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HomeMy WebLinkAboutBuilding Permit # 11/24/2015 i TOVVN OF NORTH R VEF. APPLICATION FOR PLAN EXAMINATION r� Permit NO: Date Received t a � �oC"U Date Issued: IMPORTANT: A licant must corn fete all items on this a e w LOCATION Print PROPERTY O R � int MAPNO.: P CI ZONING DISTRICT: TYPE AND USE OF BULDING HISTORIC DISTRICT 4 S d TYPE OF IMPROVEMENT PROPOSED USE Residential Non-Residential —— ❑New Building ❑One family ❑Addition ❑Two or more family ❑Industrial ❑Alteration No. of units: ❑Repair,replacement [IAssessory Bldg [I Commercial ❑Demolition ❑MovLm relocation ❑Other TE110thers. ❑Foundation onl DESCRIPTION OF WORK TO BE T9 EFORMED r identification Please Type ger Print lea y) OWNER: Name: �\3( f \ ` - Rhone" - -- Address:__ y� CONTRACTOR Name:- sole: Address:, Supervisor's Construction License:� ,g ( C) -(k —Exp. Date: 41- Home Improvement License:, (���� _E�p. Date: �► � " . ARCHITECT/ENGINEER _ Narne: Rhone:,, Address: M— _ _ _Reg.No. -- FEE,,SCHEDULE.B ULDEVG EIT 0 1 .000 PE $OXO oo oi7IHE TO.TAF E�STIMAT'ED COSI' ASE, l ON �25.001PER S.F. Total Project Cost __ X12.00=FEE: Check No.: Receipt No.:- ) Page tof 4 TYPE OF SEWERAGE DISPOS Tanning/Massage/Body Art ❑ Swimming Pools ❑ Public Sewer Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Permanent Dempster on Site ❑ Private(septic tank,etc. ❑ Electric Meter location to project NOTE: Persons contracting w' u regi tered co tractors do not have access to the guaranty fund Signature of Agent/Owner. Signature of contra for Plans Submitted ❑ Plans Wait ed ❑ Certified Plot Plan ❑ Stamp d Plans ❑ THE FOLLOWING SECTIONS FOR 0 + CF USE ONLY INTERDEPARTMENTAL SIGN OFF e U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ []Water Shed Special Permit ❑ Site Plan Special Permit ❑ Other 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/S nature T1a�e Driveway Permit Temp Dempster on site yes_no— Fire Department signature/date Wk I 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 ap roval of Electrical Inspector yes No p ®ANGER ZNE LITERATURE; yes No MGL Chapter 166 section 21A—F and G min.$1o0-$1000 fine NOTES and DATA-- (For department apse) -'t6 ® Notified for pickup Call Email Date Time __..__------------_._...._.__......... ....__ ..................._._.._.._...... _.__�._.____ Contact Name Doe.Building Permit Revised 2014 i 'Town ofNORTH ndover No. = - i _ - ver°, ass, Q LAKE r— COC-41CHE-ICK V ®S RATE D U BOARD OF HEALTH Food/Kitchen PER LD Septic System THIS CERTIFIES THAT . ... „4 BUILDING INSPECTOR ................. .... . ...... . ............. .. .. ..... .................... Foundation has permission to erect.......................... buildings on .......i ...... .!�.. . ........ .... . ........ 44 Rough tobe occupied as ...........5... ........ ...... ................. ... ....4 M 14 ................................................... Chimney provided that the person accepting t is permit shall in every respec onform 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 ERIVIIX T ELECTRICAL INSPECTOR LESS ST Rough l 3 • Service ............. ... ...... ... ................ Final BUILDING INSPECTOR GAS INSPECTOR ccul2ancy 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. CSL N 106011 HIC N 174718 xr � r 3 4 t � ( ; "v zz �a „6e l..rLs �....�,+�2 Cx .d tj,5 JOB NAME N REPRESENTATIVE:FREDDY CAMPOVERDE SOURCE WEB page Form Fill DATE: Golden Group Construction Corp. OUR WORK,OUR WORD." EXPIRATION DATE: 20 TATTAN FARM ROAD,WORCESTER,MA,01605 Phone 508-873-1884 CELL 508-873-1369 gotdengroupconstruction@yehoo.com GENERAL CONTRACTORS AGREFAENT I/We, the Owner(s) of the premises described below, hereby authorize you as contractor to furnish all necessary materials, labor, and workmanship to install, construct, and place the improvements described herein according to the following specifications, terms and conditions on the premises described below. COUNTY OWNERS NAME : ,_I STATE ZIP ADDRESS CITY MA NORTH ANDOVER 1< 'P 320 SUTTON ROAD CITY STATE CONSTRUCTION SITE NORTH ANDOVER MA ZIP 320 SUTTON ROAD HOME PHONE WORK PHONE ALTERNATIVE EMAIL (( PHONE l o TEAR OFF All existing_LAYERS o REPLACE SHEATHING IF DRY ROT IS PRESENTED ( ADDITIONAL COST) o 3 COMPLIMENTARY SHEETS OF PLYWOOD. o USE ALL WEATHER STOPPER SYSTEM CERTAINTEED WINTERGUAD ICE AND WATER SHIELD/ SYNTHETIC DIAMOND DECK CERTAINTEED ICE AND WATER SHIELD 6 FEET OF ALL EVES CERTAINTEED ICE AND WATER SHIELD 3 FEET OF RAKES CERTAINTEED ICE AND WATER SHIELD 3 FEET IN ANY ROOF VALLEYS. CERTAINTEED ICE AND WATER SHIELD TO CODE AGAINT ANY SIDING TRANSITION, CHIMNEY, PIPE BOOTS, SKYLIGHTS, OR ANY OTHER ROOF TRANSITION. o INSTALL DIAMOND DECK SYNTHETIC UNDERLAYMENT IN ALL OTHER EXPOSED ROOF DECK. o INSTALL FB ( B INCH) DRIP EDGE ALUMINUM COLOR:—MILL o CERTAINTEED LEADING STARTER STRIPS ON ALL ROOF EDGES. o INSTALL CERTAINTEED LIFETIME LANDMARK. o INSTALL AIRVENT 12 INCH FILTERED RIDGE VENT. U' 115 �v` n o INSTALL CERTAINTEED SHADOW RIDGE CAPS ON A ROOF HI RIDGE. o INSTALL ALL NEW FLASHINGS ON WALL TRANSITIONS. o RE-FLASH AND RE LEAD OF CHIMNEY USING 12 INCH LEAD, ICE AND WATER shield and 5 BY 7 aluminum step flashing. O REPLACING ALL EXISITING PIPE BOOTS, WITH NEW FLASHING PIPE BOOT KITS. o REPLACE ANY EXISTING BATHROOM VENTS. O Registered Extended 4 Star Manufacturer Warranty.Transferable 1 time to a New Homeowner. o Installation of 6 nails per shingle per manufacturer code to ensure shingle warranty up to 130 miles per hour. O CLEAN UP OF ALL DEBRIS IN YARD SPACE. o ALL DEBRIS WILL BE HAULED WITH GOLDEN GROUP SUPPLIED DUMPSTER. O PERMITS AND LICENSES FILED WITH YOUR LOCAL TOWN HALL. SALES TAX $ INCLUDED BALANCE TO BE PAID $6,266.67 UPON COMPLETION TOTAL DUE $9,400.00 CAU home improvement contractors and subcontractors must be registered by the Chief Administrator of the Massachusetts Board of Building Regulations and Standards.Any inquires about a contractor or subcontractor relating to a registration should be directed to: Director of Home Improvement Contractor Registration, One Ashburton Place, Room 1301, Boston, MA, 02180, (617)727-8598. The contractor shall obtain and pay for the building permit and other permits and governmental fees, licenses, and inspections necessary for proper execution and completion of work. If the owner elects to obtain the foregoing permits, or to deal with unregistered contractors, the Owner will be excluded from the guaranty provisions of M.G.L.c 142A. The owner shall obtain and pay for all necessary approvals, easements, assessments and charges. The Contractor and the Homeowner hereby mutually agree in advance that in the event the Contractor has to dispute concerning this contract, the Contractor may submit the such arbitraation as provided in Mas achusetts General laws, Chapter 142A. Ci, Homeowner Signature Date ntractors Signature Date Great care will be taken not to damage plants and shrubs. Clean gutters and respike where necessary after reroofing. All roof related debris will be removed from job site and hauled away. A "drag magnet" will be used to pick up stray nails after installation. Permit price is included in job price. GOLDEN GROUP CONSTRUCTION CORP. Is licensed, and insured MA Home Improvement. License #174716 MA CSSL#106011 All material is to be installed as specified to code of MA Building Code. All work to be completed in a workmanlike manner according to standard practices. Any alteration or deviation from above specifications involving extra cost will be executed only upon written orders and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents, or delays beyond our control. Homeowner to carry fire, tornado and other necessary Insurance. Our workers are covered by Workman's Compensation Insurance. We are covered by a $2 million Dollar General Liability Policy. By signing this Contract you are agreeing to Golden Group Construction Corp. Labor Warranty. Golden Group Construction Corp. will provide a five year Material, Labor, Dumpster, and Interior or Exterior Damage caubeu installation roofing error. Golden Group will arrive at the property where a water test, along with an inspection will be performed to identify the problem and source of leak. Things such as pipe boots, skylights, siding transition walls and chimneys will be water tested as well to ensure no such products have failed and have become an entry point for water. Products such as chimney bricks above the lead and flashing line, exhaust vents ( her ht Brother than newthatare skylight installed instal�d 6y Golden Group at time of install), skylig Golden Group), siding, window trims above the flashings and roof line are not covered in our labor on thranty.e rooft is , and perform omeowner liability maintenancand e, especially the life of such products especially in the event of major storms. When a leak or error has been reported a Golden Group representative will perform an inspection, the team will file a report and consult the next steps with property owners. Golden Group accepts full responsibility for any Application Technique Errors in the roofing system they ducts installed install.The ve year labor warranty on the roof by Golden only covers the roofing system and any p Group Construction Corp. Our five year Labor Warranty does not include or cover Product Failure. Product Failure is covered in the manufacturer Warranty provided by the Manufacturer. In the event of a product failure, Golden Group Construction Corp. will assist the Customer in Filing a product failure claim with the Manufacturer. Our Labor Warranty does not Warranty Ice Dams, it is the responsibility of the Home Owner to ensure that no ice backs up into gutters and other areas of the roof in order to prevent Ice dams from occurring. NOTICE:The signature of the parties above apply only to the Contract of the parties to alternative dispute resolution initiated by the Contractor.The homeowner may initiate alternative dispute resolution even where this section is not separately signed by the parties. No work shall begin prior to the signing of this contract and transmittal to the Owner of a copy of this contract.This contract constitutes the parties'total agreement.This contract may be amended or supplemented only by a written change order signed by owner and contractor. All surplus materials is property of Golden Group Construction Corp. You agree to be bound by the general conditions of the reserve side. The owner has seen sample warranties that will be provided by Golden Group Construction Corp. upon installation. NO ORAL AGREEMENTS ARE ACCEPTED DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES You,the buyer, may cancel this transaction at any time prior to the midnight of the third business day after the date of this transaction. IN WITNESS WHEREOF, the parties have hereunto signed0their names this SEPTEMBER daytof 23 Signed Owner � Signed Owner Golden Group Con. 'ruction Representative Make All Checks Payable To Golden Group Construction Corp. The Commonwealth of Massa.chuseffs Department of.Indlustrial Accidents 1 Congress Street,,Suite 100 w=' Boston,MA.02114.2017 Sy:v�t www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE PILED WITH THE PE12N.QTTING ATJTHORiTY. A licant Information Please Print Leydbl Name(Business/Organization&dividual): kl ) -- Address:_ a® City/State/Zip:��(� J ��®klopL Phone#: d U t ' 18 Are yo an employer?Check the appropriate box: Type of project(required): 1. m a employer with-��__employees(full and/or part-time).* 7. 0 New construction 2.[]I am a solo proprietor or partnership and have no employees working for me in 8. E]Remodeling any capacity.[No workers'comp.insurance required.] 9, ❑Demolition 3.❑I am ahomeowner 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,F]Electrical repairs or additions proprietors withno employees. 12.0 P umbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached ached sheet. 13. Roof repair's These sub-contractors have employees and have workers'comp.insurance. 14.[1 Other 6.❑We are a corporation and its officers have exercised their right of'exemption per MGL c. - 152,§1(4),and we have no.employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'comp ensationpolicy information. i homeowners who submit 11iis 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 employerthat is pi•oviding woj*ers'compensation insurance for my employees.'Below is thepolicy and job site information. Insurance Company Name: Policy#or Self-ins,Lia#: �CL���I ®� Expiration Date: Job Site Address: ��Cl \( ( (a. City/State/Zip: Attach a copy of the workers' compensation policy declaration page(sholving the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishablo by a Pine 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 h,er•eby certify der e ain ndpenalt'es ofperjury that the informationpr•ovided above is true and correct. Signature: Date: 1® Phone#: 1 Official use only. Do not write in this area,to he 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#: DATE(MWDONYYY) AC CERTIFICATE OF LIABILITY INSURANCE 11/19/2015 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(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 A COSTA INSURANCE AGENCY INC NA CONTACT: 2 FRANKLIN COMMON PHONE FAX A/C No: FRAMINGHAM, MA 01702 E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC! INSURER A: Liberty Mutual Fire Insurance 23035 INSURED INSURER B GOLDEN GROUP CONSTRUCTION CORP 20 TATTAN FARM ROAD INSURER C WORCESTER MA 01605 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 27357708 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 TYPE OF INSURANCE ADDL SUER POLICY NUMBER MMM/LDICY EFF MPOLICY EXP LIMITS PO TR COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTEIT- CLAIMS-MADE D OCCUR PREMISES Ea occurrence $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY 1:1 PROJECT ❑ LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANYAUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOSAUTOS Per accident) UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ A WORKERS COMPENSATION WC2-31S-385387-025 4/19/2015 4/19/2016 �/ STATUTE ER AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y N/A E.L.EACH ACCIDENT $ 100000 OFFICER/MEMBEREXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 100000 K yes,describe under DESCRIPTION OF OPERATIONS below I I E.L.DISEASE-POLICY LIMIT $ 500000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached If more space Is required) This certificate cancels and supersedes all previously issued certificates,only as they relate to workers'compensation coverage Workers compensation insurance coverage applies only to the workers compensation laws of the state of MA. CERTIFICATE HOLDER CANCELLATION TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1600 OSGOOD STREET BUILDING 20, SUITE 2035 ACCORDANCE WITH THE POLICY PROVISIONS. NORTH ANDOVER MA 01845 AUTHORIZED REPRESENTATIVE Liberty Mutual Fire Insurance U ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD 27357708 1 1-385387 1 15-16 WC I Kartik Wali 1 11/19/2015 1:29:25 PH (SST) I Page 1 of i Of fice nt Consume Affairs& Busines's Regulation license or registration valid for individul use only 'HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: k R,gistration: 174718 Type: Office of Consumer Affairs and Business Regulation . "Expiration: 3/12/2017 Corporation 10 Park Plaza-Suite 5170 Boston,'SIA 02116 GOLDEN GROUP CONSTRUCTION CORP. ;r FREDDY CAMPOVERDE f h f 20 TATTAN FARM RD. f WORCESTER, MA 01605 [nderseactuy Not valida �Ithout signature t ��1 t snani usa t1 pa fm�I�Y f 'P!_at h S fFiy a r_i �T iIn �nc1 +faficyr,_ d Ind ards CSSL-106011 FREDDY CAMPOVERDE 20 TATTAN FARM ROAD Worcester MA 01605 ColSar'lcssu:,n;�r 06102/2017 - AJC SanDiego Extension Amedcan Safay€oundl- INTERNATIONAL SAFETY EDUCATION INSTITUTE(iSEI) Th al d cerfifies that: FREDDY CAMPOVERDE has completed a 10-Hour OSHA Hazard d Recognition Training for the Construction Industry. 03/01/2043 0irectoc Scott MacKay It ainc Taylor Sikes Grad.riati