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HomeMy WebLinkAboutBuilding Permit #695 - 75 HILLSIDE ROAD 6/15/2009Permit NO: C Date Issued: BUILDING PERMIT n of "° oT "q� TOWN OF NORTH ANDOVER c? APPLICATION FOR PLAN EXAMINATION T : Date Received —SCS 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: Demo i ion Other Septic . 1Nell Floodplain '11Ve#lands " Ulla#ersedNDstric# Water/Sewei UE5(;RIPTION OF WORK TO BE PREFORMED: T Identification Please Type or Print Clearly) OWNER: Name:_ Phone: ql€-6q' l� 38� ARCHITECT/ENGINEER Address: Phone: Reg. No FEE SCHEDULE. BOLDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ t 157 bo . OA FEE: $ Check No.: ' Receipt No.: NOTE: Persons contracting witijunregistered contractors do not have access to the guaranty fund 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 Water & Sewer Connection/Signature & Date - Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street ;F1RE DEPARTMt,NT -Tem :Dumpster on-site yes no Located at 124 Main Street Fire-Deparrnerit signature/date lo COMMENT'S 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 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 ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of .H:I.C. And/Or C.S.L. Licenses. -p 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/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) LP 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: INSPECTIONAL SERVICES DEPARTMENC:BPFORM07 Revised 2.2008 Location 4115 � No. A Date NTOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # // / 22`c Building Inspector m Oco w v Cl) O U p O x U G x ■ L O p oG co C w p w v cn G LL o O CG ca G w Q m i N i 8 m CD i O co c CD ■ L O 1 Z o ` o O O C Q A. �N m w P-4 Z O U CD O co c CD ■ L O 1 Z o ` O O C c N O CD cm c c V Q 4 OCcm y CJ CD 0 co V CL c O m CD c O •~ := o O d4-1 MCC �Cc m N ...� E a twod :..0 :. _...... ts •Q., ca c0 CD CF cac p _ - = s C m Q Q a N CO) E c ocA -a A. � o � r ai m c E E low y: N N CD �. N m y... Qm m N �yy c CO c cc o 1 : O p CLU v m H m � cr- � tm c am c o Q 'o • N v C H +r coo a c Q 0�i!ymc o :a 0 Cc m .y to �• C a.=.. O m •N Z O C.3 CD COD _ d m� O. 0 =tea m:10 w P-4 Z O U CD O CD ■ L O 1 Z y O O C CD cm c ca Q 4 OCcm y O O CD 0 co V O •~ O d4-1 MCC �Cc twod :..0 :. _...... ts •Q., ca c0 ci Z cac p _ c ■� C m a CO) Q Information a nd 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, associatioun or other legal entity, employing employees. However the own6rof 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 sucb 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 *o construct buildings in tine commonwealth for any applicant who has not produced acceptable evidencezir compliance with the insurance' coverage required." Additionally, MOL 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 preswited to the corttsacting authority." Applicant Please fill out the workers' compensation, affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), addrms(es); aund phone numbers) along with their certific a*s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members orpm ners, are not required to cant' 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 Accident 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 .app.lication 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'iiceme number on the'appropiiate Tine. 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/licrose number which vvill be used as a reference number. In addition, an applicant that must submit multiple pennit1 icelm applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should writt "all locations in(city or sown)." 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 affudavrt 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 flog 1 license or permit to bum ieavrs etc.) said person is NOT,required to complete Buis affidavit The Office of investtgations 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. The Commonwealth of Massachusetts Department of 13ndustrial Accidents Office of Investigations 600 Washington Street Boston, lvlA 02111 TeL # 617-7274900 ext 406 or 1-8.77-MASSAFE Revised 5-26-05 Fax 4617-727-7749 www.mem.gov/dia h, jr N The Commorzwealfh ofMassachusetts Department of industrial Accidents Office of Invesdg ations 600 TfZashington Street Boston, MA 02111 ? . www mass gov/dia . Workers' Compensation 1s4rance Affidavit. Builders/Contractors/Electricians/Pi mbers M iCant Inforrnafinn Name (Business/Organiraiiorvindividual) Address: i y i ;N n �I _ S ► I �i CT 1� Are u an employer? Check the appropriate box: 1. I am a employer with Z.r. 4. ❑ i am a general contractor and I employees (full and/or part-time).* 2. ❑ I am .a.sole proprietor or have hired the sub -contractors listed partner. on the attached sheet ship and have no employees' . These stj&contractors have working for me in any capacity, [No workers' comp. insurance . workers' comp. insurance. 5. ❑ We are a corporation and its required.] 3. ❑ 1 am a homeowner doing officeas have exercised their all work right of exemption per MGL Myself . [No•w.orkers' comp, c. 152, § 1(4),'and,we have no insurance required.] t ..employees. [No workers' cOmP. insurance required.] 2 Type Of project (requited): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. (] Building addition 10.[3 Electrical repairs or additions 11.❑ PIumbing repairs or additions I2.❑ Roof repairs 13.70ther "Atry applicant that chmb krZ # 1 must elso fill out the section WDW showin theirworkers' oom t— t tiomeownet� who submit tha atiidavit indicatting they am doing an work and than hire outside c nuactors Policy submit a n xCantraotors that check this box musta_ftehed an additioasl sheer showing. the namb-e of the su comractors aew affidavit indi�tinF succi nd their workers' comp,is Fr••c5' ir�fimflation. !art an ewkyeP that is-Pr0vi eng:war&ers' compensation insurancef or a & information. A mil' Pees: Below is the poifep and job site . Insurance Company Name: Policy # or Self -ins. Lic. #:W/�(� _MO' r (7 1 u Expiration Date: t)1 p Sob Site Address:=�� City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy Failure to snumber and expiration date ecure coverage as required under Section 25A of MGL c. 152 can iead 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 5250.00 a day against. the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations oftheDIA for insurance coverage verification. I do her under the pains and penalties of perjury tYtat the infor►nation provided above is true and correct offjcw us��y. [ Do not write in this area, m be completed by t* or town officioL City or Town;: � Permit/License # Issuing Authority (circle one): L Board of Health 2 Building Department 3. City/Town Cierk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone #: T\ k <mx M v Z m Z D r r Oil 1 ^r 1y' yr{ n C� C/ PSI 0 10 (i+t tit OI (n C- 0SIG o rn c O G OD a, .1G r fo OD d T\ S_ <'+F, _. � F � 1. ... _}��. � ._ .. a ',.� C ` a �r n 1 � Of maM 4 HOME ENERGY, INC. JOHN J. CALL 14 EDGEHILL ROAD HAVERHILL MA. 01830 TELEPHONE (978) 374-6256 I0 q79 iqy , -)o Estimate for. Address City/Town: Telephone: Appointment date: Steve & Francine Jones 75 Hillside Rd. No. Andover, MA 01845 978-691-5385 This proposal is quoted for acceptance within thirtydays. This proposal becomes a upon signing by both parties. Once the contract is signed all prices are firm. Any ry permits will be procured by the contractor. All workmanship is unconditionally ?ed. Product warranties will be registered upon project completion. Our usetts contractor supervisor license is#036866. Pay ment will be made as 1/3 deposit, 1/3 upon delivery of materials, 1/3 completion of the contract. IROPOSAL: We are submitting these specifications for your approval and acceptance; Our agreement includes material and labor for the following work : vu•�nne_ Jrcurm^ i ivNb: t;omplete liability and property damage insurance will be carried by this company until completion of work. Owner to cant' fire, tornado, and other necessary insurance as we cannot be responsible for acts of God or other casualties beyond our control. Our employees are covered by workers compensation insurance. You have the unconditional right at any time within three business days after the date of acceptance to cancel this agreement, providing you notify us by phone or in writing by ordinary mail at our main office. Estimator: f'*"'Approxim ate Completion date: Acceptance er: Date: a« COST 1. Remove & replace siding on southside adjacent to driveway. Install new Tyvek moisture barrier and primed cedar $2184.00 clapboards, approx 280 sq.ft. 2. Remove & replace siding on southside of dormer adjacent to $633.60 driveway. Install new Tyvek moisture barrier and primed cedar clapboards, approx 72 sq -ft. 3. Replace 200 lin.ft. misc. clapboard. 4. Repair fascia on dormer approx. 20 lin.ft. with #2 primed $780.00 pine. S. Install energy efficient dryer vent and 25 ft. insulated hose. repair existing hole. $275.00 6. Install new Panasonic Whisper Green Ceiling fan in bathroom and vent throuh exterior wall. Remove and replace existing sheetrock ceiling. $820.00 7. Electrical allowance to install fan & light. Homeowner to purchase light if separate from fan. $250.00 8. Disposal & building permit. $800.00 vu•�nne_ Jrcurm^ i ivNb: t;omplete liability and property damage insurance will be carried by this company until completion of work. Owner to cant' fire, tornado, and other necessary insurance as we cannot be responsible for acts of God or other casualties beyond our control. Our employees are covered by workers compensation insurance. You have the unconditional right at any time within three business days after the date of acceptance to cancel this agreement, providing you notify us by phone or in writing by ordinary mail at our main office. Estimator: f'*"'Approxim ate Completion date: Acceptance er: Date: a« \,vvcRHur_0 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 ACM OF LIABILITY INSURANCE OP ID DJ DATE(MM/DD/YYYY) 1 .CERTIFICATE HOMEE-1 06/09/09 PRODUCER McSweeney & Ricci Ins Ag Inc 420 Washington Street THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P.O. Box 850984 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Braintree MA 02185 Phone:781-848'-8600 Fax:781-843-8807 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: National Union Fire Insurance INSURER B: National Grange Mutual EACH OCCURRENCE $2,000,000 INSURER C: Home Energy Inc 14 Edgehill Rd Haverhill MA 01830 INSURER D: INSURER E: 07/01/08 \,vvcRHur_0 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 BEEN REDUCED BY PAID CLAIMS. LTR NSR TYPE OF INSURANCE POLICY NUMBER POLICYEFFECTIVE DATE MM/DD/YY PO EXPIRATION DATE MM/DD/Yl LIMITS C,Ei.BRAL LiAfitLtiY EACH OCCURRENCE $2,000,000 B X COMMERCIAL GENERAL LIABILITY MPB6176H 07/01/08 07/01/09 PREMISE s(Ea occurence) $500,000 MED EXP (Any one person) $10,000 CLAIMS MADE a OCCUR PERSONAL & ADV INJURY $2,000,000 GENERAL AGGREGATE $4,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $4,000,000 POLICY PRO- JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) .. ALL OWNED AUTOS r... -_ .. 1 i BODILY INJURY $ ` 'SCHEDULED AUTOS.... _ _- " (Per person) •,. _ - • • HIRED AUTOS.»�.-.._. BODILY INJURY $ NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EAACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR ❑ CLAIMS MADE AGGREGATE $ DEDUCTIBLE, $ RETENTION $ $ WORKERS COMPENSATION AND X TORY LIMITS ER A EMPLOYERS' LIABILITY _ E.L. EACH ACCIDENT $500000 ANY PROPRIETOR/PARTNER/EXECUTIVE WC3 6 3154 9 10/01/08 10/01/09 OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ 5 0 0 0 0 0 If yes, describe under E.L. DISEASE - POLICY LIMIT $ 5 0 0 0 0 0 SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS CFRTIPICATG"uni nco I Kill r- "' ..: CMELROI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL TE MAIL! 10 DAYS WRITTEN City do f Melrose Building Department NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL 562 Main Street IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR Melrose MA 02176 REPRESENTATIVES. ACORD 25 (2001108) v © ACORD CORPORATION 1988