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Home My WebLink AboutBuilding Permit #179-2017 - 88 JOHNSON STREET 8/22/2016 �� I� , -�-� �✓ BUILDING PERMIT / O� NoRTk� q fff/// �(TLED 6 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Co p ea Permit No#: / W1 Date Received 9SSACHUS�4 Date Issued:4e 7,7,ZPI� IMPORTANT: Applicant must complete all items on this page 4 LOCATION �() s7\ 6�oy N. Print PROPERTY OWNER&O Ma �;Ik Print 100 Year Structure s no MAP _PARCEL: ZONING DISTRICT: Historic District es no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Resi ential 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 I]Water/Sewer SCRIP ION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: Phone: 97�'55l -71 Address: - Contractor Name: L.c„� ��>,w,� Phone: °I1S ";51 -7y� Email: Address: ING L.,,)t ✓10 k0A 1--,a\ Supervisor's Construction License: CSS& JQ>!„OI Exp. Date: I Home Improvement License: 17 Exp. Date: ylq ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $�r-,n , JJ FEE: $ lam" Check No.: 0�z-,7 Receipt No.: 30 7-161 NOTE: Persons contracting with unregistered cconoactors do not have access to th guaranty 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 Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS , CONSERVATION Reviewed on Siqnature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes panning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Signature& Date Drivewav Permit DPW Town Engineer: Signature: w Located Street FIREMEPARTMENT TernpiDumpster omsite ,yes_ _ . . Locatedlaf`124EMain;Street. Fi`re,Departmentsignature/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) i ❑ Notified for pickup Call Email Date Time Contact Name Doc.Bnilding Permit 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 OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks 4 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) ,rF 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) iL Building Permit Application 4 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 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 Location644 No. � � Date G,7 Z Z✓� • - TOWN OF NORTH ANDOVER n -- Certificate of Occupancy $ Building/Frame Permit Fee $ J04--, Foundation Permit Fee Other Permit Fee $ TOTAL $ �_ Check# ~ >i ,:'�/r�!,--•-.-.,moi Building Inspector �` r ORT - 1 � N F1 . w. .. . . _ _ _ d ve." 'e. e h ver, Mass, ,Oia Zz ZD/ NIC Nl-PC �.p NTED 0 S U BOARD OF HEALTH Food/Kitchen PERMIT T L D I Septic System THIS CERTIFIES THAT ........PABUILDING INSPECTOR Foundation has permission to erect ........... ........... buildings on .. ..... .. iityN, a ..... ...... Rough tobe occupied as ... . . ... ..... .. . xiava ............................................................. 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 - UNLESS CONST TION Rough Service . .. ....... ...... .... ............. �6�TAW Final BUILDING GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough i 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. *Your home will be treated like our own throughout the entire project. *Protection and clean-up of the property are our biggest concerns. Ise Scheduling: +We do our best to stay within stated scheduling;_however, Mother Nature and emergencies can lead to delays. We will do our best to limit those delays. - We will contact you within 48 hours before installing you.i new roof and work will not be commenced until you are contacted first. If mte time is necessary to accommodate your schedule, kindly let us know. Job cost. Roof Cost: $11,250.00 Payments shall be made as follows: 1/3 deposit due before scheduling work, balance due upon completion of the work. QUOTE GOOD FOR 30 DAYS ONLY. SIGNING INDICATES ACCEPTANCE OF THE PRICES AND SPECIFICATIONS SET FORTH HEREIN AND ACCEPTANCE OF THE TERMS AND CONDITI NS OTHIS CONTRACT. i Wicke mart Exteriors: Ho Ow er Date: 1 Date ~ _,Au46rized Representative Thank you, Ryan.Dolan 978-551-7484 a 2 The Commonwealth of Massachusetts z ' f Department of IndustrialAccidents I n 1 Congress Street,Smite 100 - d Boston,MA 021142017 i www.mass.govldia Workers'Compe*nsatiionlnmrance.A.ffi"davit:Builders/Contractors/Electricians/Plumbers. TO BE J�LED WITH THE I'EI2NIITTIl�TG.AUTHORITY. A�pplicantInformation )) C • Please Print Legibly Name(Business/Organization/L &vidual): wiG�_ 1MG�✓t X h✓S Address: 1`I h L-n c� �A-A lr. City/State/Zip: Iyct j�\O\ 1 _ Phone#: 0300 Arey an employer?Check&e appr1opriate box: Type of project(required): 1.7am a employer with. Q ttime employees(full and/or par ).* 7. Q New. COlistluCttOn 2.0 I am a sole proprietor or partnership and have no employees working forme in 8. Remo deliiig any capacity.[No workers'comp.insurance required.] 9 ❑Demolition 3-1]lam a homeowner doing all work myself[No workers'comp..insurance required]t 10 F1 Building addition 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 11.Q Electrical repairs or.a.dditions proprietors withno employees. 11-Q Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.'0 Ro` rep airs These sub-contractors have employees and have workers'comp.insurancC. ' 14.E]Other 6.[]We are a corporation and#fi officers have exercised their right of exemption per MGL c. 152,§1(4),andwehaveija..nployees.[No workerscomp.insurance required.] Any applicant that:checks box41 must also fill out the section bBlow showing their workers'compensation policy information. i Homeowners who udEif f1w affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box ma st 4gaehed R 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. .rain an employer th at is pjovidingworkers'compensation insurance for my employees'Below is thepolicy grid job site information. Insurance Company Name: d i& T,15l<✓ rct r�,�� Policy#or Self-ins.lia-#:_ / �6 1a A ,) - 40070 A111a Expi'ationDate: / d JJ Job Site Address: $0 J61/ \Sy 5+ City/State&ip: V\�, ,n U 0� Attach a copy of the workers' compensation policy declaration page(showing the policy number and Apiration 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. X do hereby certify der, the pains and penalties ofperjeary that the information provided above is true and correct Signature: Date: Phone# Official use only. Do not write in this area to be completed by city or town offeciaX. City or Town: Permit/License# Issuing Authority(circle one): ; 1.Board ofHealtb. 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 empl oyees. Pursuant to this statute,an employee is defined as"...everyperson 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 renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who lias not produced acceptable evidence of compliancewiththe 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 fll-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•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 p policy,please call the Deartment at the number listed below. Self-iirsurecd 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 fll 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 areference number. In addition,an applicant that must submit multiple permithicense applications in any given year,need only submit one affidavit indicating current otic information if necessary)and under"Job Site Address"the " P Y ( arY) h 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 maybe provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. Anew 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 wwwm.ass.gov/dia Client#:45591 WICSM ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD1YYYY) 07/26/2016 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. l 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). r.. PRODUCER .. -. CONTACT" NAME: Gall DAUg1aS Eaton&Berube Commercial Line PHONE AX 11 Concord St. AIC N Ext:603 882-2766 AIC No E-MAIL Nashua,NH 03064 ADDRESS: 603 882-2766 INSURER(S)AFFORDING COVERAGE MAIC p INSURER A:Arch Insurance -INSURED Wicked Smart Exteriors INSURERS:AIM Mutual Insurance Company 149 Lund Rd wsuREa c I Nashua, NH 03060 INSURER D: �} INSURER E: INSURER F.- COVERAGES :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 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 POLICY EFF POLICY EXP { TYPE OF INSURANCE INSR UBD POLICY NUMBER MMIDDIYY MMIDD LIMITS I A GENERA!LIABILITY BINDER295612 7/2912016 07/29/2017 EACH OCCURRENCE $1,0001000 X COMMERCIAL GENERAL LIABILITY PREMISES &EoNTE soca $100,000 CLAIMS-MADE. Q OCCUR MED EXP(Any one person) $10,000 X BI/PDDed:1,000 PERSONAL SADV INJURY $1000,000 ..'..' . GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGO s2,000,000 X I POLICY M PRO LOC s AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO "�-� BODILY INJURY(Per person)- S ALL OWNEDSCHEDULED AUTOS AUTOS BODILY INJURY(Per acddern) $ HIRED AUTOS NON•OWNED PROPERTY DAMAGE AUTOS Per accident $ IUMBRELLA LIAB $ OCCUR j EXCESS LU4B EACH OCCURRENCE S CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B" WORKERS COMPENSATION AND EMPLOYERS'LIABILITY AWC4007029342 7/23/2016 i7/2312017X WC STATU OTH- 1TORY LIMITS __ Eg ANY PROPRIETOR/PARTNERJEXECIlT1VEY%N n ( OFFICER/MEMBEREXCLUDED? r l NIA E.L.EACHACCIDENT $100000 (Mandatory in under E.L.DISEASE-EA EMPLOYEE $500,000 yes describe und DNESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $100,000 i DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACOR0101,Addillonal Remarks Schedule,If more space a requlrad) Workers Comp-MA Proprietor Excluded: Ryan Dolan,owner CERTIFICATE HO >R CANCELLATION f FOR INFORMATIONAL PURPOSES ONLY \ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE I THE EXPIRATION DATE -THEREOF, NOTICE WILL"BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE.. . I l CORPORATION.All rights reserve GDX � The ACORD name and logo are registered marks of ACORD )051 1 of 1 T `ACORD 2n WU I fie Ja,vrTv nears-arm rvyv arc rzy.a%......,,o . .. .• ""%% qtr:. r � • ,r }r ensee Details uemographic Information Full Name: RYAN DOLAN er Name: 'cense rasa n orma eon City: Nashua State: NH Zipcode: 03060 o nt : - U 'ted -tates icense n orma eon License No: CSSL-106038 License Type: CSSL-RF Roofing Profession: Building Licenses Date of Last Renewal: ' Issue Date: Expiration Date: 8/13/2018 License Status: Active Today's Date: 8/22/2016 Secondary License Type: Doing Business As: Slatus Change R as License issuance rerequis' e n orma ion . Licensee: DOLAN, RYAN Relationship: Attribute Of License No: CSSL-106038 Close Window @2.011 Commonwealth of Massachusetts - Site Policies Contact Us r Gt http://elicense.chs.state.ma.us/Verification/Details.aspx?agency_id=1&license_id=798257& 8/22/16,6:29 AM Page 1 of 1 C�ela�aasaapu�� 090£0 HN`` nHS`!N 021ONn bbl NY100 NVA?J S2101831X3121dWS 03NOlM d90LiO.Zl6/8y :uolleiidx :ed61 Z££9L1 :uo4eilsloo 2i01011a1N001N3W3A0HdW13WO � : F uogelnIag ssaalsng 1p si!vjjV iawnsao3 jo aaWO rt��rn�JU��U)J�(!U 1l��I7JU21101[[2lCU�r7�n Ucense 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