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HomeMy WebLinkAboutBuilding Permit #259-2017 - 68 BEAR HILL ROAD 9/13/2016 I L I -J40 Jl BUILDING PERMIT o�No°T bgtio TOWN OF NORTH ANDOVER � o APPLICATION FOR PLAN EXAMINATION ` Permit No#: c e 7 Date Received G� gSSAC HU`S Date Issued: / f3 I PORTANT: Applican�ntnn—must complete all items on this page LOCATION �Q�- 1011 Wdl 14r� d vt.✓ Print PROPERTY OWNER Atk—i- Lyhcick �✓ Print 100 Year Structure yes no MAP 64- PARCEL: 06 ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building WOne family ❑Addition ❑ Two or more family ❑ Industrial VAlteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ` Septic ❑Well ❑ Floodplain ❑Wetlands 0 Watershed'District C7 Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: I; tr? i r, G✓ IS (,/al v) vn t god Oe&-4- OSI >� � AOt Identification- Please Type or Print Clearly G`a� OWNER: Name: pkv- 6 13,e lV±!:� Phone: -78'l-3/s Address: Contractor Name: lvolw G CuI41; 7vcfivH Phone: '?7S- (1a3 Email: Address: �' Cf v $ Sit Mef-AuQ,-, 04th O/ RVI Supervisor's Construction License: C'S -03YO 3 7 Exp. Date: 7N /Z,01 Lq Home Improvement License: Exp. Date: Z7 Z.Z! 7 ARCHITECT/ENGINEER J/)G,h ACG?cl lkIia Phone: q 66V- 666 Address: 3L��6-MQI'm 5T A10^ 464h4 MPf 016bVReg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 $1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 5 DO(7 > " FEE: $ Check No.: Oz�/ Receipt No.: 5C)� 2' 7 NOTE: Persons contracting with unregistered contractors do not have access to the gu anty fund Locationf No.,z,) 4) J/ Date • - TOWN OF NORTH ANDOVEN . � Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ L Check A2-7b - a i Building Inspector 1/ i Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer Taming/Massage/Body Art ❑ Swimmning Pools ❑ I well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ k Private(septic tank, etc. ❑ Pennanent Dmnpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On IZ Signature '`ti COMMENTS G f 'CONSERVATION Reviewed on Signature COMMENTS_ Vk- uJ ��'��� �� t O C, HEALTH Reviewed on Signature I T COMMENTS ) i Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments i i Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: FIRED x Located 384 Osgood Street sgoo S eet EPAR�TtMENT Tem D „n � ,?a ,P' rnpster onasite°, ' 17 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 I DANGER ZONE LITERATURE: lies No MGL Chapter 166 Section 21A—F and G min.$1oo-$1000 fine NOTES and DATA— (For department use) a'A i I Pe�' ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Pennit Revised 2014 r 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 ;���a -Contract n r roposed Interior Work Engineering Affidavits for Engineered products IS OTE: All dumpsterpermits require signn offrom Fire Departmentartment prior to issuance of Bldg Permit Addition Or Decks Building Permit Application ;r« 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 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 ;r 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. 1 NORTH Town of t sAndover O !, h ver Mass wh m 115sAlk coc«Ic«ew't« A- 0 ATED •° ATED S U BOARD OF HEALTH Food/Kitchen Septic System THIS CERTIFIES THAT .....PERMIT c'� L ��� !� BUILDING INSPECTOR ... ............ .... .......... . ................. Foundation has permission to erect ......... .. ...i , �� ......... ................. buildings on ..................... Rough to be occupied as ...... � �1!�. '' .....IAr .� . ... 5!:� ! �'.`. ..1��+..... . . ..1..... Chimney provided that the person accepting this peinit shall in ever respect conform toe terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration a d , Construction of Buildings in the Town of North Andover. �� � ` PLUMBING INSPECTOR �« r��r VIOLATION of the Zoning or Building Regulations Voids this Permit. � Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR_ UNLESS CONST TIO S Rough 000, Service XXV.. . . . .. . .... ....... .... Final BUILDING I ECT R 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. 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. ❑ Pennanent Dwnpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF m U FORM PLANNING & DEVELOPMENT Reviewed On"I IZ) Signature 'j x COMMENTS -ex-uaoy-1 Yc\ ai'o_ CONSERVATION Reviewed on Signature COMMENTS V`-O ua �• '��,,,�,�� �� ,� l O c7• -? HEALTH Reviewed on Siqnature COMMENTS 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 FIREDEPARTMENTsTerripDumpster on site,ayes . �� � ,;� no'', el,' ''= '**' � %• !��'w`� .-+'r.,....,���:''�"'TJ. ��:t� r a+.':� A r. r �,`R•- '. R #•t L� 4 T l�`+��r�,J S a�� �* tr.4 i 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) ❑ Notified for pickup Call Email Date Time Contact Name Doe.Building Permit Revised 2014 The Commonwealth ofMassa�chusettsi z.. DepaTtment ofLAdusi'ialAccidents 1 Congress Street,Suite 100 #' Boston,MA 02114-2017 • ;�'.•:.�;�`` wwsv.mass:govIclia . Wa�:kere Compensation insurance.A,�davit:Builders/Comtrac�o�rslEleeErzcians/Plu�abers. TO BB JE�ED W1'TH THE PBRI1dXTTINO AUTHORITY.A licant Information • Please Print LeaibXy Name(Easiness/©rganizationLCndivzdual): ��(J N 0 6 - CO�'S ry C.S//o N Address: ret Lf,4 City/State/Zip: pn ah C,ty- Dura OCA 4 Phone Are ou an emplcyax? checkllie ap�zopriafe box: Type of project(VegmrW)' 1.71 am a employervna !. , employees(fall and/or part time).* 7. []NeW coristrpction 2.0 I am a sole proprietor or partnership and have no employees Working far me in $. Remo deag any capacity.[No workers'comp.insurance required_] 9. ❑Demolition 3.Q I am a homeownerdoingall workmyselt[No workers'comp.dusoranee required.]t 10 Fj Building addition 4.0 lam a hom.eovmes and will.be hiring contractors to conduct all work on my property. I will ensile that all contractors either have workers'compensation insurance or are sole 11.[]Electrical repairs or additions proprietors with.no employees. 12 0 Plumbing repairs or additions 5.❑I ani a general contractor and I have hired the sub-contractors listed on the attached sheet. 1j.-E]Roofrepairs These sub-contractorshave employees and have comp.inc rce. ' 14. Offer 6.Q We are a corporation POP WEFTS have exoreisedthasrigbt of exemptionperMGL c. - •it.�� 152,§1(4),andwehaveno.employees.vpworkers'comp.insuaaucerequired.] IF . "Any applicant ffa cheeksbox#i must alsoMoutthesection below showingtheirworkers'compensatioupolicyinformation. T Homeowners vvho s6iHif'VT aWavit indicatingthey are doing allwork and thenhire outside contractors must submit a new affidavit indicating such- ?Coafractorsthat checkthisbog nasi aifaghecl an additional sheet showing the name of the sub-contractors and state whether ornot Those eniitres have employees.•Ifthe sub-coriiracfors Piave employees,icy must pro-vide their workers'comp.policy number. I aia an erriployer tlzat ispYopicz'ingtvorkets'compensation insurance for my employees'Belofv is thepolicy aril job site information. _ Insurance Company Name: /��V Policy#or Self-ins.122.#: 0/ 2-0(09!Z) ExpirationDate: !1 ta/4 Job Site Address: �'L-5 ��- ��- - Czty/,State/Zip: N �N`�' �r M4 Attach a copy oftheworkers' compep4a-tionpolicy declaradonpage(showing the policy number and expiration date). c 52 25A is a criminal violation punishable by a fine up to$1,500-00 e to secure cover e as re aired under MGL . 1 , § I'ailur � cl and/or one-year imprisonment,as Well as civil penalties in the form of a STOP WORK ORDER and a fne of up to$250.00 a day against st the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA.for insurance coverage Verification. I do 12ere-by certify u r t]ie airs and penaides ofperjrrU Haat the 1n/bTMaa0n provided above is" ue an`d torr ect Si afore: Date: b O - 6 6 Phone# Official zcse only. Do not write in this area,to be completed by city or toTwn official City or Town: Permit/Liceuse# Issuing Authority(circle one): i 1.Board of Health 2.BuildirngDepartment 3.City/Town Clerk 4.Electrical Xnspector 5.Plumbingluspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for theiremployees. 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 enferprise,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 au the commonWealtlt for any applicant-who lias not produced.acceptable evidence of compliance with.the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any ofits political subdivisions shall. enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance xequirements ofthis chapter have been presented to the contracting authority." Applicants Please f l-out-the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary, supply sub=contractors)name(s),address(es)and-phone numbers)along with their certifcate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees'other than the members orpartuers,are notrequired 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•7n.dustrial. Accidents fok 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 IndustrialAccidents. Should you have any questions regarding the law or if you'are.required to obtain a workers' compensation policy,please call the Department•at the number listed below. Self-insure_d 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 permit/license number which will be used as areference 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"lob 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 futare 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 bum.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 wwwmass.gov/dia i "Junior G. Construction" General Contractor Remodeling & Building 39 Carleton St.Methuen MA,01844 Cell:978-423-8158 Licensed and Insurance PROPOSAL Peter 68 Bear Hill North Andover MA 01845 05/04/16 Place of Work: Same as above Work Detail: • Excavation • Remove trees • Make 2 parking spaces using millstone pavers 20X20 • Make Patio 20'X18'using PA irregular Flagging • Install new drainage • Make new walkway using millstone pavers in the back and front of house • Make a new retaining wall in the front 2 feet tall and the back 3 feet tall using PA Fieldstone 3"to 5" pavers in both • Repair foundation crack • Make new stairs with Goshen Stone Natural Random Color *To initiate the job half money will be needed,one third when the work is half done and the remaining balance upon completion. I Labor& Materials: r OWNER SIGNATURE i CONTACTOR SIGNATURE **IF any changes are made after the signing of this proposal, it will result in additional fees. ** JUNIGCO-01 SSIMOES ACORO� CERTIFICATE OF.LIABILITY INSURANCE DATE(MM/DD/YYYY) �•�+� 9/8/2016 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 HOLDER. IMPORTANT: If the certificate holder 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 lieu of such endorsement(s). PRODUCER CONTACT NAME: Durso 8r Jankowski Insurance Agency PHONE (978)688-7000 AX No:(978)688-7001 11 Saunders Street A/c No, o ExtAIC, North Andover,MA 01845 EMAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Preferred Mutual Insurance Co. 15024 INSURED INSURER B:MSA Group 14788 Santos Reyes DBA Junior Construction INSURER C:Travelers Ins.Co. 19038 39 Carlenton Street Floor 1 INSURER D: Methuen,MA 01844 INSURER E: 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 V'JiTH 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 TYPE OF INSURANCEADDILSUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 500,000 DAMAGE T 7T— CLAIMS-MADE T OCCUR BOP0100720690 11/19/2015 11/19/2016 PREMISES Ea occurrence $ 100.000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 500,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 1,000,000 POLICY F1 PRO LOC PRODUCTS-COMP/OP AGG $ 1,000,000 JECT OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident B ANY AUTO M1 T5030M 01/28/2016 01/28/2017 BODILY INJURY(Per person) $ 100,000 ALL OWNED X SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ 300,000 NON-OWN PROPER X HIRED AUTOS X AUTOS EO P.rraccidentDAMAGE $ 100,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER C ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N 6HUB9F72835316 05/25/2016 05/25/2017 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? F—] N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 if yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Masonry/carpentry Re:68 Bear Hill Road CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1600 Osgood Street Ste 2043 ACCORDANCE WITH THE POLICY PROVISIONS. North Andover,MA 01845 AUTHORIZED REPRESENTATIVE i i I ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Massachusetts Department of Public Safety Board of Building Regulations and Standards I License: CS-084037 Construction Supervisor A SANTOS REYES 39 CARLETON ST x !� METHUEN MA 01844 �M CA-- Expiration: Commissioner 07/15/2018 �lzeoa�nrwncue�cl��a�Ccr�aac�acaeLY� License or registration valid for individuCuse only Office of Consumer Affairs&Business Regulationbefore the expiration dateif found return to: OME IMPROVEMENT CONTRACTOR Tpe Office of Consumer Affairs and Business Regulation registration 128 y 600 10 Park Plaza-Suite 5170 `� . �412712017 DBA Boston,MA 02116 Expiration: JUNIOR G.CONSTRUCTION". SANTOS REYES 39 CARLETON ST. t signature I METHUEN,MA 01844 Undersecretary '