Loading...
HomeMy WebLinkAboutBuilding Permit #133-2011 - 104 MAIN STREET 8/17/2010 BUILDING PERMITof "ORT" tt`ec ,6 N TOWN OF NORTH ANDOVER o� h` �°� APPLICATION FOR PLAN EXAMINATION A p?� �� w^o Permit NO:J2J Date Received 74�°N�7eo►�4.�* Date Issued: f�j� 7/�D �SSACHU`'�� IMPORTANT:Applicant must complete all items on this page ;-. ``a......=.:f"b e^cr- •,:-,aii.i64�_ri3.•='.E.�' =nN'^'_;ia1i�_ .:Ic�c - -- th1"r:.ri=:':✓. - _ _ �l-�_'`�.'- Y�•+:.�f'> ��. X ST f:.'-a�- 7 'JS ��"--4Y•Fiv. .>._ 3 f i.l -f r•F. Tr. � '+Fy�;;'.`z• r` r � > - �"'<�v�-c/ Z--Sr�� � -i-..-.$_c.^-ue-'.;�3:- .g y„� .:rdp aT'.-z`•� �l ;i'-j;-4--•� - �`r-r- ^i'1`};�•. r d'` M� -�- ., y r +� ,y+Se y_. }.."'r �'._-.cS f+,s a-<- c-7 e�.. {y '3'�t •s Ila ".;'3=� _�..�.X as �" :�`h =^£f �,-',F.t .,.,S:x-�,�.>� �r +. o�+�k...-•y-- 5 .r.4 i S t;'c C 4' 4 r ."E; "'"- n!'� Y ate" �• � r d u" _ - - �t;.r, j^ -r-_ .�.�w.`��•' 8s"� -�` w��`'_"'€_-s�€�.� .� E m..: � _s'' a'' s...✓ ' ;�7'- -'`ril' ry s�u's'r._ Ean.•, .x+. ,� ". 1 ar,.,� ;"i!!! 4.1 �^kaa�"��"' i� s.-_. <�'a 'r;,.."' ��+ q• ,�s.n„-,"° .N���'"z`zes. Y M -71 '« - � �' °µ' a �' '1$� �A�7 W Js.'l,Y.i W+.,[,�•��.�� w���<'tz"Srt!CG�S++(+£'�x'e...e'�.' h'.�;L�''�'J�F:..v _ ova.. � .Y2'1s• a y- �,--�„ S� � i �1J .fi- 4�i -". .,t 't' _ I .r,,-.s.'Stka�aue,�P�, -,. sr �i �'';~ -va ��.t,- -q; ,�_'�.'Y7'y'' s :7'�2- u?*'' '�"r }r'•' '��#_�'�.�"-.,. � c:=.�.-:�� r:'_ �v. .eu�.. 'a:*'•?'utrti�::�r'.7�F.•��.;s= a.. -+,;r,� �;t-R.,.wmr�'-`; a: - �.�,; .0 t t� '':'r"7vj�u TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration No. of units: Commercial, Repair, replacement Assessory Bldg Others: Demolition Other - ¢' P3a1TJA ,-� •I���� r't� f�' n r, -� T. 1.��, 5 �:'.g,>,..,.,.,:�:ya...�,F y4�:�-� a� xr"...�.':.�. :a�e,j, x��W1�NY•.eT ;'?�`��,, -�'`'6' 's•-��$-^4s�r�n �^+ aY, ",,�; ., .,-:,' .;E�a,��;������,,s�.d�•F�� - :+o��na>= `��r•e. _.��rY��x -ss;.�': xNa:�'y,.�k??ir�"�.-t�.�,.;-_�J.•.:.- 'i"���'�"''�xw -� ,a-,� ,t y- u �s,,. DESCRIPTION OF WORK TO BE PREFORMED: 5 � Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: tar ' x IS+� b }� },pry ,�7 " '.L�7'` A _.i�••I��'� yy��jr ; ,r^_ r'-;' S: JS3:MrCilM1�n.. rr.; , fj i_r ;f•.. -ems`as,.yt. ^�'������"Y iy„�,� -.a � � •e, i f'G' .;;�Jy���.�."—�^"' �� �?i F :�IYF�^�b` �� .�. se„u,.x'1Y,'.:k7�. ��i� _ y�.,� ,�,;,,'- �ir121 R 6✓ �{r $.�� Y �s�.k�E•.��� .r,�� k�����s."�rMk'�� � �.+Jxy S ^k�3�''s 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. Total Project Cost: $ FEE: $_ d�' Check No.: Receipt No.:?_.,33.2 <"- ' NOTE: Persons contracting with unregistered contractors do not have acce to the Pruaranty.fund SI naturefAr /17nr T 9� �_ J�-:. _ St9naure �F corgi_ 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 DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature ' 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 Connect ion/signature & Date Driveway Permit DPW Town Engineer: Signature: .. .. Located s o0 Street of _ .:4 , .. ..^:r.�'::,:a.::::.i:�i:�:.t:i':..:+.:.. :.-:ccs _ Pita i i......I . ...r�• .:..:..:_... ,,�.�_�•' �ini�!:. :'d^�I4i��. i:f�4:-:r+'I:J�'i�:`:;^'. N - _ v� _jai ;:,:v'.. .e rc „ _ .... :i�`.=R;i,,,u .1..�. — . vE > i� 1.IIl�: y .r. a`� z +......,. �i _ :. .r.. ..- {•�. �:�'.,:`:Vii, �.x. ...._r.:._... : .. ._. t _Dt� �+},per - _...-v.r..._._..._.:-:. ..•:.... ..: .....��-: -.�-........::�. - ` _ i.h , . :. ted. . .. .—.. ...... .... .... ., .._....._.. .. ... :.... .+. _.. ...,,• 'ate. -�=s„3 = .:!`=",_ _ r. 1 fIJI - I - .+•:Eve:... - r If.J �,,.•—�—a l - ? 4 — y A n- WM==AA ff ,[+ r' 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-21 A—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 o 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:Building Permit Revised 2008 Location No. ,/3�''�D�� Date i 7// &ORTN TOWN OF NORTH ANDOVER y a }�a Certificate of Occupancy $ �7 ITS ACHUSEt� Building/Frame Permit Fee $ 3� Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 3 �� At 0 233� ;> Building Inspector F NORTH Tovm of And TO No. o -_ LAKE O d.over, Mass., coC MIC"...:. �S RATED PP���� BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.......(/l-4!YC/.e/V14-F.... ..:!............... .................... Foundation has permission to erect........................................ buildings on ..05,1 . 7.0. ACORD CERTIFICATE OF LIABILITY INSURANCEOP ID DATE(MM/DD/YYYY) PRODUCER BONEM1 08/17/10 �'° , THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Whittemore Insurance �k, -,� '. j HOLDER.THIS CERTIFICATE DOES NOT AMEND EXTEND 501 Mammoth Road Londonderry NH 03053 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Phone: 603-432-2577 Fax:603-432-4700 INSURERS AFFORDING COVERAGE INSURED NAIC# INSURER A: NGM Insurance Company 14788 INSURER B: ACE American Insurance Company MJB Construction INSURER C: 11 Cove Street Derry NH 03038 INSURER D: 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 NSR TYPE OF INSURANCE POLICY NUMBER DATEYMM/DD/YY E PDATE M //D /YEXPIRATION LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1000000 A X COMMERCIAL GENERAL LIABILITY MPK0313N 04/30/10 04/30/11 PREMISEs(Ea occurence) $50000 CLAIMS MADE 4]OCCUR MED EXP(Any one person) $5000 PERSONAL&ADV INJURY $ 1000000 GENERAL AGGREGATE $2000000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- PRODUCTS-COMP/OPAGG $2000000 JECT LOC AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT $ (Ea accident) ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per person) $ HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ GARAGE LIABILITY (Per accident) AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR 7 CLAIMS MADE AGGREGATE $ DEDUCTIBLE RETENTION $ WORKERS COMPENSATION AND B EMPLOYERS'LIABILITY TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE 6S62UB-4280P69-4-10 07/03/10 07/03/11 E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? If yes,describe under E.L.DISEASE-EA EMPLOYEE $ SPECIAL PROVISIONS below E.L. OTHER DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Carpentry CERTIFICATE HOLDER CANCELLATION MACDONA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN MacDonald and Pangione NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Insurance Agency 104 Main St. IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR North Andover MA 01845 REPRESENTATIVES. A HO D RES TA ACORD 25(2001/08) ` l ©ACO D CORPORATION 1988 Certificate of Insurance This certifies that ❑ State Farm Fire and Casualty Company, Bloomington,Illinois ST1IT�RM ❑ State Farm General Insurance Company, Bloomington, Illinois ®® ❑ State Farm Fire and Casualty Company,Aurora,Ontario INSUR1NCEo ❑ State Farm Florida Insurance Company,Winter Haven,Florida ❑ State Farm Lloyds, Dallas,Texas insures the following policyholder for the coverages indicated below: Policyholder Jean-Pierre Bonenfant Address of policyholder 81 Chester Rd Location of operations Derry, NH 03038 Description of operations Carpenter-interior work The policies listed below have been issued to the policyholder for the policy periods shown.The insurance described in these policies is subject to all the terms, exclusions, and conditions of those policies.The limits of liability shown may have been reduced by any paid claims. Policy Period Limits of Liability Policy Number Type of Insurance Effective Date Expiration Date (at beginning of policy period) Comprehensive BODILY INJURY AND 44bbk4424 Business Liability 5-12-2010 5-12-2011 PROPERTY DAMAGE This insurance includes: Products-Completed Operations X Contractual Liability Each Occurrence $ 300,000.00 Personal Injury Advertising Injury General Aggregate $ 600,000.00 Product-Completed $ Operations Aggregate Policy Period BODILY INJURY AND PROPERTY DAMAGE Policy Number EXCESS LIABILITY Effective Date Expiration Date (Combined Single Limit) ❑ Umbrella Each Occurrence $ ❑ Other Aggregate $ Policy Period Effective Date i Expiration Date Part I- Workers Compensation-Statutory Workers'Compensation Part II-Employers Liability and Employers Liability Each Accident $ Disease-Each Employee $ Disease-Policy Limit $ Policy Period Limits of Liability Policy Number Type of Insurance Effective Date Expiration Date (at beginning of policy period) THE CERTIFICATE OF INSURANCE IS NOT A CONTRACT OF INSURANCE AND NEITHER AFFIRMATIVELY NOR NEGATIVELY AMENDS, EXTENDS OR ALTERS THE COVERAGE APPROVED BY ANY POLICY DESCRIBED HEREIN. Name and Address of Certification Holder If any of the described policies are canceled before their expiration date, State Farm®will try to mail a written notice to the certificate holder 30 days before cancellation. If we fail to mail such notice, no obligation or liability will be imposed on State Farm or its agents or representatives. Signature of Authorized Representative Insurance Rep 5-12-2010 Title Date Joe Ashooh Agent Name Telephone Number (603) 624-1000 Agent's Code Stamp Agent Code 1001260 AFO Code 106399.10 08-25-2009 Marco Bonenfant 11 Cove Drive Derry,NH 03038 978.360.0937 Michael Pangione 104 Main Street North Andover,MA 01845 Estimate:06282010 June 28,2010 Materials and Labor Price ROOF REPAIRS • Remove Roof,architectural roof section;approximately 2 squares including any sheathing affected and or not structurally sound. • Apply ice and water shield. • New Bin drip edge • Apply min 30yr architectural roof. • Remove all debris for premises Total Cost 1 $1800.00 Payment Plan and Acceptance of Job 06282010 Proposed price is$1800.00 Payments are to be made as outlined below. 1. A deposit of$900.00 is upon contract acceptance. 2. The final payment is due upon completion of job. AccepAwce of Estimate 06282010 The above prices,specifications and conditions are satisfactory and hereby accepted.You are authorized to do the work as specified.Payments will be made as outlined ove. Signature MJB nstruction Date Signature Owner Construction will begin on June 28,2010. Initials Initials Massachusetts- Department of Public SafetN Nw, Board of Building Rz„uluticws 11nI1,St"indards Construction.Supervis,& License' License: CS. ;4957 Restricted to '00 `. s JEAN P BONE4ANT' ; 1 DREW WOODS DR DERRY, NH 03038 Ex it p- tion: 7/12/2.011 Commissioner Tr#: 19104 ---- ----� -- -� - -.✓f7.2 IO�)26126?2GlJP2GffL /NCO�I'JCLCfLtILBCCd'. ' E Letts ,bTluild nI:lF i,+,<<ti ti�u ni�c�Ste s.:..- I HC°,E.IMa'RCVEM1t�L�IT Regi.stedion: i62540 . Expiration:.3/16/201. frF'Z .'• '3 ` �. Type: Cf?� I- JEAN,.PIERRF bONENF-ANT CON l`" ! JEAN-PIEIhE DONENf ANT 21 RESERVOIR ST F MEATHUE a,`SAA 0$44