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Home My WebLink AboutBuilding Permit #573 - 1 Village Green 3/26/2010 H BUILDING PERMIT otNORTH tt,�D gtio TOWN OF NORTH ANDOVER ?`': '`- 0p APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received ^reD s%�`r Id �SSACHU`�E( Date Issued:0 Q�{o IMPORTANT: Applicant must complete all items on this page LOCATION 1 Print ti PROPERTY OWNER d :f" I`wb Print 1 MAP 210 PARCEL: ZONING DISTRICT: Historic District yes _ 6 41 Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One famil Addition Tw�unmitosr:6 �; Industrial Alteration I;o. Commercial Repair, replacemen Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands- Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: O- OAQJ iii S fin) 660 14 lel 1,0?111 IdentificaY n Please Type or Print Clearly) OWNER: Name: �iu, MS 0eci4-T70 1V Phone' '��'� Address: ��/ � I /�3'St�G: el," ' OV-elz CONTRACTOR Name: Rwd44.ol Phone. d Address;_ 1'� �► Supervisor's Construction License: 35 Exp. Date: 9/3/ /r y , i Home Improvement License: Exp. Date:, / ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:MOO PER$10 0.00 OF THF©TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 1 FEE: $ Check No.: Receipt No.': 2-1 NOTE: Persons contracting with unregistered contractors do not have access to the g aranty $ nature of A ent/Owne g _ gi�eJ Signature of contractor Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art Swimming Pools Well We 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 DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature _t x COMMENTS Y 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 Main Street Fire Department signature/date COMMENTS 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 NOTES and DATA— (For department use) ❑ Notified for pickup - Date Doc.Building Permit Revised 2010 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 P P 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:Building Permit Revised 2008 SAO RTit Town of 4Andover . 70 * _ - W. LAKE Clover, Mass., %3 Z� • • COC MIC ME WICK �� ORATED O`? 7 BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System THIS CERTIFIES THAT.......4.4.11. BUILDING INSPECTOR .....'.�Ili ............. 00 ....1111� ......................... """""'""" """"""' Foundation has permission to erect.......................... ............ buildings .t ... ... .........I...... .......... Rough to be occupied as../.D........... �t ./`!........ , Chimney ey provided that the person accep ng this permit shall in every respect conform to the terms of the application. .......on....file. ....in.. Chi Final 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 PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRU N STARTS ELECTRICAL INSPECTOR Rough .... .. .............. ..........................................:................................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Finalh No Lathing or Dry wall To Be Done Until Inspected and Approved by the Building Inspector. Burner FIRE DEPARTMENT Street No. 1[_SEE REVERSE SIDE Smoke Det. From:Nata"Rufa FaxID:Santo Insurance Page 2 of 3 Date:326/2010 09:09 AM Page:2 of 3 CERTIFICATE OF LIABILITY INSURANCE OP ID NN FDATE(MMIDDIYYYY) SALEM-2 03/26/10 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Santo Insurance - Salem HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 224 Main Street, Suite 2A ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Salem NH 03079 Phone:603-890-6439 Fax:603-890-0315 INSURERS AFFORDING COVERAGE NAIL# INSURED INSURER A: ezogxasaiv Insutand cosipany INSURER B: St Paul Travelers Salem Vinyl Siding LLC INSURER C: Glenn Cot 46 Herrick Circle INSURER D: Pelham NH 03076 INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR SR TYPE OF INSURANCE POLICY NUMBER DATE(UI DDIYYYY) DATE(MMIDD/YYYY) LIARS GENERAL LIABR.ITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY PREMISES(Ee occurence) $ CLAIMS MADE �OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY 7 jEa LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT A ANY AUTO 08921148-5 01/21/10 01/21/11 (Eeeccidert) $750000 ALL OWNED AUTOS BODILY INJURY X SCHEDULED AUTOS (Per person) $ HIREDAUTOS BODILY INJURY NON-OWNED AUTOS (Per eccidert) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABI.rTY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS I UMBRELLA LIABfl.RY EACH OCCURRENCE $ OCCUR F]CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION X LIM TORY ITS ER AND EMPLOYERS'LIABILITY B ANY PROPRIETOR/PARTNER(EXECUTIVE 0 6KUB0243N16509 03/24/10 03/24/11 E.L.EACH ACCIDENT $100000 OFFICERMEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $100000 It yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $500000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS WC 3A state NH Glenn Cote is excluded CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION TOWNNAN DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR Town of North Andover REPRESENTATIVES. Attn: Bldg Dept AUTHORIZED REPRESENTATIVE 400 Osgood St James A Santo orth Andover MA 01845 ACORD 25(2009101) 01988-2009 ACORD CORPORATION. AN rights reserved The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts Department ofTndustrial Accidents Office of investigations 600 Washington Street Boston, MA 02111 www.mas&gorldia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LeQibl Name(Business/Organization/IndiJidual): ` Address: City/State/Zip: Od� �/ Phone 3.--c46' FV-E1 ou an employer?Check the appropriateox: am a employer with 4. I am a general contractor and I TyE f project(required): employees(full and/or part-time).* ave hired the sub-contractors 6 New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet l 7• ❑Remodeling ship and have no employees These sub. contractors have working for me in any capacity. workers' comp.insurance. g' Demolition [No workers' comp. insurance 5. ❑ We are a corporation and its 9. ❑Building addition 3.❑ required.] officers have exercised their 10.❑Electrical repairs or additions 1 am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers'comp. c. 152,§1(4),and we have no insurance required.] t 12.E]Roof repairs q ] employees_ [No workers' POMP.insurance required.] 13.[]Other :Any applicant that checks box#1 must also rill out the section below shon2n^ _ _ t Homeowners who submit tris affidavit indicating they are doing all work and th nrh $Contractors that check this box must attached an additional sheet showing outside contractors must.submit a new affidavit indicating such. the name of the sub-contractors I sub contractors and their workers'comp.policy informatiam an employer that is providing workers'compensation insuranceforinformatonmy employees. Below is the policy and job site Insurance Company Name: Q,Uf�f � r Policy#or Self-ins.Lic.#: V Expiration Date: Job Site Address: ��QSd� WI City/State/Zip:_&/dw?2 iIA_ 61,,4 Attach a copy of the workers'compensation policy declaration page(showing Failure to secure coverage as required under Section 25the policy number and expiration date). A of MGL 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 I do hereby certify under pains and p/al ' 'oferjury that the information provided above is true and correct Si ature: Date.: d 3•— � --•07�/ 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): Z. Board of Health 2.Building,Department 3.City/Town Clerk 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 of hire, 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-contractor(s)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 may be 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 perruit 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(if necessary) 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 Commonwealth of Massachusetts Department of Industrial Accidents Office of Invesfitggatons 600 Washington Street Boston,MA 021.11 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax#617-72.7-7749 wv,-v7.m ass..g ov/di a F' Massachusetts- Department of Public Safety Board of Building .� Regulations and Standards Construction Supervisor License License: CS 35152 Restricted to: 00 GLENN C COTE 46 HERRICK CIRCLE PELHAM, NH 03076 r Expiration: 8/31/2011 ('umnrissiuncr Tr#: 7240 J 0/ ffam"i Office of Consumer Affairs&Business Regulation I HOME IMPROVEMENT CONTRACTOR Registration,1,,x,14134 Expiratto3r #6/ZIAi,1 Tr# 291434 TYpeh,i� h,jl hl�7=2E �c-uu- s1's-1SalemVinyl,Sid' in :c � ' ,. GLENN COTE 46 HERRICK CIR6E' �._; �� d n PELHAM,NH 03076'1 :`r" Undersecretary J CERTIFIED z . i VINYL SIDING f INSTALLER `R ASTM D4756 #800003878 5°°nsored by tris VW Skft Insihiute s Cote,Glenn Expires: 03/01/11 46 Herrick Circle Administered By: Pelham,New Hampshire 03076 �L Architectural Testing,inc. t Salem Vinyl Siding & Windows LLC 46 Herrick Circle, Pelham, MH 03076 Glenn C. Cote.......... 603-893-8043 -------------------------------------------------------------------------------------------- Name of Purchaser: PropertyManagement of Andover Date:01-26-2010 Address: P.O. Box 488 Phone#:978-973-3038....fax 978-686-4664 City: Andover State: Mass Zip Code: 01810 Project: Village Green Condo Association, Rt 125, North Andover Mass. 01845 Proposal for : ....Front Entrance and Rear doors.... #1. Furnish and install Harvey Therma-Tru, entrance door unit............$ 2,289.00 Style: S-210.... no-glass door.... Finish: smooth fiberglass Size: 3'x 6'8" Side-lites: 2 units.... with 14"x 6'8"side lites with %2 glass Wall thickness: 2"x 4" Exterior Casing: Primed pine 908 design casing or 5/4" 1"x 4"Flat primed pine. Interior Casing: Primed 2 '/2"colonial style molding pine casing Door slab: primed from factory... finish paint coat not included . Door handle: Handle set only(no dead bolt) Brass finish........ additional Location: Front entrance nnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnAAAAAnnnnnnnnnnnnn 42. Furnish and install Harvey Therma-Tru Smooth Star.....................$ 873.00 Style: S-210.... no-glass door.... Finish: smooth fiberglass Size: 3'x 6'8" Side-lites: none Wall thickness: 2"x 4" Exterior Casing: Primed pine 908 design casing or 5/4" 1"x 4"Flat primed pine. Interior Casing: Primed 2 '/z"colonial style molding pine casing Door slab: primed from factory... finish paint coat not included Door handle: Handle set only (no dead bolt) Brass finish........ additional. Location: Rear entrance AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA #3. Schlage Plymouth Knob locking handle set without dead bolt.........$ 95.00 each /AAAA/VVI/AAAA AAAAAAAAAAAAA AAAAAAAAA AAAAA AAAA AAAAAAAA AAAAA AAAA AAA Sub Total: Front Entrance door with side-lites...................................$ 2,289.00 Rear Entrance door ...................................................... 873.00 Two Schlage entrance knob kits with numbered keys alike $ 190.00 SubTotal...............................................................................$3,352.00 Project for 1 building: 2 doors for I garden style building. ......$ 3,352.00 ................. Project for 5 buildings; 5 Front doors and 5 rear doors with handle sets x 5 Buildings Total project......as described above..............................................$ 16,760.00 ze 11 We agree to pay for the aforementione materials and labor the sum of $...16,760.00....Dollars, in the fo wing manner: Deposit herewith, $...5,260.00..:and the balance of$ ...11,300.00...to be divided into ...(2) equal installment of$...5,650.00....as deemed appropriate by the seller. This order is subject to acceptance by the seller. The seller shall not be liable for delays caused by strikes, shortage of material or any other causes beyond his control. THE SELLER WARRANTS THAT IT WILL PERFORM THE TERMS OF THIS CONTRACT IN A GOOD AND WORKMANLIKE MANNER AND MAKES NO OTHER WARRANTIES EXPRESSED OR IMPLIED OTHER THAN THOSE WRITTEN WARRANTIES OF THE MANUFACTURER AND FURNISHED TO THE BUYER BY THE SELLER OF ANY GOODS OR MATERIALS SUPPLIED BY THE SELLER. Title to all the materials shall remain with the seller until this contract is paid for in full and according to the terms stated previously. The seller may at his election remove the materials without liability for damage or otherwise unless payment is made within the time herein specified and retain payments made as liquidated damages without legal process. The materials covered hereby shall remain personal property even though affixed or attached to the building in which it may be contained. You may cancel this agreement by a written notice directed to the seller at his main office by ordinary mail posted, by telegram sent or by delivery,not later than midnight of the third business day following the signing of this agreement. This constitutes the entire agreement, and not other agreement, oral or written, expressed or implied shall qualify the terms herein. Any amount overdue subject to 2%monthly interest and any reasonable legal fees necessary to collect thereof. 39 Years Experience Mass Lie,#CS 035152' Mass i:1 C # 11404 _ VSI Lie;#8,60003879. ins i�Tiit'ionwide&Travelers ` Glenn C. Cote , Agreement Understood !/ Salesmar� .. Accepted Date: _01-26-2010_ Accepted by: Elaine Romano Property Management of Andover for Village Green Condominiums Location , rr -P No. J 7 ` ✓ Date ,v NORTH TOWN OF NORTH ANDOVER 0 9 s Certificate of Occupancy $ ��s'""'•Eta Building/Frame Permit Fee $ +cMUs r Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check #C 22x79 Building Inspector