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HomeMy WebLinkAboutBuilding Permit #265-15 - 14 LINCOLN STREET 9/16/2014 O BUILDING PERMIT of",oT"_qti TOWN OF NORTH ANDOVER o� APPLICATION FOR PLAN EXAMINATIONP* n0 en Permit No#: /T Date Received ��SSACHUs���h Date Issued: IMPORTANT: Applicant must complete all items on this page et - r _ PROPSRTY OWNER__, )_1_V1.t _ �_IC.C1 nn Pnnt100 Year Structure yes no MAP 7A -PARCEL%= -._ ZONING DISTRICT. _ Historie,District yes no -- - _sRT Machine Shop Villages yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ®•bne family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑'Septic ❑V1/ell ❑tFl do,dplain Q`Wetlands o Watershed District ❑Water/Sewe"r_,. -_ __ _ DESCRIPTION F WORK TO BE PERFORMED UO Ide ti ication- Please Type or Print Clearly OWNER: Name�iNVl ► iAi Phone: (v?S9/0 Address: i IAV) C,Dt �� N • j— rM EA Co;ntractor!Na(e Address: Supervisor's Constructign yLicense q� _ R _ _ -Exp. Date: Home 1ri1provement L-icense « J - --Ex p. - �._ x - L - 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: $ ,- -0� Check No.: '5� e-//6; Receipt No.: NOTE: Persons contractin with unr gistere contractors do not have access to the guaranty f nd Sig gnature of A ent/Qwvner Signature of contractor - - _ F i 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 o Building Permit Application o Workers Comp Affidavit Li Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract ❑ Floor Plan Or Proposed Interior Work o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks o Building Permit Application o Certified Surveyed Plot Plan o Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract o Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) D Mass check Energy Compliance Report (If Applicable) o 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) o Building Permit Application o Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) D Copy of Contract o Mass check Energy Compliance Report o 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 Doe:Building Permit Revised 2014 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL j Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ permanent Dumpster on Site El THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments s; Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no _ Located at 124 Main Street T Fire'Department signature/date ;COMMENTS 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) ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 Location No. �t Date . - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ � � ] a � Foundation Permit Fee $ rar `tti�' Other Permit Fee $ TOTAL $ Check# O Building Inspector NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit at: I q Ll Ott)I u C is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150 A. Also, note Permits are-required under Fire Prevention laws Chapter 148 Section I 0A. The debris will be disposed of in: (Location of Facility) Signature of Permit Applicant Tq Date .� ' fI �e D h s lv � �5-7 - 60 tem;7. NORTH own of ndover No. C. ver, Mass, COCNIC"a WIC" U BOARD OF HEALTH Food/Kitchen PERMIT T LD/ Septic System THIS CERTIFIES THAT .......9.. �. !l....... .�..,c�. o�v!! ./:................................................................... BUILDING INSPECTOR Foundation has permission to erect buildings on .. / -� _ Rough to be occupied as .................. �'� .... .. .. .el.. 1i. . .. ex__ ...................................................... Chimney 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR • UNLESS CONSTRUCTION S ARTSRough Service ................ .... ... .. .. r n•a _:......................... 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. � NORTN Town of No. 2499! *y T I h C, h ver, Mass, 9rc �y coc"Ic Nl WIcm S U BOARD OF HEALTH Food/Kitchen PERMI. T T LD Septic System THIS CERTIFIES THAT .......l��l�. t...., , ,f.. C,5? .................................. BUILDING INSPECTOR has permission to erect .......................... buildings o� Foundation !! C.'ole ...��............................ .44:)�. ........................... Rough to be occupied as .................. l?ip.... �`. .......................... Chimney 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION S ARTS Rough Service 9- -B'1"UWi_Ml4G-1-NSPECTOR ...... Final GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz 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. CONTRACT ROBERT BOHONDONEY CONSTRUCTION CO. 12 HALL STREET METHUEN, MA 01844 978-68S-0970 (office)/978-685-8262 (fax) Fully Insured Construction Supervisor License#979 Exp 4/21/2014 Home Improvement Contractor#114238 Exp 8/16/2015 bohondoneyconstruction@yahoo.com Customer Name: Jim Maccannell Property Address: 12 Lincoln St, North Andover, MA 01845 Contract Type: Main House Roof Date: September 16,2014 Scope of Services: Main House Roof 1. Supply local building permit. 2. Supply workers compensation and liability insurance certificate. 3. Strip existing main house roofing to bare sheathing. 4. Supply and install 6 ft of ice and water barrier at all roof edges. S. Supply and install IKO synthetic shingle base to remaining roof areas. 6. Supply and install white aluminum drip edge at all roof edges. 7. Supply and install new pipe flange on vent pipe through roof. 8. Supply and install 30 year architectural roof shingles(IKO Cambridge)to match garage roof— color dual grey. ,9. Dispose of construction debris from site. TOTAL CONTRACT AMOUNT: $7,125.00 Payment Terms: $3,562.50 deposit to start project and order materials,$3,562.50 at completion of project. Customer Signature: �i n-,vn 1� 1 Date: q Contractor Signature: Date: Page 1 of 1 i I A CERTIFICATE OF LIABILITY INSURANCE 7(Mmmofyyyy) g�z14 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, N the certificate holder is an ADDITIONAL 1 URED,the pol)c es)must be endorsed. if SUBROGA71ON 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 NAME: Bates Insurance Agency Inc. PHONE 781 396-4985 FAx Noll: (781) 395-9454 92 High Street, Suite B1AffiEL Medford, MA 02155 s: Andrea@Bateslns.com INSURE S AFFORDING COVERAGE NAIC# INSURERA:RCA-Essex Ins Co INSURED INSURERB:A.I.M. Mutual Ins. Co. Robert Bohondoney INSURER c: Bohondoney Construction INSURER D: 12 Hall St INSURER E: Methuen, MA 01844 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 LTR TYPE OF INSURANCE ADDL 13R POLICY EFF P CY EXP INSR WE POLICY NUMBER tMMMDIYYM (MMD!YYYY) LIMITS A GENERAL LIABILITY 2CM7726-14 2/3/14 2/3/15 EACH OCCURRENCE $ '11000,000 X COMM ERCUALGENERALLIABILITY DAMAGE TO RENTED $ 100,000 CLAIMS-MADE ©OCCUR MED EXP(Anyone person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 1.000.000 GEN'L AGGREGATE LINT APP LIES PER PRODUCTS-OOMP/OPAGG $ 1,000,000 POLICY F-1 ECT PRO- LOC $ AUTOMOBILE LIABILITY a acct N N L IT $ ANYAU70 BODILY INJURY(Per person) $ AUTOS ALLOWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS _AUTOS e,accident $ UIMIIELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION B WORKERS COMPENSATION AWC40070243322014 8/9/14 8/9/15 WCSTATU- OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNERIEXECUTNE N/A E.L.EACH ACCIDENT 500,000 OFFICERMEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ Soo,O00 It Yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS/VEHICLES(Attach ACORD 161,Additional Remarks Schedule,if more space is required) 12 Lincoln Street North Andover, MA 01845 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Toren of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood Street North Andover, MA 01845 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The AC ORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: _ is.r,, � •� .. �. •� �, I, a., '� .ii,�-. ... '. c ... .` �,.' .�°•• - t' i i Y • e t , t •s i ..-.• +....n .. ....,..n�..w.v..... �._ ..... ...n ..v;.- ..r.•s..., ...� _ ,..,: ....i ... a.o u..... «� a.-...... r.•+• 'i_ ... t I .♦ ..'. r �. I The Commonveaft of.n2asxsa0use#s • , Offlee o,fInvesfigafeovs 00 Washington Street .Boston,HA 02111 wwW.mass govIdxa �7C1 ex, ' ompea2 Zoe n u a ce.fxc�adt:BuRdear dContractoxo/ Inc e ansl'ii bex,� A cgnt Worcoaa-doxw Hama(Businossforganizationlfndividuai]: D P4�t• �1/1��V 1s��l.s� "" ' Ad&ess: 1 c +ULA �� y Cxtyl t �t : �1l t t�,tQ,u MA Ck V q PhowB: Ara you an employer?Cf.eektlnerappropxiato' box: Type of Project(Ye%'MIr6d): 1.W aM a employer with �5 4 E]S am a general contractor and 1 6. ❑New 0118fruc6on f employees(gillan(Voxpax-funs).* have nedthesab-confractors - listed on the attached sheets� 7. 1 i.�odeling 2.Q 1 am a sale propxlefor orpartnex shio and`havena.employees These sub-confraetoxshave 8. �[Demolition wox�.g forme many capacity. We ate compo.igzsuxancep 9. ❑Building addition [No work-DIS,comp.pIsmanca �. ❑We axe a havcore exercised dtheir 10.r]Electricalxepairs ox ad tions xagaRed.] officers Inave exexcised.theix 3. Z am a homeowner doing all work rzg7�E oL exemptionperMGL x1..]PImbing.xepaks ox additions mysels. loworkexs°comp. c.152,§1(4);,andwehavena 12. -Raofxeaixs irisuxarzc�recluixed.� employees.[No workers' 13.0 Other comp.insurance re�oixed.l 6AuyapplioanttfiatChecks boOfmust alsai�Tlouitheseetionbelbwshowingtheirwbrkers'aompensationpolicy nfom�ation. S 7 Soxneowners who submitthis aWdavitindioatijIfiey ire doing allworkandthenhire outside contractors mustsubmit anew affidavitindicatig such. xContactor tiatcheacthisboxmustattachedan.additianalsheetshowingthenameofthesub-contractorsandtheirworkers'comp.policyinformation. km an exnployertAaiis,vrovidiltgWoy'kels'eornpenvadaninsurarteefox��y erzzpro�ee Belot st�iepaliey raztija ,�it'e ire,fo:�.matio�2. . Lnsmance Company Name:- VUR -q- I s. rola Site f�ddxess: V�( 191 VI c'ST" fpityistafemp 1 y V"MC�( - IM AffachacopycMOwoTkexs'cOMansafzox�-PORcyOeclaxatiouPage showiztg•tltepolicyumnberande iratzondate). yogure to secures coverage as xecluixeclunder Section 25.(x.ofMGL o.152 can lead to the imposition of eximinalpmalties of a fine,up to$1,500.00 andiox one�year impriso n en E�as well.as civilpenahles in the:form_of'a STOP WO=ORDER.an:d a fine ,of-Up to$250.00 a day against th e vioXafo 13@ advised that a copy of this sfatem ent may'be,forwarded to the Office'Of Xnvestigations of'fho DIA.fox insurance coverage verifioation. do Iiereby sex ' u 'ce� Iie iri arc yer2aXties peYjr��y tXiattri�infonn�iox�proViciec�at7oYe tie ancico �ee. Si afore: Date: Thone#: Offieial use mly. .Do nOI Vrit`e in Amy area,to be==feted by city or town ofeiaX. City or Town: BeDnztlLzcense# Issuing Authority(circle one): L Board onaealth.2.Buildilipepartment 3.OylTawn.ClarkleetricaYxns eetor .l?lumhinglfnspecto 6.Otlter ,4 information tions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for the>x employees. Pursuant to this statute,anemployee is defined as"...evexypexson itithe service of another under any corifract of h7xe; • express orhial ied,oral oxwxitten.." Ane TIV;e ;s defined as"En indi-Odual,1)artnexshi�p,association,corporation or other legal entity,ax any two oxmare' Of the fiixeg'ing engaged in a joint entexpxlse,and including the,legal xepxeseutatives ofa-doc0as0d gInplvex,.or the receiver o�ft•�istee ofatc individual;partn.exship,association ox otherlegal entity,employing employees. �Sowavex the ovlxter of a dwellinghousehavingnatmoxe fhanfhree apaxtrnents andwhaxesides liherein,,orthe occupant ofthe dwellinghouse Ofanother who employs,persons to donlaintenance,consfnzctzon orxepairwaxlZOn.suc!dwellinghouse or onthe grounds orbuilding aPPurt"'Wtthexefo shallnotbecawo ofsach employmentbe doomed to be an employer." UGL chapter 152,§25C(6)also states that"ever state or to cal lic-ensing agency shall wztbhold the issuance 0r renewal of a license or permit to operate a business or to constxuct hadfugs Wile cammonwealtlt for any applzcUt who has not pro duced.acceptable evidence of compliance with the insurance(average recXnirecT:' Additionally;MOL chapter 152,§25C(7)states`weitherthe commonwealth nor any of its political subdivisions shall enter into any contract for the p erform meo of-public work until acceptable evidence of cojn.Pliance with the lmwance requirements of this chaPterhavebeenPresentedtathecorfxactingauthority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your sitaatzon and if necessary,supplysub-conixactor(s)nme(s),address(es)andphonenumbex(s)alongwntheir cerecate(s)of insurance. limitedLiabik ComPanies(LLC)or Limited Liability Partnerships(LLP)wjth no employees otfierthars the members oxPaz-trters,arenotrogairedto carryworkers'compensationinsurance. ZfanY orLLP dco ha a employees,apolicyisxequixed. BeadvisedthattWiafdavit-Maybesubmittedtothe Departmentof Industrial Accidents fox confirmation ofi-asurance coverage. Also be sure tosigtt and(Tate the ajMdavi. Ike of idavitshoudd be xetamedto the city or town that the application for thepoma or license is being re(lues ted,xtot the DBTartmentt of .TndusfrialAcoldenfs. Shouldyouhave,any questions xegaxdingthe law orifyouarexegnixedtoobtainayToxltexs' comp ensationPO&A Please call the T ePartment atthenumber listed below, Self insured companies should enter their • self-insurance license number on the gpxopriate line. ' ICify or To im Officials Pleasebesuxethattheaf idavitis completo mdprintedlegibly. The DePailment has yovided a space attire,bottom of the affidavitfaryouto nff out in.the overt the Office ofkvestigationshas to contactyouaxegardingMe applicant. Please be-sure to used as a rdforence number, fn addition,an.applicant t7iatmust submitrawtiple Permifllxconse applications itt any givenyear,need only submit one affidavitludicating cment PORGY WOTInation(Nnecessmy)and mder"Yob Bite Address"the applicant silo-aid wxife"all locations in- (city or towh.)".A:copy oi•'flie aiftdavit that-has been officially stamped orm.arked by the city or townmaybepxovided to the applicant as is ,AuewafddaemustbemQ.(IouteavR year.Where a.home owner or citizen is obtaining alicense oxpennitnotrelated to anybusiness ox commercial venture (i.e.a dog Rowse orpermitto burn leaves eta)saidperson is N'OTxequixedto complete this affidavit. The Office bfXnvest gations would like to fhank you in advance for your coopexafioa and should you have any giuest"tons, ' please dc)xtotha4tate to give us a call. The Department's address,telephone ahcI faxnumber: The Cou onwtml Of mamac,-bwf tw. opaxi e t~Of jd-a*r vj Acc�c�e�t� Otte offwe.Waaftta 6Q4 W,aftgtola. xe BMW;MU 02111 Revised 526-•o5 Fa # 7"7749 Massachusetts - Department of Public Safety Board of Building Regulations and Standards Construction SuherNi�nr License: CS-000979 ROBERT A BOHQNDONEY 12 HALL ST �Y METHUEN MA 01844 Expiration Commissioner 04/21/2016 y 11 9/16/2014 Office of Consumer Affairs&Business Regulation-Mass.Gov The Official Website of the Office of Consumer Affairs&Business Regulation(OCABR) Consumer Affairs and Business Regulation Home Consumer Rights and Resources Home Improvement Contracting HIC Registration Complaints Registration # 114238 Home Improvement Contractor Registration Home Page Registrant ROBERT BOHONDONEY CONST CO Name ROBERT BOHONDONEY Address 12 HALL ST City, State METHUEN, MA 01844 Zip Expiration 08/16/2015 Date Complaints Details No complaints found for this registrant. You can also view arbitration and Guaranty Fund high. Back To Search ©2012 Commonw eatth of Massachusetts. Mass.Gov®is a registered service mark of the Commonwealth of Massachusetts. I http://ser\ices.oca.state.ma.usthicAicdetails.aspx?bdSearchlN=14200 1/1