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HomeMy WebLinkAboutBuilding Permit #328 - 60 MIDDLESEX STREET 11/13/2008 BUILDING PERMIT C� NORT6� ti TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION 7D Permit NO: Date Received �SSACHus��� Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION /I;ddle.5ex ST Print PROPERTY OWNER S UI;e A l lard' Print MAP NO: _PARCEL: ZONING DISTRICT: Historic-District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Buildingne fami y Addition Two or more family Industrial Iteration No. of units: Commercial —Izepair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District ,,,Vater/Sewer /1,0 o I /) D DESCRIPTION OF WORK TO BE PREFORMED: Re�l�ee L.:n.Je4,S en 7'Aree 5ecson Porell cdc✓ / f Ver:or &Icor- c/o ems. Identification Please Type or Print Clearly) OWNER: Name: -T c t e- (4l1ard Phone: 2?8 Address: 6o 57• CONTRACTOR Name: KA7` Phone:_ 6a3 543-7—SVy6 3 Address: /..< 40.305:3 a Supervisor's Construction License: CS 7.3.3/6 Exp. Date: r,/c, Home Improvement License: /'t 9.3,.y Exp. Date. b-- i 2r- og ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 5 l,1.2. °o FEE: $ Check No.: ���G / Receipt No.: C NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contractor/ ,�, 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 ❑ 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 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 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 ❑ 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 DEPARTMENTMIZORM07 Revised 2.2008 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 d 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 situ yes no Located at 124 Main Street Fire Department signature/date COMMENTS ----- - - - ---- - ,tea i Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. s 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 r ❑ Notified for pickup - Date Doc.Building Permit Revised 2008 Location � No. Date „OR,h TOWN OF NORTH ANDOVER 0 • O' • > ; . Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # `7 L16I % Build4inspector . CONTRACTOR AGREEMENT Page 1 This agreement made the 5th day of November 2008 by and between Scott J. LaPointe herein after called the Contractor and Julie Allard,herein after called the owner(s). Witness,that the contractor and the owner for the considerations named agree as follows: Article 1. Scope of the work The contractor shall furnish all the materials unless noted and perform all the work shown on the Drawings and/or described in the Proposal as annexed hereto as it pertains to work to be performed on property at 60 Middlesex St.N. Andover MA Article 2. Time of completion The work to be performed under this Contract shall be commenced on or before the 13th day of December 2008 and completed on or before December 20th, 2008 Time is of the essence. The following constitutes substantial completion of work pursuant to this proposal and contract: when all items have been completed. Any change orders written once the job has started will add time to the completion date and will be stated in the change order. Article 3 the Contract Price The Owner shall pay the Contractor for the material and labor to be performed under the Contract sum of fifty one hundred twenty-two dollars and zero cents($5122.00)subject to additions and deductions pursuant to authorized change orders. Article 4. Progress payments Payment# 1 Start of site work.............................................................$2561.00 Payment#2 Completion of work........................................................$2561.00 Paget Article 5. General Provisions Any alteration or deviation from the above specifications, including but not limited to any such alterations or deviations involving additional material and/or labor costs,will be executed only upon a written order for same, signed by owner and Contractor,and if there is any charge for such alterations or deviation,the additional charge will be added to the contract price of this contract. If payment is not made when due, contractor may suspend work on the job until such time as all payments due have been made. A failure to make payment for a period in excess of seven days from the due date of the payment shall be deemed a material breach of this contract. In addition the following general provisions apply: 1. All work shall be completed in a workman-like manner and in accordance with all building codes and other applicable laws. 2. The contractor shall furnish specifications for home improvements,a description of the work to be done and description of the material to be used and the equipment to be used or installed, and the agreed consideration for the work. 3. To the extent required by law all work shall be performed by individuals duly licensed and authorized by law to perform said work. 4. Contractor may at his discretion engage subcontractors to perform work hereundre, provided contractor shall fully pay said subcontractor and in all instances remain responsible for the proper completion of this contract. 5. All change orders shall be in writing and signed by owner and contractor, and shall be incorporated in,and become a part of the contract. 6. Contractors at his expense obtain all permits necessary for the work to be performed. Page3 7. Contractor agrees to remove all debris and leave the premises in a broom clean condition. S. In the event owners shall fail to pay any periodic or installment payment due hereunder, contractor may cease work without breach pending payment or resolution of any dispute. 9. All disputes hereunder shall be resolved-before.any contracted work resumes. 10. Contractor shall not be liable for any delay due to circumstances beyond its control including strikes,weather,casualty or general unavailability of materials. 11. Contractor warrants all work for a period 12 months following completion. Any work performed by any subcontractors not hired by K-A-T construction will not be covered by K-A-T construction. 12. The contractor shell furnish a list of all items that are to be supplied by the clients. And the stages when these items are to be on site. Article 6.insurance The contractor represents that it has purchased insurance, and agrees that it will keep in force for the duration of the performance of the work, or for such"longer term as may be required by this agreement, in a company or companies lawfully authorized to do business in the state of Massachusetts. Such insurance as will protect K-A-T construction and the owners of the site from claims for loss or injury,which might arise out of or result from the contractor's operations under this project,whether such operations are by the contractor or by a subcontractor or its subcontractors. Article 7. Start date and completion date The actual start date and completion dates may vary due to circumstances beyond our control: Such as permits being issued, inclement weather,back ordered materials, scheduled inspections etc. Upon signing. T agree to pay for the above stated work that is to be performed under the conditions as specified within. Customer signature S' U Qt � ( (A,,c date K-A-T Representative date //— , --o f3 = 11assachusetts- Deput-tment of Public Safety Board of Building Regulations and Standards Construction Supervisor License License: CS 73316 Restricted to. 00 SCOTT) LAPOINTE 9 GRIFFIN RD _ LONDONDERRY,NH 03053 Expiration: 7/6/2010 ('unu��issioi+c r Tr#: 29032 ��ie�o�rUnzaneuea�/ a�✓t�a�sczcjivae� Board of Building Regulations and Standards f HOME IMPROVEMENT CONTRACTOR _ Registration:, 129364 I.Expiration: 6/18/2009 Tr# 132240 Type. DBA K.A.T Constuctton. Scott Lapointe 9 GRIFFIN RD Londonderry,NH 03053 Awa-` Administrator 11/18/88 13:88:28: ET TO: 683 421 8151 FROM: 2672951896 88 ATE(MMfDONYYY ACOWL CERTIFICATE OF LIABILITY INSURANCE 11/10/2 08) PRODUCER (978)667-2541 FAX (978)671-4514 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Merrimack Valley Ins. Agcy, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 655 Boston Road, Suite lA HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Billerica, MA 01821 INSURERS AFFORDING COVERAGE NAIC# INSURED Scott Lapointe INSURERA: Star Insurance Company DBA: K A T Construction INSURER B: 9 Criffin Road. INSURER C: Londonderry, NH 03053 INSURER D: INSURER E: OVERAGES 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,TH'E INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR D' DATE POUCYEFFECTVE POLICY EXPIRATION LTRMINDDIM NSR TYPE OF INSURANCE POLICY NUMBER LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ CLAIMS MADE M OCCUR MED EXP(Any one person) $ PERSONAL d ADV INJURY $ GENERAL AGGREGATE. $ GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POUCY PRP =LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANYAUTO (Ea accident) $ ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) F1 PROPERTY DAMAGE $ (Per accident) GARAGE UABIUTY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR ❑CLAIMSMADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND WC0378050 03/01/2008 03/01/2009 X WC'RYSTATU- OTH- EMPLOYERS'LIABILITY S PR A ANY PROPRIETORlPARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,00 OFRCER/MEMBER EXCLUDED? YES E.L.DISEASE-EA EMPLOYEd$ 100,00( If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT 1$ 500,00 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Cott Lapointe is excluded from workers comp. -CERTIFICATE HOLDER LLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 0 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Town of N. Andover BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 1600 Osgood Street OFANY KIND UPON THE INSURER,ITS AGENTS.ORREPRESENTATIVES. N. Andover, MA 01845 AUTHORIZED REPRESENTATIVE Anthon Lucacio JOANNE ACORD 25(2001J08,) FAX: (603)421-0151 VACORD CORPORATION 1988 NThe Commonwealth of Massachusetts Department of Industria!Accidents Office of Investigations - 600 Washine�on Street 1 f 11 I' Boston, MA 02111 www.rnass,gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le6ibly Name (Business/Organization/Individual): T Address: City/State/Zip:L o"�o,� Q _�� ��oS3 Phone #: Are you an employer?Check the appropriate box: l Type of project(required):.[ I an a employer with a . 4. ❑ I am a general contractor and 1 employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7• e'Rernodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its 9. Building addition required.] officers have exercised.their 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself [No.workers' comp. C. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.] t employees. [No workers' comp. insurance required.] 13.❑ Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information, Homeowners who subnmii-this ar;mdavit indicating U'iey are uui;ig ea'::odk&nd!then hire outside coniraciors must submit a new am—davit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: 5 Ta P i g U r2n p Policy#or Self-.ins. Lic.#: GUr (23 7 A asc) Expiration Dater —/—09 Job Site Address:_615 M:r1e1/e5 ,e T Ci /State/Zi 04ys �' P�G���r-niA os-acs Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). .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 a 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 hereby certify under the pains andpenalties of perjulY that the information provided above is true and correct Sianature: � Date // /Qt"j 0 Phone#: Official use only. Do not write inn 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# Information and Instructions Massachusetts General Laws chapter 152,requires all employers 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 including 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 o r local licensing agency shall withhold the issuance or renewal of a license or permit,to operate a business or to 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 work 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 completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractor(s)name(s), address(es) and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(.LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to cant'workers' compensation insurance. If an LLC.or LLP does have .- employees, 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 the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the la:a,or if you are required to obtain a workers' compensation policy,please call the Department at the number 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 permitllicense number which will be used as a reference number. In addition,an applicant that must submit multiple permit/ficense 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 a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn 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 Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26=05, Fax# 617-727-7749 www-mass.gov/dia XAORTty ONM Of 6 over No. 43 Z a .`, © dover, Mass. //ZX Z2Z O -- L A COCHICHEWICK y�. 1 %p ADRATED P'Pat�� BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System lo_�' BUILDING .INSPECTOR THIS CERTIFIES THAT.........�e/�.............................................. . Foundation has permission to erect........................................ buildings on ............'.................... ..� .... .......... Rough to be occupied as............... C` 1.G?.C!`.....-��... ���..�y'.l �h:c.���'.1�i� . G�� ......... . ...... .f.G�..S'�.. C imney h' provided that the person accepting this permit shall in every respect co to. -the terms tie application on file in Final 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' EMPIRES IN 6 MONTHS UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR Rough �„�!�/ /.•' .. .......�.. ........... Service :.. BUILDING INSPEE TO.R Final Occupancy Permit Required to Occupy Building GA.SINSPECTOR 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. SEE REVERSE SIDE Smoke Det.