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HomeMy WebLinkAboutBuilding Permit #245-14 - 96 SECOND STREET 9/18/2013 t ! 14ORTF/ Q�STb[D 16�� BUILDING PERMIT F2`4!;. 0� TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION11L b Permit NO: Date Received Date Issued: �9SS�cNUS IMPORTANT:Applicant must complete all items on this page LOCATION sea-,r d S�, 91)C)4tA Pr PROPERTY OWNER 4GC Gt �/') Print MAP NO&I PARCELa�ZONING DISTRICT: Historic District ye no Machine Shop Village ye 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 ❑Wetlands ❑ Watershed District ❑ Water/Sewer J Identification Please Type or Print Clearly) OWNER: Name: 1<0 t C(Pt Phone: Address: c-�"C 4� CONTRACTOR Name: Phone: kip Address: Supervisor's Construction License: �.� � -2&,R, Exp. Date: Home Improvement License: .Z_ Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$1200 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ � r����C�o FEE: $ g2 Check No.: 40 Receipt No.: NOTE: Persons con ratting with unre istered contractors do not have access to g aranty fd Signature of Agent/Owner USignature of contractor C s c Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ -TYPEOF'-SEW-ERAGE:DiSPOSAL Public Sewer ❑ Tanning/Massage/BodyArt ❑ .. 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: DATE APPROVED PLANNING & DEVELOPMENT' ❑ COMMENTS :CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zonirfg 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 Todvas Engineer: Signature: Located 384 Osgood Street FIRE DEPARTM�_NT - Temp Dumpster on site yes no Located-at 124 Mair Street Fire Departmerit 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, roast 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 - Date s Doc.Building Permit Revised 2010 Building Department The folhwing is a- 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 ❑ Building Permit Application o Certified Surveyed Plot Plan o Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) La Mass check Energy Compliance Report (If Applicable) o 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 o 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 o Mass check Energy Compliance Report o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all casts if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the apw-al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm.+.ted with the building application Doc: Doc.Building Permit Revised 2012 Location No. S— 1 Date . - TOWN OF NORTH ANDOVER • Certificate of Occupancy $- �a Building/Frame Permit Fee $1 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check#� Building Inspector NORTIi Town of Andover No. � - �. h ver, Mass, Q�RgTEo r'p�,�'(y S U BOARD OF HEALTH PERM T T LD Food/Kitchen Septic System �0 IJ ............................... BUILDING INSPECTOR THIS CERTIFIES THAT ............................................. .... ... ................. . �i(� Foundation has permission to erect .......................... buildings on ��.I. .........� ........ .... .... ................... f.......................................................................... Rough to be occupied as .....-�.t.!�'.�.....�....r�.�0Chimney 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 CONSTRUCTPST TS 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 The Commonwealth ofMassachusetis Department of IndustrialAccWnts Office of Investigations 600 Washington Street Boston,MA.02111 wwlv.mass gov/clia ' Workers' Compensation Insurance,Aff'ida'vit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly t . Name(Business/Organization/lndividual): 4ri� Address: V' / - City/State/Zip: �� Phone#: Are you an employer?Check the appropriate box: Type of project(required): 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.EJI am a sole proprietor or partner- listed on the attached sheet.? ❑Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9, El Building addition [No workers' comp.insurance 5. F1 We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself.[No workers'comp. c. 152,§1(4),and we have no 12',0<of repairs insurance �uired.req i employees.[No workers' 13.❑Other comp.insurance required.] !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 a7re doing all work and then hire outside contractors must submit anew affidavit indicating such. #Contractors that checkthis 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'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:. <Irrdl Policy#or S elf-ins.Lie.#:_ ©/2 5 7-"/ —/ Expiration DateaL Job Site Address: RC1 City/State/Zip: '�J��// 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 maybe forwarded to the Office of 'Investigations of the DIA for insurance coverage verification. I do hereby cerci u der t12 pal nCl alties of rjury that the information provided above is true and correct. signafore: � Date: Phone#: Official use only. Do not write in this area,to be 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.PIumbing Inspector 6.Other - - C.�nta rt PPrcnn Phone#: 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 ofhire, express or implied,oral or.written." An employeiis 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 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-contractor(s)name(s),address(es)and phone numbers)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 maybe submitted to the Department of Industrial Accidents for confnmation 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 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 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. 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 burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The CoMi-Ammalth o1'Ma..ssacl?usetts Dapartr-acct ofIndustrial.Accidents Office ofI"estigatiom 600 Washington.Street Boston MA 02111 Tel,#617-727-4.900 ext 406 or 1-877,MASSAFF, Revised 5-26-05 Fax#617-727-7749 w WOOSTER ROOFING PROPOSAL i ALL TYPES OF ROOFS DATE: 9/12/13 o0S &ROOF RELATED SERVICES Always Hand Nailed License Numbers: Charlie and Steve Wooster Construction Supervisors 54268 • - nail at a time 1-888 ROOFIN-1 (766-3461) Home Improvement Contractor Main: 978 251-7181 Registration 100712 Serving MA&NH since 1984 Fax: 978 251-0159 Call For Our References Proposal Submitted To Work To Be Performed At Name Mr_&Mrs.Dudney Name Company Name Company Name Street 470 Lacy St. Street 96 Second St. City No.Andover State MA Zip Code01845 City No,Andover State MA Zip Code Home# Mobile# 508 527-8023 Work# Fax# We hereby propose to furnish the materials and perform the labor necessary for the completion of the following job. Strip the entire roof to the roof deck. 1. Renail any loose decking and replace any rotted at$2.00 per foot. 2. Install 8"white aluminum dripedge. 3. Install 6' of Grace Ice and Water Shield on all eaves and valleys. 4. Paper remainder of roof with Grace Tri-Flex roofing underlayment. 5. Install Certainteed Landmark Lifetime shingles,hand nailed. 6. Install new lead flashings on chimney. 7. Flash skylight and vent pipe to roof. 8. Install Shinglevent Il ridge vent. 9. Clean and dispose of all debris. Workmanship guaranteed for 10 years. We are fully insured with workers'compensation as well as liability insurance. Please return copy of proposal: All material is guaranteed to be as specified,and the above work to be performed in accordance with the specifications submitted.All work will be completed in a substantial workmanlike manner for the sum of Dollars($6,850.00), with payments to be made as f lows:Job Vpecpletion. Respectfully submitted . Note-This proposal ma be with rawn us i not accepted within 30 da s. ACCEPTANCE OF PROPOSAL The above prices,specifications and conditions are satisfactory and are hereby accepted.You are authorized to do the work as specified. Payment will be made as odtlined ab Date yI/ ��/� Signature -A- i.04A 0 Mailing Address: P.O. Box 8051 - Lowell, MA 01853 Location: 525 Woburn Street-Tewksbury, MA 01876 E-Mail: Info Wooster-Roofin .com Website: www.Wooster-Roofinq.com Office of Consumer Affaksr4d.Business Regulation 10 Park Plaza - Suite 5170 - Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 100712 Type: Supplement Card CHARLES J. WOOSTER ROOFING Expiration: 6/23/2014 STEPHEN WOOSTER 525 WOBURN ST TEWKSBURY, MA 01876 Update Address and return card.Mark reason for change. 1 0 2OM-0511 Address Renewal Employment Ej Lost Card Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration _Registration: 100712 Type: DBA Expiration: 6123/2014 Tr# 227218 CHARLES J. WOOSTER ROOFING Charles Wooster -- R_O. BOX 8051 LOWELL. MA 01853 Update Address and return card.Mark reason for change. Address ❑ Renewal [] Employment Lost Card 'S;c safaly 3card 0t t:i.^_,�il@ :�c�;�i�'_'.':`ie� c,:-e:.i J"tdnde"}i'dS U'Cerse: CS-054268 CHARLES J WOOSTER , PO BOX 8451 _ LOWELL MA M$53 `.�..�...J1 �OmM+ss,vner 05/11/2014 WOOST-1 OP ID:GM /Q40oRL/ DATE(MMIDD)YY111� � CERTIFICATE OF LIABILITY INSURANCE 10116112 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 certficate holder is an ADDITIONAL INSURED,the policy(iss)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement Astatement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 781-848-8600 Cca cr Ger McDonald 420Wa hingtonicci StririsAgInc eet 781-843-8807 r''''cN Et:781-952-4143 No;781-843-8807 P.O.Box 850984 E-MAIL Braintree,MA02195 ARESS' Paul Marks INSURERS)AFFORDING COVERAGE IgAIC1, INSUR62A:Acadia Insurance Company 31325 INSURED Charles J Wooster dba Wooster INSURERB:Star insurance Company Roofing PO Box 8051 INSURER c Lowell,MA 01853 INSURER o: INSURER E: INWtER - INWtER 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. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MIDD MA LIMITS GENERAL LIABIL TY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY CPA0083583 10/17/12 10/17/13 PRfMISES occurrence $ 250,00 CLA1W,WIDE QOCCUR MEDB(P(Any one person) S 5,09 PERSONAL&ADV INJJRY $ 1,000,090 X Per Project Aggre GENERAL AGGREGATE $ 2,000,0 GEITLAGGREGATE UMITAPPLIES PER: PRODUCTS-COMPIOPAGG $ 2,000,00 POLICY Fx I PRO El IECT LOC AUTOMOBILE LIABILITY t�M �tSP1GLELPAR $ 1,000,00 AANY AUTO MAAM79734 10/17/12 10117/13 BODILY INJURY(Perperson) $ ALL OWNED 1771 SCHEDULED AUTOS AUrOS BODILY INJURY(Per addent) $ X HIREDAUrOS X NO"VVNM PROPE2TYDAMAGE $ AMOS Per accident $ X UMBRELLA UAB X OCCUR FACHOCCURRENCE $ 1,000,00 A EXCESS LtAB CLANIS-MADE CUA0383967 10117112 10/17/13 AGGREGATE 5 1,000,00 DIS I X I RETENTIONS 0 $ WORKERSCOMPENSAnoN X WCSTATU- OTH- AND EMPLOYEW LIABILnY YIN TORY I MITS ER B ANY PROPRIETORIPARTN@2fF)CE-CUTIVE [-- WC0720M 10117112 10/17/13 1:1 EACH ACCIDENT $ 7,000,00 OFRCERiMiaABER EXCLUDED? NIA (Mandatory In NH) EL DISEASE-EAEMPLO $ 1,090,09 If yes.describe under DESCRIPTION OFOPERATIONS below E.LDISEASE-POLICY LIMIT $ 1,000,00 A Property CPA0083583 10/17/12 10/17/13 A Equipment CPA0083583 10117112 10/17/13 DESCRIPTION OF OPERATIONS ILOCATIONSIVENCLES(Attach ACORD 101,AddlOonal Remarks Schedule if morn space is regWmd) CERTIFICATE HOLDER CANCELLATION EVIDENI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Evidence Of Coverage CCORDANCE WITH THE O�PROMSIONR Wn.L BE DELIVERED IN AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved.. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD