INC. INSURER 8: Merchants Mutual Insurance Company 11 WILSON STREET SALEM MA 01970 INSURER C: Hanover Insurance INSURER D: Atlantic Charter insurance Com any COVERAGES INSURER E: 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 HERRN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IIITTRR NSR TYPE OF INSURANCE POLCYNUmQFA POLICY EFFECTIVE voucwEYOIRgTWn LIMITS DATE MMIDD DATE GENERALLIABILnY H440000161-0 01/04/07 01/04/08 EACH OCCURRENCE 1,000,000 X I COMMERC AL GENERAL LIABILITY 0�6E TO RENTEO r—; PREM ES Y eonm,,,e:) 5 50,000 CLAIMS MADE� OCCUR MEO.EXP(Any one person) S 5,000 A �_..._.. PERSONAL&ADV INJURY S 1;000,000 GENERAL.AGGREGATE $ 2,000,000 GEN L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG. $ POLICY JECT : X -LO(; 1.000,000 AUTOMOBILE LIABILITY AFN 85715"0 01/09/07 01/09108. COMBINED SINGLE LIMB X ANY AUTO (F,aacpoprn) $ 1,000,000 ALL OWNED AUTOS BODILY INJURY C A' SCHEDULED AUTOS (Per person)) $ X : HIRED AUTOS X ' NON-OWNEDAUTOS (OTDILY,c�I em)RY $ PROPF.RTY DAMAGE S GARAGE LIABILITY (Per aai0e� AUTO ONLY-EAACCIOE ' S ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG 5 EXCESS/UMaRELL_A LIABILITY CUP9138304 01101/07 01/01/08 EACH OCCURRENCE $ 5,000,000 X OCCUR CLAIMS MADE AGGREGATE $. 5,000,000 B ' S DEDUCTIBLE S " X RMNTION S 10,000 $ ORKERS COMPENSATION AND WCV00754900 01/05/07 01/05108 X o T AW ; 'OTHER EMPLOYERS LIABILITY D ANv PROORIETOWAQ�ERjE X9-CuTIVE EL EACH ACCIDENT S 100,000 — CERIMFJMBER EXCLUDED? ymOewnbeunder ELDISEASE-EAEMPLOYEE $ 100,000 CIALOROV*tONS brWw E.L DISEASE•POLICY LIMIT s 5003000 OTHER: DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SAMPLE...SAMPLE...SAMPLE SHOULD ANY OF TI4C ABOVE DESCRIBED POUCIFS BE CANCELLED BEFORE THE EXPIRATION DATE THEPEOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOIIGE 10 1 HE CEKTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABtUTY OF ANY KIND UPON T14C INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORI23ED REPRESENTATIVE Attention; Harold night ACORD 25(2001108) Certificate# 6824 ®ACORD CORPORATION 1988 License o Board of Building Regulations and Standards 1 c�.q.. -----. . before the expiratton:date. If found return to: HOME IMPROVEMENT CONVtACTOR Board of Building Regulations and Standards Registration: .154326 One Ashburton Place Rm.1301 Expiration: 2/27/2009 Tr# 254379 'Boston,Ma.02'108'. Type: Private Corporation ALPINE PROPERTY SERVICES CO,INC. STA RROS.MOUTSOULAS "'��""'� Not vagi. without.signatu e 11 WILSON STREET Administrator Y. SALEM,MA 01970 Board of Building Regula ions and Standards One Ashburton Place - Room 1301 Boston, Massachusetts 02108 Home Improvement Contractor Registration Registration: 154326 Type: Private Corporation Expiration: 2/27/2009 Tr# 254379 ALPINE PROPERTY SERVICES CO, INC. STARROS MOUTSOULAS 11 WILSON STREET SALEM, MA 01970 Update Address and return card.Mark reason for change. DPS-CA1 0 50M-05/06-PC8490 F� Address 0 Renewal E] Employment Ej Lost Card