Loading...
HomeMy WebLinkAboutBuilding Permit #880-15 - 44 ASHLAND STREET 5/6/2015TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition V fwo or more family ❑ Industrial ❑ Alteration No. of units: 3 ❑ Commercial ";Pair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑ Well ❑ Floodplain ❑ Wetlands ❑ Watershed District ❑ Water/Sewer OWNER: Name: Address: CONTRACTOR Name'. Identification Please Type or Print Clearly) q-1 F) Liao � I .-I L4 Q1 Phone: cats V0 �ao�e -7 Qf V" Address: `0--�t�J �+ �- Z)1$Uy Supervisor's Construction License: n Exp. Date: U 12J I 1 b Home Improvement License:'' � a3 ry Exp. Date: gI I LIZ:,'—,)� I S 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: $ (,-:x!:)00 FEE: $ "-.>c Z Check No.: ��DReceipt No.: NOTE: Persons contracting with unregistered contractors do not have ac ess to the guaranty fund Signature of Agent/Owner ignature of contractor BUILDING PERMIT p* NO 7 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION 70 Permit No#: Date Received �gssgcHuS�t�y Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION Print PROPERTY OWNER Print 100 Year Structure yes no MAP 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 E-1 Wetlands ❑ Watershed District ❑ Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification - Please Type or Print Clearly OWNER: Name: Phone: AdrirP¢-.- Contractor Name: Phone: Email Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: 4 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: $ E: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Location No. Date Check# 67 C�)% 2 8:7 2� S/ TOWN OF NORTH ANDOVER Certificate of Occupancy $- Building/Frame Permit Fee Foundation Permit Fee Other Permit Fee $ TOTAL $ '-1551ding Inspector Plans Submitted'-❑ • Plans Waived ❑ Certified Plot Plan Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanuing/Massage/Body Art ❑ Swiunming Pools '❑,, r Well ❑ Tobacco Sales ❑ Food Packaging/Sales - ❑ Private (septic tank, etc. ❑ Permanent Dempster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF a U FORM PLANNING & DEVELOPMENT COMMENTS Reviewed On Signature, CONSERVATION Reviewed on Signature COMMENTS HEALTH COMMENTS Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes . Planning Board Decision: .,$ Commen Conservation Decision: Comments Water & Sewer Connection/signature &Date Driveway Permit DPW Town Engineer: Signature: Re DEffiRa;TR�Lcaian a�h�o� e, JIENITS 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: lies No MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine NU I t5 and UA IA — wor department use ❑ Notified for pickup Call Emai j Date Time Contact Name _ Doc.Building Pennit 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 Building Permit Application 4, Workers Comp Affidavit Photo Copy Of H.I.C. And/Or C.S.L. Licenses Copy of Contract Floor Plan Or Proposed Interior Work 4 Engineering Affidavits for Engineered products OTE: 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 as Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) 4, Mass check Energy Compliance Report (If Applicable) .& Engineering Affidavits for Engineered products TOTE: 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 2012 IECC Energy code Engineering Affidavits for Engineered products TOTE: 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 6d c 0 H C, r�rw Cc V1 . 0 0 e ^ •� L _..ICD c� CL r= o - <v W O CD i • Q F h c Cc ,NSC V L ]���; Cc � J � N a O d > C .c 0 CD V _ a o (D o z CL — N o 0 W3 o :_. a, a) CL CD 0 MAW � � c ® �.b•vn F- o c c _ 00i ca CL CD N w V m W = -a - 0 0 •N a' � w•� = C LU w N = LU v C vCL m ��a'N Z y m e r- am H . 0.0 V O LU x ~ o u Z 0 0 Z 0 m z Q LLI C .00 Z V z co z z w F— ui U) CL LL O O w J CL H a O z CO z v Z Z uu O J Q W V (7 cr m U E m J a W LL r-+ O u Y A O m ai O z Y a1 \ U O tCC: to bDuC S a _v h0 y a/ v Y O Q 7 O E n7 ca D 0 i cu L LL In LL 2' U LL c' LL (n LL CL' LL [Q ,n Ln C, r�rw Cc V1 . 0 0 e ^ •� L _..ICD c� CL r= o - <v W O CD i • Q F h c Cc ,NSC V L ]���; Cc � J � N a O d > C .c 0 CD V _ a o (D o z CL — N o 0 W3 o :_. a, a) CL CD 0 MAW � � c ® �.b•vn F- o c c _ 00i ca CL CD N w V m W = -a - 0 0 •N a' � w•� = C LU w N = LU v C vCL m ��a'N Z y m e r- am H . 0.0 V I w 5 E nc z cn W CD d CLC V V .y U cu _cu Q N IM7 O LU Z Z 0 m Q Z C .00 Z V co w F— U) CL O w CO CL Z I w 5 E nc z cn W CD d CLC V V .y U cu _cu Q N IM7 CONTRACT ROBERT BOHONDONEY CONSTRUCTION CO. 12 HALL STREET METHUEN, MA 01844 978-685-0970 (office) / 978-685-8262 (fax) Fully Insured Construction Supervisor License #979 Exp 4/21/2016 Home Improvement Contractor #114238 Exp 8/16/2015 bohondoneyconstruction@vahoo.com Customer Name: Russell Hertrich Property Address: 44-46 Ashland St, North Andover, MA 01845 Contract Type: Roof Repair Date: May 4, 2015 Scope of Services: Roof Repair 1. Supply local building permit. 2. Supply and install new %" recovery board over existing roof and install new EDPM .060 rubber membrane roofing. 3. Remove all construction debris from site and dispose and provide job site clean-up and safe work zone. TOTAL CONTRACT AMOUNT: $6,000.00 CUSTOMER SIGNATURE: DATE: �_ q" CONTRACTOR SIGNATURE:4LZ DATE:, L - Page 1 of 1 \ The Commonwealth of Massachusetts Department of IndustrialAccidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 www. mass.govli is «'orkers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Name (Business/Organization/Individual): Address: '9L �Acw a ii g ht City/State/Zip: U A uQA I Irl` b0q Phone #: qlg bg�5& o Are you an employer? Check the appropriate box: 1. Wam a employer with 3 mployees (full and/or part-time).* 2.❑ I am a sole proprietor or partnership and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3.EJ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t 4. ❑ I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers' compensation insurance or are sole proprietors with no employees. 5.❑ I am a general contractor and I have hired the sub -contractors listed on the attached sheet. These sub -contractors have employees and have workers' comp. insurance.: 6. ❑ 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): 7. ❑ New construction 8. ❑ Remodeling 9. ❑ Demolition 10E] Building addition 11.0 Electrical repairs or additions 12. Q Plumbing repairs or additions 13. gRadf repairs 14. ❑ 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 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 isproviding workers' compensation insurance for my employees. Below is thepolicy and job site information. //jj Insurance Company Name:,i6�" _.k_A — Policy # or Self -ins. Lic. #: ��� O;C q&J gg Ir -1 Expiration Date: 84t Job Site Address: "I q ' q ( r 5Jk 1_a- -(,'(JJ �S+ City/State/Zip: N , 'Vern /-T C) Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by 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. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby_ceAgfy_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 #: CERTIFICATE OF LIABILITY INSURANCE THIS aTE(IaA�IYYYY' 5415 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERnFICATE 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 HOMER 1 t to holder is an ADDITIONAL INSURED, the policyges) must be endomed. If SUBIROGAMON IS W VED, subject to the terms and conditions of the policy, certain policies may regUire an endorsement A statement on this cartificate does not confer rights to the certf8cate holder in Hsu of such srdorsemen . PRODUCHIt Bates Insurance Agency Inc. 92 high Stmt, Suite 81Xmas; Medford, MA 02155 a NE P . 7 9 -4 (791) 395-9454 Andrea BatesIns.com aNSURE S AFFORDIN3 NAICS INSURER A: RCA -Esse Ins Co mum Robert Bohondoney Bohondoney Construction 12 Hall St Methuen, MA 01844 INSURERs:A.I M. mutual Ins. INSURER C : I , e: NSURER : Imam.- THIS IS TO CERTIFY THAT THE POLICES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDNG ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAN, 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 CLANKS. A TYPE OF INSURANCE OENERALLIABSJTY COMMERCIAL GENERAL LIABILITY ©OCCUR an im POLICY MWER 2759_15 IMLUSTS 2/3/15 2/3/16 EACH OCCURRENCE S_ 1.000.00 PRFMISFA (FA $ 100.000 ?RD EXP (A ore Parson)- $ 5,000 PERSON4L&ADVINJURY $ 1.0 O0.000 CLAIMS -MADE GENERAL AGGREGATE $ 1,0 00 PRODUCES-OOMpA>PAGO $ 1 O CEMLAGGREGATELIMITAPPUESPER POLICY P LOC $ AUTOMOBILE LJABIUTY a eoctderR = - 80DILY INJURY (Pat POMOM $ _ ANY AUTO ALLOWNFO AUTOS LED AUTOS NON-OM HIREDAUTOS __ OS ED BODILY INJURY (Par aeeldent) S E D S eraccideM S UMBRELLA UA9 OCCUR EACH OCCURRENCE S AGGREGATE i EICCESSLd1S CLAIMS -MADE ORFTjn1ONWC COMPENSATION AND BAPLAYERS'UAaBJTM YIN ANY PROPRIETORIPARTNERIEXECUTNE OFFICERAIEMBEREXCLUDED? I�YIerldslory M�N1i) r St Ad IP N OPE TIONS WOW B N I A AofC40070243322014 el9/14 8/9/15 STATU H- T RV T ATU- _. E.L.EACHACCIDEW 500.000 500 000 EL. DIS YL 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Aitch ACORD 101, AdIYI MI Rernda Sdtdl111.0 OWS eta Y m4dad) SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED N ACCORDANCE WITH THE POLICY PROVISIONS. AUMOMMD REPRESENTATNE 0 1988-201041CORD CORPORATION. Ali rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD Phone: Fax: E -Mail: Massachusetts - Department of Public Safety Board of Building Regulations and Standards G)n%trurtilm SuprrN i,nr License: CS -000979 1II, , ROBERT A BOHQNDONEY 12 HALL STS METHUN MA 81844 Ilk Expiration Commissioner 04/21/2016 5(4/2015 Office of Consumer Affairs & Business Regulation - Mass.Gov The Official Website of the Office of Consumer Affairs & Business Regulation (OCABR) Consumer Affairs and Business Regulation Home Consumer Rights and Resources Home Improvement Contracting HIC Registration Complaints Registration # 114238 Registrant ROBERT BOHONDONEY CONST CO Name ROBERT BOHONDONEY Address 12 HALL ST City, State METHUEN, MA 01844 Zlp Expiration 08/16/2015 Date Complaints Details No complaints found for this registrant. You can also view arbitration and Guaranty Fund hig=. Back To Search ©2012 Commonwealth of Massachusetts. Mass.Gov® is a registered service mark of the Commonwealth of Massachusetts. 0 HomeImprovement Contractor Registration Home Registration Home Page httpJ/services.oca.state.ma.us/hicAicdetails.aspg?WSearchLN=142 1/1