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HomeMy WebLinkAboutBuilding Permit #338-2017 - 64 PHILLIPS COMMON 9/29/2016 NORT#j BUILDING PERMIT O��gLED qq. i � 9�••fit -_:n Y6 O 461 Iq ly A4'q �6 GV� TOWN OF NORTH ANDOVER � APPLICATION FOR PLAN EXAMINATIONoe 70 O 4y N � Permit No#: Date Received �gSSgTEDUs��cS CH Date Issued: l PORTANT: Applicant must complete all items on this page LOCATION (� y �/�/ L //J,� t"�/�/'�2®/✓ r"o . PROPERTY OWNER Pr it nr- �2 Print 100 Year StructureY es no MAP PARCEL:6z ZONING DISTRICT: Historic District yes no Machine Shop Village yes no I 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 ❑1Nell" ❑ Flgodpla;in D Wetlands �, Watershed ®istnct;_ m _ s V1later/S'ewer i ., DESCRIPTION OF WORK TO BE PERFORMED' Identification- Please Type or Print Clearly OWNER: Name: NSA ,moi rno A/ - _'f9O,LL,2 Phone: Address Contractor.Name: .�7 7 rZ Phone: Email: Ae d ►3/-e/- cord Address D /q--F e,?- Supervisors ,?Supervisors Construction License: Exp: Date: .' /V Home Improvement License: �. 124 Exp. Dater ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING,,PPE�ER''MIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. ti �A Total Project Cost: $�y PAW FEE: $ ' Check No.: ���} Receipt No.: NOTE: Persons contracting with unregistered contractors d of have ss o the guaranty fund Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ ul TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/BodySwimElming Pools Art ❑ well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Pennanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS ~ e i -HEALTH : - Reviewed on Signature COMMENTS Zoriliig 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: tedOsgood i yt a 84 FIRE DEPARTMENT - Temp D ster o�nsite:`ryes `�, 3noLZ i $ Street .�= 'fig���`, _ J k§ Y 9:� •y,p.x . t t�S 3>1{ ?. i�q TV hat =;Imreepartment}snature/dateA ; , ni, r+u •. o a a + c Y. E' 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.$1oo-$1o6o fine NOTES and DATA— (For department use) i. I i El Notified for pickup Call Email Date Time Contact Name I� Doc.Building Permit Revised 2014 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 OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks 4 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 IN OTE: 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 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 I I Location l.0 No. �3 2c)17 Date l 2q ko y'rY .t4�r . - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ L Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# _ j 30968 . .. • ( -f Building Inspector . 96 $ . t,ORT11 q Town of t _ 6 ndover h ver, Mass CKl �� y C, 2,AIJP o11. 641 S U BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System THIS CERTIFIES THAT .........Z...l�,�,.....:Siw..M� Sko... BUILDING INSPECTOR . le....... has permission to erect g Foundation ..................:....... buildings ... .. ..... ��.0. .. ....C�11 Rough to be occupied as ..�M43 r...t�A!"Y........... ...... ... ,A2.t......:............ Chimney provided that the person accepting.this permit all in every respect conform to the terms o application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Iteration and Construction of Buildings in the Town of North Andover. Laet �1 WS I*S PLUMBING INSPECTOR Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRPNVTA 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. CO,TE OSTt z i MI . BUILDING REMODELING ! i � j This agreement made thus 22°d day of July,year.Twp o tho usand and Sixteen by and between Cote and Foster Contracting, Inc.hereinafter called the Contractor and Rhea Simon-Skoler,hereinaft r called the Owner,witne�ses that the Owner intends to repair&' replace windows and exterior trim at the address of 64 Phillips Common,North Andover, MA. Now,therefore the Contract , o and the Owner,far consideration hereinafter fi named, agree as follows.+ 1 i � ARTICLE 1 The Contractor agrees to provide all the 'lab l rand materials to do all things necessary for the proper construchon and completion`of the work shown and described on drawings. The drawings and specifications are the basis of the contract. ARTICLE '' f In consideration:of the erformance of the Jontr,cPt the Owner agrees to a the �' pay Contractor;in current fiinds as compensation for his services hereunder$40,809.00 to be paid as follows: r Payment 1 $15;000.00 at signing of contract to order the windows Payment 2 -$15,000.00 at start of work Payment 3 -$5,000.00 at completion of windows Payment 4-$5,809.00 at completion of trim:re pairs ARTICLE 3 Final payment onount as agree above to be paid within ten(10)days of project completion or,occupancy. Ifcontract amfinal payment has not been made within this time a 10%charge per month on the balance due wt l+ g P ! ,, ! 1 *becharged. All minor punchl;tst items will be complete as part of the one ear warran , o, the finish r +, Yh' p oduct. Failure to pay , balance within ty(90)days maylres ult in legal on. .rt Initials: + i 20 Aegean Drive!• Unit 15 -{Methuen,MA 01844 Tel: 978-682-6518 - Fax:978-682-1221 www.coteandfoster.com ARTICLE 4 F Additional work above and beyo�d the contrae agreement: All additional work done to,be quoted at the time t'he;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 after he or she has been billed for its,. Initials: I In witness whereof they have executed this agreement the day and year first above written. k t i Rhea Simon-Skoler,Owner ! i Steven M. Cote DBA Cote& Foster j i 1 1 i r ' j j f 1 t • (d � i { { i The Coit monivealth ofMassaelutseas DeeparbuentF of Industrial Aeeldepits Offs e qflm esdgalstons 600 Washington street - Boston,MA 02111 ° 39rwDtr maassgovldiaa Workers' Compensation Insurance davit:Buffders/Contractors/Eietctricians/]?Iu€mbers iicant Information Please Print Legib Name(Business/Organizadon&dividunl): �T� �y ✓� ��P- A ddress: 40 ! F 6 C ,9 N Z) 1f/Y / 7" lb— City/State/ZipA i 7-Y11 cc f -V(4 i1 6 i,W Phone#: Are you an employee'?Check the appropriate box: .4. I am a general contractor and I �e of project(e'equafl'ed}: 1_[Q I-am-aemployer with g employees(full and/or part-time).* have hired the sub-contractors New construction 2.Q I am a sole proprietor or partner- lisipd on the attached sheet. 7. Remodeling slop and have no employees These sub-contractors ctors have . ®Demolition working for in an capacity. employees and have workers' g y p ty. 9: ®Building addition [No workers' comp.insurance comp.insuramce required.] 5. We are a corporation and its 10.[]Electrical repairs or additions 3.0 I an a homeowner doing all`work officers have exercised their 11.0 PIumbing repairs or additions myself[No workers'comp. right of exemption per MGL 12.1 Roof repairs insurance required.] c. 152,§1(4),and we have no employees.[No workers' 13.Q Other comp.insurance required.] 'Any applicant that chwh box 02 must also fill out the section below showing their workers'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. tContractors that-check this box mast attached an additional sheet Showing the`uume of the sub-coruractors and state whether-ornot those entities have employees.If the sub-contractors have employees,they most provide their workers'comp.policy number. lam an eaaaployer ilaat is providing workers'conYpeYYsrafion insuranYce for my enaplayees Beloit,is diepolicy and Job site information. 1. D 2 f i�C Insurance Company Name; c: n N US 7W y S /� . Policy#or-Self-ins.Lic.V ' c © � 1V 9 6 a 3�� F piration Date: Job Site Address: io �`/ �i�i�L J 5 Ob m/,1 e i1-C1ty1State/zipJ\/e 47-1- 4A(b6 Ve- P— f� 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 thisstatement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby ceiWfy under the pains orad penalties of perjury Haat the hiformation provided above is trate and correct. j Sianature: / Date: Phone#: Of,jaeial use only. leo not write in dais area,to be completed by city or a rim offtciaL City or Town: Permit/License# Issuing Authority(circle orae): i.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector fr.Other Contact Person: Phone#, 1 �4 F _ AC® I IKDATE[wrMrDDrvYrrl CERTI ATE 6F LIABILI INSURANCE I i ! 12/2i/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 FOLDER. ji IMPORTANT: If the certificate.holder is an ADDITIONAL INSURED,the"policy(is)must be endorsed_ If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certa)n policies may require an endorsement: A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(si. f j PRODUCER ! NAMEACT Vi.ctori.a Lowes, CISR MTM Insurance Associates PHONE c (978)681-5700 No:(978)681-5777 1320 Osgood Street E-MAIL ADDRE vickiel@mtminsure.com INSURERS AFFORDING COVERAGE NAIC# North Andover MA 01845 i I INSURERIA:St3te Auto Insurance INSUREDI. INSURERIB National Liability & Fire Iris Cc Cote 4 Foster Contracting,: Inc ' 4 INSURERIC: 20 Aegean Drive INSURER D:' I Unit 15 < 1, INSURERIE: Methuen MA 01844' INSURERIF: COVERAGES CERTIFICATE NUMBER:15-16 & 16-17 Vr,C I 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-I CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH-THIS CERTIFICATE MAY 8E-ISSUED OR.MAY.PERTAIN,I THE INSURANCE-AFFORDED BYl HE'.POLICIES DESCRIBED HEREIN IS SUBJECT TO-ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN'.MAY HAVE BEEN RDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE A L BR POUCY NUMBER E I APA D MMM/UDD EXP LIMITS X COMMERCIAL GENERAL LIABILITY !` EACH OCCURRENCE $ 1,000,000 DAMAGET RENTED A CLAIMS-MADE ❑X OCCUR i PREMISES Ea trearrence $ 100,000 PE 274-7539 ! 12/31/2015 12/31/2016 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY -$. 110001-000 - GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 X POLICY❑jECT LOC �., I PRODUCTS-COMPIOPAGG S 2,000,000 OTHER S AUTOMOBILE LIABILITY t COMBINED SINGLE LIMIT I, Ea accident $ 1,000,000 A ANY AUTO I` I BODILY INJURY(Per person) $ 20,000 ALL OWNED SCHEDULED AUTOS X AUTOS BAP2370166 03 112/31/2016 BODILY INJURY(Peracatlent) S 40,000 NON-OWNED X. HIRED AUTOS X �213112015 PROPERTY DAMAGE AUTOS { (Per accident) I Medical'payments $ 5,000. UMBRELLA UABHCLAJMS-MADE OCCUR i EACH OCCURRENCE $ EXCESS UAB I AGGREGATE S DED 1 11 RETENTION$ WORKERS COMPENSATION f I PER OTH- ANDEMPLOYERS'UABIUTY YIN i j X STATUTE OR ANY PROPRIETOWPARTNERIEXECUTIVE E.L.EACH ACCIDENT $ 500 000 OFFICER/MEM9ER EXCLUDED? �N/A I I B- (Mandatory in NH) v9WC709549 t /20/2016 6/20/2017 E.L.DISEASE-EA EMPLOYE S 500 000 If yes,describe under DESCRIPTION'OF OPERATIONS belowE:L DISEASE-POLICY LIMIT "S -50D DOD i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES;(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate holder as listed below it This certificate of insurance represents coverage currently ineffect and may or may not be in compliance with any written contract. 1 I CERTIFICATE HOLDER I 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, MA 01845 f AUTHOR REPRESENTAi1VE I i P MacDonald CPCU, CIC .16WI44 . { 101988-2014 ACORD CORPORATION. All rights reserved. ACORD 26(2014101) The ACORD name and logo are registered marks of ACORD INS025 on l4ni i I -Department of Public Safet Massachusetts y Mations and Standatds Board of Su lcling'Reg - �Onjt uC ei�ii iij�iiils0i License: CS-085173, �t ` WILLIAM T FOSR j l 65 COACH DR � � t DRACUT MA 011:926 i iy� ! �iri,,• Expiration 1111012016 '! Cbmrnissioner ii ranemaoaaruea>�/� �? Ii -trice of Consumer Affairs&Business'Reguiation Q— OME IMPROVEMENT CONTRACTOR I * Registration 167602: Type: Expiration.�8/5I�Ot8 Supplement Card . i COTE&'FOSTER CONTE WILLIAM FOSTER i 20 Aegean Dr Unit 15 1 ; Methuen,MA 01844 Undersecretary