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HomeMy WebLinkAboutMiscellaneous - 24 WAVERLY ROAD 4/30/2018d �a. Plans Submitffid Plans Waived ❑ Certified Plot Plani❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanuing/Massage/Body Art ❑ Swbm ing pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc. ❑ Pennanent Dempster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT COMMENTS Reviewed On Signature_ CONSERVATION Reviewed on Signature COMMENTS HEALTH COMMENTS Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes rfPlanning Board Decision: Comments `Conservation Decision: Comments Water & Sewer Connection/signature Date Driveway Permit ]DPW Town Engineer: Signature: Located 384 Osgood Street atC9s2 "" 1`;f,f 3 11 #,FIRED P R ENT Tem®ufn stero es tLo at 124 Main Street �` ,,,£�f *►, 'y, 7. �'' Fire Department Signature/date �' ° �` •}�,;. _ ' y y.a{ ; 1s fi -,e r2 '4 t r7— .. w '`" ;�+�' .` f✓"�+.�<,�{a + t� ;,, 4 A.!� 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 NU I t5 ana UA 1 A — (1 -or aepartment 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 4. Building Permit Application 4, Workers Comp Affidavit ,,. Photo Copy Of H.I.C. And/Or C.S.L. Licenses 4; Copy of Contract 4 Floor Plan Or Proposed Interior Work �& Engineering Affidavits for Engineered products 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 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 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 E: 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 104 J cX kll e l? t P—"" No. "' 2.o i� Date 2 `Z Check # 3-101 29;-8 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $" Foundation Permit Fee $ `. Other Permit Fee $__w TOTAL $ ,r /J r Building Inspector v C � U) n m O CD .�. CD Q �' N O < vCD oCDQ C 0 CD CCD O CDW -' o U) CL CD C � v O a ' 0r-4p,r-r O CD 3 CD Z m cn v O z h 5 CD N O W co CD O O O Q N N OO O m O . CD 0 0 0 :3 CLc)am o � 3� U in a; CD m O O .+ CL m - h =t �.,, y W C-- O N O _ CD 0 O 2 'D t O n to O. O `� N -10L O O rt n •'*CD CD . CD .0 � O O O < c0 013 z CD O O a :-r D CCD Q_. 0cc y c� p. O O O. — < CD N O O �� CD CL CD O rU) � CD cn rOr 0 O C QRh O CD C N CD .••t U) CD S CD D� CD :. 0 n � rt 0) o CL L O ry N (D — O W C 3 ((D T O' ;o O OCG , S T N V1 rD N ;u O OCG S T j ;aT O OCG 3 n S 7 rD x O OG 3 T O M Q p N (D n Ln < T O O- \ n rt m v "° D m y > 2M O m m 70 A m m 0 M e 9 p0 � 0 3 c �_ Z n O z 3 s W D z O D 2 OCA NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit at: 11.41 1AAC'LXJ1-f-1, is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11,S150A. Also, note Permits are required under Fire Prevention laws Chapter 148 Section 1 OA. The debris will be disposed of in: G� (Location of Facility) ignature of Permit Applicant -a/-a //,/- D to J �Ia�S Iv t5Sde.eoD p V —M& 0442 4 ree- Betterbuilt Construction �3 RUXT 100 Cummings Center Suite 226 G Beverly, MA 01915 Phone # (978) 998-4751 info@betterbuiltcorp.com Fax # (978) 998 - 4861 www.Betterbui[tcorp.com J & M Reatly Trust Matthew Xenakis 701 Salem St North Andover, Ma 01845 Estimate Date Estimate # 1/6/2016 EL 821 Page 1 As agreed Roof Strip Vork 0 0.00 0.00 Asphalts Shingl.:. Strip existing Asphalt Shingles on the entire house and install a new roofing system according to the procedure below. 802 - Inspect D... Inspect roof decking for any rotten or damaged areas. 0.00 0.00 803 - Replace/... Replace any rotted or broken roofing boards at a cost of $4.00 per linear foot for ledger board 0.00 0.00 and $70.00 per sheet for 1/2" plywood 804 - Ice ft Water Install 6 feet of ice Et water on all leading edges, valleys It transitions 0.00 0.00 806 - 15 pound... Install 15 pound felt paper to cover the rest of the roof 0.00 0.00 808 - Drip Edge Install an 8 -inch drip edge on all eave and rake edges. Color: White 0.00 0.00 809 - Vent Pip... Install new vent pipe flanges 0.00 0.00 810 - Chimney ... Install new lead flashing around chimney 0.00 0.00 813 - HD Timb... Install new GAF HD Timberline Architectural shingles, fastened by nails (six nails per shingle - 0.00 0.00 hurricane nailing) 814 - Shingle C... Home owner to choose color of shingles. Color: 0.00 0.00 820 - Ridge Ve... Install a ridge vent system on the main peak of the house 0.00 0.00 815 - Roof Stri... Strip existing rubber roof over the front porch and install a new roofing system according to 0.00 0.00 the procedure below. 816 - Poly -Iso ... Install 1/2" Fiberboard over entire roof surface, fastened by screws and aluminum plates 0.00 0.00 817 - .060 roof... Install .060 fully adhered EPDM rubber roofing 0.00 0.00 808 - Drip Edge Install an 3" drip edge around the perimeter of the flat roof. Color: White 0.00 0.00 819 - 6 Cover ... Install 6' Cover tape on all aluminum L -Stock to rubber sears 0.00 0.00 951 - Cover Be... Homeowner will cover all belongings in attic to protect from debris, BetterBuilt is not 0.00 0.00 responsible for any damage 952- Cracks We are not responsible for any of the cracks that may arise in any walls or ceilings 0.00 0.00 953 - Dumpster Dumpster will be placed next to house in the driveway 0.00 0.00 955 - No Interr... Job will be started and completed without any interruptions 0.00 0.00 954 - Timely M... All work will be done in a professional and timely manner 0.00 0.00 956 - Clean BetterBuilt will clean jobsite at the end of each day and dispose of all job related debris 0.00 0.00 958 - Permit Cour price includes the cost of the building permit obtained at the Andover Building 0.00 0.00 Department 959 - Payment ... Payment terms: 30% deposit, 30% work in progress and 40% due upon completion 0.00 0.00 Total Thank you for the opportunity and please call us with any questions. Acceptance Signature Page 1 Betterbuilt Construction Es E MI 100 Cummings Center Suite 226 G Beverly, MA 01915 Phone # (978) 998-4751 info@betterbuiltcorp.com Fax # (978) 998 - 4861 www.Betterbui[tcorp.com J li M Reatly Trust Matthew Xenakis 701 Salem St North Andover, Ma 01845 24 Waverly Road North Andover, MA 01845 Estimate Date Estimate # 1/6/2016 EL 821 As agreed Roof Strip It - •.- • . • . 960 - Warranty Warranty: BetterBuilt Enterprises LLC Guarantees all work performed for a period of two years. 0.00 0.00 If any problems with workmanship occur we will cover the cost of all labor and materials to correct the problem and meet the customers satisfaction. MA License #160616 961 - Addition... Unseen and additional carpentry may be necessary to complete roof. Siding may need to be 0.00 0.00 removed to ensure proper flashing at dormers. Additional labor will be billed at an hourly rate of $65/hr plus any necessary material 50 - Roofing Total Cost for all labor, Material, Permit Fees and Trash removal fees to replace roof. 1 8,200.00 8,200.00 962 - Right to ... You may cancel this agreement provided you notify BetterBuilt in writing at our main office by 0.00 0.00 ordinary mail posted, by telegram sent or delivered, by e-mail, not later than midnight of the third business day following the signing of this agreement. Total $8,200.00 Thank you for the opportunity and please call us with any questions. Acceptance Signature Page 2 Name MITI Workers, Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE PILED WITH THE (PERMITTING AUTHORITY . __ _ _ . . City/State/Zip: #A 0 /5 Phone #: Are you an employer? Check t .e appropriate box: LW I am.a employer withemployees (full and/or pari time).' 2. I am a sole proprietor or partnership and have no employees working for me m any capacity. [No workers' comp. insurance required.] 3.Q I am a homeowner doing all work myself [No workers' comp. insurance required.] t 4.[] lam 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 5.F] I am a general contractor and I have hired the sub-coiztractors listed on the attached sheet. These sub -contractors have employees and have workers' comp. insurance.1 6. Q We are a corporation and ifs offigers have exercised their right of exemption per MGL c. 152, § 1(4), and we have nq employees. [No workers' comp. insurance required.] Type of project (required): 7. [] New construction 8. [] Remodeling 9. ❑ Demolition 10 [] Building addition 11.[] Electrical repairs or additions 13.r] Roof iepairs 14. ❑ Other Mny applicant that checks l.. I must also fill out the section below showing their workers' compensationpolicy information. Hoowners who submit this affidavit indicating they are doing all work and hire outside contractors must submit a new affidavit indicating such. ?Co meotors that check this box musk -attached an additional sheet showing thg name of the sub -contractors and state whether or not those entities have me . oyees, they must provide their workers' comp. policy number. employees. If the sub conlraclors have empl I am an employer that is providing workers' compensation insurance for my employees.' Below is the policy and job site information. Insurance Company P Ji c # or Self -ins Lic. #: 000 (; M Date: fob Site Address: "M � �� City/State/Zip: �/yC,r�� �n Q(''�r'r 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 e. 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 he. eby certify under t se that the information provided above is true and correct. 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): i 1. Board of Ifealth 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person ]Phone #: Ell The Commonwealth of Massachasefts : Department of IndustrialAceldents N I Congress Street, Shite 100 - << Boston, MA 02114-2017 www.massxov/dza Name MITI Workers, Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE PILED WITH THE (PERMITTING AUTHORITY . __ _ _ . . City/State/Zip: #A 0 /5 Phone #: Are you an employer? Check t .e appropriate box: LW I am.a employer withemployees (full and/or pari time).' 2. I am a sole proprietor or partnership and have no employees working for me m any capacity. [No workers' comp. insurance required.] 3.Q I am a homeowner doing all work myself [No workers' comp. insurance required.] t 4.[] lam 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 5.F] I am a general contractor and I have hired the sub-coiztractors listed on the attached sheet. These sub -contractors have employees and have workers' comp. insurance.1 6. Q We are a corporation and ifs offigers have exercised their right of exemption per MGL c. 152, § 1(4), and we have nq employees. [No workers' comp. insurance required.] Type of project (required): 7. [] New construction 8. [] Remodeling 9. ❑ Demolition 10 [] Building addition 11.[] Electrical repairs or additions 13.r] Roof iepairs 14. ❑ Other Mny applicant that checks l.. I must also fill out the section below showing their workers' compensationpolicy information. Hoowners who submit this affidavit indicating they are doing all work and hire outside contractors must submit a new affidavit indicating such. ?Co meotors that check this box musk -attached an additional sheet showing thg name of the sub -contractors and state whether or not those entities have me . oyees, they must provide their workers' comp. policy number. employees. If the sub conlraclors have empl I am an employer that is providing workers' compensation insurance for my employees.' Below is the policy and job site information. Insurance Company P Ji c # or Self -ins Lic. #: 000 (; M Date: fob Site Address: "M � �� City/State/Zip: �/yC,r�� �n Q(''�r'r 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 e. 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 he. eby certify under t se that the information provided above is true and correct. 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): i 1. Board of Ifealth 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person ]Phone #: Ell 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 6i tke, express or implied, oral or written." Aja employer is defined as "an individual, psrtnersWp, 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 ofthe dwelling house of anotherwho 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 x equired." 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 f".ill• out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub=contractox(s) name(s), address(es) and -phone, number(s) along with their certificates) of - - - insurance_ Dimited—Uabifiiy-Companies-(L-LC)-or Limited -Liability Partnurs i s (LL-Prith no employes other than ED members or partners, are not required to cant' workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation ofinsurance coverage. also be sure to sign and date the affidavit. The affiidavit'should be retuned to the city or town that the application for the permit or license is being requested, not the Del artment of Industrial Accidents. Should you have any questions regarding the law oz 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 Gffeials 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 ffffl 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 "rob 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. Anew 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 (La. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of bdustrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax ## 617-727-7749 Revised 02-23-15 www.mass.gov/dia YYYY A� a CERTIFICATE OF LIABILITY INSURANCE DATE(MMl/13//116 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 endorsemen s . PRODUCER Cocca Insurance Associates Inc dba Water Street Insurance Age 27 Water Street CONTACT NAME: Carmen Cocca PHONE FAX 781 245-0888 A/ No: (781) 246-3926 E-MAIN.L ADDRESS: carmen@getinsurancehere.com Wakefield, MA 01880 INSURERS) AFFORDING COVERAGE NAIC# INSURERA:Arch Specialty INSURED INSURER B: Travelers Indemnit Betterbuilt Enterprises LLC I NSURER C: Evans ton 100 Cummings Ctr Ste 226-G INSURER D: Beverly, MA 01915 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 WrrH 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 OFSUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPEOFINSURANCE ADDLSUBR INSR WVD POLICY NUMBER POLICY EFF MIDDN POUCY EXP MM/DD/YYYY LINTS A GENERAL LIABILITY X COMMERCIAL GE NE RAL LIABILITY CLAIMS -MADE OCCUR y AGL00293300 9/2/15 9/2/16 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMIE Ea occurrence) $ 50,000 MED EXP (Anyone person) $ 5,000 PERSONAL&ADV INJURY $ 11000,000 GENERAL AGGREGATE $ 2,000,000 GENTAGGREGATE LIMITAPPLIES PER X 1 POLICY PRO - CT LOC PRODUCTS - COMP/OPAGG $ 2,000,000 $ AUTOMOBILE LIABILITY ANYAUTO ALLOWNED SCHEDULED AUTOS AUTOS NON -OWNED HIREDAUTOS _ AUTOS COMBINED SINGLE LIMIT a accident $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY YDAMAGE OPERTt$ e C g UMBRELLA LIAB EXCESS LIAR X OCCUR CLAIMS -MADE TBDF 1/11/16 1/11/17 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 DED RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITYLlh ANY PROPRIETOR/PARTNER/EXECUTIVE Y /N OFFICER/MEMBER EXCLUDED?N (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below / A 000768353 4/28/15 4/28/16 WCSTATU71 I IM - OTH- E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE -EA EMPLOYEE $ 1,000,000 E.L. DISEASE -POLICY LIMIT 1 $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is regui red) Home Depot USA,Inc. ,its parent,affiliates and subsidiaries are named as additional insureds. CERTIFICATE HOLDER CANCELLATION © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD Phone: Fax: E -Mail: SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Home Depot USA, Inc. ACCORDANCE WITH THE POLICY PROVISIONS. c/o First Advantage® AUTHORIZED REPRESENTATIVE 1100 Alderman Drive Alpharetta, GA 30005 Carmen Cocca © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD Phone: Fax: E -Mail: I I 0 t ° _ •? 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