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Home My WebLink AboutBuilding Permit #84-13 - 65 COTUIT STREET 7/31/2012BUILDING PERMIT TOWN OF NORTH ANDOVER i APPLICATION FOR PLAN EXAMINATION Permit NO: ` Date Received Date Issued: I ry IMPORTANT: Applicant must complete all items on this nage /w LOCATION 5 �7 CGf�I PROPERTY OWN MAP NO PARCEL: Print �a�'��5�'►u rne� U�Z � �e24'r - v',�ttieo .6 H 2, • C O \*'V p_ �� c .iui..K. , �• Print J ZONING DISTRICT: Historic District yeno Machine Shop Village ye no 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 Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORE( TO BE PREFORMED: Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: CONTRACTOR Name: t0ae-f Phone: (T7e - & I S7 - Add ress: 'Address: P O &X SCO D a7>4fa\ ` 4 6 (q Supervisor's Construction License: S - ci,3 Exp. Date: w I 2-00 Home Improvement License: 111 S 569 Exp. Date:-... 2-h 7 O 2-- ARCHITECT/ENGINEER Phone: Address: Reg. No FEE SCHEDULE: BOLDING PERMIT: $1200 PER $1000.00 OF THE TOTAL ESTIMATED COS BASEQ ON $125.00 PER S.F. Total Project Cost: $ j` FEE: $ Check No.: �1 I Receipt No.: SC� NOTE: Persons contracting with unregistered contractors do not have access a guara and .. Signature of Agent/Owner Signature of contractor (3 Location Dater-" No. I�K Check # 25566 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee Other Permit Fee TOTAL —f B ina InSDector u2ld g Inspector 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 PLANNING & DEVELOPMENT COMMENTS CONSERVATION COMMENTS HEALTH COMMENTS DATE REJECTED DATE APPROVED Reviewed on Signature Reviewed on Signature 4 Zonng Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: Comments Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS 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 ivu 1 CJ ana UAI A — (I- or department use ❑ Notified for pickup - Date Doc.Building Permit Revised 2008 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 o Building Permit Application ❑ Workers Comp Affidavit Li Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract o 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 o 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) o 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 o Workers Comp Affidavit Li 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 Li 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 DEPARTMENT:BPFORM07 Revised 2.2008 ° V •� L CL O' �oo CD N d Q L N � C d d Ef+ E _ G U) �J Q. ` a _ � � L m a � N U) a`� N 0 0 o > a ° 0 �. s Eo° U'0° w •y =O tm c > 3 = ' . �� = Q. 4) G c E _ Q L LCD ca CL V m LIJw_ _ LFWF=L--� •. y o o .N = JO N -� Z '= �v �v V CL N N M o O .CLC > t O O Irk W :a ° V •� L CL O' �oo CD N d Q L N � C d d Ef+ E _ G U) �J Q. ` a _ � � L m a � N U) a`� N 0 0 o > a ° 0 �. s Eo° U'0° w •y =O tm c > 3 = ' . �� = Q. 4) G c E _ Q L LCD ca CL V m LIJw_ _ LFWF=L--� •. y o o .N = JO N -� Z '= �v �v V CL N N M o O .CLC > t O O W :a CD c m v� O OO Tun.: LU U J G.. Z w0 9zz Cl) W a- Z m LLI O LU = N Z Z O C7 Q Z a 0 Z Z u - 0 00 y LA LU m 3J E LL v v m c O. w av ?O O Y y cu Z u to o 0- cu 0 :Ec c c c LCL N CC LL W U LL LL d' {n LL d' LL m N (n ° V •� L CL O' �oo CD N d Q L N � C d d Ef+ E _ G U) �J Q. ` a _ � � L m a � N U) a`� N 0 0 o > a ° 0 �. s Eo° U'0° w •y =O tm c > 3 = ' . �� = Q. 4) G c E _ Q L LCD ca CL V m LIJw_ _ LFWF=L--� •. y o o .N = JO N -� Z '= �v �v V CL N N M o O .CLC > t O 0 Cl) Z LIq E O O d Z y O = 0 wI c W Q 01— E m m a Cc O v O m O O. a CL a� Q s ca V J •CL O �z v v U) a ccQ B LLI U) W W W H O W :a CD c m v� Tun.: LU U G.. Z w0 Cl) W a- Z m 0 Cl) Z LIq E O O d Z y O = 0 wI c W Q 01— E m m a Cc O v O m O O. a CL a� Q s ca V J •CL O �z v v U) a ccQ B LLI U) W W W H The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers r Name (Business/Organization/Individual): Address: Y"0 Rby, (Go et (fkw ad City/State/Zip: Phone #: l /& CS `Z�� Are you an employer? Check the appropriate box: 1. q1 am a employer with GJ Q- 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors listed on the attached sheet. 2. ❑ I am a sole proprietor or partner- ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. 5. ❑ We are a corporation and its [No workers' comp. insurance officers have exercised their required.] 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no employees. [No workers' insurance required.] t comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.0 Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other *Any applicant that checks box # 1 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. $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. y o � ••1. Insurance Company Name:ci6CcC Policy # or Self -ins. Lic. #: W( G5co& 4-3*w � W__7J Expiration Date:20 � Job Site Address: � � � (AV 1 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 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. l do hereby unr Zt 'ns nd penalties of perjury that the information provided aboveistrite 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 #: Y JUL-31-2012 14:36 Sennott Insurance 978 887 2404 P.01 CER 979.987.4900 FAX 978.887.2404 rd F. Sennott Insurance Agency, Inc. South Main Street P. 0. Box 457 Topsfield, MA 01983 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND ALTER THE COVERAGE AFFORDED BY THE POLICIES OR BELOW. INSURERS AFFORDING COVERAGE wsURERA: Nautilus Insurance Co.��- " """"""""'"""'•__�__— NAIC # isuRED Roger S. LeBlanc Carpentry P.O. Box 160 Boxford, MA 01921 INSURERB; Associated Employers Ins. Co. GENERAL LIABILITY INSURER C: 03/02/2012 INSURER 0: M.. 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, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE B5EN REDUCED BY PAID CLAIMS, i�kTR NSR ,..... TYPE , .. ,.",...... M „-•..---.... _..._--•--•---- •--•------•---,., .,, ,. ,.. . D OF INSURANCE POLICY NUMBER P LICMMIGDCn y DPOLICY TA MM/DIDI�YYYYN LIMITS GENERAL LIABILITY NN186869 03/02/2012 03/02/2013 EACH OCCURRENCE 3 1,000100 u X COMMERCIAL GENERAL LIABILITY PREMIE Ee occurrence 3 50.00 CLAIMS MADE X OCCUR MED EXP (Any one person) $ S1000 A N y .— PERSONAL Q ADV INJURY 8 1,000,0 GENERAL AGGREGATE 3 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS • COMP/OP AGG 3 2,000,000 POLICY 7 PROJECT" 7 LOC M AUTOMOBILE - LIABILITY ANY AUTO COMBINED SINGLE LIMIT $ (Ea eccld.0 BODILY INJURY (Perpe/Son) S ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS BODILY INJURY 3 (Per a"iCenl) PROPERTY DAMAGE $ (Per accldent) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ _ OTHERTHAN EAACC 3 ANYAUTO AUTO ONLY, AGO $ EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE S OCCUR 1 CLAIMS MADE L_ AGGREGATE 3 3 3 oEoucTIeLE 3 RETENTION 3 B WORKERANDEMPfi YERS'L8ATIONILIT AND EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNERIEXECUTPM[]E.L. OFFICERIMEMBEREXCLUDED? (Mancintory In NN) WCC5006432012012 07/03/2012 07/03/2013 X TORY LIMITS ER• EACH ACCIDENT s 100,00 ^•^^^ - El, DISEASE • EA EMPLOYEE 3 1000000 It ea, deacrlbe under SPECIAL PROVISIONS below I E.L. DISEASE - POLICY LIMIT 3 500,000 OTHER ESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSION$ ADDED BY ENDORSEMENT I SPECIAL PROVISIONS :ERTIFICATE HOLDER CANCELLATION Brian Leathe 1600 Osgood St. North Andover, MA 01845 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES K CANCELLED eEFORG THE EXPIRATIO DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO DO SO SMALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY IUND UPON THE INSURER. ITS AGENTS OR AUTHORIZED REPREGENTATIVE Robert Sennott/RP FAX; 978.688.9542 ®1988-2009 ACI The ACORD name and logo are registered marks of ACORD ,PORAT10N, ■■ z t s. GENERAL CONTRACTOR • RESTORATIONS PERIOD Linda Hartnett James Thyne/Liz Pelczar 65/65 Cotuit St 147 CD& i' t North Andover, Ma 01845 May 31,2012 Job Description Change exterior door to new fiberglass unit with building permit SINCE 1970 1. Remove existing exterior door and replace with new unit of equal style and dimension. 2. Fiberglass door will be a 36"X80" Thermatru door with no glass. 3. Thermatru sidelight panel will be 14"X 80" with glass halfway up 4. The door unit will be trimmed out with fluted pilasters and sunburst pediment on top Model # ESWDH 761IX23"Fypon brand 5. No allowance for wall or floor frame being rotted 6. No electrical work or alarm security connections. 7. No tile repairs or floor replacement. 8. No Painting 9. Remove and dispose of all trash generated by job. IO.We will install supplied hardware. Total Price Deposit When door is delivered Upon Completion Roger S. LeBlanc, Linda Hartnett James Thyne/l $2285.00 $750.00 $750.00 $785.00 1 5/31/12