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HomeMy WebLinkAboutBuilding Permit #764-15 - 785 TURNPIKE STREET 4/6/20154 y%ORTH q BUILDING PERMIT TOWN OF NORTH ANDOVER ° t o �l APPLICATION FOR PLAN EXAMINATION ;�* Permit N0: Date Received '� °4 c�.....�. �9SSACHUs���y Date Issued: 1 "� i 'IMPORTANT: Applicant must complete all items on this page LOCATION D r, t 1 7 2T ©� /a s Print PROPERTY OWNER A I. (J�i Print MAP NO PARCEL ZONING DISTRICT: Historic District yes no Machine Shop Villaae ves no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: .9 Commercial 0 Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑ Well Floodplain ❑ Wetlands Watershed District ❑ Water/Sewer S s'��n C vcG� . h,S �� �� � � j f 1l'�,i�ll IZery /�-Gti.G�i� lil'Cl'!i OWNER: Name: /4k Address: m CONTRACTOR Name: Address: �, 11 o K /RLff �1'4 .tel �/ �f We bgle-r /t( 01570 Supervisor's Construction License: Exp. Date: g7iss AJI. -77 /!r Home Improvement License: /05-1191� Exp. Date: 711-7114, / /4, /7 i "6- Identification Please Type or Print Clearly) a /D — f ARCHITECT/ENGINEER Phone: Address: - Reg. No. FEE SCHEDULE: BOLDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ / FEE: $ �a\ Check No.: I Receipt No.: clot NOTE: Persons con racti unregistered contractors do not have access to the zaar�t fu r1 4 BUILDING PERMIT TOWN OF NORTH ANDOVER 117 APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received nn+m Icellarl. TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential El New Building 0 One family El Addition El Two or more family El Industrial El Alteration No. of units: El Commercial 0 Repair, replacement 0 Assessory Bldg 0 Others: El Demolition El Other D Q $ at W 0 FI ift ❑Wetlands - q Watershed' Distract DESCRIPTION OF WUKM I U tit F1:Mt-UM1V1r-L): Identification - Please Type or Print Clearly-' OWNER: Name: Phone: A A A nnee - tan tramit, Name; A xp roato,%_ -.on 'Odn'll-Jo , A i)(h I ARCHITECT/ENGINEER Address: Phone, Reg. No FEE SCHEDULE. BULDING PERMIT: $1200 PER $1000.00 OF THE TOTAL ESTIMATED COSTBASED ON $125.00 PER S -F. Total Project Cost: $ FEE: Check No.: Receipt.No..-*:­ -NOTE:----Persons-contracting- with- unregistered contractors do -not havewccess- to- the uaran _9 tyfund-__._...._.. -- f Ae _11___,r%__',_wn_e.(,_____ - _.- �,-ig,aOtgtpe gif, L-ght 6,1_ Plans Submitted_[] Plans Waived Certified Plot Plan ❑ zStamped Plans ❑ f TYPE.' " F SEWERAGE DISPOSAL public Sewer ❑ Tanning/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 COMMENTS Reviewed On Signature CONSERVATION Reviewed on Signature COMMENTS HEALTH COMMENTS Reviewed on Signature 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: ;� . 84O �FLRE ID'EPAR7TMENT T3emp ±Dumpster on site ~ yesu 3no T - .� Located sgood Street IL ocated�at 124+Main Stroet Fr�e iDepartment s.=gnafure/date �_ 'COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Extera.T:.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 Doc -Building Permit Revised 2014 k Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. I . Roofing, Siding, Interior Rehabilitation Permits o 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 a 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 rl ( .t No. Date b r ' CheckJ f u 61:5 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ k Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Building Inspector in J m •a OF 0 : O J •Cc p U G .QI- 4: Z > O :a NE w w CL Qd cc= p W :z = Z z Z a LL O E J Z Q N p m Z N a Q Z _ Z cl) ;v m W co D E LLI • NCc W E 0L CO O m V •. J v LL l� 3 t Z C O d W a iV+ T N O ? a. ZV O z � N \ U y "a -C w C E a� t CLO t mo U Cl) N N O Q 7 N ` O LL N LL Q� V LL K LL 0.+ d' (n Q. :yea c O m N t� in J m •a O cv : O •Cc U G .QI- W > O :a NE CL Qd cc= :z :teaO Lr) }. O E J Z Q N m N �j _ cl) ;v m co E 0 0 • NCc z E 0L O V •. v l� 3 = Z O O fid► m a a. ZV X00 y a� >rCc Cl) .ti XZ 0.+ Q. :yea c O "`� a �-. 1 �+ 0t� 'r. LU Lsi Q T 0 _ CLU) � �s� }. _ s .0 . !� 3W > O W J •QO =oma aZ z d CL �_ •� Z AW JU •�• c m L O Q (A cc 0 o r a •� O ca i RS •a U) M: �, i -0 O O •°' w a O Q : Z o N 0=L �0-0 > C m• "_ o J O_ .O+ QOV > r 1 ROOFINGSYSTEMS INC. � MILL STREET • P.O. BOX 1248 • WEBSTER, MA 01570-4248 1-800-427-99T3 FAX 508-943-9968 Randy Kehs Lehigh Gas 645 Hamilton Blvd. Suite 500 Allentown PA 18101 484-201-7831 c 610-625-8044 o rkehsna,lehighgas.com RE: BP Gas Station North Andover, Ma 785 Turnpike Street Dear Randy, 508-943-9973 March 23, 2015 The following is our proposal to replace the shingle roof on the above referenced gas station as outlined below. Because the pitch on this roof is only a 2.5 pitch we recommend and have quote installing Grace Ice and Water shield over the entire roof deck before installing new shingles. Grace is a far superior ice and water shield than Certainteed, GAF or any other product we have come across in our 32 years of business. Scope 1. Remove and dispose of existing shingles. 2. Replace any rotted decking if any is found at 1.95 per square foot. It cannot be determined how many s.f. is rotted, if any, until the shingles are removed and the decking can be examined. 3. Install Grace Ice and Water shield over the entire roof surface. 4. Install F-8 White aluminum drip edge around the perimeter. 5. Install Certainteed LandMark AR M architectural shingles over the prepared surface. 6. Install matching hip and ridge caps. 7. Includes cost of building permit. Cost: $14,219.00 Ce� Submitted By: Todd W. Jankowski Tort W. - )lk-Itt vsli,. The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street, Suite 100 Boston, MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Name (Business/Organization/Individual): Address: _�O lbox U.4Zy, At I l si v City/State/Zip: �NJ e o kc 0 kS710 Phone #: 5o% 943 X9'13 Are you an employer? Check the appropriate box: 1. ® I am a employer with 11 employees (full and/or part-time).* 2. FJ I am a sole proprietor or partnership and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3. Q I am a homeowner doing all work myself. [No workers' comp. insurance required.] t 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 proprietors with no employees. 5. ❑ I am a general contractor and I have hired the sub -contractors listed on the attached sheet. These sub -contractors have employees and have workers' comp. insurance.: 6.F_J We are a corporation and its officers have exercised their right of 'exemption per MGL c. 152, §1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 7. ❑ New construction 8. [] Remodeling 9. ❑ Demolition 10 ❑ Building addition 11. E] Electrical repairs or additions 12. F-1 Plumbing repairs or additions 13. ® Roof repairs 14. F] Other *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 am an employer that isproviding workers' compensation ittsurance for my employees. Below is the policy and job site information. ,� i Insurance Company Name: �. Mu-- i,�t 11'�(,c.d awgJ Policy # or Self -ins. Lic, #: AWC gpOio52.zc Expiration Date: 1 ILP Job Site Address: 985 T"'T,6\Le SA City/State/Zip:-41-0 C* _)At0iO er)PA o1246 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 the pains andpenalties of peijuiy that the information provided above is true and correct. .iianafirre- /, Tfb 1��C n��� tz.�d Date: q I (O l 1 S 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 #: ACORV CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDmrYY) 4/6/2015 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(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 Herlihy Insurance Group 51 Pullman Street Worcester MA 01606 C C NAME: Liz Saari PHc" o :50 - 5 -5 59 MAX No):508-751-5747 E-MAIL ADDRESS: I I r INSURERS AFFORDING COVERAGE NAIC # /1/2015 INSURERA:IronShore Specialty Insurance EACH OCCURRENCE $1,000,000 INSURED APPLI INSURER B:Safety s n e Company INSURER C :N tion I Union Fire Ins. Applied Roofing Systems, Inc. INSURERD:A.I.M. Mutual Insurance Company PO Box 1248 WEbster MA 01570 PRODUCTS - COMP/OP AGG $2,000,000 $ INSURER E:E an ton Insurance Co. INSURER F: LIABILITY ANY AUTO ALL OWNED x SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS COVERAGES CERTIFICATE NUMBER: 2068908031 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 LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF MM/DDIYYYY POLICY EXP MMIDD LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE li-I OCCUR RCS00028000 /1/2015 /1/2016 EACH OCCURRENCE $1,000,000 A O R ED PREMISSES Ea occurrence $100,000 MED EXP (Any one person) $5,000 PERSONAL 8 ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GE N'L AGGREGATE LIMIT APPLIES PER: POLICYFX PRO LOC JECT PRODUCTS - COMP/OP AGG $2,000,000 $ B AUTOMOBILE XX LIABILITY ANY AUTO ALL OWNED x SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS 6232030 /1/2015 /1/2016 Ea accident$1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Paccident) C X UMBRELLA LIAR EXCESS LIAB X OCCUR CLAIMS -MADE BE016827019 /1/2015 /1/2016 EACH OCCURRENCE $5,000,000 AGGREGATE $5,000,000 DED I I RETENTION $ $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? a (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A AWC4007032205 /1/2015 /1/2016 X WCRSTATLIMIT- OTH- ----- E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 E.L. DISEASE - POLICY LIMIT $1,000,000 E Pollution Liability 15CPLONE60562 /1/2015 /1/2016 each CGL Limit 1,000,000 Aggregate 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) ttlLhaill 112L7G\I;4ffLei III liR; WWIICPfaIII +GULa1LIII Town of North Andover 1600 Osgood St Bulding 20, Suite 2035 North Andover MA 01845 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 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD NO Office of Consumer Ai airsBusiness e ulation g 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improve actor Registration -.., Registration: 105499 t Type: Supplement Card f�, y Expiration: 7/17/2046 APPLIED ROOFING SYSTEMS, INS: STEPHEN JANKOWSKI 26 Mill St.;'; Webster, MA 01570 update Address and return card. Mark reason for change. SCA 1 0 zone -05111 � Address E] Renewal [] Employment F� Lost Card CJ��. �p'am•ma�u�sea� o��aasac/zuJet� frice of Consumer Affairs & Business Regulation ME IMPROVE.KENT CONTRACTOR egistration:. _ Type: Expiraor '7%72p;16i_ Supplement Card APPLIED ROOFING; SYSTEMS;. i;N£. STEPHEN JANKOVAKI PO Box 1248 Webster, MA 01570 Undersecretary License or registration valid for individul use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, MA 02116 �} Massachusetts - Department of Public Safety Board of Building Regulations and Standards construction Supervisor License: CS -089888 �� r'i".ti �; I p` r: 1, STEPHEN J JANK-bW a_ *1-1 33 HENRY MARSH DUDLEY MA 0171 T Expiration Commissioner 10/27/2016