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HomeMy WebLinkAboutBuilding Permit # 6/11/2015 %h0RTf1 BUILDING PERMIT 0 0 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: 0 Date Received Too Date Issued: IMPORTANT: Applicant must complete all itejr �s on this page LOCATION, PERTP ry tJ MAP NO GE N 'sitbrid"Di8tri yes no .. , 77777777�,� ....... Shop: 77 Village� ,.yes- no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential El New Building [] One family 0 Addition [I Tw o or more family El Industrial ZONING TK El Ayeration No. of units: El Commercial vfRepair, replacement El Assessory Bldg El Others: [I Demolition El Other ❑Septic "El VUeII 6701"F" 5hed,District A a�DA Aut Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: CONTRACTOR T am ,,,Adldress— '0— D —'' "I","I il 71 11" ("', ''i " ......." I Sulpie i, r"& License'�"':' "i,15xp.,f' ,,.,.',Date 'Hb rn' eI m' �,n n, License* ARCH ITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDINGPERMIT.,$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: FEE: 1; Check No.:. Receipt No.:,Jk4;e'1 1 NOTE: Persons contracting with unregistered contractors do not have access o th gu r my nd ne(.:. SignatOr' 'f'A' '""VIOW" '6t," e:'10 Agent/Ow VV T �.a Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ y TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ permanent Dwupster 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 744�x�z4Q COMMENTS zon 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 Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT;-Temp,Dumpster on site yes no Located at 124 Mara Street Fire ®apart , ,`rignature/date S COMMENT Town of' nclover I.- _n No. A0IT -t , : A,�! h ver, ass, COC 1 LKl WICK �1. 004 D PPS 5 U BOARD OF HEALTH Food/Kitchen rERMIT TSeptic System THIS CERTIFIES THAT .......... vrBUILDING INSPECTOR has permission to erect .......................... buildings on ... ......pa.L.0y"-1.✓. l.00....... Foundation Rough to be occupied as ... .... .S�A.t. ......... ... .. ....... ct4x......z ... .l. �`....................... chimney provided that the person accepting this 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 I MONTHS®NT S ELECTRICAL INSPECTOR LESS CONSTRUCTI ST RTS 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. ltit • LANI)SCAPl:S • DESIGN—CONSTRUCTION—MAINTENANCE -IRRIGATION 617 828-2733 masonworkzxom 25 SHADOW RD MELROSE MA 02176 Article 1 —Parties Homeowner Information Contractor Information Name Company Name Mr. Jonathan Ilurtig Masonworks, LLC Street Address Contractor/Salesperson/Owner Name 66 Palomino Dr., Arlen "Jeff' Souza City/Town State Zip Code Business Address North Andover Mass 01845 25 Shadow Road Daytime Phone Evening Phone City/Town State Zip Code 617 835 5033 Melrose MA 02176 if Entail Address(Optional) Business Phone 'ehurt comcast.net (617) 828-2733 Mailing Address(If Different from Above) Email Address aisouza@comeast.net Federal Employer ID No. 46-0493870 Home Improvement Contractor Reg.No. Expiration Date 147178 6/15/2017 Construction Supervisor License No. Expiration Date 76715 3/8/2016 Article 2— Scope of Work Contractor agrees to do the following work for Homeowner: Scope of work: 1- Back patio under the deck—240 SF. Excavate area to a depth of 8". Install a layer of landscape fabric to help prevent weed growth. Install 5" of crusher run(road base) 2" at a time and compact it with a heavy duty plate compactor. Install a 1" leveling layer of course bedding sand and install pavers., Cut the edges and set borders on concrete. Apply Polymeric sand to ; ► lock in pavers (Polymeric sand expands on itself and performs as a barrier for weed growth and prevents insects from borrowing through). Compact and 1 ,A 3 � '3 sweep patio to finish it. Work to be done with Cambridge Pavers Kingscourt Collection 6x9 on a 90°Herring Bone Patter and soldier course Borders on Onyx Natural color $ 4,390.00 Add 70- SF of pavers to wrap around back steps as shown on modified plans $ 1,281.00 2- Front steps— 7'x5'6". Demolish and dispose of existing steps. Excavate to a depth of 12" and form for a concrete pad. Concrete pad will have 4 sonotubes, one on each corner to a depth of 3' below the bottom of the concrete pad to make it a monolithic free stand footing. Rebuild steps solid cored using Glengarry 53 dd for risers and sidewalls. Provide and install Flamed Bluestones fortreads�and landing. Existing configuration and size of steps will not be:modified.Wrought iron railings not included on given price $ 4,135.00 -� 3 Walkway- 1,10 SF.Demolish and dispose of existing concrete walkway. Excavate area to adepth.©f $" Install a layer of landscape fabric to help prevent weed growth. ;Install 5'" of crusher run(road base) 2" at a time and compact it with a heavy duty plate compactor. Install a 1"leveling layer of course bedding sand and install pavers. Cut the edges and set borders on concrete. Apply Polymeric sand to lock in pavers (Polymeric sand expands on itself and performs as a barrier for weed growth and prevents insects from borrowing through). Compact and sweep patio to finish it. Work to be done with Cambridge Pavers Kingscourt Collection 4x8 on a 900 Herring Bone Patter and soldier course Borders on Toffee Onyx color. $ 1,870.00 Availability will be discussed with Homeowner. Upon agreement a Certificate of Insurance will be provided to owner. Article 3 —Proposed Start and Completion Schedule Commencing and finishing dates will be discussed with owner and will be dependant on work load already in schedule and could be delayed due to inclemented weather. Contractor agrees to adhere to the proposed schedule unless circumstances arise that are beyond his control. Article 4—Required Permits Contractor will secure any and all required permits It shall be the obligation of Contractor, as agent for the Homeowner, to obtain the Permits. If Owner obtains any and/or all of the Permits, Owner shall be excluded from the guaranty fund as described in Massachusetts General Law chapter 142A. 2 sj r omeowner's Signature oWrt re a Date NOTICE OF CANCELLATION YOU MAY CANCEL THIS TRANSACTION,WITHOUT PENALTY OR OBLIGATION, WITHIN THREE BUSINESS DAYS"FROM THE ABOVE DATE. IF YOU CANCEL,ANY PROPERTY TRADED IN,ANY PA)l4IENTS MADE BY YOU UNDER THE CONTRACT;OR SALE,ANDS Y:NEGOIABIE INSTRUMENTS EXECUTED BY YOU WILL BE RETURNED WTI' I ISI )3pSINESS DAYS FOLLOWING RECEIPT BY THE SELLER OF Y{}U CANCELLATION NOTICE, AND ANY SECURITY INTEREST ARISING OUT OF THE TRANSACTION WILL BE CANCELLED. IF YOU CANCEL, YOU MUST MAKE AVAILABLE TO THE SELLER AT YOUR RESIDENCE, IN SUBSTANTIALLY AS GOOD CONDITION AS WHEN RECEIVED, ANY GOODS DELIVERED TO YOU UNDER THIS CONTRACT OR SALE; OR YOU MAY, IF YOU WISH, COMPLY WITH THE INSTRUCTIONS OF THE SELLER REGARDING THE RETURN SHIPMENT OF THE GOODS AT THE SELLER'S EXPENSE AND RISK. IF YOU DO MAKE THE GOODS AVAILABLE TO THE SELLER AND THE SELLER DOES NOT PICK THEM UP WITHIN TWENTY DAYS OF THE DATE OF CANCELLATION, YOU MAY RETAIN OR DESPOSE OF THE GOODS WITHOUT ANY FURTHER OBLIGATION. IF YOU FAIL TO MAKE THE GOODS AVAILABLE TO THE SELLER, OR IF YOU AGREE TO RETURN THE GOODS TO THE SELLER AND FAIL TO DO SO, THEN YOU REMAIN LIABLE FOR PERFORMANCE OF ALL OBLIGATIONS UNDER THE CONTRACT. ANY CANCELATION DONE AFTER 72 HOURS OF SIGNING THE CONTRACT WILL BE SUBJECT TO A 30% CANCELATION FEE UNLESS A SUBSTANTIAL REASON IS PROVEN FOR SUCH CANCELATION TO CANCEL THIS TRANSACTION, MAIL OR DELIVER A SIGNED AND DATED COPY OF THIS CANCELLATION NOTICE OR ANY OTHER WRITTEN NOTICE, OR SEND A TELEGRAM TO [Name of Seller], AT [Address of Seller's Place 9 Cy-E, M1 _r �, ,: •;_- � epi�" , ,� ,_ .� 1� d f i 1 it t i y is Y; I 1 W y i a,i r f The Commonwealth of Massachusetts Department of Inia[Aceiden& Offtce,of A vatiffadons 600"Washrngton S'freet Boston,MA,02111 wwminassgov/dia Workers' Compeation Insurance Affidavit:Builders/Contractor5/E A licantInformation Iectrici2us/Plumberg Nametrti / Please Print Le 'bi (Business/OxgazatioMn, nal); /�, Address: ezt IZH , Z, #; . , Are yo," vn,empIayer?Check thea 1 PPropriate box: am .,employer with 4o []I am-a general contractor andil Type of project(required): El emPIO) W(full-and/or part-time).* have hired the sub-contractors' 6. FJ Re construction I am.a sole proprietor or partner- listed on the atfached sheet: 'l. Remodeling [] slop and have no employees These sub-contractors have. . working fnr me in any capacity. employees and�Ve workers' $' ET Demolition [Noworkers'comp..insurance comp,insurance# 9. []Building addition ( required] 5. [] We area corporation Eland its 10.I am a homeowner doing all work officers have exercised their 0 Electrical repairs or additions myself~[No workers';comp. right of exemption per MGL 11'n PIumbing reps or additions in4srtrance required]t c. 152,§1(4);and we have no L1 Roof repair employees;[No workers' 13.[],Other co g ce r� 1 Y$PPIi `.hat checks box#1 must also flu out the section below.-howm their'workers' `meowners )submit this affidavit indicating they are do' compensation policy information, hactors that. k tfiis,box must attached an additional sheet showing the same of e o aside contra otors`mustsulit¢ut a tte w affidavit indicating such, .oyexs. if the sG -oa[ractors have exnptoyees, b-contraOhm and state whether or not those entities have --� theymustprovideChoir workcts comp,,Policytnumber. 1 a an employer that is providing workers'eo �rmatior� P adon'insurance for my entp[oyeyes Below s the p6ticy and job site Lu ,ranee Company Name: P,, ;y#or Self-ins.Lic.#: ,� Expiration Date: Jo'. ``e Address: � At"',. li, o 7-- City/State/ = Py Of ers compensation policy declaration page(showing the:polt'cynu her andeapir date). Pail .'e to. - Y p:.:.., ure coverage as required under Section 25A of MGL c.152 can lead, Clic un osru of criminal penalties of a fine:; ;o :$ $1, ', i d y and/or one- ear.imprisonment,as well as civil penalttes;m the.form ofa'STOP�rOgg OSB Of u to$250,1; �day against the violator. Be advised that a copy ofthis statemer►t may be forwarded to the Office fd a fine inv. ^agations o 1 DTA for insurance coverage verification; X dc, :.ereby rti fy e the andpenalties of perjury that the information provided above* true SIQ' are: and correct Phar t#: Date: :ial use only.,Do not write iii this area,to be completed by cuyoiltdion ojjiscial Town: Xssa ug A: `°hority(circle one): Permit/License# i•l 'and of. 'IR th 2.Building Department 6LLC'O 3 City/Town Clerk 4:ElecErical Ins ector 5. t: `her p Plumbing inspector .act Persoa:== -- Phone,#- DATE(MMJDDIYYYY) Ate✓" CERTIFICATE OF LIABILITY INSURANCE 6/4/2015 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 Eileen Bartell NAME: M.R. Shaw LLC PHONE }` (978)744-4540 �_,�FAXAAIC.ANe} tsTe}74s_ass4 -- P.O. Box 4428 EMAIL ADDRESS:eileen@shawins.com 18 Hawthorne Blvd. INSURERS AFFORDING COVERAGE NAIC# Salem MA 01970 INSURERA:Ohio Casualty__Ins_ Ca 24082 INSURED _INSURER B_Safety_Insurance Company-�_ _ _ 39.454------ Mason Works LLC INSURER C:Travelers 25 Shadow Rd INSURER D: INSURER E Melrose MA 02176 1 INSURER F: -`------ -- -- - — r '----- COVERAGES CERTIFICATE NUMBER-CL1552009142 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 i ' POLICY EFF POLICY EXP LTR TYPE OF INSURANCE { I POLICY NUMBER h1MIDDIYYYY MMIDD YY LIMITS X COMMERCIAL GENERAL LIABILITY I EACH OCCURRENCE 5 1,000,000 A r I CLAIMS-t FADE CX OCCUR DAMAGE TO RENTED 100,000 000 J .� :' PREMISES Ea occurrence) rS_ _ 13KS56587148 1/28/2015 11/27{2015 E MED EXP(Any une person} $ 5,000 PERSONAL 3 ADV INJURY S — 1,000,000 ',.... GENT AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE ;S 2,000,000 X POLICY JE c LOC j i PRODUCTS-COMPIOP AGG 2,000,000 OTHER: Expense Mod Factor 1 `S -_,_--- AUTOMOBILE LIABILITY + COMBINED SINGLE LIMIT !S 1,000,000 B I j ANY AUTO BODILY INJURY(Per person) is ALL014"NED SCHEDULED 6207580 8/17/2014 : 8/17/2015 80DILYINJURY(Peracadenf}'3 AUTOS (._- AUTOS ? NON-OVlNED { ;PROPERTY DAMAGE S I I HIRED AUTOS _ J AUTOSF t_Ter accident_—.� SS UMBRELLA LIAB I_ OCCUR I + EACH OCCURRENCE S _. I EXCESS LIAR CLAIMS-MADE; ? AGGREGATE S DED i i RETENTIONS i S WORKERS COMPENSATION I i i i PER 0TH- !AND EMPLOYERS'LIABILITY Y/N r STATUTE x I OR jANY PROPR`ETOR/PARTNERlEXECUTIVE ! ELiEACH ACCIDENTS 500 000 I.FFI,ER/MEMBER EXCLUDED? NIA; — -- 2E204971 6/4/2014 6/4/2016 C (Mandatory in NH) �E.L.DISEASE-EA EPhPLOYE>3$ 500 D00 '. It yes.describe under i DESCRIPTION OF OPERATIONS beloai E DISEASE-POLICY LIMIT E S 500,000 I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) '.. 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 North Andover, MA 01845 ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZED wiATIV Mark S - 1 . FSH ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS025(201401) Bc7ard Of a n d,"s- a CS-076715 ARLF -I SOUZA 25,SILADOW RD-- Melrose ALA 02176 0310812046 A-R Ism, OVE-MENTCONTRACTOR .147178- TY00, xpira io 'T u1; Ltd Ljabiiitv Com,-, LLC- ARLEN SOUZA 25 Si-fADOW RD NII UROSE A0A 02