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HomeMy WebLinkAboutBuilding Permit #439-2016 - 64 PHILLIPS COMMON 10/7/2015 t t%ORTH BUILDING PERMIT oF�tE° ,b�tio TOWN OF NORTH ANDOVER o APPLICATION FOR PLAN EXAMINATION ?° m N y^ //0 Date Received V Permit No#: R"TE° gSSACHus�� Date Issued: 6- IMPORTANT:Applicant must complete all items on this page •� r S n LOCATION Print PROPERTY OWNER L eA Sf A4D/1 Print 100 Year Structure yes no MAPOISB PARCEL: So� ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family [I Addition ❑Two or more family [I Industrial Iteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other .� {Wella "^ `` �� 4 ,Wetlands. ® 1IU`a hetl DiStrict Septic ❑ ; �,ooh p a:m� t DESCRIPTION OF WORK TO BE PERFORMED: IdentifiFatio - P lease Type or Print Clearly OWNER: Name: Ut Phone: Address: 3. Contractor Name: 1/i� Cx>lG?G" o Phone: 5 Y-r7 Email: Address 3 6 &,� 5 -F- Supervisor's Construction License: to rc{ it 5 Exp. Date: -7©Sr75r Exp. Date: Home Improvement License: — 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. 101060() FEE: $ Total Project Cost: $ Receipt Check No.: 29q 0 NOTE: Persons contracting with unregistered con ractors av a cess to the guaranty fund C L - Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swim,ning pools Elwell ❑ Tobacco Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ Food Packaging/Sales ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF m U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS i Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes L Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Signature ®ate Driveway Permit DPW Town Engineer: Signature: r R Located 384 Osgood Street *rrE•-c-�.�.�..€K'"�r�,csrd*az �;�-+. , -r { :;,� �•r'= �•, P w� .�- ,FIREARilTh ENT Ternp ®umpste,V?%site yes Located at 1824 Streeth x" "a�'a- , ` * ; ;, '•; .rte. "' �rtment SI n e�Qat@i rrt`;`� +� ►,° r� ` s � `,. ' :*. t�* Fire Dep a Tti y< _, ,�. .€'Yipt '=r' `'�#X. a"3l F"i �tphl'��`'..,�!..� t*�-s�r 7����'• (i3�'��"�� �� 3 .��; i ��-� ����iu 3 �e �' 7S �t� -a` 7�3 Gr { e 'a �7 ;7gJi tc1 sem"`,} e�. '`i�"� yr 9 r L { 4 .(dig }k y� S �" �# a r _ �� `C~$� #� r s'SLi:'4e°� �2 .'.`�,i�li�'`.+�6.� 4,,,yxs`. '''3 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.$1oo-$1oo0 fine NOTES and DATA-- (For department use) a ® Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 i Building Department appropriate The following is a list of the required forms to be filled out for the pe rmit to be obtained. Roofing, Siding, Interior Rehabilitation Permits 4 Building Permit Application 4. 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 OTE: 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 1 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 OTE: 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 2012 IECC Energy code Engineering Affidavits for Engineered products OTE: 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 ocat on J Na �' � � Date f�17A 5 • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ /3 d Foundation Permit Fee $ Other Permit Fee $ TOTAL -$ Check# , f: f Building Inspector NORTH own o s^a 1, Andover O " 1 No. ver, Mass, �F o LAKII 1. COCNICHEWICK V S U BOARD OF HEALTH Food/Kitchen PER- MIT T LD Septic System THIS CERTIFIES THAT , BUILDING INSPECTOR .........:.."R'Ai�`. ... o .... ........ ..... ..... .. ��y,� Foundation has permission to erect .......................... buildings on :`.!'!••1...P�.'hvat.. � �. ........... Rough pi „� .. . .... e.r.�a.% y t0 be occupied as ............ .... ...... ..................................................................... Chimney provided that the person accepting t is 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 CONSTRUCTIONS RTS Rough ............ Service ............... ........ . ,� ... '�`"""''"""' Final UILDING 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. CD Roofing Vincent Colangelo 3 Hodgson St. o o Tewksbury,Ma 01876 •THERE'S NO ROOF WE CAN'T COVER 978-656-8497 97 4S- 656-48497 i vincentcolangelo@sbcglobal.net • • • HIC Llc# 170575 CSSL Lic# 105943 00 Customer: 4� 1��-�c10 OWENS CORNING (H PGI411PS CAAA) PREFERRED CONTRACTOR AJ- l .,�dovr qZ� ���s'� Of(o� Description of work Performed: (Obtain required town permits& provide certificates of insurance&workers compensation Provide Dumpster set on planks*for contractors use only(materials all recycled) (Attach Large Tarps to protect adjacent finishes, landscaping,and property. Strip-off( ( )existing layers of roofing on complete house& re-nail any loose decking Install 8inch _Aluminum Drip edging/Owens Corning Starter Shingles Install Owens Corning Ice&Water shield Eft at eaves, 3ft in valleys, around all penetrations i, Install Synthetic felt paper to entire roof Oc Install Owens Corning LifeTime warranty Tru Definition Duration shingles Fq Install new neoprene vent pipe flashings on all plumbing pipes Install Owens Corning VentSure ridge venting with moisture guard Install Owens Corning ProEdge hip& ridge cap shingles NP Camilla • ro �ns V With le_ad... NOwens Corning Preferred contractor installation with full warranty re-por b a l,e- ha*- roo# on -ro i,v+ 4 1,cSe All work will be completed according to state and manufacturing codes and specifications. Every day we will have the roof water tight,cleangutters, completely Ma an the j b site, and use a magnet roller to collect scattered nails. /./ L / Additional work to be performed /+ a �� �. PCO pk u�o w�eQ d S ac-S All material is guaranteed to be as specified. All work to be c4pleted in a workmanlike manner according to standard praitices. Any alteratio or deviation from the above specifications must be made in writing on an Add-on/Modification of Contract form and may become an extra charge over and above the amount stated herein. This agreement is contingent upon delays beyond our control.Owners to carry fire,tornado and other necessary insurance.Our workers are fully covered by Worker's Compensation Insurance. Homeowner agrees to pay for all work as set forth below. If the homeowner defaults, homeowner agrees to pay all costs of collection, including reasonable attorneys fees,in addition to other damages incurred by contractor.Full Payment is due upon completion of work. We propose hereby to furnish material and labor - complete in accordance with the above specifications, for the sum of: dollars($ MI 80C_)_ 0 ). Said amount shall be paid as follows: Note:This proposal may be withdrawn by us if not accepted within 6� days. YOU, THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT F— THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION. SEE THE ATTACHED NOTICE CANC TION FOR AN EXPLANATION OF THIS RIGHT. THIS SALE IS SUBJECT TO THE PROVISIONS O OME S61_1C ATION SALES ACT AND THE HOME IMPROVEMENT ACT THIS INSTRUMENT IS NOT NEGOTIABLE. a Work will not begin until,vour right to cancel has expired and paid d osit of ` dollars($ �,v�d ) unless this agreement provi s is I Signature of Contractor or authorized representative: *(I/We)have read the terms stated herei ;t y have been a ained to(me/us),and( )f. them to be satisfactory and hereby accept them. Signature of Homeowner(s): 3 &pfe y � CD - �v I i II' The Commonwealth of Massachusetts x Department of IndustrialAccidents 1 Congress Street, Suite 100 Boston,MA.02114-2017 " F www mass.go /dia . yJ♦ Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legib Name (Business/Organization/Individual): V1 all p a j Address: ILdu SUn Sf City/State/Zip: GU(,,/ Phone#: �{ 28 ` 5'6-SVQ"? Are you an employer?'Check the appropriate box: Type of project(required): L❑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 8. EIRemodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3..❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]t i 10E]Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my properly. I will ensure that all contractors either have workers'compensation insurance or are sole 11.[J Electrical repairs or additions proprietors with no employees. 12.E]Plumbing repairs or additions 5.rM I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.$ 6.❑We are a corporation officers have exercised their right of exemption per MGL c. 14.F1 Other ,and its o., , 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 submif 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. lam an employer that is providing workers'compensation insurance for my employees.'Below is the policy and job site information. Insurance Company Name: ,q Q c{ ,/% S ri Policy#or Self-ins.Lie.#: Loa 1 bof(,2,7(2 Expiration Date: Job Site Address: lri s CO AIM v/1 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$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cer • u eritliep i andpenalties ofpeijury that the information provided above is true and correct. Si ature Date: / Phone#: 7 4�—G ^$tl 4 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 b6 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 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-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 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 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 ACo CERTIFICATE OF LIABILITY INSURANCE °p'' `"°"/D°"yYY' 4/23/15 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 play require an endorsement. A statement on thi s certificate does not confer rights to the certificate holder in lieu of such endorsemen PRODUCER CONTACT Angela Westen Insurance Agency PHONE FAX 557 Central Street mall 978 735-4094 N : (978) 735-4095 ADDRESS: angela@awesten.com Lowell, MA 01852 INSURE S AFFORDING COVERAGE NAIC# INSURER A:ATLANTIC CASUALTY INSURANCE CO INSURED INSURER B:HARTFORD UNDERWRITERS INS COMP FO CONSTRUCTION CORP. INSURER C: 40 READ ST. INSURER D: LOWELL, MA 01850 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVP POLICY NUMBER M/DD/Y MMIDD/YYYY LIMITS A GENERAL LIABILITY L021008696 3/18/15 3/18/16 EACH OCCURRENCE $ 11000,000 ]C COMMERCIAL GENERAL LLABILITY DAMAGE TO RENTED $ 100,000 CLAIMS-MADE 7 OCCUR MED EXP(Any one person) $ 5 000 PERSONAL&ADV INJURY $ 11000,000 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATE LIMITAPPLIES PER PRODUCTS-COMP/OP AGG $ 1#000F000 POLICY PRO JE CT LOC $ AUTOMOBILE LIABILITY COMB INEDtSINGLE LIMIT(Eaacciden $ ANYAUTO BODILY INJURY(Per person) $ ALLOWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE HIRED AUTOS _AUTOS (Per accident) $ UMBRELLA LIABOCCUR EACH OCCURRENCE $ EXCESSLU\B CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION AND EMPLOYERS'LIABILITY 2E112O68 3/30/15 3/30/16 WC STATU- OTH- ANYPROPRIRIPARTECUTNy/N E E.L.EACH ACCIDENT $ 1OO OFFICERMIEMBMBEREXCLUDED?UDED? � N/A 000 (Mandatory In K yes describe ander E.L.DISEASE-EA EMPLOYEE 00$ 1000 under DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT $ 500 000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,it more space is required) CERTIFICATE HOLDER `, CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CD ROOFING ACCORDANCE WITH THE POLICY PROVISIONS. VINCENT COLANGELO 3 HODGSON ST. AUTHORIZED RE PRESENTATIVE TEWKSBURY, MA 01876 ©1988-20 10 ACORD CORPORATION. All rights reserved. ACORD 25( ) The ACORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: VINCENTCOLANGELO@SBCGLOBAL.NET Massachusetts - De partment of Public Safety Board of Building Reg6titioils Mrd Standards `. C t� gtr rti: Su_petwisur Special ' License: CSSL-105943 lit- t VINCENT COI: NGFLO ice 3 HODGSON<S�TREET } Tewksbury 1VIA 01876 — f a r ,r a CommissionerExpiration; 03/09/201&1 .vim I &4 60w�weal44 01Q4&daC11 Office of Consumer Affairs& Business Regulation _ - ME IMPROVEMENT CONTRACTOR tXegistration: tX70575 Type: piration: 1Of2415 DBA CD ROOFING t VINCENT COLANGELO - 3 HODGSON ST !r} TEWKSBURY, MA 01876 Undersecretary, j y.