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Home My WebLink AboutMiscellaneous - 110 WAVERLY ROAD 4/30/2018 (2)Location 0 VJ '6'-J C ft D, No. 61 Date Check # '? 3 -1 "17 0 TOWN OF NORTH ANDOVER Certificate of Occupancy Building/Frame Permit Fee $ Foundation Permit Fee Other Permit Fee TOTA. L $ Buildi , n'g Inspector (� I� TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: 601 ",?-4 17 Date Issued: j 1- I y - "t b Date Received 11 s /V ' aoi 6 IMPORTANT: Applicant must complete all items on this page LOCATION /'10 yaye el, 04 c� PROPERTY O MAP NO. i-% leS PARCEL:f TYPE AND USE OF RTTTT,nTNG R Print ZONING DISTRICT: T4TCTn12U'TITCTR19-T VVC n TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential 0 New Building ❑ Addition ❑ Alteration ❑ One family ❑ Two or more family No. of units: ❑ Industrial X_Repair, replacement ❑ Demolition ❑ Assessory Bldg ❑ Commercial ❑ Moving relocation ❑ Other ❑ Others: ❑ Foundation only i TUN Ur w Uxx I Bh F �P Mo L./ e Kn n• I -f-6kqf OWNER: Name Address: lit Identification Please Type or Print r1J,4,e 5 ,� z /� CONTRACTOR Name Address: e444n G2 . (qld 360 °52o2— Supervisor's Construction License: 65�-6a1336-� Exp. Date: /,;? /Y1Rd ! r Home Improvement License: %b T? i V t Plans Submitted ❑ , r. Plans Waived 0 Certified Plot Plan ❑ Starz -,ped Plans ❑ 1-'' Type bF 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 e U FORM PLANNING & DEVELOPMENT COMMENTS Reviewed On Signature_ CONSERVATION Reviewed on Siqnature Y COMMENTS J HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connectionlsignature &Date Driveway Permit DPW Town Engineer:. Signature: Locatea jo4 usgooa btreet FIRE DEPARTMENT Temp Dumpster on site yes no Located at 124. Main Street Fire Department signature/date COMMENTS `` -)imension 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 dropYrequires approval of Electrical Inspector Yes No . ®ANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$10041000 fine Doc.Building Permit Revised 2014 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. r 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.1. 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 Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan o 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 ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products 40TE: 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 v C � 0 o CD n Z N C o =r O cc O 0CD cD o ca)� _ CD CCD O _ CD Q O CD S, CO C � v 0 0 o o CD O CD n n h' z c .. 0 1 0 Z cn �m c Cl) 0z Z cn 0 /� cn V/ o = a O 2MU O =_<,� N CO CD N O CD 0 n�Q-C m o N r. a. 0 rn �, ID , � CO) W N O (D m 2 c CD -D-I C. Q O � rt(CD =r O - -wN� o o -� : • a h E C DCD Cn = O= CL o = ca sz N CD �( �C CL r� CD 0 0 o to'4j)rt O CD rt `.) � O -. - �= v CD '••� : 0 O O OCL O N 3 o � h Ln r o W C r�o m D -ztO T 3 °-' w O T N M T = °-' N < 0 A O 04 s m r -r n Z M m 0 T °-' ;O 03 opo s fl G7 Z H m 0 o, S j m O s T C z Q 0 3 \ W z n' M 0 a != n m T O o_ n m D O m m D 2 m v 0 n ,qm or, IA 56 Pleasant Street Methuen, MA 01844 Phone/Fax: 978-688-3944 Company Email: Dave@DavidReitanoRemodel.com Proposal Date: 10/26/2016 Submitted To: Mr. and Mrs. Souza 110 Waverly Road N. Andover Ma. Email — Sob Description: Roof We hereby submit specifications and estimates for: *Complete house and garage roofing shingles will be removed completely. All debris will be removed from jobsite. Dumpster will be supplied by contractor, location to be confirmed prior to delivery. *Complete roof will be inspected for any decay. Contractor allowed for 64 square feet of miscellaneous sheathing replacement. * Ice and water shield will be installed on lower 6 feet of roof edge. *synthetic building fabric will be installed on remaining areas of exposed sheathing. *Complete perimeter of roofs will have 8 inch aluminum drip edge installed. *All flashings will be inspected and replaced where necessary. *Complete roof will be re -shingled with a Architectural style CertainTeed Land Mark asphalt type shingle; properly fastened and secured. *Venting system will be a continuous vinyl ridge vent on both garage and main house. Above total price -$7900.00 *Contractor is responsible for allowances mentioned, anything that exceeds these allowances - Homeowner is responsible for. *Please review this proposal carefully for any items which may be missing. Contractor is not responsible for items not mentioned here. *Please do not hesitate to contact us if you Thank you for considering us for this project Workmanship Completely Guaranteed (Please sign and return one copy) Signature: Date: l deco Signature: Date: The Common wealth of Massachusetts Department of Industrial Accidents Office of Investi ations 1 Congress Street, suite 100 ► Boston, AM 02114-2017 q ' ►att}iv.tnaa:s.��ot�/riirr Workers' Compensation .lnsnraucc Affidavit l3ullticrs/C(nIt,-actors/Electricians/Plumbers nnlicant Information ('lease Print l.�e�=ibh Name (Business;01g:tnir,atio11'I11di+'i(i/ual):— _DA_V_C__.K_e Address: --- C Civ/State/Li �( Phone !` Are Vol, an employer•? Checic the appropriate box: 11 4. [] 1 atn a general contractor and 1 1vC1' \ '111 t,( 1'1111aC11111(, _ — cnlplovices (lull and'or part-time).': 2. ❑ 1 ani a sole proprictol- or partner- ship and have no elnploYces Work Ing for me in ally capacity. [No workers' comp. insurance required.1 3. C] 1 all, a homeowner doing all work myself. [No workers' comp. insurance redaired-] ha\°C hired the sub -contractors listed on the attached sheet. ' 'These sub -contractors have employees and have workers' COMP, insurance., 5. We are a corporation and its officers have exercised their rir„ht of exemption per MGL c 152• § 1(4), and we have no e111ployces. [No workers' comp. insurance required.] 'rVpe of project (required): 6, R New Coll structl(111 j_ IU Kcil1odelinu �. R Demolition 9, [] Budding addition 1 o.❑ Electrical repairs or additions I I .❑ Plumbing repairs or additions 12.❑ Roof repairs 13.0 Otllcr __-.- - "Aon apptitivu that checks hvx 1.1 must als+? till nut the section belo+'hm+"int; ticir+vorkcrs' compensation polio inlbmratu)n- + 1 lomcownecs mho submit this affidavit inclicalil), tile\, are doing all +work and then lure outside contractors nmsl submit a new affidavit indicating such Contrretors that check Iles boy must attached an addinunal sheet sho+vint; the name of the sub-cnntractnrs and sGnc ++'lelhcr or not (lose enuucs have employees. 11,111C suh-contractors have cmptoyre_s, tl)c% must provide their worker' comp- polic} nunlher. I am all enrplrn,-er that is prowling workers' compensvltirm insurance for my employees. Beloit, is the polish and job site information. Insurance Company Name: ��, t----�j._. ___QDCtiU► _ _ ��z/z�i �6_ — t Expiration late: _ _ � _ Policy ,� or Sell -los. [,1c. it: ___�- -- - - , t U_ _(-(9�-�--------- , City/State(Li 1: Joh Site Address �a Attach a copy of the workers' compenstill police declaration page (sho�4�ing the policy nunlbee and expirationmlli datea failure to secure ct�tvera��e as required tmdcr Seetion'5A of MGL. c. 152 can lead to the. imposition of criminal penahies of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a S�`01' WORK ORDER and a tine of up to $250.00 a day against the violator. Be advised that a cop; of this statement may be forwarded to the Office of lilvestioations of the DIA for insurance coverage verification. I du here/ r ce ifgjmtier ,f airs and penalties of perjurr that the information provided above is true and correct. C, 74- 7/n - �%0,2 nffrciul use aril. /)o not write in this area, to he completed br cit►' or town Official. Giv of - Town: lssning Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector a. I'lumhing Inspector 6. Other ——_-_—�—` �I Contact Person Phone fl:__ _ --__-- CERTIFICATE OF LIABILITY INSURANCE DATE OQVDDIYYYY) CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, F09/14/2016 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 ADDITONAL INSURED, the policy(les) must be endorsed. If SUBROMION 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 endomement(s). PRODUCER %Iwmf�l HAM: GABRIELLE BERTHOLDT ALDEN C GOODNOff JR INS AGCY INC -------- -- - - -- -� 978-774-2620 16 16 PARK ST '.)978-774-7560 — - --- - . . �DRESS' GMURRAY. GOODNOWMS@GZGLIL. COM P.O. BOR 297 INSURER(9) AFFORDING COVERAGE NAIL i DANVERS, MA 01923 INSUMA:ACE AMERICAN INSURANCE CO INSURED INSURERS DAVID REITANO D/B/A DAVE REITANO REMODELING AND BUILDING INSURER C; 56 PLEASANT ST MED EJP (Any one Person) S -- INSURER D: METSQEN, MA 01844 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. MR LTR TWE OF INSURANCE AVUL INSR ZVJM WIND POLICY NUMBER POLICY EFF (MMMONYYY) POLICY EXP (MWDDNYYYI UNITS GENERAL LIABILITY EACH OCCURRENCE $ PREMISES (Ea occ urtence) $ COMMERCIAL GENERAL LIABILITY MED EJP (Any one Person) S -- CLMMSAMADE ❑ OCCUR PERSONAL S ADV INJURY $ GENERAL AGGREGATE s GENL AGGREGATE LIMIT APPLIES PER: �' PRODUCTS - COMPIOP AGG S POLICY JJEEC LOC S AUTOMOBILE LIABILITY ! (Ea saident) S ANY AUTO ! BODILY INJURY (Per Person) S ALL OWNED SCHEDULED AUTOS AUTOS 'BODILY INJURY Pat acGQeM) S HIRED AUTOS AUTNOµ OS OWNED O (Per eCddM� S '— UMBRELLA LUIB OCCUR i EACH OCCURRENCE S EXCESS UAB CLAI S4AADE AGGREGATE S DED RETENTION S— A `NORKERSCOMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNERWXECUTiVE CfMCEPAWMBER EXCLUDED? a (Mandatory In NH) NIA 6S62UB9F93916816 9/2/2016 9/2/2017 == 1 Eli EL EACH ACCIDENT s 500,000 t—_.. E -L. DISEASE - EA EMPLOYEE S 500,000 U yes. describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LWT 3500,000 I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Allacb ACORD 101, Additional Remarks Schedulea, E More space is nqubed) CERTIFICATE HOLDER b w4 CP 1� Iq t, L i) C/ e - CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOtTCE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS: AUTHORIZED ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD AeO CERTIFICATE OF LIABILITY INSURANCE[7��J_- 13000 5' TYPE OF INSURANCE ADDL. 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 polity(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 endorsement(s). PRODUCER Paychex Insurance Agency, Inc. """mac FAX Sawgrass Drive eML (Air, N° (AC150 E-MAIL Rochester, NY 14620 ADDRESS` INS aFFORrnrIs�vERAGE Name 877-266-6850 ttiatriots ppZSoNAL&ADVINJURY 1 S INCLUDED WSURIEtA• NDRGUARDINSURANCE COMPANY INSURE DAVID REITANO INSURER 8; REMODELING AND BUILDING INSURER C. 56 PLEASANT ST 1NSURERD: METHUEN, MA 01644 INSURER E: INSURER F: ~ 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. TYPE OF INSURANCE ADDL. POLICY NUMBERPOIJCY EFF OA EXP ! UMRS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY I # EACH OCCURRENCE S 11000,000 DAMAGE TO RENTED i PRBdISES (Ee ooeumance) S 50,0w MEDEXP(Anyoneperson- !)m ------ CLAIMS -MADE Lx] OCCUR DAB%13505 12rot/2Dt5 ttiatriots ppZSoNAL&ADVINJURY 1 S INCLUDED GENERAL AGGREGATE S 2,000,000 ---j __ i GEN'L AGGREGATE LIMTr APPLIES PER: i PRODUCTS -COMPIOP AGG S 2.000.000 X `•. POLICY i ;PRO- (- LOC lj AUTOMOBILE LIABILITYi }J M ED SrdGLE LIMIT DILY INJURY (Perpera°n) S TWODILY ANY AUTO INJURY (FWaaddwm s A OAUTIDS ED j AS SLED �— AWNED i� HIRED AUTOS i AUTOS i I PRS FJ2TY DAMAGE S S UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE S --- EXCESS LIARyIgADE --+ — f DED I RETENTIONS S WORKERS COMPENSATION ( AND ENPL.OYERS' LIABILITY YIN ANY PROPRIETORIPAR TNERIMCUTIVE i OFFICEWMEMBEREXCLUDEW I (Mandatory in NHj NIA i 1 STA[1L 1OTH- 1 E.L. EACH ACCIDENT S E.L. DISEASE- EA EMPLOYEES E.L. DISEASE - POLICY LIMIT S Ityes, desafbeunder 1 DESCRIPTIOtd OF OPERATIONS beft - ......... ........ . ;.. . - . - .. I ( 1 ncennm nnu nr MCOA-00 ) t fl - Q f UMAM4 FO teM—h AttMn Sal Addii—I Ra ,ba 5ehadWA. H f affl IMCe In raanlredi - 10(A) 0 U ACORD 26 120141051 :AN(.-1_LLA i IUN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WTrH THE POLICY PROVISIONS, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR UABIUTY OF ANY KIND UPON THE COMPANY, ITS AGENTS, OR REPRESENTATIVES. O ACORD The ACORD name and.logo are regtstered-xnar" of AGQRD rights reserved. �ie �Gaj�ra�ra��rtlea�(fa C` latioo er Affairs & Business Rego k. TOR Office of Consumer MENT CON CRp .. . IMpRO Type- t HOME '-j08782 0 oration Registration Private C 8►2512018 t DAVID REITANO REMADE BtlILD r David FwitanO 56 Pleasant St : '" underseeretarY Methuen, NIA 01844 Massachusetts Department of Public Safety Regulations and Standards Board of Building `-023365 License: Construction Supe rvisor. n DAVID REITANO 66 PLEASANT STREET METHUEN MA 01844 Expiration: 121fl412017 Commissioner