HomeMy WebLinkAboutBuilding Permit #774 - 35 COLGATE DRIVE 5/23/2007Permit N0:
Date Issued:'" L
BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Date Received
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OWNER: Name: () V
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PROPOSED USE
TYPE OF IMPROVEMENT
Residential
Non- Residential f
❑ New Building
❑ One family
El Addition
[I Two or more family
[I Industrial I
11 Alteration
No. of units:
❑Commercial
❑ Repair, replacement
❑ Assessory Bldg
❑ Others: 1
❑ Demolition
❑ Other
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OWNER: Name: () V
Address:
�"ONTf=2AGT R,Name J gVC Cf ZA e: Phone
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: $ q 1, a00 FEE: $ 5 Ute— 1
Check No.: Receipt No.:
NOTE: Persons contracting wit unregistered contractors do not have access to the guaranty fund
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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: $ q 1, a00 FEE: $ 5 Ute— 1
Check No.: Receipt No.:
NOTE: Persons contracting wit unregistered contractors do not have access to the guaranty fund
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Signature of AgentlOwner �� ._ g ature. of contractor
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Location
Date
p01tT" TOWN OF NORTH ANDOVER
D
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $ "
Other Permit Fee $
TOTAL $
Check # { 0 s 2-
2
XBuilding Inspector
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer
Tanning/MassageBody Art ❑ Swimming Pools ❑
Well ❑
Tobacco Sales ❑
Private (septic tank, etc.:
tc. ❑ Food Packaging/Sales ❑
Permanent Dumpster on Site ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING &DEVELOPMENT ElDATE REJECTED DATE APPROVED
COMMENTS
CONSERVATIq����� ATE REJECTED DATE APPROVED
COMMENTS
DATE REJECTED DATE APPROVED
HEALTH El
COMMENTS
Zoning Board of Appeals: Variance, Petition No:
Zoning Decision/receipt submitted yes
Planning Board Decision:
Conservation Decision:
Water & Sewer Connec
Located at 384 Osgood Street
emp yu fps
Inatwre/date.
Revised 2.2007 1
Comments
------------
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
I
DANGER ZONE LITERATURE: Yes No
MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine
Doc.Building Permit Revised 2007
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
i
❑ 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
❑ Copy Of Contract
❑ Floor/Crossection/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
❑ 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
Doc: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07
Revised 2.2007
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
s� www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): 1j
Address: ) I - 1) c e !S4,
City/State/Zip: He�11,ey, B A , 0) `59 4 Phone #: 97 8- `70 a-'701 S_
Are you an employer? Check the appropriate box:
1. ❑ I am a employer with 4. ❑ I am a general contractor and I
employees (full and/or part-time).*
2. g I am a sole proprietor or partner-
ship and have no employees
working for me in any capacity.
[No workers' comp. insurance
required.]
3. ❑ I am a homeowner doing all work
myself. [No workers' comp.
insurance required.] t
have hired the sub -contractors
listed on the attached sheet.
These sub -contractors have
workers' comp. insurance.
5. ❑ 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.]
Type of project (required):
6.,�New construction
7. ❑ Remodeling
8. ❑ Demolition
9. ❑ Building addition
10.0 Electrical repairs or additions
11.❑ Plumbing repairs or additions
12.❑ 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.
:Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information.
I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: J k, Fo ,J 1 c
Policy # or Self -ins. Lic. #: C 1 f U 11 0 5:15 y 5 `7 1 Expiration Date: 11 - 30 -01
Job Site Address: 3 .; D j_±City/State/Zip: U, AYJ a ;e? i MA
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.
1 do hereby certify under the pains and penalties of perjury that the information provided above is true and correct.
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 Person: Phone #:
MAY -23-2007 09:00 A&K FOWLER INSURANCE LLC
ACORD CERTIFICATE OF LIABILITY INSURANCE
PRODUCER THIS CERTIFICATE IS ISSUEDASA
A 6 K Fowler Insurance, LLC ONLY AND CONFERS NO RIGHTS UI
200 Park Street HOLDER THIS CER?TIFICATED08S
North Reading, M 01864 ALTER THECOVERAGEAFFORDED
INaum
Steve Levesque
d/b/a Levesque Construction
11 Wallace St.
Methuen, MA 01844
9786642209 p.01/O1
OATE IMMICOfYM
5/23/07
MATTER OF INFORMATION
'ONTHECERTIFICATE
IOr AMB40: EXTEND OR
INSURERS AFFORDING COVERAGE 'INAIC 0
INSURERa Preferred Mutual Insurance Cc'
INSURER e: Crani_ to State Insurance Comps .. .
INSURER C:
INSURER D: - — I -
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REOUIREMENT, 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 CONDIVONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
PDu�yp- CTIPIRATDN .
Hong6 RANCE POLICY NUMBER TE MEWDD I LIMITS
GENERALLIMILITY
-
X ICOMMERCIALGENEMLLIABILITY
CPP0110594571
11/30/06
11/30/07
EACH OCCURRENCE II 1,000 000
DAMAGEIQREN IED
PREM18ES(Edoocwm.'I 100,000
CLAMS MADE l IOCCUR
Kerri A. Boutin, CIC CISR
MED EXPIArwasPffm) 1 55.000"ASONAL"VINJURY
F�OEW
S 1,000i000
OENERALAGGREG#TE S. 2QO0, OOOLAOOREGATELIMITAPPUEBPER-
I
PRODUCTS-COMPIOPAGG S '2 000,, 00Q
I IPOLICY n JEC I 'LOC
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AUTOMOBILE LIABILITY +
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COMBINED BNGLELIMIT
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ANY AUTO
(E!MmWe+Q
BODILY INJURY
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IALL ONMROW0S {
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{ SCHEDULED AUTOS {
(Per ptrsaq
BPOOILYINJURY
jMIR EDAUTO$ ' I
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NON•OVwED AUTOS I
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PROPERTY DAMAGE
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j GARAGE LIABILITY I I
I AUTO ONLY - EA ACCIDENT S
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OTHER THAN EA ACC , S
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AGO f
FXCESINMBRELLALIABILITY
I EACH"CURRENCE I
AGGREGATE
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I DEDUCTIBLE
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WORROISCOMPENSATIOHAWD
B
•W'C2245655 12/6/06
12/6/07
STATU
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(EMRovERe•upoLITY
ANY PROPR IETORIPAR TNERAX ECUTIvA
E s 100,000
OFFICERnNEMBEREXCLUOED?
E1.DISEASE •EAEMPLOYEB $ 100.000
upi'4 pFbt rc
SPECIAL PRCAII80YS oelow
:101SEASE-POLICY LIMIT. S 500,000
OTHER
0 OCRIPAONOF OFWTIONS I LOCATIONS I VEN CLES) EXCLUSIONS ADDED BY END CRSEMSNT I SPECIAL PROVISIONS
Insurance verification - 35 Colgate Dr,
ACORD 26 (7001108)
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TOTAL P.01
SHOULD ANY OF THE ABOVE DESCRIBE) POLICIESSE CANCELLED BEPORE THE EXPIRATION
DATE THEREOF. THE =UINO INSURER WILL ENDEAVOR TO MAR. 10 OATSWRIT1EN
Town of North Andover
ROTIC ETO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FALURE TO DOSO SMALL
Fax 978-688-9542
IIINOSENO084WAATiONORLIABILITYOFANY KIND UPONTHE WSURER.ITBAGENTSOR
Attn: Brian
REPAESENTAPVEe,
AUTHORED REPRESENTATIVE
Kerri A. Boutin, CIC CISR
ACORD 26 (7001108)
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TOTAL P.01
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581Imn
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w s
- --Map" 91 Lot 129800
21,400 sq.ft.
7-1/2' x 11-1/2' wooden shed
3
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c
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�
Stoke W/Tack
(Set) r � .r � � r err 77ZZ71; —/1W,
Stake Wt ack
/35 3.00'
(Set)
1 Sty. m
Dwelling
31.40'
77.86'
Stake W/Tack
(Set)
Stake W ack
N89'13'20'E
(Set
125.00'
Colgate Drive
(Public — 45' Wide)
Plot Plan
In North Andover, MA
Prepared For
Paul R. & Claire Ouellette
REFERENCES-
1 Deed Book 5788 Page 174. Prepared By
2 Plan 0373 in N.E.R.D.
Vernon J. LeBlanc, PLS
161 Holten Street
Danvers, MA 01923
(978) 774-6012
HOR. SCALE IN FEET
0 20 50 100 Oct. 23, 2001 Scale 1 "=20'
Iron Rod
W/Cop
(Set)
Iron Rod
W/Cap
(Set)
Map 91 Lot 12
61.49' 21,400 sq.ft. w a
12.0000' -*—• Proposed
24 Dia.
Above Ground Pool
39.32' 58'33'
#.::::.... .......i 24.0000'
-- j Deck
Stoke W/Tock [
(Set) 77777" iiR':F"Y:''J'%i Tt"�'"iYyJ'7"� d%"Y7:a'«+';.":J:",gt
Stake W/Tock
(Set)
f35 /35
0 0 1 Sty.
I� v Dwelling Z
PN o
Stake W/Tock
(Set)
125.00'
Colgate Drive
(Public — 45' Wide)
REFERENCES:
1) Deed Book 5788 Page 174.
2 Plan /3373 In N.E.R.D.
HOR. SCALE IN FEET
0 20 50
Stoke W/Tack
(Set)
Plot Plan
In North Andover, MA
Prepared For
Paul R. & Claire Ouellette
Prepared Bp
Vernon J. LeBlanc, PLS
161 Holten Street
Danvers, MA 01923
(978) 774-6012
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May 20, 2001 Scale 1"--20'
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Levesque Construction
11 Wallace Street
Methuen, MA 01844
Paul Ouellette l
35 Colgate Sheet 1)
1 North Andover 1
Terms 1/3 up front balanc...
Date 5/22/2007
Invoice # 41467
Due Date
POOLDECK
-deck is to follow contour of pool
Each side will extend out from pool apprx. 8'. The ends will make a right angle and tie in
together at the middle.
There will be a 4'x4' landing off the deck with a set of stairs running along the side.
Intersecting the landing and the deck will be a gate apprx. T wide.
Bottom of deck will closed in with lattice. It will also have a gate to gain access to the
underside.
f Deck material:
All material will be pressure treated.
2"x8" construction
-5/4" deckboards
1-2"x4" handrails
I -square 2"x2" ballusters
5/22/2007
(05
4,200.001 ,
-diagnol lattice I
-3/4" trim boards i
Signatures
a j dvV _7 j i
i
i
levesqueconstruction@comcast.net 978-702-7095 Total $4,200.00
Fax 978-258-1472