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Home My WebLink AboutBuilding Permit #648-2017 - 62 BLUEBERRY HILL LANE 12/19/2016all ��e� ,� �=' BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: InLl V - I nate I-q-qi ipri- Date Received TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential 0 New Building )o One family 0 Addition 0 Two or more family D Industrial 0 Alteration No. of units: El Commercial IFZepair, replacement El Assessory Bldg 0 Others: 0 Demolition El Other - Ej 181M ❑Wetlands 16 ol`do� 91 Watershed District . �-Watd L 4, .,:.z DESCRIPTION OF WORK TO BE PERFORMED: , - \k- Doorl 9L 61 L- I �16 (2 Identification - Please Type or Print Clearly' OWNER: Name: 01-LyotA7 13 EL,.?Z Phone: 9W 0 Address: IV �cC.-drit actor Na- M-4qfLyCT-hbhe,,, - 7rb/ 8 e k- License- -@--R-8tru ent t ,QMP; Improvement Licensee o Exp_ ARCHITECTIENGINEE Address: Phone: No - FEE SCHEDULE. BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. 1.,__,rotaI Project Cost: o 13 FEE: $ f Check No.: Receipt No,, `313 �5V NOTE: Persons tin-with-wknregistered contractors do not have: access to the guarantyfund ent/.OWhe'r- Sidnaturo of contractor .,J -r- Locatio, (0;, No. -(0'49'- Check # Y1 3�1) 1, AJ Date 1 -'7 A�' /" " 1 1. TOWN OF NORTH ANDOVER Certificate of Occupancy $- Building/Frame Permit Fee $ Foundation Permit Fee Other Permit Fee TOTAL Bidding Inspector Plans Submitted ❑ Plans Waived 11 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 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: .i Conservation Decision: Comments Comm Water & Sewer Connection/signature & Date Driveway Permit DPW Town Engineer: Signature: FIRE DEPARTMENT - Temp Dumpster on site yes Located at 124 Main Street Fire Department signature/date COMMENTS Located 384 Osgood Street no -Nmension Number of Stories: Total square feet of floor area, based o -in 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 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. r 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.1. 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 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 o CContr act ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products DOTE: 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 E Doc: Building Permit Revised 2014 QLAu LL O cc Q0 m N cLj�if E 0 a z Z m O a Z O Z m J d a0 Z J V }��' W W W H Z NLU LU Q W LL .F+ Y O LL N Q Ln N O LL 7 d' N U C LL O 1' ro LL m O C' v i 4J N rp C LL L to. O Q' C LL cu ` E m z N v N Y O N 4m* 0 cn 1: z m CD z W w a.x LLIW a 0 a z 0 • J m co O U .5.1 m 0 0 0 N CD .E CLL V ca a v .Q U cc CLw lw L.: 0 W m m 00 0 0 - CL �Q t � Cc J � 0 0 z CDN RICHARD FLUET CONTRACTING INC 102 BRIDLE PATH LN METHUEN, MA 01844 ANNUAL PREMIUM: FORM OF BUSINESS: CORPORATION BUSINESS DESCRIPTION: CARPENTER SEGREVE & HALL INS INC 305 NORTH MAIN ST ANDOVER, MA 01810 WE AGREE WITH YOU TO PROVIDE THE INSURANCE AS STATED IN THIS POLICY. THIS POLICY CONSISTS OF THE FOLLOWING COVERAGE PARTS. 20 $5,120 COVERAGES PREMIUM Commercial roperty Coverage $100 Commercial General Liability Coverage $4,920 Commercial Inland Marine Coverage $100 TOTAL $5,120 FORMS AND ENDORSEMENTS MADE PART OF THIS POLICY AT TIME OF ISSUE 28AP1264 01-15 OFFER OF TERRORISM 30AP1001 01-96 COMMERCIAL POLICY JACKET 30AP1078 09-14 EQUIPMENT BREAKDOWN ENDORSEMENT 31AP1001 10-09 MAIN SAIL PROPERTY COVERAGE ENDORSEMENT CP0090 07-88 COMMERCIAL PROPERTY CONDITIONS CP0109 10-00 MA CHANGES CP0176 09-06 MA EXCL VIRUS BACTERIA IL0017 11-98 COMMON POLICY CONDITIONS 30AP1093 02-02 ASBESTOS EXCLUSION CGO062 12-02 WAR EXCLUSION CGO063 12-02 WAR EXCLUSION CG2149 09-99 TOTAL POLLUTION EXCLUSION ENDORSEMENT CG2196 03-05 SILICA OR SILICA -RELATED DUST EXCLUSION CG2426 07-04 AMENDMENT OF INSURED CONTRACT DEFINITION CG3370 03-05 SILICA OR SILICA -RELATED DUST'EXCLUSION IL0021 04-98 NUCLEAR ENERGY LIABILIft EXCLUSION AGENCY AT ANDOVER MA DATE 04/21/16 PAGE 1 Arbella Protection Insurance Company a 1100 Crown Colony Drive, Quincy, MA 02269-9174: PROTECTION INSURANCE COMPANY WORKERS COMPENSATION AND EMPLOYER'S LIABILITY POLICY INFORMATION PAGE 'Policy Number Transaction Effective Date - Bill Type 4220051550 01 RENEWAL 03/31/2016 _ Direct Bill 1 Named Insured and Mailing Address Agent RICHARD FLUET CONTRACTING INC SEGREVE & HALL INS INC 102 BRIDLE PATH LN 305 NORTH MAIN ST METHUEN, MA 01844 ANDOVER, MA 01810 Phone # 978-975-1300 All workplaces are shown on an attached schedule. 2. P61116y'Perio6 at 12:41 A.M.- Standard at Address of Na Insured From: 03/31/2016 To: 03/31/2017 Form of Business =. Business:Description Corporation CARPENTER 3. A. Workers Compensation Insurance: Part One of the policy applies to Workers Compensation Law of the states listed_here: Massachusetts 3 B. ;, Employer's liability Insurance: hart Tw0." f the policy applies.to worlt,in each state..) sted',in, Item 3; A The limits of our Liability under Part Two are. _.. Bodily Injury by Accident $500,000 Each Accident Bodily Injury by Disease $500,000 Each Employee Bodily Injury by Disease $500,000 Policy Limit 3. C. Other States; Insured Part Three of the :policy applies to the:states, ,f any, listed here Connecticut New Hampshire Rhode Island 3. D. This policy includes these endorsements and,stedules: WC000000C WC 00 03 08 WC000406A WC 00 04 14 WC000422B WC 20 03 01 WC200302A WC200303D WC 20 04 03 WC 20 04 05 WC200601A WC000000C 4 The premium for thin policy will be determined by our Manuals of Rules, Classifications,iRates and Rating Plans. All information required on the attached Information Page Extension is subject to' verification and change by audit, Minimum Premium Total Estimated Premium $550 $16,857 Countersigned by Date FEB 12 2016 68 AP 1021 01 16 4220051550 01 INSURED COPY 02/09/2016 FEB 11., 3 2'' 3 Page 1 RICHARD FLUET CONTRACTING, INC 102 BRIDLE PA'T'H LANE METHUEN, MA 01844 Name / Address ELWOOD & JUDY BENT 62 BLUEBERRY HILL LANE N. ANDOVER MA. 01845 Description PROPOSAL Date Estimate # 11/23/2016 669 FRONT DOOR; INSTALL NEW THERMATRU S236 WITH TWO 10" SI170SL SIDELITES WITH LOW"E" CLASS. REPLACE EXTERIOR FLUTED TRIM WITH NEW 7" PVC FLUTED TRIM. PAINT EXTERIOR OF DOOR CRANBERRY. EXTERIOR OF SIDELITES AND TRIM WILL MATCH EXISTING PAINT COLOR. INTERIOR OF DOOR AND SIDELITES WILL BE WHITE. REUSE EXISTING INTERIOR TRIM IF APPROPRIATE. INSTALL NEW LARSON STORM DOOR PAID FOR BY OWNER. $4438.00 DECK: REMOVE EXISTING RAILINGS AND DECKING. INSTALL NEW AZEK 5/4 X 6"DECKING(SILVER OAK) WITH .BLIND FASTENING SYSTEM AND PERIMETER BOARDS. NEW 36" HIGH AZEK PREMIER RAILINGS WITH 5.5" POST SLEEVES WITH ISLAND CAPS. NEW STAIR RAILING ON ONE SIDE LIKE EXISTING.INSTALL WHITE AZEK TRIM BOARDS AROUND THE EXTERIOR OF THE FRAME, SKIRTBOARDS AND RISERS. $12,575.00 BOT14 JOBS INCLUDE PERMIT AND TRASH REMOVAL. PROPOSAL 1S VALID FOR 30 DAYS. EXTRAS OR CHANGES TO BE COMPLETED AT A RATE OF $90.00 / HR / MAN. MA. LIC. # 50710 HIC. # 106620 FINANCE CHARGE OF 1 & 1/2% PER MONTH FOR UNPAID 'BALANCES. PAYMENT SCHEDULE; FRONT DOOR, 1/2 WITH ACCEPTANCE, BALANCE UPON COMPLETION. DECK; $575.00 WITH ACCEPTANCE, $10,000.00 DAY WORK BEGINS, BALANCE UPON COMPLETION. go ' o Total $0.00 Signature Phone # Fax # E-mail 978-685-70W 978-685-7010 RFC102Cverizon.net ACRO" CERTIFICATE OF LIABILITY INSURANCE OP ID: J DATE (MM/DD/YY" 12116/2016 THIS CERTIFICATE 13 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTENO OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BIETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. ,r.rwrcrhrv,; Ir the cemncam noicler 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 Ileu of such endorsement (0 - PRODUCER Segreva & Hall Insur.Assoc.lnc 305 North Main St. Andover, MA 01810 Michael L. Segreve INSURED Richard Fluet Contracting Inc. 102 Bridle Path Lane Methuen, MA 01844 CONTACT NAME: TYPE OF INSURANCE 4M It C Na Quo E-MAIL ADDRI $S; PO MM/DD CUSTOM ID FLUET•1 5,001 INSURERJ§1 AFFORDING COVERAOE INSURER A: Arbella Protection Ins. Co. NAIC ti 41360 INSURER o: Commerce Insurance Co. 34754 INSURER C 2,000,001 INSURER D. X COMMERCIAL GENERAL LIABILITY INSURER E: COMBINED SINGLE LIMIT (Ea accident) INSURE F 06/12/2015 DVERAGES 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. LTR TYPE OF INSURANCE -WL Quo POLICY NUMBER PO MM/DD POLICY MM/DD' 5,001 GENERAL LIABILITY 3 11000,00( GENERAL AGGREGATE $ 2,000,001 A X COMMERCIAL GENERAL LIABILITY 2,000,00( COMBINED SINGLE LIMIT (Ea accident) 8500034727 06/12/2015 06/1212016 $ CLAIMS -MADE OCCUR BODILY INJURY (Per aeddr:Ill) S 30D,00( PROPERTY DAMAGE (PER ACCIDENT) $ 100,000 $ 8500034727 06/1212016 06/12/2017 AGGREGATE GEN'L AGGREGATE LIMIT APPLIES PER: $ WC 3TATU- I TQELY QTH- $ X POLICY PRO LOC E.L. EACH ACCIDENT $ 500,000 E.LD16EASE-EAEMPLOYEE 6 500,000 E.L. DISEASE - POLICY LIMIT AUTOMOBILE LIABILITY 500,000 ANY AUTO ALL OWNED AUTOS B X SCHEDULED AUTOS X HIRED AUTOS XV1460 12/01/2016 12/01/2017 X NON -OWNED AUTOS UMBRELLA LIA9OCCUR PCLAIMS-MADE EXCESS LIAR DEDUCTIBLE RETENTION s WORKERS COMPENSATION A AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE OPPICERIMEMBER EXCLUDED? �Y N / A (Mandatory in NH) 4220051660 03/31/2016 03/31/2017 K yes, describe under DESCRIPTION OF OPERATIONS/ LOCATIONS / VEHICLES (Attach ACORD 161, Additional Remarks Schedule, Irmors epn¢ I: requlred) LIMITS EACH OCCURRENCE $ 1,000,001 DAMAGE TU RENTED PREMISES Ea accurrence $ 100,001 MED EXP (Any one persan) $ 5,001 PERSONAL& ADV INJURY 3 11000,00( GENERAL AGGREGATE $ 2,000,001 PRODUCTS - COMP/OP AGG $ 2,000,00( COMBINED SINGLE LIMIT (Ea accident) 51 $ BODILY INJURY (Per person) $ 100, 00( BODILY INJURY (Per aeddr:Ill) S 30D,00( PROPERTY DAMAGE (PER ACCIDENT) $ 100,000 $ EACH OCCURRENCE $ $ AGGREGATE $ $ WC 3TATU- I TQELY QTH- $ E.L. EACH ACCIDENT $ 500,000 E.LD16EASE-EAEMPLOYEE 6 500,000 E.L. DISEASE - POLICY LIMIT z 500,000 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. 120 Main Street North Andover, MA 01845 AUYHORIZED REPRESENTATIVE ©1988-2008 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD Office of Consumer Affairs & Business Regulation HOME IMPROVEMENT CONTRACTOR b Registration: ,. 106620 Type: WW Expiration'. _--__--1!24W1 8 Private Corporation 1) RICHARD FLUET CONTRACTINGINC. Richard Fluet 102 Bridle Path Lane Methuen, MA 01844 Undersecretary Massachusetts - Department of Public Safety -Board of Buiiding. Regulations and Standards 'Carlsti--u-c—do-11 a'unervisor License: CS -0507.10 RICHARD A FLUO 102 BRIDLE PATH jRqF_ 2�' MEETHUENMA 01844,& jf*L Expiration Commissioner 04122/2017