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HomeMy WebLinkAboutBuilding Permit #064-2016 - 655 MIDDLETON STREET 7/14/2015 (2) NORTH BUILDING PERMIT 161�tio =+ ��� ►1 TOWN OF NORTH ANDOVER o� b APPLICATION FOR PLAN EXAMINATIONTIV �y C ,1�`t fes' LAS O e w 1� Permit No#: Date Received rEO S SACHUS Date Issued: h IMPORTANT:Applicant must complete all items on this page LOCATION r not PROPERTY OWNER b"� ��'�� `'^ (Au Print 100 Year Structure es no Y 0� (� Historic District a no a ZONING DISTRICT: MAP l PARCEL. � � Z Y Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑ Two or more family ❑ I ustrial ❑Alteration No. of units: Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other fl'tSesptic O Welli 4 ❑ Floodplain Wetl4antls ❑ 1N�tershed Districtu ty DES RIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Pt Clearly OWNER: Name: -� o..Af S u IW�w, �� Phone: 919_ctg� 4 Address: Contractor Name: woks \�� Phone: 178 6 Email: oy--. Address: P a 13,0' �� \`a r « `, r Supervisor's Construction License: LS Cri rGl� Exp. Date: Home Improvement License: I-) S 0 5 Exp. Date: 7-�t ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PE MIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED.ON$125.00 PER S.F. Total Project Cost: $ D FEE: $ �y Check No.: Receipt No.: 2-PIO(0 c�. Recei NOTE: Persons contracting with unregistered contractors do not have access to the uaranty fund J 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 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 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 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swilmning Pools ❑ well. ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dempster 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 Zcing Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments I � Water& Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: _ /�_►/�C Located 384 Osgood Street J PA R�TIVI E '1'. Al' ;it .t. _ r, a. .y .. r ,. ,1. i.TMr. s7"ls='7r,", " F L DE iV&�IL,' rnp Dumps'tera�ori�site, ;�y�es o}'`_>_" " 3 F* I Located at 124 Main Str eta , .. -.w.r�..�e...�r^c a,..,rt r@�CI a�,4Yc,t +s�.+ � .Gcf�,�y'4 �y+'• -,• •: I � amu , �SY .i3't1 ,ID 'rr ': �,, ,�. ;' �+ i" '4 . y i ti ""t` T Yi'4'(�';"er'R"""„�"a5.�'r"�r'..—we''”` Y Z'�J {b'4`. ,.•,y i .? ♦.g 4. ♦ . '4� w.l. xRa ". r.: {v A { •..�..M:1 .'f�' xb�'�,s. R....u.....w .$„x 1w�..�t .-.�l.+wa#..nWv..r.k�.acr.F.-+�svI.�Jr. Y�.-l.�ww-.w.w.wW�..�w 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 NOTES and DATA-- (For department use) ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 s Location 14 No. � �� Date � 1 15 z, • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $�A !� n Foundation Permit Fee $ Other Permit Fee $ s TOTAL $ Check# c9 )1 D - j # Building Inspector aa��+��.a�rs.:._w i.�a...�....,,�'..�::.,u..zt,,�:�.:��.:a:.��..s,.�z--.�:j✓�r..�.:._��.:--:::;,�.:.. -:.*,.".:.-_...,,.::,��:.-4...:�::�-�-., =��. F NORTH Town of s E ndover ti ,� o�h , ver, Mass,� �`f 211 A- coc"Ic«ew.cw �1. 7d A0RATE 0 1"IPv`�,�5 1S BOARD OF HEALTH Food/Kitchen PERMIT T LD\ Septic System THIS CERTIFIES THAT ...........04� 41 ....Sp.n.h_x � �1 BUILDING INSPECTOR .......... ,5. .. ....... ....... .................. Foundation a has permission to erect .......................... buildings on .. ................ ..................!J...� .......................... Rough to be occupied as ............ .:L......... . ... . .! -... ...................................................................... Chimney provided that the person accepting this 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 CONSTRUCTION S TS Rough Service ............... ... ...... .................................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz 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. PO. Box 185), iil,orth Billerica, ,MA 01862 t'97842?11-;"1 ase, Fax (978' 663-2987 PROPOSAL SUBMITTED TO: Brad Reichter ADDRESS: 655 Middleton rd N Andover,MA DATE: July 6,2015 JOB SITE: Andover Sportsman Club WE HEREBY submit our proposal for the following scope of work: 1. Rip and remove existing metal&shingle roofs and dispose. 2. Install GAF Weather Watch ice&water shield to entire roof. 3. Install F8 aluminum drip edge metal to perimeter of roof. 4. Install GAF Pro Start starter shingles on rakes and eaves. 5. Install GAF Timberline HD Lifetime architectural shingles to roof. 6. Install new pipe flanges to all pipe penetrations. 7. Install new lead flashing to all chimneys. 8. Install GAF Cobra ridge vent to vented ridges. 9. Install GAF Timber Tex cap to ridges. 10. Install white 6"seamless gutters to 2 trap buildings. 11. Issue GAF Weather Stopper System Plus Limited Warranty. 12. Clean site of all roofing debris. NOTES: 1)Any damaged roof decking will be replaced at$2.50 per s.f. (64 s.f. included) 2)If entire roof needs plywood,$8,900.00 will be added to total cost. 3)Rain diverters will be added above doors as requested. 4 Trap storage a shed&wood shed included. 5) 10% holding up to 2 rain storms,or 30 days,whichever comes first. WE PROPOSE to hereby furnish material and labor,complete in accordance with the above specifications for the sum of: Nineteen Thousand Five Hundred dollars. ($ , .00 AUTHORIZED SIGNATURE: Justjfi 0. Morgan. oject Manager ACCEPTANCE OF PROPOSAL:The above prices,specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified.Payment will be made as outlined in TM Roofs Inc terms agreement. Authorized Buyer Signature* Date: 011- A, rte- Ix,,, r 16 tmroofsinc.com Thank you for choosing TM Roofs Inc. facebook.comhmroofsinc The Commonwealth of Massachusetts . Department oflndustrialAccidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 www massgov/dna Workers'Compensation Insurance Affidavit:Builders/Contractors/EIectricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant InformationPlease Print Lelzibly Name(Business/Organization/Individual): Address: 0 e V l City/State/Zip: N �����;`�' �rw Phone#: 1 7 f 66 y 7 b ) Are you an employer?Check the appropriate box: Type of project(required): 1.L1A`am a employer with • : employees(full and/or part-time).* 7. ❑New construction 2.F1 I am a sole proprietor or partnership and have no employees working for me in $, 0 Remodeling any capacity.[No workers'comp.insurance required.] 9. F1 Demolition I F1I 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 11.❑Electrical repairs or additions proprietors with no employees. • 12.FJ Plumbing repairs or additions 5. 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 and its officers have exercised their right of exemption per MGL c. 14. 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. I 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 state whether or not those entities have employees. If the sub-contractors have employees,1ey must provide their workers'comp.policy number. I am an employer that is p/'oviding workers'compensation insurance for my employees.'Below is the policy and job site information. t Insurance Company Name: �Ey^L s n v/,C-, Policy#or Self-ins.Lic.#: ►•N C Obi ���� Expiration Date: '7 16 Job Site Address: b�-5 f'^y- '`' 11 r J City/State/Zip:a A^eAcl q---r 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 certify under thepaIns and penalties ofperjury that the information provided above is tue and correct. Signature: � Date: � � Phone#: S L 0 370 l 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." 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 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 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-NIASSAFE Fax# 617-727-7749 Revised 02-23-15 www.mass.gov/dia TMROO-1 OP ID: LO CERTIFICATE OF LIABILITY INSURANCE DATE(M 07106/15 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 WANED, 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). CONTACT PRODUCER Phone:781-936-8480 NAME: DeSanctis Insurance Agcy,Inc. �F 1-933-5645 PHONE �( ax 100 Unicom Fax:78Park Drive AIe Nodare Not_��- Woburn,MA 01801 E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIL 0 INSURER A•Maxum Indemnity Company - 26743 INSURED TM Roofs,Inc. INSURER B:Plymouth Rock Assurance Group 14737 Tim Morgan INSURERC;HanoverInsuranceCompany 22292 —_ PO Box 185 North.Billerica,MA 01862 INSURER D:Star Insurance Company_ 012245 INSURER E:Evanston Insurance Co. 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 T TYPE OF INSURANCE ADOL'S BR LICY EFF PLIY EXP LIMITS LTR POLICY NUMBER MMPOIDD MOM/DCD GENERAL LIABILITY y EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY GLP 6022466-03 O7/O1M5 07/01/16 PREMISES(Ea ocwnence $� 100,000 CLAIMS-MADE i A I OCCUR MED EXP(Any one person) $ 5,00 PERSONAL&ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 2,000,00 POLICY X PRO-CT LOC �— $ —' AUTOMOBILE LIABILITY (Ea SINGLE LIMIT 1 Ea accident 000$ , ,00 B ANY AUTO PRC00001004279 06128/15 06128116 "BODILY INJURY(Per person) $ ALL OWNED XSCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OWNED j PROPERTYDAMAGE $ — AUTOS 1 Per accident $ X UMBRELLA UAB OCCUR EACH OCCURRENCE $ 5,000,00 E EXCESStJAB CLAIMS-MADEJ MKLVIOLF102361 07/01/15 07101/16gGGREGATE S 5,000,00 DED X(RETENTION$ $ WORKERS COMPENSATIONT�RYLIIT ER AND EMPLOYERS'LIABILITY D ANY PROPRIETORiPARTNERIEXECUTIVE YIN C0679614 07101115 0710116 E.L.EACH ACCIDENT $ 1,000,000 OFFICERIMEMBER EXCLUDED? a N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEd$ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS Mow 1 E.L.DISEASE-POLICY LIMIT $ 1,000,000 A Equipment Floater IHNA61052200 04/15/15 04/15/18 A Property Section IHNA61062200 04115/16 04115118 DESCRIPTION OF OPERATIONS I LOCATIONS r VEHICLES(Attach ACORD 101,Additional Remarks Schedule,N more space is required) CERTIFICATE HOLDER CANCELLATION REGIS-4 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 �tt ' ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD ..... ---- _I /�n` o��z»�a:rrae{rill a�C///Iljlaekv4e#j `\ Office of Consumer Affairs&Business Regulation NOME IMPROVEMENT CONTRACTOR egistration 175609 Type: Expiration 5.24/12 a1.7.: Coisporation TM ROOFDANC TIMOTHY MORGAN�> ` 56'ROGER ST. <' BILLERICA,MA 01827 Undersecretary it Massachusetts-Department of Public Safety i Board of dui=ding ReguWiOns and 5'_anda;cls Ceastru t€nn supervisor License:CS-095653 TIMOTHY R MOOG 56 ROGERS STRREZ" BILLFRUCA MA, 0.186 92, 09128/2096 commissioner