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Home My WebLink AboutBuilding Permit #558 - 45 HOLLOW TREE LANE 4/24/2009 BUILDING PERMIT "ORT" A v C TOWN OF NORTH ANDOVER 02`by..''.- APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received gDq'TED �SSACHU`�� Date Issued: 4 `�c `� I PO TANT:Applicant must complete all items on this page LOCATION 'Pi � .. F �` , kt PROPERTY OWNER � /� - - r Print MAP NO PARCEL: ZOIINGDIS7'RICT: Historic District " yes du no �y - Machine;ShopVillage yes . no TYPE OF IMPROVEMENT PROPOSED USE Residen ' Non- Residential New BuildingOne family clition Two or more family Industrial Iteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic Well, Floodplain _Wetlands Watershed Dlstrict' Water/Sewer',�. e DESCRIPTION OF WORK TO BE PREFORMED: 11 szf-z� ?q-zz m &fF' V11)II t- S'l x/167 Identification Please Type or PrinA Clearly) OWNER: Name: f 2l f-l) v/ �n `= C;V Phone: � ��11 Address: 1b1fVCJ2 CONTRACTOR" Name: 'Vone:, && AddresAw Ap s: ` t } x''7.7 411 Supervisor's Construction License. '' - Exp. g-Date: Home Improvement License: l Exp. `pate: '-. i / 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: $ �r Check No.: Receipt No.: - 3 _`0 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund____ ~ Signature of Agent%Owner. Signature of contractor.,.,,u 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 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 rc_Temp Durrpster:on site yes -.. " no Located=at 124,Main Street m n ,.Fire .Department"signature/elate ry , :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 I I ❑ Notified for pickup - Date Doc.Building Permit Revised 2008 I 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 I ❑ 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 y aulic 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 i 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) Li Copy of Contract ~ , f ❑ 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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 Location - No. SsclP' Date �oRTM TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame/Frame Permit Fee $ C90 �! s+cMuse 9 Foundation Permit Fee $ 1 Other Permit Fee $ TOTAL $ Check # 211910 Building Inspector TAOTH R Town of 4Andover L A KE dover, Mass., o COCMICME WICK x.95 RgTED P �� BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System THIS CERTIFIES THAT ...... BUILDING INSPECTOR,..... ... .14'x........... ....4+�1�...... ................................................................................... Foundation has permission to erect.............. �............... buildings on .......... ....... . .. ..I.�o .'T. .......... �..� Rough to be occupied as.... .......C 6.4. ...... ......................... . .... .. ... Chimney provided that the person accepting this permit a�in every respect conform to a term the application..on... file. .in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Final Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMEXPIRES IN 6 MONTHS IT T �TLESS CONSTRUCnON STARTS ELECTRICAL INSPECTOR civ Rough Service B ING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT Burner Street No. SEE REVERSE SIDE Smoke Det. Information and Instructions Massachusetts General Laws chapter 152 requires all emp Ioyers 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 includirkg 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 1to 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 worts 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 comptc-,tely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es),and phone number(s)along with their certificates)of insurance. Limited Liability Companies (LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are net required to cant'workers'compensation insurance. If 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 theapplication 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 requimd to obtain a workers' compensation policy,please call the Department at the nuanber 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 valid affidavit is on file for futum permits or licenses. A new affidavit must be fled out each year. When a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a flog license or permit to bum 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 LnvestiDations 600 Washington Street Boston, MA 02111 TeL#617-7274900 ext 406 or 1-8.77-MASSAFE Revised 5-26-05 Fax#617-727-7749 www.mass.gov/dia The Common wealth of Massachusetts kf ! Department of Industrial Accidents t, Office of Investigations Rip.f,, 600 Tf-ashington Street r�z Boston, MA 02111 www_mass gov/dia . Workers' Compensation Insurance Affidavit: Builders/Contractors/Eleotricians/Plumbers Applicant Information PleasePrint Lei Name (Business/Orgenizadon/individual): 11W 4M V n C/ L Address: t1a J} O fiye -7 7f / City/state/Zip: 6�05M 12R 63 (,S—JPhone#: . Are you an employer?Check-the appropriate box: 1.❑ I am a em to ye with 4. F7. G4tg�o'&ling ject(required): P Y ❑ 1 am a general contractor and I � ployees(full and/or part-time),* have hired the stub-cont actorsconstruction 2. I am.a:sole proprietor.or partner_ listed on.the attached sheet I ling ship and have no employees .These sub-contractors have lition working for me.in any capacity, workers' comp.insurance.[No workers'eom ittsttranee 5. ng addition p [] We are a corporation anditsrequired] officers have exercised their ical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL I I-n Plumbing repairs or additions myself,(No•workers'comp, q 152, §1(4),and we have no 12. Roofinsurance requiredlt employees. [No workers' repairs camp. insurance required..] I3.❑.Other *Any applicant that checks boz'#I must also fUl out the seetion'below showing their workers'compensation policy information t Homeowners who submit this affidavit indicating they are doing all worts and then hire outside connac#ars must submit a new affidavit indicating such. ;Contractors that check this box must attached an additional sheet showing•the name of the sub•contnrcton and their workers'comp.policy irfommoo, t am an employer that is providing:workers'compensation insurancefor or informadon. m1'employees; Below is the policy assns job site . Insurance Company Name: Policy#or Self-ins.Lie,#: Expiration Date: Job Site Address: City/State/Zip- Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration datej, . Failure to secure coverage as requited.under Section 25A of MGI:c. 152 can lead to the imposition of criminal penalties of a imprisonment,as well as civil penalties in the form of a STOP WORK Q fine up to$1,500.00 and/or one-year RDER 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 hereby certify under the pains and penalties a pz4ur9 jrM the information provided above is rare and correct Si eters: '. wi Date: (� 9 Phone F only. Do not write in this area,to be completed by city or town ofcial n: Permit/License# ority(circle one): ealth 2 B utld�ng Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing lnapecEor 6.Other Contact Person: Phone#: :h. w . IN 14 . APRIL 21; 2009 BRIAN & ,, NWFEENEY 45 HOLLOWTREE LANE , NORTH ANDOVER, IVIA• 978-688-6155 WORKCONTRACT:. INSTALLATION OF,3/8" INSULATION 1.5R VALUE:OVER-EXISTING SIDING INSTALLATION OF VINYL, SIDING USING'CERTAINTEED MAINSTREET DOUBLE.4 PANEL IN THE COLOR GRANITE GRAY. INSTALLATION OF WHITE VINYLVENTED SOFFIT ON ALL 'OVERHANG . SOFFITS - S SO SWILL BE PRE-DRI LED - L WHERE NECESSARY TO ALLOW'F R BETTER R VENTI CATION. •INSTALLATION OF WHITE•METALCOVERAGE ON AI;L RAKES AND:FASCIAS. INSTALLATION OF 2 /2" WHITE VINYL CASINGS AROUND.ALL : WINDOWS AND DOORS. INSTALLATION OF STANDARD CORNERS.IN THE COLOR WHITE. r E -INSTALLATION OF,WHITE VINYL;LIGHT BLOCKS;END VENTS AND-PLUG BLOCKS WHERE NEEDED TOTAL FOR ABOVE. $16,800.00 s WARRANTY: THE ITEMS LISTED ABOVE ARE GUARANTEED.AGAINST. WORKMANSHIP FOR AS LONG AS THE ORIGINAL`PURCHASER IS. ' STILL LIVING AND REMAINS OWNER OF THE PROPERTY: THE . MANUFACTURER-IS RESPONSIBLE:FOR THEIR`PRODUCT AND ITS,: , WARRANTY.: WARRANTY OF WORKMANSHIP APPLIES TO ALL ` ACCOUNTS THAT HAVE BEEN I'AIID IN FULL AT;TIME OF JOB'. , COMPLETION: . PAYMENT SCHEDULE: THE FIRST PAYMENTI IS DUE UPON DELIVERY OF MATERIALS, 'SECOND PAYMENTIS DUE WHEN PROJECT IS50% COMPLETE , .AND FINAL PAYMENT IS DUE UPON JOB COMPLETION - ' FIRST.PAYIVIENT.: .:$5,600.00 ,SECOND PAYMENT ` :..$5,600.00. r FINAL PAYMENT: .$5;600.00 $16,800.00 :THE "TOTAL AMOUNT DUE" DOES NOTREFLECT ANY CHANGES j. WHICH HAVE'.00CURRED DURING THE PROJECT' A SEPARATE: INVOICE WILL BE ISSUED REFLECTING ALL CHANGE ORDERS UPON SIGNING BELOW;L.AGREE .TO .ALL PAYMENTS AS.STATED.; : --ABOVE. JF ANY PAYIVIENT.IS NOT MADE ACCORDING,TO THE PAYMENT ARRANGEMENTS. LISTED ABOVE, HUDSON VINYL SIDING AND WINDOWS; HAS,THE RIGHT TO•STOP WORK UNTIL '. THE AGREED,PA F YMENTS HAVE BEEN MADE: `THERE WILL,BE'A.. $30..00 CHARGE FOR ANY RETURNED HECKS. , T MER CUS O SIGNATURE � - ATE. HUDSON VINYL SIDING AND WINDOWS: ! - �3�77. - Board of Bmldina� HOME I Standards MPROVEMENT CONT(LgCTOR . Registration: 1 Exp�rat►ara 26998 8/19/2010 Tr# 2-73441 ,TYpe DBA HUDSON VINYL SiD1NG AND KEVIN'MONTGOMERY WINDOWS 42A'BARRE7TS HILLRD '' HUDSON, NH 03051 ,. Administrator; - - gegulationand Sta a t* Cons truction,Supervisor.Licerise u Lieu CS 72402of . 1 ... ` 172010 Tr# 20778 _ Restnit o hsf M MONTGQi :E 42A BARRETTS HILA.R r' HUDSON, - - Commissioner _ . �T , Client# 19543' HUDVI ' - '.A CORD;, : CERTIFICATE OF-LIAB�ILITY,IN�SURANCE : 04/21/2009 PRODUCER,' --.THIS CERTIFICATE IS ISSUED AS A MATTER''OF INFORMATION Eaton 8_Berube Ins. ' ONLY-AND CONFERS.NO RIGHTS UPON THE:.CERTIFICATE': 1`1 Concord St. ' HOLDER:THIS CERTIFICATE DOES NOT,AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE_POLICIES BELOW. P.O.Box 1089 r Nashua, NH 03061 - - INSURERS AFFORDING COVERAGE,Y j NAIL INSURED wsuRERA: Peerless•Insurance Co Hudson Vinyl Skiing 8 Windows r. INSURE_R B: Concord Group 42A Barretts Hill INSURER C: Hudson, NH 03051 . INSURER D' INSURER E: `` .COVERAGES a 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 DOOUMENT WITH RESPECT TO WHICH THIS.CERTIFICATE MAYBE ISSUED OR., MAY PERTAIN,THE]NSURANCE AFFORDED BY;THE POLICIES DESCRIBED HEREIN IS SUBJECT TO 'ALL THETERMS,EXCLUSIONS.AND CONDITIONS OF SUCH - POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID.CLAIMS.:. POLICY EFFECTIVE POLICY EXPIRATION LTR NSR -'"TYPE OF.INSURANCE :POLICY NUMBER DATE MMIDD DATE MM/DDIYY °LIMITS A GENERAL LIABILITY ` CiCP.9725728 O5/22IO9 O5IZZ/1 O}». EACH OCCURRENCE $1000 000. COMMERCIAL GENERAL LIABILITY. DAMAGE TO RENTED' $rj0 OOO X PREMISES Ea occurrence i ;CLAIMS MADE. .00CUR ,. MED EXP'(Anyone.person) PERSONAL&ADV INJURY o-060600..- GENERAIL bREGATE s2 000"OOO GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS r`COMP/OP AGG $2.000'OOO POLICY PRO- LOC JECT B, AUTOMOBILE LIABILITY C676755':- 12/31/08 '.- 12131/0.9` COMBINED SINGLE-LIMIT, , ' ANY AUTO (E8 accident) $500,000, ALL OWNED AUTOS T ; BODILY INJURY $< XSCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY U $ (Per'acddent) - NON=OWNED AUTOS. ` r' PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY. 1 AUTO'ONLY.-EAACCOENT. $, ANY AUTOOTHER THAN EA ACC $,' AUTO ONLY: AGG EXCESS/UMBRELLA LIABILITY' EACH OCCURRENCE $.. OCCUR CLAIMS MADE. v AGGREGATE $ ' DEDUCTIBLE ; $ - RETENTION - . WC STATU- :. OTH- WORKERS COMPENSATION AND jY EMPLOYERS'LIABILITY: - 4 L.L.EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE. s OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $. If yes,descn e'unde'r.' • - .- - - SPECIAL PROVISIONS below.. E.L.DISEASE:POLICY LIMIT, $ -OTHER r .. DESCRIPTION OFAPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS'ADDED BY ENDORSEMENT'SPECIAL PROVISIONS - :CERTIFICATE HOLDER CANCELLATION 10 Da s for Non-Payment ; SHOULD ANY OF THE ABOVE'DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION ` Brian A Ann Feeney DATETHEREOF,THE ISSUING INSURER WILL'ENDEAVOR TO MAIL An DAYS WRITTEN 45 HOIIOYYtree Lane ',. NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL., ' North Andover, MA 01 845 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR.- REPRESENTATIVES. AUTHORIZED REPRESENTATIVE