HomeMy WebLinkAboutBuilding Permit #262 - 81 LINDEN AVENUE 10/1/2009 TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
+ Permit N0: T Date Received
Date Issued: ' / 01
IMPORTANT:Applicant must complete all items on this page
LOCATION
Print x
PROPERTY OWNERne,1 !Q-q-0—n '
-�7 Print
MAP NO i Gr-PARCEL:--7 -` ZONING DISTRICT: Historic District yes no
r 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 - Welt Floodplain Wetlands Watershed District
Water/Sewer
DESCRIPTION OF WORK TO BE PERFORMED:
CA
Identification Please Type or Print Clearly)
OWNER: Name: r`' /�I�:s -Jqo0c."-O Phone:;? �77"Q�9
Address: 1>° ►�
CONTRACTOR Name: I Mme Phone:
Address:
Supervisor's Construction License: / `13"x" Exp. Date: _ i�= 361
m
Home Improvement License: c2 37427 `Exp. Date: 7 Z X0
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE:BULDING PER IT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Bd
Total Project Cost: $ ,� FEE: $
Check No.: Z��// �� Receipt No.: o�
NOTE: Persons contracting with unregistered contractors do not have access t e ar y
Signature of Agent/Owner Signature of contrac r
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/Crossection/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
Doc: Doc.Building Permit Revised 2008
1
I
Plans Submitted Plans Waived Certified Plot Plan Stamped Plans
TYPE OF SEWERAGE DISPOSAL
Public Sewer Tanning/Massage/Body Art Swimming Pools
i 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 I
I
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT
COMMENTS
CONSERVATION Reviewed on Signature
e
COMMENTS
HEALTH Reviewed on Signature
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes j
I
Planning Board Decision: Comments
I
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 signature/date
COMMENTS
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
l
I
❑ Notified for pickup - Date
Doc:.Building Permit Revised 2008
r—
1
Location
No. 2 Date
"pRTN TOWN OF NORTH ANDOVER
0
.. 9
' Certificate of Occupancy $
JCMUs c� Building/Frame Permit Fee $ a:
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check #
�. Building Inspector
97
i
I i
I
Town xAORTly
of : 4 over .
No. a 6 c. v
o z-= LA E dower, Mass., •
COCHICKEWICK`,-
7�ADRATED pPp �y
S E BOARD OF HEALTH
Food/Kitchen '
Septic System
PERMIT T
BUILDING INSPECTOR
THIS CERTIFIES THAT • 1 ••••••••••••• Foundation
.......... ................ ...... .....
has permission to erect........................................ buil s on ...&c.................�t ....... Rough
to be occupied as.... } �-h arms f the Chimney ,
provided that the person accepting this permit shall in every respectkiorm tot e t plication on file in Final
this office, and to the provisions of the Codes and By-Laws relating e 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
r PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
1a
UNLESS CONSTR TARTS Rough
.............. . ............................................................................
Service E
BUILDING INSPECTOR Final
E
Occupancy Permit Required to Occupy Building GAS INSPECTOR
Rough
Display in a Conspicuous Place on the Premises — Do Not Remove Final i
No Lathing or Dry Wall To Be Done FIRE DEPARTMENT '
Until Inspected and Approved by the Building Inspector. Burner
Street No.
SEE REVERSE SIDE Smoke Det.
SEP-30-2009 09:05P FROM:JEFF CARBONE INS 7818267447 TO:19786642442 P.1
j�~!�•y1'. (�<<Q v'� �t 7 K ' b'6 a "'.z� 7 CIL
ac R& CERTIFICATE OF LIABILITY INSURANCE 7`W"°0"'""`
9/30/09-
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Jeff Carbone Insurance Agency, ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
429 Main Street HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Melrose, MA 02176
INSURERS AFFORDING COVERAGE NAIC#
INSURE _ INSURERA WESTERN WORLD INS CO
RELIABLE ROOFING AND HONE IHSURa£RB. THE HARTFORD
IMPROVEMENT INC INSURERC
21 MAPLE RD INSURER a.
NORTH ING, MA 01864-1808 INSURER R
COVERAGES
THE POLICIESOF INSURANCE LISTED BELOW HAVE BEEN ISSUEDTO THE INSURED NAMEDABOVEFORTHE POLICY PERIOD INDICATED.NOTWITHSTANDING
ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE NAY BE ISSUED OR
MAY PERTAIN`THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT MALL THE TERMS.EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES.AGGREIGATE,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSRA00' A M, ._ __ ...... _-.—
III= YVEDFINSURMCP POLICY NUMBER PO EFFECTIVE P RATION LIMITS
GENERAL LIABILITY EACH OCCURRENCE s 1,000,000
A X CONMERCKGENE PAL LIABIUTY NPP1206073 3/24/09 3/24/10 DAh%GE TO RENTED mcd) S 50,000
CLAW MADE Q OCCUR NE0 B(P w one amo,) 5,000
PERSONAL&ADV INJURY_ _ S 1,000,000
GENERAL AGGREGATE f 2,000,000
GEWLAGGRE13ATRIMT APPLIES PER PRODUCTS-COMPIOPAGO E 1 1000 000
POLICY[71 PRO- LOC
AUTOMOBILE LIABIUTY
ANYAUID COMBINED SINGLE LIMIT i
aeociclail)deril
ALL 0 WNED AUTOS BODILY INJURY
SCHEDULEDAUTOS (Parpaaan) i
HIRED AUTOS BODILY INJURY i
NON-OWNED AUTOS (P°r acdda"h
PROPERTYDAMAGE i
LPeraecideidl
GARAGEL)AB/UTY AlAOONLV-EA ACCIDENT i
ANYAUTO OTHER THAN EA ACC i
AUTO ONLY: AtGG i
EXCESS IUMBRELLA UABIUTY EACHOCCURRENCE $
OCCUR CLAIMS MADE AGGREGATE i
i
DEDUCTIBLE
REIENMN
MORKERS COMPENSATION I WC STATU OTH-
AND EMPLOYERS'UABIUTY
$ ANY PROPRIEIOWPARTNERIE)EgJT1VE YIN E.L.EACHACCIDENT 111 500,000
OFFICERNEMBE t EXCLUDED?
6lanm1IbrylnNH1 GS60UB-0398NOS-7-0 2/12/09 2/12/10 EL.DIs -EA E s 500,000
n ae Pmeur�derSbelow MIT 500,000
OTHER
DESCRIPTION OF OPERATIONSI LOCAM4I'VEHICLES 1EXCLUSIONS ADDED BY ENDORSEMENT I SPECIALPROYISIONS
ALL WORK TYPICAL TO ROOFING AND HOME IMPROVZbIENT
CERTIFICATE HOLDER CANCELLATION
SHOULD MYOFTHEABOVE OESCRIBEDPOLICIES BECANCELLEDBEFORE THEE)IPIRATtON
DATE THEREW.THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS VMTTEN
TOM OF NORTH ANDOVER NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO So SHALL
1600 OSGOOD STREET IMPOSE NO OBLIGATION OR LIABILITY OP ANY KIND UPON THE INSURER,ITS AGENTS OR
NORTH ANDOVER, MA 01845 REPRESENTATIVES.
AUTHORQED REPRES&NTATNE �)_N [/
ACORD 25(2009101) ®1988-2009 ACO N. All rights rooarved.
The ACORD name and logo are registered marks of ACORD
�� venom `�X-F'7S .plc
H d 1 ellw 1 3� 7
i�>
proposal
Roof System Proposal Prepared,for: Quality Is In The Details. Compare
Ours To Anvbody—and.See Why...
JANET BEGONIS
81 LINDEN A V RELIABLE ROOFING Is Your
NORTII ANDOVER , MA 01845 Best...and�Vgfest Choice!
(781)477-9039
Thank you./or considering.RELIABLE ROOFING and giving us the opportunity to provide
you with a quality roofing system. A quality roo f l"ng system is essential.for the long-term
protection and value of your Home. It would be an honor for REMAME ROOFING to install
your roofing system.
We will provide the labor, materials, and equipment to perform the,following:
Specifitcation What We Will Do
ff4ty It Is Important...
1. Preparation Check weather forecast
Prevents interior water damage caused from unexpected storms
Avoids moisture damage to roofing materials
Setup job site by your instruction
Considers any special needs that you may have
.• Avoids hassles and problems for you
Z. Remove Old Roof Remove old roof—tear off all layers to original roof deck.
Allows for inspection and repair to the roof deck
Provides smooth surface for new roof
Note: We will replace rotted decking as needed at an additional cost of
4-5.00 PER SHEET .
As additional cost may,be a concent, we invite you to inspect the deck
when it is exposed if there are any deteriorated areas.
3. Leak Farrier Install 6' Leak Barrier along eaves,valleys, and other vulnerable areas
Provides extra protection at the most vulnerable areas of the roof
Prevents damage caused by"ice damming"along the gutter
.• Required by code agencies
a Roof Beck Protection install Roof Deck Protection— fiberglass reinforced product
Provides an additional layer of water shedding protection under the
shingles
• Provides a smoother surface for shingle application
I
A
Specsfi" ation What We Will Do
• " T It Is Ina ortant...
5. Flashing Details Eaves and rakes—install Leak Barrier and white drip edge
Helps to seal all edges
.• . Prevents wind-driven rain from entering
Vertical walls...install Leak Barrier and step flashing
• Provides protection at vulnerable area
Chinaneys...install Leak Barrier and step and apron flashing
Provides protection at this very vulnerable area
.4kylights...install Leak Barrier and step flashing
Prevents leaks by shedding water
Plumbing vents...install Leak Barrier and rolled flashing
,- Prevents leaks by shedding water
Mise.prgjections...handled based upon manufactures' recommendations
6 Ouality Shingles Install a starter row of shingles at the eaves
• Seals the first course of shingles
Prevents shingles from blowing off
Provides an added laver of protection
Install Timberline 30 GAF Materials Corp. Quality Shingles
.• Provides quality weather and fire protection
Adds to the beauty of your home
Z Ventilation Prepare for and install a complete ventilation system
Prevents moisture damage to your roof deck
Provides energy cost savings
Meets shingle warranty requirements
Exhaust...install GAF Midge Vent
Most effective method.for venting a roof
8. IIip and Ridge Cape Install GAF Hip and Ridge Shingles
Shingles "Frames"the roof and enhances the beauty of your home
Warrantv that matches the life of the roof shingles
Specaflcation TI'daat We ff ill Do
"j7 It Is Important...
i
9. WARRANTY WE OFFER A FIVE YEAR WARRANT'ON INSTALLATION OF ALL
NEW ROOFS.
System warranty ...covers GAF accessories
Re-sale value ...may increase the value of your home at re-sale
10. Daily Joh Site Cleanup Pick up and haul away all debris. Lawns are raked and a magnet is used to
pick up stray nails
Maintains clean appearance, so your home does not look like a
construction site.
11. father Issues
Note: When comparing costs make sure that you are comparing equal roofing systems.
I
c
Yes...I A cceptl!
Wliat We Agreed To...
WeAhvays Use GAF Shingle Type:
QualitjySaingles Color:
i
All GAF Shingles have a class "A" Fire Rating, and are inspected by UnderNkTiters Laboratory
Installations Icy All of our installations will be done according to the following respected industry standards and codes: I
The Experts... e NRCA,National Roofing Contractors Association.
® ARMA: Asphalt Roofing Manufacturers Association
{
® GAF Pro Field.Guide to steep slope roofing
I
s All local; state and federal building codes and requirements
Keeping Your Site ® We will clean the job site at the end of every day.
Clean... ♦ We will completely remove all debris at the completion of the project.
0 We will remove nails from the site using a special nail-finder magnet
If anything We will provide written notice if any extra costs beyond this written estimate are required, your verbal
Changes ... or written approval will allow us to proceed with extension to this contract.
Quality Our management will personally inspect your roofing installation...after all;the continued excellent
Assurance reputation of our company is required to assure fitture referrals from you based on your satisfaction.
Inspection...
Total Cost
NEW ROOF 6,000.00
I
Agreement
(above prices and CUStOITIer NarIle:_''���( �_Accept
specification are
acceptable) Signatu
re Date:Date:
Payment required is'./:down at the start of the job:balance due at completion.
This proposal may be withdrawn if you do no accept within 1.0 days.
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
www mass gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Business/Organization/Individual):
Address: C1,�0
City/State/Zip: IVdf4�q e.,�:d4 t-., _ phone#: 7�r/— � /7?039
Are jou an employer?Check the appropriate box: Type of project(required):
1.
Are
am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction
employees(full and/or part-time).* have hired the sub-contractors
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 1 7• ❑Remodeling
ship and have no employees These sub-contractors have 8. ❑Demolition
working for me in any capacity. workers' comp.insurance. 9. ❑Building addition
[No workers' comp. insurance 5• ❑ We are a corporation and its
required.] officers have exercised their 10.❑Electrical repairs or additions
3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions
myself. [No workers' comp. c. 152,§1(4),and we have no 12. Roof repairs
insurance required.] t employees. [No workers' 13. Other lqi 1/ 0!"
comp.insurance required.] o
*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.
:Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information.
I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site
information. r
Insurance Company Name: � 1� CA(ZBOY)e L,1/;
Policy#or Self-ins.Lic.#: Expiration Date: A& J
Job Site Address:._ o `n V / [1?n6!/L
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 Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby c fy u er ai s and pena ' s p p' t z e information provided above is true and correct
Si ature: }/ Ie"-
Date:
Phone#: _ — 9n �F
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
4 •
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 bum leaves etc.)said person is NOT required to complete this affidavit.
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address,telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
Tel. #617-727-4900 ext 406 or 1-877-MASSAFE
Fax# 617-727-7749
Revised 5-26-OS www.mass.gov/dia