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HomeMy WebLinkAboutBuilding Permit #999-15 - Bldg 36 6/2/2015BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received Date Issued: 'IMPORTANT: Applicant must complete all items on this page t&ORT#1 0 LOCATION Rlby 36, P int _1J PROPERTY OWNER VA UL MAP WI Al Print 100 Year St—ructure yes /1 PARCELtMi ZONING DISTRICT: Historic District yes Machine Shop Village ryes) no TYPE OF IMPROVEMENT PROPOSED USE fESCRIPTION OF WORK TO BE PEVFORMED: , / ( �QWJ:t 4�,, f- I ( !,ae - H D, Residential Non- Residential El New Building El One family El Addition El Two or more family El Industrial El Alteration No. of units: ' ommercial X,Repair, replacement El Assessory Bldg El Others: 0 Demolition El Other 0 eptic 11 Well El Ploodplain El Wetlands [I Watershed District 0 Water/Sewer 1�41 L J 01 + P Supervisor's Construction License:i!� 107 q Exp. Date: Home Improvement License: Exp. Date: - ARCH ITECTIENGINEER Phone: Address: Reg. No. FEE SCHEDULE: BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COSTBASED ON $125.00 PER S.F. Total Project Cost: $ q 9, bon, FEE: $ ;-) 5 a-'—" Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund , r �co 7 fESCRIPTION OF WORK TO BE PEVFORMED: , / ( �QWJ:t 4�,, f- I ( !,ae - H D, r !A < 4ks,� _1 q Ll " ) I V1 s k air J4,1S Ic t cA I 1�41 L J 01 + P rO A Jo � -e,- 64 o�� - %_., "AN -rn1-,4 Identification - Tlease Type pr rint Clearly I 61:7 OWNER: ary 6- !,,J �i e: Phone: a2a� Address:__]_�2 1_�l f� U I, /M sa vi z .)I' Me -A�6, Contractpr Name: C-60J)Va RQ0k16A_ 11i C, Phone: (n 1:7 7;� Email: r66�i4!�o k�Wnoj Cof/n- Address: tn v.,, r -k�, r fl)- LA. CS,� �e, i Supervisor's Construction License:i!� 107 q Exp. Date: Home Improvement License: Exp. Date: - ARCH ITECTIENGINEER Phone: Address: Reg. No. FEE SCHEDULE: BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COSTBASED ON $125.00 PER S.F. Total Project Cost: $ q 9, bon, FEE: $ ;-) 5 a-'—" Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund , r �co 7 a Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL _r Publhic Sewer Sew, [ Taming/Massage/Body Art Swimming Pools w 'I ell Tobacco Sales El Food Packaging/Sales El Private (septic tank, etc. El Permanent Dwnpster on Site El THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature'— COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH COMMENTS Reviewed nature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer ConneGtion/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street ID' JEIRRVE nA,-! RvTwqEffi,� _em. � iF -.AT, Isit iye if T %�,a �re— �1 1,F. g4ft 0 NO t—bbili fate 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.$100-$l 000 fine NOTES and DATA — (For department use) El Notified for pickup Call —Email Date Time Contact Name Doc.Building Pennit Revised 2014 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 TE: 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 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) 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) ,4-- Building Permit Application 4� Certified Proposed Plot Plan Photo of H.I.C. And C.S.L. Licenses Workers Comp Affidavit �6 Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) .4� Copy of Contract -Ar 2012 IECC Energy code ,4� Engineering Affidavits for Engineered products E: 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 Location No. 9 Date Check # 0 U TOWN OF NORTH ANDOVER Certificate of Occupancy Building/Frame Permit Fee Foundation Permit Fee Other Permit Fee TOTAL ,22 Buiid-in'g Inspector b < 0 0 Ma -11 =r --I 0 M " 0 :3 —h 0 r r- U) CD cn CD 0 CD 0 5 . CD 0 M 0 CL 0 Cl) z o =rmo 0 is- -h 0 0 0 CL h =t w me. cn m CD F)- CD (a 0 CD mO- CD CD 0 2� a) -% U) CD TD M = 0 0 cm CL doom CO r -s- 0 o =r 0 CD CD 0 s 0-0 ;z z -0 --1;3 0 ,r— m * F =r - r 2) o 'o Cl) co --h U) -0 0 Cl) CD o 0 -% > 0 M =r 0 -0 M (n : CL 0 >< o -0 1 z 0 cl) Z C=L o o CL 0 0 M 2. CD 0 < CL CD U) CD 0 M U) (<D CL = a r -L Cr U3 Z -0 < @ CD CD r!- U) CD It CD o a CD z Im cn 0 0= 40 CD Z C-7 0 CD a EL 0 U) m Alo cn 0 0 zr cn =r CD CD -P, U) U) '0 CD z (D 0 r 0 jS 0 0 —h POO 0 > CD Cl) CD '0 -0. 0 m < 0 CD --i 0 0 = . CL Ln 3 0 x- fD Ln rD — z OD rD m m M m z -n 5. ;;o o r_ crQ =r M m 0 w Ln !� < F . rD ;;o 0 r- = :r m r- m r) > r- m 0 M m w — ::u 0 c UQ M c z L) z m 0 n =r * rD :;o 0 C m m 0 C ID 0 C m 0 Ln rD 'a Ln (D 3 -n 0 0 o- r) = rD 0 > :0 a 0 m > CONTRACT AGREE, MENT made as of the VIA day.of 2015. .1. CONTRACTINiC, PARTIES Owner: 'RCG Wc�t Mil I N A LLC c/o RCO LLC, 17 Ivaloo St, Suite 100, Somerville, MA 02143 Trade Subcontractor: � q Portanova Roofrng� Inc. Tax ID# > ,q 149 Minot Street, Dorchester, MA 02122 I - 1. PROJECT Roofing Work — Building 36 at One Higil Street, North Andoym MA 0 1, 845.(.fo.r merly tile Converse, Inc. WorlO_HM Ill. WORK TO BE PERVORMED Supply and install all labor, material, and equipment to perform the fbilowing work: Included-, - Rerrioval of ballast fron-i roof - Removal of rubber From old roof exposing existing insulation Installation of] /2" HD plusinsulation on top of existing Instiladon will be mechanical ly fastened with HD masonry roofing screws Fully adhered Versico EPDM roofsystern with 20 yr warranty Now door pan Copper wall cap with soldered scams 245' of termination bar with copper reglet cut into masonry -Rubber turned up and over parapet walls - 8 New Oly-Flow roof drains - Durapsters for roofing debris - Permits Excludvd: - Masonry work or any structural work - Taking out door and reinstalling -Any Existing insulation that has to be replaced - Any carpentry work - Any problems that could come up relating to the concrete deck Changes to this Contract increasing or decreasing the Scope of the Work must be in writing and signed by the Owner and Trade Subcontractor. Page 1/3 IV. COMMENCEMENTAND COMPLETION Date of Commencerneut: lipon Execution. of the Contract Expected Date of Completiow June 30, 2015 TIME IS OF THE ESSENCE IN THIS CONTRACT, V. PRICE and TERMS The General Contractor shall pay the Trade Subcontractor the folto "" 4".- win.g amount for the Workincluded in this Contract: $199,000 Scbedule of payments shall be as follows: • $49,750.00 Deposit upon.E%ecution. of the Contract • $49.750.00 at 50% Complete. • $99,500.00 at 100% Complete. Th -e Trade Subcontractor shall submit an applicati.on for payment in theforIll of all Invoice to the Owner for each Payment Due. The Omi-ner, upon inspoction and approval of the completed Work by the Trade Subcontractor, will pay th.eTrade Subcontractor the approved Invoice annount within two weeks of submission of approved Invoice. The Trade Subcontractor shall submit Partial Lien Waivers, in the amount of each progress paymeriti. if any, and a Final Lien Waivers upon receipt of the final payment for the War L - Aft Lien Waivers shall be signed by an authorized representative of the Trade Subcontractor in the presences of a notary public, and so noted. 'The Owner shall not release any payments to the Trade Subcontractor without. a signed Lien Waiver, VI. INSURANCE PROVISIONS The Trade Subcontractor shall maintain in effect industry standard Workmen's Compensation Insurance for al I of its employees and General Liability Insurance for the duration of the Work of this Contract. No Work shall Commence and no Payments shall be made until a CeIlificate of Insurance is issued fromTrade S�ibcontractor's Insurance Company na i,n RCC - M � 9 LLC and RCG West Mill NA LLC as certificate holders and additionally insured. Page 2/3 0 VIL HANNER. OF EXECUTION All Work. shall be performedand cornpleted in compliallce i h all federal, state city and -wit local codes and ordinances. All Work shall be performed in compliance with. OSHA rules and: regulatio-ii .s, A � I OSHA violations And fines related to the Work of this Contract shall Trade Subcontractor perform . ing the Work. be -the responsibility of the All Work shall be performed in a first class workmanlikefashion... consistent with the highest standards in the construction industry AGREED�- owlier RCG West Mill NA Trade Subemytractor ate Ken Portanova, Portanova Roofing, Inc. Page 3/3 The Commonwealth of Massachusetts Department ofIndustrialAccidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 www.mass-gov1dia Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITE[ THE PERAUTTING AUTj10RIiY. — --i— i Name (Business/Organization/Individual): Address: C,ty/State/Zip: A&, Phone#; Are you an employer? Check the appropriate box: 1. 1 am a employer with _Lg employees (full and/or Part-time).* 2 . I am a sole proprietor or partnership and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3, 1 am a homeowner doing all work myself [No workers' comp. insurance required.) t 4Q 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 proprietors with no 6mployees. 5.FJ I am a general contractor and I have hired the sub -contractors listed on the attached sheet. These sub -contractors have employees and have workers' comp. insurance.t 6.FJ We are a corporation and its office rs have exercised their right oflexemption per MGL c. 152 §1(4), and we have no ernpl*�s- [No workers' comp. insurance required.] Type of project (required):. 7. New'c6nstruction 8. Remodeling 9. El Demolition 10 F1 Building addition ME] Electrical repairs or additions 12. ,,. plumbing repairs or additions 11F] Roof repairs 14. F1 Other--. *Amy applicant that checks box #I must also fill out the section below showing their workers' compensation policy information. icating; they are doing all work and then hire outside contractors must submit a new affidavit indicating such. t Homeowners who submit: this affidavit ind entities have tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those, employees. If the sub-c6nLctors have employees, they must provide their workers' comp. Policy number. I am an employer that is providing workers 2 compensation insurancefor my emplbyees. Belowjsthepollcyand)obsit� information. Insurance Company Name: Expiration Date: policy # or Self -ins. Lic. 9: City/State/Zip: d Job Site Address: ate). _L_� i Kco Attach a copy of the wor er 9 . peisation policy declaration page (showing the policy number and expiration 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 veri ication. . ury that the information provided above is true and correct. I do hereby certify under thepain�jmdpenalties Vey official use only. Do not write in this area, to be completed by citY or town of ficial. City or Town: Permit/License # Issuing Authority (circle one): 'I 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: — Phone Ir 13 15 01:45p Ann Gallsghet 6173257892 P. 1 -T--- CERTIFICATE OF LIABILITY INSURANCE F Al. (.kMcDfYYYY) THIS CERTIFICATE IS 103/05/2015 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE VOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND. EXTEND OR ALTER THE COVERACE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERJS), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANI. it the certificate holder is an ADDITIONAL IN6UNE13, the poliCy(jes) must e endorsed. If Z)U5KUGA1IUN 15 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 ol'such endorsement(s). RODUCER -=IAC71 17HE INSUPJWCE STORE NAIAE; -FH'5-NIE- ' ' "-' ' " * ­ *- - I FAX" ----'---- L06 SPRING smjEET 0 (617) 325 8952 -AJC, No- E.Q- j,V,,,o)z(617) 325 — 7892 EIMIL MST ROXBURY, mAL 02132 ADDRESS: IN�UKt:K(N) AFFORDING COVERAGE NAIG 0 ISURED INSURER A:NESTERN WORLD J14SURmcE CobjpANy 'ORTANOVA ROOFING -TNC INSURER a;TRAVLMS CoDn�MRCIAL AUTO - YND9IxlNIrY COMPANY io Elm street INSURER c.- TRAVELERS :ohasset Ma 02025 INSURERD: ERF: OVERAGES CERTIFICATE NUM13ER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE LICIES OF INSURANUE: LISTED BELOW HAVE BEEN l,:i6UI::U TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDJCATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITI'- RESPECT TO WHICH THIS CERTIFfCX-1E MAY BE ISSUED OR MAY PERTAIN, THE INSURA14CE AFFORDED BY THE POLICIES DESCRIBED IiEREIN IS SU13JECT TO ALL THE TERMS,] EXCLUSIONS AND CONDITIONS OF SUCH POLICIES- LIMITS qHC)Wr4 IVIAV WaWr- Dccl. !F� JI TYPE OF INSURANCE INSR INVID POLICYNUMBER (MM/DDrff") IMMADONYYYI LIMITS LIABILITY B RRENGE s 1,000,000 COMMERCIAL G NERAL LKO'UrTY TGENERMAL -D I..PREhIlSES (Ea oc��Irr�nce) s 3.00,000 LA CLAIMS -MAD E OCCUR ITPPS184354 11/04/14 11/04/15 MEDEXP�Anyonepomon) S 5,000 PERSONAL &AN, IIIIJUR� $ 1,000,000 GENERALAGGREGATE s 2,000,000 GEN't-AGGREGATE LIMIT APPLIES PER: -PRODUCTS-roM PRO. ('CWPIOPAGG S 2,000,000 POLICY JECT LDC 1-1, F] _�K .OrADBJLE LIABILITY QEa accidarit) UNCLE 11000,000 ANY AUTO ALL OWNED Sc.-M:.LED - BODILY INJUR't (Pat;:erson) 3 AUTOS x AUTOS BA2D290560 130D.LY IN TLI.�Y­ (Pe(acddelt) 4 X HIREDAUTOS x NON -OWNED AUTOS 05/06/14 -FR-OP-=RYTOWA-�.�— 06/05/15 I (Peraccident) 6 100,OOD UMBRELLA LIAO OCCUR EXCESS UAB 0- EACH URRI NCE EACHOCrURRENCE CLArMS-MADE A.r AGGRE GATE _REGATE 0 WORKERS COMPENSATION AND EMPLoYERS- L)ABRiTy �Ti" X L OTH- AN YIN YPROPRIETORIPARTINER(EXECUTIVE OF;710ERIMEMBER EXCLUDED7 N/A 6mm BD807841 o" L IT T ER 10/28/14 10/28/15 ":�'i I' E L. F-ACHACCIDENT (M andat-y in N"I N T V", descrite under E.L. DISEASE - EA EMPLOYEE DES�R.PTHON OFOPERATICNS below E.L. DISEASE - PO, CYJMI- is CRIPTION OF OPERATIONS I LOCATIONS? VEHICLES Attach ACORD 101, Additional Remarks Schedula, It more sPace is required) OFING & CARPENTRY :2TIFICATP 14ni nFP 3..L=ng Department ty of North Andover GO Osgood sticeety Bldg 20 Smite 2035 rth Andover Ma 0184S )RD 25 (2010105) SHOULD ANY OF THE ABOVE DESCRIBED PDUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POUCY PROVISIONS. REPRESENTATIVE 1A 1) P11988-2010ACORDICORPORATIO The ACORD name and logo are registered marks of IR Fri. C\ Office of Consumer Affairs & Business Regulation ME Im'PROVEMENT CONTRACTOR egistration: li8521 Type: pir tibri: :4/2�1�2*0'16 Private Corporatio! PORTANOVgROOFINQ:INC. KENNETH PORTANQVI� 148 MINOT STREET DdRCHESTER, MA 02122 Undersecretary Uw4't- w"no �ev- 163. License- CS -J07 1,0V T11 I "NNE 148 MIRo-f ST � _I 2 .2 vi D,,,cheiter NA V,ypiration . oi/211120117 X% 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 ajoint enterprise, and including the legal representatives of a deceased employer, or the receiver'or trust6e 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 c i hapter 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(l) 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 neceisary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLQ 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 reque ted s , not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are requ'iredto 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 thai 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