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HomeMy WebLinkAboutBuilding Permit #931-2016 - 105 FOXHILL ROAD 3/2/2016— 4 LIP BUILDING PERMIT LL ,,oRTN w- O`�t LES Ib16 �•r0 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION R : . Permit No#: � Date Received gSSACH�15�� Date Issued: 2 PORTANT: Applicant must complete all items on this page LOCATION _Y f-A/ Z-.L Print PROPERTY OWNER Print 100 Year Structure yesCno MAP 037/ . PARCEL: °Z ZONING DISTRICT: Historic District yes Machine Shop Village yes 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 _- _ ❑ Septic ❑1Nell �GFaoodplain °Wetlands D \NatershedDstnct DESCRIPTION OF WORK TO BE PERFORMED: mo Identification- Please Type or Print Clearly OWNER Name: f-f�i o i 5 Phone: Address: Contractor Name: ��� F�s-�-£ .2 Phone: /�7 '._6 �"� >°:!5 / Ae- Email: h�//lam Lo f� a nc� � C-° Address: as Supervisor's Construction License` Exp. Date: . Home Improvement License: �a ��6 a Exp. Date: ARCH ITECT/ENGI NEER Phone: 4 L Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST 8 SED ON$125.00 PER S.F. �' FEE: AQ . Total Project Cost: S $ T � $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered on actors do not have access to t guaranty fund . :Aqen -10 Location" No. A U� Date i • - TOWN OF NORTH ANDOVER i Certificate of Occupancy $ Building/Frame Permit Fee . . - Foundation Permit Fee $ A Other Permit Fee $ p TOTAL Check# ` Ij Building Inspector I Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL i Public Sewer ❑ Tanniug/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 PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS I 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: FIRE DEPS'" Located 384 Osgood Street ART EM NTS Temp Dmpste on site Located at 124 Mam S reet' � R Fire Dertmen na u ; D t sig�- re/date I, mss , V ny # �P2e �i3Ai� Yd�[VialSs..e �'F il'2 tS Ga�a � d°A �'ti` - a' wx ¢b tj' 'C®MMENI S rr 'a .c+sh?.a,'t+*scr.z —•.ew.4 - .t ;r A .. �''.�°"��-�+�5�.'f..:1•:, '*,E�. x '1 .. �F aha. .' t 'f"t. "f.. �y`., '�`yii i ���id .�g7i �: 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 WNE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use) f i! 1 ® Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 t 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 r 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 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 New Construction (Single and Two Family) Building Permit Application 4, 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 2012 IECC Energy code 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 I Doc:Building Permit Revised 2014 r 1 NORTH . _ :. .c . . ver No. 261 z 2 h � ver, Mass o > > COC"IC"IWIC c y1. �as RATED LPa�,�S , ll BOARD OF HEALTH Food/Kitchen Septic System THIS CERTIFIES THAT PERMIT X ..A. .... BUILDING INSPECTOR ..... '�� ..... ...1. ........ ... ............ Foundation has permission totect .......................... buildings on .lori..44.'a A... a......�...... Rough Yr to be occupied as ...... ..��. .. �... ..........C .. ..� .. �� .�.... � 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 Rough VIOLATION of the Zoning or Building Regu Mons Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTI Rough 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. COTEfbl�l� FO,)TER-z CUSTOM. BUILDING + REMODELING This agreement made this 22"d day of October, ear Two thousand and Fifteen by and between Cote and Foster Contracting, Inc. hereinafter called the Contractor and Heidi Gladstone,hereinafter called the Owner, witnesses that the Dwner intends to remodel the existing front entry and side entry porticos at the address of 105 Fox Hill Rd, Andover, MA. Now,therefore, the Contractor and the Owner, for consideration hereinafter named, agree as follows: ARTIC E 1 The Contractor agrees to provide all the labor and 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. ARTICLE 2 In consideration of the performance of the contract,the Owner agrees to pay the Contractor,in current funds as compensation for his services hereunder$35,500.00 to be paid as follows: l� Payment 1 - $3,500.00 at signing of contract to acquire permit Y Payment 2 -$8,000.00 at start of demolition Payment 3-$8,000.00 at completion of front ent Payment 4 - $8,000.00 at completion of side entri ARTICLE 3 Final payment on contract amount as agreed above to be paid within ten(10)days of project completion or occupancy. 1f final p yment has not been made within this time a 10%charge per month on the balance due wi 1 be charge 1. All minor punchlist items will be complete as part of the one year warn on the fi 'sh product. Failure to pay balance within ninety(90) days may result in legal action. Initials: <: 'Sig a`: !—His-7r, 20 Aegean Drive - Unit 15 - Methue ,MAO 18 44 Tel: 978-682-6518 - ax: 978-68 -1221 w-ww.cotean fostencozn ARTICI E 4 Additional work above and beyond the contract agreem me .All additional work done to be quoted at the tie the client requests the work. The work will be done and billable at its completion. The client has ten(10)days to pay the additional cost after he or she has been billed for it. Initials: In witness whereof they have executed t lis agreeme rit the day and�year first above written. Heidi Gladston wner i Steven M. Cote DBA Cote& Foster Tne Conawnwealthof assachusef s Dep en ofIndustrk[Acciden n I Congress st eez"& e 101 Q Boston,19A 0,2114-2017 Weeke;rs9 Compensation Insurance ff-Idavite BuffderslCoytrractors/hiectirici /Pl beirg A- ���anL Pease PrInt Name(Business/Oraaanization/Individual): Address: City/Sta-te/Zip: T*UI Al- f. e /,/Vj/ Phone W: Are you an employer?Check the appropriatex• Type of project,(redo!red): employer with P 1.❑ I am a em o 4. am a general contractor and I b. C]New construction employees(full and/.or part-time)." have Nixed the sub-contractors - 2.Q I am a sole proprietor or partner- listedon the attached sheet. 7. Remodeling ship and have no employees 'mese sub-contractors have g. Demolition working for me in any capacity.ca employees and have workers' � 9. ❑Building addition [Nd workers'comp.insurance comp.Msmance. required.] 5. [� We are a corporation and its 10.[]Electrical repairs or additions 3. I an a homeowner doing all work officers have exercised their 11.®plumbing repairs or additions myself [No workers'comp. right of exemption per IMCL 12.0 Roofrepairs insurance required.]T c. 152,§1(4),and we have no employees.[No workers' 13.E]Other comp.insurance required.] °Auy applicant that checks box ffl must alsd M out the section below showing their workers'compensation policy information Iiomeov'Mers who submit this affidavit indicating they are doing all work and then hue outside contractors must submit a new aindavit indicating such. $Cont:raciors that check this box must attached an additional sheet showing the name ofthe subcontractors and state whether or not those entities have employees. Ifthe sub-contractors have employees,they must provide their workers'comp.policy number. Ott` z e p yer that s proviftg workers'compansaflon i wmancefor W ervployem _Bel�sr;is Me poBv errad job site T t�d/ rn £ c 4� Z/�i� U S 7 i� �st..rance Company Name: Policy r or Sel=ins.Lia 9: 1 Expiration Date: job Site Address: / D C= x I L /?1J City/State/Zip: IVO R-7W A-tach a copy of the workers'€offipensation policy declaration page(showing the poUcy a tuber and em-pira#lon date). Failure to secure coverage as required under 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 civfi penalties in the form o:Ca STOP WORK ORDER and a fine of up to X250.00 a day against the violator. Be advisedtllat a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. do hereay craider Sze crus cared eta es of a zLry that the itzformathm ppoviderz above is frao and corrEct ate Phone Offlciel use only. Do not write in this areas to he completed by city or Gown of icicl Ci:,l or Town: permit/�neense =ssvhg Authority(circle orae): 11.Board of Ha2ith 2.Building DeparMent 3.Cfyfl'ov�C,.eik J.It �etrfitw l Impector S.Fl am biag hmacto_ {r.Other Contact Person: phone#: ACORV CERTIFICATE OF LIABILITY INSURANCE -DATE-(MWDDNYYY) `� 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(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 victoria NAME: r LOW2S CISR MTM Insurance Associates (978)681-5700 Ext: (978)681-5700JVC No): (978)681-5777 1320 Osgood Street E-MAa ADDRESS:vickiel@mtminsure.com INSURERS AFFORDING COVERAGE NAIC# North Andover MA 01845 INSURERA:State Auto Insurance INSURED INSURER B AIG Casualty Company Cote & Foster Contracting, Inc INSURERC: 20 Aegean Drive *: INSURERD: 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 INSURANG'E 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 I ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MMIDD MM/DDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $. 1,000,000 A CLAIMS-MADE ❑X OCCUR DAMAGE TO RENTED 300,000 PREMISES Earrence $ PBP2747539 12/31/2015 12/31/2016 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PRO-JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: Contractors Plus Endt $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident) _ $ 1,000,000 A ANY ALTO BODILY INJURY(Per person) $ 20,000 ALLOWNEDX SCHEDULED BAP2370166 03 12/31/2015 12/31/2016 BODILY INJURY(Per accident) $ 40,000 X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTOS Per actident $ Medicalpayments 5,000 UMBRELLA LIAR HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTIONS $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETORIPARTNERIEXECUTIVE OFFICER/MEMBER EXCLUDED? F__] N i A E-L.EACH ACCIDENT $ 500,000 B (Mandatory in NH) WC004962937 6/20/2015 6/20/2016 E.L DISEASE-FA EMPLO $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L DISEASE,POLICY LIMIT 1$ 500,000 DESCRIPTION OF OPERATIONS/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, NA 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(zbuoi) - '�< .T vlir o�svt�za�rccrna���c������xJ�crcdrlf3��3' Mee of Consumer Affair's&Business RegulatEon , ME IMPROVEMENT CONTRACTOR ' egistration 107602 ' fiype T Expiration 8/5/2016 k �'•Supplemrit$C. , COTE&FOSTER'CON�T.} i� 'WILLIAM FOSTER d i N .. 20 AegeaniDr Unit 15�� f ;Methuen,MA 01$44+ H Utideesecretary , s_l I cr M8S5hiJSttS t3 tvcarCiepartrr�ent _ �_ rsf 8€ 9 ljdan °f f'ublrc S-Ifety ' i; Re ula" ns.Qnd Stntridj,c% on��,"Gor,Su�e;tiscrr ' License: CS-0851746 WILLt, j f `fit xsr r�. �i. 65 C M T F �R OS 3 A C$ MA DRD 3 RA C UT 01126 oma-'r �♦ . ii ti r G 'mmesstoner " Ex it` lori d{ ti 11/.10/2016 (I