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HomeMy WebLinkAboutBuilding Permit #318-2016 - 34 OLD VILLAGE LANE 9/14/2015�J OORT11 BUILDING PERMIT `' o�°b 6�0 TOWN OF NORTH ANDOVER „ APPLICATION FOR PLAN EXAMINATION + - Permit NO: 1� Date Received Date Issued: � �9SSACHUS���� IMPORTANT Applicant must compTete all items on this page Wil ME LCAT Nq` � em< ` PRPON lU1A' NO ARCEtz ZON�N i ae .n .. �'; � ,� ' ,��,�� �,��.� _.;, Mc`�CIl1n��S .op�Itl)a �n � � � ,• TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential El Buildin p 9 ne family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ff epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other I `€ SeptIlelt � Floodpl€ r�� #1tcis` s � tershed DstriCt A'!< I Identification Please Type or Print Clearly) OWNER: Name: ° 3 �-- /� e Phone: Address: �OITRITOR �) tl s xhi� e "4V All " n � i.it�'Y sor It �Vtl� ' 147 .ILve!I�ir�� H mlmproeetacele e 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: $ a yl 0 0,0 FEE: $ Check No.: 2t� Receipt No.: NOTE: Persons contracting w' n stered tractors do not have access to the guaranty fund S�nature ofA in '4"9 a. 9. ._ Signature of co�atractor ,` N j r .. Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanuing/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dempster 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 I Conservation Decision: Comments Water& Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: —406-P, RIO Located 384 Osgood Street ,f� z,� E ��'a� Temp Dumpsferon site yes # � no µ a- t Loca Qd 4IMai Ma d at,,12 an a t.' fFire De`�artment�s'� -"` �cl" ,_ . WEN" t e-� {k COMMENTS: +_r •' 4 ;� z 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 4. 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 OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks 4. 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/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 OTE: 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 46 Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) Copy of Contract 2012 IECC Energy code Engineering Affidavits for Engineered products OTE: 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 i NORTH awn of t E ndover 0 No. ��_ 0� h ver, Mass, �� 16 o� > A- coc NIc Ht WICK 7d p�RATEO PP���S 7S U BOARD OF HEALTH PERMI L D Food/Kitchen Septic System IV BUILDING INSPECTOR THISCERTIFIES THAT ........... ... ........ ..............3�... ........... .... ....... ................... ................. Foundation has permission to erect .......................... buildin son ... ... � .. �. ..... ............... • Rough tobe occupied as ........... ... .....p....Q�'.. .... ................................................................. Chimney provided that the person accepting this permit shall in every respect conform 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 I THS ELECTRICAL INSPECTOR UNLESS CONSTR S T Rough Service ....... ....................................................................... Final BUILDING INSPECTOR 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. Meadows Construction ' .; 4 New Pasture Road + . Newburyrport,MA 01.950 Phone: :978463-4487 ,. gofigureapp.net Bob Barnett September 8, 2015 34 Old Village Lane North Andover,MA Project Details Siding-Fiber Cement Clapboards James Hardie Evening Blue • Remove existing siding to sheathing. Furnish and.Install air vapor barrier over entire wall. Furnish and Install membrane flashing at window and door openings. • Furnish and.Install aluminum flashinp-at window and door heads. Furnish and.Install fiber cement clapboards. • Blind nail all siding.- Proposal Notes Existing trim to remain Remove existing shutters and replace with vinyl shutters provided by owner. Total Price: $24,000.00 1/3 Deposit 2/3 upon completion ------ el L12 9/A Meadows Construction Signature/Date Customer Signature!Date 3 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,Mass. 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Meadows Construction Company LLC Address: 4 New Pasture Road City/State/Zip: Newburyport, MA 01950 Phone#: 978-4654735 Are you an employer?Check the appropriate box: Type of project(required): 1. X I am an employer with 40 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. ? Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers'comp.insurance comp.insurance.I required] 5.❑ We are a corporation and its 10. ❑Electrical repairs or additions 3. ❑ 1 am a homeowner doing all work officers have exercised their 11. ❑Plumbing repairs or additions myself [No workers'comp. right of exemption perm MGL insurance required]t c. 152,§ 1(4),and we have no 12. ❑Roof repairs employees. [no workers' 13. ❑Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. tHomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contactors that check this box must attach 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: Travelers Property Casualty Company of America Policy#or Self-ins.Lic.#: UB6B226814-14 Expiration Date: 9/12/2015 Job Site Address: 34 Old Village Lane City/State/Zip: North Andover, MA 01845 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 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 $250.00 a day against violator.Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for coverage verification. I do herby cern under the pains nd penalties of perjury that the information provided above is true and correct. Si natur ` Date: 9/11/2015 Print Name: Brian Dias Phone#.- 978-815-7149 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 Heath 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contactp erson: Phone#: I MEADO-3 OP ID:JA DATE(MWDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 06/24/2015 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 Marcos W.Shaner Chase&Lunt LLC NAAME:ME: 65 Parker Street a/C°No EI:978-462-4434 1 Fa N,):978-465-6204 Newburyport,MA 01950 E-MAIL Michael C.Howlett ADDRESS: INSURERS)AFFORDING COVERAGE NAIC# INSURER A:First Mercury Insurance Co. INSURED Meadows Construction Co, LLC INSURER B:Safety Insurance 4 New Pasture Road INSURER C:Harleysville Insurance 23787H Newburyport, MA 01950 INSURER D:National Union Fire Ins.Co. 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. NSR TYPE OF INSURANCE DDL UBR -POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MMIDDNYY MMIDDNYYY A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S_ 1,000,00 CLAIMS-MADE 1-il OCCUR X MACGL000001642403 09/12/2014 09/12/2015 DAMAGE O RENTED PREMISES Ea occurrence S 50,00 MED EXP(Any one person) $ EXCLUDE PERSONAL&ADV INJURY S 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,00 POLICY PJ F7LOC PRODUCTS-COMP/OP AGG S 2,000,00 OTHER: S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S 1000,000 Ea accident , B ANY AUTO 5059124 09/12/2014 09112/2015 BODILY INJURY(Per person) $ ALL OWNED X SCAUTOS HEDULED AUTOS BODILY INJURY(Per accident) S X X NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident $ X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 5,000,00 D EXCESS LIAB CLAIMS-MADE 8517G130ALI 09/12/2014 09/12/2015 AGGREGATE S 5,000,00 DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITYSTATUTE ER ANY PROPRIETORIPARTNERIFXECUTIVE YIN N TO BE ISSUED BY CARRIER E.L.EACH ACCIDENT 5 OFFICERIMEMBER EXCLUDED? F—]N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1 $ C Equipment Floater CIM93977Q 09112/2014 09/12/2015 RENTED 150,00 Special Forms EQUIP DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Lowell Housing Authority are listed as Additional Insured with respect to the General Liability if required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED /REPRESENTATIVE �� I ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(M93igni YYY) fCECRTIFICATE ICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS E DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE ER 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 and endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: CHASE&LUNT LLC PHONE FAX PO BOX 590 (A/C,No,Ext): (A/C,No): E-MAIL NMkTURYPORT,MA 01950 ADDRESS: 73JGX INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: TRAVELERS PROPERTY CASUALTY COMPANY OF AIVIERICA N EADOWS CONSTRUCTION CO LLC INSURER B: INSURER C: INSURER D: 4 NEW PASTURE ROAD INSURER E: NEWBURYPORT,'VIA 01950 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. INSR ADD SUB POLICY EFF DATE POLICY EXP DATE LTR TYPE OF INSURANCE L R POLICY NUMBER (MMIDDIYYYY) (MMIDDIYYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ CLAIMS MADE OCCUR. PREMISES(Ea occurrence) MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY r-1 PROJECT❑LOC PRODUCTS-COMP/OP AGG $ AUTOMOBILE LIABILITY COMBINED SINGLE $ ANY AUTO LIMIT(Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULE AUTOS (Per person) HIRED AUTOS BODILY INJURY $ (Per accident) NON-OWNED AUTOS PROPERTY DAMAGE $ (Per accident) UMBRELLA LIABOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE _ $ RETENTION S $ A WORKER'S COMPENSATION AND cr WC STATUTORY OTHER EMPLOYER'S LIABILITY YIN UB-6B226B14-14 09/12/2014 09/12/2015 A LIMITS ANY PROPERITOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/RESTRICTIONS/SPECIAL ITEMS THIS REPLACES AMY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTLN'G WORKERS COMP COVERAGE. CERTIFICATE HOLDER CANCELLATION Z' SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENT VE 0 Ufl ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 1988-2010 ACORD CORPORATION. All rights reserved. (� � rtrl�?2��'1�?ZCU�'Cli�12 C�' ��l�i� C�Gl?,'GGJC'i Office of Consumer Affairs and Business Regulation 4, �rs• -' 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 157479 Type: Private Corporation Expiration: 10/4/2017 Tr# 270240 MEADOWS CONSTRUCTION CO. - MICHAEL MEADOWS 166 MIDDLE RD. BYFIELD, MA 01922 Update Address and return card.Mark reason for change. SCA 1 20M-0511 ❑ Address 0 Renewal E] Employment Lost Card �._ Office of Consumer Affairs&Business Regulation License or registration valid for individul use only 1 �-HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: s Registration: 157479 Type: Office of Consumer Affairs and Business Regulation x Expiration: 10/4/2017 Private Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 MEADOWS CONSTRUCTION CO. MICHAEL MEADOWS 166 MIDDLE RD. -- BYFIELD, MA 01922 Undersecretary 17Not valid without tore f1 Massachusetts _ --_ Board of Building Re artrnent of Public Contitr 5uiations a Safety License: SuPenisor and Standards nse: Cg-075914 M Dias 7Sir �. Isaac Way ." E Hurls p °n NH 0305 :. I _ �; IY 7 ✓ !S. ��-/� -�1'I8ll Co►nmissioner EXPi ration 09/28/2016 Location 64 qll1 Y i j 4- No. �' Date (`f F • - TOWN OF NORTH ANDOVER • Certificate of Occupancy $ Building/Frame Permit Fee $cam u v .1 J a Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# V /1 Building Inspector 2 :