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HomeMy WebLinkAboutBuilding Permit #1167-16 - 284 BRENTWOOD CIRCLE 5/19/2016 419R I A-P 4 ,t TN q V BUILDING PERMIT 0���,�t•�eo 6 tares� TOWN OF NORTH ANDOVER ,. APPLICATION FOR PLAN EXAMINATION ey Permit NO: Date Received Date Issued: �9SSACHus i IMPORTANT: A licant must com tete all items on this age ty� s TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building One family I-]Addition [:: Two or more family Industrial ❑Alteration No. of units: E Commercial epair, replacement ❑Assessory Bldg Others: ❑ Demolition ❑ Other Identification Please Type or Print Clearly) OWNER: Name: L`)U*W Phone: %Cf� Address: �� ARCHITECT/ENGINEER t��`� 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: $ 5:� FEE: $ J� d• �' Check No.: `3 8-�2 Receipt No.: ae NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund 4•,... �. f a„s„5r,.,,,,,..,,,_,...., wc�.. !l'«rNfi/%s:� n'��1k�„%�� rF��' �?N,xi,��./�.�,/.:� ',i7�✓v�r r/J�b >G.'..,. ,..f//`' NORTH BUILDING PERMIT °�.ILE° 16q"o TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received *�l9.OffATec Permit No#: AC US Date Issued: IMPORTANT: Applicant must complete all items on this page TPRO_PERTYOWNER - _ - - �""inn{ 100 Y,ear.Structure yes no MAP _ ¢PARCEL_ rZONING,DISTRICT- tH'istoncDist�ict eyes ono �� _ ��TIVI�.c ine�Sh�oprVillage ryes, �n TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family [I Addition [I Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑`Septic {❑'Well zFlo dplain O W�antlsi -�W shistrict DESCRIPTION OF WORK TO BE PERFORMED. Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: Y 77�ContractorName 3 IPhone � add Supervisocs, onstructionL'icense - _ Exp a 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: $ Check No:: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of:FAgen'JOwner �'wSi nature of contractor Location 2 9+ 6m--4 ^- ' 4 No. k 1 l— Date • - TOWN OF NORTH ANDOVER , Certificate of Occupancy $ _ Building/Frame Permit Fee $ ' Foundation Permit Fee $ Other Permit Fee $ ' TOTAL $ Check# �J L/ (; ,4 Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ -TYPEE 0'F-SEWE -AGEDiSPOSAL - - Public Sewer ❑ Tanning/Massage/Body Art ❑ .. Swinumng 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 Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes . Planning Board Decision: Comments Conservation Decision: Comments Nater & Sewer Connection/Signature&Date Driveway Permit DPW Tow;-, Engineer: Signature: Located 384 Osgood Street FIRE [?EP,4RTttllFel�1' =Temp Dumpster on site yes.. no Located'at 124 Mair Street Fire-Department sigriatureldate` 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 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 Application o Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract ❑ Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) o 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) o 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 o 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:Building Permit Revised 2014 N®RT1y Town of �� _ :.:.F�. *, n ove h , ver, Mass, CONIC„l WICu 1' ��p vRwTED APa`,��5 S BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System THIS CERTIFIES THAT .........4<g�' C�'. ”>ur/ ........................................................................ BUILDING INSPECTOR .. . has permission to erect ................... buildings o .. c .� �?. „ Foundation ... ............................s:. Rough 1 to be occupied as ............... 1 .... ...... `.lr:.S./:� .....:............../...............................*...................... Chimney provided that the person accepting this permit shall in every respect conform to the terms of te application 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. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough . Service ........... ..... y,Ltr.' .... -`.... ......................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Reguired to Occupy Building 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. IF/ Tel hone: (603)8874468 CONTRACT Cell: (603)235-7624 T Free: (800)4584468 RIC#106603 Fax: (603)887-8300 A.J. WOOD CONSTRUCTION, INC. 337 Haverhill Rd Chester,New Hampshire 03036 Email:info@ajwoodconstruction.net Website:www.ajwoodconstruction.net ROOFING*SIDING•WINDOWS•DECKS•KITCHEN&BATH REMODELING , Workmen's Compensation and General Liability Carried on All Work Date April 1,2016 No. 284 Brentwood Ci. N.Andover MA (Street) o (City) (State) (Zip code) Owner's Name Lauren Connelly Telephone: 978-8074718 C'0,1 0 t 1-1 a l nn P,t ,o lam.�w✓I Address SAME AS ABOVE Email: connellvl'�urenQvahoo.c$m 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: • James Hardie Board Siding $32,500 # G • Demo existing siding. ,v. #f/-3 • Install Tyyek. v ■ Install James Hardie siding—Color to be Pearl Gray Install Azek Trim • Install 8+/-pairs of shutters N/C • 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. The contractor agrees to perform the work,furnish the materials and labor specified above for the Total Sum of$32,500.00(Thirty Two Thousand Five Hundred Dollars and 00/100) Total amount of each payment will he made according to the following schedule: 1/3 due with signed contract: $11,000.00(Eleven Thousand Dollars and 00/100) 1/3 due 54%eompkte: $11,000.00(Eleven.Thousand Dollars and 00/100) I/3 Due When Project Is 100%Complete:$10.500.00(Ten Thousand Five Hundred Dollars and 00/100) 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. /��ed permits–The following building permits are required and will be secured by the contractor as the homeowners' agent. , oposed start and completion schedule will be adhered to unless circumstances beyond the contractors control arise. The contractor will start the project within 30 days and the project will be done within 60 days of the start day. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACESM 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 fust above written. J Suyer(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. By Qichard�� 03mith L.S. (Richard J.Smith,President) (Legal owner of property t e improved) 337 Haverhill Rd.,Chester,NH 03036 f� FID:20-0487037 '-/ — /Z HIC#: 106603 (Date Signed) I AJW00-1 OP ID: NB ACORO" DATE(MMIODNYYY) CERTIFICATE OF LIABILITY INSURANCE 03/0412016 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. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: James A Santo Planright I nsurance-Salem PHONE FAX 224 Main Street Suite 3C (AIC,No E :603-890-6439 AIC No): 603-890-6521 Salem,NH 03079 ADDRESS:jam ie@santoinsurance.com James A Santo INSURERS)AFFORDING COVERAGE NAIC Il' INSURERA:Acadla Insurance 31325 INSURED A J Wood Construction, Inc INSURERS: Julie Smith 337 Haverhill Rd INSURER C: Chester,NH 03036 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 MAYHAVE BEEN REDUCED BY PAID CLAIMS- INSR TYPE OF INSURANCEAUDIL POLICY EFF POLICY EXP LIMBS LTR NSD WVD POLICY NUMBER MMIDDIYYYY MMIDDIYYYY A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE �OCCUR CPA5136932 0212312016 02123/2017 PREM SESTO O (Ea occurrence $ 250,000 MEC EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY IA PRO- a LOC PRODUCTS-COMPIOPAGG $ 2,000,000 OTHER F $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident A ANY AUTO CAA5136933-11 0212312016 02/23/2017 BODILY INJURY(Per person) $ ALL OWNEDX SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS XX NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 3,000,000 A EXCESS LIAB CLAIMS-MADE CUA5136934 02/23/2016 02/23/2017 AGGREGATE $ 3,000,000 DED X RETENTION$ 0 $ WORKERS COMPENSATIONX PER TH- AND EMPLOYERS'LIABILITY STATUTE ER A ANY PROPRIETORIPARTNERfEXECUTIVE YIN CA5136936-11 02123/2016 02/2312017 E L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N f A (Mandatory in NH) 3A: MA NH EL.DISEASE-EAEMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below EL.DISEASE-POLICY LIMIT S 1,000,000 A CRIME CPA5136932 02123120111 02/23/2017 �Empl Dish 100,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Richard Smith is excluded from work comp coverage. 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. AUTHORIZED REPRESENTATIVE .G� ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts N Department of Industrial Accidents I Congress Street,Suite 100 ae Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:General Businesses. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Information Please Print Legibly Business/Organization Name:AJ Wood Construction Address:337 Haverhill Rd. City/State/Zip:Chester, NH 03036 Phone #:603-887-4468 Are you an employer?Check the appropriate box: Business Type(required): 1.Q I am a employer with 5 employees(full and/ 5. ❑Retail or part-time).* 6. ❑Restaurant/Bar/Eating Establishment 2.❑ I am a sole proprietor or partnership and have no 7. ❑Office and/or Sales(incl.real estate,auto,etc.) employees working for me in any capacity. [No workers'comp.insurance required] g• E]Non-profit 3.❑ We are a corporation and its officers have exercised 9. ❑Entertainment their right of exemption per c. 152,§1(4),and we have 10.❑Manufacturing no employees. [No workers'comp.insurance required]** 11.❑Health Care 4.❑ We are a non-profit organization,staffed by volunteers, with no employees. [No workers' comp.insurance req.] 12.0 Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. **if the corporate officers have exempted themselves,but the corporation has other employees,a workers'compensation policy is required and such an organization should check box#1. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy information. Insurance Company Name:Acadia (Agent-Santos Insurance) Insurer's Address:224 Main St., Suite 3C City/State/Zip; Salem, NH 03079 Policy#or Self-ins.Lic.#WCA5136936-10 Expiration Date:2/23/1-7 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, under the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: 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.Licensing Board 5.Selectmen's Office 6.Other Contact Person: Phone#: www.mass.gov/dia ..._ - - .. ,.-- - �i'a 'G�""X'f.3:YQ�YJ2k�f'Cf:•lJCt�1z'Ec�Ja�'�\ti.�#�tacatrtt--.,,._... ti __,.w_.,....,,....,.,,.,,_.. 10 Park Raza - Suite 5170 --...Boston Massachusetts 02116 ' Home Improv/errlerl�onfr-5C`tor-Registration Registration: 106603 Type: Private Corporation r_Expirationv-7124!20''6` Tr# 253856 AJ WOOD CONSTRUCTION, INC. --- Richard Smith — 337 HAVERHILL ROAD -- - - _ CHESTER, NH 03028 Update Address and return card.Mark reason for change. SCA' 0 20M-W11 Address a Renewal ^ Employment r— Lost Card Ot lee of Consumer Affairs&Business Regulation License or registration valid for individul use only � LL ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: On: 106603 Type: Office of Consumer Affairs and Business Regulation expiration: _7a4'lZtR6 Private Corporation 10 Park Plaza-Suite 5170 Boston,IMA 02116 AJ WOOD CONSTRO'Lice} INC. Richard Smith 337 HAVERHILL ROAD ���� CHESTER,NH 03036 Undersecretary Not valid id Kith t signatur Massachusetts Department of Public Safety Board of Building Regulations and Standards Goma�nofthof GttUSEtS License:CS-070882 DeparfteWof Labor Skf f& � Construction Supervisor `" w ,Drectr `t`'shet _ er.SuporvEsor RICHARD J SMITH-� , ��y "" RtG!>lAEtp J SMITH 337 HAVERHILLRD c �~ 1 CHESTER NH 03036 = Eff.Date 05V/t5""-'` (, Ev.Date 0527/96 DS900505 t rt t++�l o3C.0.N.E.S.T. Co � � �M Expiration: missiontVer 07/281017 7777777­��� A111111 fulfil 1111 k.. _..„�,. ,�...,,,..,_.'. _ '^r^--.,., i Ce>t#iiCate t�'Fr .Yrrt t ✓i . f. I x 43 C OFr LaBat�AX: -J `E Q2114 f337 HA VE"T TLL,ST P &'Ato;Itd1),J* 1r A J—,;CH.