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HomeMy WebLinkAboutBuilding Permit #346 - 177 REA STREET 11/18/2008 BUILDING PERMIT Of No RT: TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received +,.@o cMus�t Date Issued: D IMPORTANT:Applicant must complete all items on this page .3++• S ). -•fir .s �,>•M .•�' t„ uty,.� ,.�- ,X c. -c#�. ..�. -y�.. may. x' ver TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential 0 New Building ❑ One family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: 0 Commercial &Aepair, replacement 0 Assessory Bldg 0 Others: 0 Demolition ❑ Other g�ygy INI-w ;t I DESCRIPTION OF WORK TO BE PREFORMED: GI�•OC'/S' o� Iry ow Identificatiog Please Ty De or Prii t Clearly) OWNER: Name: 1 p�i�/Jl,d� Phone: . / it 2 Address: - �• o. .4U_r1VV,-5 _.,,,+ ,�'•,,�+y t'4 �..�+•4 7, aF?+� �.. ...,� .� �. yc� �k i.; � �w9,�� }t ��.K,.,,,:c�,a-�ix� y;=. �,€y -. MM �'^�Q�� f t��Y: x, .,�. s5'����+1�� »r � ..`,t v le�;: �_- �'Y' ?�nr'"�j..� •1 -t i;, �'. ' j 3•?Na .0 ,' M „y �yb.� i 'Ss ��� y��.}�[�fyyr �K.�St`%7',•` €U,�• t47�,�sF'(' 4 �✓�L�u nYC<w"3;yS Y . +f C'L�j'F'��� �' "q�`•.ya tGi,'•..' #K.w�N ,..\ w-t...y.,�,,� T. 'Y A1�✓ Tt aw •7''t' �+�5. :`l+F"i" t P w .k K,z�. I __ Y aa3!' .., ''S i�.`��'* "`�,�,*' ,�s"r`�.,�y��iw ,. v- •f".M.w!.•..ra „f ,,. ""g` a+. ..•N�r�.'�'��'S`*�.''f"3`'��fiC'.�rr,;,F .�":v�-�` ,r.'4��.¢ �.;1� 3�,,. ��F�` ."•! �L`r Ew'`�r '�F 't}� p�}"`["� :,d,S,+r`'"' .���;� �9. .. "# _s'�-• r• �' :i ° 't k'. 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: $ �.�� r Q FEE: $ 0 (� Check No.: /`O� 7 Receipt No.: 2/ 7 D o NOTE: Persons contracting with unregistered contractors do not have access to the gua anty n r 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 NTERDEPiARATL' IIgN'OFF��11�4Mk'-g*E ONLY DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ ` NITS +n" ring adard p 4#s: Variance, Petition No: r) ecision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Signature &Date Driveway Permit Located at 384 Osgood Street I �7Y E xZar yF�ffio j' # ,may, i l � �` "Y']T tr n`� vC'•'f��`a`�k+S'��" � �r j 4> t T" ''- ...,Y'^' F �L`ih� p "t' i I.. / ��� � �W41 FQ41 � �•',}Ssw --f F� < �� Q1i i.+,�^NT�'t -,r''�'"s. �,��` j'�:H,fir q 44haG j,�'°" Y �'"4'�-,t��i.J�'„".'tS.``1.�. EPA [� pa �,(" tinat �4 c,y�.atm�0htgr.J:t-�''-a.,�,f�.r�Fst �rx*5� .,,.z(y tt.;.� rl'Y� �v t'voc.�^,�s-. fi3.ss� ��•y�^+F,s .�`�s�'Ss�X [[��tNt?,yY��£.,iF,amh`1r.Ct,J�y"'kT[�%, �S � X..-„l L t,,,,i 5' ,�� �'�� '"•. Z�6 `j h 3'L. 1 r' `s����i .}',rAJy pr�'�r� � �F�,� ' 7 � �r t� ,���� �.. y. "� � # � u„u•.5 , `f: '^'-. `F''s� �{r'. "rt�. �j�-' Jam-is SIR ��'r", ' 1 0 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 I i i ❑ Notified for pickup - Date Doc.Building Permit Revised 2007 J 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 ❑ BuildingPermit Application pp cation ❑ 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 Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 Location No. V3 /.E Date TOWN OF NORTH ANDOVER a • Certificate of Occupancy $ �'�s'•""tt�' Building/Frame Permit Fee $ P �cwus Foundation Permit Fee $ Other Permit Fee $ ;e TOTAL $ �� -t + Check # I �� 2 ! 760 ' Building Inspector R T T Andown ooverf No. o dover, Mass., zz C% 0 A coc HI CmEWICK ORATED BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THISCERTIFIES THAT..............................................................74 .... ................................................................................... Foundation has permission to erect.......................................... buildings ......5�.................................... Rough to be occupied as.................. Chimney ....00. 1 4�le...... C..................................................... provided that the person accepting this 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 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR Rough UNLESS CONSTRUCTION MARTS Service UILID51iKG INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR 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. IESEE REVERSE SIDE Smoke Det.--Jl PROPOSAL Paul& Sharon Coleman 177 Rea Street North Andover, MA 01845 978-975-1604 November 17, 2008 cgpscoleman@comcast.net Work to be completed: Remove existing triple casement window in family room. Install new Harvey Majesty Triple casement unit with white ext./clear pine int. 70 x 35 '/z round unit mulled on top. $4055.00 Remove casement window in kitchen. Replace with Harvey Majesty white ext./clear pine int. casement unit. $ 840.00 Repair blueboard between garage doors. $ 280.00 Removal of all debris. $ 250.00 Building permit. $ 75.00 TOTAL LABOR AND MATERIALS $5,500.00 Terms: $1800.00 to start o 9 ill s$3700.00 when complete / Submitted By: Chris Rivet MA Lic#CS072173 HIC #139962 207 Winter Street (C) 508-265-3115 (H) 978-794-1165 North Andover, MA 01845 ACCEPTANCE OF PROPOSAL The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payents will be made as outlined above. Date �i l Signature '>-=. M I Date Signature /52 I ACORD,. CERTIFICATE OF LIABILITY INSURANCEDATE(MM/DD/YYYY) 11/17/2008 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION MacDonald & Pangione Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P.O. BOX 428 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 104 Main Street North Andover, MA 01845 INSURERS AFFORDING COVERAGE NAIC# INSURED Christopher Rivet INSURERA: PREFERRED MUTUAL INS CO 15024 207 Winter St. INSURER B: N Andover, MA 01845 INSURERC: INSURER D: 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 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. INSR ADD'L POLICY EFFECTIVE POLICY EXPIRATION LTR INSRD POLICY NUMBER DATE MMIDD Y MIDDY LIMITS A GENERAL LIABILITY CPP 0150 57 01 05 09/26/08 09/26/09 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES Ea occurence $ 100,000 CLAIMS MADE EOCCUR MED EXP(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 $ 1,000,000 X POLICY PEO LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE RETENTION $ $ WORKERS COMPENSATION AND WC STATU- OTH- TORY LIMIT ER EMPLOYERS'LIABILITY — ANY PROPRIETOR/PARTNERIEXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Certificate holder as listed below CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION. Town of North Andover DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN . 120 Main Street NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL No Andover, MA 01845 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2001/08) ©ACORD CORPORATION 1988 AN -Ane wrnnsvnWtX9"M UJ LPlassacnusew D q.d of Industrial Acddm& Offwe of Invesdgadons 600 Washington Sired Boston,MA 02111 www m=s govMa . WorkersCompensation bmn-ance Affidavit: BaMers/Contractors/Electricians/Ptnmbers Applicant Information Please Print LeLibly Name(Business/Orpnization/individual): Address: Aj iti City/SWeMP:NO, XIVP0419-IZ . lW ai fVf Phone.#: ,!rO Are.you an employer?Check the appropriate btu Type of pi%ject(ragniredj'` 1.El am a employer v� 4. ❑ I am a general contractor and I , --r— have hued fl><e boyo 6. p New construction �loyees(full ancllar part time). 2.e j al a sole proprietor or listed em�e attached sled. .. Remodeling and have� to These sub- �ntraccors have ship �' 1� - and have warners' 8' �Demolition Wanting for me in any drily. employees a. •9. p Bwlding.addition [No wodwrs'camp.i x gyp•1r- ' S. We area 1Q. -Electrical exrtrical or additions and 3.❑ I am a homeowner doing all wen} officers have exercised lbeir l I.p PhmA#nnpaits or additions of MGL myself[No vvorkars comp. right exemption per 12.p Roof repairs insenance wed.]t a 152,§1(4), and We have no employees.[No wark=' 13.p Other camp.insurance -] !Any applicanthat t checks box#1 must also fir out the section below showing their wort=,conq=sation policy informatian. t Honuownecs who m1mut this affidavit indicidmg they arc doing all work sad that hue outside contractors must submit a new afdsvit indicating saki. iContractors that check this box rrarst attached an additional sheet showing the name of the st&con actors and state whethcr or not those entities have employ=- If the sub-coahactas have empbyees.tbcy must prOW&dwk workers'wmp•Policy number I I am,an eWfoyer that ispnoVWMg wor*ws'Mvmssg�n insurance for my Mxpuyees Ddew is the policy and job site information. p,� Insurance Company Name: 0�/,S ,Ei�.CG Q 7WL k Q Policy#or Self-ins.Lic. Expiration Date: p?� Job Site Address: `2 ,/���iQ S/X�/�T City/Statp: /Uo.A�VrJO t//S, Attach a copy of the workers'compensation policy declaration page(shown g 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 andlor one-year imprisonment,as-well as civil penalties in the form of a STOP WORK ORDER and a fine of up to 5250.00 a day against the violator. Be advised that a copy of tins statement may be forwarded to the Office of hmmgfigi ons of the DIA for insurance covtxase verification. . Ido herby y the paw of perijay dia the Wonsation prurrilevi is frac and correct /� / 0 / ate: Phone k- O�(juial.use only. Do not writs in lira area,to be cnmplded by city or town offwjaL City or Town:- PermitUcense# Issuiag Anthority(circle one): =1.Board of Health 2.Burldiog Departme6t 3.Cityfrowa 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 is defined as"...every Berson in the service of another under any contract of bice, express or implied,oral or written." r An employgr is defined as"an individual,partnership,assomatw%corporation or other legal entity,or any two or more of the foregoing engaged in a joint entinprise,and including flee legal representatives of a deceased employer,br tfie 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 apartments and who resides therein,or die occupant of the dwelling house of another who employs persons m do maintenance,construction or repair work on such dwelling house or on the grounds or Building appurtenant thereto shall not because bf such employment be deemed to be an employer." MOL chapter 152,§25C(6)also states that"ever state or local licening agency shalt withhold the issuance or renewal of a license or permit to bpersl't ra business or to construct bniidings in the commonwealth for any applicant who has ndt produced ac table evidence of compliance with the inswance coverage required." Additionally,MGL chapter 1.62,§25C(l)states'"Neiiher the comomonweakh nor any of its political subdivisions shall enter into any contract for.the perfommnce of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented'to the contracting au9rordy." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-con�s)name(s),addres (es)and phone n m*=(s)along with their certificates)of insurance. Limited Liability Companies(LLC)or Limited Liability Partne rsbips(LLP)wi$c no employees offier 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 maybe submi ted to the Departin. of Industrial Accidents for confirmation of insurance coverage. Also be sate tau sign and date the affidavit. The affidavit should be returned to the city or town that the application for tate permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law.or ifyon.are required to obtain a workers'- compensation policy,please call the Department at the number listed below. Self-hisured companies should enter their sel€-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 lune stigations 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 permit/license applications in a4y 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 dhat.his 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 perbeits or licenses. A new affidavit mast be filled out each year.Where a home owner or citizen a obtaining a license or permit not related to any business or commercial venture (Le.a dog license or permit to bion 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 usa call. The Department's address,telephone-and fax number: The Commonwealth of Massachusetts Dgwhi2ent of ln&stcial Accidents Cffice of Investigations 600 Washington Street Boston,MA 02111 _ Td.#617-727-4900 ext.406 or 1-877-MASSAFE Fax#617-727-7749 Revised 1122-06 www.mas&gov/dia t Massachusetts- Department of,Public Safety Board of Building; Regulations and Standards Construction Supervisor License License: CS 72173 Restricted to. 00 - CHRISTOPHER F RIVET 207 WINTER ST N ANDOVER, MA 01845= ,, Expiration: 6/2/2010 .. Commissioner Tr#: 25403: --. :. � . :✓lte,�d�n2nom t';-tr Board ot'BuildingRtgutations and Staadar�9s HOME IMPROVEMENT CONTRACYOR Registration:,139962 ` _ .Tr# 132286" E_xpirt;�,�n;;,918!2009 ;T:etc "InilividuR^i CHRISTOPHER F RNET CHRISTOPHER RIVET t 207\YINlTER SYYs< . it4A0184 �''Adrtiin;stKgo , 1'N.,ANDOVER,