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Home My WebLink AboutBuilding Permit #690-15 - 65 COTUIT STREET 3/2/2015r� Q Q NORTy BUILDING PERMIT:: TOWN OF NORTH ANDOVER—'C�w� h' APPLICATION FOR PLAN EXAM[NATTQ.N" III A�-DI Permit No#: Date. Received:. IZt � 7-1��DRATED 9SSACHusB Date Issued: IMPORTANT: Applicant must complete, all--it6ms on:this page L®CATION} 1 S. W t nhl'':'� 4 4 �Y' &y tTYO P OPEWNER� ' nbh. o MAP PARGEL� �_k20NINQ': �STRI�T` . ` Hrsto,Gic IN' bbt ^ t `yes n.© . . r Machine..Sfop Village., yesArm TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial Iteration No. of units: ❑.Commercial ❑ Repair, replacement ❑ Assessor Bldg ❑ Others: ❑ Demolition ❑ Other _ Q Septic ❑ 1Nell _ ❑ Floodpl_am Wetlands ❑: Watershed Districf, �r 4..-{ a iwa..,. r: >u _ - t •- DES RIPTION OF WO K:T E PERFUKMtU: Identification- Please Type or Print Clearly.,.,....OWNER: Name: Name: Phone: %b 3 Address: C®ntractor Name: w on,e: __.W. _ _. Address. 4 _ c o 0-- •' syi� fid® Su emsors ConstruotiorpLicerisegt�4 " Exp*Dafe< ,�,j[�0,..r �«,}r.. . ^r • r — 'sky .. sz- _ -- —t �—. HornerImprovement License: ARCHITECT/ENGINEER Phone., Address: Reg�.No:' FEE SCHEDULE: BOLDING PERMIT: $12.00 PER $1000.00 OF THE -TOTAL: ESTIMATEDCOST BASED ON $125.00 PER S_ F ao Total Project Cost: $ FEE:;:$: -� Check No.: NOTE: Persons contracts g with unregistered contractors; dounot'have`access to the giy ,&ty.r'z�(qd PPPF- Location 64�q" J L No. 6 to ' 6 Date 2 7 Check # TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $'' Foundation Permit Fee $ or Other Permit Fee $ TOTAL $ &tb Building Inspector 0 Plans Suhnitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ WERAGE DISPOSAL. ❑ Tanning/MassageBody Art❑ Swimming Pools ❑ ❑ F Tobacco Sales ❑Food Packaging/Sales ❑ tank, etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT COMMENTS CONSERVATION COMMENTS HEALTH COMMENTS Reviewed On Signature_ Reviewed on Signature Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Planning Board Decision: Conservation Decision: Commen Comments Zoning Decision/receipt submitted yes Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: t_ocatea ��4 us ooa Street iF,IRE DEPAR.TMENiT -Temp'..®umpster ony site yes . no__ . _ Locatetlat 124 Main Sfreet: Fire Department sg,nature/date COMMENT$ 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) 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. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses a 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/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) o 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) o Copy of Contract o Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products VOTE: 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 a� 0 4m* 0 y E9 * F- u W LL O aCL cr.Z mv u 0 u W Z 0 m c O O d OO a Z Z m a u a Z V ��; W W ,� CL oc O woc N ? N U) z ui a !JJ 0 LLI LL ++ = Y \ O LL N U Q N m "p 7 LL t 7 w v C E U f6 LL t j O d' f0 LL CLO =z L 3 O d' O U O V) f0 O LL O V t j p d' 6 c LL v L c p m z ++ N N N p N C C O R w V CL a) �a �. c 0 r S a as � :Z o '^ <v W 0 Oai V+ c Q i w h p c m Z -J co .ul `m a Z CD Cl) uj C d O I : •� O > Li O O r' m n - =a to a> Q = X tt O W . A. .�, "-c � I-- ° Z CL _ 0 0' Nor 1► t •> c LJJ I c �- v O 0 .N O H v I Oc _ Q i i t4 'a •O 0CL (D f!1w m N LU LU O 'C � ° ° LL. •N O C O � ,E . M v -o c O p v (D 0-00+ Q to 0 -0 > 4- = J O O F- t � Q 0 0 > co J F. v O �ZI O d 0 ,� CL CL U) o = a CLO =z Z2 O V CL v (1) i JOB DESCRIPTION AIR SEALING: Provide labor and materials to seal arras of your home against wasteful. tot w air I performed in concert with the use of special tools and diagnostic tests to assure that your home will be left with a healthful level of air exchange and indoor air quality. Materials to be used to seal your home can include caulks. foams, eratlictstripping and other products. Primary arms ror sealing include stir Ink -age to auics, bascmem attached garages and other unhGued ar= (windows arc not generally addressed.) (t 0) working hours. At the Camphlion of the weatherization ti%wk. and at no additional cast to the homemvner. a anal blotrer door and/or combustion salary analysis will be conducted by the sub -contractor to ensara the safely ofthe indoor air quality. ATrtC ACCESS: Provide labor and materials to insulate (2) back of the kncewall Welt with 2" rigid Than= board, and sealthe edge orthc hatch ► ith ttcatherstrippint. KNEEWALLS: Provide labor and materials to install 2° PSK faced semi-rigid fiberglass board insulation to (106) square fat of kn=vaif arm. BASEMENT DOOR: Provide tabor and materials to imulate the back of the basement door leading to the bulkhead with 2- rigid board that MUCIS the sections R-316.5.4 and 316.6 requirements of building cDdc. Scat all ad_= and scorns with FSK tape. D [ Total: gram incentive: ustomer Total: WE AGREE HEREBY TO FURNISH SERUiM . WRH ASM SPECIFICATIONS. FOR THE SUM OF 'One Hundred Seventy -Three & 27/100 Dollars 5750.00 S120.00 5350.86 S72.2z $1,293.08 $1,119.81 $173.27 $173.27 uPONPWAI ursPECT1aeIANDAPPROVAI aTFM Cu VGMAGRMTCIM6VT"AUN MMUgArtLDITERFSTo>cixrrotaECNARQI3lLOLMIYONAICY loo+AiDBAtArA:EAFTERSODAYa.sEEREVERSEPOROtOORTANTa60RY1ti7pAox CURRANT»i6,RNiMTEOFRIS�,,RDtO,ANDCONTRAC7pRREGafiRATNMf. DO NOT SIGN THIS CONTRACT IF 7NY BLANK CESCENd PTANCE NOTE TNIS CORTRACT LAY EE VnrAMVM SY old 1p M0? xK9CUrm W"MU DATE OP ACCEPTANCE 2 , ACCE"ANCEOPCONTRACT.THEAtA710hRANDCONCmONSARE {1 DAYS. saTiOFACTORYTOusANDAl1ENERE87ALCEprED.Y�IAREAurm=zaToDO7NEVYORtt AS SP�IFIfA, PAYIOiNT NAeetlEirADE AS OUrtD7ED AaoYE r RISE Engineering 10Federal109 COnIMdW RelMdon No .l d'ntision oCThietsch Eagiaecring MA Contractor eg Riisbxft NO CT Contractor Regbibatton Na 60 Shmmut Unit #Tq Cnnton. MA 02021 339-302-6335 FAX 339-5426345 CONTRACT iPage 1 PROGRAM ENGINEERING CMA -HES TACO150frolEDarro6ETWUMM iKUNOtrEKE WWORKAa � Linda Hartnett P DATE DATE d tEAn a waR,t orm> u 12/12/2014 407599 00002 entrMo a7REEr _..- . — _.. ------ - 65 Cotuit Road B 65 Cotuit Road B SER11nECM.3TAMZIP�� North Andover, MA 0I845 North Andover, MA 01845 JOB DESCRIPTION AIR SEALING: Provide labor and materials to seal arras of your home against wasteful. tot w air I performed in concert with the use of special tools and diagnostic tests to assure that your home will be left with a healthful level of air exchange and indoor air quality. Materials to be used to seal your home can include caulks. foams, eratlictstripping and other products. Primary arms ror sealing include stir Ink -age to auics, bascmem attached garages and other unhGued ar= (windows arc not generally addressed.) (t 0) working hours. At the Camphlion of the weatherization ti%wk. and at no additional cast to the homemvner. a anal blotrer door and/or combustion salary analysis will be conducted by the sub -contractor to ensara the safely ofthe indoor air quality. ATrtC ACCESS: Provide labor and materials to insulate (2) back of the kncewall Welt with 2" rigid Than= board, and sealthe edge orthc hatch ► ith ttcatherstrippint. KNEEWALLS: Provide labor and materials to install 2° PSK faced semi-rigid fiberglass board insulation to (106) square fat of kn=vaif arm. BASEMENT DOOR: Provide tabor and materials to imulate the back of the basement door leading to the bulkhead with 2- rigid board that MUCIS the sections R-316.5.4 and 316.6 requirements of building cDdc. Scat all ad_= and scorns with FSK tape. D [ Total: gram incentive: ustomer Total: WE AGREE HEREBY TO FURNISH SERUiM . WRH ASM SPECIFICATIONS. FOR THE SUM OF 'One Hundred Seventy -Three & 27/100 Dollars 5750.00 S120.00 5350.86 S72.2z $1,293.08 $1,119.81 $173.27 $173.27 uPONPWAI ursPECT1aeIANDAPPROVAI aTFM Cu VGMAGRMTCIM6VT"AUN MMUgArtLDITERFSTo>cixrrotaECNARQI3lLOLMIYONAICY loo+AiDBAtArA:EAFTERSODAYa.sEEREVERSEPOROtOORTANTa60RY1ti7pAox CURRANT»i6,RNiMTEOFRIS�,,RDtO,ANDCONTRAC7pRREGafiRATNMf. DO NOT SIGN THIS CONTRACT IF 7NY BLANK CESCENd PTANCE NOTE TNIS CORTRACT LAY EE VnrAMVM SY old 1p M0? xK9CUrm W"MU DATE OP ACCEPTANCE 2 , ACCE"ANCEOPCONTRACT.THEAtA710hRANDCONCmONSARE {1 DAYS. saTiOFACTORYTOusANDAl1ENERE87ALCEprED.Y�IAREAurm=zaToDO7NEVYORtt AS SP�IFIfA, PAYIOiNT NAeetlEirADE AS OUrtD7ED AaoYE OWNER AUTHORIZATION FORM 1, G ffwwof#*pmp"bwwat a 1 YAO cs� an a0ffbad mftwb torfcw ME ftftwft to act on my behalf to obtain a bttHt V pmt wd to Petbtm wft on aw p o ty, s She Oft (92epa�zrnto�zrueutf� o�u�u�uael Office of ConsumerAffairs & Business Regulation License or registration valid for individul use only ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: ' e91stradon: .04800 Type: Office of Consumer Affairs and Business Regulation iration: ;; 7�5f201fi Private Corporation 10 Park Plaza - Suite 5.170 ==M4 Boston, MA 02116 HUGH'S ENERGY C0�!ORA7fON?.? DANIEL DRISCOLL 259 MILTON STREET' ---,`r DEDHAM, MA 02026 -- - ' Undersecretary Not valid without signatu Massachusetts - De Soar of Building R- art+nent of Public Safefy Coijj ti- -� r u.arions and Si'-. uLuO') o`r1�er+'iso, License: CS -050 tet; r r ` Thomas P ` 259 Auton Street IWA Cornrnissioner expiration 10%22J2016 0 *MOW CERTIFICATE OF LIABILITY INSURANCE 1 11111111 CAZEtlAtroomyYj EI"* 0CIES u rD A MArnM OF INFORMATION ONLY AND CQA1FERg HO 10/00/2aggLy 014 $E' THIS CERi1FICATE OF 1HSURANCE DOES HOT�CON RtGH7;3 OPON 711E CERTIFICATE HOLDER. THIS AMM EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES REPRESENTATNE OR PRODUCER, AND THE CERTIFICATE HOLDER, A CONTRACT BETWEEN THE ISSUING INGURERay HE POLICIES S IMPORTANT If the tmrtfRlmte holder is an ADDITIONAL INSURED, the the terms and conditions of the polFcl/:certain an endorseme pciesrequieaj must be endorsed. ff SUBROGATION IS WANED. subject to lobusER t holder in lieu of such endors oli!I re nt: A SiMment on this offig cat. does not confer rights to the ODUC$ insuran +semen Sinee�ce Agencyi lrm *R, MA 02474-M4 INURm 258 Milton Stneet - Dedham. PAA 02026 781.641-s008 THIS IS •i .�VffIOCR� - _ O CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE 8EB1(!5$U® TQ THE INSURED NAMED ABOVE pR T HE POLIGY PERIOD INDICATED. NOTWITHSTANDING ANY REQU1tRF.MEt+R, CERTIFICATE MAY BE lSSUEp OR MAY PERTAIN. THE INSURANCE AFFORD® BY THE POLICIES DESCRIBED HEREIN 1E SUBJECT TO ALL THE TERMS RM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WIT H RESPECT TO WHICH THIS EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS 5♦{pyyry M,qY BEEN REDUC®SY PAID CLAIMS. —j CLAAIS.MApE � 0=R x x L AGGREGATE LWAPpi POLMElWT C7LOO AUrO1Vt ou 1J wwv C ANVAUTO OMM AVM x HtREDAVrOS AUTOS UMBRELLA UAS x OCCUR A DCCEMULU S --- B Appltoa OW410141 08114/2015 508/1412014 08t-ps S 10107014 08H4015 08112014 08192/2015 OESC19PiIONO1OPEtiAiIONSlLoCA71M VEHICLES (ACORD10t.A o�m2Ramae(a - !myboatfmorespaepte ADRRCHE TM SHOULDANYOFTWABOVEvE=WWpW nBECANCELLEEOBEFORE ACCORDMCEiN m TM FIEpoTHEREOF, NCMCE V&L BE DEIIYERED IN TucYPROVwoN� i ACORD 25 (2014101)0 4988 2014!CORD CORPORATION. Aa n9hts reserved. The !CORD name and logo arra metered marks ofACORD The Commonwealth of Massachusetts Department of IndustrialAccidents - d 1 Congress Street, Suite 100 Boston,'MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print LeLyibly Name (Business/Organization/Individual): % U / 5 G-�N 60�GL/ Ci Address: City/State/Zip: Are you an employer? Check the appropriate box: W Phone #: 7y/ a 6 J U 1„Q4-attia employer with employees (full and/or part-time).* 2. ❑ I am a sole proprietor or partnership and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3.Q I am a homeowner doing all work myself. [No workers' comp. insurance required.] t 4. ❑ I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers' compensation insurance or are sole proprietors with no employees. 5. ❑ I am a general contractor and I have hired the sub -contractors listed on the attached sheet. These sub -contractors have employees and have workers' comp. insurance.1 6.Q We are a corporation and its ofcers.have exercised their right of 'exemption per MGL c. 152, §1(4), and we have no employees. [No workers' comp. insurance required.] . Type bf project (required): 7. ❑ New construction 8. ❑ Remodeling 9. ❑ Demolition 10 ❑ Building addition 11.❑ Electrical repairs or additions 12.0 Plumbing repairs or additions 13. ❑ Roof repairs P 14. , ther ., *Any applicant that checks box # 1 must also fill out the section below showing their workers' compensation policy information. 1 t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. 4 Insurance Company v Policy # or Self -ins. Lic. (- A—r 36 3 Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by 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. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I /–) I do hereby certify under Phone #: that the information provided above is true and correct, Official use only. Do not write in 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 #: