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HomeMy WebLinkAboutBuilding Permit #052-15 - 1120 Great Pond Road 7/16/2014 i �IORTh 1 BUILDING PERMIT Q�� LED ,6q�0 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Q q. Permit No#: ©��'f� A<O"ArE Date Received �gSSACHU`����� Date Issued: i lv IMP RTANT: Applicant must complete all items on this page 4 CATION1 a PROPERTY a — _ Fnnt 100 Year Structure o yes no `MAP PARCEL = �. ZONING F:ISTR:I:C ° Historic,DiWict yes,. no — - r n z ' MacfrieShop Vila'age = yes; no a_ TYPE OF IMPROVEMENT PROPOSED USE Resioential Non- Residential ❑ New Building One family ❑Addition ❑ Two or more family ❑ Industrial Iteration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other I ❑;Se trc7 ❑V11,k: _ - h�d per: r ❑ Floodplain Wetlands + ❑�VVaters' a '�Dstnct; F ❑Water/Sewe`r3 ° . � - 4 DESCRIPTION OF WORK TO BE PERFORMED: I; Identification- Please Type o Print Clearly Y i OWNER: Name: 0110095 - L O 3 ��G t"L-cJw f��Sv P one: Address: an (Ofi J U MD f Contracr�Nuv cv hone.G7�? to, ame Address: t ..d-�.- , t�? Supervisor's C-onstructi6n License 1 �7 /U Exp . Date n Fio`me'Imp 1 rove`ment`License (,G�1 'Ex Date ARCHITECT/ENGINEER Phone: , Address: Reg. No. FEE SCHEDULE.BOLDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: Lt � 1 Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guara d Signature of�Agent/Qwner . __- Signature of confractor_- _ _ 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 PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Siqnature 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: _ �, _ _ 'FIRE DEPART r,MENT - TernpDumpster;on site yesr Fnoo F Located -- - _ Located3at:124�Ma�n Street � � "' -`- - - f AF'irelob partmentsignature/date an .r IC'OMMENTS, 4 I 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) II Em LI Notified for pickup Ca it a i j 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 o 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 thea appeal period is over. The applicant must PP P pp 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 ii I Location QEF No. l/,J — / Date 711t. L C E Y • - TOWN OF NORTH ANDOVER • Certificate of Occupancy $ Building/Frame Permit Fee $ �S av Foundation Permit Fee $ Other Permit Fee $ ' 14 r.t�a" TOTAL $ Check t � t 27779 ��-- Buijding!pdpector r V NORTH - w: : -c ver 0 No. y h ver, Mass /6 / coc NIC Hl WIc1[ *_ S t) . BOARD OF HEALTH Food/Kitchen PERMIT T Septic System THIS CERTIFIES THAT ............ C'od �-�.... /���' ®�................................................................. BUILDING INSPECTOR .............. ......,. . .. ... .. A� Foundation has permission to erect .......................... buildings on �.,.77 .�...�.. �.` �.f.l�'Q:�r. ........... P to be occupied as ........................xo�l. ...::��r..``.`.! ..,�...!��..�.vW'®c-vs ................................. Chimney � Rough 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final. PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO S ARTS 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. RICHARD FLUET 02 BRIDLE PATH O N RACTING, INC PROPOSAL METHUEN, MA 01844 -- Date Estimate# 6/25/2014 334 Name/Address BROOKS SCHOOL 1160 GREAT POND RD. N.ANDOVER,MA.01845 BIGALOW HOUSE Description BIGALOW HOUSE; STRIP AND REROOF ENTIRE HOUSE WITH 30 YEAR ARCHITECTURAL SHINGLES,INSTALL 72"ICE AND WATER SHIELD,NEW DRIP EDGE,REFLASH CHIMNEY,CUT BACK EDGE OF ROOF TO ADJUST FOR GUTTERS,INSTALL SOFFIT AND RIDGE VENTS,REUSE GUTTERS AND SHUTTERS,REPLACE TOTAL OF 26 WINDOWS WITH SAME STYLE HARVEY WHITE VINYL REPLACEMENT WINDOWS WITH ENERGY STAR RATED GLASS,GRIDS IN GLASS AND SCREENS.STRIP SIDING AND INSTALL AIR BARRIER,DOUBLE 4"MASTIC WHITE CARVEDWOOD SIDING,3"CORNER BOARDS,REPLACE ROTTED AREAS AS NEEDED,WRAP EXPOSED WOOD WITH WHITE ALUMINUM.REPLACE ONE SIDE DOOR WITH NEW THERMATRU TWO LITE S-296 WITH NEW HARVEY SOLID CORE STORM DOOR.REMOVE AND REINSTALL ELECTRICAL SERVICE.REPLACE THREE LIGHT FIXTURES.REMOVE BULKHEAD,RESEAL AND PAINT.SUPPLY PERMIT AND TRASH REMOVAL. PROPOSAL IS VALID FOR 30 DAYS. EXTRAS OR CHANGES TO BE COMPLETED AT A RATE OF$85.00/HR./MAN Finance Charges on Overdue Balance 1%/MONTH PROGRESS PAYMENTS AS WORK PROGRESSES. Total $29,850.00 Signature Phone# Fax# E-mail 978-685-7010 978-685-7010 RFC102@verizon.net r Ofticetonmer 1rs us�iness egulaho �! HOME NPROVEMENT CONTRACTOR Registration: -,�j06620 Type: I; Expiration: r4L2014 Private Corporatio t R RD FLUET 8 NT 46 I#i�IG LNC. Richard Fluet r ; 102 Bridle Path Methuen,MA 01844 =- Undersecretary De artment of Public Safety Massachusetts P 'Board of Building Regulations and Standards Construction SuperN isor x h<: License: CS-050710 I, RICHARD A FLUP 102 BRIDLE PA1i M I�i[T ,N A ME , Expiration 041221 04122!2015 Commissioner i E= OP ID:J( CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DoNyyy) ffMA CERTIFICATE IS NOT ISSUED �g A MASER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER- THIS TIFICATE DOE�i NOT AFFI11MATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES OW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED RESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. RTANT: If the ceRificate hl�lder Is an ADDITIONAL INSURED,the polic les must he endorsed. If SUBROGATION IS WAIVED,subject to erms and Conditions Of the FoliCy,certain policies may require do endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement s. ER $ e&Hall Insur.Assoc.lnc 978-975-1300 NAMTAC7 rth Main St 978-975-7596 PHONE r MA 01810 C N Ex, l�..Segreve E- A�iLADDRESS: Richard F U—et C Ltrn ao Cting Inc. IN9URER(SIAFFORDING COVERAGE INSURERA:Arb@Ila Protection Ins. Co. NAICS 102 Bridle Path Lane 41360 Methuen, MA 01844 INSURER B:Commerce Insurance Co. 34754 INSURER C: INSURER D: INSURER 6: COVERAGES ~� IN$URERF: I'.ERTIFICATE NUMBER: .THIS IS TO CERTIFY THAT THE POLI13IES 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 MAYO ISSUED OR NAY 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, SR TYPE OF INSURANCE POLICY NUMBER M DDm MM/0 Y GENERAL LIABILITY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE g 1,000,00 CLAIMS-MADE �ti J OCCUR PRE_ MISES_(Es acuter once $ 100,00 MED EX�poraon) S 5,00 8500034727 06/12113 06/12114 PERSONAL$ADV INJURY $ 1,000,00 8500034727 06112114 06/12/15 GENERAL AGGREGATE $ 2,000,00 GEN'LAGGREGATE LIMIT APPLIES PER; X POLICY PRO PRODUCTS-COMP/OP AGG $ 2,000,00 LOC AUTOM091LE LIABILITY S COMBINED SINGLE LIMIT ANY AUTO (Eoaccldenl) ALL OWNED AUTOS BODILY INJURY(PerpP,gon) a 100,00 Q X SCHEDULED AUTOS BODILY INJURY(Per eccldmq $ 300,00 X I IIREO AUTOS 1460 12!01/13 12/01114 PROPERTY DAMAGE $ 100,00 X NON-OWNED AUTOS (Persecidgnl) UMBRELLA LIAR $ OCCUR EACH OCCURRENCE $ EXCESS LIAB _ CLAIMS-MADE DEDUCTIBLE AGGREGATE $ RETENTION $ WORKERS COMPENSATION $ AND EMPLOYERS'LIABILITY a WC STATU- OTM- A ANY Porr,CROPRIETOR/PARTNER,EXECUTIVE YIN 9104340312 JRJ3YJ.ID91T Et ERM(Mandatory In NH)MBER EXCLUDED CJ N l A 03131/14 03/31/16 E.L.EACH ACCIDF-NT $ 500100 (Mandatory In NN) Iryyo0a deaalbe udder E.L.DISEASE•EA EMPLOYEE S 500,00 DESLIRIPTIDN OF OPERATIONS below E.L.DISEASE-POLICYLIMIT $ 600,00 DESCRIPTION OF OPERATIC NS/LOCATION NS l VER CLES(Attach ACORD 101,Additional Remarks Schedulo,If more aDeco In roqulrod) CERTIFICATE HOLDER CANCELLATION NORTHAN $HE ULD ANY OF EXPIRATION H DATTHEREOF,BE VNOTICE WILL BE DELIVERED IN DESCRIBED POLICIES CCBEFORE Town of North Andover Building Deparment ACCORDANCE WITH THE POLICY PROVISIONS_ Main Street North Andover, MA 01 BAS AUTHORIMO REPRESENTAME ACORD 25(2009!09 ®1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD - . The Commonwealth of tl4`assachusetts , Department of indo strigl Accidats Office of Investigation. 600 Washington.,Street -Boston,MA 02111 mmmass gov/dia workers,Compensation fusuxance Affidavit:Baders(Contractors/ElectricianslPl berP A ulUant lWox nation Please Pxxn Le ibZv Name(Businesslorganizationlndividual): ��r��i� �'l—✓L� �(Ir�/"T`�7�1V� �+'« Address: o}, qfl r Oc ' ):�-71/ l �) - City/State/dip: V� (. def, v► D rte`r 7 Phone px Cl a L 63 S 3 Areyouan employer?Check the appropriate box: Type of project(reegTured.): 1.[� 1 am.a employer with.—3 4. E]I am a general contractor and I 6. ❑New constraction. F employees(full and/or pax-tame)* have bkod the sub=contractors 2.❑ I am a sole proprietor orpartner listed on the attached sheet.T 7• [�Remodeling ship and`haveno.employees These sab-contractors have 8. [(Demolition working forme in any capacity. workers'comp.insurance. g, 11 Building addition Wo workers'comp.Jnsurance 5. ❑We are a corporaiaon and its 10.[[Electricalrepairs or additions required.] officers have exerdsed.their right of exemption or MGL 11=[(Rlumbing repairs or additions 3.[� Z am.a homeowner doing all work c 152 1�, andw have no myself.[No workers comp. § ( )� 12.[.Roofrepairs iusurancexequixed.�Ti employees..[No workers' 13.[]Other comp.insurance required.] Mnyapplicantthat checks box#lmustalso fill outthesection beldwshowingtheirworkers'compensationpolicyinformation. i-Homeowners who submitthis affidavit indioatkgthey ire doing all.wont and then hire outside contractors muntsubmit a new affidavit indicating stick. TContractors that checkthis bob must attached au additional sheet showingthe name of the suh.-contractors and their workers'comp.policy information. t arra an empfoyer that is providing workers'compe�asation inszc�ance fog m empfoee ot w is the policy andjob site information. _ ,S Insurance Company Name: Policy#or Leh"-ins.f #: Ci 10 fob Site Address: 1 ��� lam ' jCity/Sate/Zip: I &V0W0/ y Attach a copy of tete workers'compensation-polley declaration page(showing the policy number and expirationt crate). Failure to secure coverage.as required under Section 25.A ofMGL o.152 can lead to the imposition of eriminalpenaltzes of a fine up to$1,500.00 and/or one.-Year imprisonment,as well.as civil penalties in the:form of a STOP WORD ORDER.and a fine of up to$250.00 a day against the violator. Be,advised that a copy of this statement maybe forwarded to the Office of Investigations ofthe DIA.for insurance coverage verification. ado Hereby enartie o erdury that the infora adon provided above is true and correct. - Si afore: Date: / Phone# —? > 0 �- 93 �-3 Offzeiaz use oply. .Do not write in this area,to be completed by city or town official City or Town: Permit/Llcense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.Cxtyffowa Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Information and I . . nstructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an ernployee is defined as"...every p erson iii tho service of another under any contract o hire, express orimplied,oral oxwxitten." An eWloyer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or More of the foregolug engaged in a joint enterprise,and includingthe,legal repies entatives of a:deceased employer,.or the xedeiver ox tnistee ofan individual,partnership,association or other legal entity,employing employees. Mwever the owner of a dwelling house having notmoxe than three apartments and who resides therein,or the o coupant of the dwelling house of another who employs persons to do.maintezance,construction or repair work on such dwelling house or onthe grounds or building appurtenant thereto shall not because of such employment be deemed to bean employer." IVIGL chapter 152,§25C(6)also states that"every state or local HP-ensimg 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."a Additionally,MGL chapter 152,§25C(7)states `Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance ofpublic work until - cceptable evidence of compliance with the insurance requirements of this chapterhave beenpresentedta the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,mPP1Y sub-contractors)name(s),address(es)and phone numbers)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no members orl?rtners,arenotrequiredto can7woxkers'compensation insurance. SfanLher than the LC orLLP empltooyees ees other employees,apolicyisxequired. Be advised thattbisaffxdavitmaybesubmitted tothe Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit the affidavit should be retum.edto the city or town that the application for thepandt or license is being requested,xtot the Department of Indusfrial Accidents. Should you have any questions regarding the law or if you are requiredto 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 pxinted legibly. The D eparbnent b.as provided a space at the bottom of the affidavit for you to fill out in the event the Office of Ioveti sti a ' p' g ons has to contact you regarding the applicant. Please be-sure to fill iuthe permiMicense number whichwill be used as a reference number, In:addition,art applicant thatmust submitmultiple permit/license applications in any given year,need only submit one affidavit indicating current policyinformation(ifnecessaW)and'uuder"Job Site Address"the applicantshouldwxite"alllocationsin (eityox town.)":A copy o£the affidavit that has been officially stamped or marked by the city ox town may be provided to the applicant as Irbof that a valid affidavit-ii on file fox future p eimits or licenses. A new affidavit must be,filled out each year.Where ahome owner or citizen is obtaining a license oxpexm-it not related to any business or commercial venture (i.e.a dog license orpermit to burn leaves eta)said person is NOT required to complete this affidavit. The Office 6f Investigations would like to thank you in advance for your cooperation and should you have any c�uesfions, please do not hesitate to give us a call. The Department's address,telephone anal faxnumbex: 1 Tho CQ o wealth o S as ao?v P M'ParbGlat o£Zndus-trial,Acoidum off oe ofTn. e tzz a ou 600 W46Von re t Boston,,VA. 02111 TO, 617n72'�-4900 e:A40f ox 1-877W .��Mg _ Revised 5-26-05 Fay, 617-727-7749