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HomeMy WebLinkAboutMiscellaneous - 122 CHADWICK STREET 4/30/2018 (3) JA4 BUILDING PERMIT o` tLEo ,6 �+ TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION yH Permit No#: Date ReceivedA� F 7 �RATEo gSSgC US 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 ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other D`Septic aWell A � ❑`Flgodpl�tn' �D1Wetlan s ? Wat shed ®is dict ` [ Wat_erlSe_w_-er - 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. FEE SCHEDULE:BULDING PERMIT:$92.00 PER$9000.00 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 Au�re�. �s Ly t3UILUINV F'tKMI l TOWN OF NORTH ANDOVER ° t APPLICATIONFOR PLAN EXAMINATION 1 d c Permit NO: � Date Received ,. �9SS Date Issued: -7ACFiUS��� ATAORTANT:Applicant must complete all items on this page LOCATION lC)a C A401 w IC �C.Print PROPERTY OWNER `0, . 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 ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑ Well ❑ Flobdplain ❑Wetlands ❑ Watershed District 0 Water/Sewer cg —A-L Identificcation Please Type or Print Clearly) OWNER: Name: .^r"APhone: `q "efoC 5_eS Q- Address: CONTRACTOR Name: Phone: / Address: �G / � 0�Wit: U ,y Supervisor's Construction License: Exp. Date: to Home Improvement License'. -3 -5�/ Exp. Date: a A �> ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ -# -7 EV " FEE: $ 7 OSy&v Check No. _Receipt No.: NOTE: Persons contracting with unrgistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contracto 4___, 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 m 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 . rte Conservation Decision: Comments Water& Sewer Connection/Signature& Date Driveway Permit ]DPW Town Engineer: Signature: Located 384 Osgood Street FIREDEPARTMEN;T�'TenipDumpster ..�t7�,3�.,�(•'� Ei R 4M ,�T it � �u3.'Rl a4+Z..M _ j .. f G�,� ", ;'';�7 r, x..ti 4 �' ���i"� k�y`'� -}a -`.} �as i 3'.Fa. •1 l`t'Y �M.::�'4jx ���''.t?� tt�r ��,<'��ky �'��'y�+•`�,i�'!t� ..ti{�. C.®MMENTS.'`' `` .��:�� t=x�``F�'�: � .i �:e� � ._�;; . ; �n�, � .r�� ,�<,��►�+��,T.`.'._ +-{���r k +ri.�,�„• •j-. .:J. +.-...,.a:.....� - .L.. .� .�.. .f-S?1.�16Y.�,.R.IIL�.�3Y..i'�C:�Ar?,F•,�..3' 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.$10o-$100o fine NOTES and DATA-- For department use) ❑ Notified for pickup Call Email Date Time Contact Name t 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. Roofing, Siding, Interior Rehabilitation Permits 4� Building Permit Application 4. Workers Comp Affidavit 4. Photo Copy Of H.I.C. And/Or C.S.L. Licenses Copy of Contract 4. Floor Plan Or Proposed Interior Work �: Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks 4, Building Permit Application � Certified Surveyed Plot Plan Workers Comp Affidavit � Photo Copy of H.I.C. And C.S.L. Licenses � Copy Of Contract 4. 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 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 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 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. TOWN OF NORTH ANDOVER • .� ,,�.- Certificate of Occupancy $ �` - Building/Frame Permit Fee $ $ .a � _a ,n Foundation Permit Fee $ ��Q <,��A a,� �� Other Permit Fee �� ATETiQ $_ TOTAL Check# • Building Inspector • Page No. of Pages xX Builders License # 58443 Home Construction Reg. # 167338 DuvaIAL .Roof®nLLL° (781)944-1994 (978)664-2557 READING NORTH READING P.O. Box 637, North Reading, MA 01864 Please visit us at www.duvalroofing.com PROPOSAL SUBMITTED TO ( ONE ! DATE f y „� f' . f'7 f \/ Q? J if J o�.. d! /1S STREET jj CITY,STATE AND ZIP CODE / We hereby submit specifications and estimates for: f Ll LI Rip& Remove all existing roof related debris from roof as well as job site with our own disposal truck. NO DRIVEWAY DUMPSTERS ❑ 1 layer of existing roof shingles 0 2 layers of existing roof shingles ❑3 layers or more of existing roof shingles eplace any damaged roof decking; not to exceed 32sq.ft (additional at$1.70 per sq.ft.) 0 Install 8'Aluminum Drip-edge/Rake-edge along entire perimeter(Choice of,� rown or Mill) dInstall ICE&WATER UNDERLAYMENT on all horizontal eaves, sidewalls,skylights, chimney flashing and valley areas Install a premium base sheet underlayment(felt)that is in compliance with the asphalt shingle manufacturer chosen by the homeowner (Id'Install The Homeowner's Choice of the selected Tamko/IKO or GAF Limited Lifetime Architectural Roof Shingles See individual manufacturer's warranty for specific details or please call us with any questions © Replace all existing bathroom louver and/or exhaust pipe(s)with new aluminum flanges O'Chimney(s) -counter-flash and re-step existing flashing ❑Cut& Install new lead flashing Install a continuous low profile Ridge-Vent on all ridge lines ❑Soffit-Vents ❑Roof Louver-Vents / ❑Seamless Aluminum Gutters-Custom fabricated on site with our own gutter machine' � ) — ❑Downspouts at additional ❑Leaf Guards ' J Other � r ❑ Roof Insulation- Increase existing R.value to R.value Pr Propose hereby to furnish material nd I bor-complete in accordance with above specifications,for the sum of: Total price not including options. dollars($ Payment to be made as follows: 30%deposit required before ordering materials. Balance due in full upon day of completion. Please make all payments out to Kenneth Duval, mailed to: P.O. Box 637, No. Reading, MA 01864 Final Payment is due upon day of completion and is subject to the Authorized / supplemented Terms&Condition sheet when scheduling. Signature / ✓ THIS PROPOSAL IS VALID FOR DAYS DUE TO FLUCTUATIONS IN MATERIAL&DISPOSAL PRICES. • � NORTy own of EAndover mOA'"" 'k No. b2,6— Zol T Z h o A , ver, Mass, � /� A- COCHIC Nl WICK y1 7�A01RATIE '`P�,`,�5 S V BOARD OF HEALTH Food/Kitchen PERMIT T LD�j Septic System � BUILDING INSPECTOR THIS CERTIFIES THAT ...... ..................................... ............... .................................................... has permission to erect .......................... buildings on ..� .r�..... Gc GcJl ,,;,5 .................. Foundation ��A t Rough tobe occupied as ..........................S 1. ..a�..�..�F:.�,,,z.........:............................................ Chimney provided that the person accepting this permitltall 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 CONSTRUCTION STARTS Rough Service ................. . ............................................ Final BUILDING INSPECTOR 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. The Commonwealth of Massachusetts W Department of Industrial Accidents I Congress Street, Suite 100 Boston,MA 02114-2017 5ye�, www mass gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Hanle (Business/Organization/Individual): Duval Roofing LLC Address: P.O. Box 637 City/State/Zip: North Reading, MA 01864 Phone#: 978-664-2557 Are you an employer?Check the appropriate box: Type of project(required): 1.Pel I am a employer with 8 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. ❑Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10❑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 11.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.M I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑ p Roof repairs These sub-contractors have employees and have workers'comp.insurance? 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box 41 must also till 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. #Contractors 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 providing workers'compensation insurance for my employees. Below is the policy and job site information. Travelers Insurance Company Name: Policy#or Self-ins.Lic. #:7PJUB-023ON91-9-15 Expiration Date:3/9/16 Job Site Address: 122 Chadwick Street City/State/Zip:North Andvoer 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby ceM?W the pains and penalties of perjury that the information provided above is true and correct 1 -15 Signature: (LL Date:�� el Phone#:9A-664-2557 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#: Ace CERTIFICATE OF LIABILITY INSURANCE D1/6/IODtY 1 /6/2nl4 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 CONTAcr 13arbaza MDh NAME g Gilbert Insurance Agency, Inc. PHONE , (781)942-2225 Fax (7811942-2226 137 Main Street E-MAIL .bmcdonough@gilbertinsurance.com INSURERS AFFORDING COVERAGE NAIC# Reading MA 01867-3922 INSURER A:Harlesvi.11e Nationwide 26182 INSURED INSURER B:Pl ouch Rock Assurance CoM. 004154 Duval Roofing, LLC. INSURER C:Travelers Ins. Co. 0031 P.O. Box 637 INSURER D: INSURER E: North ReadingMA 01864 INSURER F: COVERAGES CERTIFICATE NUMBER:CL1411601329 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 ADDLSUBR POUCY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER Y MMIDD GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 AGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES WeoccurreQc49A_ S 100,000 A CLAIMS-MADE F0OCCUR GL0000006415BG 10/23/201410/23/2015-MED EXP(Any oneperson) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 rGEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY JECT F1 PRO LOC $ AUTOMOBILE LIABILITY COMBINED deSINGLE LIMIT 500�000 •r ANY AUTO BODILY INJURY(Per person) S B ALL OWNEDX SCHEDULED PRC00001003709 0/23/2014 0/23/2015 AUTOS AUTOS BODILY INJURY(Per accident) 5 X NON-OWNED PROPERTY DAMAGE $ X HIRED AUTOS AUTOS (Poromwentl Uninsured motorist BI split limit $ 100,000 UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED I I RETENTION S $ C WORKERS COMPENSATION WC STATU- OTHFR - AND EMPLOYERS'LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTIVE❑ NIA PJUB-0230N91-9-15 E..L EACH ACCIDENT $ 100,000 OFFICERIMEMBER EXCLUDED? /11/2015 /11/2016 (Mandatory In NH) E.L DISEASE-EA EMPLOYE $ 100,000 It yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Evidence of Coverage 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. Town of North Andover 1600 Osgood Street AUTHORIZED REPRESENTATIVE North Andover, MA 01845 M Gilbert, CIG/BARBAR ACORD 25(2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025(201005)-01 The ACORD name and logo are registered marks of ACORD �yOb�d � o N n � r"�'i � T '" s N I\5 \ y/ m . (2.' (OD y .« 3 - o M I\ i10, c U) Cr � x 0 N � ;�, r• A M O O - Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 167338 Type: LLC Tri 256221 Expiration: 9/10/2016 DUVAL ROOFING LLC. KENNETH DUVAL P.O. BOX 637 NO. READING, MA 01864 7. Update Address and return card.Mark reason for change. i 7 Lost Card Address E] Renewal C Employment u SCA 1 0 20M-05/11 THENIIRFOLK EDHA1116ROUP@ February 19, 2015 FORM OF NOTICE OF CASUALTY LOSS TO BUILDING UNDER MASS. GEN. LAWS, CH. 139, SEC. 3B Building Commissioner, or Inspector of Buildings c/o City or Town Hall 1600 Osgood Street North Andover, MA 01845 Board of Health or Board of Selectmen c/o City or Town Hall 1600 Osgood Street North Andover, MA 01845 Fire Department or Arson Squad c/o City or Town Hall 1600 Osgood Street North Andover, MA 01845 RE: Our File No.: P1587207 Insured: CHADWICK ESTATES CONDO TRUST C/O KARA CAFFREY Address: 122-124 CHADWICK STREET, NORTH ANDOVER, MA Policy No.: R1477464A Loss Date: 01/10/2015 Loss Type: Building or Other Structure Damage A claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or cause Mass. Gen. Laws, Ch. 143, Sec. 6 to be applicable. If any notice under Mass. Gen. Laws, Ch. 139, Sec. 3B is appropriate, please direct it to my attention and include a reference to the captioned insured, location, policy number, loss date and claim or file number. If no reply is received from your office within ten days, we will assume you have no liens of any type against this property, and the claim will be paid in our customary manner. Sincerely, Ima'aa 7?ev�� Michelle M. Roust Senior Property Claims Examiner 1-800-688-1825 x1171 NORFOLK&DEDHAM MUTUAL FIRE INSURANCE CO. 222 Ames Street,P.O.Box 9109,Dedham,MA 02027-9109 DORCHESTER MUTUAL INSURANCE CO. Telephone:(800)688-1825 FITCHBURG MUTUAL INSURANCE CO. Fax:(781)329-1818