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HomeMy WebLinkAboutBuilding Permit # 3/2/2016 BUILDING PERMIT 001?T#1'T.D TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received V C US Date Issued IMPORTANT: Applicant must complete all items on this page LOCATION 0 Y_ /-/-/J_ Print PROPERTY OWNER a A-,q-b,5 -7-V Ar e-r Print 100 Year Structure yes (n o MAP 05/7 PARCEL: ae/R_ ZONING DISTRICT: —Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED OSE Residential Non- Residential [I New Building 0 One family [I Addition 11 Two or more family 11 Industrial 7Alteration No. of units: 11 Commercial El Repair, replacement El AssessOry Bldg El Others: Li Demolition 11 Other DESCRIPTION OF WORK TO BE PERFORMED:Identification- Please Type or Print Clearly OWNER: Name: k/_41 0 / 6 Phone: Address: -,5- J Contractor Name: Phone: Email: �e a ,/i d -'-c f-, 0a /Y7 Address: q-6 6 IV_^1- P .12 -Le '- / --& Supervisor's Construction License: Exp. Date: Home improvement License: —Exp. Date: 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: $ FEE: Check No.: Receipt No.: NOTE: Persons contracting with, unregistered ont actors do not have access to,t guaranty fund ure__(�� I n %AORTh Town of Andover L 2til 51-- 2D C, LANE h Ver, Mass, COCNICMEWICKmonk x.95 RgTED MQ�L�.(5 , UBOARD OF HEALTH Food/Kitchen ERMIT T Lao Septic System THIS CERTIFIES THAT „� .,.A-...... .,.. BUILDING INSPECTOR ............. .... .... .N ........ ... ............ Foundation has permission to a ct.......................... buildings on .. ® ..S.)c. �. �.... .... . Foundation has Rough to be occupied as ...... ..l11.. .. .. ... .......... ..!s.. .. .. �� !,�.... 1��s Chimney provided that the perso accepting this permit shall In every resect 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 J VIOLATION of the Zoning or Building Regulatitons Voids this Permit. Rough Final PERMIT EXPIRESI 6 MONTHS ELECTRICAL INSPECTOR LESS C CTI. ............................... Rough Service ............... ................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy BuRough 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. 16-9 R C_ CUSTOM BUILDING + RE ODELII'\IG This agreement made this 22nd day of October, ear Two th usand and Fifteen by and between Cote and Foster Contracting,Inc. hereinafter called the Contractor and Heidi Gladstone,hereinafter called the Owner,witnesses that the wner intends to remodel the existing front entry and side entry porticos at the address of 105 Fox Hill Rd, Andover, NIA. Now,therefore, the Contractor and the Owner, for consideration hereinafter named, agree as follows: ARTIC E I The Contractor agrees to provide all the labor and n aterials to do all things necessary for the proper construction and completion of the work shown and described on drawings. The drawings and specifications e the basis of the contract. TIC I+;2 In consideration of the performance of e contract,the Owner agrees to pay the Contractor,in current funds as compensation fir his services hereunder$35,500.00 to be paid as follows: ll�; r � Payment 1 -$3,500.00 at signing of contract to a quire permit Payment 2 -$8,000.00 at start of demolition Payment 3 -$8,000.00 at completion f front entry Payment 4 -$8,000.00 at completion of side entri ARTICLE 3 Final payment on contract amount as al r,reed above to be paid within ten(10)days of project completion or occupancy. If final p yment has not been made within this time a 10%charge per month on the balance due wi 11 be charged. All minor punchlist items will be complete as part of the one year warranty on the f 'sh product. Failure to pay balance within ninety (90) days may result in 1 gal action. Initials: 0 20 Aegean Drive ® Unit 15 ® Methue ,MA 01844 Tel:978-682-6518 ® ax: 978-68 -1221 www.coteancI ostencom ARTICI E 4 Additional work above and beyond the contct agreem ... All additional work done to be quoted at the tirrle the client requests the work. The work will be done and billable at its completion. Thclient has t n(10)days to pay the additional cost after he or she has been billed fo it. Initials: In witness whereof they have executed t its agreeme rit the day and year first above written. Heidi Gladston caner Steven M. Cote DBA Cote &Foster 1 A t w ` T Coi ess Stree,, ufte 100 l - — �r�ton,fly iToekearsl Compensation insurance.Affidavit: Buflde>rs/Co»i>l•ac A Cant�olrmat.on Please ►F rE_nt Name(Business/Organization/Individual): I-Z V- 1_�_U5 7-1 AZ- Address: D z:) g City/State/Zip:IU MI/I 1,: VJ/ Phone W: re-oro n ems- o e�?Check the ap ropr 71�;n -K° a 5' tp� y PType of pr o jec,(requIr Ad). 1.❑ I am a employer with 4. a general contractor and i 6. ❑New construction employees(full and/or part-time)." have hired the sub-contractors 2.0 I am a sole proprietor or partner- listed on the attached sheet. 7. JZRemodoaa slip and have no employees Tese sub-contractors have Q. ❑Demolition worlds for me in an capacity. employees and have workers' g Y P tY• t 9. F-1Building addition P3Td workers'comp.insurance comp.insurance. required] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions i am a hameowner doing all work of vers have exercised their 11.❑Plumbing repairs or additions myself. [No workers'comp. right of exemption per MCL 12.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no employees.[No workers' 13.❑ Other comp.insurance required] Aay applicant that checks box 41 must also alt 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. TContractors#hat check this box must attached an additional sheet showing the name ofthe sub-contractors and state whether or not those entities hay e employees. Ifthe sub-contractor.have employees,they must provide their workers'comp,policy number. s aln an employer•fiSL"is pyov di g Pw lreysl coylgpensadoi?irnurance- or sny enrployees. Bellow is Me fiSiP1Cy 4'aEd j be Insurance Company Name: C�/"n m E ,L c e_ (t =/f/) US 77,--? Policy r or Self-ins.Lic.T: -�G a 3 7 Expiration Date: 0 lob Site Address: / r x /7"),� L R City/State/Zip: Atrach a eopy of the workers'coripensation poky declaration page(showing the policy name,and e,;ph-aflon date). Failure to secure coverage as required under Section 25A of IMGL 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 of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of investigations of the DIA.for insurance coverage verification. '~ do hereb i cep�iy icsrdet the pains an enables of pedllry that the h?f0i:nada`& r'Oviea above h�Se aNd cnrrEcL Signature: '� - ---- ------ -- ,Date, -- -- — Phone Y: u ` ✓�� Ocia.7 rose only. Do no,afrr-fie in z1,1IS area,to be completed by eky orYown of aciaZ City or Town: Pew;tr�geense�= =ssubg Authority(€ircYe one): !� 1.Board.of Health 2.B s�gDepar�ent 3.CR-YIT-ov,,CIer � �tn- Electrical e bys�ector S.Plt=�ia-�g�-spz��.,_ 6.otheh Contact Person: Ph6ue : �� DATE(MM/DD/YYYY) C _ ® CERTIFICATE F LIABILITY INSURANCE 12/21/2015 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 CONNAME CT V1 CtOr1a Lowes, CISR MTM Insurance Associates PHONE (978)681-5700 FAX (978)AIC No Ext): A1C No 1320 Osgood Street ADMEAILDRESS:vickiel@mtminsure.com INSURER(S)AFFORDING COVERAGE NAIC# North Andover MA 01845 INSURERA:State Auto Insurance INSURED INSURERB:AIG Casualty Company Cote & Foster Contracting, Inc INSURERC: 20 Aegean Drive INSURER D: Unit 15 , INSURER E: Methuen MA 01844 INSURER F: COVERAGES CERTIFICATE NUMBER:15-16 Master List 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 INSURANeE 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE D D POLICY NUMBER MMIDD/YYYY MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 A CLAIMS-MADE X❑OCCUR DAMAGE TO RENTED 300,000 PREMISES Ea occurrence $ PBP2747539 12/31/2015 12/31/2016 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X JECT POLICY❑ PRO ❑ LOC PRODUCTS-COMP/OP AGG S 2,000,000 OTHER: Contractors Plus Endt S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1'000,000 Ea accident A ANY AUTO BODILY INJURY(Per person) $ 20,000 ALL OVMIED X SCHEDULED BAP2370166 03 12/31/2015 12/31/2016 BODILY INJURY(Per accident) S 40,000 AUTOS AUTOS X X NON-OVMIED PROPERTY DAMAGE- (PL S HIRED AUTOS AUTOSr accident Medical payments I S 5,000 UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTIONS $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? N I A 13 (Mandatory in NH) WC004962937 6/20/2015 6/20/2016 E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate holder as listed below This certificate of insurance represents coverage currently in effect and may or may not be in compliance with any written contract. 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 384 Osgood Street ACCORDANCE WITH THE POLICY PROVISIONS. North Andover, MA 01845 AUTHORIZED REPRESENTATIVE P MacDonald CPCU, CIC ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401) - ! ��G (('(1472�72Cti77t(ll,'f!-/�✓G(J��'l�fl:S�f/f1�j`.�St'6'�,�:i ffice of Consumer Affairs&Business Regulation . ME IMPROVEMENT CONTRACTOR egistration; .107002 -, Type:! Expiration 8/5/2016 r Supplement71 f, COTE&FOSTER CONT WILLIAM FOSTER 20 Aegean Dr Unit 15 G tlejllUen,MK01844 Undersecretary �. N9assahusetts - -- - -- - ---- - -Oepa aar rfinent Off� - - --- OfS0idding a, uiatiQns �biieSafet C,3, tYrsct#�;fi anci Star€ ar �3Frr3'ISol- \ License: CS-08$173 WILIJ6AMT FOSAR AC,EID-R DRACUT N1A 01W26 r commissioner Expiratioll 11/10/2016 Jf a