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HomeMy WebLinkAboutBuilding Permit #411-15 - FOULDS TERRACE 10/30/2014 T%ORTH BUILDING PERMIT o*"<LED I" TOWN OF NORTH ANDOVER 0 - ,_•.,.�a o p APPLICATION FOR PLAN EXAMINATION y T Z a yT Permit No#: �r Date Received �14A°A�reo�Pay4y gSSACH�15�� Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION _ CSU t_t>S _��c 4Z pE-: %J>(-, A -3 Print PROPERTY OWNER N© YVD(�yL� _ l�Ol}SI/L9Cs -U���© � y Print 100 Year Structure yesnno MAP� —PARCEL: _ ZONING DISTRICT:-_ Historic District yes LL Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ATwo or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial K Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain 0 Wetlands Watershed District Water/Sewer DESCRIPTION OF WORKTOBE PERFORMED: L L, 0�O �aJ S"T ALL- ko b( zse Cb &)U&mss(0/0 P(-P-KO0E� * yt� �-L.IkC,� �AJYKY D00 4Z S Identification- Please Type or Print Clearly OWNER: Name: V C>2'VA A O Dou t:k- H ou s(yu 6 AV ul Phone: 393�- Address: 1 MO(Zfi�51r'� tlt/96(9(JS Contractor Name: � ,1oaPhohe: Address: L00AL,nslt-T 5"C' Supervisor's Construction License: U�?G 5<0 3 _ Exp. Home Improvement License.____._ n>�f��__..G _ _ _.Exp. Date: ARCHITECT/ENGINEER OzAR N 5 I t>e N Phone: 91 g- 7 q/- S QJ?� Address: a(*2 eSSP-X S'- StNLe'1, Mall, yq9 c) Reg. No. FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED�ONN$125.00 PER S.F. Total Project Cost: $ 5 aZ l FEE: $ Check No.: Receipt No.: -��01 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund ,Signature of A ent/Owner nature of contractor g� _ _. Location CD 4, A-cst— r5k(Q) A --3 No.A H 5 Date W>-Y (—i • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ a r� . Building/Frame Permit Fee $(2�� : � Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# 28201 Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE'OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swinnning 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 PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Nater & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster,on site yes no _ . Locatedat 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 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 NOTE: 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 NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New ConstructionSin le and Two Family) � g Y) ❑ Building Permit Application ❑ 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) ❑ 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 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 r -IN�H . W­ t ;, : �. .c ve' 'o 0 No. 1 . 16 h ver, Mass, ?O o A- COC LAKG NIC"IWICK ��' 7� A�R�TED I'PP�,�S S V BOARD OF HEALTH Food/Kitchen PERMI Septic System 1 THIS CERTIFIES THAT BUILDING INSPECTOR .... .. ...... .. .. . .......... .............. ........................ . ....,..'. .. � � Foundation has permission to ere t .......................... buildings on ..... .. Rough to be occupied as ... .. ....11a. �.. .. .� .... ... ............... Chimney provided that the person accepting this permit shall in every respect conform to t e 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 RT Rough 4411 Service ................................................. BUILDING INSPECTOR Final GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz 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. The Cornmonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lezibly Name(Business/Organization/Individual): V A1z-1i Address: 9 aa3'19 City/State/Zip: ,& l - ` Phone#: Are you an employer? Check the appropriate bog. Type of project(required): 1.® I am a employer with� 4 ❑ I am a general contractor and I 5 E]New construction I (full and/or part-time).* have hired the sub-contractors Reeling 2.❑ I am a sole proprietor or partner- listed on the attached sheet 7 ❑ These sub-contractors have g. []Demolition ship and have no employees employees and have workers' 9 ❑Building addition working for me in any capacity. [No workers' comp.insurance comp.insurance E]5. We are a corporation and its 10.0 Electrical repairs or additions required.] officers have exercised their 11.E]Plumbing repairs or additions 3.❑ I am a homeowner doing all work right of exemptionper MGL .12.[:]Roof repairs . myself. [No workers comp. c. 152, §1(4),and we have no insurance required.]t employees.[No workers' 13.0 Other-22-1 21 Npotx95 comp.insurance required.] Uo `S *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 mast submit a new affidavit indicating such. *Contractors that check this box n mst attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees;they must provide their workers'comp.policy unixm I am an'employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. --- ----- ----- - --- _- - ---- ---- - Insurance Company Name: -- C - NS 0 _ ---.N Ge, Policy#or Self-ins.Lic.#: W CA d l ( a-(D _-)_9 - OLo Expiration Date: !� Job Site Address: Ci /State/Zip:AkZTq 60� 2,YP Ul ��t��b-52Y��� ry 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 of the DIA for insurance coverage verification. Ido hereby certify under the pains and penalties of perjury that the information provided above is true and correct: Signature �M9 J )_,'� `'' Date 1 FJ Phone#: 9 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.Plumbing Inspector 6.Other Contact Person: Phone#: CERT'IFICAT'E OF LIABILITY INSURANCE DATE09/0044/D/22014014) 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 CONTANAME:CT E. J. Wells Insurance Agency E. J. Wells Insurance Agency aCONoExt: 978.392.4567 XcNo:978-392-9696 Div of HUB International New England LLC ADDRESS: DDREss: 275 Great Road PRODUCER CUSTOMER ID#: Acton, MA 01720 INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURERA: Union Insurance Vareika Construction Co., Inc. INSURER B: Acadia Insurance Co. 219 Walnut Street INSURER C: The North River Insurance Co West Bridgewater, MA 02379 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 14-15 Std 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 ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MM/DD/YY MM/DD/Y GENERAL LIABILITY CPA 0092564-2 06/20/2014 06/20/2015 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $ 250,000 CLAIMS-MADE [_i]OCCUR MED EXP(Any one person) $ 5,000 A 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 X E OT LOC $ AUTOMOBILE LIABILITY MAA0092 568-2 06/20/2014 06/20/2015 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ B X SCHEDULED AUTOS PROPERTY DAMAGE $ X HIRED AUTOS (Per accident) X NON-OWNED AUTOS $ $ UMBRELLA LIAB X OCCUR 581-103022-506/20/2014 06/20/2015 EACH OCCURRENCE $ 5,000,000 C EXCESS LIAB CLAIMS-MADE AGGREGATE $ 10,000,000 DEDUCTIBLE $ X RETENTION $ 0 $ WORKERS COMPENSATION WCA0112029-2 06/20/2014 06/20/2015X ORY LIMITS OER AND EMPLOYERS'LIABILITY Y/N TH- ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 B OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 A Stored Materials CPA0092564-2 06/20/2014 06/20/2015 $200,000 Any One Job Site $200,000 Temp Off Premises DESCRIPTION OF OPERATIONS/LOCATIONS 1 VEHICLES (Attach ACORD 101 Additional Remarks Schedule if more space is required) )-4-14 Job: Window replacement, exterior doors & frames 47-3 Vorth Andover Housing Authority is additional insured with respect to the General Liability where required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. n North Andover Housing Authority AUTHORIZED REPRESENTATIVEOne Morkeski Meadows �G No. Andover, MA 01845 jPaul Coffey/NAM ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor Ltense: CS-076563 ROBERT G VAREWA 86 Bedford Street` r Lakeville MA 02347 Expiration Commissioner 12/18/2015 "r0M`M!0NWEALTH ER-CONTRACTOR AGREEMENT C070SEG OF MASSACHUSETTS- DEPARTMEN OCOMMUNITY DEVELOPMENT This agreement made this 4"day of September,2014 by and between the NORTH ANDOVER HOUSING AUTHORITY hereinafter called the "Owner",and VAREIKA CONSTRUCTION,INC.,hereinafter called the "Contractor". Witnesseth,that the Owner and the Contractor,for the consideration hereinunder named,agree as follows: ARTICLE 1.SCOPE OF WORK: The Contractor shall perform all Work required by the Contract Documents for exterior window and door replacement at the 667-3 Elderly Housing Development prepared by Nilsson+Siden Associates,Inc.,acting as and referred to in the Contract Documents as the"Architect". ARTICLE 2. TIME OF COMPLETION: The Contractor shall commence work under this Contract on the date specified in the written"Notice to Proceed" and shall bring the Work to Substantial Completion within 75-calendar days of said date. Damages for delays'in the performance of the Work shall be in accordance with Article 9 of the General Conditions of the Contract. ARTICLE!.CONTRACT SUM: The Owner shall pay the Contractor,in current funds,for the performance of the Work,subject to additions and deductions by Change Order,of the Contract Sum of TWO-HUNDRED THIRTY-SEVEN THOUSAND THREE-HUNDRED DOLLARS $237 300 . ARTICLE 4.THE CONTRACT DOCUMENTS: The following, together with this Agreement, form the Contract and all are as fully a part of the contract as if attached to this Agreement or repeated herein: The Advertisement, Bidding Documents, Contract Forms, Conditions of the Contract, Specifications and Drawings enumerated in the Table of Contents and all Modifications issued after execution of the Contract. Terms used in this Agreement which are defined in the Conditions of the Contract shall have the meanings designated in those Conditions. ARTICLE 5. REAP CERTIFICATION: Pursuant to M.G.L. c.62(c) §49(a), the individual signing this Contract on behalf of the Contractor,hereby certifies under the penalties of perjury,that to the best of their knowledge and belief the Contractor has complied with all laws of the Commonwealth relating to taxes, reporting of employees and contractors, and withholding and remitting child support. ARTICLE 6.WORKER DOCUMENTATION CERTIFICATION: In accordance with Executive Order 481 the undersigned further certifies under the penalties of perjury that the Contractor shall not knowingly use undocumented workers in connection with the performance of this contract; that pursuant to federal requirements, the Contractor shall verify the immigration status of all workers assigned to such contract without engaging in unlawful discrimination;and the it shall not knowingly or recklessly alter,falsify,or accept altered or falsified documents from any such worker(s). The Contractor understands and agrees that breach of any of these terms during the contract period may be regarded as a material breach, subjecting the Contractor to sanctions, including but not limited to monetary penalties,withholding of payments,contract suspension or termination. ARTICLE 7.VALIDATION:This Contract will not be valid until signed by the Department of Housing and Community Development. In Witness Whereof,the Parties Hereto Have Caused This Instrument to be Executed Under Seal. ' CONTRACTOR 'AWARDING AUTHORITY VAREIKA CONSTRUCTION,INC. NORTH ANDOVER HOUSING AUTHORITY Name of Contractor Name of Housing Authority 219 Walnut Street,Suite B One Morkeski Meadows, W.Brid ewater,MA 0237 North Andover,MA 01845 Address Address By: Signa ure and Seal By: rgnature and Seal President Title ,s Title Witness � Attest: r If a Corporation,all d a notarized copy of the orporate Z If signed by s eone other than a Housing Authori Boardin er,attach a copy of Vote authorizing signtt ryry o sign Contract. Certified Bo d Vote authorizing the signatory to sign Contract. DEPARTMK:�T OF HOUS G&COMMUNITY DEVELOPMENT By: Under ecretary gr Designee Date: DHCD 9/2014 Owner Contractor Agreement