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HomeMy WebLinkAboutBuilding Permit #456-2017 - 29 BEAR HILL ROAD 10/31/2016 V' BUILDING PERMIT OEt?LED.6 byO TOWN OF NORTH ANDOVER o APPLICATION FOR PLAN EXAMINATION * _ Permit No#: 4 6 � Date Received 10brduI1 5 �y'�R TEo�Qa�5 q / b� [✓ SSACHV`��� Date Issued: lo l Vl IMPORTANT:Applicant must complete all items on this page a n 64=1= _ A� —, PROPEFWV®WNER } IUD Yrea� trn np 3 3nnt« cture yssl MA1P"'1PRCELZONING,DISTRIC _`H1�sto�rl�;Dlsfrict, Y0 noa A EMachinerSopXVlllagea yes, no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family [I Industrial ❑Alteration No. of units: . ❑ Commercial Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition 0 Other " pt c° L]Wellc' AFIo do plain w 17=WetlandsF s''Watershed ®istnct _Y -� - .. �' - _ i ®tV;VaterlSewef s :_,� �.�:���:,.�.__.�...�...-..-� . 4 �._,.- ��.�....�__�._._._....___._ •�..�.- DESCRIPTION OF WORK TO BE PERFORMED: p�� 1,/, r,t fyyy r 2 u`i�i�, �;`- oyw- �7 yy�� , 1✓ Identification- Please Type or Print Clearly CoER: Name: C�KI L ,► ' � �5 Phone: dr ) 3 `7. 90 Address i`.Contracor,'Name<� 12 � rf` uv"7w.Phone Adtl e`ss J- _.rC, d..u� 1�✓�-�t1"1:.n� ,: � `, _ a t Supervisor„s:`C©n5tructlon License `4 -ilm ,ro�ement,Llc ARCHITECT/ENGINEER Phone.- Address: Reg. No. FEE SCHEDULE_BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED OON$125.00 PER S.F. Total Project Cost: $ 0� 1 1 y FEE: $ Check No. G V/1 bb Receipt No.: ` I 00 NOTE: Persons contracting with unregistered contractors do not have access to af �'' anty fund :74 - rG 5�gnature of Agent/Owner ignature of contracto Loclit( �L�K G� t&t z � �- No. � Date • • TOWN OF NORTH ANDOVER �Y -- Certificate of Occupancy $ _ Building/Frame Permit Fee $ 33� Foundation Permit Fee $ _ Other Permit Fee $ TOTAL $ Check#�M6 f '(i 'f ioV Building Inspector 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 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 Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street fiFIRE+DEPARATtIVIENT TempDum � pster on,slteyes � _ not i�Located r'Fire�Depart nttsi nature%elate•-u„i .�.;,o,;;. j= �'� '`-�-��" �• '' R �#� y..•Y `�;.„�,t w ,g .�,r.; .s.,...t`_:�,.u.c..ti:..._.a'L'.� __.��,.�._.._ = � «_.s......_,d.R.._,�.�. - COMMENTS' t, r Lam`*1 •� � ♦ lx 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.sloo-sl000 fine NOTES and DATA— (For department use) i ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Peunit 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 o Building Permit Application o Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract o Floor Plan Or Proposed Interior Work o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks o Building Permit Application o Certified Surveyed Plot Plan o 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) ❑ 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 o 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 o 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 Doe:Building Permit Revised 2014 Enter construction cost for fee cal- North Andover Fee Cakulaflon Construction Cost $ 27,742.00 m $ - $ 332.90 Plumbing Fee $ 41.61 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 41.61 Total fees collected $ 516.13 41 Bear Hill Road 456-2017 on 10/31/2016 Kitchen remodel pORTFH Town of - ���. 6 ndover 0 No. �I ,� oh ver, Mass, ze di/ COCNIC tWK.I 1 �� S U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT ......... r 1.C.....W:T.�! •� BUILDING INSPECTOR .�. .. . Foundation has permission to erect.......................... buildings on .... .l.... /� .. /. .fir.. ... Rough to be occupied as ... A*T.....4% � �..:. ... �.. Chimney provided that the person accepting this permit shall i every respect confor to the terms of the 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 CONSTRU N ST Rough Service .. ... . . G ........ ..... Final USP GAS INSPECTOR Occupancy Permit Required 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. RICHARD FLEET CONTRACTING,INC 102 BRIDLE PATH LANE -PROPOSAL R®®POS A /moi METHUEN,MA 01844 Date Estimate# 10/13/2016 642 Name/Address ERIC JONES 41 BEAR HILL RD. N.ANDOVER,MA.01845 Description REMOVE EXISTING KITCHEN,UPDATE PLUMBING AND ELECTRICAL PER ATTACHMENTS.REPLACE WINDOW ABOVE SINK WITH NEW HARVEY WHITE VINYL TWO LITE SLIDER WITH ENERGY STAR RATED GLASS AND SCREENS..INSTALL 2 114"WHITE OAK HARDWOOD FLOORING SANDED WITH THREE COATS OF POLY IN KITCHEN AND LIVING ROOM.INSTALL ONE ANDERSEN PS510 WHITE VINYL SLIDER WITH SCREEN AND WHITE HARDWARE.INSTALLC ABINETS AS PER SKETCH DATED 4!2712016.�"�'6'l.._";;ice{"'"'"-..rm,�,'.'�,44 SMOOTH FINISH OVER EXISTING CEILINGRECONN:ECT VENT OVER STOVE.PROVIDE 36"CASED OPENING BETWEEN DINING ROOM AND LIVING ROOM.NEW WOODWORK AND WALLS TO BE PAINTED OR STAINED TO MATCH EXISTING USING TWO COATS OF BEN MOORE PRODUCTS.SUPPLY PERMIT AND TRASH REMOVAL. OWNER TO SUPPLY;CABINETS,TOPS,SINK,FAIJCET,COOK TOP,OVENS,HOOD VENTED WITH EXISTING DUCTWORK. PROPOSAL IS VALID FOR 30 DAYS. EXTRAS OR CHANGES TO BE COMPLETED AT A RATE OF$90.00/HR/MAN. MA.'LIC.#50710 HIC.#106620 FINANCE CHARGE OF I&1/2%PER MONTH FOR UNPAID BALANCES. PAYMENT SCHEDULE;$742.00 WITH ACCEPTANCE,$15,000.00 DAY WORK BEGINS,$5000.00 WITH COMPLETION OF ROUGH INSPECTIONS,$5000.00 WITH COMPLETION OF CABINETS BEING INSTALLED.BALANCE UPON COMPLETION. Total $27,742.00 Signature �^+ Phone# Fax# E-mail , 978-685-7010 978-685-7010 R'FC102@verizon.net I R . { i I I 1 I � 12._6OL- f x," ---d$,1 �� v 1 �A . q ] , ....-. ._...,._ ,-..I._, 1 , I I I I ' V VI236, W,243B 1536 ER36 W361824 -' J 5 I, TEP2411 DISHW24 D9F' �R M � .-....m -��` -__ '4 TiSS i � 1 Ed CL UJ 0 — -C4 — W - - - - - .. _._ —'- '- � ■ 2 ._ 01 �ePanaleinWall I .. .....F--....: .,. ....Ny W Ce Inets Not IncWed „ { " B18RTR8M1W02734 � y _ o® _ r f Roll4?utTroya J i I _ s Al r��.... ._..._-.�.. � .�........�.1........_..,__. __.'-. R .�..._.�1..-_�...._,�._. _��.••-y....._.®-.....i *_._._._v..._.'.._ _ -.1...._.I _ `_ _—_'�.-_-._.,._...,«Y,__...y...-----`�`-----•-.._.'^A!_._._.. �__. !-,_._,[fes .�-. cq rn + { ;,. i I w � �- I C ---------------------� )Roll4 iTrays _-----_ =—_t 6oII.Out_Trays ., ------- " i s l , 171UQ09024RT OCD339024 U309024RT y i i [ IQ •Cw I � � r i 1 I I � i i ...,..,,_{„ --._.,... ..... _.. - __.,. ,•__. _...... .,.�.._._.. ._,�. .,y,.._...._ �........ _._.rel. _,.._._- ' - .1.....,,..._.y.._ w. _..,._. __m...-.,.,�._.__ _.,.._.._ -. ..... n.,. _..--__._... _ _. ....... _---� r - The Commonwealth of Massachusetts Department of IndustrialAccidents 1 Congress Street,Shite 100 Boston,MA.02114-2017 ~ �< www.mass.gov/dia b, ��, s�• Workers'Compensation Insurance•A,ffidavit:Builder&/Contxactors/Electricians/Plwnbers. TO BE FILED WITH Tffg PERMIT 171VG AUTSORITY. •please Print Le 'bl A ••licant Information _ Name(Businesslorganization/Individual): R[ C,L J �/� f��—�'�-'� C c�7t/''' Y✓ Address: NO), C) S City/State/Zip: Cit$`/`l Phone 4: I/�'►•� , F7EO] .� . _pp p ofproject(required):Ate yon an employer?Check6e a ro riatebox:em to ees full and/or part time).* Nev,T'donstruciion 1•�am a employer with 3• ? y 2.❑1 am a sole proprietor or partnership and have no employees Working for men 8. Remo debug any capacity-[No workers'comp.insurance required.] 9, ❑Demolition 3•❑1 am a homeowner doing all work myself[No workers'comp.insurance required.]t 10E]Building addition 4.❑1 am a homeowner and will be hiring contractors to conduct allwork on my property.1 will 11.❑Electrical repairs or additiops ensure that all contractors either have workers'compensation insurance or are sole bin repairs or additions proprietors with.no employees. 12TQ Pruni- g and Thave hired listed on the attached sheet 13•.0 Ro6f repairs 5.0 1 am a general contractor These sub-contractors have employees and have workers'comp.insurance.t 14.n Other 6.Q 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 required] *Arty applicant that check's box#1 must also 511 out the section below showing their workers'compensation policy information: Homeowners who sukb�sthis m of c a theyare nal sheet showing theame of the sub-contractorsoing aU work and then hire outside and sta o wctors must he_th r or nt a now ot fholse entihaes have •Contractors that ch employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. X am an employer that is providing workers'compensation insurancefor my employees. Below is flee policy and job site information. Insurance Company Name: /�S� _ Expiration Date_ Policy#or Self-ins.Lic.#: 1A Lt- _City/State/Zip: ./ Job Site Address: L' ' ' compensation policy declaration page(showing the policy number and expiration date). Attach a copy'of the workers' e by a RdO up to Failure to secure coverage as reqs w ll as c ivil penalties 2inthe form o25A is a f aaSSTOP nal rWORK ORDER olation Iand�n of up to$250.00 a and/or one-year imprisonment, ent may be forwarded to the Office of Investigations of the DIA.for insurance day against the violator.A copy of this statem coverage verification. Ido Hereby certify un pains a e les of pe 'ury that the information provided above is true and correct Date' 1O Si ature: I Phone#: in this area,to be completed by city or town official, Official use only. Do not write l Permit/License City or Town- issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Phone#: Contact Person: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their empl'o'yees. 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 d'efuied as"an individual;partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enferprise,and including the legal representatives of a deceased employer,or the receivet'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 b6 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 xequiired." 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 Pleasb 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 number(s)along with their certificates)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. DO advised that this affidavit maybe submitted to the Department of Industrial Accidents for confirmation 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 permit or license is being requested,not the Department of IndustrialAccidenis. 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. S elf-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 p ermit/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 stamp ed or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit 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 Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 Tel.#617-727-4900 ext.7406 or 1-877-MASSA-FE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia Lill Iv_rev DATE(MMIDOIYYYY) CERTIFICATE OF LIABILITY INSURANCE 1012-612016 AND CONFERS No GHTS UPON THE CERTIFICTE HOLDER-THIS THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLYNp OR ALTER R1HE COVERAGE A FORDEDABY THE POLICIES CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER- ies) must be endorsed, if IMPORTANT: I f the /of thehpollier s an icy!certainDDITIONAL pOflciies may require an require A Statement on this certifl ate does not lconfern rights lto the the terms and conditions certificate holder In lied of such endorsemen e. NTA PRODUCER NAME: X Segreve&Hall Insur,Assoc.lnc PHONE Arc No: 305 North Main St. EODRLSs: Andover,MA 01810 RD R FLUET-1 Michael L.Segreve C TOME Dg: INSURER S AFFORDING COVERAOE N0 41360 IwsuREo Richard Fluet Contracting Inc. INSURERA:Arbella Protection Ins.Co. 34754 102 Bridle Path Lane INSURER 0:Commerce Insurance CO. Methuen,MA 01644 IwSURER C: INSURER 0: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS is To D T THE INSURED ED ABOVE FOR T CERTIFY THAT THE ANYES OF REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCENT WITH RESPECT TOLWHICH THICY IS 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 EVEN REDUCE DE6Y P PIO CLAIMS YE LIMITS NSR POLICY NUMBER MM Drr Ml 1,000,00 TYPE OF INSURANCE EACH OCGURRENCE $ GENERALLIARILMY $ 100,00 06112/2D15 0611212018 PRE IBES ocCll nce A x COMMERCIAL GENERAL LIABILn 8500034727 MED ECP Anyone Doraon) S SAC CLAIMS44ADE � OCCUR 06112/2018 06/1212017 PERSONAL&ADV INJURY $ 1,000,0C 8500034727 2,000,00 GENERAL AGGREGATE $ PRODUCTS-COMP/DPAGG $ 2,000,0( GEN'L AGGREGATE LIMIT APPLIES PER: $ X POLICY PRO- LOC COMBINED SINOLF LIMIT $ AUTOMOBILE LIABILITY (Ea sccidenl). BODILY INJURY(Parperson) $ 100,01 ANY AUTO BODILY INJURY(per auoldent) S 300,01 ALL OWNED AUTOS 100,0 PROPE=RTY DAMAGE $ i B X SCHEDULEDAUTOS 1460 12/01/2015 12/0112016 (PERACCIDENT) X HIRED AUTOS 1 S X NON.OWNSD AUTOS $ EACH OCCURRENCE $ UMORELLALIAB OCCUR AGGREGATE $ EXCESS LIAR CLAIl $ DEDUCTIBLE $ RETENTION S WC STATU- OTH- WORKERS COMPENSATION T 600,( AND EMPLOYERS'LIABILITV E.L.EACH ACCIDENT $ A ANY FROPRIETOR/PARTNERIEXECUTNE YIN NIA 03/3112016 03/31/2017 E.L DISEASE-EA EMPLOYEE $ 500,( OFFIC1nR/MEll EXCLUDED? 220051550 500,1 (Mandatory in NMI E.L.DISEASE-POLICY LIMIT 8 If Ypea,aeBcriba unoor DpSCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101.AddiQonal Remarla Schedule,If mora space Is requlnd) ref:41 Bearhill Road No.Andover,Ma CANCELLATION CERTIFICATE HOLDER NORTHAN THE SHOULD EXP EXPIRATION DATE VTHEREOF,ENOTICE POLICIES WILL CBE CELLED R WILL I Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. Building Deparment 1600 Oil St. AUTHORIZED REPRESENTATIVE North Andover,MA 01845 ®1988-2009 ACORD CORPORATION. All rights reserved ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD rtment OT (poorvmo�ccrieC � hoar aG�'� r<tdacfttr<te/%1, (' d of$ud ng.iaeguiatlOailS anCluStandards • :. ' r_ . Office of.Consumer Affairs&Business Regulation .. _ ,.�„n.��ii%tioii�iiriCi"i;�{;i .� HOME IMPROVEMENT CONTRACTOR License: CS-00710 ?„•, Registratioe4106620 Tye' Expiration 7/2412018_ Private Corporation R11CHAgD A FLUUT R l� 1 102 BRIDLE PA19 RICHARD FLUET 6O&It ACTING INC. METH JENMA $184 i-� r .; ”� Richard Fluetr= ��zt ��r 102 Bridle Path Lane Jam,,.JJ Expiration Methuen,MA 01844 Undersecretary Commissioner 04/22/2017