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HomeMy WebLinkAboutBuilding Permit #304-16 - 100 PHILLIPS COMMON 9/9/2015 E 9 ZZ ism BUILDING PERMIT of TOWN OF NORTH ANDOVER ,�� y -' 46 li APPLICATION FOR PLAN EXAMINATION . �6 ' Date Received A� Permit No#: 7gA�RAre.�PPtgS SSAC H►lsfc I Date Issued: t IMPORTANT: Applicant ust complete all items on this page LOCATION lob r� I � " � Print PROPERTY OWNER Vv Print PROPERTY us Print 100 Year Structure yesno MAP PARCEL:_ ZONING DISTRICT: Historic District yes no Machine Shop Village ye no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ne family ❑ Addition ❑Two or more family ❑ Industrial Iteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other 0 Septic 1-]1Nell ❑ Floodplain- D Wetland- u ❑ ?1Natershedd District, : i {� Water/Sewer _ - i; DESC PR,� TION OF W RK TO BE PERFORMED: I Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: 15al37 Contractor Nam e: �v, Q � (�CZone: ��� Email: Address: Supervisor's Construction License: LO &S �D Exp. Date: 3-33-U9 . Home Improvement License: 7 3�S S Exp. Date: V,a a la 4►( ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. ,)CDtal Project Cost: FEE: �_ vr� 15 1 Check No.: ay Z Receipt No.:1�p I> NOTE: Persons contracting with unregistered contractors do not have access to the gu ranty fund _ - . Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dinupster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature 4 COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town )Engineer: Signature: .. Located 384 Osgood Street FIRE in E. - Temp ®umpsteron siteyes ,� '' ' no r ` i Located at 124 Main Street ? a Fir - �`Rs %' ' .{ry4 tt¢ fit.-til € r'�r+r"�"F� " e De r, �-. it _ M. v . P� t,si. nature/date . � ,: t ,..gip g ���� ��� �, .�,�. ,,^ t•,t '�.1 � 5,�,$`R ^ ' g,a�,ta.�s�.} t` }Ft cr. ° 'p`�*^r r. ` a�'j" rF�`-a n ` i r '".�T�"`P" -''`• qv- .�, r 1 r a8 �L, �. �` C• x n,�' � '.sa s `�'-s &,h`�i.'*r a � �.'� +.�'i��4+�rte', 2t:-,...4..+�.. +.....—G.,i .:.a. .:ar, .4c-ate.► � i-:&$...., i=..� s s�. 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 rase) I I i ® Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 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 OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks j 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 OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit - I' New Construction (Single and Two Family) 6 Building Permit Application Certified Proposed Plot Plan Photo of H.I.C. And C.S.L. Licenses Workers Comp Affidavit Two Sets of BuildingPlans One To Be Returned to Include Sprinkler Plan And ( ) Hydraulic Calculations (If Applicable) Copy of Contract 2012 IECC Energy code 4, Engineering Affidavits for Engineered products OTE: 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 e 1 Date . ' TOWN OF NORTH ANDOVER Certificate of Occupancy $ k - Building/Frame Permit Fee �•"^ Foundation Permit Fee °�- Other Permit Fee TOTAL 4 M ( Check# l t Building Inspector NORTH own of F �. Andover 0 . 0 No. oh ver, Mass, COCMIc«ewKK �1' �a pDAATED � S U BOARD OF HEALTH Food/Kitchen PERMIT L D Septic System • THIS CERTIFIES THAT 4 ......... BUILDING INSPECTOR ........... ...... .... . ........ ......v. :.. .............................. has permission to erect .......................... buildings on h..f.!.eFoundation • e Rough to be occupied as .. .... .. ..�!' ... ........!.! ... > .!`.......*-........ ......... 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 53. RoughPERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCT40NTS Service .......... ..... .... ..... ........................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy 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. Back River Development 231 North End Boulevard Salisbury, MA 01952 (978) 852-3733 CONTRACT To: Walter Radulski Date: September 8, 2015 Re: Exterior repairs to residence at 100 Phillips Common N. Andover, MA Scope of services Back River Development will be responsible for the following: Front door o Remove and dispose of existing front door o Install new door with interior and exterior trim o Prep area around door for painting Exterior siding and trim o Remove and replace approximately 15-20 pieces of siding and trim Rails o Install 3 new 36"Transform rail system o Install 5"posts throughout with base and cap TOTAL COST $ 4,400.00 Terms and Conditions 1. Contractor agrees to furnish all necessary labor, materials, tools and equipment to complete the work outlined in the scope of services. r 2. Contractor shall provide copies of a valid builder's license and proof of liability and workers' compensation insurance prior to commencement of any work. 3. Contractor-agrees,to complete the Scope of Services in a timely, professional manner in accordance with the specifications set forth by the architect and engineers, and in compliance with state and local building regulations. 4. Contractor agrees to clean all debris from construction only and to keep job site in a clean and workable condition at all times 5. Homeowner shall be responsible for any costs occurring from engineering or architectural plans and site work and any costs incurred from permitting, zoning board of appeals, planning or DEP. 6. Any costs incurred from hazardous materials found during construction are the responsibility of the homeowner 7. Homeowner is responsible for contacting utility companies for disconnect and new hook ups, cable,telephone,gas and electric and any costs that results from these services. 8. Manufacturers' warranties will be turned over to the homeowner and become the homeowner's responsibility to file and pursue any defects or problems that may occur. 9. Any materials, products, or labor not specifically mentioned in scope of services is not covered under contract and will be paid for out of allowance fund or billed to homeowner 10. Homeowner is responsible for any price increase in materials prior to signing of contract 11. Homeowner (not lender) is ultimately responsible for payment upon completion of services and receipt of invoices PAYMENT SCHEDULE The payment for the contract will be as follows 50%upon execution of contract 2,200.00 50%upon completion of project 2,200.00 Walter Radulski,Homeowner William J. Fe6is, Back River Development The Commonwealth of Massachusetts z . Department oflndusiWarAccadents r d 1 Congress Street,Suite 100 Boston,MA.02114-2017 F www.mass.go v7dza Sy. Workers'Compensation.Insurance Affidavit:Builders/Contractors/Eleetricians/Plumbers. TO BE FILED WITH TEE PERIdIt MG AUTHORITY. Applicant Information Please Print Legib Name(siitsiness/Organization&dividual): Address: Citylstate/Zip: - <CIL Phone Axeyou an employer?Cbecktlie appropriate box: Type of project(required): 6 1.�Iamaemployer with —employees(fall and/or parttime).* 7. ❑New construction 2.E]I am a sole proprietor or partnership and have no employees working for me in g. [1 Remo delirig any capacity.No workers'comp.insurance required.] o workers'coin .insurance required.]t 9. ❑Demolition eo er Join all work myself. p q ] . 3..Qlamahom homeowner g � 10 []Building addition 4.❑I am a homeowner andwill 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.Q Electrical repairs or additions proprietors with no employees. 1i plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.0 Roof repairs These sub-contractors have employees and have workers'comp.insurance.T 6.Q We are a corporation and its of�cers have exercised their right of'exemption per MGL c. 14.❑Other 152,§1(4),and wo have no.employees.[No workers'comp.insurance required.] *Any applicant that checks box 4l must also rill out the section below showing their workers'compensation policy information. Y Homeowners who submit this affidavit indicating they are doing all work andthen hire outside contractors must submit anew 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-c' ctors have employees,they must provide their workers'comp.policy number. lam an employer tliat ispidvlding workers'compensation insurance for my employees'Below is thepolicy androb site information. Insurance Company Name: i°�rz,f r --��5 � ✓ �a i — Policy#or Self-ins,I,ic.#: V" ����'��l� `� ��� Expiration Dater Job Site Address: V City/State/Zip: Attach a copy of the workers'comp exisataon•policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MCTL o.152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a SWOP 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 Offica of Investigations of the DIA.for insurance coverage verification. X do hereby certify under the pains andpenalties ofperfury Haat the information provided above is true and correct. Signature: Date: Phone#: Official use only. -deo 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#: DATE(MM/DD/YYYY) .4C - CERTIFICATE OF LIABILITY INSURANCE 9/1/2015 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(ies)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 CONTACT NAME: M P ROBERTS INS AGCY INC HONE Ext: (978) 683-8073 FAX 1060 Osgood Street E-MAIL (A/C.No:(978) 683-3147 ADDREss:paula@mprobertsinsurance.com North Andover, MA 01845 INSURER(S) AFFORDING COVERAGE NAICN pip INSURER A:MERCHANTS INSURANCE GROUP INSURED BACKRIVER DEVELOPMENT, LLC. INSURER B: 231 NORTH END BLVD INSURER C: SALISBURY, MA 01952 INSURER D:ASSOCIATED EMPLOYERS INS CO 978-852-3733—Bill INSURER E 978-804-9383-Brian 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE IVSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1 000,000 DAMAGE TO RENTED CLAIMS-MADE CI OCCUR PREMISES Ea occurrence $ 500,000 X PRIMARY & BOPI080037 06/20/15 06/20/16 MED EXP(Any one person) $ 5,000 A NON—CONTRIBUTORY Y PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY CI JEC PROT CI LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY MBIN DIN LE LIMIT Ea accident $ 1,000,000 ANYAUTO BODILY INJURY(Per person) $ ALL OWNEDSCHEDULED BOPI080037 06/20/15 06/20/16 A AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS Per accident $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I RETENTION$ $ WORKERS COMPENSATION PER 0TH- AND EMPLOYERS'LIABILITY YIN WCC50050142202015A 01/12/15 01/12/16 EXCLUDED? EACH ACCIDENT $ 50O000 X STATUTE ER ANY PROPRIETOR/ R/EXECUTIVE E.L. D OFFICER/MEMBER EXCLUDED? CI NSA � If yes, i describe under E.L.DISEASE-EA EMPLOYEE$ 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION WALTER RADULSKI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 100 PHILLIPS COMMON THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN NORTH ANDOVER MA 01845 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2014 AC RR CORORATION. All rights reserved. ACORD25(2014/01) The ACORD name and logo are registered marks of ACORD 1 Massachusetts -Department of Public Safety Board of Building Regulations.and.Standards License. OS-065006 z BRIAN A LYNCH -31 SEVEN STAR" GROVELAND 18P34, ` .1 rV J.�..+ .?r O Expiration commissi oner . 11/15/2015 License or registration valid for individul use only before the expiration date. If found return to: -Office of Consumer Affairs and Business Regulation "lO Parlt Plaza-T, u to 5170:. . Boston,MA 02116 ;- � J � f Not val' wi ou lire