Loading...
HomeMy WebLinkAboutBuilding Permit #061-15 - 75 MEADOW LANE 7/17/2014 BUILDING PERMIT NORTH o`��,Eo ,b qti TOWN OF NORTH ANDOVER o� ` '` o APPLICATION FOR PLAN EXAMINATION ' q 1t� Permit No#: Date Received ADRA7ED �SSACHUSE� Date Issued: ' / �' '/`� IMPORTANT:Applicant must complete all items on this page LOCATION � G(� PROPERTY OWNER rz4,6 t. 8. 5 Print 100 Year Structure yes no MAP PARCLV 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 _ � IDE;�CRIPTION/OF WORK TO PERFORMED: Identi is tion-�,IeaseTy aor Print ClearlyOWNER: Name: P, uPhone: Address: Contractor Name4O �( 9' Phone: Address: Supervisor's Construction License: 0!5*2.Z/Z2 R Exp. Date: ^ lI Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT:$12.00 P $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 w th r gi r c ntrac r e access to the guaranty fund Signature of Agent/Owner a of ontractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ —TYPE_OF-SEWERAGE_DISP O.S A.L— Public Sewer ❑ Tanning/Massage/Body Art ❑ Swirmning 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 Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signatureldate COMMENTS LZi.men.sion Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: I ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No i DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use) i ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Pen-nit Revised 2014 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 Doe:Building Permit Revised 2014 Location No. Date /(/c/ o '- TOWN OF NORTH ANDOVER 0 a Certificate of Occupancy $ Building/Frame.Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# Building Inspector NORTy Town of E n O No. 11L - h ver, Mass, I'llCOC NIC Nl WICK �1' �,�ADR TE D I.PQ`�•�5 S U BOARD OF HEALTH PER IT T LD Food/Kitchen —) ).j Septic System THIS CERTIFIES THAT ......... ....AO L...... �sI� ,... BUILDING INSPECTOR ...... .........................�...................................... Foundation ' has permission to erect .......................... buildings on .... �..�...... 5,......��FLAc P !J..Lei.�::� Rough CC. tobe occupied as .......�..?. .... ........"y''. !'. ...^.............................................................. 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 3 UNLESS CONSTRUCTI SS Rough eT 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. aC"Rf>0 CERTIFICATE OF LIABILITY INSURANCEMIMDATE(MM/DD/YYVY) 7/17/2014 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(les)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 NAME: Gerry McDonald McSweeney& Ricci Insurance NCONN Ext:781-848-8600 __ (1 AX No:781-843-880 420 Washington Street E-MAIL P.O. Box 850984 ADDREss:mrireception(@mcsweeneyricci.com Braintree MA 02185 INSURER(S)AFFORDING COVERAGE NAIC f1 INSURER A:Acadia Insurance Company 1325 INSURED WOOST-1 INSURER B:Star Insurance Company Charles J Wooster dba Wooster INSURER C: Roofing INSURER D: PO Box 8051 Lowell MA 01853 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:579904000 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 TYPE OF INSURANCE ADD SU R POLICY EFF POLICY EXP LTR INSR WVD POLICYNUMBER MM/DD/YVYY MM/DD/YYYY LIMITS A GENERAL LIABILITY CPA0083583 0/17/2013 10/17/2014 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMA TO E ED PREMISES Ea occurrence $250,000 CLAIMS-MADE X-1 OCCUR MED EXP(Any one person) $5,000 PERSONAL 8 ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY X PRO- LOC $ A AUTOMOBILE LIABILITY MAA0379734 10/17/2013 10/17/2014 COM Ea accidern) $1,000,000 ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X X NON-OWNED PROPERTY DAMAGE $ HIREDAUTOS AUTOS A X UMBRELLA LIAB X OCCUR CUA0383967 10/17/2013 0/17/2014 EACH OCCURRENCE $1,000,000 EXCESS LIAB CLAMS-MADE AGGREGATE $1,000,000 DED X RETENTION$0 $ B WORKERS COMPENSATION WC0720669 10/17/2013 0/17/2014 X I WCSTATU- OTH- AND EMPLOYERS'LIABILITY Y/N T Y I IT R ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $2,000,000 OFFICERMIEMBER EXCLUDED? NI N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $2,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIM IT $2,000,000 A Property CPA0083583 10/17/2013 10/17/2014 Cont Equipment DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if 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 Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. Gerald Brown North Andover MA 01845 AUTHORIZED REPRESENTATIVE r ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD WOOSTER ROOFING PROPOSAL ALL TYPES OF ROOFS DATE: 7/16/14 &ROOF RELATED SERVICES 0 Always Hand Nailed License Numbers: Charlie and Steve Wooster Construction Supervisors 54268 ® - 1-888 ROOFIN-1(766-3461) Home Improvement Contractor Main:978 251-7181 Registration 100712 Serving MA&NH since 1984 Fax:978 251-0159 Call For Our References Proposal Submitted To Work To Be Performed At Name Paul Dubois Name Company Name Company Name Street 75 Meadow Lane Street City No.Andover StateMI_Zip Code 01845 City State Zip Code Home# Mobile# 978 420-8266 Work# Fax# We hereby propose to furnish the materials and perform the labor necessary for the completion of the following job. Strip the entire roof to the roof deck. 1. Renail any loose decking and replace any rotted at$2.00 per foot. 2. Remove vinyl soffit,cut out old wood soffit and reinstall the vinyl soffit on main house and breezeway. 3. Install 8"white aluminum dripedge. 4. Install 6' of Grace Ice and Water Shield on all eaves and valleys of house and breezeway. 5. Paper remainder of roof with Grace Tri-Flex roofing underlayment. 6. Install Certainteed Landmark Lifetime shingles,hand nailed. 7. Install new lead flashings on chimney. 8. Flash vent pipe to roof 9. Install Shinglevent II ridge vent. 10. Replace missing elbow on rear downspout. 11. Clean and dispose of all debris. Workmanship guaranteed for 10 years.We are fully insured with workers'compensation as well as liability insurance. Please return copy of proposal: < All material is guaranteed to be as specified,and the above work to be performed in accordar_ �'th the specifications submitted.All work will be completed in a substantial workmanlike manner for the sum of Dolle($11,450.00), with payments to be made as follows:Job paid upon completion. Respectfully submitted_5fe fAn e. E. W&qs,� Note-This proposal may be withdrawn by us if not accepted within 30 days. ACCEPTANCE OF PROPOSAL The above prices,specifications and conditions are satisfactory and are hereby acYou are authorized to do the work as specified. / Payment will be made as ou ' edce ve. Date 1 Signature Mailin A dress: P.O. Box 8051 -Lowell MA 01853 Location:525 Woburn Street-Tewksbu MA 01876 _ �/ /"l/C/ �ti�J/l//%��'1��;�I/LL/'�C���L�:/r1/l/ \/-i�1���/Lf/J • Office of Consumer Affairs nd Business Regulation -, 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home lmprovementrContractor Registration Registration: 100712 `-1 ',,j Type: Supplement Card CHARLES J. WOOSTER ROOFING ` , !°', F . ';. ! Expiration: 6/23/2016 STEPHEN WOOSTER 525 WOBURN ST TEWKSBURY, MA 01876 Update Address and return card.Mark reason for change. SCA 1 r 20M-05/11 Address Renewal Employment Lost Card Office of Consumer Affairs and Bus/mess Regulation 10 Park Plaza - Suite 5170 ':"'"e ,,,y-., +i ♦.1.�t H¢ k .. a" � '� z{ 6 k4.1.i"1, i"' �'�` 3+4 ri";�.f•1 i''" iA^{; C>Fas e, f � � • ,.".3s _,, 4p:y�r ..k4:��oa t.{�j,+4:. ��'•+` �(,.�.'}"3P i���:.r n`� hh`,1.'-'i ���i,�J, Home Improvement Contractor Registration {i Registration: 100712 P Type: DBA Expiration: 6/2312016 Tr# 253696 CHARLES J, WOOSTER ROOFING Charles Wooster P.O. BOX 8051 s LOWELL, MA 01853T----- Update Address and return card.Mark reason for change. + Address Renewal Employment [:] Lost Card SCA 1 02oM o5d 1 Massachusetts -Department of Public Safety I t Board of Building Regulations and Standards Owfrilk1I,+1r 4tiit1W1%,,r Auk + License;C$-o5426$ k 1,. Charles J Wooster; `,�•. P.O SOX#9051 Lowell MA 01953 o. � ., Ilk ` Expiration + Commissioner 05111/2016 r�C:O CERTIFICATE OF LIABILITY INSURANCEDATE(MM/DDIYYYY) 6/17/2014 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 NAME: DonaldTGT McSweeney&Ricci Insurance a"rCD"ro E>a:781- FA/CC No: 81 7 420 Washington Street E-MAIL P_O. Box 850984 ADDRm: tin m w n i. Braintree MA 02185 INSAFFORDING COVERAGE NAIC:i INSURERA;Acadia Insurance Company 31325 INSURED WOOST-1 INSURER B r Insurance m Charles J Wooster dba Wooster INSURERC: Roofing INSURER D: PO Box 8051 Lowell MA 01853 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER.1047726848 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 TYPE OF INSURANCE ADDL POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICYNUMBER 1MMfODNYYY1 (MNVDDffYYV) A GENERAL LIABILITY CPA0083583 0/17/2013 0/17/2014 EACH OCCURRENCE $1,000,000_ XI DAMAGE TRENTED COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $250,000 CLAIMS-MADE �OCCUR MED EXP Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY X PRO-JECT LOC - $ A AUTOMOBILE uABILITY MAA0379734 0/17!2013 0!17!2014_ Ea accident) $1,000,000 ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ X HIRED AUTOS t X AUTOS Per acciden $ A X UMBRELLA LIAB X OCCUR CUA0383967 0/17/2013 0/17/2014 EACH OCCURRENCE $1,000,000 EXCESS LIAR CLAIMS-MADE AGGREGATE $1,000,000 DED I X I RETENTION$0 $ B WORKERS COMPENSATION WC0720669 1011712013 10117=14 XwC STATU I OTH- AND EMPLOYERS LIABILITY YIN _Eg -- ANY OROP EIMBOER/D (C UDED?ECUTIVE It, NIA E EACH ACCIDENT _ $2,000,000 OFF(Mandatory in NH) EL DISEASE-EA EMPLOYEE $2,000,000 If yes,describe under DESCRIPTION OF OPERATIONS belov i E.L.DISEASE-POLICY LIMIT $Z-000,000 A Property CPA008q583 0/17/2013 0/17/2014 Cont Equipment DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If 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 Town of Lexington ACCORDANCE WITH THE POLICY PROVISIONS. 1625 Mass Ave Lexington MA. AUTHORQED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD