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Home My WebLink AboutBuilding Permit #352-12 - 77 WEYLAND CIRCLE 10/21/2011 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION / R C;rc 12. Print PROPERTY OWNER F Y 0 Unit# MAP NO: SPrint � ' PARCEL: 4 �1`L�ZONING DISTRICT: Historic District yes no Machine Shop Village yes no 100 year-old structure yes no I TYPE OF IMPROVEMENT PROPOSED USE R 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 M&P-t cl ®;W0111 l`oodplain� s Q Wetlai i �i WatersliecltI)istrict D}Water/Sewer+ t DESCRIPTION OF WORK TO BE PERFORMED: t t. fs1 exp S�;r,�J Lu;i,Jow __L r SW l IV e hJ2 SCh �4 k.. �0 w.s r p` 4 },e 2'?v s4(1 rT&,, )\q g (Identification Please Type or Print Clearly) OWNER: Name: pc"Ll 4 B<4k Fe►v)I o Phone: Address: :7_7 �-QY ��'�� C,rc lo. ----- dy 0r4, 6 JC VP i,- yM/1 ' CONTRACTOR Name: _cis C_cK �`►�e n ytT`^�c�- '�`c Phone: S U e-S�X 3-k3 S. Address: �]� Prrv, cJ2h c� �4a 1( /LJ ,d�v,`� Sri ru �f G 3 Ir Supervisor's Construction License: C S -70 U LI Exp. Date: - x Home Improvement License: ) !q L) 4 y Exp. Date: y C) ARCHITECT/ENGINEER Phone: Address: Reg. No. i FEE SCHEDULE.BULDING PERMIT.•$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $__7L " FEE: Check No.: I U Receipt No.:_ NOTE: Persons co tracting with unregistered contractors do not have access to he guaranty f nd ;Signature of Agent/Ov►rner - ...._,. Signature of contractor <,. . 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 I 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 I Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: k Located 384 Osgood Street FIRE DEPARTMENT -Temp Dumpster on site yes no Located at 124 Main Street I Fire Department signature/date i COMMENTS Dimension Number of Stories:__Total square feet of floor area, based on Exterior dimensions. I Total land area, sq. ft.: ement of Meter location, mast or service drop requires approval of ELECTRICAL: MOVYes No Electrical Inspector DANGER ZONE LITERATURE: Yes No MGL Chapter 166 section 21A—F and G min.$100-$1000 fine t NOTES and DATA— For department use �1 f I I i I ❑ Notified for pickup - Date Doc:.Buildmg pe rmit Revised 2011 June/mi 1 '� 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 i Comp Affidavit ❑ Photo Copy of H.I.C. And/Or C.S.L. Licenses a Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products I NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg i g Permit Addition or Decks o Building Permit Application Certified� ❑ led Su rve yed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Flo or/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 9 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 o 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 from the Board of Apeals that the appeal period is over. The applicant must then get his recorded at the Registry of Deedsc�sion One copy and proof of recording must be submitted with the building application Doc: Doc.Building Permit Revised 2008mi Location za h No. Date NpRT� TOWN OF NORTH ANDOVER F R A ♦ y }'o Certificate of Occupancy $ sCHU <�' Building/Frame Permit Fee $ Y Foundation Permit Fee $ Other Permit Fee $ ` TOTAL $ Check # Building Inspector AORT- 0 TMo over . •��- �� _ o '� dover, Mass.,LAKE �� • � COCHICHEWICK �Dj"�ATE D BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System *I= BUILDING INSPECTOR THIS CERTIFIES THAT........--f 14,i ?j......... .�i. ..V............................................ . i Foundation has permission to erect.... ........ ........................ buildings on ......;NM4..... ............ .. .... Rough to be occupied as............ ...��. 1I!C�!! ... 1.!� r!�w.......Ir�1.��1►fi/.�. il ................. chimney provided that the person ptmg this permit shall in every respect conform to the terms of the application 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 IIT 6 S ELECTRICAL INSPECTOR UNLESS CONSTRUCTI ST Rough ......................................... .......... Service BUILDING INSPE TOR 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. Burner Street No. SEE REVERSE SEDE smoke Det. 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 Applicant Information Please Print Legibly Name (Business/Organization/Individual): �o <_Cy\ (Yl Cvlaee heI+. Address: _7 d�. '- Jk YL c) City/State/Zip: W hal, N�1 O' 1t Phone#: Are on an employer?Check the appropriate box: Type of project(required): 1. I am a employer with 'a 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet.t 7• ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp. insurance. 9. ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.F1 Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.] t employees. [No workers' 13.0 Other comp.insurance required.] *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. i 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. Insurance Company Name: _1 c%.•t 1e Policy#or Self-ins.Lic.#: l J _�.'3 p P)170 fc Expiration Date: G�51�d-O I Job Site Address:---1-7 IA)f J10`3 C;rclt, Nor''`' A.r}over City/State/Zip: Norah Aaayen. 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. I do hereby certif under the pains and penalties of perjury that the information provided above is true and correct. na Si ture: Date: 1 G13-1/t Phone#: 's O 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#: OCT-21-2011 11:02A FROM:ADVANTAGE INS AGENCY 19787944833 T0:16034891568 P.2 iii�Li YL VA Vi 4 iV/Lei!4Vii V+NV.Y1 (ll'7 i'(1VL L/VVL i iiA idyl'r%.04 q " CERTIFICATE OF LIABILITY INSURANCE �a 21201 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATWELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY TtIE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTtI'UTE A CONTRACTBETWEEN THE ISSUING INSURER(S).AUTHORIZED REPRES£MTATtWE OR PRODUCER AND THE CERTIFICATE HOLDER. 1MPORTAMT-If the certiftea 11 hok1wr Is an ADDITIONAL INSURED;the polle y(las)muss be andorsad.N SUBROGATION Is WAIVED,93b*t to the terms and oar►sAkm at the pwK7,certain policies may mgWie an endarsernent.A sb Rent on this eertlfIcatie does not confer e4hts to the ewtBieate holder In Ibu of atrch endo PPMUCFA C ACr. HUB INTERNATIONAL NEW ENGLAND LLC o , eDa w,3m e� 298 BALLARDVALE STREET.UNIT t WILMINGTON,MA01887 �m (898)681-3938 PrtODUCER etaePlstan _ SV420 700 tNStiRE AFPDRDeDGCOV&RAI6E _ _ NAICa INSURED INSURER ATRAVREReCAS mADSuRgIrcorrPm JOSCON MANAGEMENT INC INSURERS TRAVELERS eASUALTYINSURAIICE COMPANYOFAMMCA 72 PROVIDENCE HILL ROAD INSURER C-INE TRAVELERS INDEWiTY COMPANY ATKINSON,NK 09811 INSURER 0- INSURER E _INSURERf lrMRER F: OOVERAGES CERTIFICATE NUMBER; 51001P22B401492 REVISION NUMBER: THIS IS TO CERYITY THAT THE MLICIES OF INSURANCE LISTED BELOW HAVE BEEN MUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REOUIREMENT, TERM OR WMITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES nM- FOBED HMFIN IS SUBJECT TO ALL THE TERIAS,EXCI AISKUR AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS 11489 Rout SUOR POLICY PAF POLICY mti TYPE OFINSURANCE INSR POLICY MMSER IMMODOTMI LIAM WNERALLIAeIfff 680.306IN34A-11 05/30/2011 05/3012012Mv or COMMERCIAL GENERAL LlA91LRY CLAIMS-MADE M OCCUFI $300.000 Ha1EOAtlf4 M X uar,OWkMAuraPERSONAL$ # 000000 2 GSN'LAWA EGATE LIMIT APPLIES PER SZOOO,000 POLICY MR PR0. M LOC 1 $ C AUT0110611LE UAMUTY BA-4588NS1 S-11 05/05/2011 08/05/2012 CO 88BI�NNED ISLE UM T e500.000 ANY AUTO BODILY INJURY(Par pm" $ XL OWNED AUTOS DODILYINJURY(Per umdwM $ SCHEOULEDAUTOS HIRED A" /'ROPE ACtE $ Par NONOWNED AUTOS $ =BRHLLALLwOCCUR EAOHOOCURRENCE $ EMCEES UAB CLJUMS-MADE A(i OGIATE $ DEDUCTIBLE RETENTION A WORKOWCOWEIMAIIIM RIA UB-23OM3062-11 10/05/2011 10/0512012 K 1MOTIVIVS d'" AND EMPLOVERU-UARtUPI VAt Y PROPRIEFOWARTNEPAOT-MMVE❑ E.L.EACH $1,000.000 FF10EfWEIA8W EIICLUDED9 (MandatmY In NLD E.L.DiseASE-EA EAIPLCYE-E $1,000,000 N—.Aeerxlnuemaer liFEr;VU.PROIA N3gdGw E L.Dl$CJISE POLICY LIMIT $1,OOp,p00 098CIIIHMON OF OPERATWNI I LOCATIONet VD1CIM(Attach ACM101,Add end Rwnwm Beh&*A%a mar.apeeo is r"ArOM CERTIFICATE HOLDER CANCELLATiota TOWN OF NORTH ANDOVER SMWLDANY OFTHE ABOVE DESCRIBED POLICIES BECAJ"LLEDB9:dtETHE 1600 OSGOOD STREET B](PIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE NORTH ANDOVER,NIA 01845 WITH THE POLICY PROVISM36 AUTItOli2EO RtPR0i6iTA7IVG O 1986-20D9 ACORD CORPORATION.All d9tda raserved. ACORD 25(20OW69) The ACORD name and Toga are registered maAts of ACORD PROPOSAL BUILDING&REMODELING PFarre Date CONTRACTOR 9/21/2011 72 Providence Hill Road Job Nand Location Atkinson,NH 03811 Window replacement To: Mr.&Mrs.Ferullo 77 Weyland Circle North Andover, MA 01845 Job Number Job Phone We hereby Amna specftdoos and estimates bar. , Joscen Management,Inc.proposes to fumish all Labor,Materials and Equipment for the above referenced job and location. Remove and replace(1)Living Rm double window,(1)Dining Rm double window,(1)Living Rm single window, (1)Dining Rm single window,(1)Guest Rm double window and(f)Daughters Rm double window. Window replacement work to include removal,disposal,window prep for new units,window install,interior/exterior window trim. Exterior trim to be PVC and interior trim to be similar to the existing trim. Window sizes will be smaller than the existing unless custom sizing is ordered,which will increase the cost. Painting by others. Windows: Anderson Tift Wash White on the exterior clad finish,High Performance Low-E4 glass,finelight grills between the glass and insect screen white. The interior of the window unit will come primed ready for painting. Remove and replace the(1)garage window trim for the top and 2 side pieces. Building Permit included per North Andover. Labor pricing above includes staging,disposal,permits and the above items mentioned above. Painting by others. Rot repair will be considered an extra billed on a Time&material basis. Labor @$50/hr per carpenter. We Propose hereby to ramrsh malaial and labor ete in accordance with the above spealcabons,b r the arm of. $7,985.00 Seven Thousand Nine Hundred Eighty Five Dollars Paymord to be made as Umm Deposit @$4,500.00 Payment#2 @$1,742.50 Half completed Payment#3 @$1,742.50 Project Completed Authorized Signature Acceptance of Proposal-/.busrices.q edicabions Signature and conditions are saiisbadory and hereby accepted. You are authorized to do the work as spelled. Signature Payment vd be made as outrned above. �J Date of Acceptance: 4 C ir 80 t rrr_ cons truction Superv�so nti � cn areto '! CS 7p043 r License hard,• 185NATLq N 0SULLIV,q SALISBURY MA *4 N 1952 Expiration. 8126/ 2012 Tr# 2541 p� fie Consumer AffareaB o�/�a�acfucae�a �\ Office of Cons4emer Affairs&B°s�ness Regulation = HOME IMPROVEMENT CONTRACTOR Registration: ,_1.59444 Type: Expiration: 413012012 Private Corporatia JO 'ONMANAGEMENTINC'- JONATHAN O'SULIVANN _;_ _ 72 PROVIDENCE HILL RD ATKINSON, NH 03811:,,`== Undersecretary