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HomeMy WebLinkAboutBuilding Permit #813-15 - 63 HOLLY RIDGE ROAD 4/16/2015BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: I Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION -L3 � 0Ay_ Print _ PROPERTY 01NNER__ _ _ �_ �- _. V C� Print 100 Year Structure I ti. MAP PARCEL Z®NING'DISTRLCT. �t-listoric District a _ Machine Shop, Village V -'(t LED 1646N� O? 7eRp�f%ATED yes A011 TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial 101teration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other — — El Septic ❑ 1Nell _ ❑�Floodplai_n Q Wetlands ❑ Watershed District nVater/Sewer DESCRIPTION OF WORK TO BE PERFORMED: A,< l _- _, n.l. F11( I,.,- r,—a4 23O' 4- o : �� s OWNER: Name: A(irlrPcq- Identification - Please Type or Print Clearly Ala "7'kS Phone: CoritraetorNarne -- - _ Address:.- --- - Supervisor's Construction Licen_$e' ARCHITECT/ENGINEER vi —WFA Exp bate: Phone: Address: Reg. No. FEE SCHEDULE: BULDING PERMIT; $92.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ ,[�,�SS✓C7 FEE: $ 14;L— A Check No.: R tly 1� Receipt No.: A�501, NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanuing/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 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 r. I '?lanning Board Decision: Comments { Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street iFIfRE+D`-PARTME'NT ;Tiem;p l y PA urn er on " �y nog I atecigat� 04 Main Street a PA pis g, Ite es ;Fire Departmenrt si' tureldate �. , gra - o-� 7 - 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 NU its and UA I A — (t -or department use ❑ Notified for pickup Call Ema I Date Time Contact Name Doc.Building Pennit Revised 2014 Z 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 ❑ 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 -AJ No. v Date iQ TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee Other Permit Fee $ t TOTAL $ �� � ��-� sir:► rlqmr� �w ca o ,AGO v i 0 M CD Z Lid W. x LLIM LLI a— Z O CO LLIJ �7 v v O W O O ♦J O Z N Q W Q N m m a 0 i O 0 0 O C' a CL �a o m ca V J � �CL O �Z.ci O U c� m CL C = O cc Cc O v, .Q � Q as J Q Lj- O Q v Y Q O O LL E vwi In T N U Q N (n p W z Z m 'D 7 O LL L 7 O O' C L U (9 O LL O W z Z J d L 7 O 0' O LL ® v W L � O OC U i (n N O I.l O: O a Z Ln Q L O O d' _ fD O LL Z W W W LL O co O Z O1 {% Y 0 41 Y O V1 ca o ,AGO v i 0 M CD Z Lid W. x LLIM LLI a— Z O CO LLIJ �7 v v O W O O ♦J O Z N Q W Q N m m a 0 i O 0 0 O C' a CL �a o m ca V J � �CL O �Z.ci O U c� m CL C = O cc Cc O v, .Q � Q as � Q O, r r. N Q. N � � d O ca o ,AGO v i 0 M CD Z Lid W. x LLIM LLI a— Z O CO LLIJ �7 v v O W O O ♦J O Z N Q W Q N m m a 0 i O 0 0 O C' a CL �a o m ca V J � �CL O �Z.ci O U c� m CL GCL CONSTRUCTION PROPOSAL project roofing City..zip North andover attn rosemary Address 63 holly ridge rd company Gcl construction Bid date 04.09.15 Tel/fax/cell Heard of us by friend Based proposal as per attached scope of work: Alternates: Any Additional customer requested carpentry work will be billed at per hour + material. Proposal to remove 1 layers of roofing and replace roof shingles secure required building permit protect building and grounds remove and dispose of existing roof shingles inspection of sheathing and penetration Flashing renail loose boards as needed sheathing rot replacement priced at $60 per 4*8ft masonry work chimney re -leading included warranty from labor - install new pipe boots install new ridge vent On roof install ridge ca �aF Ice &Water shield 6 ft from edge install new aluminum drip edge on perimeter of roof and eaves areas install new 30 year shingles certainteed select shingle master warranty 5 -star coverage upgraded wind warranty 1 IOmph or 13Omph clean roof gutters and downspouts thoroughly clean grounds daily of any roof Shingles type color to be determined at meeting with contractor ? TCf Note: Price only valid for 14 days. PAYMENT: A non-refundable deposit Of 1/3 of ALL ACCEPTTED PROJECTS is due upon authorization is the amount of _$_11Meach 00 with the 1/3 of EACH PROJECT, and the balance of EACH PROJECT due upon completi iproject along with any addition work requested by customer. DISCLOSURE: State law requires us to inform you of contact liens. Any Contractor, supplier or subcontractor may lien your real property if you or the general contractors fail to pay for goods or services delivered or installed at the work location. Some contractors and suppliers atomically send lett ers0fnotifrcation Simi-lar-to-thisnequest;we-will-provide-origirral lierrrele-ase documents from anyone who provides said material or services. Please call if you have any questions regarding liens. ACCEPTANCE: The signature on this proposal reflects acceptance of the proposal as per the attached scope of work, authorizes commencement of the work and hereby guarantees payment as outlined above, Any amounts not paid within thirty days of invoice are subjective to service charges 1 %i % per month (180/oAPR). All cost of collections, including reasonable attorney fees are to be paid by customer. You may cancel this transaction at any time prior to midnight of the contract amount if the job is cancelled by customer after three business day. PERMITTING: The signature on this proposal authorizes a representative of gel construction to sign for and obtain any permitting necessary to complete this project. -- -- -- -------- ----- ----f ome wner/Builder Datecustomer signature Date The Commonwealth of Massachusetts M Department oflndustrialAccidents 1 Congress Street, Suite 100 Boston, MA. 02114-2017 www mass.gov/dna Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PER1YETTING AUTHORITY. Applicant Information L Please Print. Legibly Name (Business/Organization/Individud): (36L • � 9hQCAt'01I Address: 10a'4 O cLln(44:: A Qa+ W-77 City/State/Zip: Phone #: 0 :2,30 7 765 Are you an employer? Check the appropriate box: Type of project ()required): 1.[ T am a employer with _employees (full and/or part-time).* %, Q New construction 2. ❑ I am a sole proprietor or partnership and have no employees working for mein 8. Fj Remodeling any capacity. [No workers' comp. insurance required.] 9. ❑ Demolition 3.Q I am a homeowner doing all work myself. [No workers' comp. insurance required.] t 10 [] Building addition 4. ❑ 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 ft.FJ Electrical repairs or additions proprietors with no employees. - 12. E] Plumbing repairs or additions S. ❑ I am a general contractor and I have hired the sub -contractors listed on the t ached'sheet. 13. ROOf repairs These sub -contractors have employees and have workers' comp. insurance. 6. Q We are a corporation and .its officers have exercised their right of 'exemption per MGL c. 14. Q Other 152, §1(4), and We have no employees. [No workers' comp. insurance required.] , *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 din an employer than is providing workers' compensation insurance for my employees.' Below is the policy and job site information. Insurance Company Name: t�J Policy # or Self-ins.� ( , Lic. #: `a �d1:8Expiration Date: 3 Job Site Address: 3 hQl 1 y riAti, PGC City/State/Zip: 9, Q,17C& J0,f 0,� 3S� Attach a copy of the workers' compe, sation poliy 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 certify under the pains and penalties of perjury that the information provided above is true and correct. 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 emplotyees. Pursuant to this statute, an employee is defined as ...every person in the service of another under any contract o'?Mfe; 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." 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 commonNyealth 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=contractors) 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 foi• confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the cityor 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' compensatiod 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 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 permits 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 Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 02-23-15 www.mass.gov/dia '°'� "® CERTIFICATE OF LIABILITY INSURANCE DAT4/16/DI15 04!16!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 CONTACT NAME: Finnerty Insurance Agency INC.PHONNo Ext): (781)337-1009 FAIL No): (781)337-1171 ADDRESS: bdan@finnertyinsurance.com 1598 Main Street INSURER(S) AFFORDING COVERAGE NAIC # Weymouth, MA 02190 Phone (781)337-1009 Fax (781)337-1171 INSURER A: PROVIDENCE MUTUAL $ 1,000,000.00 INSURED INSURER B : TRAVELERS GCL Construction INSURER C : INSURER 0: DAMAGE TO RENTEDEa occurrence) PREMISES xurrence 102 Walnut Street Apt #7 MED EXP (Any one person) $ 5,000.00 Abington MA 02351- INSURER E: INSURER F GUVtKAbtJ GtKI II-IGAIt NUMISLK: - 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 I TYPE OF INSURANCE ADD UBR POLICY EFF POLICY EXP LTR INSR WVO POLICY NUMBER MM/DD MMIDDIYYYYI LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00 0 COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTEDEa occurrence) PREMISES xurrence $ 50,000.00 MED EXP (Any one person) $ 5,000.00 OCCUR [-]CLAIMS-MADE E]OCCUR A F]PERSONALBADVINJURY 0077924 01 05/07/2014 05/07/2015 $ 1,000,000.00 ❑ GENERAL AGGREGATE $ 2,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000.00 ❑ ❑ ❑ POLICY JET LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ❑ ANY AUTO BODILY INJURY (Per person) $ ❑ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident $ ❑HIRED AUTOS NON -OWNED ❑ PROPERTY DAMAGE $ AUTOS Per accident ❑ ❑ $ ❑ UMBRELLA LIAB ❑ OCCUR EACH OCCURRENCE $ EXCESS LIAB ❑ CLAIMS -MADE AGGREGATE $ ❑ DED ❑ RETENTION$ $ WORKERS COMPENSATION El PER ❑ AND EMPLOYERS' LIABILITY Y / N STATUTE ERH ANY PROPRIETOR/PARTNER/EXECUTI� B OFFICERIMEMBER EXCLUDED? NIA 7PJUB 2E79058 03/19/2015 03/19/2016 E.L. EACH ACCIDENT $ 100,000.00 (Mandatory in NH) E.L. DISEASE - EA EMPLOYE $ 100,000.00 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 500,000.00 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) VCRI lrl%,P%IQ r7ULUCR TOWN OF NORTH ANDOVER 120 MAIN STREET NORTH ANDOVER MA 01845 1. ACORD 25 (2014101) QF t:AN V tLLA I IUN 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 ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Office of Consumer Affairs & Business Regulation - Mass.Gov Page 1 of 1 The Official Website of the Office of Consumer Affairs & Business Regulation (OCABR) ` Consumer Affairs and Business Regulation Home Consumer Rights and Resources Home Improvement Contracting Home Improvement Contractor Registration Lookup To search by registration number, enter the registration number in the textbox below and click the 'Search' button. Search by Registration Number Search To search by other fields, enter the search criteria in the fields below and click the 'Search Registrants' button. For the State field, use the two character state abbreviation such as "MA "for Massachusetts and "RI" for Rhode Island. All search fields allow partial text so the search will look for any values that begin with what was entered. For example, if you enter "Fr" in the City/Town field and "MA" in the State field then the search will return records for Framingham, Franklin, and Freetown which all begin with "Fr" and are located in Massachusetts. To return less information enter in more criteria. For instance, entering in a state of "MA" will return a large number of records but entering in a state of "MA" and a city/town of "Medford" will lower the results. Search by Registrant's company's name Search by Registrant's last altif name City/Town !State ' ip ! _ _ .._ code Search Registrants Click on the registration number to view complaint history. You can also view arbitration and Guaranty Fund history. The list is current as of Wednesday, April 15, 2015. Search Results REGISTRANT RESPONSIBLE REGISTRATION EXPIRATION ADDRESS STATUS NAME INDIVIDUAL NUMBER DATE MEADOWBROOK ALTIF, JOHN 175504 2 REBECCA AVENUE 05/16/2015 Current MOBILE HOME PARK HUDSON, MA 01749 2012 Commonwealth of Massachusetts. Aass.Gov® is a registered service mark of the Commonwealth of Massachusetts. http://services.oca.state.ma.us/hic/licenseelist.aspx 4/16/2015 Ma sachiisettsry-iep Hoar,>d o€-Bca i�f �trc 5fet ., t�cdittg i2egutatioeSSiarcdar onstr¢etion acehsPq e: CS-0998p _Joh .TAItif .4f 2 ©alcr►ood ' n n r " $vrciesLer 1VIA . 0Y6W ,,� xP. Itx ° .. 'nfn ssianer 't' ` Expiration 0 w 2/09/2016