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HomeMy WebLinkAboutBuilding Permit #055-2016 - 92 ANDOVER STREET 7/13/2015 BUILDING PERMIT o�"��T 6�°�0 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION y� 7y0 /� .K I•O U Permit No#: v z/fo Date Received �,4"�q�TE,•ea c5 AcHUs�� Date Issued: 3 7 / /� �SS IMPORTANT:Applicant must complete all items on this page LOCATION l Z- S T_ Print PROPERTY OWNER om p11 IF�:L Ilu4-V Print 00 Year Structure yes no MAP OV3� PARCEL: h52- ZONING DISTRICT: Historic District yes 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 ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic Q Well ❑l Floodplain Ki`Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: fe-J& c oo ��irr le-S Identification- Please Ty a or Print Clearly OWNER: Name: Ct Phone. Address: Contractor Name: (il/l ,Gf.¢6 � l/ti ✓! Phone: 7(r - 3Z.- !�Z 12>1 Email: CJ Address5cqc-f-r- gp C?cock Supervisor's Construction License: s 0 5-0 Z�l Exp. Date: ('y Home Improvement License: �d -� 7 Exp. Date: 1'<-/0- 2 C 3 ARCHITECT/ENGINEER Phone-. Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ :76 FEE: $ Check No.: 767 Receipt No.: c29() 5�) NOTE: Persons contracting with unregistered contra ors do t have ss to the guaranty fund R � . Location C/O No. ' cai �� Date7//3J/! ,t TOWN OF NORTH ANDOVER v� Certificate of Occupancy $ Building/Frame Permit Fee s—&,— Foundation Permit Fee $ Other Permit Fee $ ' TOTAL °` $ ` Check# 17&q f r� ; Building Inspector Plans Submitted ❑ Plans Waved ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL F Public Sewer ❑ Tanning/Massage/Body.Art ❑ Swfimling 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 m U FORM i PLANNING & DEVELOPMENT Reviewed On Signature_ I i COMMENTS i CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature I I COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes 1 Pianning Board Decision: Comments 1 ' z Conservation Decision: Comments Water& Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street *iFIRE DEP R�TLMENT Temp ©umpstera�gn�site i;Lto� ed at 12,4i"MamStreef, ". _' --- ;Departmentgnature/date, Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, roast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No � MGL Chapter 166 Section 21A—F and G m1n.$100-$1000 fine NOTES and DATA—(For department use I ® Notified for pickup Call Email Date Time Contact Name Doc.Building Pennit Revised 2014 I 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 Building pp 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 Building Permit Application Certified Surveyed Plot Plan Workers Comp Affidavit Photo Copy of H.I.C. And C.S.L. Licenses f 4. Copy Of Contract 4. 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) 'I 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 IECC 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 NORTly Town of FAndover - , y to No. . rh ver, Mass COCHIC HI WICK �.95 RgTED ''QP,��y U BOARD OF HEALTH Food/Kitchen PER I LD Septic System THIS CERTIFIES THAT ..... �!... BUILDING INSPECTOR M.. ..... ........... .......................................................... 1!;1l1r111 10111019 Foundation has permission to erect .......................... buildings on ...... ..� Q ..... ........ Rough to be occupied as ........... . .... ....................... ..... .. .......................................... Chimney provided that the person accepting t ' permit shall in every respect confor o t e terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating o 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 CONSTRUCTIO S RT Rough Service ................... ... �.4 ............................... Fina BUILDING INSPECTOR 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. i i i WM. J. ZANNONI, INC. GENERAL CONTRACTING 806 Salem Road,Dracut,MA 01826 Ph./Fax(978)689-3444 License No.050281 AGREEMENT #070915 To: Anne &Mike Delaney July 7, 2015 92 Andover Street No. Andover,MA 01845 978-681-9133 annedelaney@comcast.net Job: Roof E Description: We Shall Provide All Necessary Materials and Labor to Install New roof Shingles on the Home, Same Address as Above, Including: 1. Strip Existing Shingles Down to the Roof and Truck Away All Debris. 2. 8"Aluminum Drip Edge On All Roof Perimeters. 3. Ice&Water Barrier Along the Bottom 6' of the Main Roof, and 15#Black Felt Paper, Or a Better Equivalent Over the Balance of the Roof, and the Two Porch Roofs. 4. Architectural Asphalt Shingles By Certainteed, Grey Blend Color or Similar to Be Selected By Customer. 5. Flashing and Boots As Required Around Chimney and Pipes. Total Job Cost $ 7650.00 Notes: Repairs to the Roof Shall Be Done As Discovered and the Cost Determined in the Field. Customer Shall Be Informed of the Additional Cost and a Change Order Shall Be Executed. Terms: 25%Due With Signed Contract Balance Due Upon Completion NOTE: This Contract May Be Rescinded Within 3 Days of Signing By Customer, and All Deposits Returned. Date: Date: 601 - 40tI-e- SGC The Commonwealth of Massachusetts Department of IndustrialAccidents 1 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. ADMicaut Information Please Print Le ibl Name(Business/Organization/Individual): (LC4,ft Address: City/State/Zip: 5�� � G�9- Phoneej#: �� �/ 3 4o Are you employer?Check the appropriate box: aL 0 �i�i Type of project(required): 1. I am a employer with J. ._employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.F1 I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 E]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.❑Electrical repairs or additions proprietors with no employees. 12. Plumbing repairs or additions 5. I am a general contractor and I have hired the sub-contractors listed on the attached sheet. ❑ 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.t 6.❑We are a corporation and its officers 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 applicant that checks box 41 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 is providing workers'compensation insurance for my employees.'Below is the policy and job site information. Insurance Company Name: Ail?/4'C— Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: 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 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. Ido hereby cer 'y under the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: — f Phone#: 70,11- ' -13 Official use only. Do not write in this area,to be completed by city or town official. i 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#: k 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 Iocal 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 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 j 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 perinit/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 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-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia E 7/13/2015 10:15 AM FROM: HOWE INSURANCE AGY TO: 978-688-9542 PAGE: 001 OF 001 i ' 7 DATE (MM/DD/YYYY) SII collo CERTIFICATE OF LIABILITY INSURANCE 0711312015 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 Phone: (978)475-0400 Fax: (978)475-2171 CONTACT Tina Grange THE HOWE INSURANCE AGENCY PHnNFFAX 4 PUNCHARD AVE ac No E,a: (978)475-0400 ac No: (978)475-2171 ANDOVER MA 01810 E-MAIL tgrange@howeins.com INSURER(S)AFFORDING COVERAGE NAIC A INSURERA : National Grange Mutual INSURED INSURER a National Grange Mutual WILLIAM J ZANNONI INC 806 SALEM ROAD INSURER C : Liberty Mutual DRACUT MA 01826 INSURER D: INSURER E INSURERF COVERAGES CERTIFICATE NUMBER: 23504 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 ALLTHE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADUL SUER POLICY NUMBER POUCY EFF POLICY EXP LIMITS LTR INSR NND MM/DDNYYY MM/DD/YYYY A GENERAL LIABILITY MPB39171 02/26/15 02/26/16 EACH OCCURRENCE $ 2,000,000 X COMMERCIAL GENERAL LIABILITY PREMISE 70 RENTED $ 500,000 PREMISES(Ea occurence CLAIMS-MADE I:xl OCCUR MED.EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 4,000,000 PRO- ' POLICY JECT LOC $ B AUTOMOBILE LIABILITY M1 B39171 09/24/14 09/24/15 COM�BINED S114GLE LIMIT $ ANY AUTO BODILY INJURY(Per person) $ 250,000 ALL OWNEDX SCHEDULEC AUTOS AUTOS BODILY INJURY(Per accident) $ 500,000 HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ 100,000 AUTOS (per aaident $ 41EI MBRELLA LIAR OCCUR EACH OCCURRENCE $ UA- CLAIMS-MADE AGGREGATE RETENTION$ $ WORKERS COMPENSATION WC231S384548-014 01/14/15 01/14/16 wcsTATu- OTH C AND EMPLOYERS' LIABILITY TORY LIMITS ER $ ANY PROPRIETOR/PARTNER/EXEY/N CUTIVE � E .EACH'ACCIDENT $ 1,00„000 OFFICER/MEMBER EXCLUDED? J N/A E.L.DISEASE-EA EMPLOYEE $ 1,00„000 (Mandatory In NH) If yes,describe under E DISEASE-POI ICY I IMIT $ 5,00,,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) I CERTIFICATE HOLDER CANCELLATION TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE BUILDING DEPARTMENT THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Attention: FAX#978-688-9542 Christine J. Grange ACORD 25(2010!05) ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD k �l r { e , toy: Is J 1 Vii?—' 44 L7' � Aga�l }pig _ ww y r. I • �.St�.�_:��i-�_� f ... u t tel: - .�+.+e '�'