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Home My WebLink AboutBuilding Permit #934-14 - 15 WOODCHUCK LANE 6/23/2014 BUILDING PERMIT 3�0$No cT 6gh�L TOWN OF NORTH ANDOVER o APPLICATION FOR PLAN EXAMINATION Permit NO: Date ReceivedM 4 `p Top �9SSACHU`��t Date Issued: IMPORTANT:Applicant must complete all items on this paLe LOCATION—0Y PROPIt�4 R-+-�-�t_�j (�L�Pnnt' Print MAP NO:t PARCEL ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE -Residential Non- Residential ❑ New Building sio6ne family ❑Addition ❑Two or more family ❑Industrial S4iteration No. of units: ❑Commercial ❑Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed_District ❑Water/Sewer t2P VINL L<� Ar--J (IG 2J C-2j=- fl a)s VjnciL �Pmr- cP -m c, ftb�',F� - / Identification Please Type or Print Clearly) OWNER: Name- 4- 11_y LL Phone: q-1T• Address: 157 CONTRACTOR Name: Phone: Address:Ll ddress:L a i� PtV_Z� 'r-KS ti 1 LL, Supervisor's Construction License: Exp. Date: 3. Home Improvement License: Exp. 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: $ (o FEE-: $ 7 Check No.: 317)5 Receipt No.; NOTE: Persons contracting with unregistered contractors do not have access to the guar' ig�a e f Iger fl�+rt r; �_ atur.gnof contractor -- BUILDING PERMIT a - ej "°D, "�tio TOWN OF NORTH ANDOVER - o � APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received .0" TED y 9SSACHU5�� Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION . - --- -- o- a Pri_t . 'PROPERTY OV1lNER� � " _ - 9 _ _ —�_s —�-_ - P-_nnt, 100 YearpStructure =yes r ono MAPA __..,Y , .'PARCEL:° _ _ ZONING DISTRICT_rHistoric District yes no,ve� _ - _ - _MacNhe Shop Village t _yes I 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 O'Septic V11ell° _ ❑ Floodplain Wetlands ❑'1Natershed Dstnct;� - - -Water/Sewer; u DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: Contractor Name:' b w �Address: . ..` n:• . . �� - m — --- - - - - - - a -_ T - — Supervis.or'sw onstrwction License:rT �z rExp. :©ate_ r Home` -rove Improment°Licen"se ExpDate,-_ _ t— orn e ARCHITECT/ENGINEER Phone: Address: Reg. No. ,y FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund I Signature-of=Agent NO r _ - Signature of cgntrabtor. I Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swinnning Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Pennanent Dumpster on Site ❑ 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 a Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments i Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street - - �F_IRE DEPARTMENT ? !ernp IDumpster on site yes Located,at 124 Mam.S.tfeef Fire"Departmentz'- -tur'Id;ate 'COlqqN- �S . - 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 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 ❑ Building Permit Application o 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 o Certified Surveyed Plot Plan o Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses o 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) 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 ❑ Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract a Mass check Energy Compliance Report Li 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 Doc:Building Permit Revised 2014 I Location "`'�� c ""`AL,,j, No. 3�0 1-1 Date e r< TOWN OF NORTH ANDOVER Certificate_of Occupancy $ Building/Frame Permit Fee $ Alb Foundation Permit Fee $ Other Permit Fee $ ' t i"" 'e, TOTAL $ Check# 27705 Building Inspector -`` tAORTH Town of O .. ` 0 * h ver, Mass, vo 3 26 Iq o 'P cocH�cMew�c� 1' TED S u BOARD OF HEALTH Food/Kitchen PER IT T LD Septic System THIS CERTIFIES THAT ........�.. ..C. G, .. ., ,.,,,. BUILDING INSPECTOR ... ... .... ....... .......��1� 1 d ..6�� ,................ Foundation has permission to erect .......................... buildings on ................ .. ..................................... Rough tobe occupied as ........... .............. ...................... ..... .................................�............ Chimney provided that the person accepting this permit shall in every respect co rm 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 MO ELECTRICAL INSPECTOR UNLESS CONSTRUCTION Rough WOW Service .................... .. .............................................. BUILDING INSPECTOR.. Final 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. Office o�ons�ame°�rirs&nas►ness egu a`fion TN HOME IMPROVEMENT CONTRACTOR Type: Registration: 1:26998 DBA Expiration:: 8��g/2014 VINYL SIDI 7�ND I DOWS ! �•Yj \11 , KEVIN MONTGOM�ER`�Y-- 11` 42A BARRETTS HILkRI9 HUDSON,NH 03051 � t� if Undersecretary ' W Massachusetts-Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License:CS-072402 �,.I F.. KEVIN M MONTOMERY 42A Barretts Hill Roan` o s Hudson NH 0305$ Expiration 03/17/2016 Commissioner QN The Commonwealth of Massachusetts Print Form Department of IndustrialAccidents -- Office of Investigations ' I Congress Street,Suite 100 Boston,MA 02114-2017 www massgov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual); Address: by h �� LL �� City/State/Zip: I I l.��S l)Y"') J)" 0305-1 Phone#: Are ou an employer?Check the appropriate box: Type of project(required): 1. am a employer with_( _ 4. I am a general contractor and I PI (full and/or part-time).* have hired the sub'-contractor's 6. F]New construction 2. I am a sole proprietor or partner- listed onthe attached sheet. 7. remodeling ship and have no employees These sub-contractors have g• Demolition workingfor me in an capacity. employees and have workers' y p �'• 9. .❑Building addition [No workers'comp.insurance comp.insurance.: 10. Electrical repairs or additions required.] 5. We are a corporation and its ❑ P officers have exercised their 11. Plumbing repairs or additions 3.❑ I am a homeowner"doing all work ❑ g P • myself. [No workers' comp. right,of exemption per MGL 12.0 Roof repairs insurance required.]t c. 12,§1(4),and we have no employees.[No workers' 13.❑Other 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. �y Insurance Company Name: zl U � �,��/ _� �� )s lQ U�l 11 1�' , l� 1�A PTU Policy#or Self-ins.Lic.#: � p� �j 3 (�[� �� Oxpt ation Date: L-7 - t Job Site Address:_ City/State/Zip: 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 Hereby cern under the airs a ties o "e'u. that the information provided aboveis true and correct. Si ature: ---- — ---- - —– Date Phone#: (,�2 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/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Penson:.._..., __ Phone#:.._, __... .___......:..__-..w.__ __.__,..m...._.._...,_ __... ACC) CERTIFICATE OF .LIABILITY INSURANCE 5;DA2W M D"W") 5114 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 endomemen s. NTCT PRODUCER NAME: Debbie Moux Eaton&Berube Insurance Agency,Inc. PHON o 2-27 6 FAX(AIC Ne.-603-886,4230- 11 Concord St E-MAIL Nashua NH 03064 ADDRE 1 INSURER(S) AFFORDING COVERAGE NAIC p INSURER A.-Libeft Mutual 24198 INSURED HUDVI INSURER a':RiVe o" Insurance Company` Kevin Montgomery DBA 1NSURERC: Hudson Vinyl Siding&Windows INSURER D: 42A Barretts Hill Hudson NH 03051 1 INSURER E. INSURER.F: COVERAGES CERTIFICATE NUMBER:987908352 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: NOTWITHSTANDINGANY 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 IN R SWVD POLICYNUMBER .MM/DD POLICY EFF MM/DD LICY EXP LIMITS A GENERAL LIABILITY CCPq725728 /22/2014 5rjj2015 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO ENTED c PREMISES Ea ocxurrence _$50,000 CLAIMS-MADE K OCCUR MED FRCP(Any one person) $5,000 PERSONAL&'ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY PROJEC- LOC $ AUTOMOBILE LIABILITY Ea," lrtbINULI:LIMIT $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident UMBRELLA LIAB OCCUR EACH.000URRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE DED RETENTION$ $ B WORKERS COMPENSATION VVC288300610200 /22/2014 /17/2015 X m STATU- OTH- AND.EMPLOYERS'.LIABILITYLI T R Y/N ANY PROPRIETOR/PARTNERIEXECUTIVEELEACH ACCIDENT $100,000 OFFICER/MEMBEREXCLUDED? Y❑ N/A (Mandatory In NH) E.L.DISEASE-FA EMPLOYEE $100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS/.LOCATIONS/VEHICLES(Attach ACORD 101,Adddtonal.Remarks Schedute,if more.space.is.requlred) Workers Compensation Covered State:NH. Excluded Sole-Proprietor: Kevin Montgomery CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN For Informational Purposes Only ACCORDANCE WITH THE POLICY PROVISIONS. *NH: AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD i- JUNE 23, 2014 HENG-CHENG AND LILY LIN 15 WOODCHUCK LANE NORTH ANDOVER,-MA. 01845 978-204-5742 L.INRAYTHEON@YAHOO.C OM WORK CONTRACT: INSTALLATION OF VINYL SOFFIT ON ALL OVERHANGS. INSTALLATION OF WHITE METAL COVERAGE ON ALL FASCIA. $3,232.00 LEFT GARAGE SIDE OF HOUSE AND RIGHT SIDE OF THE HOUSE ON BOTH SIDES OF THE CHEMMY: INSTALLATION OF 1/4" INSULATION. INSTALLATION OF WOLVERINE VINYL SIDING IN THE COLOR LIGHT MAPLE. INSTALLATION OF J-CHANNELS AROUND THE WINDOWS. $3,187.50 TOTAL FOR ABOVE: $6419.50 Y •[r WARRANTY: THE ITEMS LISTED ABOVE ARE GUARANTEED AGAINST WORKMANSHIP FOR AS LONG AS THE ORIGINAL PURCHASER IS STILL LIVING AND REMAINS OWNER OF THE PROPERTY. THE MANUFACTURER IS-RESPONSIBLE FOR THEIR PRODUCT AND ITS WARRANTY, WARRANTY OF WORKMANSHIP APPLIES TO ALL ACCOUNTS THAT HAVE BEEN PAID IN FULL AT TIME OF JOB COMPLETION. PAYMENT SCHEDULE: THE FIRST PAYMENT IS DUE WHEN PROJECT BEGINS, SECOND PAYMENT IS DUE WIN PROJECT IS 50% COMPLETE AND FINAL PAYMENT IS DUE UPON JOB COMPLETION. FIRST PAYMENT...............$2,139.83 SECOND PAYMENT:............$2,139:83 FINAL PAYMENT...............$2,139.84 $6,419.50 THE "TOTAL AMOUNT DUE"DOES NOT REFLECT ANY CHANGES, WHICH HAVE OCCURRED DURING THE PROJECT. A SEPARATE INVOICE WILL BE ISSUED REFLECTING ALL CHANGE ORDERS. UPON SIGNING BELOW, I AGREE TO ALL PAYMENTS AS STATED ABOVE. IF ANY PAYMENT IS NOT MADE ACCORDING TO THE PAYMENT ARRANGEMENTS LISTED ABOVE, HUDSON VINYL SIDING AND WINDOWS, HAS THE RIGHT TO STOP WORK UNTIL THE AGREED PAYMENTS HAVE BEEN MADE. THERE WILL BE A $30.00 CHARGE FOR ANY RETURNED CHECKS. G '2- CUSTOMER SIGNATURE: DATE: HUDSON VINYL SIDING AND WINDOWS: