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HomeMy WebLinkAboutBuilding Permit #119-12 - 115 SHERWOOD DRIVE 8/10/2011 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO-� 'ti Date Received Date Issued: 9-le-It E fPORTANT:Applicant must complete all items on this page LOCATION rmt PROPERTY OWNER l �i Print MAP NO: p 5 pARCEL: ZONING DISTRICT: Historic District yes 6noMachine 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 KIN;4�_WhSepattei""cr..�/s~S-++[7wWereR,Er M-*�dDra sa rc 'l rk. + e h a t. 1 ` D CRIPTION OF WORK TO BE PE ORNIED: Xd ntificatio Please Type or Print CIearly) OWNER: Name: ��� '�� �n e �` Phone: Address: 90 CONTRACTOR Name: O GC`'� Phone*7� � �aQ3, Address: )4,1 fczccA-k s X N(-) Supervisors Construction License: �3 Exp. Date: Home Improvement License: /6 fr9O 3 Exp. Date: 7 t a ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ �-I'� �VO r c,y FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund ----' en %Owne.= :` - ►gnature:ofcontracf";^ Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/BodyArt ❑ Swimmingpools- '" "�❑ 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 1 1. ) COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connectio17 Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street 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 2008 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 ❑ 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 . OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals i't the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording . ist be submitted with the building application Doc: Doc-Building permit Revised 2008mi Location I�Jr sal« `��� yn J No. " Date5-lb-11 11 NORTIy TOWN OF NORTH ANDOVER _ O s Certificate of Occupancy $ J'KMU t� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 24 �► 62 Building Inspector i NORT1y 0 o over No. /�- -- - - - _ o , dover, Mass., O�l COC MIC EWICK\_ CO 00 TE o PPS`_ CO S V BOARD OF HEALTH Food/Kitchen Septic System .... .PERMIT T D• BUILDING INSPECTOR THIS CERTIFIES THAT ...........�� f' '. .�' ........................................................................ Foundation has permission to erect ............................. bu'ldings on .11C.......S.A0jft'%00- Dr...i�.. ........... Rough to be occupied as........ !! '+..'r..............................0.0 r Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in 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 5��r PERMIT EXPIRES IN 6 � NTHS ELECTRICAL INSPECTOR UNLESS CONS I RUC N S Rough ................ . .................................... .............................. Service ...................... BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To BeDone FIRE-DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE smoke Det. e� Redden Construction '"�P; Rodden Construction Mrd 1> 47 Prescott Street -ceiag 47 Prescott Street ling North Andover, MA 01845 nom"'" North Andover, MA 01845 .tune ompaay ti+ame Sandra Rincon _ Rodden Construction Stred Address(do not use a pat otrnx Box eQdras) Carwnrcta/Sal -- ----_.�..__.__._......_._. 115 Sherwood Drive Michael Rodden Citylrowrt - - NOW ZipCode — Btuiaat Address(must include a strut address) Forth Andover Ma. 01845 47 Prescott st. Daytime phone Eva»ng phone Citylroam stets 'Lip Code 978-689-2721 Borth Andover Ma. 01845 Mailing Addttw i)t diCretent Imre above) ^ Bwiness Phare FedcM Employer @ ar S.S.Numbtr _._.. harm Inpoivsesr Casmrra BM,Wttabn E;74 en thus lwr ssgate.s tananst roar abrmnfwrna"rrsaosw lana """' 105903 17/21 /12 The C;ontrketor agrees to do the following work Tor the Homeowner; (Describe in detail the work to completed,specifying the type,brand,and grade of materials to be used,use additinal sheets if allZa tv.) Supply materials & labor to create a new finished basement area. work will be done fox a fixed fee of $4,000 plus time 9: materials . Fee payments are $2, 000 at job start & $2, 000 at completion. Carpentry rates are 49.00 per hour. RrgninA Perndta-The following building permits an mquircd Proposed Start mad Complig ice 5chedwo-The following schedule will end will be seetued by the contractor as the hmnm"a's agent: be adhered to unless cvemnwatces beyond the conarector's control arise (owners who secure their own permits will be excluded from the Guaranty]Fund proviaiame of 8-/R 11 LDee when contractor will begin contracted work, NlC;4.,chapter 142A,) / 9 1 5 f late when contracted work will be substmttially completed Total Contract Price and Payment Schedule The Contractor agras to perform the work,furnish due.,r aterial and labor specified above for the total sum of S t. 4,S.(�g __._(•t Puymcnttt will be made according to the following schedule: s-5 r. 0 00 upon signing cuntmct(not to exceed 1/3 of the totall contract price or the cost of special order items,whichever is greater I by or upon completion of Progress payments will be submitted $ -- --- by —/—/— or upon completion of_— ----.—.. --- --.__._............................_ _.... upon completion of the contract. (law forbids demanding full payment until contract is completed to both party's sntisfnction) Tuts:following material/equipment must be special $_— _to be paid for_ ordered before the convected work begins in order to meet the completion schodale.("") S to be paid for NOTES:(")tnduding.all finnncc Charges(—)Law requires hat any deposit or down•paywent required by the contractor bcfwc work begins may not excused the greater of(a)one-third o£the trot wntra:t p ice or(b)the actual cost of any special equipment Or custom made material which must be special ordered in advance to meet the completion schaduie. KsBryps Warrinty-Is an esnnsa warranty helm orevided by the eantrsdoll M - a the Werraob asst be attached am the nrntruti Subcontractors-Tho contractor agrees to be solely realwnsible for completion of the work described regardless of the actions of any tharl pasty/subcvntmctor utilized by the contractor. The convWor herd=er agrees to be solely responsible for all paymems to all uubcontrectors for tnnio�iela tmlD Atihpz thio Agreornent _--- Contract Accepladoe-upon signing,this document bt comes a binding contract carder law. Unless otherwise noted within this docomrnt,the contract shall not imply that any lion or other security interest has been placed on the residence. Review the fbllowmg cautions and notices carefully before signing this contract. a Don't be pressured into signing the contract.Take time to read and fully understand it. Ask questions if something is unclear. • My(ip sure the p wa=r hat a valid Home Impmement Contactor Rexisiration, The law requires most home improvement contractors and subcontractors to be registered with the Director ol'Home Improvement Contractor Registration, You may inquire about contractor registration by writing to the Director at 10 Park Plaza,Room 5170,Boston,MA 02 t 16 or by calling G M973-8787 or 88a-283-3757, a Does the contractor have insurance? Ask the Contractor for his insurance company information se that you can confirm coverage,or ask to see a copy of et"proof of insurance"document. . Know your rights and responsibilities. Read the Important Information on the reverse side of this firm and get a copy of the Consumer Guide to the Home hnprowincnt Contractor Law. You may cancel thea agreement if it has been signed at a place tither than the contractor's normal plies ofbusincss,prmrided you notify the contractor in writing at his/ber main office or breads oPlico by ordinary mail posted,by telegram sem or by delivery,not laser than midnight of the third business day following the signing ofthis aVver sent See the attached notice of r:amcdWion form for an expktnatimt of this right DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES!!! 1'-,idemicnl copies Draw serener a+wt be compk:t 1 uW signed.One copy stamid oro to the homeowner.11W oats copy stmuld tx kept h+the conutctur. IAT Homeowner's Signature Contractor's Signa ora l ci l ► '� 141 r _ - _ tra.,t *11 m Leri is & sub contractorsDawil7 be billed at con ctor cost with no markup. The Comntonwealth a Mr � kzrsetts Department of Industrial Accidents Office of Investigations I Congress Street,Suite 100 .. ' Boston,MA 02114-2017 www.mass gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/organization/individual): Address: Ci /State/Zi t3' P: Phone#:_ 9�)4 Are you an employer?Check the appropriate bog: 1. " I am a employer with 4• ❑ I am a general contractor and Ie of project(required): employees (full and/or.part-time). * have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. [.remodeling ship and have no employees These sub-contractors have g, ❑Demolition working forme in any capacity. employees and have workers' 9 B�� addition [No workers'comp.insurance Comp.insurance J ❑ g required.] 5. ❑ We are a corporation and its 10.F1 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no 13.❑ Other employees. [No workers' comp.insurance required.] *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information: t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new 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-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: A Policy#or Self-ins.Lic.#: !�L S `� Expiration Job Site Address: ��(IPi�CA�CX�C'� ���(�, City/State/Zip:_ &A� 2( Q(4j Attach a copy of the workers'compensation policy declaration page(showing 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 insurance coverage verification. I do herebcerci under the pdm and penalties o ' e u that the information provided above is true and correct Si afore: l - - - — J Date Phone#: Official use only. Do not write in this area,to be completed by city or town offuial 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#• '4CC)RO CERTIFICATE OF LIABILITY INSURANCE DEMM ) oB/lO/2011 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 endorsements). PRODUCER CONTACT NAME: NORTH ANDOVER INSURANCE AGENCY, INC. .CG,NNo. EXt: (978) 686-2266 lc, No):(978) 686-6410 M.J. FOSTER INSURANCE SERVICES ADDRESS: cfernandez@nafins.com 163 MAIN STREET PRODUCER CUSTOMER ID #.RODDEN CARPENTRY NORTH ANDOVER MA 01845-2508 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A MERCHANTS INSURANCE GROUP 23329 RODDEN CARPENTRY INSURER B ACE PROPERTY CASUALTY 47 PRESCOTT ST INSURER C INSURER D INSURER E NORTH ANDOVER MA 01845— 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 I TYPE OF INSURANCE A DL SUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER (MMIDDIYYYY) (MMIDD/YYYY) A GENERAL LIABILITY BOPI054995 2/01/2011 02/01/2012 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $ CLAIMS-MADE a OCCUR / / / / MED EXP(Any one person) $ 15,000 PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: / / / / PRODUCTS-COMPIOP AGG $ 2,000,000 POLICY JECTPRO LOC / / / / FILL $ 500,000 A AUTOMOBILE LIABILITY MCA7015515 07/16/2011 7/16/2012 COMBINED SINGLE LIMIT $ 1,000,000 ANY AUTO / / / / (Ea accident) / / / / BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $PROPERTY DAMAGE $ rX SCHEDULED AUTOS / / / / HIRED AUTOS / / / / (Per accident) NON-OWNED AUTOS / / / / $ / / / / $ UMBRELLA LIAB OCCUR / / / / EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE / / / / AGGREGATE $ DEDUCTIBLE / / / / $ RETENTION $ / / / / $ C WORKERS COMPENSATION WC46393120 1/01/2011 01/01/2012X WC STATU- OTH- AND EMPLOYERS' LIABILITYI To Y LIMITS ER Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ N/A E.L.EACH ACCIDENT $ 100 OOO (Mandatory in NH) / / / / E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below / / / / E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. TOWN OF NORTH ANDOVER 120 MAIN STREET AUTHORIZED REPRESENTATIVE NORTH ANDOVER MA 01845— ACORD 25(2009109) ©1988-2009 ACORD CORPORATION. All rights reserved. INS025(200909) The ACORD name and logo are registered marks of ACORD 5� I l � \p (n � . i tit i I � �J 4 I caY� i 'ter � ? ; ' �' ,�/ ' .- , ' ,-, r j,P � -- . -• � r