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HomeMy WebLinkAboutBuilding Permit #742 - Exception 4/16/2012BUILDING PERMIT °` TOWN OF NORTH ANDOVER 03 L �- APPLICATION FOR PLAN EXAMINATION VL . ea Permit NO: (/ Date Received �q� R.T.o'p�'c�i TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family. El Industrial ❑ Iteration No. of units: ❑ Commercial Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other �. a a a n ,-t, az. ®fie tic CIlI(eli"«=, �`x ^I y� } •-k�j,^r; ',Fsr?a;"Ec" S i � . ,"' .va"�. gN �Flood�amDINetlanss 4-.. �4;�`rtr� .r+.m.. *vgF,rj ��. '-""^t 3^�``�� '�,tt ; 2�latersh+etl®rict�;��` UE5GKIP I IUN ur VVUM- M i V or- rRCrvrxivnv,v. �tSPosa� 0� kx�sil ?�� �1���,;�es - /v /,�, 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: -0 FEE: $ Check No.: 2 Receipt No.: � 19 4 NOTE: Persons contracting with unregistered contractors do not have access tot gu ara my fu^d Location No. Date � Y Check #--dT� TOWN OF NORTH ANDOVER Certificate of Occupancy $- ----Building/Frame Permit Feet $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 25194 Building Inspector 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 PLANNING & DEVELOPMENT ❑ COMMENTS CONSERVATION COMMENTS HEALTH COMMENTS DATE REJECTED DATE APPROVED El DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED ❑ ❑ Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/S�nature &Date Driveway Permit Located at 384 Osgood Street 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 Doc.Building Permit Revised 2007 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 ❑ Copy of Contract - ❑ Floor Plan Or Proposed Interior Work ❑ 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) ❑ 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 s•. m 0 z . • w v o a` O U w q z �' G U w o EE a co a w O W a U w W I, r2 cn w Fol U r4° w A w m' o z cn v Q o cn o � C y O C c+ *O V V C CL C W W (D C o COD= Ea co CF *• «. cD o o. y C a .. O O "s osr ' ;mm o cm CD 3 y � CO) Co N t CD QV L ® N O O Q C a .act •mcg 83M O cc • C O C F Cs O O. Q E e - CD C = m : O :s 3 W C ea m t LLJ LL r I--MA�G. W t O C N 'E. C3 C CLC.3 CD' CD O � _ � � 0M f- S n$ m E CA - cm CD C: cm C m O Q1 C �C N CD t O Z O 3 O zoo N Ok 9 2 O a� O CO ■ L O o s Z d O CO) G C O cm i O CD — y O O 'E m m CD ow CL ~_.+ O CD L � O � CL CMa ca c o *- /Cc v co C Z � C.3 CO) � C C . C c CL— h 0 ui ui W 19 W LU 19 W W k 22 ` � /§ \ ../ CL 0 'Z3 {k3 Lr) w LL, 00) CL 0 X LU (Y (D 2 W W (Y \ / \ �� p� y\ LLI LL- J \ oo 0 CL N -J ry The Commonwealth ofMassachusetts - Department of IndustriglAccidents Office of Investigations qu 600 Washington Street Boston, MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant information Please Print Legibly I��Name (Business/Organization/Individual): � T 1(�(c Q,1 n ' Address:g City/State/Zip: 1-oW e . C 6 Phone #• 7?'" 7 3 �_- 5"6_37 Are you an employer? Check the appropriate box: Type of project (required): L ❑ I am a employer with 4. ❑ I am a general contractor and I 6. [] New construction mployees (full and/or part-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. EJ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.F1 Electrical repairs or additions 3. ❑ 1 am a homeowner doing all work right of exemption per MGL 11.❑ umbing repairs or additions myself. [No workers' comp. c. 152, § 1(4), and we have no 12. [Roof repairs insurance required.] t employees. [No workers' comp. insurance required.] 13.❑ Other *Any applicant that checks box #1 must also fill outthe section below showing their workers' compensation policy information. T Homeowners who submit this affidavit indicating they a're 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. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Policy # or Self -ins. Lic. Expiration Date:. Job Site Address- City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A ofMGL c. 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 ofup to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA. for insurance coverage verification. X do hereby certi under thepains rndpenaldes ofperjury that the information provided above is true and correct. Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # - Dw a Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town CIerk 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 ofhire,- 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 -contractors) 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 carry 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. Also 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 (ifnecessary) 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 bum 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; The COMM031wealth of J\4_assaeh1)sPtts Department of hadustrial ,Accidents Office ofIuvestfga 10=. 600 Washington Street Boston, MA 02111 Tel. # 617-727,4900 oxt 406 ox 1-877:IYlASSAFB Revised 5-26-05 Fax # 617;,727-7749 - wwwal ass,gov/dia REILL-2 OP ID: CY A� �'� CERTIFICATE OF LIABILITY INSURANCE DAT04/09//2 04/09/12 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 978-957-3588 CONTACT NAME: CHARLES J COUGHLIN 978-957-6612 INSURANCE AGENCY 14 DINLEY ST. P.O.BOX 10 DRACUT, MA 01826-0010 ACNE Ext: AX No: E-MAIL - ADDRESS: INSURERS AFFORDING COVERAGE NAIC # INSURER A: National Grange Ins Co 14788 X COMMERCIAL GENERAL LIABILITY INSURED Patrick Reilly INSURER B: Workers Comp. Bureau of Mass MPT6413D DBA: BPR Construction 28 Farragut Street INSURER CALM. Mutual Insurance Co. PREM SES Ea occurrence) $ 500,000 — — Lowell, MA 01854-2423 INSURER D: MED EXP (Any one person) $ 10,000 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 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 TR TYPE OF INSURANCE ADD SUBR POLICY NUMBER POLICY EFF MMIDD/YYYY LEXP MM DDY /YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY MPT6413D 02/24/12 02/24/13 PREM SES Ea occurrence) $ 500,000 CLAIMS -MADE Fx] OCCUR MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,0_0_ GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 $ POLICY F PRO LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per accident NON -OWNED HIRED AUTOS AUTOS I$ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR CLAIMS -MADE DED I I RETENTION $ $ C WORKERS COMPENSATIONX AND EMPLOYERS' LIABILITY YIN N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? FY -1 (Mandatory in NH) N / A ASSIGNED TO A.I.M. 02/29/12 02/28/13 WC STATU- OTH- R IMIT ER _ E.L. EACH ACCIDENT $ 100,00 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 / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) CARPENTRY CERTIFICATE HOLDER CANCELLATION ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Paula Stonesifer THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 69 Davis Street North Andover, MA 01845 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD Contractor Agreement ............................................................................................................................................................................................................. THIS AGREEMENT made 4th day of April, 2012 by and between Patrick Reilly, hereinafter called the Contractor and Paula Stonesifer, hereinafter called the Owner. Witnesseth, that the Contractor and the Owner for the consideration names as follows: Article 1. Scope of'the Work The Contractor shall furnish all of the materials and perform all of the work shown on the Drawings and/or described in the Specifications entitled bid memo, as annexed hereto as it pertains to work to be performed on property at 69 Davis St. North Andover, MA. 01845. Article 2. Time of Completion The work to be performed under this Contract shall be commenced on or after April 14th, 2012 and shall be substantially completed on or before May 14th, 2012. Article 3. The Contract Price The Owner shall pay the Contractor for the material and labor to be performed under the Contract the sum of Five Thousand Three Hundred Eighty Dollars(5,380.00) subject to additions and deductions pursuant to authorized change order. Article 4. Progress Payments Payments of the Contract Price shall be paid in the manner following: Y2 upon start of job in the amount of $2,690.00. Y2 upon completion of job in the amount of $2,690.00. Article 5. General Provisions Any alteration or deviation from the above specifications, including but not limited to any such alterations of deviation involving additional material and/or labor costs, will be executed only upon written order for same, signed by Owner and Contractor, and if there is any charge for such alteration or deviation, the additional charge will be added to the contract price of this contract. If payment is not made when due, Contractor may suspend work on the job until such time as all payments due have been made. A failure to make payments for a period in excess of 14 days from the due date of the payment shall be deemed a material breach of this contract. In addition, the following general provisions apply: 1. All work shall be completed in a workman -like manner and in compliance with all building codes and other applicable laws. 2. The contractor shall furnish a plan and scale drawing showing the shape, size dimensions, and construction and equipment specifications for home improvements, a description of the work to be done and description of materials to be used and the equipment to be used or installed, and the agreed consideration for the work. 3. To the extent required by law all work shall be performed by individuals duly licensed and authorized by law to perform said work. 4. Contractor may at its discretion engage sub -contractors to perform work www.socrates.com Page 1 of 3 SS4301-230 • Rev. 05/04 y hereunder, provided Contractor shall fully pay said sub -contractor and in all instances remain responsible for the proper completion of this Contract. 5. Contractor shall furnish Owner appropriate releases or waivers of lien for all work performed or materials provided at the time the next periodic payment shall be due. 6. All change orders shall be in writing and signed both by Owner and Contractor, and shall be incorporated in, and become part of the contract. 7. Contractor warrants it is adequately insured for injury to its employees and others incurring loss or injury as a result of the acts of Contractor or its employees or sub -contractors. 8. Contractor shall at its own expense obtain all permits necessary for the work to be performed. 9. Contractor agrees to remove all debris and leave the premises in broom clean condition. 10. In the event Owner shall fail to pay any periodic or installment payment due hereunder, Contractor may cease work without breach pending payment or resolution of any dispute. 11. All disputes hereunder shall be resolved by binding arbitration in accordance with rules of the American Arbitration Association. 12. Contractor shall not be liable for any delay due to circumstances beyond its control including bad weather that may create dangerous working conditions, casualty or general unavailability of materials. 13. All home improvement contractors and subcontractors shall be registered and any inquiries about a contractor or subcontractor relating to a registration should be directed to: Director, Home Improvement Contractor Registration P.O. Box 871 Taunton, MA 02780-0871 Tel: 508-821-9375. 14. The homeowner has three day cancellation rights under MGL c 93 s 48, MGL c 140D s 10 or MGL c 225D s14 as may be applicable. 15. Homeowners who secure their own construction -related permits or deal with unregistered contractors will be excluded from the guaranty fund provisions of MGL c 142A. 16. Contractor warrants all work for a period of 12 months following completion. Signed this 4th Day Of April, 2012. Signed in the presence of: Witness Witness Name of Owner: www.socrates.com Page 2 of 3 SS4301-230 • Rev. 05/04 By (Signature): Name of Contractor: Patrick Rei By (Signature): Street Address: City/State/Zip: Telephone No.: Contractor's License No 28 Farragut St. Lowell, MA. 01854 978-735-5637 80702 www.socrates.com Page 3 of 3 SS4301-230 • Rev. 05/04 BID MEMO BID NO. 2 DATE: 3/11/2012 JOB PAULA STONESIFER LOCATION 69 DAVIS ST. N. ANDOVER, MA. 01845 FIRM B.P.R. CONSTRUCTION PREPARED BY PATRICK REILLY ADDRESS 28 FARRAGUT ST. APPROVED BY City/State/Zip LOWELL, MA. 01854 TYPE OF WORK ROOF REPAIR PHONE 978-735-5637 WORK INCLUDED AMOUNT OF BID REMOVAL & DISPOSAL OF EXISTING THREE TAB SHINGLES. INSTALLATION OF NEW 30 YEAR ARCHITECTUAL ASPHAULT SHINGLE. INSTALLATION OF NEW 81N. WHITE ALUMINUM DRIP EDGE ALONG PERIMETER OF ROOF. INSTALLATION OF NEW ICE & WATER SHIELD ALONG THE BOTTOM FIRST 3 FEET OF ROOF. INSTALLATION OF NEW 15LB. FELT PAPER AFTER INSTALLATION OF ICE & WATER SHIELD. INSTALLATION OF NEW RIDGE VENT SYSTEM & NEW RAIN DEVERTERS AT FRONT & BACK DOORS. DUMPSTER WILL BE DELIVERED FOR DISPOSAL & REMOVAL OF EXISTING ASPHAULT SHINGLES & OTHER DEBRIS OR WASTE FROM WORK BEING PERFORMED AT THIS JOBSITE. TOTAL COST OF LABOR & MATERIAL. 5,380.00 TOTAL BID 5,380.00 EXCLUSIONS AND QUALIFICATIONS ACKNOWLEDGEMENT OF ADDENDA TAX DELIVERY EXCLUDED INCLUDED RECEIVED BY