HomeMy WebLinkAboutBuilding Permit #307-15 - 26 WEST BRADSTREET ROAD 9/25/2014 BUILDING PERMIT O�NO oT 6�ti
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
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Permit No" �� Date Received
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Date Issued:
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IMPORTANT: Applicant must complete all items on this page
LOCATION
_ _
Printn _
PROPERTY OUVNER__\ f _ _ 1Q.
-� Si
Pnnt v 100 Year Structure yes no
MAP " -'PARCEL.ZONING DIST. 1, T _-'Historic District ye'_ no !'
Mach ne'Sh9 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
Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
❑ Septic 1Nell ❑ Floodplain ❑Wetland's JNatershed r stnet
❑WaterLS,ewe.r _ _
DESCRIPTION OF WORK TO BE PERFORMED:
Q clnc�` z f=4 j;�'Q M�A ZS Oji t)�" D sk), rck Cy-_-'\o&\
r�-Qw C-\S\c c c--C�-20--k C�00QS
Identification Please Type or Print Clearly
OWNER: Name: 1 Q Phone: 01-la l^eo
Address: o
C..bhtractor Name.CL'@'� one:l Q0�7
Supervisor's Construction L ease:/! -Q�� _ ju tDate:
- _ _
Home I,mprovement,License:.T - "�U _ -:- _ ExN. uDate V�_.�L 3
ARCHI .NGJNEER Phone:
Address: �g-No_.
FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED O $15.00 PER S.F.
Total Project Cost: $ FEE: $
Check No.: Receipt No.: �d ��
NOTE: Persons contracting with unregistered contractors do not have access to the guars fund
Is ature ofAgent/Qwner ____ _ - _ Signature of_contractors;_- ___
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
PLANNING & DEVELOPMENT Reviewed On Signature_
COMMENTS
CONSERVATION Reviewed on Siqnature
COMMENTS
HEALTH Reviewed on Signature
COMMENTS
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i
I+ Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
I
Planning Board Decision: Comments
Conservation Decision: Comments
Water & Sewer Connection/Signature & Date Driveway Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street
AFIRE DEPARTMENT = Temp JDumpsteron site byes
Located at 124Qain,Street
Fir6bepartment ignature/date_
h
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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 Call Email
Date Time Contact Name
Doc.Building Permit Revised 2014
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 mlt Appllcatlon
❑ Certified Surveyed Plot Plan
❑ Workers Comp Affidavit
❑ Photo Copy of H.I.C. And C.S.L. Licenses
❑ Copy Of Contract
❑ Floor/Cross Section/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
Li 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
i
Doc:Building Permit Revised 2014
LocationG;)�
No. .9-0-2 Date q2 l
• • TOWN OF NORTH ANDOVER
• , Certificate of Occupancy $
Building/Frame Permit Fee
Foundation Permit Fee
Other Permit Fee $
TOTAL $
Check# Y
28062
___ Buil mg Inspector
A RTH
Townof s : ,,
Andover
No. . _ _-
' h
, ver, Mass
COC MI[Me WIC/[
�qs R�TEO PYP�,�S
U BOARD OF HEALTH
Food/Kitchen
PERMIT T LD Septic System
THIS CERTIFIES THAT ......... ... ... . ......... BUILDING INSPECTOR
�...................... ................................
has permission to erect .......................... buildings on ........i,'"limnsiid...... . ... Foundation
L Rough
,dk
to be occupied as �. ... ...�.Lin
.. .�.kl/..�............ .. ............ . Chimney
provided that the person accepting this p it sh every respect conform to the terms of the applicatl 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. rn�v�1 ,� �0�rbs' op PLUMBING INSPECTOR
Rough
VIOLATION of the Zoning or Building Regulations Voids this Permit.
Final
PERMIT EXPIRES IN 6 M S ELECTRICAL INSPECTOR
UNLESS CONSTRUCTIO T Rough
Service
..................... ............................ .... Final
BUILDING INSPECTO
GAS INSPECTOR
Occupancy Permit Required to Occupy Buildin:; 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.
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
I Congress Street, Suite 100
t Boston, MA 02114-2017
4 5 www mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Elecctrici Print Le umbers
A iicant Information
A.J. Wood Construction, Inc.
Name (Business/Organization/Individual):
337 Haver .
Address: hill Rd -
City/State/Zip:
Chester, NH 03036 Phone #:603-887-4468
Type of project(required):
Are you an employer? Check
k the appropriate I�a general contractor and I
6. n New construction
J.Q I am a employer with — have hired the sub-contractors
employees (full and/or part-time). 7. Remodeling
listed on the attached sheet.
2.0 I am a sole proprietor or partner- These sub-contractors have 8. ®Demolition
ship and have no employees employees and have workers'
working for me in any capacity. p 9. n Building addition
comp. insurance.-
[No workers' comp. insurance 5 ❑ We area corporation and its 10.[]Electrical repairs or additions
required.] officers have exercised their 11.[]Plumbing repairs or additions
1 Q I am a homeowner doing all work right of exemption per MGL 12.[]Roof repairs
myself. [No workers' comp. c. 152, §1(4),and we have no
insurance required.] t 13.❑ Other
employees. [No workers'
comp. insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
sub
t a new affidavit
d then
e outside
t Homeowners who submit this m l�a�ndicched ti additional sheetgshowiwork
ng he name of the sub-contractors contractors and state whether or not thosetentit(esha such.
'Contractors that check this box
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.
Acadia
Insurance Company Name:
WCA5139636 Expiration Date:2/23/15
Policy#or Self-ins. Lic. #:
Jay Site
Address: �s� �+ City/State/Zip: t
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 ODER 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.
Ido hereby certify under the ins andpenalties of perjury that the information provided above is true and correct
Signafore: Date:vl
Phone#: 603-887-4468
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 Percnn: Phnna it.
1
AJWOO-1 OP ID: NS
CERTIFICATE OF LIABILITY INSURANCEDATE(KNIOW"
03/0312014
THIS CERTIFICATE IS IWUED 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 I
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(Sb AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the.certificate holder is an ADDITIONAL INSURED,the policyCtes)must be endorsed. if SUBROGATION IS WAIVED,submit to
the terms and conditions of the policy,certain policies ies may require an endorsement A statement on this certificate does not corded d9lnts to the
certificate holder in lieu of such endorsements
ACT
PRODUCER NAME: James A Santo
Planright Insurance-"em PHONE FAX
224:Main Street Suite 3C Ar N Exi.603-880-6439 No 603-NO.6521
Saleir4 NH OW79 EF"mA jamk-@santoirtruranm.com
s 1a ntoinsuranm.com
:Tames A Santo
INSURERS)AFFORD=COVERAGE NAIL�
INSURER A:Acadia Insurance 131325
INWRED A J Wood Construction,Inc: INSURER 8:
337 Haverhill Rd
Chester,NH 03036 INSURER C:
INSURER D:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.ADM SUOR INS I
LTR TYPE OF INSURANCE POLICY NUMBER POLICY
LIMITS
GENERAL LIABILITY # I EACH OCCURRENCE S 1,fl00,
iCPAS13692 0223/2014 02232015 -A X COMMERCIAL GENERAL LIABILITYPREMIs S 250,001
—77 CLAIMS-MADE i -- 7 OCCUR I MED EXP(Any one person) S 5,00
f j i PERSONAL&ADV INJURY S 1,000,00
GENERAL AGGREGATE S 2,000,00
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000+
X POLICY PRO-JECTI L� 1 1 I s
AUTOMOBILE LIABILITY I j i COMBINED SL4G'LE LIMIT(Ea acadent) S 1,006,00
A ANY AUTO ICAA5136933 i 02/23/20141 02123/2015 BODILY INJURY(Per pen on) S
ZU OS
OWNED �( AUTOS�'� BODILY INJURY(Per accident) S
i
rx-1 HIRED AUTOS I X AtlFOS ED 1 f i I PROPERTY $
xr 1 uMBREll.A LAB X, OCCUR I I EACH OCCURRENCE S 3,000,00
A EXCESS UAS CLAIMS-MADE CUA5136934 02!2312014 02/23/2015 AGGREGATE 5 3,000,000
DE] I X I RETENTION S ® C S
WORKFRS COMPENSATION X 14FATU Tw
AND EMPLOYERS'LL484 rY
A ANY PROPRIETORIPARTNERIEXECUTNE YIN
N N/A CA5136936 02123/2014 02123/2015 E L EACH ACCIDENT $ 1,000,0
OFFICER/MEMBEREXC MEDT F -NH 8i MA
W-dawty In NH) i F—L DISEASE•EA FMPLO $ 1100010
ff�5 deScnb under
pESGRIPTION OF OPERATIONS Wow � E.L DISEASE•POLICY LIMIT S 1,000,00
DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES(AU=h ACORD 101,Additional Remarks Schedute,if more space is requhvd)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
For Information Only ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZE/EDD^/}REPRE_S-ENTATMEX(//�
®1988.2010 ACORD CORPORATION. AN rights reserved.
ACORD 25(2014105) The ACORD name and logo are registered marks of ACORD
•-, ;'""�*`"�l1`13C'%C"lJ1�V'tJ'l"li`1TGI"""t�"'11e11i"Jc2tally'Ll'1aJ13iL�'J�'1�U�'tx1G[�1vxY'�^�^^�-^�+^-��:,- .._ ...,_ .. .,... . .. •..I
10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
Home Improvement Contr or Registration
Registration: 106603
� Type: Private Corporation
z
FW Expiration: 7/24/2016 Tr# 253856
AJ WOOD CONSTRUCTION, INC.
Richard Smith
337 HAVERHILL ROAD`
CHESTER, NH 03028 � _ � �l
pdate Address and return card.Mark reason for change.
Address [-] Renewal F-� Employment F_� Lost Card
SCA 1 0 20M-05/11
Vlee t0anrirrroarurecr�aP�iaac�ivaeGtQ
Office of Consumer Affairs&Business Regulation License or registration valid for individul use only
ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
gistration: 1 6603 Type: Office of Consumer Affairs and Business Regulation
Private Corporation
10 Park Plaza-Suite 5170
xpiration: 67"[24.1;QjA� p
Boston MA 02116
AJ WOOD CONSTRUCTJON;INC= 5-
Richard Smith
337 HAVERHILL ROAD\N
CHESTER,NH 03036 .Undersecretary Not valid with t signator
assachusetts-De' artment of Public SaY
C0711'lt1'OnWe8�1 of tatWchtls'�'
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part
:Board of Building.Reputations and Standards
De - -.meat0 La SfaidardsS
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Construction Supervisor - Heather EM Y9.40,iiedor
�Deleader Su
License: CS-070882 ! i Pe�"sOr -
�. c.'. (RICHARD J.SMITH
A.
RICHARD J S1VII i � '�: i Eff 106/04/14- i
337 HAVERHIt,If tD Exp.!Date OWWO3115
Chester NH 030137 ` fls900506
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Expiration
Connni's�si�o�ner` .07/2$12015 � I � �'� ,
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.e3�,. ^..._,.,:a. :F.,....,T.'",.ur.,<a,.liaor�evr.
Telephone: (603) 887-4468 CONTRACT Cell: (603) 235-7624
Toll Free: (800) 458-4468 HIC #106603 Fax: (603) 887-8300
J
A.J. WOOD CONSTRUCTION9 INC.
337 Haverhill Rd,
Chester, New Hampshire 03036
Email: ajwoodconstruction@gmail.com.,
Website:www.ajwoodconstruction.net
ROOFING•SIDING•WINDOWS•DECKS•KITCHEN&BATH REMODELING
Workmen's Compensation and General Liability Carried on All Work
Date September 11,2014
No. 26 West Bradstreet Rd. Andover MA
(Street) (City) (State) (Zip code)
Owner's Name Steve Ventre Telephone: 978-697-9807
Address SAME AS ABOVE Email: steve@ventre.us
I (we), the undersigned, hereby accept your proposal to furnish Labor and Materials to perform the following work on premises
located at the following address:
SPECIFICATIONS OF CONTRACT
The contractor agrees to do the following work for the homeowner: i
• ROOFING $11,000
■ Strip off all existing roofing material
■ Install ice and water shield on all roof edges and valleys
■ Install 8"aluminum drip edge
■ . Install 30 year Certainteed Landmark Pro Gallery Max Def roofing shingles with a Cobra ridge vent on
peak—Shingle Color to be: Georgetown Grey
■ Install Certainteed Eave protection materials
• SIDING $22,000
■ Remove the existing siding
■ Install James Hardie siding color TBD by owner
■ Custom wrap all trim with Azek.
• WINDOWS $11,000
■ Remove and install new Alside windows as discussed to include the kitchen window and front window
KITCHEN WINDOW TO BE:
■ Includes all basement windows
• INSTALL FRONT DOOR AND TWO SIDE DOORS $3,800
■ FRONT AND SIDE ENTRY DOOR TO HAVE STORM DOORS
• INSTALL ONE SLIDING DOOR UNIT $1,500
• All permits and debris removal included. Homeowner is responsible for the protection of all trees, shrubs, and flowerbeds.
We guarantee our workmanship and provide a one(1)year Labor Only Warranty from date of completion.
• NOTE: Stripping old roofing will cause a great deal of deteriorated roofing to fall between the spacing of the boards, it is our
strong recommendation to have the homeowner cover and protect the articles in the are below the roof.Articles and materials
inside the home are the responsibility of the homeowner.A.J. Wood Construction,Inc.,is not liable for any damages incurred
to the articles and materials within the home. We recommend keeping the windows closed and window fans and air
conditioning units off during roof stripping. We further recommend taking down any article that may fall off walls or
shelving during the roof procedure.
The contractor agrees to perform the work furnish the materials and labor specified above for the
Total Sum of$49,300.00(Forty Nine Thousand Three Hundred Dollars and 00/100)
Total amount of each payment will be made according to the following schedule:
30%due with signed contract: $14,790.00(Fourteen Thousand Seven Hundred Ninety Dollars and 00/100)
30%due when project is 1/3 complete: $14,790.00(Fourteen Thousand Seven Hundred Ninety Dollars and 00/100)
30%due when project is 2/3 complete: $14,790.00(Fourteen Thousand Seven Hundred Ninety Dollars and 00/100)
10%due when project is 100%complete: $4,930.00(Four Thousand Nine Hundred Thirty Dollars and 00/100)
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Required permits — The following building permits are required and will be secured by the contractor as the homeowners' agent.
FFJposed start and completion schedule will be adhered to unless circumstances beyond the contractors control arise. The contractor
Al start the project within 30 days and the project will be done within 60 days of the start day.
NOTES:
(*) Including all finance charges (**) Law requires that any deposit or down payment required by the contractor before any work
begins may not except the greater of(a) 1/3 of the contract price or (b) the actual cost of any special equipment or custom made
material which must be special ordered in advance to meet the completion of schedule.
You may cancel this agreement if it has been signed at a place other than the contractors normal place of business,provided you notify
the contractor in writing at his/her main office or branch office by ordinary mail posted,by telegram sent or by delivery, not later than
midnight of the third business day following the signing of this agreement. See attached notice of cancellation form for an explanation
of this right.
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES!!!
Two identical copies of the contract must be completed and signed. One copy should go to the homeowner. The other copy should be
kept by the contractor.
• 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:
Office of Consumer Affairs and Business Regulation—(617)973-8700
10 Park Plaza, Suite 5170
Boston,MA 02116
Owner agrees that the title or equity in this property is his and is security for this contract.
IN WITNESS WHEREOF the undersigned has(have)hereunto set his(their)hand(s)the day and year first above written.
Buyer(s)Acknowledge Receiving a Completed Legible Copy of This Contract.
This contract may be voided by the Owners giving written notice to the Contractor by ordinary mail within three full business
days following the date hereof.
B Qicha-rd _ . 03mith L. .
Y S
(Richard J. Smith,President) (Legal owner of pro to be improved)
337 Haverhill Rd., Chester,NH 03036
FID: 20-0487037
HIC#: 106603 (Date Signed)
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