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HomeMy WebLinkAboutBuilding Permit #619-13 - 87 UNION STREET 3/25/2013Permit NO: (0/ Date Issued TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received /i -s IMPORTANT: Applicant must complete all items on this pave LOCATION S 7 Un I O r) sl Print PROPERTY OWNER ��� GC.o o,`r2 Unit # Print MAP NO: 0'? PARCEL: %ef ZONING DISTRICT: Historic District yes no Machine Shop Village yes no 100 year-old structure 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 0 Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑'Septic ❑ Well 0 Floodplain 0 Wetlands 0 Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: OIoW-in cello lose (Identification Please Type or Print Clearly) OWNER: Name: P h e -f-CAec. G c o u %e Address:?7 union ST PorTh Andove1- 78-3o.s-y$13 CONTRACTOR Name:A+m Geilrla' ConTCrcO(n Phone: q,Ij"-2`i,- 7-27 Address: I �'k R d^oSTer s 1 P6 -61y MA. n n 6 0 Supervisor's Construction License: 01 � 9 33 Exp. Date: Home Improvement License: N/1-24 ARCHITECT/ENGINEER Exp. Date: / Phone: Address: Reg. N FEF_ SCHEDULE: BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ /3a70 - O o FEE: $ 1�O'— Check No.: -7 l� Receipt No.: &-a �2 cl NOTE: Persons contracting unregcontractors do not have access t he guaran fund Signature of Agent/OwSignature of 10 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 Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Siqnature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Com Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: FIRE DEPARTMENT - Temp Dumpster on site Located at 124 Main Street Fire Department signature/date COMMENTS Located 384 Osgood Street yes no 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 - Date Doc:.Building Permit Revised 2011 June/mi 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 2008mi Location j7r No.- 6 / 32-1 Check #7 1� 9� 26224 Date TOWN OF NORTH ANDOVER Certificate of Occupancy $- Building/Frame Permit Fee $ Foundation Permit Fee Other Permit Fee TOTAL Building Inspector j 2 IQ x LL o Q OLL co al Y o LL E al V) a VI O (A z z J m C O Y ' LL M J O c LL 0 � z z m j d o K (6 c LL 0 N Z u u J W i t o OC A ,n W _ (6 c LL °C O Wa IA Z Q 2 IQ x LL o Q OLL co al Y o LL E al V) a VI O (A z z J m C O Y ' LL j o W t U c LL 0 � z z m j d o K (6 c LL 0 N Z u u J W i t o OC 41 U a) LO _ (6 c LL °C O Wa IA Z Q t o CC _ fa c LL CW C o~c Q o NJ L alto L 3 CD O Z al i, ,, V7 +' cu a/ Y O E VI O J �•o � F— LL fn i O _ V Q Q. 4) �a O+ E Q, N � C • d d • \� • o \: C c �• �ccc `•v• yr L cam: a m c CD ca w, ?'�o� U) C6 0 Q 0 CL t (j_�Z N 0- T) T 3 rn > O c�H CL • 4) m • 'U, o c c a, •O C O w m O aD W O •n -0 O m N C ,. O Ln O LZ 0 V d 0-0 O ..+ g•d > :� C J cn H to = O a. O U 0 > 2 Z G CD z ujw CL W F- W M 0 : LU Z Z m r Q N O U F- • Z U Cl) J C7 n Im E ri O O G� Z N ICD N 0 � Q N .E m m CL 0 �+ v D O O O' CL c Q �CL0 C Z v O CLC U ca = Q. A Job Number 1.WEATHERSTRIPPINGICAU LKING Door Kits Q -Lon or Equty. Door Sweeps (Regular) Door Sweeps (Automatic) Reglaze Windowslln.lnch Window.Weethstr Schlegal per side Tenmal Recessed Can Cover Attic air sealing per man/hr basement and living space air sealing SUBTOTALS 2A.INFILTRATION / INSULATION Domestic pipe Hot Water Tank 1 st 6 Sill Insulation R-19 CF Sill Two Part Foam w/ Fiberglass Batt Drape Perimeter R-5 Anch. Sq. ft. Perimeter 2" T-max or equivalent foam board sq. ft. Drape DOOR R-5 or T-max or equivalent on door. Tape Joints (Aluma Grip only) per hr. Duct Insulation & Tape sq. ft. R-5 Rigid Foam Board Anch. 1" per board Hydronic pipe insulation to 1" R-5 Hydronic pipe ins.1.25"-1.5" R-5 Sleampipe Ins. tol.25" Iron pipe R-5 Steampipe Ins. 1.5"- 2" Iron pipe R-5 Steampipe Ins. 3" iron pipe R-5 Air Conditioner Meeting Rail Air Conditioner Cover Air Conditioner Cover Special Order SUBTOTALS 2B. INSULATION Open Unrestricted R 49 Open Unrestricted R 38 Open Unrestricted R 30 Open Unrestricted R 20 Open Unrestricted R 10 Restrict FUSloped R 30 Restricted FUSloped R 20 Restrict FUSloped R 10 R-19 FGB open raftershxalls/kneewalls R-11 FGB open rafters/walls/kneewalls Attic Stairs(stairwell & common wall) Cover Pull Down Stairs Thermadome Site built pull down stairs 2" foam box 4521 Client address city 1 town contractor QUANTITY 4 4 0 0 0 0 0 4 0 0 90 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 DATE 20 -Mar -13 PHAEDRA GAOUTTE 9783054813 0 MEII �n y� 87 UNION ST IST RIGHT V IF NORTH ANDOVER MA MAR 2 12013 A&M TOTAL 182.00 63.00 0.00 0.00 0.00 0.00 0.00 300.00 545.00 0.00 0.00 198.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 198.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 KEEP IN MIND 4 FAMILY AUDITOR NOTES (PLEASE SEE NOTES AUDITOR NOTES BY:..l � .... .............. . Attic / Kneewal Floor Transition. Dense pack cellulose W.S. Hatch Q -Lon or equal W.S. & bat Hatch R -3010 -Lon or = Kneewall R-12 cell behind Per.Memb Open Rafter R-20 Cell. /w poly Open Ratter R-30 Cell. lw poly Basement Overhead R-19 fiberglass Basement Overhead R-30 fiberglass Crawlpace Overhead < 4' high R19 Crawlpace Overhead <4' high R30 Garage Ceiling cavity filled w/ cellulose Wood,Shake,Clapboard, Shingles Vinyl Asbestos (single nail) I Asphalt Asbestos (doub. Nail) / Aluminum Brick/Stucco Vinyl over Asbestos Multl-layered 3 or more layers Drill rough plaster or finish wood plug Drill finish plaster Test Drill Walls (all 4 ) SUBTOTALS 2. INSULATION TOTAL 2A.*2B. 3. STORM WINDOWS / DEADLITES Plexiglass up to 88 u.i. Additional per UI over 88" Other (Negotiated Price) SUBTOTALS 5. OTHER MATERIAL Ridge vent In ft. Vents Gable rectangular Varipitch Vent Vent Roof 135 (1 sq ft NFV) Large Vent Roof 855 (A sq ft NFV) Small Vent Soffit Rectangular Turbine Vents All Stack Vent Propa Vent Permabie House Wrap Vapor barrier Energy Star R-4 Rigid Vinyl Repl 94-101 U.I. SUBTOTALS 6J7. E.C. MATERIALILABOR 88. HEALTH S SAFETY 0 0 0 0 0 0 0 0 0 0 0 765 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 AI 11"11TA� \IATCc f 0.00 0.00 0.00 0,00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1369.35 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1369.36 1667.36 AUDITOR NOTES 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 2112.36 AUDITOR NOTES Page 3 AUDITOR NOTES Vent Bath / Kitchen Fan Dryer vent w/ exhaust duct Heartland Dryer Transition Duct only Blower Door Test Pre Post SUBTOTALS 81). REPAIR MATERIAMABOR Basement outside door only Basement outside door w/ jambs Door Repl pre hung 32-36" Steel** w I Lite Door Repl interior solid core 28-32" Door Rept pre hung 32-36" wood'* w / Lite Window Replacement w/ SIR less than 1 Basement Window Repl. Awning/ Hopper Basement Window Repl. With a frame Lockset ( door) Schlage or equal Repair/ Refit Door Replace Side Stop Replace Casing Glass Replacement to 64 u.i. Glass Replacement per u.i. over 64 Sash Sidelock Prop Replacement Threshold (Wood) Threshold (Aluminum) Slide Bolts Plug Plate Cover Cut / finish aflic-kneawall access Cut / Gose attic-kneewall access Labor Rate Hours Labor Rate Hours Labor Rate Hours Labor Rate Hours Labor Rate Hours Permits I Fees (Wap only) SUBTOTALS TOTAL REPAIR + HEALTH & SAFETY 1 89.00 1 89.00 0 0.00 0 0.00 ALWAYS INCLUDE PRE AND POST 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 178.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 178.00 GRAND TOTAL WORK ORDER # (A) 4521 2290.35 PHAEDRA GAOUTTE 978-3054813 87 UNION ST 18T RIGHT NORTH ANDOVER MA Any alterations or deviations from the above specifications involving extra costs must be cleared In writing before installation. The Work Order must be complete within 15 working days from acceptance date below. CONTRACTORICOMPANY: ACCEPTANCE:Company/Contracto r AUTHORIZED SIGNATURE: AGENCY APPROVALS: CTI Authorized Signature: AUDITOR :NOTES &M Date 3 a 3 Date GLCAC Authorized Signature: Date ,t.:. , . is :,.)r:, r, Office of Consumer Affairs &iiusmcss Regulation i 1' HOME IMPROVEMENT CONTRACTOR Type: Registration: 141124 Supplement Card Expiration* 1/1212014 A+M GENERAL CONTRACTING INC. MICHAEL FITZGERALD 5 SOUTH RIDGE CIRCLE LYNN, MA 01904 Undersecretary J - 'j (,�mtrrtittun tiuper� �.,+r 1p�it'.ta� CSSL-099933 MICHAEL P FITZGERALD 10 Overlook Trail #1018 Peabody MA 01960 'J %�� 06/19/2014 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations d 600 Washington Street Boston, M,4 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Name (Business/Organization/Individual;' ±M Address:z/1JQ r S I City/State/Zip:, Phone.#: 1-79 - Iq l - -7 7 ? _? Are you an employer? Check the appropriate box: 1 I am a employer with X 4. [] I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors ❑ I am a sole proprietor or partner- listed on the attached sheet. .2. ship and have no employees These sub -contractors have working for me in any capacity. employees and have workers' [No workers' comp. insurance required.] comp. insurance.$ 5. We are-"orporation and its 3. E] I am a homeowner doing all work officers have exercised their myself. [No workers' comp. right of exemption per MGL insurance required.] t c. 152, § 1(4), and we have no employees. (No workers' coma. insurance re4uired.1 Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. Demolition 9. ❑ Building addition 10.0 Electrical repairs or additions 11.0 Plumbing repairs or additions 12.❑ Roof repairs 13.❑ 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 adidavit 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 is providing workers' compensation insurance for my employees Below is the policy and job site. information. Insurance Company Name: TG A Cn�s -,&nJu rckn ee. di e Policy # or Self -ins. Lic. #: & 4)( 3 q5-6 2A Expiration Date: 011,9-o Job Site Addres- onioo S—) City/State/Zip: CoA And_o der' 01 9L/.S 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 cfp fyn49-Jke paiM4nd penalties of perjury that the information provided above is true and correct 7,' - 7V1 " 7 77 7 use City or Town: area, to be complete by city or town ofjlclal Permit/License # Issuing Authority (circle one): 2. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: A&MGE-1 OP ID: SM AGGRO' �.., CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 03/21/13 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 781-914-1000 TGA Cross Insurance, Inc. 401 Edgewater Place, Suite 220 Wakefield, MA 01880 John Scanlon ACT NAAMNE: PHONE FAX Alc No Ext): AIC,No): E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Peerless Insurance Co , INSURED A&M General Contracting, Inc. Norman Dube 119R Foster St. Bldg 14 Peabody, MA 01960 INSURER B: Guard Insurance Group 03/20/13 INSURER C : EACH OCCURRENCE $ 1,000,000 INSURER D : MED EXP (Any one person) $ 5,000 INSURER E : INSURER F: GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO LOC JECT 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 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 SUBR POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DDIYYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Fx� OCCUR , CBP8833284 03/20/13 03/20/14AMA EACH OCCURRENCE $ 1,000,000 E T 100 000 PREMISES Ea occurrence $ MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO LOC JECT PRODUCTS - COMP/OP AGG $ 2,000,000 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNEDX SCHEDULED AUTOS AUTOS X HIRED AUTOS X NON -OWNED AUTOS BA8762301 03/20/13 03120/14 COMBINED SINGLE LIMIT 1,000 000 Ea accident $ � BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per accident A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE CU8762601 03120/13 03120114 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 DED X1 RETENTION$ 10000 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? �N (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below / A AMWC345622 03/20/13 03/20/14 X WC STATU- OTH- TORY LIMITS ER E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE $ 500,000 E.L. DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HOLDER CANCELLATION TOWNNA1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood Street North Andover, MA 01845 AUTHORIZED REPRESENTATIVE , ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 26 (2010/05) The ACORD name and logo are registered marks of ACORD