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HomeMy WebLinkAboutBuilding Permit #449 - 11 FOXHILL ROAD 1/2/2008 BUILDING PERMIT VtORTp,6gti TOWN OF NORTH ANDOVER o? o0 APPLICATION FOR PLAN EXAMINATION 70 ,> Permit NO: Date Received � ��SSACHUS�� Date Issued: •O IMPORTANT:Applicant must complete all items on this page LOCATION 8 4 ` PROPERTY OWNER, ��t�C-ep" VVA, tPn�ntl� Print0 o M .MAP NO:° PARCEL: ZONING DISTRACT: Historcbistrict s yes n Math Ship Village Yes o . TYPE OF IMPROVEMENT - PROPOSED USE Resi Non- Residential New BuildingOne family Addition Two or more family Industrial No. of units: Commercial Repair, replacement Assessory Bldg Others: Demo i Other Septic t Well Floodplain, Wetlands Watershed"District: WaitedSewer" DESCRIPTION OF WORK TO BE PREFORMED: 1y�s�►11 �3 fc�pl c�c�c��- Ww��cl,o�s K sic 1t Incw rckc:�k S Identification Please Type or Print Clearly) OWNER: Name: �Ul pl c vlyy% w i,,,-Ge kc:1 Phone: 'k Address: 1 k" (=0� 1� - No . �e,.r I(,t A V l S 4S CONTRACTOR �Narne. lili ►wt < . PByt'+n ✓cs Phone. x Address: 10 #W<<w,�" l✓uoG� Sc7 " t 1 " Isu ervisor' h s Construction P License. ,� �Z�����: ��� exp. Date: Ct� Home lmprpveme-ntbcense: t'Z, bi A0 xp. :Date. t� �? ARCHITECT/ENGINEER Phone: Address: Reg. No: FEE SCHEDULE:BULDING PERMIT:$1200 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 5 k Ste)� , 8 FEE: $ 90 Check No.: Receipt No.: NOTE: Persons contracting ith unre t red contractors do not have iSigratt�re:° t/ e " access o the uar fa nd ofAgeno� - efctor Plans Submitted Plans Waived -Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art Swimming Pools , 1' 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 DATE REJECTED DATE APPROVED CONSERVATION COMMENTS s. DATE REJECTED DATE APPROVED C?MMENTS JJ11 , i 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 Located at 384 Osgood Street "FIRE.D.EPARTMENT '..Temp'Dumpster on=si#e 'yes ' no Loc ated.at 924Main7Street 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 2007 ' Location No. Date 2 d Na^T� TOWN OF NORTH ANDOVER 0 a » Certificate of Occupancy $ CHus t� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # q J (i 20883 Building Inspector AORTH q Town of ? s` Andover - No. �9 - o dover, Mass.LA , � COCMICIIEWICK \, %d ADRATED P? �5 IT BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.....Ch, . ........................................................... .� . ................................................... Foundation has permission to erect............. g �i ........................... buildings .. ...... ...... ... ........ �0....... ..... ..;!�....................�.. Rough T h 1 Chimney to be occupied as... .............. .......... .. ..............�i!�........ ir.N .a...... ..... �... �.. ......... ..... . y provided that the person acceptin this permit shall in every respect conform to the terbf the application on file IIf 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 Final PERZIv U EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRU ` FARTS Rough Service BUILDING INSPEC Final Occupancy Permit required to Owipy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry (Nall To BeDone FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. ti BOARD OF BUILDING REGULATIONS License CONSTRUCTI°ON'SUPERVLSQR Numb—er-��CS 0791'81 Birtf at x11106fC�J53 Ezpares 111060 08 Tr. he: 3556.0: { Restrict d 0`0 WILLIAM 4 PENN 1 2 COPLEY-DRI 'E, rj� � ANDOVER• MA 0'181, ; Commissionn �: ✓� -Pau ���� BoAfrd of Buildmg R-Ou t►o;ns and Standards j HOME tMPROVEMENT CONTRACTOR Re4�stra#7br 5 12$016 _. E ►oM1 2007 y � Type Pnate Corpbratidn ANDOVER RENOOfcCS©rU^TfONS,"ING WILLIAM fiJ r � WOBURN,MA 01801 ?idmimstrator. ANDOVER RENOVATION SOLUTIONS,INC. ANDOVER Wo Winn Street,Suite 203 Woburn,Massachusetts 01801 781937-8805 RENOVATION SOLUTIONS FAX 781932-1174 04-3452338 MA Home Improvement Contractor 128016 Date:November 6, 2007 MA Construction Supervisors License 079181 Purehase Agreement Name: Malcolm and Helaine Winfield Project Address: 11 Fox -Road,North Andover, MA 01845 Home Phone: 978 681-9956 Mailing Address: cash- ✓= e-mail: W 10 & CO"C ts+. Vl c Day Phone: Malcolm cell 978 973-8559 Work To Be Performed under this Agreement: 1. We will furnish and install in a workmanlike manner the remodeling project according to the scope of work attached, and the terms and conditions made part of this agreement. 2. This agreement is subject to Addendum A made part of this agreement. 3. The final price listed below will.change based on the final scope of work determined at the pre-construction meeting and will be adjusted by Change Order#1 outlining additions and deletions to this agreement. Anticipated Construction Schedule at time this agreement is signed: Approximate Start Date of Work: 12-01-07 Approximate Substantial Completion Date: 01-31-08 The above schedule are approximate dates for overall planing purposes only. We can not be held responsible for circumstances arising during the course of construction beyond our control. { Price $57,50618 Payment Payments are to b made as per the payment schedule on page 6 of this Schedule agreement The parties agree to the attached schedule v This .t agreement su ercedes all conversations statements and agreements expressed or implied between the parties, their agents and representatives. Do t sign this Agreement if there are any blank spaces. Owner Date O r Date �t/.b A0 William C. Penny, President. Da Andover Renovation Solutions, Page 1 of 6 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/E�ectricians/Plunmlbers Applicant Information Please Print Eegibly N (Busines /OrganizationMdividual): AmUd aA, je&s4yyo,J ,�" Co k, //8'N$, /K L . Address: /f D LJ 1,d,,� S City/State/Zip: A1,4 0 L& Phone #: 761 °13 7 F�� Are you an employer? Check the appropriate box: Type of project(required): 1. ❑ I am a employer with 4. %1 am a general contractor and 1 6. ❑ New construction employees (full and/or part-time).* have hired the sub-contractors 2. ❑ I 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 o'workers' comp. insurance 5. ❑ We are a corporation and its � p- 10.❑ Electrical repairs or additions ! required.] officers have.exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL 11.[:1 Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no 121:1 Roof repairs insurance required.] t employees. [No workers' 13.❑ Other comp.insurance required.] *Any applicant that checks box tY 1 must also fill out the section below showing their workers'compensation policy information: Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such lContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. i I am an employer that isproviding workers'compensation insurance for my employees. Below is the.policy andjob site informalion_ Insurance Company Name: S-ee A�� Policy#or Self-ins. Lic. tl: Expiration Date: I Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(shoAing the policy number and expiration 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 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 insan..ce coveu ig..q verification. I do hereby cep fy under the in and penalties of perjury that the information provided above is true and correct . L S1 -ature: ��JJ Date: y I j Phone#: 7&/ c:73-? 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/Tow-n Clerk 4.Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: Information and Instructi®ns 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 legalentity, 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 ofIanother 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." _4 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 building`s in the.c'ornmonwealth•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-contractors)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. .Re 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 perm?t/licensP 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 burn 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 Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 5-26-05 www.mass.gov/dia i Andover Renovation Solutions, Inc. 110 Winn Street, Woburn, MA 01801 General Contractor Subcontractor Insurance Information December 14, 2007 MacKenzie Forms, Inc. 8 Allston Ave, Wilmington, MA 01887 Granite State Insurance Company C Group 0264497 05-10-2006 Turco Plumbing and Heating, Inc. 10 Princess Ave., Chelmsford, MA 01824 A.I.M. Insurance Co. 70133449012003 09-28-2006 Gracia Backhoe Michael J. Gracia 2 State St., Wilmington, MA 01887 Hartford Underwriters Ins. Co. 6S60UB-0223B59-7-03 11-10-2005 O'Keefe Construction 21 Francis St.,North Reading, MA 01864 Zurich American Insurance Co. 6ZZUB934X60803 08-31-2006 T& M Construction P.O. Box 157, Hampton Falls,NH 03844 Granite State Insurance Co. WC 680-71-48 10-05-2006 Brett Belisle 262 Hackett Hill Road, Hooksett,NH 03106 Cental Insurance Co. WC7983201 07-29-06 Cooling Unlimited 565A Main St. Reading, MA 01867 Liberty Mutual WC5-3125-227239-044 06-22-2006 D Cronin's Welding Service 90 Main Street,North Reading, MA 01864 Arbella 4600025785 z Thomas Park 5 Star Demo Service POB 222, Woburn, MA 01888 Associated Industries of Mass AWC7009498012005 Jones Brothers Insulation 16 Oakland Street, Amesbury, MA 01913 Zurich American Insurance Company WC913952600 Joseph S Savani, Inc. 84 Ravine Road, Medford, MA 02155 Continental Casualty Company UB-8067A00-0-06 12/20/2007 11:20 7817290600 SCOTTI INS PAGE 02 LMG 12/19/2007 11 :20 PAGE 002/002 LMG Liberty Mutiml Group Liberty p.0..&,N 9090 mutuiflm Dover,NH 03821-9090 Telepbom(300)653-7893 Fax(603)-245-5330 December 19,2007 TOWN OF NORTH ANDOVER ATTN:BLDG DEPT 1600 OSGOOD ST NORTH ANDOVER, MA 01845- RE: Cer•tllffeate of Workers Compensation Insurance Ynsured: ANDOVER RENOVATION SOLUTIONS INC 110 WINN STREET WOBURN, MA 01801 Policy Numbrrt WC2-31S-332770.027 Effective: 10/23/2007 Expiration_ 1.0/23/2008 Coverage afforded under Workers Compensation Law of the following s�a,1;c(s): INIA �s ..Liaadi`tut 5 Iamits ; Sole Pro rietor/Partner Cavcra p Re Election: Bodily Injury By Accident: $100,0(X} Each Accident Bodily Injury by Disease: $ 100,000 R,,ach.Person Bodily Injuryby Disease: $i00,000 policy Limits As of this date,the above•nefereneod policyholder is insured by Liberty Mutual Fire.lmquranoc Co under the policy listed above. The insurance afforded by flze listed policy is subject to all the terms,exclusions and Conditions,and is not altcrrd by any requirement,term or condition of any nr,other documents uith respect to which this certificate may be issued. This certificate is issued as a matter of in formation only kind conFers no right upon you.the certlfaca.tc holder. This certificate is not An i:nsumce policy and docs not amend,extend,or alter the cove rage afforded by the policy listed above. If this policy is cancellecl hcfore the si:a.tedcxpirn3 i.on date,Liberty Mutual will end.cavor to notify you of such cancellation. 1 �� ENALaIL ALMIOR17TI1 REPRESENTATIVE LIBERTY MUTUAL,.INSURANCE oR.oUp Tl$,Cwffl ft is exCCnfid l,v 1_7t113RTY mu-ruAL TNN1RANCE aR0t11?as r"Peets 311chimtttaace-in nfros4rA lty t6bac a°mlwiria, cc: Insured: Producer of Record: ANDOVER RENOVATION SCO TTI&COMP SOLUTIONS [NC 1ANY,INC. .9 MOUNT VR 110 WINN STREET RNON STRFF7' WO:BURN, MA 01801 P O BOX 1000 72/tg/2007 WINCHESTER, MA 01890 I I