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Home My WebLink AboutBuilding Permit #451 - 124 PHILLIPS COMMON 2/23/2009 BUILDING PERMIToAO RT A TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received °qoR �SSACHU`�� Date Issued: ?1 I ORTANT: Applicant must complete all items on this page 10CATION a � � 'nnt, PROPERTY 01NNER�Qt Prd/`q _ 0i emery;, prat VAP NO PARCEL: ..ZONING DISTRICT, , > `Historic ' tnct yes 1Ulacfine 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 Sept'►c11lell ;1=loodplain Wetlands . Watershed,Dstrict'' Water/Sewer ' DESCRIPTION OF WORK TO BE PREFORMED: To .- T,e macro QST S Tgir ��c/ Oe-,7— Identification tTIdentification Please Type or Print Clearly) OWNER: Name: Ple r d ra Phone: 978�--6 r�62 Address: /Z $4 ,-, /,/ /� ' y CONTRACTOR K6mei Phone:. 9 Address:° Zo s ,- Supervisor's Constrwction I �cen,se. Exp. #Date �I - 1.. . ., R Hume 'h1 "rovernent.Lrcense p Exp. .Date::" ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125..000 PER S.F. Total Project Cost: $ /�. o a FEE: $ Z.2 ,!Z % a7i� ' Check No.: /� Receipt No.: NOTE: Persons contractingwith unregistered gistered contractors do not have access to the guaranty fund I �p " Signature of Agent/Owner"' 'Signature ofi contractor= �L 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 4' 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: Located 384 Osgood Street AFIRE'"DEPARTMENT. ='Terrrp Dumpseron site :;yes .,no Located iat 124 Main Street . . v- Fire;Departmeratf stdnature/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 i ❑ Notified for pickup - Date _._........................................................._..............._.............._.._............................................--............_-..........................................._......--....................................................................._._........................................................................ ---._.......................................................... ......._............__. Doc.Building Permit Revised 2008 III f 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 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 1 Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 Location No. Date 13 �. �oR,M TOWN OF NORTH ANDOVER � 9 + ' Certificate of Occupancy $ Building/Frame Permit Fee $ yX —o?,v-1d 4C Mus T Foundation Permit Fee $ Other Permit Fee $ f TOTAL $ Check # 2836 5 Building Inspector From:Bonnie Welch At:Francis Provencher Insurance Agency,Inc. FaxID:9784549343 To:Town of N.Andover Date:22312009 01:45 PM Page:1 of 1 ACORD. CERTIFICATE OF LIABILITY INSURANCE OP DATE(MMIDD/YYYY) D6RBU-1 02 23 09 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Francis Provencher Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Agency, Inc. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 530 Rogers Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Lowell MA 01852 Phone:978-459-8681 Fax:978-454-9343 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Merchants Insurance Group 23329 INSURER B: D and R Building 6 INSURER C: Construction Inc. 12 Virginia Ave. INSURER D: Lowell MA 01852 INSURER E COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TOTHE 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 POLICY INSRE TYPE OF INSURANCE POLICY NUMBER DATE(MMIDDIYY) DATE(EXPIRATION LIMITS GENERALUABR.TY EACH OCCURRENCE $1000000 A X1 COMMERCIAL GENERAL LIABILITY CCP1039025 04/01/08 04/01/09 PREMI`SE S(Eeoccurence) $50000 CLAIMS MADE N71 OCCUR MED EXP(Any one person) $5000 If-- PERSONAL&ADV INJURY $1000000 GENERAL AGGREGATE $2000000 GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPlOPAGG $2000000 POLICY PEO- LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ A ANY AUTO 7AM0277014551 03/25/08 03/25/09 )Ea accident) ALL OWNED AUTOS BODILY INJURY $100000 X SCHEDULED AUTOS )Per person) X HIRED AUTOS BODILY INJURY $300000 X NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ZOOOOO )Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY ALTO EA ACC $ OTHER THAN AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR 0 CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ AIU WORKERS COMPENSATION AND TORY LIMITS ER EMPLOYERS'UABILTY ANY PROPRIETORIPARTTJERlEXECUTIVE E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ It yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ OTHER i DESCRIPTION OF OPERATIONS I LOCATIONS!VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CARPENTRY 2004 CHEVY EXPCUT VAN 1GBJG31U441159353 **THE WORKERS COMPENSATION CERTIFICATE WILL BE ISSUED DIRECTLY BY THE CMeANY WITHIN 2 BUSINESS DAYS. CERTIFICATE HOLDER CANCELLATION NORTHAN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN Town of North Andover NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL fax (978)688-9542 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR 1600 Osgood St. REPRESENTATIVES. N. Andover MA 01845 ACRE v ACORD 25(2001/08) 0 ACORD CORPORATION 1988 J Board of Building Reg no�nand d t. ' HOME IMPROVEMENT CONTRACTOR i Registr� n� 143170; top E?"iMtton O%21/201p { T 4�. Pri'va'te Tr 207710 r Corporation. D+R BUILDERS i rs{ RICHARD ARSE x i' NA'ULT# 1 r ° 12 VIRGINIA LOWELL,MA 01852\ I i Administrator ' The Commonwealth of Massachusetts De artment o P f Industrial Accidents r L, Offace of,investigations 600 W ashineton Street Boston MA 02111 c : wwrv.rf ass.gov/dia Workers' Compensation Insurance.Affiday..it; guilders/Contractors/Eleetricians/Plambers Aa lica.nt Information Please Print Lm- * Name (Business/Organization/Individual): .� Address: w�' City/State/Zip: Phone#: Are you an employer?Check the appropriate box: i.❑ I am a employer with 4. ❑ I am a -e F7. e of project(required): ..neral contractor and I employees(full and/or part-time).* have hired the sub-contractors ,NNew construction 2.❑ 1 am a sole proprietor or partner- listed cm the attached sheet Kemodelingship and have no employees Thesestab-contractors haveworking for me in any capacity. n!workers' comp. insurance. ' Demolition [No workers' comp. insurance 5..Z e are a corporation and its 9' ❑ Building additi.on 3.❑ required.] officers have exercised.theair ]0 ❑Electrica.l repairs or additions I am a homeowner doing all work right of exemption per MGL 1 I.❑ Plumbing repairs or additions Myself. [No.workers' comp, c. 152 §l..(4);and we have no 12.Q Roof repairs insurance required.] t employees. [No.workers' comp, insurance required.] 1.3•7 Other Any applicant.that cheeks box#1.must also fill out the section below showing their workon,compensation poiic} information. t Homeowners wllo submii.illi,a-,,Idavit illaiGalillg.t�`ley are doln�Ell i7g.-rk .ted Ehen hir„outsiae coniraciurs muni submii a zContractors Ilial check this box must attached an additional sheet showirtc the name ht new a-davit ineicanng such. oft.-sub-c�„uactors and their workers'comp, of icy t am an employer that is providing workers'co errsafion i P P c} information. mP assurance for 'employees. Below is the information Policy cy and job site Insurance Company Name: 4- Ghf�r Policy#or Self-.ins. Lic.#: Expiration Date: 6 2- Job .lob Site Address: 2 City/state/Zip: A/O�T/ ivOoy-Qs� Attach a copy of the workerscompensation policy declaration page(showing the policy number and expiu-ation date). Failure to secure coverage as required and ) under Section q tion LSA o f MGL C. 152 cimposition of fine up to$1,500.00 and/or ane-year imprisonment- the violatort as well as civil penalties in es of a STOP WOties of a RK1ORDERnal 1and a fine ga . Be advised that a copy of this statement may be forwarded to the Office of of up to 5250.00 a day a Investigations of the DIA for insurance coverage verification. I do hereby certi u er the pains and penadies of perjure that the information provided�OVe true and correct Si�rlature: Date: Phone#: — 2 Official use onip. Do not write in.this area, to be completed by city or town ociaL City or Town: Issuing Authority(circle one): Permit/Licertse 4 L Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector S. Plumbirto 6.Other b Inspector Contact Person: Phone Bo ConrUction Super L'jCen an ar s Se License: CS 65110 { r i s Expiration 1/15/2010 Tr# 18299 a� ��; Restriction � i DANIEL D MONT MARQUT �st 20 KIENIA RD Ia f HUDSON, NH 03051 Commis§ioner f I I I I w � ct - D & R Builders, Inc. Richard Arsenault Dan Montmarquet 12 Virginia Ave 20 Kienia Rd Lowell, MA 01852 Hudson, NH 03051 (978) 454-8706 (603) 883-2514 Proposal Submitted to Phone 978-618-0242 Date 1-26-09 Plof Dierdra O'Leary 978-021-3902 Street Job name 124 Phillips Commons City,State&Zip Code Job Location North Andover, Mass. 01845 Architect Date Of Plans Job Phone We hereby submit specifications and estimates for: Basement Remodel/Gas fireplace/Mantle/Bookcase unit; Remove old carpets&pad&put in dumpster.Remove3 1/2'"col.base&replace with 5 %"2 part base. Add wainscoting&chanTad main room of basement and up stairway. Change 2,6 panel colonist doors to 15 lite doors.Install 30,000 btu gas fireplace.Build mantle floor to ceiling around fireplace(raised panels,fluted pilasters,and crown&dentil moulding).Build boocase unit floor to ceiling(Raised panels,crown&dentil,2 shelves,paint grade,birch plywood). Sand all walls.Paint walls&mouldings 1 coat primer,2 coats finish Benjamin Moore). Carpets by homeowner. Granite by homeowner. TOTAL STOCK&LABOR; $6,000.00 ®�O 9ti ID 000 Acceptance of Proposal-The above prices,specification,and conditions are satisfactory and are hereby accepted. You are authoriZO to do the work as specified. Payment will be made as outlined above. Signature � Date of Acceptance: / U Signature We propose hereby to furnish material and labor-complete in accordance with abovecations : speci£i >for the sum of All material is guaranteed to be as specified Al 1 work to be completed in a workmanlike manner according to standard practice. Any alteration or deviation from above specifications involving extra costs will be executed only upon written orders,and will become an extra charge over and above the estimate. All agreements contingent upon strikes,accidents or delays beyond our control. Owner to carry fire,tomado and other necessary insurance. Note: This proposal may be withdrawn by us if not accepted within 60 days. Authorized Signature