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Home My WebLink AboutBuilding Permit #397-14 - 57 GREEN HILL AVENUE 10/30/2013 TOWN OF NORTH ANDOVER PLICATION FOR PLAN EXAMINATION Permit NO:Sq A Date Received Date Issued: 6 ' b IMPORTANT:Applicant must complete all items on this page fi � Y ZI LOC r a * i Y PROPERTtY 01NNER{�` fi`ey� ME Z5 5 ' rf 1Ye :OO� a Old St ur cture e o ter, v D ,?Yx -¢ Print '2"w ', rte' MAPNO }PARCEL' Q�a� ZONING ®ISTRICT ti� Histone Distract w e no b eS la v J, Vil._ g nog - achtn�_„ ' hop. e - 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 ❑ Floodplainr , ❑Wetlantls> _w Watershed Distract ' ❑1Nater4ewer x DESCRIPTION OF WORK TO BE PERFORMED: l��r�� w ti Off' ��°fie �v ��, ►�e�,� � �-r/2� Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: CON,TRACTOR"'lName 1c� rPhone:' 44L Q Supervisor's�Construction License / !� Exp Date z --F - "- - ` _ a Home ImprovementtiLicense� 3 (� . ` Exp Date %' ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULD/NG PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMAT COST BASED ON$125.00 PER S.F. Total Project Cost: $�,L-,« FEE: C � Check No.: Q4 I Receipt No . NOTE: Persons contractink with unregistered contractors do not have access to the guaranty fund Si nature-of,A'ent/Owner$ . Si nature,of:contract,_ a t _, _. ' 8 `Y r Plans Submitted �_j Plans Waived ❑ Certified Plot Plan ❑ S ed Plans ❑ Building Department The foE awing isa list of the required-forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits Li Building Permit Application u Workers Comp Affidavit u Photo Copy Of H.I.C. And/Or C.S.L. Licenses u Copy of Contract u Floor Plan Or Proposed Interior Work Li Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire-Department prior to issuance of Bldg Permit Addition Or Decks o Building Permit Application o Certified Surveyed Plot Plan o Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract Li Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) u 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 o Certified Proposed Plot Plan u Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit a Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) a Copy of Contract a 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 apu,al 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 Doc: Doc.Bui?ding Permit Revised 2012 . Plans Submitted-❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ I T.YPE_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 e Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes . Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer ConnectioniSignature& Date Driveway Permit DPW Tow;2 Engineer: Signature: Located 384 Osgood Street FIRE-DEPARTM NT --Temp Dumpster on site yes no Located at-924RMairStreet - -- '' 1 - • - . . � ..• ...� -.,. ' -'"' Fire Departme►itsgnaturelclate COMMENTS ; . x ®Ifi'i�Ef7Slon 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 D Notified for pickup - Date Doc.Building Permit Revised 2010 Location ) No. Date � l � f . - TOWN OF NORTH ANDOVER • Certificate of Occupancy � J Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# � r 2705 ----�-16U-iIding Inspector BONEMAI OP ID:SH AREV CERTIFICATE OF LIABILITY INSURANCE DATE(MMI00lYYYY) ID/30/2013 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 15 WAIVED,subject to the terms and conditions of the policy, certain policies may require an ando.rsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s), PRODUCER CONTACT Whittemore Insurance NAME'- 172 Rockingham Road PHO N ;603-432-2577 Lrc,Nai; 603.432-4700 Londonderry,NH 03053 E-MAIL ADDRE8at INSURER(S)AFFORDING COVERAGE NAIC d _ INSURER A:NGM Insurance Company.. 14788 INSURED MJB Construction INSURER a:Llbe Mutual Marco Bonenfant dba -- 11 Cove Street INSURER C: _ Derry, NH 03038 INSURER D; INSURER E: IN$URER F i _ 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 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. TN_SR TYPE OF INSURANCE - LILY EFF MI XP TR POLICY NUMBER MM O YYYY MM70DIY LIMITS GENERAL LIAPILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY MPK0313N 04130/2013 04/30/2014 pREMICDAMA ��(EaoccuEence � 50,000 CLAIMS-MAOC rX I OCCUR MED EXP Any anu person) S Y 51000' PERSONAL 6 ADV INJURY S 1,000,000 _�J _ GF-NERALAGGREGATFt $ 2,000,000 QEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-C_OMPIOP AGO 9 2,000,000 FP"" r-• ...,.._ POLICY LOC $ AUrOMOEILE LIABILITY COMBINED SINC9LE LIMIT ANY AUTO BODILY INJURY(Per Parson) $ ALL OWNED SCHEDULED 9001LY INJURY(Per etx dnrq) $ _ .. AUTOS AUTOS _ NON-OWNED PROPER WDAMAGE " HIREDAUTOS _ AUTOS (PER ACCIDENT! S UMBRELLA LIAR OCCUR EACH OCCURRENCE $ _ EXCE88 LIAR _ CLAIMS-MADE AGGREGATE DED RETENTION$ S WORKERS COMPENSATION WO STATU- 0TH- AND EMPLOYERS'LIAMLm T_0RY-LI, 9— B ANY PR0PRIET0RIPARTN5RIExE0UTIVE YIN WCS-31 S-391795.013 09118/2013 09118/2014 E.L.EACIi ACCIDENT $ _ 100,000 OFFICER/MF,MBER EXCLUDED? N/A (Mandatory In NH) E.L. 100,000 DISEASE-EA EMPLOYEE $ I(yos,dascrlbe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT •S 500,000 I DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES IAttath ACORD 1D11 Addlllonal Romorks Sehodula,N mora space is raqulrodl Project location 57 Green Hill Ave in North Andover HA CERTIFICATE HOLDER CANCELLATION TOWNOFN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, 1600 Osgood$t North Andover, MA 01845 AUTHORIZED REPRESENTATIVE 01988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010106) The ACORD name and logo are registered marks of ACORD BONEMA1 OP ID:SH AC"�RIa CERTIFICATE OF LIABILITY INSURANCE F D 10130/ 0/Y2013 10/30/ 3 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOE$ 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 CONTACT Whittemore Insurance NAME' - _ __ 172 Rockingham Road LCo_K,.jExtl;603-432-2577 L(c,Nal;603-432.4700 Londonderry,NW 03053 E-MAIL _ _ INSURERIS)AFFORDINO COVERAGE _ NAIC d NSURERA:NGM Insurance Company. _ 14788 INSURED MJB Construction INSURER 0,LibertyMutual Marco Bonenfant dba -- — -- 11 Cove Street INSURER c: Derry, NH 03038 INSURER D; - INSURER E: INSURER F 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 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. INSRTYPE OF INSURANCE - LILY EFF P L XP V— LT, INSR POLICY NUMBER IMW22LYYYYI IMMIED)YYYY1LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY MPK0313N 04/30/2013 04/30/2014 PREMISES(Ee occ0AMAGF TO urr nae _ 50,000 CLAIMS-MADE Lx 1 OCCUR MED EXP(Any ann person) $ 51000 k�EN'L PERSONAL B ADV INJURY S 1,000,000 GENERAL AGGREGATE $ 2,000,000 AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGO $ 2,000,000 POLICY PRO LOC a AUroMOaILE LIABILITY COMBINED SINCjLE LIMIT ANY AUTO BODILY INJURY(Per parzon) S ALL OWNED I SCHEDULED BODILY INJURY Peroccidnn{ $ _ .. AUTOS AUTOS ( ) HIREDAUT08 NON-OWNED PER JAMA13E _.. _ AUTOS (PER ACCIDENT) UMBRELLA LIAR OCCUR EACH OCCURRENCE $ _ EXCESS LIAR CLAIMS-MADE AGGREGATE _ R DED RETENTION$ 8 WORKERS COMPENSATION VJC IT.LIA EMPLOYERS'LIAMILITv T_O.O ITA L�__ B ANY PROPRIETORIPARTNERIEXECUTIVE YIN WC5.31 S-391795-013 09/1812013 09118/2014 E.L.EACH ACCIDENT $ 100,000 OFFICER/MF-MBEREXCLUDED7 NIA (Mandomry In NMI E.L.DISEASE-EA EMPLOYEE a 100,000 Ifes,&a'crlbe under - 500,000 D,SCRIPTIONOFOPERATIONS bel ow E.L.DISEASE-POLICY LIMIT S I _T DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (AIlaeh ACORD 101,Additional Romorkg 8ehodulo,It morn spate le roqulrodl . Project location 57 Green Hill Ave in North Andover HA CERTIFICATE HOLDER CANCELLATION TOWNOFN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1600 Osgood St ACCORDANCE WITH THE POLICY PROVISIONS, North Andover, MA 01845 AUTHORIiED REPRESENTATIVE k e I 0 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD r -i r NORTf� - _ c . . ver O Z h h , ver, Mass, C0C"1C"2W.CK AERATED NP�,`'�y _ S V BOARD OF HEALTH PER LD Food/Kitchen Septic System COO THIS CERTIFIES THAT ............ .............................. ........b.` .. .. t. . ............................ BUILDING INSPECTOR aq: has permission to erect Foundation .......................... buildings on .. ..... ....... ............................ / Rough L-&�.fA •.. T'��R:.... .....1 ..."ofication .�.... Chimney to be occupied as .......... ........ . . . .. provided that the person accepting this per shall in every respect conform to the terms 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 Rough .VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIONA T 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. SEE REVERSE SIDE r - NORTH w: :. . it 11, : c . . ver No. bil— C. _ y�A�f h , ver, Mass, coc"Ic Nl WICK �� S U BOARD OF HEALTH PER LD Food/Kitchen Septic System THIS CERTIFIES THAT ............. .............................. ........b.` .. A t. . ............................ BUILDING INSPECTOR has permission to erect .. buildings on .. 6r s AJ Foundation / Rough to be occupied as ........ ...... .4F... ... Chimney shall in every respect conform to the termst�aftnprovided that the person accepting this eof 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 Rough .VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIONqAT Rough Service ....................... .... ...................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildine 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. SEE REVERSE SIDE 577 G e A • , , •'Q'� Man, ' { a , r : 1 ' Ci a _ , T I V ! ; , f � � Massachusetts,-Department of Public Safety ` Board of Building"Regulations and Standards Construction Super-isor License: CS-106799 I I. MARCO`BONENF�NT 11 COVER• DRNE = - + Derr NH 03038 c :� J, � � ,+ +.+'' • Expiration i commissioner. 03/31/2016 - c✓Fie ep¢rivr�au�izuse�c��a�C ��ccc/ua� � - Office of Consumer Affairs&Business Regulation r OME IMPROVEMENT CONTRACTOR -- egistration:- .132426 Type: J Expiration 2 201-5= -Individual' I Marco Bonenfant Marco Bonenfant r 1,1•COVE DR I 1 DERRY, NK03038 ry °Undersecreta A-NC3819/T-3850-3-part carbonless contractors proposal — �--- ---=ma=r - �•�-��®® Page# of pages PROPOSAL SUBMITTED TO: JOB NAME JOB# ` Q1- ADDRESS JOB LOCATION DATE DATE OF PLANS PHONE# FAX# ARCHnECT 1� t Tx�e hereby submit specifications and estimates for: ..__._ ,nom y r „f } M1 Ve propose hereby to furnish material and labor-complete in accordance with the above specifications for the sum of: ° $ / Co. Dollars u with payments to be made as follows:, Any alteration or deviation from above specifications involving extra costs Respectfully �-- will be executed only upon written order,and will become an extra charge submitted over and above the estimate. All agreements contingent upon strikes, 7 accidents,or delays beyond our control. Note—this proposal may be withdrawn by us if not accepted within days. t,. Acceptance of Propogar The above prices,specifications and conditions are satisfactory and are � �..—' �� ,,.• ,�_._J-. 4� hereby accepted. You are authorized to do the work as specified. Payments will be made as outlined above. Signature Date of Acceptance Signature - r A-NC3819/T-3850 09-11