HomeMy WebLinkAboutBuilding Permit #187-15 - 365 JOHNSON STREET 8/20/2014 NONTF1 O� t-aD ,bgti BUILDING PERMIT OOL TOWN OF NORTH ANDOVER ° APPLICATION FOR PLAN EXAMINATION « Permit NO: W— K Date Received tOcw¢Mw¢w +' Date Issued: CHUS IMPORTANT: Applicant must complete all items on this page LOCATION NSG J L,CT v Print 'fPROPERTY OWNER Print MAP NO: OW PARCEL: ZONING DISTRICT: Historic District yes no !Machine Shop 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 ❑ Well ❑ Floodplain ❑Wetlands ❑ Watershed District Water/Sewer 14QA- 0 !Ala& kAk r-)b ple 1)La't­� -�rk ST gA��Ci'� Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: CONTRACTOR Name: Phone: Vic; 7t U4 rF c V,v N 12 Address: Supervisor's Construction License: Exp. Date: / CS 0.7 3 �._ ©2- Home Improvement License: Exp. Date: 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.: '2-1°17J NOTE: Persons contracting with th nregistered c tractors do not have access to e guaran fund Signature of Agent/Own Signature of contractor 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 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 FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date !. COMMENTS 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 o 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 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 o 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:Building Permit Revised 2014 Location . Gtl 4/I S�2 �1 No. i Date Zl! • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ r TOTAL $_ Check#3k `" ' `• Building Inspector c ver No. t _ h ver, Mass, Quo COC NICNl WICK y1. 7S V BOARD OF HEALTH Food/Kitchen PERMI. T T LD Septic System THIS CERTIFIES THAT 2Sd cin. BUILDING INSPECTOR // has,permission to erect .......................... buildings on ....-�6IS.........�0'\'.i A. ........... Foundation _ /���� �� ; Rough to be occupied as ��� / .Y.!"'��.......46. L ..' 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 IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION T TS Rough Service ................................................................................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz 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. CONTRUCTION CONTRACT Agreeme entered i to this_NL day of01*,by and between ""C 01 Massa usetts;hereinafter called the Owners and J&S Carpentry and Construction, Inc., and its authorized representative,Jeffrey A. Schultz, President, hereinafter called the "Contractor". Witnessed,that the"Owners"and the-"Contractor", for the consideration hereinafter named, agree as follows: 1. Scope of the Work—The "Contractor" shall furnish all of the materials (except as noted)and perform all of the work necessary for the following job: io Z 2. Time of Completion—The work to be performed under this Agreement shall be commenced on or about- I?- l!%- 14 , and shall be completed within a reasonable time, weather permitting: 3. Contract Sum—The"Owners" shall pay to the"Contractor"for the performance of this Agreement,the sum of LhAtj 10% 8S;'f.I'T, +%W Iz�,/00/100 Dollars, ($ 6ar4e14-T3 This price includes the foil win rr Tu LOW I The"Owners"are responsible for paying any amounts due for plans, drawings, architectural work,permits, and any other related fees. 4. Impossibility of Performance—In the event that any contingencies beyond the control of the"Contractor", now unforeseen including but no limited to Acts of God, shall arise which shall render temporarily impossible the performance of this Agreement by the "Contractor",the performance hereof shall be suspended temporarily until such impossibility is removed: and if such impossibility of performance by the "Contractor" shall continue for more than thirty(30) days, then it shall excuse performance by the "Contractor"and shall discharge both parties from all obligations under this p g Agreement. 5. "Or Equal" Clause—Whenever any item in this Agreement, defined by describing a proprietary product or by using the name of a manufacturer or vendor,the terms term"or-equal", if not inserted shall be implied. The specific article,material, or equipment mentioned shall be understood as indicating the type, function, standard of design, efficiency, and quality desired, and shall not be construed in such a manner as to exclude manufacturers' products of comparable quality, design, and efficiency. 6. Extra Work or Changes—No extra work or changes shall be done except upon a written order signed by the "Owners" and the "Contractor". Such order shall state the cost of such work and the time allowance for same, if any. 7. Settlement of Disputes—If payments are not made by the "Owners" and received by the"Contractor"by the due date ser forth in this Agreement, the A� CERTIFICATE OF LIABILITY INSURANCE DATE IMMIDDIYYYYI 08119@014 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(les) 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 CONT CT Cowan Cowan hatirance Agency,Inc. PHONE 978 372-1451 F"x 978 521-4669 359 Main Street �a1 la cowaninsurance.com Haverhill MA 01830 INSURFRIS1 AFFORDIN COVERAGE NAIC k IH a Associated Employers Insurance Company INSURED 1 R J&S Carpentry&Construction Inc. INSURER : POB 655 R Middleton MA 01949 INSURER E• IN RER 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. (LTR NSR TYPE OF INSURANCE DL UB UMBER POLICY EFF POLICY EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED CLAIMS MADE OCCUR MED EXP(Any one $ PERSONAL&ADV INJURY $ rGNERALAGGREGATEGENL AGGREGATE LIMIT APPLIES PER: ODUCTS-COMP/OP AGG POLICY PMr F-1 RO LOC AUTOMOBILE LIABIUTY COMBINED SINGLE LIMIT ANY AUTO ALL OWNED SCHEDULED BODILY INJURY(Per person) $ AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOSNON-OWNED PROPERTY DAMAGE AUTOS $ S UMBRELLA LIAR OCCUR EACH OCCURRENCE 14 EXCESS LIAB CLAIMS-MADE AGGREGATE gETENTION$ WORKERS COMPENSATION x WC STATU- OTH- AND EMPLOYERS'LIABILITY Y N FR A OFFICANY REM(EMBER EXCLUDED?ECl1TIVFJ',� ) NIA WCC50050136502014 07116/2014 0711612015 E.L.EACH ACCIDENT 100,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $100.000 If es,describe under RI F RA E.L.DISEASE-POLICY LIMIT $500 000 DESCRIPTION OF OPERATIONS/LOCATIONS 1 VEHICLES(Attach ACORD 101,AddlOonal Remarks Schedub.K more space Is required) Carpentry contractor. CERTIFICATE HOLDER CANCELLATION Town of North Andover SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Building Department THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 9 P ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood St North Andover,MA 01845 AUTHORIZED REPRESE Fax:978- m 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are40/tered marks of ACORD ti 11t Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Superb icor License: CS-073424 JEFF A SCHULT7f` PO BOX 655 MIDDLETON MA Ol i W Expiration Commissioner 02/08/2016 � � !-�/ee`�am,�raoozurea lC�i ��aroac�uoelt �!. Office of Consumer Affairs&Busi ess Regulation ." ME IMPROVEMENT CONTRACTOR egistration: 168289 Type: xpiration: 1/28/2015 Private Corporatic - - J&S CARPENTRY AND CONSTRUCTION,INC. JEFFREY SCHULTZ {' 22 FOREST ST + MIDDLETON,MA 01949 Undersecretary The CommonweaM offfassachusetts Depa�€men�o,�.�hr�����r�r.Acczc�en�� • , 0flee off-avesti'gadons 600 WaYhingtoxt eet .Easton,.MA 02111 r�w�vrnassgol�Ic�ir� ' wor ke:c$l CIIoMpengation insuranceAffidavit:�u�de�°e�Ca��°ac�oz��fGXc����ic�ansl�'ZYimbex� App cant orrnaaAon Please.Print Lew-ly Name(Business(drganizationfXndzvidual}: tl '�-�M� CGV� /�y a w�. .iA1 C'-•- Address: cc rr tS Czty/StateMP: �c d Are orx an employer?Cheektho appropriate box' Type of project(required): 1. 1 ara a employer whh __� 4• ❑x am a general contractor and I 6. ❑New constractzon. F Gulland(oxpa t�rne).T have li odthe sub-contractors employees 2.p T ani.a sole proprietor or partner listed on the attached sheet: 7. Remodeling These su SMP and`havezta•employees sub-contxactoxshave 8. [[Demolztzon working forme in any capacity. workers'comp.insurance. 9, E]Building addition [No work-DIG'comp.insurance 5• Q o ffi are a corporation andiiscers have exercised.theix 10.0 Electrical repairs or additions xecluired.] offi • tion right of exemption erlt OL 11..[]1'lumbingrepairs or additions 3.C] I am a homeowner 09-alt work g p p mysel�. loworkers'comp. c.152,§1(4),and wehaver.o 12.M]Poofxepairs insuranceregaixed.I i employees..[No workers' 13.[]Other comp,insurance requixed.j 9A-ay applicant thha�checks box#Z mus�also ill ouitbe section belbwshowing Heir workers'compensagon.poEcy information. 7 Homeovrners who mbmRht g amdavitindica#they 6se doing allwork andthen hire outside contractors muse:submit anew affidavit indicating such. ?Corchactars that checktbis be const attached an additional sheetshowingthe name ofthe subcontractors andtheirworkers'comp.poffoyinfounation. IManernpray�vtiiatisp ovidingtuor ers'eornpe�sationir�sr�raneefbP -a er�zproyees del'oto%sth v 7ieyacndjo.�sYe infoxmatior2. /� � T Insurance Company �-} Policy#or Eel ins.SIC'.#: "U 3�o ��� �Xpkp&n,Date: Job Site Address' --- LAv► Attach a copy of tete workers'compensation-poRcy declaration page(showlnVAe policy wortberr and expkatiorx date). yailure to securo coverage as xecluiredunder Sectzon 25A OMCM 0.152 can lead to the imposztzon of eriminalpenalties of a e up to s 1,50 0.00 and(or one-year imprzsonment,as wallas crud penalizes in the form.of a STOP W OP ORDER and a�n e f o£up to$250.00 a.day against the violator. Be advised that a copy ofthis statement maybe forwarded to the Office ot• 7nvestzgations of:the DTA.for insurance coverage vex%ixcation. ,I do flereby cerafy uridert zeyains andpenaXtles oj,perPry tliatdie irg OTMaflon,provided above is tare and correct - Si afore: Date• Phone i#: official use 0,11Y. Do not write in 616 area,to be completed by city or toren of cial. City or Town: Berrnitl�icense# fssuing Authority(circle one): 1.Board of Health?.Buf&g)Dapartmen&I 3.CitylTbwa Clerk 4.Electricallnspector 5.Bumblugh8pector f.Other - r