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HomeMy WebLinkAboutBuilding Permit #334-14 - 93 MAIN STREET 10/8/2013 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received I Date Issued: IMPORTANT:Applicant must complete all items on this page 1 LOCATION-- ant QCATION__ - _. T - _ �• . rant PROPERTY OWNER O pp,�--�� r Print 100 Year.Old Structure yes nc MAP NO: C PARCER ZONING DISTRICT: Historic District ye no 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 KRepair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Septic ❑Well ❑ Floodplain E Wetlands ❑ Watershed,District ❑Water/Sewer 1 DESCRIPTION OF WORK TO BE PERFORMED: Sl f it r If U� F ©G.�efls �rTf ,4,e Identification,, ease Type or Print Clearly) OWNER: Name: 'r�I•z27C, Phone: G 78- (e�'5-801 Address: "? jS S'F• CONTRACTOR Name: -Uf114911T- C(G (10 Phone: X787(05' -18 q` 7 . Address: St - 5On Supervisor's Construction License: (OExp: Date: 3���1 Home Improvement License: -7 oS" S'' Exp_ Date: -11//-0,A3 ARCHITECT/ENGINEER Phone: Address: Reg. No. 4 FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 3,-200 FEE: $ `fq Check No.: �Z73 z4d Receipt No.: -2- NOTE: Persons contracting with unregistered contractors do not have access to uar fund Sig_nafure'of A'gent/Owner ignature of contrac �i.,r� Chw,i#oi3 n Plane 1AInixiPri n (:prtifipd Plot Plan ❑ Stamped Plans ❑ Plans Submitted ❑ PlansWaived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE.OF°:.SEWERAGEDiSPDSAL Public Sewer ❑ Tanning/MassageBodyArt ❑. . .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: DATEAPPR_OVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS .CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS 0 f Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes . Planning Board Decision: Comments Conservation Decision: Comments ,,Water& Sewer Connection/Signature& Date Driveway Permit i DPW Toiai2 Engineer: Signature: Located 384 Osgood Street FIRE DEPARTIiIEW --Temp Dumpster on site yes no Located'at 124 Mair, Street Fire Department signatureldate 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 Il Notified for pickup - Date i Doc.Building Permit Revised 2010 Building Department The fohIswing is--"a-list of the required forms to be filled out for the appropriate.permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits o' 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 o 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 E3 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 E3 Certified Proposed Plot Plan o 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 o 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 cas<s if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the apo,-al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must bP subm.tted with the building application Doc: Doc.Bui?ding Permit Revised 2012 Location No. '`f ` Date • - TOWN OF NORTH ANDOVER �n • S�'�' j64er . . • Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $x.00 Other Permit Fee $ TOTAL $ Check# ' ,l 4 Building Inspector NORTH own of EAndover 0 . 0 No. _ ILI y o h , ver, Mass, & Jth�� 19.2b13 { COCNIC"IWICK �ds�RA7ED 1 U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT ....... V�a Z-'0.' BUILDING INSPECTOR ...................,............ ......... ............. .... ....... ....... } � . Foundation has permission to erect .......................... buildings on ........ .......... ............ .... ............................. Rough g tobe occupied as ... ..........�.....*.r�c.......................................................................... 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 j UNLESS CONSTRUCTION TARTS Rough Service .......... ..... .. . .. ... Final 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. SEE REVERSE SIDE John S. Rizza, DMD,North Andover, MA 01845 Page 1 of 1 f1 7 First Street,North Andover,MA 01845 Phone:978-685-5804 g OH�T S. RIZZA l nloi Fax:978-685-7556 _ FAMIIY DENTISTRY � — Dr- Rizza's Practice is proudly associated with S, h Home " ` Office Hours Mon:8 AM to 7 PM Dr.John Rizza _ Tues:8 AM to 7 PM Meet Our Staff wed: closed Directions Thurs:8 AM to 2 PM Fri:8 AM to 5 PM Services Alternating Office Tour Sat 8 AM to 1 PM a For Emergency i Dental Only �. _.. FAQ 978.545-4618(pager)...i q Contact Us Confirm Appointment Our Mission Download Forms ', ` sf h - ! _ 1 a t} 6 . ) The Dental Office of i,. �m�,_..t'�s Dr.John Rizza is dedicated to providing Contact Billing Doctors and staff offer a variety of cosmetic dentistry, i superior personalized implantology, routine cleaning,and maintenance.All treatmentspatient and family care Contact Front Desk y are carefully planned to enhance your beautiful smile I in a modern,clean 3 1 and comforting ; Dr.Rizza has been in the private practice of dentistry for 30 years. environment. Jfj Since 1994 Dr.Rizza has served as a Clinical Instructor and �—� Lecturer at Tufts University,School of Dental Medicine ;=NE�N Ts i Click here S, to learn more! i �y-r vS.j I i9 TUFTS rut..r c;rm+ti c�o++wr.,rw X, Privacy Terms Copyright 2010-13 johnrizzadmd.com Site proudly built and maintained by DocWebTRC com http://www.johnrizzadmd.com/ 10/8/2013 3 Hodgson St. Residential/Commercial Tewksbury, MA 01876 , Masonry Ph: (978) 656-8497 Vincent Colangelo Free Estimates Lic. #170575 ROOFING Fully Insured Proposal Submitted to Homeowner Work To Be Performed At Name -TO�^ F. !Z Z Q Street A 4.4 Street 77 IS City State city— 1. 4 6 do i /' State_ _ Date Cl /(a// 3 Telephone g78-68.r-'5_60y Telephone Complete Description of Work to be Performed: f I / ! v AM P e + Pq rx C / (.tjr f dor ! � ' A 2 e o ,.� -- ' — r , ret% Ac Date work will start Date work will be completed 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,tornado 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: dollars($ 3 � - �'°.. ). Said amount shall be paid as follows: r Note: This proposal may be withdrawn by us if not accepted within C_ D —days. YOU, THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION. SEE THE ATTACHED NOTICE OF CANCELLATION FOR AN EXPLANATION OF THIS RIGHT.THIS SALE IS SUBJECT TO THE PROVISIONS OF THE HOME SOLICITATION SALES ACT AND THE HOME IMPROVEMENT ACT THIS INSTRUMENT IS NOT NEGOTIABLE. Work will not begin until your right to cancel has expired and you aveh� paid a e it=of-- -A U '7 dollars($ ),unless this agreement p Vides otherwis r - Signature of Contractor or authorized representative: 4 *(UWe)have read the terms stated herein,they ha: a bei plaingdAcr( e/ and(I/We)find them to be satisfactory and hereby accept them. Signature of Homeowner(s): {�sg ry The Commonwealth oflMlassachusetts - Department of IndustrinlAccitlents Office of Investigations 600 Washington Street Boston,MA 02111 wminassgov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lel4ibly Name(Business/Orgmization/Individual): V('1 CP'll Address: O(67� City/State/Zip:_ IP_G_) �skU/, Phone#: �/7e 6-5-6 - �l 7 Are you an employer?Check the appropriate box: Type,of project(required): 1.❑ I 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.x 7• E]Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. g, ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.) officers have exercised their 10.[]Electrical repairs or additions 3.❑ 1 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.❑Roofrepairs insurance required.]i employees.[No workers' comp,insurance required.] 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 aie 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 their workers'comp.policy information. X am an employer that is providing workers'compensation insurance for my employees. Below is the policy rcnd job site information. Insurance Company Name% T04 �7 M ( 1p(, -f- Policy f- Policy#or Self-ins.Lic.#: M�' p16 r—/Lf d o2 Expiration Date: rob 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 requirodunder Section 25A ofMGL o.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 maybe forwarded to the Office of Investigations of the or iu7lc coverage verification. X:her. CertI nder t1 pains andpenaldes ofperjury that file information provided above is true andcorrect.Sire: � Date: P p Phone#: [I. fficial use only. Do not write in this area,to be completed by city or town official. ty or Town: Permit/I,icense# suing Authority(circle one): Board of Health 2.Building Department 3.CitylTown CIerk 4.Electrical Inspector 5.PIumbing Inspector .Other Contact Person: Phone#: i i Information and bstrueflon s . 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 ofthe 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 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 chapterhave been presented tathe 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 notrequired 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 fbr 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#hat-the affidavit is-complete and-printedlegibly: ThdD epartmbrit leas pf6vided 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 applicanfi. 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. 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 bum leaves etc)said person is NOT required to complete this affidavit. The Office oflnvestigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a ca1l. The Department's address telephone p and fax number: Tho Commoawealth ofmfassachwotts Department of Jadustrzal accidents Office of IuvestigaIiQ.X.s 600 Wasbitt&-, Street Bosto'MA02111 TOI-#617-72-7-4900 est 406 ox I-8 7 7-MA 8 S A FF, Revised 5-26-05 Fay,#617-727-7749 ^� CDROOFI.01 MGIRARD CERTIFICATE OF LIABILITY INSURANCE F DATE("M°DN" 5/8/2013 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 CONTACT NAME: John M.Glover Agency PHONE 203 838.5 P.O.Box 700 ac,Nu Ent)_( _) 554 Ne: 203 857-7848 Norwalk,CT 06852 E-MAIL —)-- ADDRESS: INSURER(S)AFFORDING COVERAGE NAIL 0 INSURER A:Mesa Underwriters Specialty Ins.Co. 36838 INSURED INSURER B:Massachusetts Workers Comp Vincent Colangelo dba CD Roofing INSURER C: 3 Hodgson Street — RER D: Tewksbury,MA 01876 NSURER E: INSURER F: 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 — -- ADDL 8 LTR _TYPE OF INSURANCE _ INS-_ 11WD_ - POLICY NUMBER A! P�Y EFF 'POUC�Y LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,0001 A X COMMERCIAL GENERAL LIABILITY MP0006001014422 4127/2013 4/2712014 A CLAIMS MADE a GETOI�ENTED PREMISES jEa oocurrenne)_ $ 100,000 OCCUR MED EXP(Any one person) $ _5,000 PERSONAL&ADV INJURY $ 11000,000 ——_ GENERAL AGGREGATE _ $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 2,000,000 X POLICY J€a LOC __ $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea acaderrt1_- —_ S ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS PER ACCIDENT),- $ UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB_ CLAIMS-MADE AGGREGATE $ DED RETENTION$_` — $ WORKERS COMPENSATION AND EMPLOYERUABILTY WC STAIU- OTH B ANY IPARTNER/EECUE YIN CZO-20-00363 -01 5/14Z013 5/142014 TORY-LERRNEACH ACCIDENT NIA 100,000OFFICERlMEMBER EXCLUDED? (Mandatory in NH) IFyes,describe under E.L.DISEASE-EA EMPLOYEE $ 100,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS!LOCATIONS!VEHICLES (Attach ACORD 101,Additional Remarks Schedule,H more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Tewksbury THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1009 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Tewksbury,MA 01876 AUTHORED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD �� messacnuse us -urparernrrn yr rvvl�c aalety IF Board of.Building Regulations and Standards Contra rtiun Super%i,ur Specialty License: CSSL-105943 fj VINCENT COLANGELO 3 HODGSOMSTREET ; Tewksbury MA 01876 = °✓�''�` JJ� `�" Expiration Commissioner 03/09/2016 i Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 Home 11nprovement Contractor Registration — Registration: 170575 - - Type: Individual Expiration: 11/10/2013 Tr# 218996 VINCENT COLANGELO VINCENT COLANGELO 3 HODGESON ST TEWKSBURY, MA 01876 Update Address and return card.Mark reason for change. DPS-CA1 0 soM-0004-0101216 pO C Address 7 Renewal G Employment Lost Card L� fjze "(�JO�pgy�Je4GCIt•O�✓ ,�tuGe�Id - - --- -- - Office of Consumer Affairs&Business Regulation License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR, before the expiration date. If found return to: Registration: 170575 Type: Office of Consumer Affairs and Business Regulation r Expiration; 11/10/2013 individual 10 Park Plaza-Suite 5170 VIN -ENT COLANGElO Boston,MA 02116 VINCENT COLANGELO 3 HODGESON ST �S ,, 6 Undersecretary Not valid without signature