HomeMy WebLinkAboutBuilding Permit #566-2016 - 66 EQUESTRIAN DRIVE 11/9/2015 BUILDING PERMIT o� NORTy
'(t LED 6 -y
TOWN OF NORTH ANDOVER �� 5�`,_ _a ,,
APPLICA {^ON FOR PLAN EXAMINATION _ 70
Permit No#: � 2% �' Date ReceivedJ16) Yr-,-
� gSSgcHUSE�
Date Issued: 1 l CA
IMPORTANT: Applicant must complete all items on this page
LOCATION (10 414 v fu14,ru DK-
Print
PROPERTY OWNER / ' �� q&CI 7� 7
�/� 1/ Print 100 Year Structure yes no
MAP PARCEL: `� ZONING DISTRICT: Historic District yes no
Machine Shop Village yes 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 Q Floodplain 11 Wetlands, El Watershed District
r I
0 Water/Sewer
-- _ ,
DESCRIPTION OF WORK TO BE PERFORMED:
Identification- Please Type or Print Clearly
OWNER: Name: Phone:
Address:
L
Contractor Name: �e /uC�� Phone: d 3 37�g tf
Email: e2 C00 ac.�=ri 6@ �r4n 1 C2 P—,
Address:
Supervisor's Construction License: �> �J Exp. Date:
Home Improvement License: 193 4 2q Exp. Date: /0-A0 / 00/7
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE:BULDING PERMIT:$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: 4-1 4Z'- FEE: $ J 50
Check No.: C ` Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
�:
Location lfJ`F' f 1,� �r✓L
No. - 261 _ Date
. - TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $lam'-
.
Foundation Permit Fee $ !�
Other Permit Fee $
TOTAL $
Check /1
`. j Building Inspector
Location -'' e,
No. � ��' t f� Date
1
• - TOWN OF NORTH ANDOVER
. Certificate of Occupancy $
Building/Frame Permit Fee $Z,5-6 —
Foundation
Z56 "Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check#. r
Building Inspector
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑ Taming/Massage/Body Art ❑ Swimming Pools ❑
well ❑ Tobacco Sales ❑ Food Packaging/Sales r
Private(septic tank,etc. ❑ permanent Dempster on Site ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING & DEVELOPMENT Reviewed On M-5- Signature_
COMMENTS
CONSERVATION Reviewed on 14 Si nature li
COMMENTS
HEALTH Reviewed on �M Si nature
COMMENT
lJ
r
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
F,IREDEPAR�TMENT ernDumps r onsite.; yeses
T'
to
+;Lo—ca tedjat5124Maint
Street
.�
'Fi,rEetDepartmerit4signature/d`a`te
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
NOTES and DATA— (For department use)
V"'
VO
IQ Le- te- k&Vl�l e- ue�) Y—C-P—A
❑ Notified for pickup Call Email
E
Date Time Contact Name
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
Photo Copy Of H.1.6-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
Building Permit Application
Certified Surveyed Plot Plan
Workers Comp Affidavit
Photo Copy of H.I.C. And C.S.L. Licenses
4. Copy Of Contract
4. 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
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
Deems, Maura
From: Barry Coorey <bcoorey@yahoo.com>
Sent: Tuesday, November 10, 2015 10:32 AM
To: Deems, Maura
Subject: 66 equestrian Dr
Hi Moura ,this is to inform you that I will not be doing the job on 66 Equestrian Dr. So I would like to stop or cancel tf,
Sent from Yahoo Mail on Android
r
1
t%O R T#i
Town of : s_E 1, Anoverd '
No. 1 -tia 116 ..•.
h ver, Mass I �
o > >
COCHIC"RWICK 7'
�A°R�reo ►P9L`y�(5
qS '�
U BOARD OF HEALTH
Food/Kitchen
PERMISeptic System
THIS CERTIFIES THAT ..........ti- ke!
Qenit'.1..,,... BUILDING INSPECTOR
......
has permission to erect . ....................... buildings on ...�(D... ... �' 11 I+r!...... .....ox
Foundation
Rough
• .. �.
to be occupied as ................... ............... .� .�.. ..... r,&R ... �.................. Chimney
provided that the person accepting this permit all in every respect conform to t3terms of the application Final
on file in 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 EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
UNLESS CONSTRUC I A Rough
Service j
........................................................�.':�:.:++.�............. Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Reguired 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.
66 Equestrian Drive: New deck dimensions '
3'2 C--, '
I- 1813" 18' 0"
4, 0„
(Vk-
8$ 0» �_ 23' 11"
1- `? -7 --------------- Tw:
Existing Deck
11' 11"
Septic
i Z« Sunroorn
131 6
. c
Sliding Door
S�a c.�e
5
onO;t-
2X /o 50 ,5 "
i �X � po5f
�� e
Massachusetts -Department of Public Safety
Board of Building regulations and Standards
_
- ♦,1�1.1t7UlLlil t7 .)V I)CI V 11j-,1
License: CS-082195
'r..r.i_`. -0 .
PETER.TNETT r ',
3 KELLEY RD I IF
%PLAISTOW NH 8386WJ
J.�.•� �rs��:�` Expiration
04102/2016-
Commissioner
'
Office of Consumer Affairs and Business Regulation
= 10 Park Plaza - Suite 5170
" Boston, Massachusetts 02116
Home Improvement Contractor Registration
Registration: 183479
Type: DBA
Expiration: 10/20/2017 Tr# 271479
PLM CONSTRUCTION
PETER NETT
3 KELLEY RD
PLAISTOW, NH 03865
Update Address and return card.Mark reason for change.
l Address j Renewal Employment ! Lost Card
SCA 1 0 20M-05/11
,/// /
r �C' Ce
a License or registration valid for individul use only
Office of Consumer Affairs&Business Regulation before the expiration date. If found return to:
._ gl,? HOME IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Business Regulation
^, Registration: 183479 Type:
- 10 Park Plaza-Suite 5170
Expiration: :10120/2017 DBA Boston,MA 02116
WI1
PLM CONSTRUCTION.
PETER NETT
3 KELLEY RD
PLAISTOW,NH 03865 Undersecretary Not valid ithout signature
Rightfax C3-2 9/23/2015 2 : 32 : 15 PM PAGE 2/002 Fax Server
x >. DATE(MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE
T. `1'IFICATE 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 HOLDER.
IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to
the terms and conditions of the policy,certain policies may require and endorsement. A statement on this certificate does not confer rights to
the certificate holder In lieu of such endorsement(s).
PRODUCER CONTACT
NAME:
INSURANCE SOLUTIONS CORP PHONE FAX
60 WESTVILLE ROAD (A/C,No,Ext): (AJC,No):
E-MAIL
PLAISTOW,NH 03865-2941 ADDRESS:
76R5B INSURER(S)AFFORDING COVERAGE NAIC 1I
INSURED INSURER A: TRAVELERS INDEMNITY COMPANY OF AMERICA
PLM CONSTRUCTION LLC INSURER B:
INSURER C:
INSURER D:
3 KELLEY ROAD INSURER E:
PLAISTOW,NH 03865 INSURER F:
COVERAGES 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.
INSR ADD SUB POLICY EFF DATE POLICY EXP DATE
LTR TYPE OF INSURANCE L R POLICY NUMBER (MM\DD\YYYY) (MIADD\YYYY) LIMITS
GENERAL LIABILITY EACH OCCURRENCE $
COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $
CLAIMS MADE OCCUR. PREMISES(Ea occurrence)
MED EXP(Any one person) $
PERSONAL&ADV INJURY $
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $
POLICY F]PROJECT FILOC PRODUCTS-COMP/OP AGG $
AUTOMOBILE LIABILITY COMBINED SINGLE $
ANY AUTO LIMIT(Ea accident)
ALL OWNED AUTOS BODILY INJURY $
SCHEDULE AUTOS (Per person)
HIRED AUTOS BODILY INJURY $
NON-OWNED AUTOS (Per accident)
PROPERTY DAMAGE $
(Per accident)
UMBRELLA LIAROCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DEDUCTIBLE $
RETENTION $ $
A WORKER'S COMPENSATION ANDX i WC STATUTORY OTHER
EMPLOYER'S LIABILITY Y/N UB-0147N706-14 12/17/2014 17/17/2015 LIMITS g
ANY PROPERITOR/ R/EXECUTIVE
EXCLUDED?
OFFICER/MEMBER EXCLUDED? N/A E.L.EACH ACCIDENT $ 100,000
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000
It yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/RESTRICTIONS/SPECIAL ITEMS
THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE.
JOB SITE 66 EQUESTRIAN DRIVE
-----------------
CERTIFICATE HOLDER CANCELLATION
TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
1600 OSGOOD ST,BLDG 20,STE 2035 BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED
IN ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENT&V VE
NO ANDOVER,MA 01845
?3� <: ..`
A
ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 1988-2010 ACORD CORPORATION. All rights reserved.
The Commonwealth of Massachusetts
Department of IndustrialAccidents
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 Legibly
Name(Business/Organization/Individual): h'P- e- T f /P1 "o el
Address:
City/State/Zip:
Oct ( 5foc."i 0-�4 v �} Phone#: G o 3 7 70 3 7�-- 13
Are you an employer?Check the appropriate box: Type of project(required):
LF-1)am.a.employer with : employees(full and/or part-time).* 7. ❑New construction
2.g I am a sole proprietor or partnership and have no employees working for me in 8. 0 Remodeling
any capacity.[No workers'comp.insurance required.]
9. El Demolition
3.r]I am a homeowner doing all work myself.[No workers'comp.insurance required.]t
10 ❑Building addition
4.F1 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 11.❑Electrical repairs or additions
proprietors with no employees.
12.E]Plumbing repairs or additions
5.❑I am a general contractor ansub-contractors d I have hired the subtlisted on the attached sheet. 13.F1 Roof repairs
g,
These sub-contractors have employees and have workers'comp.insivance.# `/ f �1
6.F1 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.F1 Other lAA f� @
152,§1(4),and we have no.employees.[No workers'comp.insurance required.]
*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 state whether or not those entities have
employees. If the sub-contractors have employ ees,'tliey 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.
Insurance Company Name: ! 5 —
Policy#or Self-ins.Lia#: I�(J Q " q 7 A) 7 C>- Expiration Date: L - / 7 Z 7
Job Site Address: 6 4 v f 5"f r ' '1 City/State/Zip: - SS/ 0(
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 do hereby certan er the pa' A�annalfies of perjury that the information provided above is true and correct.
Si nature: �/" ` i f�(' �. + f Date: l �✓U / l �j
Phone#: U 770 (-
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#:
0cc.,
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 or 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 carry workers'compensation insurance. If an LLC or LLP does have
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 law or if you are required to obtain a workers'
compensatioii'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 pen-nit/license number which will be used as a reference number. In addition,an applicant
that must submit multiple permit/license 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 Department's address,telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street, Suite 100
Boston,MA 02114-2017
Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE
Fax#617-727-7749
Revised 02-23-15 www.mass.gov/dia
7 F •- -7(+ —`.' f ) 0 PROPOSAL NO...
CF� 1 �I
'1_7 .,, yw / 1.1 j ,I' SHEET NO.
/YLOA� -eC DATE
PROPOSAL SUBMITTED TO: f WORK TO BE PERFORMED AT.
NAME ADDRESS
ADDIRZS
t �
DATE OF PLANS
t P ` NE l {L� L. (- I 72 ARCHITECT
1" 1
We hereby propose to furnish the materials and perforin the labor necessary for the completion of.__ -> c'
IY
{ S �K0 iJ
it C
I\C> Zj
All material is guaranteed to be as specified, and the above work to be performed in accordance with t' drawing and ecifications
submitted4or above wore completed in su s antial workmanlike manner for the sum of �-
7 ------ -_--. --�` � Dollars ($ '✓ }
with payments to be made as follows: f ruqL
Respectfully submitted
Any alteration or deviation from above specifications involving extra costs
will be executed only upon written order, and will become an extra charge Per
over and above the estimate. All agreements contingent upon strikes, ac
cidents,or delays beyond our control.
Pe-C fk k- +.� Dote - This proposal may be withdrawn
by us if not accepted within_ days.
ACCEPTANCE OF PROPOSAL
The above prices, specifications and conditions are satisfactory and are hereby accepted.Yo are authorized to do the work
as specified. Payments will be made as outlined above.
Signature CCC...
Date Signature r -�
D8„$ PROPOSAL
-h- MADE IN USA