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Home My WebLink AboutBuilding Permit #349 - 70 HUCKLEBERRY LANE 10/21/2011 _ L TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: IMPORTANT:Applicant must complete all items on this age LOCATION 7 S /". &&_ &ir,4- Print PROPERTY OWNER f f`7oo Unit# Print MAP NO: b 6S'.0 PARCEL: OZI(- ZONING DISTRICT: Historic District y0sno Machine Shop Village y100 year-old structure y TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building Ukl family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition 0 Other_ ❑'Septioy Well' ' O''Floodplain� 0,'Wetl'an(ff Q).Watdrsbed0i'striet E]Water/Sewer _ D SCRIPTION OF WORK TO BE PERFORMED: SQ.-1-e a4,� _)� 77-1 A,% (Identification Please type or Print Clearly) OWNER: Name: L-:> Phone: Address: '21 Hyc_hCr_ bac�� -------------- --- ----- --- -- CONTRACTOR Name: Alor; Q(w.��G��1-- _ Phone: '7S- 994/ Address: I z �41 , 6-6— Supervisor's Construction License: S— Exp. Date: feel 13 Home Improvement License: 14/S`1� Exp. Date: 1 Z/zrz (LZ 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. /`M%Total Project Cost: $ —;7 FEE: $ Check No.: i Receipt No.: NOTE: Persons contracting with unregistered contractor's do not have accs to the guaranty fund (Signature of.gent/Owner 4 _: ., _ Signature_of contractor. . ell 1111'' J 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 NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition or Decks o 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/Crossection/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) ❑ 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 ❑ Mass check Energy Compliance Report ❑ 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: Doc.Building Permit Revised 2008mi i 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 DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments I Water & Sewer Connection/Signature& Date Driveway Permit i 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 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 - Date Doc:.Building Permit Revised 2011 June/mi Location c �r A��, No. - Date NORTh TOWN OF NORTH ANDOVER WIT F w 9 �o a: Certificate of Occupancy $ CMUs<� Building/Frame Permit Fee $ aQ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # // 7 247 .�9 Building Inspector ` NORTH Town of _: Andover VO No j 1t 9 _ _ a /a-- ?, o Y dover, Mass.. ML O - LAKE �, T COCMICMEWICK y ORATED P'1, '9S BOARD OF HEALTH Food/Kitchen Septic System PER .M. IT T D BUILDING INSPECTOR THIS CERTIFIES THAT................... ....... .�................... .......... ..................................... Foundation has permission to erect........................................ buildings on .....��'�.........�' a!A!... ........ .. ........ ....................... Rough to be occupied as........I. ................ ..............:.. 1K� .�. ...� .. Chimney e provided that the person accepting this permd all in every respect c fofm to the terms of the apE ion on file in Final 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 CONSTRU T TS Rough .................. ..................................................................................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR 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. I Burner Street No. SEE. REVERSE- SIDE "smoke Det. A. B. Custom Carpentry General Contractor ESTIMATE Contractor/Supervisor Lie. #065280 Joe Blanchet Home Improvement Lie. # 145193 124 Lake Street Fully Insured Haverhill,MA 01832 978-994-6134 Date of Estimate: October 4, 2011 POLL I as mc- Client Name: Joar e &U�G� a'Y2a y Job Location: same Address: 79 Huckleberry Lane North Andover Ma.01845 Phone: 508-246-4465 Description of Work: Repairs to outside of house: -remove existing siding on right side of garage facing house and replace with new 1/2 x 6"primed cedar clapboards. Approximately 1200 linear ft. -remove existing trim on windows on left side of garage and replace with PVC 1 x4 trim. -2na floor corner board over three season porch approximately 2pcs. lx6x10'-0"replace with primed pine. -2 comers boards on the screen porch,2pcs.1x5x4'-0"replace with primed pine. -remove and replace 1x4 trim on window on the 2°a floor located on the back of the house with 1x4 PVC -remove existing stair railings on both sides and replace with PVC and PVC railing. (if post supports are rotted and need to be replace and extra charge for labor and materials will be discussed with home owner before work can be done) -2°d floor master bed room window facing driveway will be removed and replace with a Harvey industries new construction vinyl window and trimmed with 1x4 PVC outside and 21/2 colonial trim on the inside "Any unseen water or insect damage that needs repair will be discussed with home owner before work can be done. Debris: A.B. Custom Carpentry will be responsible for removal of all debris into rental dumpster. Oct 20 2011 11 :37 P. 01 CERTIFICATE OF LIABILITY INSURANCE DAYE(MIWDDfr0Y) CORP. 10/20/2011 ucFR 603..382.4600 FAX 603-.382.2034 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ��urance Solutions. Corporation ONLY AND CONFERS NO RIGHTS•UPON THE CERTIFICATE. HOLDER.THIS CERTIFICATE DOES NOT AMEND,.EXTEND OR, 60• Westville' 9d ALTER THE COVERAGE AFFORDED SY THE POLICIES BELOW. t`osta'q' INSURIRS AFFOi2DING'COVf2AGE k1A1C# r'! INSURED JO5eph .Blanchet a A B Custom Carpentry INSURER A: Merghants 23329 .. .� !F1as�'4'`.:L�7KB'�'St•"`:�::.f-�;��.. ... . .. .I. •.��'. . . .� .. .. � •�INS'.�17JRB: �., ,o .. ,. �. . �� .. - •. �I: .. ._ r_.HIver6�l'.1''•'`; IA°`01832=1TT6'E. _.....:.... � A INSURER �INSIIR COVERAGES .THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT;TERMOR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY 8E ISSUED OR MAY PERTAIN,THE INSORANGE-AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILT R SI TYPE OF INSURANCE POLICY NUMBER EXPIRATION LIMITS LTR NSR DATE MMlDD DATE MM/DDlYYYY GENERAL LIABILITY BOPIOSOZS3 07/07/201.1 07/07/2012 EACH OCCURRENCE $ 1000 01}, x',,:COMMERC1AUGENERAL LIABILITY . .'i PREMISES'Ea auiurrenco '500 'AO "CLAEMgMADE;fl'OCCUR MED.EXP Aft on6., reon - . ;. :... : {•' 'P ERSONALBAD,V:,INURY•I: -10 p,C•1;:1ift.� -------------- .2 .Y• 4.. �•. .'t" .i EN G. GATE. ••8,• '2'O�O.O:'`.�, "GEN'L.AGGI2EGATEtIMIT7APPLIES;PER: ";, •',.'.. PRODUCTS'=GON(P/OP.AG.G'= ,ZyOOO,�.O C ;.•:'..,,,.�v:.. ..POLICY.:X'.'::JECT .• .:LbC. ..,I . . .. .. .. . 7/2011 07/07/2012 AUTOMOBILEUABIUTY•.r;•• i BOPI050253 O7/O 1 .. COMBINED(Eaf�INC : ,. LE LIMIT S nNY AUTO I 000,'00.ITTOS•'i.! - 'BO JURY! $ r ;.. .•. , t '' •. (Por P®isotj) . SCHEDULED RUTOS•i . X HIREb;AUTOS` 1 800{LY.INJURY •'. "`: .. , ;.X .NON.pWNED AUT03,•• • (Per exldein): ' S ;PROPEKTY DAMAGE '(Per ifenl).. .. ; .GARAGE LIABILITY.: •• •AUTO'014LY-EA ACCIDENT $ .EAACC '$ . . .. .. AUTO ONL I. . ACG ''EXCESS:b.UMBREL1g l.lA61LIT.Y. 0 •��• CGUR �:'% � CLAIMS MADE `::'�I�� .. � .. . . A'OOREOATE S' C 13,w RETENTION ':' >YGR [tS,CA11lPENSAfjON . .. i.: .. TORY-LIMITS' .ER. 'A►iDE�nrLOYEPWCIA8ILITY:,.i. / .. Y. N ANY'CROP,RIETORrPARTl:IERlEXECUTIV� I .. 'E.LEAOHACCIDENT ,,: $ p�FF.IISER/MEIVIB6R.EXCLUDED?„' :; :. '.E:L.bISEASEr:EA.EMPLOY;EE (;'(1@lendatot(dlp NH1 :1, •-I{iyp} gscribe,)iniler:•;,;9;,``'.'•:..',. .. .. '. BPEGIIAL•PROVISIONS bbl0w'e,.:.?;,';' . :. :{ • .I,.•. .• ,;E:I::Dt5,Cl15E':POLICY LIMIT.,.$ DESCRIPTION.OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT(.SPECIAL PROV151014S . . 'CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,'FHE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE.CERTIFICATB HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Town of North Andover IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,RS AGENTS OR 120 Main Street REPRESENTATIVES. North Andover,'MA 01845 AUTHORIZED REPRESENTATIVE Marialana Costa LD ACORD.25(2009/01)' FAX: 978.688.9542 . 01988-2008 ACORD CORPORATION. All rights reserved.. The.ACORD name and logo are registered marks of ACORD Oct 20 2011 11 :37 P. 02 IMPORTANT If the certificate holder is:an ADDITIONAL INSURED,the policy(ies) must be endorsed.A statement on this certificate.does not confer rights to the certificate holder.in lieu of such endorsement(s).• 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). DISCLAIMER This Certificate of Insurance does not constitute a contract between the issuing insurer(s),authorized representative or producer,and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the covers a afforded b the policies listed thereon. 9....•..•,... . .... Y ACORD.25'(2009101) 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,orad,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 apartainents 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 co applicant .commonwealth for an nt who has noacceptableY AA t produced a id v ence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the.commonwealth nor any of its political subdvusions 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 3,supply sub-contractor(s)name(s),address(es)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' compensation policy;please call the Department at the number listed below. Self-insured companies should enter their self-insurance Iicense number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed Iegibly. 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 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(ifnecessary)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 homeowner or citizen is obtaining a license or permitnot 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 Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: Tlxe Con-noj-rweal`u of lyfassac'ansetts Department Of Industrial Accidents OfiCe of Investigation$. 600 Washington Street Boston;MA- 02111 Tot.#617727-4900 ext 4406 or 1-877-". SAFE Revised 5-26-05 Fax#617-727-7749 WWW.mass.jZoufdia The Commonwealth of Massachusetts bepartment oflnd'ustrialAccidents Office of Investigations 600 Washington Street Boston,AVIA 02111 www.mass gov/dia Workers' Compensation Insurance Applicant Information Affidavit: Builders/Contractors/Electricians/Plumbers Please Print Legibly Name(Business/organization/Individual)- �'��•(�� (�� ` Address: /Z y - City/State/Zip:_ t( Phone#: Are you an employer?Check the appropriate box: _ 1•❑ I am a employer with 4, Type of project(required): ❑ I am a general contractor and I 216 employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction I am a sole proprietor or partner- listed on the attached sh%et.1 �• ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. [No workers com .insurance 5. 9. ❑Building addition ' p ❑ We are a corporation and its required.] .officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself f No workers' comp. c. 152,§1(4),and we have no insurance re�r ed. r em to ees. 12•❑Roof repairs \] employees.[No workers' comp,insurance required.] 13.❑Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. 7 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. Yam an employer that is providing workers'compensation insurance for my employees ,below is the policy and job site information. Insurance Company Name:_ -,)� �,u G Z U/v . J1ii Policy#or Self-ins.Lic.#: z j Z Expiration Date: Job Site Address:_ e 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 ofMGL 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. I'do herehy certify under the sins and enalties o ` P P fperjury that the information provided above is true and correct. ii nature: 641 Date: oo le; 'none#:--------------------- official use only. Do not write in this area,to he 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#: Additional Work: Any alteration or deviation from above specifications involving extras or vendor price increases will be discussed and will become an added charge over and above the estimate. Work performed at$55.00 per hour/per man Laborers will be$22.50 per hour/per man. Total Cost of Estimate: Siding,trim and stairs $4800.00 Master bedroom window $2 50.00 Total $7350.00 Payment: A deposit is required before work can be started. Starting payment will be 1/2 of total a d the balance due upon completion. tra tors Signature Date G l0 l Aomeowners Sign •e Date 4 Additional Work: Any alteration or deviation from above specifications involving extras or vendor price increases will be discussed and will become an added charge over and above the estimate. Work performed at$55.00 per hour/per man Laborers will be $22.50 per hour/per man. Total Cost of Estimate: Siding,trim and stairs $4800.00 Master bedroom window $2 50.00 Total $7350.00 Payment: A deposit is required before work can be started. Starting payment will be 1/2 f total d the balance due upon completion. tra tors Signature Date uh) -M& omeowner-s Sign ure Date