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Home My WebLink AboutBuilding Permit #1012-15 - 66 PALOMINO DRIVE 6/8/2015 f H0 pTh q �i BUILDING PERMIT TOWN OF NORTH ANDOVER ° : A I APPLICATION FOR PLAN EXAMINATION + a" �--� Permit N0: Z '—� � Date Received Date Issued: A57 �9SSACHUS�� IMPORTANT: Applicant must complete all itejus on this page LOCATION Print { PROPERTY OWNE?CE Print MAP NO: P 01 __ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition 0 Two or more family ❑ Industrial ❑Aeration No. of units: ❑ Commercial U,Aepair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer &�,0- ,(/1 -/02/ Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: CONTRACTOR Name: Phone: / 3 Address: G�'-✓ �-��G� � /� �1.�� / t�- Supervisor's Construction License: 171 Exp. Date: J _�� t Home Improvement License:... /� b Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING ERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ X35 FEE: $ Check No.: 7 Receipt No.: t� NOTE: Persons contracting with unregistered contractors do not have access o rath gu r my nd Signature of Agent/Owner Signature of contracto - t i BUILDING PERMIT o* c,_x t�eo #t%ORTb �►. q ' s � TOWN OF NORTH ANDOVER 32 h.::'}` _• 6 APPLICATION FOR PLAN EXAMINATION * _ " 1• Permit No#: Date Received �'�s RATEo SACHU Date Issued: i IMPORTANT: Applicant must complete all items on this page LOCATION Print PROPERTY OWNER Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ 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 1 - _ _ DESCRIPTION OF WORK TO BE PERFORMED: r Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: Contractor Name: Phone: Email: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: 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: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to tyiz?guaAanty fund Signature of rontractort J €+ Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Twaing/MassageBody Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank, etc. ❑ Permanent Dwnpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF m U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS l/j HEALTH Reviewed on_ Signature COMMENTS `Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Wafter& Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located_ 384 Osgood Street FIREIDFPAR,TMENIT, = Temw umpster gn#situ eyes__. ..._ ;no. _ 4 Locatedat 124MamrStreet m. . .__ - - Fife,Depar�tnertMgnature/da#e .._ COMMENTS. _ _ Dimension 14 V 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) S.+ ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Penuit Revised 2014 Department p 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 4 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 IS OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks Building Permit Application 6 Certified Surveyed Plot Plan 4. Workers Comp Affidavit 4 Photo Copy of H.I.C. And C.S.L. Licenses Copy Of Contract r Plan And ,4. Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkle 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 Location f O V -C— ,� �SNo. Date • - TOWN OF NORTH ANDOVER Certificate of Occupancy $- Building/Frame Permit Fee Foundation Permit Fee $ t Other Permit Fee $ TOTAL $ Check# `7 r� � " " i Building Inspector NORTH own of s E ndover 0 � - No. h ver, Mass, o LA coc Ml WICK ,�• x.45 RATES /.PP�,�S U BOARD OF HEALTH PER .MIT D Food/Kitchen Septic System THIS CERTIFIES THAT BUILDING INSPECTOR r . .. ! _' Foundation has permission to erect .......................... buildings on ...�......Pry,.t1�J^^:.1.s'.4.C.- .......D.e✓......... �/ � Rough to be occupied as .. ... .�?..�.�.(�.........�.-1'Zia.......�u_r.....:—4.wu.�-t'........................ 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 5LO) . UNLESS CONSTRUCTI ST RTS Rough Service ............... ...... . ..................................................... Final BUILDING 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. Ix .y LANDSCAPES DESIGN—CONSTRUCTION—MAINTENANCE -IRRIGATION 617 828-2733 masonworkzxom 25 SHADOW RD MELROSE MA 02176 Article 1 —Parties Homeowner Information Contractor Information Name Company Name Mr. Jonathan Hurtig Masonworks, LLC Street Address Contractor/Salesperson/Owner Name 66 Palomino Dr., Arlen "Jeff' Souza City/Town State Zip Code Business Address North Andover Mass 01845 25 Shadow Road Daytime Phone Evening Phone City/Town State Zip Code 617 835 5033 Melrose MA 02176 Email Address(Optional) Business Phone 'ehurt comcast.net (617) 828-2733 Mailing Address(If Different from Above) Email Address a'souza comcast.net Federal Employer ID No. 46-0493870 Home Improvement Contractor Reg.No. Expiration Date 147178 6/15/2017 Construction Supervisor License No. Expiration Date 76715 3/8/2016 Article 2— Scope of Work Contractor agrees to do the following work for Homeowner: Scope of work: 1- Back patio under the deck—240 SF. Excavate area to a depth of 8". Install a layer of landscape fabric to help prevent weed growth. Install 5" of crusher run (road base) 2" at a time and compact it with a heavy duty plate compactor. Install a 1" leveling layer of course bedding sand and install pavers. Cut the edges and set borders on concrete. Apply Polymeric sand to lock in pavers (Polymeric sand expands on itself and performs as a barrier for �- weed growth and prevents insects from borrowing through). Compact and 1 T 7t ' sweep patio to finish it. Work to be done with Cambridge Pavers Kingscourt Collection 6x9 on a 90°Herring Bone Patter and soldier course Borders on Onyx Natural color $ 4,390.00 Add 70- SF of pavers to wrap around back steps as shown on modified plans $ 1,281.00 2- Front steps-7'x5'6". Demolish and dispose of existing steps. Excavate to a depth of 12"and form for a concrete pad. Concrete pad will have 4 sonotubes, one on each corner to a depth of 3' below the bottom of the concrete pad to make it a monolithic free stand footing. Rebuild steps solid cored using Glengarry 53 dd for risers and sidewalls. Provide and install Flamed Bluestones for treads and landing. Existing configuration and size of steps will not be modified.Wrought iron railings not included on given price $ 4,135.00 3- Walkway— 110 SF.Demolish and dispose of existing concrete walkway. Excavate area to a depth of 8". Install a layer of landscape fabric to help prevent weed growth. Install 5" of crusher run(road base) 2" at a time and compact it with a heavy duty plate compactor. Install a 1" leveling layer of course bedding sand and install pavers. Cut the edges and set borders on concrete. Apply Polymeric sand to lock in pavers (Polymeric sand expands on itself and performs as a barrier for weed growth and prevents insects from borrowing through). Compact and sweep patio to finish it. Work to be done with Cambridge Pavers Kingscourt Collection 4x8 on a 900 Herring Bone Patter and soldier course Borders on Toffee Onyx color. u $ 1,870.00 Availability will be discussed with Homeowner. Upon agreement a Certificate of Insurance will be provided to owner. Article 3—Proposed Start and Completion Schedule Commencing and finishing dates will be discussed with owner and will be dependant on work load already in schedule and could be delayed due to inclemented weather. Contractor agrees to adhere to the proposed schedule unless circumstances arise that are beyond his control. Article 4—Required Permits Contractor will secure any and all required permits It shall be the obligation of Contractor, as agent for the Homeowner, to obtain the Permits. If Owner obtains any and/or all of the Permits, Owner shall be excluded from the guaranty fund as described in Massachusetts General Law chapter 142A. 2 omeowner's Signature 4on t �etl e e a ate NOTICEOF CANCELLATION YOU MAY CANCEL THIS TRANSACTION,WITHOUT PENALTY OR OBLIGATION, WITHIN THREE BUSINESS DAYS FROM THE ABOVE DATE. IF YOU CANCEL,ANY PROPERTY TRADED IN,ANY PAYMENTS MADE BY YOU UNDER THE CONTRACT OR SALE,AND ANY NEGOTIABLE INSTRUMENTS EXECUTED BY YOU WILL BE RETURNED WITHIN TEN BUSINESS DAYS FOLLOWING RECEIPT BY THE SELLER OF YOU CANCELLATION NOTICE,AND ANY SECURITY INTEREST ARISING OUT OF THE TRANSACTION WILL BE CANCELLED. IF YOU CANCEL, YOU MUST MAKE AVAILABLE TO THE SELLER AT YOUR RESIDENCE, IN SUBSTANTIALLY AS GOOD CONDITION AS WHEN RECEIVED, ANY GOODS DELIVERED TO YOU UNDER THIS CONTRACT OR SALE; OR YOU MAY, IF YOU WISH, COMPLY WITH THE INSTRUCTIONS OF THE SELLER REGARDING THE RETURN SHIPMENT OF THE GOODS AT THE SELLER'S EXPENSE AND RISK. IF YOU DO MAKE THE GOODS AVAILABLE TO THE SELLER AND THE SELLER DOES NOT PICK THEM UP WITHIN TWENTY DAYS OF THE DATE OF CANCELLATION, YOU MAY RETAIN OR DESPOSE OF THE GOODS WITHOUT ANY FURTHER OBLIGATION. IF YOU FAIL TO MAKE THE GOODS AVAILABLE TO THE SELLER, OR IF YOU AGREE TO RETURN THE GOODS TO THE SELLER AND FAIL TO DO SO, THEN YOU REMAIN LIABLE FOR PERFORMANCE OF ALL OBLIGATIONS UNDER THE CONTRACT. ANY CANCELATION DONE AFTER 72 HOURS OF SIGNING THE CONTRACT WILL BE SUBJECT TO A 30% CANCELATION FEE UNLESS A SUBSTANTIAL REASON IS PROVEN FOR SUCH CANCELATION TO CANCEL THIS TRANSACTION, MAIL OR DELIVER A SIGNED AND DATED COPY OF THIS CANCELLATION NOTICE OR ANY OTHER WRITTEN NOTICE, OR SEND A TELEGRAM TO [Name of Seller],AT [Address of Seller's Place 9 J I-14 1-) GlNO W V 3 fl C) f , w C f t t t ti's a _r,> ON P��I I� II Y' , I - �� i _ r^ w The Commonwealth<o M f assachusetts Department of.&&a WAccirtents f,Zice ofl rrveshgaaoms ,r 600 askington Street Boston,MA 92111 Workers' Compensatiwww.-massgov/din on InsuranceA,ffdavit:Builders/Contrac A licant Information tors/Electricians/Plumbers ame ewor / PleasePriint Le '.bl N usin ganizatiomlln /! �� Address: . W cit, '.StateXZip: Are yo, an employer?Check theta. .3 { 11!d'I am appropriate bom employer with _ 4 _[] I. m ageneral co�ador�nd I 1 e of project(required): employ �s(full and/orp time:. have: the 2•❑ I am.a sole proprietor or paztner-� listed on-the. sub-contractors-1- New.Construction sMp and,have no;employeesThes..e:sub-contractors have: modeling working.for me m any:capacity. employees,and have workers' 8 ]'Demolition [No:worlcers'comp.insurance comp,:nuts a 9. [].Building addition ❑ ��) 5. ❑ We'are a corporation and its I0.❑Electrical I am a homeowner do' repairs or additions doing all work officers-have exercised their myself,[No workers'comp• right nfexemption per MGL 11.(]Plumbing repairs or additions insurance required]t c. 152;§1(4),and we have:no 12.[],Roof repairs employees:;['No workers' 13:0 ether. Y appliesy,at�, comP'`ansurance regn . ecksbox#1mustalso:filloutthesectionbelowsI'owm then 1 meowaets submit this affidavit indicatingg wow' atioa policy informa{ion tractors that_. *this,box must they.are doing an work and theu)hue outside Yas. If the sL ten' °� as additional sheet showing the name-ofthe. contractors mustsubmit anew affidavit indicating such. ��.. traCtOIS have h - ,Pol nt[aClots:and: °�,me!'first Provide workets'.co 'state whether or not those entities have 1 a an ehployer that tr providing workers'co rnp.;poiicy trumber. ra:. armatio mP mon insurance or 1 / f my employees Below is the olrc P y andjob.sle Iia ''ranee Company Name: I P1, y#or Self-.ins.Lic.#: " Expiration Date: 6— JG. '<"e Address: 6 Cc/ f'j'Lt Y,7 At" •h, $ City/StatelZip: (, ropy of the age ccs'compensation policy declaration page(showing the;polity jai ber and expiration date. Fart :e to. y, rage as required under Section 25A of MGL c.-152 can lead to die,unposition of . "are cove fine p to-$1, 90;00 and/or one- ) of u to$250,(, �. year.imprisonment,as well as civil penalties4n.the form imp WORK criminal penalties and of a e inv i Y against the violator. Be advised that a copy ofxhis statement may be forwarded to the Office of gations o 'DiA.for insurance coverage verification, I do ereby a the and penalties ofper�'ury that thein or f nration provided above Sig-r, :are: is true and correct Date: Phor #: pial use only.;Donot write in this ar to be co mPlered by city urMWn of.wai Ci, .�, `Down: \1Iss1 ug A: 'hority(circle one): PeratitJLit ease# I 1 and o#. alth 2.Building /T Department 3.Ci ,ty ' 6. `/ter_ own Clerk 4Eleetric3l Inspector 5.Plumbing Inspector t CO, ":.3ct Person: -_ Phone#: DATE(MWDI)NYYY) ACORD CERTIFICATE OF LIABILITY INSURANCE 6/4/2015 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). CNT PRODUCER NAR E CT Eileen Sartell M.R. Shaw LLC PHONE . (978)744-454 F o}.(978)745-8584 - P.O. Box 4428 ADDRESS:eileen@ shawins.com 18 Hawthorne Blvd. INSURER(SI AFFORDING COVERAGE MAIC# Salem MA 01970 _ INSURER Casualty_Ins Co _ 24082__ INSURED INSURERB:Safe:�y Insurance Company 39454 Mason Works LLC INSURER c:Travelers 25 Shadow Rd INSURER D: _ _ _..... INSURER E: — Melrose MA 02176 INSURER F: COVERAGES CERTIFICATE NUMBER:CL2552009142 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. !NSR; DDL Wf IR I POLICY EFF POIJCY EXP LIMITS LTR! TYPE OF INSURANCE I POLICY NUMBER 0.1kVDD1YYY fANUDD i X i COMMERCIAL GENERAL LIABILITY ? I EACH OCCURRENCE (S 1,000,000 ��p�{I DAMAGE TO RENTED ; 100,000 000 A I j CLAIMS-MADE I A OCCUR PREMISES(Ea OCCI)fienCe) S I i BKS56587148 ` 1/28/2015111/27/20155,000MED EXP(Any are person) $ _ 1,000 PERSONAL&ADV INJURY !5 000 GEN'L AGGREGATE LIMIT APPLIES PER I; ? GENERAL AGGREGATE —:S 2,000,000 ,000,000 X POLICY❑PO- �LOC 1 i I LPP.ODUCTS-COMPIOP AGG E 3 2,000,000 OTHER 1 Expense Mad Factor 1 ;S AU70M0811E LIABILITY t ! 1 COMBINED SINGLE LIMB !g 1,000,000 t is (Ea accident) B ANY AUTO ! ! €BODILY INJURY(Per person) S (J ALL O%VNEO ;—I SCHEDULED ' AUTOS AUTOS I E 6207580 8/17/2014 ) 8/i7/2015 ;BODILY INJURY(Per acudent)`:. $ NON-OY+MED ( F PROPERTY DAMAGE S I I HIRED AUTOS AUTOS 4 Per accident) ! I S UMBRELLA LIAB i OCCUR [� EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE; j ` AGGREGATE I S I DEO I !RETENTIONS t ! 15 V40RKERS COMPENSATION !STATUTE !AND EMPLOYERS LIABILITY YIN; ! ZANY PROPR:ETOR/PARTNERIEXECUTIVE i ; ;E L EACH ACCIDENT I s v 500,000 OFFICEWMEWBEREXCLUDED? NIA= ! C IMandalaq in NH) — ; ?2E204971 t 6/4/2014 6/4/2016 E.L.DISEASE-EA EMPLOYE S 500,000 DE CRoNIfes.describe OF /PERATIONS below I ! E L DISEASE-POLICY LIMIT 15 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS t VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN North Andover, MA 01845 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED g�P� A nv!A,:� Mark SH @)1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS025(201401) 4 �Y f Fdass=hu5etts-0--partmejnt of Publ.c Safety Sotird of 9ufWng-Regulations and Standards _ Conitructiun Suprm' ar License:CS-076716 L N I SGUZA-T 'F 25.SILADOW RD Melrose h'A 02f',ffi i F Expuzation {' Fi3iQft£r OU0016 -J40ME IMPROVEMENT CONTRACTOR Registration. 147178 Type: e, Expiation: &4512,W td ljargi tV CizmC. ?M,A9C7N VVORKS LLC. °:RLE°1 25 �v�/4 1L;w s MELROSS,klA, 217 t aslrr�errrt r+ :.r r