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HomeMy WebLinkAboutBuilding Permit #467-14 - 23 SULLIVAN STREET 11/27/2013TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: r�" Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION- /��tC' f PROPERTY OWNER .S _.r _ Print 100+Year Old Structure yes o MAP NO: t4ARCEL i_ _ ZONING DISTRICT: _ Historic District yes no p. _. �r — Machine Shop Village yes no_ TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family C�'Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial. ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Septic ❑ Well ❑ Floodplain b Wetlands El Watershed District Water/Sewer . . DESGKIF I IVN VI- V11VKM I V or- rcmrunmr-v. 0 A/ 5 7�%L T (fl 7— t4 / U ' X / t) 3C D R. -y e) 122 D ✓� A2 Identification Please Type or Print Clearly) OWNER: Name: Phone:a� s Address: v-/7 /✓ � � n CONTRACTOR' Name:C-7. `� f—_)5� Phone: , - �� .- Address: Supervisor's Construction Licensee lG - ExP. Date: - _ Home Improvement ticense:' _, 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: $ �� s� FEE: $F Check No.: Receipt No.: �'�-- NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund SI Mature of contracto ' Signat_ure of �A_gent/YOwner �.9_., - Plans Submitted ❑ �_ Plans Waived ❑ Certified Plot Plan ❑ Stampe Plans ❑ Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE:OYSEWERAGE.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 PLANNING & DEVELOPMENT ❑ COMMENTS CONSERVATION COMMENTS HEALTH COMMENTS DATE.APPROVED Reviewed on Siqnature Reviewed on Signature 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 Tow;z Fngineer: Signature: Located 384 Osgood Street FIRE DEPARTME NT - Temp Dumpster on site yes no Located at 124,Mair Street -- Fire Depa`rtmeii -signatu're/date' -t . x, COMMENTS 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 DARKER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A -F and G min.$100-$1000.fine NU I t5 and UA I A — (For ciepartment use El Notified for pickup - Date Doc.Building Permit Revised 2010 Building Department The foh'-I. Wing 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 a Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) a 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 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 submitted with the building application Doc: Doc.Buiiding Permit Revised 2012 Location a::� & 1 4 l d!Fn ,r /_� No. Date i r Check # TOWN OF NORTH ANDOVER Certificate of Occupancy $ { Building/Frame Permit Fee ;a— Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 27142 Building Inspector Enter construction cost for fee cal - North Andover Fee Cakulation Construction Cost $ 18,800.00 m $ - $ 225.60 Plumbing Fee $ 28.20 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 28.20 Total fees collected $ 382.00 23 Sullivan street 467-14 on 12/2/2013 10x10 Bedroom over existing foyer r 4'r J = LL o O C L \ O LL +O+ inaTi u O_ a) O z z c m C "O O LL L Q.' C u C LL O z c� z J d t :3 d' m LL 0 z z a u ui t :3 d' ai u {n C LL a z _ t 7 S C LL a o N. N i m Z - Ll {% a.+ v U1 C N uu am 0 LLIV CL Z z 0 in v, 2 O E to CD can Z V rn W > - cn X Z O W O � U cn W c W J CL zm O C .O N as t O O Q J O �l • �V N ZE rv` V w V V O CD E O O ,W L O O V CL .,CAA YI U cc cc CL U) y` a ❑, d 11 L � d •T" e°ni OG p k t t t t. ol [ U o�W N 4 O o 2 t � W N LL Ig O o6 1 0) 7 1 0 U3 Q ACORO® C `..-- ERTIFICATE OF LIABILITY INSURANCE DATE(MM/DONYYY) 6/6/2013 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. the terms and conditions of the policy, certain policies may require an endorsement. A statement on thiIf SUBROGATION IS WAIVED, subject to s certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER COACTVictoria Lowes CISR MTM Insurance Associates NAME` ' PHONE .(978)681-5700 1320 Osgood Street -MAIL FAX o • (978) 681-5777 D RESS•viekiel@mtminsure.com North Andover MA 01845 INSURERS AFFORDING INSURED INSURERA:State Auto Insu2 Cote & Foster Contracting, Inc INSURER A:CommzrC= & Indus 20 Aegean Drive INSURER C : Unit 15 INSURER D: Methuen MA 01844 INSURERE: THIS ctKTIFICATENUMBER:12-13 GL Auto 13-14 WC IS TO CERTIFY THAT THE POLICIES OF INSURANCE SION B. INDICATED. LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAREVIM D ABOVEFOR NOTWITHSTANDING ANY REQUIREMENT, TERM OR THE POLICY PERIOD CERTIFICATE EXCLUSIONS CONDITION OF ANY CONTRACT OR OTHER MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED AND CONDITIONS OF SUCH DOCUMENT WITH RESPECT TO HEREIN WHICH THIS INSR POLICIES. LIMITS SHOWN MAY IS SUBJECT TO ALL HAVE BEEN REDUCED BY PAID THE TERMS, LTR CLAIMS, TYPE OF INSURANCE D BR POLICY EFF POLICY EXP POLICY NUMBER GENERAL LIABILITY M [DOryyyY ryVppn yyy LIMITS X COMMERCIAL GENERAL LIABILITYEACH OCCURRENCE $ 1,000,00 A CLAIMS -MADE Fx� OCCUR OP2722545 2/31/2012 2/31/2013 PREMISES Meoccurrrence $ MED 300,00 EXP (Any one person) $ 10,00 PERSONAL &ADV INJURY $ 1,000,00 GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 X POLICYPRO LOC PRODUCTS • COMP/OP AGG $ 21000100 AUTOMOBILE LIABILITY $ COMBINED SINGLE LIMIT A ANY AUTO Ea accident $ ALL OWNED SCHEDULED AUTOS X AUTOS 2370166 2/31/2012 2/31/2013 BODILY INJURY (Per person) $ 1 000 001 HIRED AUTOS NON-ONMED X BODILY INJURY (Per accident) $ AUTOS PROPERTY DAMAGE Per accident $ UMBRELLA LIAB OCCUR Medical pa ments $ 5 00( EXCESS LIAB CLAIMS-MADEEACH OCCURRENCE $ DED RETENTION$ AGGREGATE $ $ WORKERS COMPENSATION $ AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN X WC STATU- OTH- Y OFFICER/MEMBEREXCLUDED? N/A (Mandatory in NH) 0004962937 /20/2013 E.L. EACH ACCIDENT $ 5.500 000 f es, RIPTION OF Odescribe under 6/20/2014 "Ps DESCPERATIONS below E.L. DISEASE- EA EMPLOYE $ 500 000 A Property Coverage E.L. DISEASE - POLICY LIMIT $ 500 000 OP2722545 2/31/2012 2/91/2013 Scheduled Equipment Busienss Personal Property $37,653 OP2722545 2/31/2012 2/31/2013 Contractors Equipment $166,928 DESCRIPTION Certificate OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACOR holder as listed below D 101, Additional Remarks Schedule, if more space is required ) TE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. 384 Osgood Street North Andover, MA 01845 AUTHORIZED REPRESENTATIVE P MacDonald CPCU, CIC ACORD 25 (2010/05) INS025 (2o1IxIs).o1 ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD h 3- FOSTERu-2: COTE CUSTOM BUILDING + REMODELING This agreement made this 19' day of September, year Two thousand and Thirteen by and between Cote and Foster Contracting, Inc. hereinafter called the Contractor and Tim Jacques, hereinafter called the Owner, witnesses that the Owner intends to construct a 10' x 10' bedroom over the existing foyer at the address of 23 Sullivan St. dover, MA. Now, therefore, the Contractor and the Owner, for consideral4" after named, a ee as follows: 1 ARTICLE 1 The Contractor agrees to provide all the labor and materials to do all things necessary for the proper construction and completion of the work shown and described on drawings. The drawings and specifications are the basis of the contract. ARTICLE 2 In consideration of the performance of the contract, the Owner agrees to pay the Contractor, in current funds as compensation for his services hereunder $18,800.00 to be paid as follows: C Payment 1- $2,000.00 at signing of contract Payment 2 - $4,000.00 at start of framing Payment 3 - $6,000.00 at completion of rough electrical Payment 4 - $4,800.00 at completion of insulation & plaster Payment 5 - $2,000.00 at completion of carpet & paint ARTICLE 3 Final payment on contract amount as agreed above to be paid within ten (10) days of project completion or occupancy. If final payment has not been made within this time - a 10% charge per month on.the balance due will be charged. All minor punchlist items will be complete as part of the'one year warranty on the finish product. Failure to pay balance within ninety (90) days may result in legal action. Initials:. f 20 Aegean Drive - Unit 15 - Methuen, MA 01844 Tel: 978-682-6518 - Fax: 978-682-1221 www.coteandfoster.com ARTICLE 4 Additional work above and beyond the contract agreement: All additional work done to be quoted at the time the client requests the work. The work will be done and billable at its completion. The client has ten (10) days to pay the additional cost a r he or she has been billed for it. Initials: _- In witness whereof thhave executed this agreement the da and year first written. Y Y above Tim Jac es; O,. ne r Steven M. Cote DBA Cote & Foster The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, AM 02111 ; - www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print 1&gibly Hanle (Business/Organization/Individual): 4f T-6 fi Iii Z) )'::7d Address: 6�G AEC � 41V, D A21 ip: AE ­1 10i At/ -146 0 /P Phone #: 97 ` t/ 4� — � / J' Are you an employer? Check the appropriatE?l x: 1. F1 am a employer with 4. am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub -contractors have working for me in any capacity. employees and have workers' INo workers' comp. insurance comp. insurance.$ required.] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t F1 We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comp. insurance reauired.l Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. f -I Demolition 9. /Building addition 10.❑ Electrical repairs or additions I LE] Plumbing repairs or additions 12. [j Roof repairs 13. ❑ Other *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. tContractors 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. Insurance Company Name:_c /wzrp_C. ec Policy # or Self -ins. Lie. #: (.l� (� O y �(o _3 (;�3'2 Expiration Date: Job Site Address: C ,3 0 LL ) V-14 /Y S % City/State/Zip: ff0 k 7—W 4- o e ✓� 1,z. 11 W Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). L ��5 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 WORD 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 under the pains and penalties of perjury that the information provided above is trite and correct. SigLiature: Date: Phone #: Off cial use only. Do not write in this area, to be completed by city or town offtciaL 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 #: