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Home My WebLink AboutBuilding Permit #339-15 - 100 OLD FARM ROAD 10/6/2014 BUILDING PERMIT "O RT b;�tio o� TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION * ,� �o K 41 Permit No#: Date Received �4"0R,rEo �e RSSAC H�15�� Date Issued: / IMPORTANT: Applicant must complete all items on this page LOCATION / �' �I�C rAem GCd� Anr a � Print PROPERTY OWNER SCO A- Print 100 Year Structure yes no MAP 0�< PARCEL:��ZONING DISTRICT: Historic District yes no `Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ne family ❑Addition ❑Two or more family ❑ Industrial C-Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic []Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: 4w,W4P eak9z�'.t[.s i�/1 �✓ y f�as-z,�' oin�r 4�•of1°C ��3�i��+ G �� Identification- Please Type or Print Clearly OWNER: Name: Scor-F Phone: SSC-S'S'A �G Address: Contractor Name:)j�e Bl f� Phone- !27*- 99�e Address: `rq ` T— Supervisor's Construction License: L'S~t��S��so Exp. Date:! a /Z6/ Home Improvement License: J�/1�l fExp. Date: �Z ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED //OO�N$125.00 PER S.F. Total Project Cost: $ 2 �-00'C9C-:) FEE: $ "/7•�0 Check No.: /,;? ZZ-5 Receipt No.: 42J-,/6y NOTE: Pers cson Persons with unregistered contractors do not have access to the guaranty fund Signature of AgenVOwner _ Signature of contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE"OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swinuning 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 Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS ti ti 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 Call Email Date Time Contact Name Doc.Building Permit Revised 2014 i 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/Cross Section/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:Building Permit Revised 2014 Location /,00 v h-1 No. Date . - TOWN OF NORTH ANDOVER � S�''C��j6g6• • Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check#,/�7413 Building Inspector Ci General Contractor ESTIMATE Contractor/Supervisor Lic. #065280 Joe Blanchet Home Improvement Lic. # 145193 124 Lake Street Fully Insured Haverhill, MA 01832 978-994-6134 Date of Estimate: October 4, 2014 Client Name: Scott Bowman Job Location: same Address: 100 Old Farm Rd. North Andover Ma.01845 Phone: 508-958-9697 Description of Work: Renovate walk in closet adding a dormer - Remove approximately 13 feet of the back half of the roof on the garage - Frame dormer according to drawing with three windows on the back wall of existing garage - Frame roof according to drawing - 5/8 plywood roof and '/2 plywood on the walls - Walls will be tyveked and roof will have ice and water ready to be roofed - Pine trim will match existing house trim - Dormer will be covered with cedar pre-primed clapboard to match existing house style Owner responsibility: supply windows: also to have it roofed: finish interior: exterior painting Additional Work: Any alteration or deviation from above specifications involving extras or vendor price increases will be discussed and will become an added charge over and above the estimate. Work performed at$60.00 per hour/per man. Laborers will be $23.50 per hour/per man. Total Cost of Estimate: $7800.00 Payment: A deposit is required before work can be started. Startin pa ent will be %2 and balance due upon completion. Quote is good for 30 days i � � f 1 f � 1 E i ° 7 NS�ll�n M�1 ►� 1 � 1 M i` �14 0-h rl Z � 1,9' r f sr-Y f 1 - - - - - - - -� _ �,..+ >✓ �o oma/ iLe - t / 1 E 1 4t $ t r` ! X o/ o i 5r, -15 ref v a'- 1 ' t 4 � General Contractor ESTIMATE Contractor/Supervisor Lic. #065280 Joe Blanchet Home Improvement Lic. # 145193 124 Lake Street Fully Insured Haverhill, MA 01832 978-994-6134 Date of Estimate: October 4, 2014 Client Name: Scott Bowman Job Location: same Address: 100 Old Farm Rd. North Andover Ma.01845 Phone: 508-958-9697 Description of Work: Renovate walk in closet adding a dormer - Remove approximately 13 feet of the back half of the roof on the garage - Frame dormer according to drawing with three windows on the back wall of existing garage - Frame roof according to drawing - 5/8 plywood roof and 1/2 plywood on the walls - Walls will be tyveked and roof will have ice and water ready to be roofed - Pine trim will match existing house trim - Dormer will be covered with cedar pre-primed clapboard to match existing house style Owner responsibility: supply windows: also to have it roofed: finish interior: exterior painting Additional Work: Any alteration or deviation from above specifications involving extras or vendor price increases will be discussed and will become an added charge over and above the estimate. Work performed at$60.00 per hour/per man. Laborers will be $23.50 per hour/per man. Total Cost of Estimate: $7800.00 i Payment: A deposit is required before work can be started. Startin pa ent will be 1/2 and balance due upon completion. Quote is good for 30 days rtment of Public Safety Massachusetts -Re aulat ons and Standards Board of Building g . I Construction Super,isor License: CS-065280r�', JOSEPH GBLAN� o rte% 124 LAIC S 1iAVFPJMLMA 01852 r Expiration 09/20/2015 Commissioner C��e�osrzo�roruaecr-lGf a��arscrc�u;telt � Office of Consumer Affairs&Business Regulation OME IMPROVEMENT CONTRACTOR egistration: 145193 Type xpi ration. 12/22/2014 Individual JOSEPH BLACHET JOSEPH BLANCHET 124 LAKE ST. ATKINSON, MA 08311 Undersecretary i 1 I - � 9 x7- 1-7-1 h z Z -- - - --- ,.�, o7 � I ZZ s „X _ � . SCOL UjohlJI-I i�uJ f ion"f�06�2 i l ("-!r' 7-0 N -7 err r Zvii �` - ' ZLlr o,, /b f/ : _Al j rZ?A/�4� ule�wW_ &WI� y a ��i r raSvJre n� SCOL ,�617�1 �n,GCi�J c.t' ftp 1 t�- Id �y�w LX,� (orr�SCKsa.a I � I -10 ' 7-0`' I� Ell i , /b Q7dG�I,vr.�rz2 S�/�L (l/L� r�J W raj �N �>vCC Pro dSG Ile 01 e 771ar Z /—a AW,44 A,) S� s� Ili�� writ E�u��,c� �v/T ep e,�- r'r.Sw w /ilk ,} ZxiO 70� �� I - S Ali 3+ II ! Lli of I El 9 yy r Z /—o I _/I rt .0 Garage 1 7177unEE New Cele,m,nece Addition Rear View Scott Bowman 100 Old Farm Road North Andover 508-958-9697 i Addition(Not to scale) Garage side View ❑❑❑ ❑❑❑ 0 Garage New Char minnce Addition Rear View Scott Bowman 100 Old Farm Road North Andover 508-958-9697 Addition(Not to scale) Garage side Mew ❑❑❑ ❑❑❑ ❑❑❑ 0 The Commonwealth of Massachusetts - Department ofIndustrigl Accidents Office of Investigations 600 Washington Street Boston,MA. 02111 UV. www.mass gov1dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le;sibly Name(Susiness/Organizatiordlndividual): Address: ?-c-( City/State/Zip: o1&-5z_- Phone#: 9-78 3 g V Are you an employer?Check the appropriate bog: Type of project(required): 1.❑ I am a employer with 4. El am a general contractor and I 6. EJ New construction employees(full and/or part-time).* have hired the sub-contractors 2, am a sole proprietor or partner- listed on the attached sheet. ❑Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. ❑Building addition [No workers' comp.insurance 5. El We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I 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 12.❑Roof repairs insurance required.]t employees.[No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. I-Homeowners who submit this affidavit indicating they are 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 Name:. Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: 166' { rl,1 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 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 may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certo under the pains and penalties ofperjury that the information provided above is true and correct. Signature: d- i5aw Date: Phone#: 7 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): 1.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 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(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 Coxa onwealtl of Massachusetts Department of Industdal Accidents Office of Investigations 600 Washington Street Boston}MA.02111 Tel#617-727-4900 ext 406 o>;1-87T MASSA E Revised 5-26-05 Fax##617-727-7749 www=ass.gov/dia Oct 6 2014 9:35 P. 01 �'°'R'�' CERTIFICATE OF LIABILITY, INSURANCE . DATE(MMI°o,YYY,,, 10/6/2014•' 1414' 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 DOE8 NOT CONSTITUTE A CONTRACT BETWEEN THE' ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. 'IM P.ORTANT:' If the.certifii:Me holder is an ADDITIONAL INSURED,the policy(les) must be endorsed_ If SUBROGATION ISMAIVED,subjectlo. the;'terrhs end e'dndltlons of the policy,certain Polldes may require an endorsement. A'statement on this Certificate doss not confer rights to the CoMfiicate holder in lieu of such endorsoMAnt(s)_ PRODUCER CONTACT Kathleen M111er, CISR, CPIW Insurance SOlutiLohs Corporation PNONE (603)382-A 600 FAC No), (603)382-203G 60 Westville Rd E-MAIL ,lcmill6r@iac-insuranae.com D INSURERS AFFORDING COVERAGE NAIC 4 Plaistow NH 03865 INSURER AMerchants 2332§ INSURED INSURER B JOSEPH• BLANCHET INSURER C DBA'.A B CUSTOM CARPENTRY INSURER D: 24 TAYLOR STREET INSURER E: H&VERHILL MA 01832-2531 INSURER F: COVERAGES. CERTIFICATE NUMBER:CL1410618605. - 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' 1NDI,CATED. 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. LTR TYPE OF INSURANCE ADDL UBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS :OENpRALLIA6(LITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMA E T RENTED PREMISES Esoocurtence $ 500,000 A CLAIMS-MADE EilOCCUR BopiO50253 7/7/2014 7/7/2015 MED EXP(Any one erson $ 15',000 PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S 2,000,000 X POLICY PRO- LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea acciden ANY AUTO BODILY INJURY(Pa parson) S A.I.OWNED 'SCHEDULED AUTOS AUTOS BODILY INJURY(Per acelden) S NON-OWNED = RTY APVrTS HIRED AUTOS AUTOSIdp :UMBRELLA LIAR. OCCUR EACH OCCURRENCE.- $ EXCESS LIAR CLAIMS'MADE AGGREGATE $ D6D RETENTION 3 $ WORKERS COMPENSATION WC STATU-, 021 TH- D; , ANEMPLOYERS'LIABILITY Y!NJQRY R1ErOR/PARTNERIEXECUTIVE❑ N/A E.L.IEACMACCIDENT $ ANY.PROP OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE b If Si,describe under . DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If mora space is required) CERTIFICATE.HbLDER CANCELLATION. (978) 688-9542 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL 13E DELIVERED' IN Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood Street North Andover, MA 01845 AU7NORIPEO REPRESENTATIVE K Miller, CISR, CPIW/ ACORD 25(2010105); ®1.968-2010 AW11D CORPORATION. All rights reser'Ved. INS025(?aloosj:01 The ACORD name and logo are rigisterod'mark9 of ACQRD t%ORTH own of t EAndover 0 - No. � * t - h ver, Mass,L K1 COCNIC Nl W.C% �- U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System BUILDING INSPECTOR THIS CERTIFIES THAT ..............C�. ..!�l? .11� ��! ................................................................. has permission to erect .......................... buildings on ..../". ......... .� . ,{ .. :". a;�..., ��,,,,,,,,,,,,,,, Foundation Rough to be occupied as .. . :�1�..�T.. 6......1/. :.'��, lf.f'...'.....G. cSE. ........................ 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 IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION TS Rough ............... Service ................. ..... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required c c u p V Puliki/ice 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.