Loading...
HomeMy WebLinkAboutMiscellaneous - 114 MIFFLIN DRIVE 4/30/2018 (2) 114 MIFFLIN DRIVE 2101032.040003-0000.0 NORTH BUILDING PERMIT TOWN OF NORTH ANDOVER �- ~'• . �, APPLICATION FOR PLAN EXAMINATION * ,� Permit NO•') 3G Date Received �qs RATSC SACHus Date Issued: `� �Y IMPORTANT Applicant must complete all items on this page +.. 3 2R t d D r . ' . x 4 r_ k r KfIT1tS 7. t,. '�'� `F JJ .��'. .. •TY�aI� 1 k � -+S f. 1- 3 � r L � t 9.' YPROPER3� j'011t�ER - w ti y Pt , N1APrj m PARCEL�, �®NiI�GISTRIfi Hisoislc D�str�ctr yes r o� h AVlach�'re Shop�fillge' �res,x o TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑ Two or more family . ❑ Industrial ❑Alteration No. of units: Q Commercial PrRepair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other xFloodlilain '�Vl/e'tlaridsr� Watesheds® e resti ict7 5ept►c> fl tll" i f r DESCRIPTION OF WORK TO BE PREFORMED: Identifica on Please Type or Print Clearly) OWNER: Name: I?A 6/1 0 Ifle hone: E7 Address r i `0'UNil iACT0R* i)7arne Phone. �. dd...... ` �Supervisor s Cansfriicti6n M ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING_jX33''R*MIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED --COST ,,BASED ON$125.00 PER S.F. Total Project Cost: $ 6! J Crt,> _FEE: $ /o Check No.: Receipt No.:__a NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund :Signature of contractor ' r signature of AgentfQwner, _._- r 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 o Copy of Contract ❑ 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 ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/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) o Building Permit Application ❑ 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 ❑ 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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 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 DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED 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 �F:IRES DEPAfiTMENT l"em` " umps�ter � x y P { �'� t ,d r,', `✓ .y.. 't sk t` n - s ..,� ? h iG �...�# S ' � +"Sy.t, COMMEVTS77 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 - Date Doc.Building Permit Revised 2007 Location m 'O/l « a - No. Date r • • TOWN OF NORTH ANDOVER e Certificate of Occupancy $_ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee ���� $ TOTAL Check# 25188 Building Inspector F DATE(MMIDDIYYYY) ACCORD CERTIFICATE OF LIABILITY INSURANCE 03/13/2012 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 CONTACT 14AME: _ Eastern Insurance Group L L C AIONN Ext); FAX No): ^.33 West Central Street ADDRESS: a MA 01760 INSURERS AFFORDING COVERAGE MAIC 0 INSURER A: Savers Property&Casualty Insurance Company _ `1771 INSU:._ INSURER B: Gera... .:Utz d/b/a Weitz Construction INSURER C: '1605 Andover Street INSURER D: Tewksbury, MA 01876 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 VU-IICH THIS CERTIFICATE MAY RE 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 POLICY EFF POLICY EXP LIMITS LTR N WV POLICY NUMBER MMlDDlYYYY MMlDDlYYYY GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTE-17- COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ CLAIMS-MADE 1-1 OCCUR MED EXP(Arty one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: -PRODUCTS-COMPIOP AGG $ POLICY PROT- LOC $ AUTOMOBILE LIABILITY M NE N E LIMIT Ea accident $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNEDA AG $ HIRED AUTOS AUTOS Per accident UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION I ICSTATU- OTH AND EMPLOYERS'LIABILITY YIN RY IMI R ANY OFFICERIMEMBEEREXCLUDED?ECUTIVE❑ NIA AR0426622 09/21/2011 09/21/2012 E.L.EACH ACCIDENT $ 100,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required) CERTIFICATE HOLDER CANCELLATION 1 Wells Fargo Bank NA#936 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXPI ,I It's Successors&/or Assigns ACCORDANCEIW WITH HE POLDATE ICY PROVISIONISE WILL BE DELIVERED IN P. O. Box 100515 Florence, SC 09502-0515 AUTHORMED REPRESENTATIVE ©1988-2010 A its reserved. ACORD 25(2010/05) The ACORD nP me and logo are registered marks of ACORD The Commonwealth of Massachusetts Department of Industrigl Accidents Office of Investigations 9 600 Washington Street Boston,MA.02111 www.massgov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Address: City/State/Zip C Phone tl Are you n employer?Check the appropriate box: Type of project(required): 1.&Ifam a employer with 4. ❑ I am a general contractor and I ' 6. Now construction employees(fall and/orpart-time).* have Hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet.x 7• ❑Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp,insurance. g, ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.E1 Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself.[No workers'comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]r employees.[No workers' comp.insurance required.] 13.�Other 'Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. T Homeowners who submit this affidavit indicating they 8ie 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 their workers'comp.policy information. lam an employer that is providing workers'compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name:. t Policy#or Self-ins.Lic.#:_ 6 C n!2 50 2 Expiration Date: 3k'-213 Job Site Address: zz City/State/Zip: Attach a copy of the workers'compensation policy decla ation page(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL o.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 DTA for insurance coverage verification. X do hereby cerfifv under the pains and penalties ofperjury that the information provided above is true and correct. - Si ature: 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.Plumbing Inspector 6.Other - - - Contact Person: 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 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 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 number(s)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 cavy 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 confirmation of insurance coverage. AIso 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: Tho ComTgonwoalth of Massachvsotts Department of Industdal.Accidents Office of111vestigations 600 WashiVoa Street Boston,MA,0211 I TTL#617-727-4900 ext 406 or I-877MA.SSAFB Revised 5-26-05 Fax#617-727-7749 www.mass,pv/dia x.10 R Tly T0 0Andover dover, Mass., Low LAKE CO C HICMEWICK AD RA TED P`v C-1 S U BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT............. !!...���........... ..hr..&-r-W.. �r... . .. .......................................... ; Foundation g has permission to erect........................................ buildings on ....... 114.............. . .. . 440%......... ...R... Rough to be occupied as . Chimney provided that the person acce t :thi Pmit shall in everY res ect conformttherms of the application on file i n Final 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 CONSTMJ S TS 7� Rough g ......................... ......... ................................................................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR 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. SEE REVERSE SIDE j Smoke Det. uote Submitted date: 3/26/2012 S.Whitey's Roofing Services, LLC 156 Westwood Drive Nashua, N.H.03062 (603)566—7937 Quote Submitted to: Frank Incropeka 114 Mifflin Drive North Andover, Mass. (978)686—4888 We hereby submit this quote based on the following desired materials and labor: A complete Re-Roof, stripping off all shingles down to plywood, and removing all gutters and downspouts. On first six feet of roof instillation we will use ice/water shield, while the remaining would be covered in type fifteen original shingle underlay. New six inch T-Drip will be installed as well. Covering all of the previously mentioned will be Land Mark Charcoal Black Architectural shingles and topped off with an all new ridge vent.A complete 100%clean-up of all old and unused materials using a dumpster provided by our company. All of the above materials, dumpster, and labor come to: $6,900 Take$400 off for home show discount- 6 500 For a new seamless gutt system by Gutter Shell along with new helmet, downspouts, and elbows comes to: $2,492 A) I C, u For a new seamless gutter system with a wire mesh top, like you have now, along with new downspouts and elbows comes to: $1.050 Total price of services and material using Gutter Shell is: $8,992 Total price of services and material using seamless gutter with wire mesh is: $7,550 Acceptance of Quote Company signature: Customer's Signiture: If awarded contract half the money is due up front. Remainder due upon completion. 50632 _-- INVOICE ! ✓' ORDER NO. INVOICE DATE " -/j DATE SHIPPED SHIPPED VIA NO. PCS. I WE FOB TERMS SOLD TO V n SHIPPED TO QUANTITY UNIT DESCRIPTION UNIT PRICE TOTAL PRICE At -4 ti 60tVUB40 - 13381S t13A04NV H3J 1 Oltl S,,,dSSdWl Z113 '� fG« 8 C i, so= • .;1(33. 19H 133tl - � fk 9£61-'80-60 ELOZ-80'60 i 61 �0�1��• ': goo • L068t L9 pS ,� '�SN3�1�$#►3I11Haf 11asnHUV$� ,=7 NL«sachusctts- Dcpaof Pun rtm,ent lic Safct� Rc��ulations grid StandAr"• i Board of Building, ervisor License Construction Sup License: CS 12649 r: GERALD L WEITZ _'i605 ANDOVER S 01876 TEW KSBURY,-MA Expiration: 91812013 Tr#: 1332 ('mm�Tisiunnerr p 01- r�bmir�z4, fairs& office of Consumer Affarrs&Bdsine�ss Reg�u ' _- HOME IMPROVEMENT CONTRACTOR TYF Registration: ,113513 Private Cor Expiration: 624/2013 r W Z CONSTRUCTION INC. �r'iJm GERALD WEITZ �J 1605 ANDOVER STS SKI _ NTEWKSBURY,'MA'01r876Undersecreta