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HomeMy WebLinkAboutBuilding Permit #295-2017 - 45 CHESTNUT STREET 9/19/2016 BUILDING PERMIT r10RTF� O� •`LED /6 q�O 11.2 hh • ._+'96 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received 9- 111)- A°/(0 �4oDR4TED ""ce Date Issued: L ` II A, Hu IMPORTANT: Applicant must complete all items on this page LOCATION yJ`— CH-1 J ?"A(UT T D> LL� Print PROPERTY OWNER N Print 100 Year Structure yeOnoMAP (0 PARCEL: 0(/ '5— ZONING DISTRICT: Historic District yMachine Shop Village y 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 Wr Others: DiA/6 ❑ Demolition ❑ Other `5i ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ` ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: /VD £L L-i £ Phone: Address: C�E 5 T�y T T C /1( J7 Contractor Name: Phone: Email: - 'tt V-t 1� C�t-E ,qui X05 �• eorYt Address: „�1 D A�6 E N f3 Supervisor's Construction License: 15/73 Exp. Date: Home Improvement License: �d 16 10.E Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BAS//ED ON$125.00 PER S.F. Total Project Cost: $ �� �-�� ' G� FEE: $ LJ1o(� Check No.: 30(D� Receipt No.: NOTE,;, Persons cont�cctti�ng with unregistered contractors do not have access to the guaranty fund 1 _ I Location S7 C f � 1 f'�1 J C- i-T• i I No. S,- 2 a t—7 k Date `7 P5- d O/,& i • - TOWN OF NORTH ANDOVER t , Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# 36�� Building Inspector JUS $ , i Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ , TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanuing/MassageBody 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 m 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 4 Conservation Decision: Comments Water& Sewer Connection/Signature& Date Driveway Permit i DPW Town Engineer: Signature: I�ILocated at124 M`a_n � L�o,c�at_e pOsgood Street nT -FIREDE ,Aff N - k Street De artment si �� : Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. I 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.$1oo-woo fine NOTES and DATA-- (For department use) I t �I i l I i i ❑ 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. I 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 4. 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 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 OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) 4, 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 OTE: 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 NORTINI Town of IF. sAndover 0 . .ti" to soh ver, Mass, COCHICMl WICK y1- �� 3 S I U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT (��I.�IC......4........ ..�t�.� BUILDING INSPECTOR � Foundation has permission to erect .......................... buildings on ....tvr.�k %?*.v..r......c7................. .1�..'..1h.f�.v.6. .. Rough tobe occupied as ............. ...................................................................................... Chimney CI 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 I� ` VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR I UNLESS CONSTRUCTI N STA S 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. i i ARTICLE 4 i Additional work above and beyond the contract agreement: All additional work done to be quoted at the time the client requests the work. The work will be done and billable at its completion. The client has ten(10)days to pay the additional cost r he or she has been billed for it. Initials:. --� i { In witness whereof they have executed this agreement the day and year first above written. i i Noel Lee,04vner l a Steven M1 Cote DBA Cote& Foster I i { i s � The Commoninealth o,f Massachatse& Deparbuent of Industrial Accidents t Offlee ofII1AStiO&J's 600 Wasliangton Street Boston,MA 02111 - _ ;vivat mass gov/dia Wo>ricers' Compensation Insurance Affidavit.Builders/Contractors/EleeMeians/Plumbers AIRRlicaint Information Please Print Leg bly Name(Business/Organization/Individual): d OTC V- oc:�y 5 YY Ae- Address: 40 '( F G LCR N D k - Il/Y city/state/zip-Ai 7VI/FA( .Jt,( II ©/-*/Phone# Are you an employer?Check the appropriate box: Type of project(required): 1.Q Ism a employer with 4. R I am a'general contractor and 1 6. Q New construction employees(full and/or part time). have hired the sub-contractors 2.Q I am a sole proprietor or partner- listgd on the attached sheet. 7. ®Remodeling ship and have no employees These sub-contractors have S. ®Demolition worldng for me in any capacity. employees and have workers' ®Building addition [No workers'comp.insurance comp.insurance.t required.) 5. Q We are a corporation and its 10.0 Electrical repairs or additions 3. 1 am a homeowner doing all work officers have exercised their 110 Plumbing repairs or additions myself[No workers'comp. right of exemption per MGL 12.0 Roof repairs insurance .re uiredr c. 152,§1(4),and we have no q employees.[No workers' 13.0 Other comp,insurance required.] 1. 'Any applicant that checks box#1 must also fill out the section below showing their warkers'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. !Cont actors that check this box must attached an additional sheet"sho'iving 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'camp.policy number. I ant an employer float is providing workers'coutpensafion insurance for my employees. Beloit,is the poliq,orad,job site in/brinadom Insurance Company Name; D >r2 f/2 C of J1� uS T72 y Policy-t or Self-ins.Lic.m Gf c o o y 9-6 a 3�� Expiration--Date: 40 Job Site Address: 'yam C�f 6 r Ar U 7- T CitylState/zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). � /PW S 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 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. I do Itereby ceyW f}r under the pains and penaides of perjuay that the information provided above is trite and correct. Signature: Date: Phone': 49 7,r" W"/ 7,4W" /7 ©f,jieial use only. Ifo not iwite in this area,to be completed by city or form official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electricaal Inspector S.Plumbing Inspector Cs.Other Contact]Person: Phone 4: .eco CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 12/21/2015 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 endomement(s). PRODUCER CONTACT Victoria Lowes CISR NAM E: r MTM Insurance Associates PHONE (978)681-5700 ac No:(976)681-5777 1320 Osgood Street E-MAIL ADDRESS:vickiel@mtminsure.com INSURER(S)AFFORDING COVERAGE NAIC# North Andover MA 01845 INSURERA:State Auto Insurance INSURED- INSURER B.-National Liability & Fire Iris Cc Cote & Foster Contracting, Inc INSURERC: 20 Aegean Drive INSURER D: Unit 15 INSURER E: Methuen MA 01844 INSURER F: COVERAGES CERTIFICATE NUMBER:15-16 & 16-17 WC 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 RE-SPE-CT 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 TYPE OF INSURANCE A DL SUBR POLICY EFF POLICY EXP LTR POLICY NUMBER M/DD/YYYY) (MMIDDIYYYYI LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE ❑X OCCUR DAMAGES(Ea occurrence)TO RENTED 100,000 PREMISES rcence $ PBP2747539 12/31/2015 12/31/2016 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY❑ PRO F—]LOC JECT PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1 r 000,000 A ANY AUTO BODILY INJURY(Per person) $ 20,000 ALL OWNED Ix SCHEDULEDer accentAUTOS AUTOS ( )BAP2370166 03 12/31/2015 12/31/2016 BODILY INJURY Pid $ 40,000 NON-OWNED PROPERTY DAMAGE X- HIRED AUTOS AUTOS (Per-accident) $ Medical payments $ 5,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATIONPER OTH- AND EMPLOYERS'LIABILITY Y/N X STATUTE I I ER ANY PROPRIETOR/PARTNER/EXECUTNE E.L.EACH ACCIDENT $ 500,000 OFFICERIMEMBER EXCLUDED? N/A B (Mandatory in NH) V9WC709549 6/20/2016 6/20/2017 E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate holder as listed below This certificate of insurance represents coverage currently in effect and may or may not be in compliance with any written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 384 Osgood Street ACCORDANCE WITH THE POLICY PROVISIONS. North Andover, NA 01845 AUTHORIZED REPRESENTATIVE P MacDonald CPCU, CIC ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025 oni4m t COTE FOSTERz- CUSTOM BUILDING + REMODE! LING This agree'ent made this 16a`day of August,year Two thousand and Sixteen by and between Cote and Foster Contracting,Inc.hereinafter called the Contractor and Noelle Lee,hereinafter called the Owner,witnesses that the Owner intends to reside the existing home at the address of 45 Chestnut Ct.,North Andover,MA. Now,therefore,the Contractor and the Owner,for consideration hereinafter named,agree as follows: ARTICLE 1 The Contractor agrees to provide all the labor and materials to do all things necessary for the proper construction and completion of the work shown and described on drawings. The drawings and specifications are the basis of the contract. I ARTICLE 2 E In consideration of the performance of the contract,the Owner agrees to pay the Contractor, in current funds as compensation for his services hereunder$38,835.00 to be aid as fol P lows:, i <pD) , Payment 1 -$5,000.00 at signing of contract Payment 2 -$15,000.00 at start of siding demo Payment 3-$15,000.00 at completion of siding Payment 4-$3,835.00 at completion of electric &HVAC reinstallation of services ARTICLE 3 Final payment on contract amount as agreed above to be paid within ten(10)days of project completion or occupancy. If final payment has not been made within this time a 10%charge per month on the balance due will be charged. All minor punchlist items will be complete as part of the one year warranty on the finish product. Failure to pay balance within.ninety(90) days may result in legal action. Initials: 20 Aegean Drive • Unit 15 • Methuen,MA 01844 Tel: 978-682-6518 • Fax:978-682-1221 www.coteandfoster.com