HomeMy WebLinkAboutBuilding Permit #316-15 - 41 BEAR HILL ROAD 9/29/2014 NORTH
BUILDING PERMIT .1,F.041
TOWN OF NORTH ANDOVER 00
APPLICATION FOR PLAN EXAMINATION
t0
Permit No#: Date Received
SSACHUS�
Date Issued: 24
ORTANT:Applicant must complete all items on this page
LOCATION' Print
PROPERTY OWNER '�� `� J G "A/
Pnnt 100 Year Structure yes CnoMAP V;r _ PARCEL o ZONING DISTRICT: Historic District yesMachineShop Village yes
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building *`Wne family
❑Addition ❑Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
❑Septic 0 Well ❑ Floodplain ❑Wetlands [I Watershed District
❑Water/Sewer
DESCFQIPTION OF WORK TO BE PERFORMED:
t ( wiIVP ou-'-,
Identification- Please Type or Print Clearly y G � 4c 0
OWNER: Name: ��`Gy��� Phone: y
Address: I t�S�✓1 tic �',
tC
.1S '
Contrame- �`��%� Phone:
Address: 101- 13/it DLz7 )94-7 ,_ c.,y rA L
Supervisor's Construction License: _00 7 U - Exp. Date:
Home Improvement License:.- �/L d-� 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: $ ► 3- yJ FEE: $
Check No.: y 4 / Receipt No.:
NOTE: Persons contracting unreeiWmd contractors do not have access to the guaranty fund
Sig tan rue of Agent/Ow �`�1' Signature of contractor
4l
Location &r-WL.,W-
/11
t (.
No. �RJ I Date
Ir
t
. - TOWN OF NORTH ANDOVER
Certificate of Occupancy $ r
« Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
d
Check#
Building Inspector
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE"OF SEWERAGE DISPOSAL
Public Sewer ❑ Swinnnin Pools ❑
TanninglMassage/Body Art ❑ g I
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
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
o Building Permit Application
❑ Workers Comp Affidavit
❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses
o Copy of Contract
o 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
D Certified Surveyed Plot Plan
o Workers Comp Affidavit
❑ Photo Copy of H.I.C. And C.S.L. Licenses
o Copy Of Contract
o Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
o Mass check Energy Compliance Report (If Applicable)
o 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
❑ Photo of H.I.C. And C.S.L. Licenses
a Workers Comp Affidavit
❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
Li Copy of Contract
o Mass check Energy Compliance Report
a 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
j
02 BRIDLE PATH RICHARD FLUET CONTRACTING,INC ANE PROPOSAL
METHUEN,MA 01844
Date Estimate#
8/13/2014 440
Name!Address j
Eric&Jennifer Jones
41 Bearhill Rd.
N.Andover,Ma.01.845
i
i Description
I i
INSTALL]] ANDERSON NEW CONSTRUCTION WINDOWS.FIVE ARE TW2842 AND SIX ARE TW284.10.ALL HAVE 616
1NGLASS GRIDS WITH PRIMED INTERIOR WOOD SASHES,FULL SCREENS AND HIGH PERFORMANCE LOW E-4 GLASS.
INSTALL NEW AZEK EXTERIOR TRIM WITH EITHER DOUBLE I"X 4"OR SINGLE 5/4"X 4"(OWNERS CHOICE)ALONG WITH
2-3/4"EMPIRE MOLDING ON FIRST FLOOR W INDOWS.GAULK AND TRIM SIDING AS NEEDED.INTERIOR TRIM WILL BE 3
1/2"PRIMED ANDOVER CASING FOR THE FIRST FLOOR AND 2.1/2"PRIMED COLONIAL TRIM FOR THE SECOND FLOOR.
OWNER WILL BE RESPONSIBLE FOR PAINTING.PAINTING IS AVAILABLE BY CONTRACTOR @$150.00/WINDOW WHICH
INCLUDES PREPARING FOR PAINT'AND APPLYING TWO COATS OF BEN MOORE PAINT.PERMIT AND TRASH REMOVAL,
ARE INCLUDED.
PROPOSAL IS VALID FOR 30 DAYS.
EXTRAS OR CHANGES TO BE COMPLETED ATA RATE OF$85.001HR./MAN
Finance Charges on Overdue Balance 1 112%/MONTH i
1/2 WITH ACCEPTANCE,BALANCE UPON COMPLETIOk
i
i
��SlI- w i�w� — n����r:� 2x � � �e�6✓ + I"5�,� �v der��.�s
i
Total $11,200.00
Signature
h.�
Phone# Fax# Email
978-685-7010 978-685-7010 Ri kCI02@verizon.net
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NORT#i
Town SE? .. : :_���.. , Andover
- 0
No.
h
h ver, Mass,0 K*
o� I
coc Nlc Nl WlcK yT
U BOARD OF HEALTH
Food/Kitchen
PERMIT T LD Septic System
THIS CERTIFIES THAT ,r{2 ... ...,9. ........ BUILDING INSPECTOR
...................... ... ..............................................
has permission to erect ......... buildings on ........ . &ktj-..Lu.......a.4t,............ Foundation
Rough
to be occupied as ......i1.......... .! w ............................................ 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 CONSTRUC N ARTS 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.
ACORp- OP ID:IY
�--- CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DO/YYYY)
THIS CERTIFICATE 1S ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
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
`cettlficste holder In lieu of Such endorsements.
PRODUCER 978-975-1300 TACT
So Ireve&Hall InsurAssoc.inc NAME:
305 North Main St. 978-975-7596 HONE10
FAx
Andover,MA 01610 IL ac No
Michael L.Segreve ADDRESS;
Roou
TOME FLUET-1
INSURED Richard FlUO Contracting Inc.
INSURER(83 AFFOROINO GOVERAOE NAIC 9
102 Bridle Path Lane INSUReRA;Arbella Protection Ins.Co- 41360
Methuen,MA 01844 INaURERB;Commerce Insurance Co. 34754
INSURER 0:
INSURER D
INSURERE:
INSURER C
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
INDICATI=D. 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 SUC}'I POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
IL TYPE OF INSURANCE AUDI.
POLICY NUMBERMM b EfF I Y
GENERAL LIABILITY /DD/YYYY LIMITS
EACH OCCURRENCE $ 1,000,001
COMMERGIAL GENERAL LIABILITY A GtIVR EiTED �
PREMISE a o=rrer $ 100,001
CLAIMS MADE OCCUR MED EXP(Arty one rson) $ S 00(
PERSONAL&ADV INJURY $ 1,000,00(
8500034727 06!12/14 06/12115 GENERALAGGREGArE s 2,000,00(
- QEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS-COMPIOPAGO $ 2,000,00(
X POLICY PRO LOC
9
ACT
UTOMOalLE UABILITY COMBINED SINGLtL1MFr
ANYAUTO (Ea accident)ALL OWNED AUTOS BODILY INJURY(P $ 100,000
B X SCHEDULED AUTOS BODILY INJURY(Per accident) $ 300,000
X HIRED AUTOS XV1460 12/01/13 12101114 (Peri eodd t)PROPERTYDAMAGE $ 100,000
X NON,OWNEDAUTOS
UMBRELLA 41AB OCCUR
EACH OCCURRENCE $
EXCESS LU39 CLAIMS-MS_
AGGREGATE $
DEDUCTIBLE
RETENTON
WORKERS COMPENSATION $
AND EMPLOYERO'LIABILITYY!N WC SLiAMTIIrI- ER
.-AVPROPRIETORIPP,RTNER/EXECUTIVE 9104340312 02!31/14 03/31!15
OFFICERIMEMBER EXCLUDED? N NIA E.L.EACH ACCIDENT 8 $00,000
It Yes.dbry in and EL.DISEASE-EA EMPLOYEE $ 500,00
It yes,desisibe under
DESCRIPTION OF OPERATIONS below I_L DISEASE-POLICY LIMIT $ 600,00
".'OE9CAPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 1017 A4dlllonel Rana"Schedule,Ir more space IS required)
CERTIFICATE HOLDER CANCELLATION
NORTHAN
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
BUllding Deparment ACCORDANCE WITH THE POLICY PROVISIONS.
Main Street
North Andover,MA 01845 AUTHORIZED REPRESENTgTNE
i
�a�,,�r --• ®1988-2009 ACORD CORPORATION. Ali rights reserved.
AGORD 25(2009/08) The ACORD name and logo are registered marks ofACORD
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ate up to$X,500.00 andloz�ne�year xmpxise n ent�as we as civzlpenaltzes in the foxte Of u$TOP WORK ORDM and a.thte
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Massachusetts Genexal Laws chapter 152 requires anemployexs to pxavidowoxlzexs'compensatien fox their employees.
Pursuaittothisstatatte,anemployeeisdefntedas",,.evexy�persoxii�ithesexviceofanotbexunderany contrac$o hire;
• e�pxess onimplied,oral orwxitten"
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dwellinghouse of another who employspersonsto do maintenance,congfxatetiouoxxepazrwotton5JRdweltbaghouse
axoxtthegrounds oxbai ngappuxLenanttheretoshallnotbecaw@ofsuchemploymezRtbedeein dtabaanemployer"
MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall wit7zltold the issuance or
renewal Of a license ox permit to op exata a husiiaeBs or to eonsixttet huRdtags in the comm onwealtlx for artyapplien-Ewflo applien--Ewfloevidenceo9'coz .91Wtcewmthahmararzcecovexagoreqnixed."
Additlomallp;-VOL chapter 152,§25CM states'Wo Cher the eommoxtwealtb nor any oflts political subdivisions shall
enter into any contractfor the p ext'ozmance ol'public woxleuntil acceptahla evidence of coxnp7iaztce with the iusuxance
.ragwxexmnts ofthis ehapterhavebeextpresentedto tha coptxactingauthorify"
.ei�pucam�s
nePleas, I, out the waxSrexs'coinpemsaRon affidavit completely,by dheclting file boxes that apply to your sifaagon ands hr
cessary supplyaub-confractot(s)name(s),addresses and lZo tonumbex(s)along Wi&their ce cate(s)of
insurance, LiroitedMabilityCompanies(LLC)or LhiNd LkbX,&y pattu.erships(l:,T,p) thno employees othexthatrtho
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Acoidem fox con-Einna&n of insurance coverage. Also be sure to sign and date the aztzdavi: oaf davit should
b e xetumedto the city or towm that the application=ox thepem�ox liaensa is bezr�.g xecluec�ted,nod the De�partme�.t of
ittdusfxialAceidenfs. ShonTdyouhaveanygaesdonsxegaxdingthelawoxifyouaxexagatedtoabtain,a*oxkexs'
compensadoiapoliey,Please call thaDepattmentatthan mber&ted'hBlow: e1f1n�,rredcompanzesshauldeniextlteir
self insurance license mulnber onthe appxopxiate line.
City orTmM O£dcials
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atxnust snbnut Multiple ezmitflicensa applications ih any giveayear,meed only submit oxie az�davit indicating cuxCenG
po2cyanformaisozx(ianeeessaxy)andI.dex 1"abMeAddress"thoapplicantshouldwxzte,%if ocatior�sin . (city ax
towns°'Acopyo Tile- da Gihathasbeenofczallystampedoxmarl�edbyft,city`extommaybelixovldedtoMe
applicantasprflof{�avalidafdavit•Is,Cuilei`oxAutuxepernuisorlicenses. A ewafizdavit:nusthaMcdauteach
year. ere aTiozne owner ox citizen is obtaining-license ox.penn tnoixelafed to anybusiuess or commercial-at each
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dog 7scense(Dxpexmitto burn leaves etc.}sazdpexson is XNxegahadto complete this affidavit.
ne,Office 6fTnvestigatzans wau7d?ilre to thakyoui-e,advaucefoxyoux coopmaka andshnuldyou:have anygi�estious,
please do zto�hesitate to give us a ca11, ` .
ThaDepartm.en oaddress,telephoneftdfaxnumbex:
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