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HomeMy WebLinkAboutBuilding Permit #230-2017 - Rocky's Hardware Ace 9/1/2016 AkoRTy � BUILDING PERMIT TOWN OF NORTH ANDOVER ' ' rIll APPLICATION FOR PLAN EXAMINATI N « Perrrkit N4: V Date Received q�47'SO Date Issued: 1, �ssatr SSS I OItTA:`T:A licant must ca fete all items on this page LOCATION-,.-, PROPER Print IG AP ISO: PARCEL: ZONING'--DISTRICT° 1-listi���©istri�: yes. no TYMachinene shag 1/illage yes . ..no PE OF IMPRO EMENT f PROPOSED USE Residential Non-Residential E 0 New Building 01 One family Addition C Two or more family ;Industrial k �Alteration No.of units: Commercial TRepair, replacement �!Assessory Bldg Others: r Fj Dernoli#ion Other D Septic. .0 Well — Wetlands lain 0 Watershed District E,Water/Sevier IrD � . Identification Please Type or Print Clearly) OWNER: Name: J���� ff�i�€i1�����i�� .�` �, t� Phone: t.� Address: CONTRACTOR Name: Phone: J��1P-66 -O:oo Address: , Supervisor's Construction License: Exp.. ate: Home Improvement ov�ement Li P cense; :. /U 2 y 3/ Exp. Date. ARCHITECTiENGINEER Phone. Address: Reg. No. FEE scffEDuLE:OuL.DING PF-RMT.MOO PER slow.t10 of TnE TorAL ESTMATED COST BASED ON$12500 PER S.F. Total Project Cost: $ �` . FEE: $ Check No.: 6 Receipt No.: t >OI}3E'E• Persons congpae iih unregister�ert contractors do not have access to a guarantyfa >i/orf-h ,�dcsre. if t> ztvs t/a,p- id,yi., 1 7���t/mac Signature of Agent(Ownenature d#:_contrast �1+� L-�or d-a� ��•f�$ s NORTH BUILDING PERMIT ?` oFt�ED TOWN OF NORTH ANDOVER - APPLICATION FOR PLAN EXAMINATION o oy w 1 Permit No#: Date Received �sqs R1TED�P��4`� SHCHUS Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION Print PROPERTY OWNER Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition El Two or more family [I Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other 09-'-ptic p:Wela, :'.v p� ,D' Wa#ersted ®istnc ❑ Flootl Jain ❑Wet�antls ❑Water/Sewers.` .� _ .—' �., M DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: Contractor Name: Phone: Email: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. ii FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Sianafure of:Aaerie'r Signature of contractor -�. r 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 ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM -- i DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ I COMENTS F CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ 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 • Located at 384 Osgood Street FIRE DEPARTMENT. - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date ft- 'fn/ -/ COMMENTS } y Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ Fublic EWERAGE DISPOSAL ❑ Tanning/Massage/Body Art ❑ Swumning Pools ❑ ❑ 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 I I Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments I Water & Sewer Connection/signature pate Driveway Permit DPW Town Engineer: Signature: �-�-� �• ,,. ?,, f� k 3,{zw Located 84 Osgood Street AFIRE DEPARTMENT Temp ®ump-sterson•ste, ye57 �;#�''°F �"" � no t�Located at 124 IVIam St 6&e � t , s '� r ► Fir egDepartmentsignatur�e/date •02' y id-1. Y 'H4�' 1}t�'h%�;i'" r'Z-X'x' ���'^: `Cw®MMENTS est=r _ 'J3i,c .Fv<,...:,,. Z ,ri.... „�'i `� 13ic `�' °,ar.sf x .'.2r+��`ii}„� r? s1l i�,..`C�� 'rJ'�' «• �`+ L��� ��'•. z� 7�� sf 1 Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions._ Total land area, sq. ft.: i ELECTRICAL: Movement of Meter location, mast or serv' Electrical Inspector ice drop requires approval of Yes No DANGER ZONE LITERATURE: Yes MGL Chapter 166 Section 21A—F andG min.$100-$1000 fine �® I. II� f NOTES and DATA— (For deparr°trnent use) ® Notified for pickup Call ------------ Email Date Time Contact Name _ Doe-Building b permit Revised 2014 Building Department F 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 4, . 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 i OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit r 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) If Applicable) Mass check Energy Complianceport ( P 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) Building Permit Application Certified Proposed Plot Plan ;k Photo of H.I.C. And C.S.L. Licenses t 46 Workers Comp Affidavit 4 . Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) Copy of Contract 2012 IECC Energy code Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit I In all cases if a variance or special permit was required the Town clerks ofce must stamp the et this recorded at the Registry of DeedsC1One copy and proof of recording from the Board of Apeals i i that the appeal period is over. The applicant must g must be submitted with the building application I Doe:Building Permit Revised 2014 I� I Location No. 3e). 7 Date f0' ' � r • - TOWN OF NORTH ANDOVER r Certificate of Occupancy _ $ Building/Frame Permit Fee $ --- i Foundation Permit Fee $ Other Permit Fee $ i; TOTAL $ R { / r; Check# f b k / i k. . f Building Inspector 3083 NORTH own of No. T �O lAN! h " ver, Mass, �/� COCMICNlWKK y�. s u BOARD OF HEALTH Food/Kitchen PER Septic System THIS CERTIFIES THAT N �• BUILDING INSPECTOR ............. . ....... ..... . ...........�.... .......... ..... .... ................ • ... . .. ...... . . . Foundation has permission to erect ........ ................. buildings on .�...... .�.. ... ...... .. . . . ................ Rough tobe occupied as .......... . . ...... .... .. ... .. ..................................................................... Chimney provided that the person accepting t is 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 CONST CTION Rough Service .. .. .. ... ........... .../sop ..... Final BUILDIN SPOR 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. Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/MassageBody Art ❑ Swimming pools ❑ WellElTobacco Sales ElPrivate(septic tank,etc. ❑ Food Packaging/Sales ❑ Permanent Dumpster on Site ❑ ' THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMENTS CONSERVATION ❑ COMMENTS HEALTH ElDATE REJECTED DATE APPROVED COMMENTS ❑ Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/s- nature Date Located d at 384 Osgood Street Drivewa Permit FIRE DEPARTMENT - Temp Du.rripster Ton site yes -/ no Located at 124 Main_Street Fire Department signature/date c COMMENTS �R VtORTH q BUILDING PERMIT ?°��``a° "•6�°� TOWN OF NORTH ANDOVER ° APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received y cx.oc..e .��• Date Issued: �9SSACHUS��� IMPORTANT: Applicant must complete all items on this page LOCATION �OC lL�l S CG J-AlYeliw referg %7a�y1"21e— Pnr PROPERTY OWNER /�df�_h 1;rg d ilii, t19411&rg_3 Zhill``62�15/�+ Print MAP NO: PARCEL: 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: 'Commercial 'K Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic El Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer b X v 01` ct9 ,1FGL_ i� Identification Please Type or Print Clearly) OWNER: Name: )WOO Pr� 1 r Phone: OyO - �7- `l��9 Address: 99r �dash/Oj}v;�9 �t # d /a, &0d_(A)e1 i, A4/I Uc) aC�Co CONTRACTOR Name: , Phone: Address: /,©d /c, / C)0�-&00/ Supervisor's Construction License: / Exp. Date: 31& / Home Improvement License: Exp. Date: 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 ?b FEE: Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund ,Signature of Agent/Owner _Signature of contractor _ _ ]M®of Maintenance & Systems Incorporated March 29, 2016 Ms. Ann Moreno Property Manager Horizons Management Associates, LLC 990 Washington Street, Suite 212 Dedham, MA 02026 Re: Rear Roof Replacement Rocky's Ace Hardware North Andover, MA Dear Ms. Moreno, Per your request we propose to furnish equipment material and labor to successfully complete the following work. Rear Roof Replacement • Remove existing roofs and underlying insulation to steel deck, dispose of in a proper mann/ . • Supply I and i nstall woad blocking to outer perimeter of the roof to reach a thickness of 6„. • Supply and instal! 1 layer of 2.5”and 1 layer of 2" poiyisocyanurate instylation attached with plate and screw per manufacturers' specifications. • Supply and install tapered polyisocyanu rate insulation at eave of roof to direct water to 4 scuppers. • Supply and install Carlisle 060 EPDM rubber roof in a fully adhered manner. • Supply and install flashing to all existing roof penetrations per Carlisle specifications- Supply and install 040 aluminum gravel stop with continuous hook strip utilizing stainless steel fasteners, in the standard color of your choice. • Supply and install 4-040 aluminum scuppers with 3x4 down spout in the standard color of your choice. • Clean all work related debris and dispose of in a proper manner. !/ Supply 20 year systems warranty from Carlisle. '; r All for the sum $53,790.00 E :: The existing HVAC units will have to be disconnected by others and may need to be lifted from roof.A meeting should take place to go over this issue with the HVAC Company. If you have any questions or if I can be of any further assistance, please don't hesitate to call me. Sincerely, Robert P. Ellard Vice President Cc: File/E032916-1 North Andover 30 Merchants Drive, P.O. Box 638,Walpole, MA 02081. Phone 508-668-0100, Fax 508-668-0619,E-Mail,Roofmain(d;TIAC.net \ The Commonwealth of Massachusetts Department of IndustrialAccidents a 1 Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Avvlicant Information Please Print Legib Name (Business/Organization/Individual): Address: (5 0 14erC%b" 6--br'1 Vim. City/State/Zip: trc tJ01 e, M 11 (,7�)�� Phone#:cJ/ D S Are you an employer?Check the appropriate box: Type of project(required): 1.E am a employer with r� employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. F1 Remodeling any capacity.[No workers'comp_insurance required.] 9. El Demolition 3.0 I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10E]Building addition 4.❑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 I L❑Electrical repairs or additions proprietors with no employees. 12.E]Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.EJ Roof repairs These sub-contractors have employees and have workers'comp.insuranceJ 6.FJ We are a corporation and its officers have exercised their right of exemption per MGL c. 14.Q Other 152,§1(4),and we have no employees.[No workers'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 are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must 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 number. I am an employer that is providitrg workers'compensation insurance for n:y employees. Below is thepolicy andjob site p P y J information. Insurance Company Name: Policy#or Self-ins.Lic.#; qU p� I �l Jia' / Expiration Date: �� Job Site Address: ��' 7 {�5 V City/State/Zip: /Inh/er W d 4`�s Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). 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. copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verificatio . I do rt y der the a t and ald of perjury that the information provideXarbov,is true and correct. Si nature: Date:e: l © Phone#: WO ` 140 Official use only. Do not write in this area,to be completed by city or tmvn 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 M From:COCran Havlin 1+781+235+1622 09/01/2016 12:13 #634 P.002/002 RO.OFMAI-01 BMCDONOUGH DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 9/1!2016 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 NpMEAcT Beth F McDonough,CIC The Corcoran&Havlin Insurance Group PHONE l7g1 235-3100 280. FAX 287 Linden Street AIC No Exit:( ) ac,No: (781)235-1622 Wellesley,MA 02482 -MAIL BMcdonchinsuranceom .ADDRESS: ou g .c INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Continental Casualty Company 20443 INSURED INSURERB:Amencan Casualty Co.of Reading PA 20427 Roof Maintenance&Systems,Inc. INSURER C.-National Fire Insurance Co of Hartford 20478 P.0..BOX,638 INSURER D Waipoie,MA 020$1 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. 1NSR TR TYPE OF INSURANCE A POLICY F-FF POLICY EXP INSD WVD POLICY NUMBER MM/DDIYYYY MMIDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 cl/1tMs-MADE occuR 4021113243 05101!2016 05101/2017 DAMAGE TO RENTED-PREMISES Ea occurrence $ 100,000 MED EXP(Ariy one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 POLICY�JET F LOC PRODUCTS-COMPIOP AGG $ 2,000,0.0 OTHER $ AUTOMOBILE LIABILITY - EO EIINdEDtSINGLE LIMIT $ 1,000,000. B X ANY AUTO 021113260 05!01/2016 0.510112017 BOD.ILYINJURY(Per person) S X ALL OWNED X SCHEDULED BODILY INJURY Per accident $ AUTOS AUTOS ( ) XXNON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 6,000,000 A EXCESS LIAB CLAIMS-MADE 4021113274 05/01/2096 05/0112017 AGGREGATE $ 5,000,060 DED X RETENTION$ 10,000 $ WORKERS COMPENSATIONPER OTH- AND EMPLOYERS'LIABILITY X STATUTE ER C ANY PROPRIETOR/PARTNER/EXECUTIVE Y® NIA 4021113257 05/01/2016 05101/2017 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) EL DISEASE-FJ\EMPLOYE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E. DIS -POLICY LIIdfT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Town of North Andover is listed as additional insured if required by written contract for General Liability of the named insured operations. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Building Department ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood St North Andover,MA 01845 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD y µ. a? c. ®g Massachusetts Department of Public Safety ' Board of Building Regulations and Standards License: CSSL-100946 Construction Supervisor Specialty �- GREGORY M LAWLOR 52 NORTH WASHINGTON!ST .. NORTON MA 02766 P s , } Expiration': Commissioner 03/06/2018