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HomeMy WebLinkAboutBuilding Permit #231 - 940 GREAT POND ROAD 9/16/2011 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO:. '�--- Date Received Date Issued. '- -ffa -a IMPORTA T:Ap licant ust c 1 e a items on this page LOCATION Pr* i PROPERTY OWNER eo Unit# Print MAP NO: /03 PARCEL: ZONING DISTRICT: Historic District ye no Machine Shop Village ye no �t 100 year-old structure ye no i TYPE OF IMPROVEMENT PROPOSED USE Re=d '�� Non- Residential ❑ New Building ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition_ ❑ Other Septic RWAIT ®fFloodpTain �® Wetlandsd a ® �Wat shedlIDistnct d DESCRIPTION OF WO RK TO BE PERFORMED. 'i (Identif on P e4se Type or Print Clearly) . Y) OWNER: Name: Phone: Address: P CONTRACTOR Name: Phone: 7� Address: Supervisor's Construction License: ( � Exp. Date: Home Improvement License: /�QZ Exp. Date: / ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.$12.00 PER 0 95F (�F THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Coat: $ � FEE: $ Check No.: ] L Receipt No.: . 9,qS NOTE: Persons contracting with unregistered contractors do not have access to t e g ara f .� >._.: _ Signatu_reoftAgent/®wne�t sx ` t -yea?,g eray� Ja yrir.i:�. . ;x4t G aA, . . �.S►ariafureof.contractor: . . � .._ _ .. i Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ II TYPE OF SEWERAGE DISPOSAL i Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ well ❑ , Tobacco Sales E] Food Packaging/Sales El (septic tank,etc. ❑ Permanent Dumpster on Site ❑ 4 . THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U'FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature ; COMMENTS HEALTH Reviewed on Si nature COMMENTS 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 DPW Town Engineer: Signature: FIRE DEPARTMENT - Temp Dumpster on site yes Located 384 Osgood Street Located at 124 Main Street no Fire Department signature/date COMMENTS I 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 Perm 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 ❑ Flo or/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 a 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 1 Doc: Doc.Building Permit Revised 2008mi s j Location qot„ of No. Date �oRTh TOWN OF NORTH ANDOVER ■??o',,,•e!_•,ham o� Certificate of Occupancy $ ; . J�cMusEBuilding/Frame Permit Fee $ Q J Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # F 24595 Building Inspector AORT#q TO" And 0 o , dover, Mass., T0 -- LAKE COCHIC ME WICK Is, RATE BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR ��+ � d Av`�r� v THIS CERTIFIES THAT.................. ........... .......... Foundation has permission to erect........................................ buildings on ...-1. ......... M. .... .............................!... Rough �►0� �� Chimney to be,occupied as.............. .......• ............................ ............................ ......................... . .....PPO .......................... provided that the person accepting t permit shall in every respect con m to the terms of thecation on file in Final 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 � ��TTpc PERMU EYI'IRES IN 5 M0N HS ELECTRICAL INSPECTOR LESS CO �I S \,""�UST, TS UNLESS Rough - Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy uildi g GAS INSPECTOR 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. SEE REVERSE SIDE Smoke Det. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 UV. www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lelzibly Name (Business/Organization/In(Ilividual): �!' Address: City/State/Zip: Phone#: Are .-an employer?Check, appropriate box: Type of project(required): 1. 0 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 ❑ on 2. ❑ 1 am a sole proprietor or partner- listed on the attached sheet. T 7• ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp. insurance. 9. ❑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.❑Roof repairs insurance required.] t 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 are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'co pensation ' suran for my em,loyees. elow is the po 'y and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Z Job Site Address: 961c0 (J 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 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 th DIA for insurance coverage verification. I do hereby ertify der th ai n penalties of perjury that the information provided above is tru and correct. Si nature: Date: Phone#: Official use only. Do not write in this area,to he completed by city or town official. 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#: i y Massachusetts-Department of Pu dic SafelN Board of Building Regmiations :end Standards Construction Supervisor 'License "`ticense: CS 92469 ,;JOSEPH_J GYS f AN 10 MEGHN LANE ` ,4 <LOWELL,>Mq 01852 . _ -- = —=' Expiration: 9127/2013 Cnmmissionc'r Tr#: 1339 1, wa �1,r,: �Domrr�nr�muiecr��•nf,�/�i��a�.uaelt� . Office of Consumer Affairs&Busifiess•Regulatiou i OME'IMPROV.EMENT CONTRACTOR egistration: , 08424 Type: F xpiration 8/18/2013 DBA ] ABCOROOFING:&CONSTRUCTION1 Joseph Gys � 10 MEGHANN LANE LOWELL;'MA41852 - Undersecretarry- 07/22/2011 12 : 10 : 00 PM FRED C CHURCH INC - 978-454-1865 PAGE 2 OF 2 DATE(MM/DD(YYYY) ACURO CERTIFICATE OF LIABILITY INSURANCE L.�` 20 i 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 Pamela Airosus Fred C.Church,Inc. NAME: 41 Well Streei PHONE 978 3227256 FAX !976)45 -1665 Lowell,ma Stree AIC No Ext): A!C No): (800)1,MA 065 E-MAIL pairosus@fredcdlurch.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Hartford Underwriters Ins.Co. 30104 INSURED INSURER B: Penn-Amenca Insurance Company 32859 Abco Construction INSURER C: 10 Meghann Lane Lowell,MA 01852 INSURER 0: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 18975 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 TYPE OF INSURANCE DD SUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MMIDDIYYYY MMIDDNYYY GENERAL LIABILITY EACH OCCURRENCE $ 1.000,000 X DAMAGE TO ENED 50,000 COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ CLAIMS-MADE A OCCUR MEDEXP(Anyone person) $ 5,000 B PAC6906417 4/26/2011 4/26/2012 PERSONAL&ADV INJURY $ 1.000.000 GENERAL AGGREGATE $ 2.000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2.000,000 POLICY ,ECT LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea acadent ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS. NON-OWNED PROPERTY DAMAGE HIRED AUTOS .AUTOS Per accident $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ J EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION X I WC STATU- OTH- AND EMPLOYERS'LIABILITY YIN TORY LIMITS ER } A ANY PROPRIETORIPARTNER/I ECUTIVE❑ E.L.EACH ACCIDENT $ 700,000 OFFICERfMEMBEREXCLUCED? N/A U80443N539 �5/1120i1 5/1/2012 Mandato in 100.000 (Mandatory ) E.L.DISEASE-EA EMPLOYEE If yes,describe under 500,000 DESCRIPTIOfJ OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) _ CERTIFICATE HOLDER CANCELLATION �_.i y ot Lowell SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 375 Merrimack St. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Lowell,MA 01352 AUTHORIZED REPRESENTATIVE i dent 40 Mstm Cert Holder# ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 26(2010/05) The ACORD name and logo are registered marks of ACORD Abco Roofing and Construction 10 Meghann Lane Date: 9/7/2011 Lowell,Ma 01852 Customer: HIC#108424 Mr and Mrs David Paolino Construction Supervisors License 940 Great Pond Rd #92469 North Andover, Ma 978-937-5840 (Office) 978-687-3046 978-475-7544 (Office) To: Mr. and Mrs. David Paolino Job to be done as follows: 1. Remove existing roof shingles to sub deck. 2. Remove specified flat rubber roofs down to boarding. 3. Install eight inch drip edge along leading edges and up all rake edges, Color: (Musket Brown) 4. Install six feet of ice and water shield along all leading edges, around chimneys and vent stacks and in all valleys. 5. Install# 15 lb. felt paper on remainder of roof deck. 6. Install GAF/ELK limited life times rran ar hitectural shingles over prepared roof deck. Color: �1Jt1 7. Install GAF Snow Country Ridge Vent System. 8. Install linch Iso board using 12 screws and plates per 4X8 ft. sheets on all specified flat roofs. 9. Install .060 Versico rubber roof systems, by gluing rubber to Iso insulation board (fully adhered). 10. Install new 026 perimeter metal on all new flat roofs, color: Musket Brown. 11. Remove all gutters on back of main house and around pool area, approximately 170 ft. 12. Install new facia boarding on right side of pool area, non-existing. 13. Install new .026 metals on facia boards on back pool area. Color: Musket Brown. 14. Install 177 linear ft. of six inch Musket Brown gutter. 15. Install 60 linear ft. of 3 inch by 4 inch down spouts (Musket Brown). 16. Remove existing facia metal on front area, replace rotted boarding, them reinstall metal. 17. Install 9 inch live Neoprene rubber cover strip in back of garage. 18. Take away all debris from job site. Warranty: Five year warranty on all specified work beginning from date completed. Limited life time warranty from GAVELK Corp. Register warranty on line @GAF/ELKCORP.COM All Contractors shall be registered; all inquiries about contractors relating to registration should be directed to: Office of consumer affairs and Business Regulation 10 Park Plaza, Suite 5170 Boston,Ma 02116 617-973-8700 Payments should be made as followed: 1/3 on signing contract. 1/3 after 1/3 of job is completed and remainder of completion of contract. Do not sign this contract if there are any blank spaces. Total as above: $25,400.00 ✓! Homeowners nature Si g Contfra torn ignature 7//0 (--/ Date // 0 M DaYe'