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HomeMy WebLinkAboutBuilding Permit #173-2017 - 85 JOHNSON STREET 8/18/2016 �')I ly BUILDING PERMIT t NORTy + O`�t6ED 16� O TOWN OF NORTH ANDOVER ,, 3 � - APPLICATION FOR PLAN EXAMINATION Date Received 7 A�R�7ED Pp` Permit No#: �y �SSACHUS Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION ,�OC1-11 .5 011 5'F Print PROPERTY OWNER I r Z q�� ,Te-rr©�, Print 100 Year Structure yes no MAP �PARCEL:�ZONING DISTRICT: Historic District y no Machine Shop Village y s no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial Iteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic 0 Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: dentification- Please Type or Print Clearly OWNER: Name: �,°�za��L �Qrr`��� Phone: Address: e) fn sonsf Contractor Name: yn i lei,,Q�e Phone: q78 -7 Email: Address: 40Y4 501) S4- Supervisor's Construction License: /,C)_S7cfq 3 Exp. Date: Home Improvement License: 1 705-7,�:— Exp. Date: I/ //0) t ARCHITECT/ENGINEER Phone: 4 Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. l Total Project Cost: $ � ' ,qoo FEE: $ 251 7� ter, Check No.: ZzZ Receipt No.: NOTE: Persons contracting with unregistered c ntractors do not have access to til a�awl fund Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank, etc. ❑ Permanent Du mpster 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 (Manning Board Decision: Comments conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPAR}TMENT - Temp,Dumpster on site ,yes no._. _ ILocated;at124ilVIain4Street - - - -- Fire Deparfinent 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) ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 A 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 :ak Floor Plan Or Proposed Interior Work Engineering Affidavits for Engineered products i 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 I ECC Energy code 4, 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 � t C Location C�� �J U� No. �� 2r t1 Date . - TOWN OF NORTH ANDOVER . Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ r Check# �2z Building Inspector l F_ , tAORTH .� - c . " ve" '* 0 y � �h ver, Mass, T 0 ICftt 1 COC MIC NlwKR V A04ATED P'P���S S V BOARD OF HEALTH Food/Kitchen PERTO'b Septic System FT LD THIS CERTIFIES THAT .. bs. .................. BUILDING INSPECTOR .......... ... ... ............. ....l......... ................ has permission to erect ........ ................. buildings on ... ... Q .11�.. �.1 ..... Foundation • Rough tobe occupied as ............ .......... ........�.......r... ................................................................ chimney provided that the person accepting is 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 CONST TIO Rough Service .. . . ..... ..... ......AV......ff...... Fina BUILDING ASPE&OR 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. CD Roofing Vincent Colangelo 3 Hodgson St. Roofing Tewksbury,Ma 01876 978-656-8497 NO vincentcolongelo@sbcglobal.net • 78 '� HIC Llc# 170575 CSSL Lic#105943 r I r'-V'6 e -r'"�� -�, �31/oi f b OWENS CORNING Customer: c� aL��t/'1S Z n �f � PREFERRED CONTRACTOR IV /AAC6Ve, .� f —)sf.- Q?oc Description of work Performed: Obtain required town permits&provide certificates of insurance&workers compensation Provide Dumpster set on planks*for contractors use only(materials all recycled) Attach Large Tarps to protect adjacent finishes,landscaping,and property. Strip-off( I )existing layers of roofing on complete house&re-nail any loose decking Install flinch j Aluminum Drip edging i Owens Corning Starter Shingles ,, OA aDf� ( Install Owens Corning Ice&Water shield Eft at eaves,aft in valleys,around all penetrations �a�� lf P { Install Synthetic felt paper to entire roof &5'3+a'0+ c Install Owens Corning LifeTime warranty TruDefinition Duration shingles Ae Install new neoprene vent pipe flashings on all plumbing pipes ( Install Owens Corning VentSure ridge venting with moisture guard Install Owens Corning ProEdge hip&ridge cap shingles (�Completely re-flash chimney with lead `( Owens Corning Preferred contractor installation with full war�rantyy All:work will be completed according to state and manufacturing codes and specifications.Every day we will have the t roof water tight,clean gutters,completely clean the lob site and use a magnet roller to collect scattered nails. Additional work to be performed �f l �' f �3t1 a l` �r.6✓'�I $ Com`>m ✓.L.r t,redah,� ( All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices. Any alteration or deviation from the above specifications must be made in writing on an Add-on/Modification of Contract form and may become an extra charge over and above the amount stated herein. This agreement is contingent upon delays beyond our control.Owners to carry fire,tomado and other necessary insurance.Our workers are fully covered by Worker's compensation Insurance. Homeowner agrees to pay for all work as set forth below. If the homeowner defaults, homeowner agrees to pay all costs of collection, including reasonable attorneys fees,in addition to other damages incurred by contractor.Full Payment is due upon completion of work. We propose hereby to furnish material and labor - complete in accordance with the above specifications, for the sum of: Y t� s follows P P aid a amount shall be dollars($ �jt�C?, --'�" Said P f Note:This proposal may be withdrawn by us if not accepted within�,Q_.._days. YOU, THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION. SEE THE ATTACH NO; t E OF CANCEL TION FOR AN EXPLANATION OF THIS RIGHT. THIS SALE IS SUBJECT TO THE PRO IONS F THE HOME SOLI ITATION SALES ACT AND THE HOME IMPROVEMENT ACT THIS INSTRUMENT IS NOT NEGOT BLE$(�,5 0C),j- Work will not begin until your right to cancel has expired and ave a d p i of r dollars($ ),unless this agreement pr es-the ' e. Signature of Contractor or authorized representativ . *(IiWe)have read the terms state In In they ve been explai ed a etus),and(I/We)find them to be satisfactory and hereby accept them. Signature of Homeowner(s): s The Commonwealth of Massachusetts z . Department of IndustrialAccidents I y s I Congress Street,,Suite 100 0• -' d Boston,MA 02114-2017 7 www.mass.gov/dia 5�. Workers'Compensation Insurance Affidavit:Builders/Contractors/EIectricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Mormation Please Print Lei=ibly Name(Business/Organization/Indiv:idual):_�� 1 Address: r ST1n City/State/Zip: ItA J A Phone Areyou an employer?eheektIie aplizopriate box: Type of project(required): 1.01a ma employerv&b. employees(full and/or part-time).* 7.- ❑New coaistraction 2.E]I am a sole proprietor or partnership and have no employees working for mein $, ❑Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition I❑I am a homeowner doing all work myself[No workers'comp..insurance required.]t 10 [❑Building addition 4.FJ 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 I L E]Electrical repairs or.additions proprietors withno employees. 12:❑Plumbing repairs or additions 5. am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13_'❑Roof repairs These sub-contractorsliave employees and have workers'comb.insurance. 6.FlWaareaC01pDratiqn.and ip pfficers 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 applicantthat checks box 41 must also'fdl outthe section below showing theirworkers'compensationpolicy information T Homeowners who submit#lois affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. tContractors that check this box must•athacft d an additional sheet showing the name of the sub-contractors and state whether ornot those entities have employees."If the sub-contradbi;have employees,Uiey must provide then-workers'comp.policy number." fain an employer th at is providing workers'compensation insurance for my employees'Below is the policy acid job site information. _ Insurance Company Name: /1r,30 ! Q� —a Expiration Date: 3419117 Policy#or Self--ins.hic.#: /C�68 6�� � Job Site Address: O 5� �(��1 c r)n 51- City/State/Zip: LP-1— Attach a copy of the workers' comperes tia on policy declamation page(showing the policy number and expiration date). Failure to secure coverage as required under MGL o. 152, §25A is a criminal violation punishable by a tine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDLR and a tim 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 verific . X do hereh erd rid ze ains andpena/ties ofpeijary tlaat the informadonprovided above is true and correct Si a e: Date: // Phone#• -`7!8 r� 4 Official use only. Do not write in this area,to be completed by city or town official. i I City or Town: Permit/License# Issuing Authority(circle one): 1.Board of)lealtlh. 2.BnildingDepartment 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing fnspector 6.Other Contact Person: Phone#: -- I Information and Instructions ' Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation fortheir employees. Pursuantto 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,ass ciation,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 ofan 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 anotherwho 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 rias not produced acceptable evidence of compliance with the insurance coverage rcequiired." 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=contractoi(s)name(s),address(es)and-phone.number(s)along with their certificates)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.In.dustrial Accidents foi-confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be retained 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 yoiz'are required to obtain a workers' compensation policy,please call the Departmentt,at the number listed below. Self-insure_d 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 fillout 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-MA.SSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia ACORO CERTIFICATE OF LIABILITY INSURANCE lulTEIMMtDDYVYY) 8/18/16 � 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 CONTA T - NAME: Angela Westen Insurance Agency PHONE FAX 557 Central Street iAIQN EldI: (978) 735-4094 IAIC,No}: (976) 735-4095 ADDRESS_,-�anqela@awesten.com Lowell., MA 01852 _� INSURE RIS)AFFORDING COVERAGE. NAIC# INSURER A:A_TLANTIC CASUALTY INSURANCE _CO INSURED INSURER B:HARTFORD UNDERWRITERS INS COMP F 0 CONSTRUCTION CORPORATION WSURERC: 4 ASTOR ST AP. 4A INSURER D: LOWELL, MA 01852 j INSURER E: INSURER F; I 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY TI-E POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS ANDCONDITIONS OF SUCH POUCIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, ILTR TYPE OF INSURANCE ;AODL!SUBR POLICY EFF POLICY EXP I POLICY NUMBER MMICONYYY MMIDDIYYYY . LIMITS A GENERALLIABILITY L021008696-2 3/18/16 3/18/171 EACH OCCURRENCE $ 1 � 000 000 DAMAGE TO RENTED --�-- __. .._ X COMMERCIALGENERALt1ABMJTY PRENIUSESIE2 !S 100 000 cFA1Ms;lADE ocxuR I MED EXPa,yonaues«qs __ 5 000 (�_ J__-_ PERSONAL s Acv INJURY I S 1,000"000 _ GENERAL AGGREGATE 's2 000 0t)0 GE_N'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMPtOP AGG+5 1,000,000 POLICY PRO — LOG AUTOMOBILE LIABIUTY C01,43INED SINGLE LIFAI: &E a are,dertj S ANYAUTO iBODILY INJURY(Per oasor,r S ALL COINE0 SCHEDULED r AUTOS AUTOS BOUIL,Y INJURY(Por xc4ont} S NON-OWNED PROPERTY DAIS_dE HIRED AUTOS AUTOS ,Perace�,denl) _$ _- S UMBRELLA LIAB OCCUREACHCI'CURRENCE EXCESS LIAB _ CLA_IMS.M_AOEI ( kGGRFGATE c DED RETENTION S — S $ NJDRKEftS COMPENSATION 2E112068-16 3/30/161 3/30/17 WC STA3U• LOTH-I AND EMPLOYERS'LIABILITY YIN TORY LIMITS 1 E R AMYPROPRIETORIPARTR'ERIEXECUTNE EL EACHti�CIUENr 3 100,000 OFFICE RIMEMBER EXCLIJDEC? N t A. _ ... _ _ IMandabry in NH) EL DIS FRSE-EA FMPLOYEE_S 100 1000 If ves DESCRIPTION OFF I EL DISEASE-POLICY LIh9ff S 500,000 DESCRIPTION OF OPERATIONS L`2bw i DESCRIPTION OF OPERATIONS I LOCATIONS I V EHI CLES(Attach ACORD 101,Additional Rerre rks Schedule.if more space is reguired) CERTIFICATE HOLDER CANCELLATION SHO ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE E ATION DA THEREOF. NOTICE WILL BE DELIVERED IN TOWN OF NORTH ANDOVER A Ott TH POLICY PROVISIONS. 1600 OSGOOD STREET SUITE 2035 NORTH ANDOVER, MA 01845 AUTHORIZ REPRESENTATIVE G 1988.2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Phone: (978) 656-8497 Fax: E-Mail: vincentcolancrelo@sbectlobal.net i ��e COanamo�riaeatt� C"'d e Office of Consumer Affairs&Business Regulation OME IMPROVEMENT CONTRACTOR -Registration: .170575 Type: i YP � Expiration:." 1.1/10/2017 DBA CD ROOFING r VINCENT COLANGELO 3 HODGSON ST TEWKSBURY, MA 01876 Undersecretary r , Massachusetts Department of Public Safety �} Board of Building Regulations and Standards License: CSSL-105943 Construction Supervisor Specialty VINCENT COLANGELO 3 HODGSON STREET TEWKSBURY MA 01876 I ^M Commissioner Expiration: 03/09/2018