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Home My WebLink AboutBuilding Permit #699 - 795 JOHNSON STREET 5/12/2010BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: ,?� Date Received Date Issued: —/ 2, —/ (-) ryss H IMPORTANT: Applicant must complete.all items on this page LOCATION 20*id99kck ST PROPERTY Print MAP 210/0 PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Villaqe ve no TYPE OF IMPROVEMENT PROPOSED USE o Residential Date Issued: —/ 2, —/ (-) ryss H IMPORTANT: Applicant must complete.all items on this page LOCATION 20*id99kck ST PROPERTY Print MAP 210/0 PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Villaqe ve no TYPE OF IMPROVEMENT PROPOSED USE v 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 Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: 1,P /I t Sit iN 6)511V C Identification Please Type or Print Clearly) OWNER: Name: ?,I77Z- %�/� �2�,,,,,G-,c/ Phone: Pyr =6 9 % -O �O Address: 7iS- _ e) S'a 1 &77, 1/, ,g tJ7�vc CONTRACTOR Name: yo '80,g6C T Phone: 977 -92o-3o 6 9 Address:—/,9t/ / 7A1t'S iLC't4 P L, I- /"51T Supervisor's Construction License: 1112,99-3 Y3 Exp. Date: Home License: . Date: ARCHITECT/ENGINEER Phone: Address: 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: $%J ,, 60c), 00 FEE: Check No.: !J,..S Receipt No.:— J NOTE: Persons contracting with unregistered contractors do not have access to e g fund Signature of Agent/Owner Signature of contractor �� /,%� ,,� Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public SewerSwimmi Tanning/MassageBArt Swimming Pools g � 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 COMMENTS Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: Comments Comments Water & Sewer Connection/Signature & Date Driveway Permit 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 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 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 2010 No 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 ❑ 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) ❑ 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 fhe`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 2008 Location_ No. Date ' �v TOWN OF NORTH ANDOVER s • Certificate of Occupancy $ 'Is,��— t�' Building/Frame Permit Fee $ Check # /L j 231 its Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Building Inspector 41 11+3 O z A NW C�l rA rA tv ui am w cin O u w w° c ,�, U w a a a°' w a a Z W a°' w a ° u: ° w w c� oca cn cn ui am E H Z N c O v CM 0 m cm m 0 co C C N 0 Z n.. O Z O CO z O U Ci) U) LLI U) W LU W U) 5 So �m c c C�1 cc H ' � O MCL.G O � C � O EA Cc CL N E c Goy LA301: ch m i1.., c a «. O m -N cm c , m My :z co N A EN m +CLCD S0 O M.= o'oaG N .O G ='" O • y : ca Z Ivo to = c o m` o a _W �+r�t .y O W R �dt N W N •E C C=1 v .N V m O 01 C COD Q. m � O oC=� 0 E H Z N c O v CM 0 m cm m 0 co C C N 0 Z n.. O Z O CO z O U Ci) U) LLI U) W LU W U) ACORDCERTIFICATE OF LIABILITY INSURANCE D /D) 05S/06106/22010010M PRODUCER 207.646.7118 FAX 207.646.8294 Peoples Insurance PO Box 1336 Ogunquit, ME 03907 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 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED Mark Bibeaul t 40 Emus Way York, ME 03909 INSURER A: North East Insurance Company 24007 INSURER B: INSURER C: INSURER D: INSURER E: LrUV 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. INSR L7RINSRE ADD'L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MMMDnnnM POLICY EXPIRATION DATE fMM1DDfYYYYI LIMITS GENERAL LIABILITY B18-3167915-03 05/31/2009 05/31/2010 EACH OCCURRENCE $ 300,00( X COMMERCIAL GENERAL LIABILITY DAMAGE TO PREMISES Ea ocurren NcTE5—ce $ CLAIMS MADE J OCCUR MED EXP (Any one person) $ 10,00( A PERSONAL 8 ADV INJURY $ 300,00( GENERAL AGGREGATE $ 600,00 GEN'L AGGREGATE LIMITAPPLIES PER: PRODUCTS - COMP/OP AGG $ 600,00 POLICY1-1 jE LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS 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 EA ACC $ AUTO ONLY: AGG $ EXCESS f UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR � CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION W T AND EMPLOYERS' LIABILITY Y / N TORY LIMITS ER E.L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTNE❑ OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYE $ (Mandatory In NH) I yes, describe under E.L. DISEASE -POLICY LIMIT $ SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS %.r -r% l lr l VM r G nUL V CR CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Patti McCrudden IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR 275 Johnson St. REPRESENTATIVES. No. Andover, MA AUTHOR12EDREPRESENTATIVE Timothv Pinkham/SGL I ne AwRo name and logo are registered marks of ACORD c� The Commonwealth of Massachusetts Department o f industrial Accidents Office of 1'nvestinations 600 Washington Street Boston, AL4 02111 www•mass.gorldia Workers' Compensation Insurance Affidavit. Builders/Contractors/Electricians/Plumbers mlicant Information T7 w _ Name (Business/Organization/l dividual): / Address: City/State/Zip: Phone #: d Z Are you an emplo erq Chk J ec the appropriate box: L ❑ I am a employer with 4. ❑ I am a general __ Ichemployees (full and/or part-time).* 2.Irp] I am a sole proprietor or contractor and I have hired the sub -contractors listed partner_ ship and have no employees on the attached sheet I These sub -contractors have working for me in any capacity. [No workers' comp. insurance workers' comp. insurance. 5. ❑ We are a corporation 3. []required.] am a homeowner doing all and its officers have exercised their .1 work myself. [No workers' right of exemption per MGL comp. insurance required_] t c. 152, § 1(4), and we have no employees. [No workers' ��i�-�� that .Any c-hL r� L comp. insurance required,] 1�, S� at 114+:111 111th i:Le^ ;: Y: n11:$t �(t 1112 out the sectionne. I�omeowners who submit this affidavit indicatin th °P' h°wi b *Weir worias' eomr_,t,..., Type of project (required): . 6. ❑ New construction 7. ❑ Remodeling 8• ❑ Demolition 9. ❑ Building addition 10.7 Electrical repairs or additions 11.❑ Plumbing repairs or additions 17•❑ Roof repairs 13.❑ Other E, ey -=mg work and the hire Outside contractsubmit a new affidavit indicating such. +Contractors that check -this box must attached an additional sheet showing owing the name of or: must r the sub -contractors and their workers��.,�., ' ..,.r:__r _. _ ,. ` `P111Yer mw is Providing workers' compensation insurance for my employees Below is the roll ,y .11lulluauon, information, p c� and job site Insurance Company Name: Policy # or Self -ins. Lie. #. Expiration Date: Sob Site Address: City/Stats/Zip: Attach It 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 ) fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP W penalizes of i of up to $250.00 a day against the violator. Be advised that a co WORK ORDER a fine Investigations of the DIA for insurance coverage verification. FY of statement may be forwarded to the Office of I do hereby oJPerJury that the information provided above is true and correct Official use only. Do not write in this area, to be completed by city or town offciaL City or Town: Issuing Authority (circle one): permit/License # L Board of Health Z. Buildinb Department 3. Ci /Town p 6. Other t3' Clerk 4. Electrical Inspector 5. Plumbing Inspector Contact Person: Phone #: Information an- d 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 maintimmance, 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 umt it 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 -cont mctor(s) name(s), address(es) and phone ni mber(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' comp enation 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 svire to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the perriah or license is being requested, not the .Department of Industrial Accidents. Should you have any questions regarditxg the taw 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 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 permittlicene 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 Office of Investigations would bice to than you in advance for your cooperation and should you have any question, please do not hesitate to give us a call The Department's address, telephone and fax -number.. The Commonwealth of Massachusetts Department of Industrial Accidents Office of harestigat ions 600 Washington Street Boston, I&A 02111 Tel. # 617-727-4900 CXt4O6 or 1-877-MASSAFE Revised 5-26-05 Fax # 617-72.7-7749 �'VUI'.IlIaSS.. �OV�tjI3. ^� � d / tj CL U) 0 00 Z: c) FE U) 0 U) cr (D ; N en LLI ' § _ ° k B � � � \ \ �� °�§ � \ / § \ � \ David Bur ess Mark Bibeault 194 Marsh Hill Rd Building and Remodeling 1l 1dlewood #36 V,,,l794"01826 978-818-3A64 es 9?8- SYS- 4112 Z"Xse.034x4 CsL #68383 FMail- mb6764@aol.com Sales r --CL # 124729 www.markbibeault.com eewyr.+Y�trr,�eiretl- li Pr.A&�r,�iis Date 04/28/2010 Customer Patti McCrudden Address 795 Johnson st. City N. Andover MA. Phone 978-697-0750 Job Description CONTRACT agl Reside entire House and Garage 1. Strip all existing siding and window trim. 2. Tyvek entire house 3. Install new vinyl window trim, with new sills, Insulate around windows where ever possible 4. Install new double 4" vinyl siding 5. Install new wide fluted corners 6. Install new soffits 7. Install new dental trim at top of house, front only 8. Install new shutters, front and sides 9. Wrap all rakes and facures with aluminum 10. Dispose of all construction debris in 15 yd dumpster to be set in yard in a out of the way location Price for complete job as described above comes to $15,600.00 *** This does not include the cost of the permit. Customer will reimburse when permit is issued*** Work will begin as soon as permit is issued and be completed approx 2 weeks All home improvement contractors and sub contractors shall me registered and that any inquires about a contractor or sub contractor relating to a registration should be directed to : Office of Consumer Affairs and Business Regulation, Ten Park Plaza, Suite 5170, Boston Mass., 02116. 617-973-8700 Payment to be made as follows: Total $5200.00 once permit has been issued $5200.00 once front of house is done $5200.00 when job is completed $15,600.00 Patty McCrudden Contract. Pg 2 All materials are guaranteed to be as specified. All work is to be completed in a professional manner according to standard practices. Any alteration or deviation from the above specifications involving extra costs will be executed only upon written orders, and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire, tornado, and other necessary insurance. Our workers are fully covered by Workmen's Compensation Insurance. necessary insurance. Our workers are fully covered by Workmen's Compensation Insurance. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES The contractor and the homeowner hereby mutually agree in advance the in the event that the contractor has a dispute concerning this contract, the contractor may submit such dispute to a private arbitration service which has,,UeA approv by the Office of Consumer Affairs and Business Regulation and the consumer shall be A ' -' q sub it 19,411arbitration as provided in MGL c 142A. Patti McCru44en Home Owner Date 4, Y /,, ,A tvi u es on for Dae 'l -I �Wailfllibeiult Contractor Date NOTICE: The signature of the parties above apply only to the agreement of the parties to alternate dispute resolution initiated by the contractor. The owner may initiate alternative dispute resolution even where this section is not signed separately by the parties