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Home My WebLink AboutBuilding Permit #324 - 165 MILL ROAD 10/21/2009 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: 2w Date Received 16 0 S Date Issued: .6 — -/ - 0 7 IMPORTANT:Applicant must complete all items on this page LOCATION PROPERTY OWNER --j+1 U +4 t l Ski✓ - CO M C4 Print MAP NO: -PARCEL:ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration No. of units: Commercial Rep ' , replacement Assessory Bldg Others: Demo i ion Other l � tw,kill Septic' Well Floodplain Wetlands _ Watershed Distric# WaterfiSeWer DESCRIPTION OF WQRK TO BE PERFORMED: L4/,1 w ' D Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: 211 CONTRACTOR Name: Phone: tk 4i Address: Supervisor's Construction License: Exp. ;Date. Home Improvement License: Exp. Date; ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ � FEE: $ 30 Check No.: ("011 S� Receipt No.: eP0P;;T6 NOTE: Persons contracting with unregistered contractors do not have access ano nd gnature'of Agent/Owner Signature-of contractor 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 PP 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 Doc: Doc.Building Permit Revised 2008 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 Siqnature CaMMENTS i 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 FIRE DEPARTMENT -Temp Dumpster on site yes no m ti =Located at 124 Main Street Fire Department'signa#uareldate -COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. i 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 a Location ( l / '�y //�� No. v Date MORTN TOWN OF NORTH ANDOVER F 9 a ' Certificate of Occupancy $ s i � Building/Frame Permit Fee $ SACNus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 22556 Building Inspector e10RTH ONVNMM Of RAndover * LAKE fly dover, Mass., • O COCHICHEWICK ORATED S BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.....................� .. 1�!1� ...................... Foundation has permission to erect.................. . ..... buildings on... `t. .... ,iI....... ..... ............. Rough to be occupied as......8b..!!!.... ..T......... I. �ij.......... imn y Ch' e provided that the person accepting th 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 30. PERMIT EXPIRES IN 6 MONTHS UNLESS CONS O STARTS ELECTRICAL INSPECTOR Rough ....... .......................... .................................................................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises - Do Not Remove Rough Final No Lathing or Dry wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. tAORT#i Tovm of RAndover . No. AKE dover, Mass., • d COC HICHEWICK �ds'QATE D PPS` �� 7 BOARD OF HEALTH Food/Kitchen PERMIT . T D Septic System THIS CERTIFIES THAT BUILDING INSPECTOR�� .......................................... :. w•..t..., . ...................... ......................... Foundation has permission to erect.................. ................... buildings on...14C .,. I� ...�......,.,,, Rough to be occupied as......lb-Ift ........ .............&4., �j.......... Chimney provided that the person accepting th 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 30. PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR. UNLESS CONSTN O ST TS Rough . ....... .......................... .................................................................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. ESEE REVERSE SIDE j smoke Det. y �I75'.5',rc �4 8r�c nrs /in,Or'tnr(y Restr license tr4Ction.S�� tr/;rtir)t 0/'pw1vi !cteq to. Ops Sp?10 �per�isorrrs'a.pU Ct, S`ni't► Ci�ense 1nU'� Wv . RICNgRp i' 102 A p MST��lO`M q ET EN 8O AO N 44 Expiration. Tr#. 3 p 32011 1 Board of Buil° o�urr��dffi �� g Regulatio s$nd Standard, r HOME IMPROVEMENT CONT RACTOR Reg jstradon`.106620 top Expiration _ 7J24T2010 Tr 270996 zTYpe Pnva'te Corporation RICHARD FLUET CONT l k NC. Richard Fl uet n RACT1yi�1G 102 Bridle P /. ., ath Lane�4 � Methueh,MA 01844 or i I The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov%dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): 91 /64hl—lp -Ilv l Com Address: /0}- tall ol0 C15�� f;�q- City/State/Zip: A" 7G4, A11A o/,,?y Phone#: ; Are you an employer? Check the appropriate bog: Type of project(required): 1.[l]-am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor orP artner- listed on the attached sheet. 7• E] Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its 10. Electrical re required.] officers have exercised their ❑ pairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.] t employees. [No workers' 131 other comp. insurance required.] b A..........T• . 8 ,....�. .H applicant that checks box..l mus`a.s..,.11.out the section below showing their workers'compensation policy informat;on. 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 their workers'comp.policy information. I am an employer that isproviding workers'compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name: Policy#or Self-ins. Lic.#: C3"LI 3 Lt (73 Q Expiration Date: 31 Job Site Address:__J L s�� ! t 1� /?0 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 certify the pa' p alf'es of perjury that the information provided above is true and correct Signafore: Date: v4.) / CJ Phone#: 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 Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee isdefined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged.in a joint enterprise, and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartrnents and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or Iocal licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary, supply sub-contractor(s)name(s), address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability.Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permittlicense applications in any given year,need only submit one affidavit indicating current . policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or Iicenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us`a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington.Street Boston,MA 0.2111 Tel. # 617-7274900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax 4 617-72.7-7749 wvvw mass.gov/dia RICHARD FLUET 02 BRIDLE PATHLONN CONTRACTING, INC PROPOSAL METHUEN, MA 01844 Date Estimate# 9/27/2009 77 Name/Address MICHAEL&KRISTEN COMEAU 165 MILL RD. N.ANDOVER,MA 01845 Description INSTALL 8 HARVEY WHITE CLASSIC DOUBLE HUNG VINYL REPLACEMENT WINDOWS WITH LOW E/ARGON GAS GLASS,FEDERAL INCENTIVE GLASS PACKAGE,AND 1/2 SCREENS.$315.00 EACH TOTAL$2520.00 WORK TO INCLUDE;INSTALLING,INSULATING,PERMIT AND TRASH REMOVAL. PROPOSAL IS VALID FOR 30 DAYS. Finance Charges on Overdue Balance 1 1/2%/MONTH 1/2 WITH ACCEPTANCE,BALANCE UPON COMPLETION. OWNER IS RESPONSIBLE TO REFINISH INTERIOR WOODWORK. I i i Total $2,520.00 Signature Phone# Fax# E-mail 978-685-7010 978-685-7010 RFC102aCOMCAST.NET ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID I DATE(MMIDWYYY FLUET-1 07/07/09) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Segreve 6 Hall Insur.Assoc.Inc HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 305 North Main St. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Andover MA 01810 Phone: 978-975-1300 Fax:978-975-7596 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Arballa Protection Dw. Co. 41360 INSURER B: Comnerce Insurance Co. 34754 Richard Fluet Contracting Inc. INURERC: 102 Bridle Path Lane INSURER D: Methuen MA 01844 INSURER E: COVERAGES 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 OFANY 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 TOALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY EFFEC POLICY EXPIRATION LTRINSRC TYPE OF INSURANCE POLICY NUMBER DATE tMWDDM DATE(MIWDDfM LIMITS GENERAL LIABILITY EACH OCCURRENCE $1000000 _ A X COMMERCIALGENERAL LIABILITY 8500034727 06/12/09 06/12/10 PREMISES Eaoccurence) s100000 CLAIMS MADE ®OCCUR MED EXP(Any one person) $500 0 PERSONAL&ADV INJURY $1000000 GENERAL AGGREGATE $2000000 GEN'LAGGREGATE LIMIT APPLIESPER PRODUCTS-COMP/OPAGG s2000000 POLICY PELT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $100000 B X SCHEDULED AUTOS M460 12/01/08 12/01/09 (Per person) X HIRED AUTOS BODILY INJURY $300000 X NON-OWNEDAUTOS (Pereccident) PROPERTY DAMAGE $100000 (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACG $ AUTO ONLY: AGG $ EXCESS/UMBRELLALIABWTY EACH OCCURRENCE $ OCCUR EICLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND TORY LIMITS ER A EMPLOYERS'LIABILITY 910434 03/31/09 03/31/10 E.L.EACHACCIDENT $500000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $500000 It yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $500000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS!VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT i SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION PROPMAN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN PROPERTY MANAGEMENT OF NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO$HALL ANDOVER, INC. IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR P.O. BOX 488 ANDOVER MA 01810 REPRESENTATIVES. ACORD 25(2001/08) 0 ACORD CORPORATION 1988