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HomeMy WebLinkAboutBuilding Permit #110-14 - 161 COACHMANS LANE 7/31/2013 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: C4 Date Received t Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION Al {-�C��''►�n b. �a%�I G _ -• f d pp 4iV mt/ /U/ PROPERTY OWNER JJ Print 100 Year Old Structure yes nno MAP NO: aQ4.PARCELM- V, ZONING DISTRICT: - Historic District yes Machine 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 ❑ Septic ❑Well ❑floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK O BE PERFORMED: 5 � ald ��i new 5j,;,, Identifi flo Please Ty o OWNER: Name: 11 rkrr� Phone: 6609��ZY Address: *20P,5 16 � -; CONTRACTOR Name: /Cha✓/ Phone:&M R1 M-S_ t // 7, Address: �o 'A44G/d A- , b��,t�G�� Supervisor's Construction License: ., C 77 Exp. Date: Home Improvement License: 1,5-710 W Exp. Date: g/57//.,3 ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 700 FEE: $ Check No.:__.4//./S, Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund Signature of A ent/Owner .5�e Coolk4.-t Signature of contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ Location /6 l flo U e_ Z N' No. 0+ ( Date 3 ' . - TOWN OF NORTH ANDOVER 4,4 Certificate of Occupancy $ 2 ' a Building/Frame Permit Fee $ G_ Foundation Permit Fee $ 1�c Other Permit Fee $ TOTAL $ Check# � r 266 : 0 - Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE-OF-.SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/BodyArt ❑. 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 Siqnature COMMENTS HEALTH Reviewed on Signature �a COMMENTS 'V 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 TovvA2 Engineer: Signature: Located 384 Osgood Street FIRE DEPARTk;L T Temp Dumpster on site yes no Located at 124 Mair, Street Fire Departmertt 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 Dieter 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 El Notified for pickup - Date Doc.Building Permit Revised 2010 Building Department The foEowing is,:a list of the required forms to be filled out for the appropriate permit to be obtained. Roofiv�,g, 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 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 a Building Permit Application ❑ Certified Surveyed Plot Plan Li Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract Li 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) o Building Permit Application ❑ 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) o Copy of Contract o 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 cans if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the apw al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm:¢ted with the building application Doc: Doc.Builjing Permit Revised 2012 . NORT1� Town of , O - No. I - i y C, h , ver, Mass, 2013 J T (� LANE 1. COCHICIOW.C. V ACOA-rED S U BOARD OF HEALTH Food/Kitchen PERMIT T LD O �1� Septic System THIS CERTIFIES THAT ......... BUILDING INSPECTOR ... ... .. .... .... .. . .... has permission to erect g �, Q 4i►,�I�, Foundation .......................... buildings ................ ..... ............. .................. p I , ...... Rough tobe occupied as ........ �. .... .. .....�......... ....��...... .......................................................... Chimney provided that the person accepting this permit shall in every re ' ect 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 m Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 NTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCT ST Rough Service ..... ......... .......................................... Fina BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Reguired 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. SEE REVERSE SIDE .ti 1"* United Home Experts & Ynited e me Experts United Painting Co., Inc. ' soy d 0 200 Butterfield Dr. Suite I ?T,AG " Ashland MA 01721� 7 MA HIC License#157108 Full Worker's Compensation Coverage 508-881-8555 FAX 508-881-5584 MA Constr.Supervisors License $4,000,000+Liability Insurance Coverage RI REG#22948 Industry leading Warranties www.UnitedHomeExperts.com RRP License#NAT-28008-1 Flexible Payment Plans available Family Owned and Operated Project: Siding Bid Date: 7/22/13 Attn: Joe&Peggy Osbaldeston Phone#: 978-660-9628 Company: Work#: Address: 161 Coachman's Lane Fax#: Email: City, St. Zip: N. Andover, MA 01845 Base proposal as per attached scope of work: Replace existing siding with Everlast composite siding $23,700 Prices good for 14 days PAYMENT: A non-refundable deposit of 1/3 of ALL ACCEPTED PROJECTS is due upon authorization in the amount of $7,900 with 1/3 of EACH PROJECT due upon half of completion of EACH PROJECT,and the balance of EACH PROJECT due upon completion of EACH PROJECT along with any additional work requested by customer. DISCLOSURE: State law requires us to inform you of contract liens. Any contractor, supplier,or subcontractor may lien your real property if you or the general contractor fail to pay for goods or services delivered or installed at the work location. Some contractors and suppliers automatically send letters of notification similar to this notice. At your request, we will provide original lien release documents from anyone who provides said materials or service. Please call if you have any questions regarding liens. ACCEPTANCE: The signature on this proposal reflects acceptance of the.proposal as per the attached scope of work, authorizes commencement of the work, and hereby guarantees payment as outlined above. Any amounts not paid within thirty days of invoice are subject to service charges of 1 Y2 %per month(18%APR). All costs of collection, including reasonable attorney fees are to be paid by the customer. You may cancel this transaction at any time prior to midnight of the third business day after the date of this contract.United reserves the right to assess a service charge equal to 25%of the contract amount if the job is cancelled by customer AFTER three business days. PERMITTING: The signature on this proposal authorizes a representative of United Home Experts to sign for and obtain any permitting necessary to complete this project. T Q7??1u� l � �- Contractor egnature Date Ckosi reDate BBB asceYER --- Addendum to Proposal and Scope pe of work Contract Price: $23,700 To be paid: 1/3 down, 1/3 at half completion, 1/3 upon final completion Contractor: United Painting Co. & United Home Experts Inc. 200 Butterfield Dr. Suite I, Ashland, MA 01721 Fed ID # 04-3541521 MA HIC License 130101 Work scheduled to be started: 8/1/13 Work to be substantially completed: 8/31/13.' Add any days where inclimate weather made the work not possible. Notice: All home improvement contractors and subcontractors shall be registered and that any inquiries about a contractor or subcontractor relating to a registration should be directed to; Registration Divison, Program Coordinator One Ashburton Place Room 1301 Boston, Ma 02108 Tel: (617) 727-3200 ext. 25239 Liens: a lien or security interest HAS NOT been placed on the residence as a consequence of the contract. Permit Notice: a. A Building permit IS required for this project b. It shall be the obligation of the contractor to obtain such permits as the owner's agent. c. Owner's who secure their own construction-related permits or deal with unregistered contractors shall be excluded from access to the Guarantee Fund. ti Arbitration: The contractor and the homeowner hereby mutually agree in advance that in the event that the contractor has a dispute concerning this contract, the contractor may submit such dispute to a private arbitration service which has been approved by the Office of Co, sumer Affairs and Business Regulation and the consumer shall bereq ' e dub to such arbitration as provided in MGL c 142A. Owner: Contractor: ad�. NOTICE. The signatures of the parties above apply only to the agreement of the parties to alternate dispute resolution initiated by the contractor. The owner may initiate alternative dispute resolution even where this section is not signed separately by the parties. NOTICE OF CANCELLATION ...7/22/13............................. (Date) You may cancel this transaction, without any penalty or obligation, within three business days from the above date. If you cancel, an property traded in an payments made b you under the YP P Y � YP Yl Y instrument executed by you will be returned within 10 business days following receipt by the seller of your cancellation notice, and any security interest arising out of the transaction will be cancelled. If you cancel, you must make available to the seller at your residence, in substantially as good condition as when received, any property delivered to you under this contract or sale; or you may, if you wish, comply with the instructions of the seller regarding the return shipment of the property at the seller's expense and risk. If you do make the property available to the seller, and if the seller does not pick such property up within 20 business days of the date the seller receives your notice of cancellation, you may retain or dispose of the property without any further obligation. If you fail to make the property available to the seller, or if you agree to return the property to the seller and fail to do so, then you remain liable for performance of all obligations under the contract. To cancel this transaction, mail or deliver a signed and dated copy of this cancellation notice or any other written notice, or send a telegram to: United Painting Co. Inc. & United Home Experts Inc. 200 Butterfield Dr. Suite I Ashland, MA 01721. Not later than midnight of......7/25/13 .................................... (Date) I hereby cancel this transaction...............................................(Date) .......................................................... Buyer's signature ,We have re iv a co of this notice. ........ ..... / ................. er (s) nature Date ............................................................ .................................. Buyer (s) signature Date The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.g ov/dia Workers' Com e nsation Insurance Affidavit: Builders/Contractors/Electrldans/Plumbers Avolicant Information Please Hut Le bb Name(Busuess/organiZabowl ivAual): Vm- G?17,7e l S Addis: �� ✓ e% ��" �G�/ -- City/State/Zip. �Qa/�r�Zj Phone#• �(� c�' C�'�SS -- >�' Are you an employer?Check theappropriate PI boa: Type of project(required): I am a employer with�_ 4• �]I am a genual contracts and I 1A employees(full and/orart-time)" have hired the sub-contractors 6. [3New construction 2.❑ I am a sole proprietor or partner- listed an the attached sheet. 7;,URrmodeling shop and have no employees These subcomiractors have 8. [3Demolition working for me in any capacity.c acit . employees and have workers' [No workers comp.insurance camp•;*suraTMe.t 9. Building addition 5. We art a c ❑Electrical repairs or addit required.) 5. corporation and its !0. 3.❑ I am a homeowner doing all work officers have exercised their 11;13Pl$unbing repairs or addil myself. o workers'comp. light d exemption . [N 8b MOL map � Pa t e 12.(]Roof repairs insurance required.) .152,§#(4),and we have no employees.[No workers' 13:0 Other comp.insurance required.] "Any applicant that check,box#1 moat also fX out the rection txlow showing their waken'compensation Polley idemu tion. t Homeowners who subrk chis affidavit indleating they an doing an work and then him outside contractors must submit a new affidavit indicating such $Contractors that check this box must attached an additional shed showing the mare of the sub-contractors and state whether at not those arm"have employees_ If the a*-contractors have employees,they mutt provide their workers'Comp.Policy Lumber. I air as employer that is providing rkers'eompenodon insurance for�ernproyees. Belowis thepolicy and job gid iRfirnaahlen J Insurance ComC�IrCi�1 / Pant Name: C'�� • rclp?CC, Policy M or Self-ins.Lic. -7 y67 6212 0/;2 Expiration Date: 0 5_// Job Site Address:_& s 417 e city/state/z p Al, )VD ter W o/d'vJ Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration dai Failure to secure coverage as n%pired tinder Section 25A of MGL c.152 can lead to the imposition of criminal penalties r 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: i of u to$250.00 a da P y against the violator. Be advised that a copy of this statement may be forwarded to the Office of j Investigations of the DIA for insurance coverage verification. 1 do herby certify under At pains and penaWs of perjury that the information protide/d aborae is true and correct. Sirmature: C/ � P�l Date !!3�/�� l�onc#: ��y� s�l X555. ME Official use only. Do not write in this arta,to be completed by city or town official. I 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 ------------------ America Irc http://inig.docstocedn.com/thumb/orig/l 0386444.png 4/5/2013 > 01 flet of Consumer Affairs fi Business Repuiat; j 7 , : 'k OME IMPROVEMENT CONTRACTOR = _ ., Registration: 157108 Expiation: 9/5/2013 Type; UNITED HOME EXPERTS Supplement t MICHAEL DUDLEY 200 BUTTERFIELD DR STE I ASHLAND, MA 01721 Undersecretary ��t � .�c5<.r-•riUSE'Tic �r �; i!'?'r_r?� - ;�; C Bcard of Euddil, FeVU ii0^s^ r:a �iandards i-icense: CS-100077 hr , 1 MICHAEL K DUDLEY . ' ..1. .tiff 137 CEN '", CENTRAL ST,U1 . . ASHLAND MA oil"" ° - 21. Commissioner Expiration 05/06/2014 A�R CERTIFICATE OF LIABILITY INSURANCE OP ID: M THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UNC E DATE(MM/oorvrvY) CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COV 04/19/13 BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN T PON THE CERTIFICATE HOLDER. THIS REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. COVERAGE AFFORDED BY THE POLICIES IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the HE ISSUING INSURERS, w the terms and conditions of the policy, � ) AUTHORIZED y certain policies may require an endorsement. A statement on this certificate does not confer rights polrseme must be endorsed. If SUBROGATION IS WAIVED,subject to certificate holder in lieu of such endorsement(s). j PRODUCER i :East Douglas Insurance Agency 508-476-2101 to the CONTACT 'PO BOX 1370 NAME: Douglas,MA 01516 508-476-1296 PHONE Marc Larocque 'ElkNo- F _ __ AX EM ADDRESS: PRODUCER --- C_urq ER ID_p:UNITE51 INSURED -- - United Painting Company, Inc - ---__ - ---- dba United Home Experts INSURERS)AFFORDING COVERAGE INSURER A:Western World Insurance CO. NAIC u 200 Butterfield Drive,Suite I - _ erce Insu INSURER a:Commrance Company Ashland, MA 01721 INSURER C:Scottsdale Insurance Compan -" 34754_ - - - - � - - Ir,SURER D;America Euro ---- pean Insurance Co. -- INSURER E:C _!4A Sure COm an COVERAGES - ---. F- y CERTIFICATE NUMBER: INSURER F: INDI IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CO REVISION NUMBER: CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES D j EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHO TO THE INSURED NAMED ABOVE FOR TNT POLICY PERIOD POLI CT OR OTNER DOCUMENT WITH RESPECT TO WHICH THIS (NSR' - --- ESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS LTR TYPE OF INSURANCE - "-- -- -- WN MAY HAVE BEEN REDUCED BY PAID CLAIM$. ADD(SueR GENERAL LIABILITY POLICY NUMBER POLICY EFF POLICY EXP MM/DOIYYYY MMlODNYVY " A X COMMERCIAL GENERAL LIABILITY LIMITS NPP8023401 EACH OCCURRENCE $ 1,000,00 _ CLAIMS-MADE X OCCUR 04/15/13 04!15!14 DAMAGE TRENT D -- _- _ PREMISES(Ea occurrences S 100,00 ------.- -__ _MED EXP;Any one person! $ 5,00 PERSONAL&ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER - -- $ 1+000,00 POLICY PRO' GENERALAGGREGATE $ 2,000,00 LOC �-..._ AUTOMOBILE LIABILITY PRODUCTS-COMPIOPAGG $ ___ 2,000,00 B - ANY AUTO --5 ALL OWNED AUTOS BDGTQN COMBINED SINGLE LIMIT ! 04/15/13 04/15/14 -(Eaaccident) 5 11000,00 X SCHEDULED AUTOS BODILY INJURY(Per person, ! X HIRED AUTOS 130DILY INJURY(Per accident, S X NON-OWNEDAUTOS PROERTY -- - PDAMAGE (Per accident) S ! UMBRELLA LIARX - S X OCCUR — g------ _- EXCESS LIAR C --- ----- _ ___- CLAIMS-MADE OCCURRENCE - DEDUCTIBLE XLS00878rJ$ - $ 4,000,00 04/16/13 AGGREGATE --__-"._".---- RETENTION $ 04/16/14 ------_ 4,00_O,OO WORKERS COMPENSATION _-_ _ $ 0 '" AND EMPLOYERS'LIABILITY D ANY PROPRIETORIPARTNERIEXECUT:VE YIN $OFFICER/MEMBER EXCLUDED ! N r A WCC5010274012012 WC STATU- OTH- (Mandatory in NH) `� 08/15/12 08/15/13 �YLIMITS_-_X ER - If yes describe uncer E L EACH DESCRIPTION OF OPACCIDENT ERATIONS below $ _ _ 500,00 i ;A Personal Property E L.DISEASE-EA EMPLOYEE $ _ _ _ 50010.0 NPP8023401 E.L.DISEASE-POLICY LIMIT $ ! 04/16/13 05/16/14 PERS PROP 500,00 I �DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schetlule,it mores 93,00 "Supplemental Name' � (Co(United Paintin Company,Inc.DBA United Home Ex arts g pace Is required) mpany,LL� P United Painting CER TIFIC ATE HOLDER UNITP02 CANCELLATION r I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE United Painting Company, Inc ACCORDANCE WITH THE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 200 Butterfield Drive, Unit 1 POLICY PROVISIONS, Ashland,MA 01721 AUTHORIZED REPRESENTATIVE Marc Larocque !/ lam;. ACORD 25(2009/09) ©1988-2009 A / The ACORD name and logo are registered marks of ACORD D CORPORATION. All rights reserved.