Loading...
HomeMy WebLinkAboutBuilding Permit #529-13 - 400 DALE STREET 1/23/2013TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION � LI-7Permit NO: v Date Received Date Issued- I IMPORTANT: Applicant must complete all items on this page LOCATION �eLo 7- - - Print PROPERTY OWNS I 2 sl 11 19AIe_ `i �r(_[� Print 100 Year Old Structure fes no MAP NO: PARCEL:C �l+ZONING DISTRICT: Historic District no.Machine Shop Village no V/ 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 . 0 Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: A— //V'- Z)/ AV'/ 1V 6 Identification Please Type or Print Clearly) OWNER: Name: ZLI/9 C 7-P k V iY 1,1CV Phone: Address: ,410d b19/- E J r jv,^o op— 7w �,4 I'v- �� j v CONTRACTOR Name: 6 �y 'J Phone: !J Address: �� Al -6614 -Al Z,,'/►"/ T 73Exp. Supervisor's Construction License: �.�/ Date: 1 Home Improvement License: /0'/ 6 G Exp. Date:/�/� ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COSTBASSED ON $125.00 PER S.F. 4'3,n Total Project Cost: $ GFEE: $ Check No.: zl/ / 2'--�'q 6 Receipt No.: 2(Dko� NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of.A ent/Ovvner Si nature.,.of contractor i Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ Location A—O No.!5� Date Check #)-" v 26109 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $Y' Z0 Foundation Permit Fee Other Permit Fee TOTAL 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 DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed onSignature COMMENTS HEALTH COMMENTS Reviewed on Signature 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 Towp- Engineer: Signature: Located 384 FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Depaftment,signature/date COMMENTS Street 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 lies No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine NOTES and DATA — (For department use Ll Notified for pickup - Date Doc.Building Permit Revised 2010 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 ❑ 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 submAted with the building application Doe: Doc.Building Permit Revised 2012 r� Z Is] 3 0 H I;.A W J ui = LL. G 0C m N u?O o o LL vm N + Q. N U H ? Z o c 7 LL j W (U E U is 11 O w CL N Z Z O. t O W co C LL O W Ln Z V W W j O cr N Ln LL oc O LVu z j O 2' m C LL �-- z W W 0 LLICC LL - c a m O Z w �`+ h F3 O !n 0 O : (D a � c c o N O E Q. L N CD ,4- 0 E c Gj c Q- o m 3 d: CL N J 4 O L MT �• � W L o c � > tq - O O 'a .�� A r . E y- 0 C oZ �� o N o =oma L Q0.0) N = C Q L L lC d H O fq Q. 2 LLIcc w moo N Q.°No F— N �m�.2 LU•L- V O C i V aD O V d �. N Q O �= C N = O H 0 Z CLOci I -M1 PMU H � •V O O O c Q 'a s _ M Ri J -0 00 AW Z U V/ M LLI LLI _I W W 19 W U 0 a- co Z z 0 m � � w Z V t W N� Cl) X Z O W Cl) J W CL z I -M1 PMU H � •V O O O c Q 'a s _ M Ri J -0 00 AW Z U V/ M LLI LLI _I W W 19 W U O� i2 l- v c^Q w .Q VI C� d� m AC40R "®CERTIFICATE OF LIABILITY INSURANCE DATE 6/4/2012) 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 MTM Insurance Associates 1320 Osgood Street North Andover MA 01845 CONTACT NAME: Victoria Lowes, CISR PHOIC.NEA No.ExtI, (978) 681-5700 A"X No: (978)681-5777 E-MAADDRESS: Rvickiel@mtminsure.com INSURERS AFFORDING COVERAGE NAIC # INSURERA:Maiden Specialty Insurance INSURED Cote & Foster Contracting, Inc 20 Aegean Drive Methuen MA 01844 INSURER B:Safet Indemnity Insurance 33618 INSURERC:Conunerce & Industry Insurance INSURERD:Travelers Insurance Group INSURER E INSURER F : COVERAGES CERTIFICATE NUMBER:12-13 Master List 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 LTR TYPE OF INSURANCE ADDL I SUBR D POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MM/DDIYYYY LIMITS N Andover, MA 01845 GENERAL LIABILITY P MacDonald CPCU, CIC EACH OCCURRENCE $ 11000,000 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE $❑OCCUR RAX1000490 12/31/201112/31/2012 DAMAGE To RENTED PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) $ Excluded PERSONAL BADV INJURY $ 11000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 X POLICY PROT LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) $ B ANY AUTO ALL OWNED SCHEDULED AUTOS X AUTOS 6216231 12/31/2011 12/31/2012 BODILY INJURY (Per accident) $ X HIRED AUTOS X AUTOS D Pe�accidRPER entDAMAGE $ Underinsured motorist BI split $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ $ C WORKERS COMPENSATIONX AND EMPLOYERS' LIABILITY YIN WC STATU- OTH- TOY IMIT ER ANY PROPRIETOR/PARTNER(EXECUTIVE OFFICERIMEMBER EXCLUDED? (Mandatory in NH) N / A 0004962937 6/20/2012 6/20/2013 E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE -E4 EMPLOYEE $ 500,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 500,000 D Property Coverage 16608A981820TIAll 12/31/201112/31/2012 Busienss Personal Property $37,853 Scheduled Equipment Contrctors Equipment $166,928 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Certificate holder as listed below CERTIFICATE HOLDER CANCELLATION ACORD 25 (2010/05) INS025 (201005).01 ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town of North Andover North Andover Town Hall AUTHORIZED REPRESENTATIVE Main St. N Andover, MA 01845 P MacDonald CPCU, CIC ACORD 25 (2010/05) INS025 (201005).01 ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LeLibly Name (Business/Organization/Individual): Cao %~� t✓ Address: �O /�'�� Z,11/'/ .;�_ City/State/Zip;/W 7ff 64 i(/ zU,4)- 67 /X/,/ -Phone #: `�/� % 4P,' Are you an employer? Check the appropriate box: L ❑ I am a employer with 4. EI am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. I ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. F1 I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, §1(4), and we have no insurance required.] f employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12. ❑ Roof repairs 13. ❑ Other kny applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ;ontractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site formation. tsurance Company Name: Cry /77/ 7 £le C A/ -t> U.5 7-Af cj -.2�7 /v' L Aicy # or Self -ins. Lic. #: GU�O Dy 96 19 9J 2 Expiration Date: W a v ��✓� �b Site Address:_ %~ City/State/Zip: ttach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). tilure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a ae 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 up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of vestigations of the DIA for insurance coverage verification. to hereby certify under the pains and penalties of perjury that the information provided above is trace and correct. Official ztse 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 Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. 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 defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver 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 be 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 required." 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 Please 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 certificate(s) 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. Be advised that this affidavit may be 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 Industrial Accidents. 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. Self-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 permit/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 stamped 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 Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 evised 5-26-05 www_m a s.R. srnv/cli a COTE f�tFosTE CUSTOM BUILDING + REMODELING November 28, 2012 Proposal submitted to Walter & Nancy White to cut a window out and frame for new 10'0" x 6'8" slider unit at the address of 400 Dale St., North Andover. Details of project are outlined as follows: 1. Debris —Removal of all debris by Cote and Foster. 2. Frame New I%" x 11" header and a2" x 4" wall framing. 3. Interior Trim —Casing to match existing. 4. Door —Install customers Marvin, 10'0" x 6'8" unit. 5. Siding No siding figured into this proposal. 6. Paint or Stain -By customer. Total cost to complete $3,570.00 Thank you for the opportunity to quote your project. Should you have any questions or would like to take your project to the next step, please contact us. Sincerely, William T Foster Cote and Foster 20 Aegean Drive • Unit 15 • Methuen, MA 01844 Tel: 978-682-6518 • Fax: 978-682-1221 www.coteandfoster.com OTEfA61 FOSTER�u� CUSTOM BUILDING + REMODELING November 28, 2012 Proposal submitted to Walter & Nancy White to cut a window out and frame for new 10'0" x 6'8" slider unit at the address of 400 Dale St., North Andover. Details of project are outlined as follows: 1. Debris —Removal of all debris by Cote and Foster. 2. Frame New 13/4" x l 1" header and a 2" x 4" wall framing. 3. Interior Trim —Casing to match existing. 4. Door—Install customers Marvin, 10'0" x 6'8" unit. 5. Siding No siding figured into this proposal. 6. Paint or Stain -By customer. Total cost to complete $3,570.00 Thank you for the opportunity to quote your project. Should you have any questions or would like to take your project to the next step, please contact us. Sincerely, &ZA4 X", wt� William T Foster Cote and Foster 20 Aegean Drive • .Unit 15 • Methuen, MAO 1844 Tel: 978-682-6518 • Fax: 978-682-1221 www.coteandfoster.com Pagel of 3 Cyndi Bonanno From: White, Nancy M (DEP) [nancy.m.white@state.ma.us] Sent: Wednesday, January 09, 2013 4:15 PM To: Cyndi Bonanno Subject: FW: Sill Detail Hi Cyndi, Could you please forward the following to Bill and please let him know that I will update you/him with the R.O. when I get home and can check the paperwork that I have there. Any additional questions that you or Bill have please let me know. Thank you, Nancy From: Sandy Gove [mailto:sandy@nswsformarvin.com] Sent: Wednesday, January 09, 2013 4:04 PM To: White, Nancy (DEP) Subject: RE: Sill Detail Nancy, Your carpenter wants to make that sill pan for 4-9/16" On the bottom of that sillin is 4-9/16 The 5" dimention is to the outside screen track. III Take care of the delivery with Samantha. On your original paperwork I gave you it has the R.O. on it. Frame size is 1" less width and %" Height Let me know if you need more info. Thanks,. Sandy Gove 239 South Main Street Middleton, MA 01949 978-762-0007 Office 508-922-1760 Mobile 866-809-3136 Fax MARVi1N DESIGN G a complus window and door showroom by NSWS From: White, Nancy M (DEP)[mailto:nancy.m.white@state.ma.usl Sent: Wednesday, January 09, 2013 1:57 PM To: Sandy Gove Subject: RE: Sill Detail Hi Sandy, 1/10/2013 Page 2 of 3 My contractor had two more questions, if you could please try to answer? He wanted to confirm the depth of the unit. The Marvin diagram shows two numbers, S 21/23" and 4 9/16", at the top of the unit but doesn't show a measurement where the sill is drawn along the bottom. He needs this measurement so that he can build a copper pan to fit under the sill. It looks like that measurement would be 4 9/16" but he just wants to confirm. Also would it be possible for you to provide the exact rough opening of the unit. And lastly, they would like to reschedule delivery of the door from Monday morning to Wednesday morning. Should I speak to Samantha regarding that? Thank you in advance for your additional help. Nancy From: Sandy Gove[mailto:sandy@nswsformarvin.coml Sent: Tuesday, January 08, 2013 9:42 AM To: White, Nancy (DEP) Subject: FW: Sill Detail Sandy Gove 239 South Main Street Middleton, MA 01949 978-762-0007 Office 508-922-1760 Mobile 866-809-3136 Fax MARVI,N DESIGN GALL E ' acomplete window and door showro©m 6yN'SWS From: Sandy Gove Sent: Tuesday, January 08, 2013 9:38 AM To: 'nwwhite37@verizon.net' Subject: Sill Detail Nancy, It will be the one on the bottom right labeled high performance. Anything else let me know. Thanks, Sandy Gove 239 South Main Street 1/10/2013 Page 1 of 1 Cyndi Bonanno From: nmwhite37@verizon.net Sent: Wednesday, January 09, 2013 6:31 PM To: cyndi@coteandfoster.com Subject: Marvin door rough opening Hi Cyndi, Could you please let Bill know that the RO for the door is 120" x 82 1/2". Thanks! Nancy 1/10/2013