Loading...
HomeMy WebLinkAboutBuilding Permit #282-2011 - 23 HUCKLEBERRY LANE 10/6/2010 BUILDING PERMIT �.10RT{{ w' o��,Eo 167�-rQ TOWN OF NORTH ANDOVER o� APPLICATION FOR PLAN EXAMINATION Permit NO: O 2 —aa& Date Received I fa G JI0 ,R rEo app c5 RSSACHus�� Date Issued: z6 �a IMPORTANT: Applicant must complete all items on this page z L-0 -A . _-�L-3 i Pnnt - PROPERT�Y�0INNER� V 6, - P.,Ht MAP NQ ,PARCEL ��ONING'DISTRICT Historic District ;yes no Machine,Sh-op Village yes no TYPE OF IMPROVEMENT P USE sidential Non- Residential ❑ New Building ❑ amily ❑Addition ❑Two or more family ❑ Industrial ❑AI eration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other `Septic �tWell D Floodplain DaWetlands ❑.`1Natersfiedipistdizt oWWM6 /Sewer_ _ _.. , DESCRIPTION OF WORK TO BE PREFORMED: � o Identification Please Type or Print Clearly) OWNER: Name: q--z Phone: 9 7 �� �.•C 3d— Address: CONT.--TOR Name: 2 t 1 GK N 1 Phone: G..� L 749 . Address:. l L? -- c.L` ��/}-7! �. �t/ w�-1`'"7 tel- - ✓►i✓� c� l 1s?'` y J -_ Su pervisol-stC_onsfruction License d .1�. Exp: Date : _ Exp HomeImprovement�License; - ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ S o�U tea, FEE: $ 6, Check No.: 10 3 Receipt No.: 913Q NOTE: Persons contracting with unre dl contractors do not have access to the uaran undd LSlgnatureuofrAgent/Ovine - _ Signature of.contractor '-�� �r 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 ❑ 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 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 MOTE: 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 DEPARTMENTMFORM07 Revised 2.2008 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 - Date 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 Signature COMMENTS i 'oning 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 FIREiDEPARTMENT _ Temp Dumpsteron site yes _ .no. _ Locatediat 124,Main.8treet FirelDepartmeritisignatureldate - I - COMMENTS Location No. — D Date NORTq TOWN OF NORTH ANDOVER F41 w A �a ;; Certificate of Occupancy $ MusEtBuilding/Frame Permit Fee $ & Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 2352. 1 �� Building Inspector RICHARD FLUET 02 BRIDLE PATH O NTERACTING, INC PROPOSAL METHUEN, MA 01844 Date Estimate# 9/20/2010 164 Name/Address JAMES DOUGHTY 23 HUCKLEBERRY LN. N.ANDOVER,MA.01845 Description REPLACE THREE WINDOWS WITH NEW CONSTRUCTION(ALLIANCE FROM JACKSON LUMBER OR EQUIVALENT)WHITE VINYL WINDOWS WITH 6/6 INGLASS GRIDS,FULL SCREENS,AND HIGH EFFICIENCY GLASS.TRIM EXTERIOR WITH WHITE VINYL ALSO.REPLACE ROTTED SIDING,SHEATHING,AND INSULATION AS NEEDED.SUPPLY PERMIT AND TRASH REMOVAL.ESTIMATED TIME TO COMPLETE WORK IS 36 MAN HOURS.ANY ADDIONAL TIME NEEDED TO COMPLETE PROJECT WILL BE BILLED AT$75.00/HR/MAN PLUS ANY ADDIONAL MATERIALS.PAINTING IS NOT INCLUDE BUT IS AVAILABLE.CLAPBOARDS CAN BE PREPAINTED EITHER BY OWNER OR CONTRACTOR. LABOR $2700.00 STOCK $2500.00 PROPOSAL IS VALID FOR 30 DAYS. EXTRAS OR CHANGES TO BE COMPLETED AT A RATE OF$75.00/HR.MAN Finance Charges on Overdue Balance 1 1/2%/MONTH ONCE JOB IS STARTED WORK IS TO BE CONTINOUS UNTIL COMPLETED. $1500.00 WITH ACCEPTANCE,$1500.00 DAY WORK BEGINS,$2200.00 BALANCE UPON COMPLETION. Total $5,200.00_ Signature 7 Phone# Fax# E-mail 978-685-7010 978-685-7010 RFC102@COMCAST.NET Office ofcoumtemr ri �nes` h'ou"_ pME lNf1Q1YEMlrNT �t+�T#3�kOR .v.:.; Registration: , 06620 Type: Expiration: ?4 012 Private Corporal R RD FLUET( �f CTii4017C. Richard Fluet � 102 Bridle Path Lane? Methuen,MA.01844 UA-derseccetaf y f lVlas�achusetts- ©et>.trtnjenY of Public S:rl'en 30dej Of Buildin,4�Re rul+ations an(�Stand rds Construction Supervisor License License: CS 50710 Restricted to: 00 RICHARD A FLUET , 102 BRIDLE.PATH.LN. METHUEN, MA 01844 Expiration: 4/22/2011 ('ummisi ncr Ti-4: 13093 The Commonwealth of Massachusetts Department of Industrial Accidents � Vlh i' Office of Investigations U 600 Washington Street Boston,MA 02111 j www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information l Please Prinf Legibly Name (Business/Organization/Individual): Yui -�) 7 OVV7 Address: ( o,,- BY tel) L6. 64 Vy✓ City/State/Zip: fvt 0­1 t+, `7 Phone#: cco �� C, Sr 7 0 I o Are you an employer?Check the appropriate box: Type of project(required): 1. I am a employer with -3 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 or partner- listed on the attached sheet. # 7• ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition workingfor me in an capacity. workers' comp.insurance. Y P tY• 9. ❑ Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its r10.❑ Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL 1 l.❑ Plumbing repairs or additions myself. [No workers'comp. c. 152, §1(4),and we have no 12.0 Roof repairs insurance required.]1' employees. [No workers' ]3.KOther comp. insurance required.] *Any applicant that checks box#1 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 their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy andjob site information, n� &, Insurance Company Name: All? �- Policy#or Self-ins. Lic.#: 1 / !3Ti o 3 U 3 Expiration Date: Job Site Address: 30 f4y C.l.0 L /30✓L-J City/State/Zip: N;+9-r-� 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 fonn 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 u ains a 1ties of perjury that the information provided above is true and correct.' Signature: Date: 1 4 Cb 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 is defined 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 apartments 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 local 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 numbers)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 confinnation 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 pen-nit 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 pennit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license 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 pen-nits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or pen-nit not related to any business or commercial venture (i.e.a dog license or permit to burn 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 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 5-26-05 www.mass.gov/dia A QW CERTIFICATE OF LIABILITY INSURANCEOP ID DATE(MMIDDIYYYY) FLUBT-1 10106110 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Segreve & Hall 1nsur.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: 976-975-1300 )Fax:978-975-7596 INSURERS AFFORDING COVERAGE - NAICiI INSURED INSURER A: Arballe PROto)otioo ine. Co. 41.3 6 0 INSURER B; Commerce Inlaurance Co. ! 34754 Richard Fluet Corl,tracting Inc. INSURER G: 102 Bridle Path Lane INSURER D' Methuen M.A. 018.44 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF/JJY 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 HPVE BEEN REDUCED BY PAID CLAIMS. LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MMIDDIYY DATEPOLICY MID�lYY LIMITS GENERAL LIABILrTY EACH OCCURRENCE $1000000 A X COMMERCIAL GE NERAL LIABILITY 6500034727 06/12/10 05/12/11 PREMISES(EaDee It $100000 CLAIMS MADE X❑OCCUR MED EXP(Any one person) $ 3000 PERSONAL B.ADV INJURY $100000'0 GENERAL AGGREGATE $2000000 GEML AGGREGATE LIMIT APPLIES PI!k PRODUCTS-COMP/OPAGG $ 2000000 POLICY PRO- LOC JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Es accident) $ ANY AUTO ALL OWNED AUTOS BODILY INJURY $ 100000 H X SCHEDULED AUTOS XV1460 12/01/09 12/01/10 (Per person) X HIRED AUTOS BODILY INJURY $300000 F7 (Per NON-OWNED AUTOS (Pnr accident) PROPERTY DAMAGE $100000 eccldent) GARAGE LIABILITY I AUTO ONLY-EA ACCIDENT S _ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG S EXCESSIUMBRELLA LIABILrrY EACH OCCURRENCE $ OCCUR CLAIMS MACE, AGGREGATE $ $ DEDUCTIRI-E $ RETENTION $ $ WORKERS COMPENSATION AND TORY LIMITS —LER• EMPLOYERS'LIABILITY A 910434 03/31/10 03/31/11 E.L.EACH ACCIDENT $500000 _ ANY PROPRIETOPJPARTNERIEXECUTIVE --- OFFICER/MEMBER EXCLUDED? F-,L.DISEASE-EAEMPLOYEE 5 500000 IfyeS.descAbeunder E.L.DISEASE POLICY LIMIT $ 500000 SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS/LOCATIONS I WMICLES/EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES GE CANCELLED BEFORE THE EXPIRATION Town of North 'Andover DATE THEREOF,THE ISSUING INSURER WALL ENDEAVOR TO MAIL DAYS WRITTEN Building Inspector NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.BUT FAILURE TO DO SO SMALL 45 Osgood Street IMPOSE-NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR Bldg 20, Suite 2-36 North Andover MA 01810 REPRESENTATIVES. AUTHORIZED REPRE KTATIVE ACORD 25(2001108) (P ACORD CORPORATION 1988 NORTH o Of over _ V10% No. h o a C11 -o dower, Mass., o — LI. I� COC MICMEWICK 7�p�oRATEO P'P�t�� lv ` BOARD OF HEALTH Food/Kitchen PER IT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT....................................../ ' � ..... Foundation has permission to erect......................................... buildings on.c ,$..1741c.!!./F! .F�. ... !V............................. Rough F C CtJ l i1t01 P�t�. /^ 6 7 ✓�` �y Chimney to be occupied as......... �C... .. ................... . . .5.............�..... �' .N..�. .. .. . r... .. ..... . provided that the person accepting this permit shall in every respect conform to the�ferms of the application on fil n 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 UNLESS CONSTRUCTI STARTS Rough 1 'yjP............................................... Service ....... ............. ........ . BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on ther 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. SEE REVERSE SIDE Smoke Det.