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HomeMy WebLinkAboutBuilding Permit #131-15 - 95 LIBERTY STREET 8/6/2014 BUILDING PERMIT O�1NORTF� t Leo ,6 Ati TOWN OF NORTH ANDOVER G2 �� ` •6 O o APPLICATION FOR PLAN EXAMINATIO Permit No#: + ( Date Received �SSACHU`��� Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION' �I_S� 1� 2rr, S� Pnnt PROPERTY OWNER Print v 900 Year Structu pre yes. ` no 'MAP � PARCEL: Z ZONING DISTRICT. _ Historic District yes 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: D Commercial ❑ Repair, replacement D Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ septic D Well D Floodplain p Wetlands D Watershed District _ ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: J - Identification- Please Type or Print Clearly OWNER: Name:!M 5Ji2iPhone: Address: C1 5- '-L' r- s Contractor•Name: Phone: AddressvC�cieS�n _ 5-� - i,� ;S Ur r Supervisor's Construction License: _ /„ S'4 y_3 --Exp. Date. 3 h Home Improvement License -._- V70Sly -Exp. Date: i//10 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: $ 7 FEE: $ 69 .b Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to Ml fund Signature of Agent/Owner 77- - ignature of contractor 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 o Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract o 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 o Building Permit Application o Certified Surveyed Plot Plan ❑ Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract ❑ Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) Li 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) o Building Permit Application o Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract ❑ Mass check Energy Compliance Report Li 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:Building Permit Revised 2014 I j 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 ❑ i THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM I PLANNING & DEVELOPMENT Reviewed •n Signature_ j COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS ir i 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 e DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes _ no Located=at 124 Main Street Fire Department signature/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) ❑ Notified for pickup Call Email f Date Time Contact Name Doc.Building Permit Revised 2014 Location W. No. Date • TOWN OF NORTH ANDOVER N ,�- -= Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ ^° Other Permit Fee 4 $ TOTAL $ 1 I Check ! Building Inspector KORTH Town of s R ndover No. �� � �0 0 � - M)*l * i4oL^K1 ver, Mass, 2Q A_ coc«IcnewICK 41 7,95 R�reo rPP,��(y - U BOARD OF HEALTH Food/Kitchen LD Septic System THIS CERTIFIES THATPERMIT �Im..... . ..... tJ ................ BUILDING INSPECTOR ..... .. ............................. has permission to erect .............. buildings on .......LA. �. Foundation ........ ...9.5Rough to be occupied as ...... p. .......................................................... 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 CONSTRUCTION-S ARTS Rough Service moo+ ................./... s:rr ........................................... Final . BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Fina' No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until_ Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. CD Roofing Vincent Colangelo 3 Hodgson St. Roof . Tewksbury, Ma 01876 THERE'S NO ROOF WE CAN'T COVER • 978-656-8497 r 8-656-8497 , s vincentcolongelo@sbcglobal.net • • • • HIC Llc# 170575 CSSL Lic# 105943 i Customer: OWENS CORNING � �" r,� be r� �7`' q� CONTRACTOR 9715 PREFERRED CONTRAC O Ai. ��d�v�l� 761 - �9a � 70_TJ ix Description of work Performed: �s4.Obtain required town permits&provide certificates of insurance&workers compensation 4,3 Provide Dumpster set on planks*for contractors use only(materials all recycled) W,Aftach Large Tarps to protect adjacent finishes, landscaping, and property. jc]_Strip-off( 0 )existing layers of roofing on complete house S re-nail any loose decking (Ainstall flinch r` P Aluminum Drip edging I Owens Corning Starter Shingles (Jnstall Owens Corning Ice&Water shield 6ft at eaves,3ft in valleys,around all penetrations (>LInstall Synthetic felt paper to entire roof (4-Install Owens Corning LifeTime warranty TruDefinition Duration shingles Install newneoprene vent pipe flashings on all plumbing pipes Install Owens Corning VentSure ridge venting with moisture guard (� Install Owens Corning ProEdge hip& ridge cap shingles ICtO Completely re-flash chimney with lead q,Owens Corning Preferred contractor installation with full warranty All work will be completed according to state and manufacturing codes and specifications. Every day we will have the roof water tight, clean gutters,completely clean the job site, and use a magnet roller to collect scattered nails. I Additional work to be performed I I I i 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.abover 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,tomado 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($ ?f (7/Oo . '4 ). Said amount shall be paid as follows: Note:This proposal may be withdrawn by us if not accepted within (C:) 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 NEGOTIABL Work will not begin until your right to cancel has expired and you have paid dep�f dollars($ ),unless this agreement provides otherwsr- Signature of Contractor or authorized representative: , r.--V— *(I/We) have read the terms statXed herein,th.y have been explained to(me/us),and(IMe)find them to be satisfactory and hereby accept them. Signature of Homeowner(s):,, �Z 14 Dr;n . I�54 ,4CAP , u rr.r , I NA."r, I Rax .IAJ� ,4-,�, n�rrn,��-�d-s�,��x Po I V W A CERTIFICATE OF LIABILITY INSURANCE DATE /)14 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(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 endorsemen s. PRODUCER CONTACT Angela Westen Insurance Agency PHONE-MAIFAX 97 557 Central Street L 978 735-4094 / N . ( 8) 735-4095 ADostEss: anela@awesten.com Lowell, MA 01852 INSURE S AFFORDING COVERAGE NAIC# INSURERA:ATLANTIC CASUALTY INSURANCE CO INSURED INSURER B:HARTFORD UNDERWRITERS INS COMP FO CONSTRUCTION CORP. INSURER C: 40 READ ST. INSURER 0: LOWELL, MA 01850 INSURER 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 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. LTR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP POU CYNUMBER M/DDIY MM/DDIYYYY LIMITS A GENERALLUIBIDTY L021008696 3/18/14 3/18/15 EACH OCCURRENCE $ 1,000,000 ]( COMMERCIAL GENERAL LIABILITY DAM4GETORENTEO $ 100,000 CLAIMS-MADE D OCCUR MED EXP(Arryone Person) $ 5,000 PERSONAL&ADVINJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATELIMITAPPLIESPER PRODUCTS-OOMP/0PAGG $ 1,000,000 - POLICY PRO-jECT LOC $ AUTOMOBILE LIABILITY Go a1NEEDNSINGLELIMIT $ ANYAUTO BODILY INJURY(Per person) $ ALLOWNED SCHEDULED BODILY INJURY(Per accident AUTOS AUTOS ) $ NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS eraccident $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ B WORKERS COMPENSATION 2E112068 3/30/14 3/30/15 WC STATU- OTH- ANDBdPLOYERTLIABILITY YIN IQRV I IRA ITS ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACHACCJCENT 100,000 OFFICERIMEMBER EXCLUDED? NIA QdandatoryinNH) EL.DISEASE-EAEMPLOYEE 500,000 If yes,describeunder INOF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 100,000 DESCRIPTO N O DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if morespace is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CD ROOFING ACCORDANCE WITH THE POLICY PROVISIONS. VINCENT COLANGELO 3 HODGSON ST. AUTHORIZED RE PRESENTATIVE TEWKSBURY, MA 01876 ©1988.2010 ACO RD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD Phone: Fax; E-Mail: VINCENTCOLANGELO@ SBCGLOBAL.NET Fite CommonweaUk gfM'assac,Eiasetts DepaYtmer2t of In�`�rstritclAccit�ents • - Office o,fInva igations 600 Washington Street .Boston,MA 02111 VMMass.gov1d1a Workev,Compensation bsuranceAf idadt:l;wi tiers/ConiractorslElcctricaianslt'l*i ero ;Appyeant Worcaxtatlon Please.pr, ntLe zlily �/ r 'Name(BusinesslorgmizationlGulivzdaa�: V(!1 GP'a-� a C Address: City/StaEe%ftp; Phone : Are ¢. ET lain a general confractor an. your an.employer?check the appropxiate box: Type of project(rceguired): dl ,1.[]-1 ana.a employerwith6. El New c6nstraction. employees Gull aud(ox paw time).* have nodthe suis-contractors 2. � I am a sole proprietor orparinex listed on the attached sheet, ❑Remcdeling -E] These sub-conteactorshave 8. [(Demolition ship and'havena.employees working forme in any capacity. workers'comp.insurance. �. ❑Building addition DTO workers'comp.insurance • ❑We are a corporation audits 10.1 Electrical repairs or additions required.] officers have oxercised.their 3.[l Z am a homeowner doing all work right of exemption.per MGL 1Q]Plumbingrepairs or additions myself[Ivo workers'comp. c.152,§1(¢),and.wehaveno UP Roofrepaks insuxancere ed. v employees.[Noworkers' comp.insurance regt*cd j 13.�]other KAny applicant that checks box Of mustaiso fl[l outthe secfioa below sim-wing(heir workers'eompeasationpoffGyinformation. "i Homeowners who sabmithis affidavit i igoatingthey ge doing allwork andthenhhe outside contractors must submit a new affidavit indicating such. xCoatracfors that cheekthm be�emust affached au additional sheetshowingthe name ofthe sub-confractors andtheirworkers'comp.policy MaTmation. I am an emyloyep tiia is providi�tg wosrkenI comquai.sation insurranee for my employees Belo s�is a`(2e pafiey aid joh s Uc information. Insurance CompanyName:. /t i a policy#ox Selz xns.7 ic.#: L. U 00 �� Pxpixation Date: P'//5� q�- 1 4.1'�-1 �jCity/sate/Zip: IV, 0,ea(^0 r rah Site Address, � f ' Attach a copy of ilia vorkers'compensation-policy declaration page(showing-Ma policy n mbar axt(I expiration.crate). Eallma to secure coverage as xequired under Section 25A ofMGL o.152 can lead to the imposition of cximinalpenalties of flue up to$1,50 0.00 and/or oner-year imprisonment,as well.as civil.penalties in the form of a STOP?WORD ORDER.and a fine of-up to$250.00 a.dap against the violator. Be advised that a copy of this statement may be forwarded to the Offioe of investigations oiffthe DTA for insurance coverage•4OTMORVOn. X do Hereby cerci e p ns d penarties of perjury treat fxie fat•formadon provided aUv/e h true and correct, Si afore: Date- 719 C.56 W official use OAly. Do not write in Mis area,to be compreteciby city or tout official; City or Town: PermitlGicense# Issuing Authority(circle one): 1.Board of Health %Buiiding)Department 3.C1tylTovmClerk ¢.Electrical Inspector 5.PlunmbingInspector f.Other Information and Instructions . - Massachusetts General saws chapter 152 requires all employers topxovideworkers'compensation£ortheiremployees. _Pursuant to this statute,an ernployee is defined as",,.every person hi the service of another under any contract ofhire,- express orhnplled,oral oxwxzttan." .Aa evTloydis defined as"an individual,partnership,associalloA corporation or otherlegal entity,or anytvro ormore ofthe foregoing engaged in a joint enterprise,and includingthe legal representatives of wdeceased employer,.ox tlae red oa trasfee dfan individual,partnership,association or other legal.entity,employing employees. however the owner of a dwelling house havingnotmoro thaaftee apartmenfs andwho resides therein,,orthe ocoupant ofthe dwelling:house of another who employs persons to do maintenance,construction ox repair work on such dwelling house or oar 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 Iicens3ng agency shall withhold the issuance or renewal of a license or permit to operate a business or to cous€ruct buildings in the commonwealth£or any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required , Additionally,lVkCL chapter 152,§25C(7)states `Neitherthe commonwealth nor any of its political subdivisions shall enter into any contract for Me performance ofpub"r,work until acceptable evidence of compliance with the inswauce xagaixements of this chaptexhave,beenpresentedto the contracting authority." Applicants Fleas efll out the woAcxs'comp enation affidavit completely,by checking fli e boxes that apply to your situation and,X A&Cc sary,supply sub-contractors)name(s),address(es)andphonenumber(s)alongwith their carocate(s)of insurance. pimitedLiability Companies(LLC)orLimitedLiabiHtyP& erships(LLl')withno employees othexthauthe xnembersoxpartners,axenotrequirecltocanyworkers'compensatiouiaxsurance. ffanLLCorLLlPdoes have employees,a policy is.required. BeadvhedthattHi aflxdavitmaybesubmittedfothaDepartmotofindustrial Accidents for connrmation of insurance coverage. Also be sure to sign and date the affidavit I ie afdrlavit should beretumedtofhacity ortown tbatthe application for thepermitorlicenseisbeingxegaoBted,azotthe DOR'Mtn.entof 7ndusttial Accidents. Shouldyou have any questions regarding the law or if you are required to obtain a workers' compensationpoltcy,please call the DepartmentattheuamberAledbelow. Self-insuredcompauiesshould enter their self insurance license number on the appropriate he. City or Town OfCzcials t'leasebasurethatf7ieai�itda�+itiscompleteandpxiutedlegibly The Department has provided aspaceatthebottom. Of the aff-tdavit£oxyou to fill out iu the event the Office of l'nvestigatlons has to contactyouxegarding the applicant ):'lease be-sure to fall inthe pemait/licenm number which.wM be used as a xetrence number, fh addition,an applicant thatinust submitmultiple permit/license applications in any giyen.year,need only submit one affidavit indicating current PORGY iufo�Mafion(if necessary)and under"Sob Site Address"the applicant should wxite"all locations in (city or towh.)".A copy of the affidavit that has been officially stamped or marked by the city or tom may be provided to the applicant as proof a valid afftdavit•Ys on file for fixtnxe p ermits or licenses. A new a fidavit must b e fUled out each year.Where ahome owner or citizen is obtaining alicense oxpemlitnot related to anybusiness or commercial venture (i.e.a dog license orpermit to burn leaves eta.)saidperson is NOTxequired to complete this ofCcdavit. The Of gee of Investigations would like to titanic you in advance fox your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone avd faxnumber. no CQ ?X 4XkT�afti o Mas ac?vsP ', Depa�itxteaU,�a.£Zndu�GxzaX,�cc�do.�� • t.��ca o�Tnv�tz�a.�a�z� • 6.90 Waabingtoa Revised526-05 Fal ' w�'.z�ta�,gQv�c�a • Massachusetts-Department.of Public Safety Board of Building Regulations and Standards (`onstl ectiu Supra icor Special6 - License: CSSL-105943 VINCENT COLXNGELO - 3 HODGSON STREET Tewksbury MU 01876 , r r Commissioner 03/0912016. ��e�anvmoraccecrl d� cr�oaccc�eCla Office of Consumer Affairs&Business Regulation !!1 MEI MPROVEMENTCONTRAC f' egistration: TOR y1705,75 Type: xpiration 11/10!2015 DBA CD ROOFING ) �• VINCENT COLANGELO ;,._ 3 HODGSON ST j TEWKSBURY,MA 018761.' Undersecretary