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Home My WebLink AboutBuilding Permit #772 - 81 PEACH TREE LANE 5/24/2007Permit NO: 7 71 - Date Issued: Cz 4Vz6r,:,, BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received ' ^+ Q �tLED 161•N�\ 6 OL x 1 DESCRIPTION OR WORK TO BE PREFORMED: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ 0 FEE: $�� f Check No.: Receipt No.: 02 0�3`1 NOTE: Persons contracting with unregistered contractors do not have access toe guaranty fund i \ A/ I Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art ❑ Swimming Pools fq• iQ. ; Well ❑ Tobacco Sales ❑ Food Packagi�• sg l�e��• Private (septic tank, etc. ❑ Permanent Dumpster on Site Ll~ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION COMMENTS 9• El DATE REJECTED DATE APPROVED DATE REJECTED - DATE APPROVED i HEALTH ❑ ❑ COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: Comments Comments Water &_Sewer Connection/Signature 8i Date Driveway Permit Located at 184'4sgood Street 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 2007 f. Building Department 4 The following is a list of the required forms to be filled out for the appropriate permit to be obtained F Roofing, Siding, Interior Rehabilitation Permits s Building Permit Application Workers Comp Affidavit Li Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract o Floor Plan Or Proposed Interior Work o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks Li Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses a Copy Of Contract o Floor/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 Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) o 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) o 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 DEPARTMENT:BPFORM07 Revised 2.2007 Location <5 �f' ' ` Al No. ? �� Date MORTM TOWN OF NORTH ANDOVER i _ _' •• SOL Certificate of Occupancy $ NUsE<�' Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # G �� 20239 Building Inspector The Commonwealth of Massachusetts Department of Industrial Accidents Office of Invesd9ations 600 Washington Street klip Boston, MA 02111 r Workers, Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers u des/Contractor Awl cant Information s/Electricians/Plumbers Le ' Name (Business/Organization/lndividual): Please Print bl � t Address: City/State/Zip: Phone #: Are you an employer? Check the appropriate box: 1 • ❑ I am a employer with 4. ❑ I am a general contractor and I Type of project (required): 2Xmployees (full and/or part-time).* have hired the sub -contractors 6. ❑ New construction .I am a sole proprietor or partner- listed on the attached sheet. 1 ship and have no employees remodeling These sub -contractors have working for me in any capacity. workers' com g C] Demolition p insurance. [No workers' comp. insurance W 9. Building addition 5• ❑ e are a coC]rporation and its required.] officers have exercised their 10•WElectrical repairs or additions 3. ❑ I am a homeowner doing all work right of exemptibn per MGL I 1 Plumbing repairs or additions myself. [No workers' comp, c. 152 and we have no required.] insurance ret ' 1 (4 )' q ] employees. [No workers, 12. ❑ Roof repairs comp. insurance required,] 13.E] Other Homeowners who submit "Any applicant that checks box #I must also fill out the section below showing their workers' compensation policy information. t this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicatingsuch. ;Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy , I am an employer that is providing workers' compensation insurance for my employees` Below is the poicy and job site information. Insurance Company Name: Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address: 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 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 of a STOP of up to $250.00 a day against the violator. Be advised that a copy othisnaltstat statement ies in the may be forwarded t � ORDER and a fine Investigations of the DIA for insurance coverage verification. herebyI do Gerd y under the pains and penalties of eryury that the information provided above is true and correct Si nature - D te• Phone #: Official use only. Do not write in this area, to be completed by city or town oJficiaL City or Town: Permit/License # Issuing Authority (circle one): I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: ACORD W. CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDNYYY) 1 05/22/2007 PRODUCER Phone: (978) 475-0400 Fax: (978) 475-2171 THE HOWE INSURANCE AGENCY 4 PUNCHARD AVE ANDOVER MA 01810 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. INSR NSR TYPE OF INSURANCE POLICY NUMBER INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: National Grange Mutual AUTHORIZED REPRESENTATIVE J4—U --- 4JrangeMk K M BROUILLARD REMODELING INSURER B: 04/14/07 C/O KEVIN BROUILLARD 101 EVERETT STREET INSURER C: INSURER D: X COMMERCIAL GENERAL LIABILITY CLAIMS MADE FX� OCCUR LAWRENCE MA 01841 ' INSURER E: DAMAGE TO RENTED $ 500,000 PREMISES (Ea occurence) UUVtKAUCS 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 LTR INSR NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFEC DATE MM/DDTNE POLICY EXPIRATION DATE MMIDD LIMITS Attention: AUTHORIZED REPRESENTATIVE J4—U --- 4JrangeMk GENERAL LIABILITY MP017108 04/14/07 05/11/07 EACH OCCURRENCE $ 500,000 X COMMERCIAL GENERAL LIABILITY CLAIMS MADE FX� OCCUR DAMAGE TO RENTED $ 500,000 PREMISES (Ea occurence) MED. EXP (Any one person) $ 10,000 A PERSONAL & ADV INJURY $ 500,000 GENERAL AGGREGATE $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: - POLICY JECPROT LOC PRODUCTS-COMP/OP AGG. $ 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO AUTO ONLY: AGG $ EXCESS / UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY WC STATU- OTHER TORY LIMITS E.L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTNE E.L. DISEASE -EA EMPLOYEE $ OFFICER/MEMBER EXCLUDED? If yes, describe under E.L. DISEASE -POLICY LIMIT $ SPECIAL PROVISIONS below OTHER: DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS <93CilIIaLw1\I;*:r9J4IJa: •f-A1roil =mww0r•7, TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE BUILDING DEPARTMENT 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 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. Attention: AUTHORIZED REPRESENTATIVE J4—U --- 4JrangeMk Christine ACORD 25 (2001/08) Certificate # 3106 © ACORD CORPORATION 1988 J*,y) c �° 5Nw2, � :I 00 - 35,600 cf enclosed space i (MGL. CA 12 S.60L) 1`A . Masonry only 1 G - 1. & 2. Family Homes Failure -to possess a current edition of the 1 Massachusetts.State Building Code is cause for revocation of this license. Q— DIG SAFE CALL CENTER: (888) 3.4'4 7r233`= _I t 72. 6m QAU2 ,/,mad� Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration '.137695 E)ipr"ration X2/19/2008 Tr# 124418 1 Type Indladual KEVIN M BROUILL,_Q KEVIN BROUILLARV 101 EVERETT ST-trµ'�° LAWRENCE, MA 01843 Administrator License or registration valid for individul. use only before the expiration date. If found return to: Board of Building Regulations and Standards One Ashburton Place Rm 1301 Boston, Ma. 02108 4 4otv without signature C. :i/l2G' ¢ l/O:I7'LiJ2lYI2CU2C%L<f� ./(/G�yQGGiO f �I BOARD QF«BUILDINf RECULATIQ[JS d - license CONS--TRUCTION SUPERVISOR. ( .'Number,. 0 '05438:4 erthdate" 0424'1=195:7 s `fEWpire7s 04/34/2008 Tr. no; 2549$ KEVIN_-M 101 LAWRENCE, BROU1�4gprSR EVERETT SkT i MA 01,843 i i Commissiorier .� ; 1 :I 00 - 35,600 cf enclosed space i (MGL. CA 12 S.60L) 1`A . Masonry only 1 G - 1. & 2. Family Homes Failure -to possess a current edition of the 1 Massachusetts.State Building Code is cause for revocation of this license. Q— DIG SAFE CALL CENTER: (888) 3.4'4 7r233`= _I t 72. 6m QAU2 ,/,mad� Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration '.137695 E)ipr"ration X2/19/2008 Tr# 124418 1 Type Indladual KEVIN M BROUILL,_Q KEVIN BROUILLARV 101 EVERETT ST-trµ'�° LAWRENCE, MA 01843 Administrator License or registration valid for individul. use only before the expiration date. If found return to: Board of Building Regulations and Standards One Ashburton Place Rm 1301 Boston, Ma. 02108 4 4otv without signature C. Lic. # CS 064384 PROPOSAL - CONTRACT SATISFIED Hic. # 137695 CUSTOMERS FOA K.M. BROUILLARD are Our best Reliable moo Service FINISH CARPENTRY & REMODELING ADS Kitchens • Decks • Additions & More SHEET NO: / COMPLETE DRYWALL SERVICE DATE:dp,e,-/ � 7 978-794-0247 ! Proposal Submitted To Work To Be Performed At Name Street Street City State city Date of Plans State. 14,6. Architect Telephone Number ,S yrzt33asem I We hereby propose to furnish all the mater s and p rform all the la or necessary for the completion OVRi ' o� D' m A NA U193 ASe Im CAL k S t^11 F, p A. r ig, oil 1 _ l 1ri / O� 3� J I i e •AO 090 R i i0 Pan d ce cgdmw s All material is guaranteed to be as specified, and the above work is to be performed in accordance with the drawings and specifications submitted for above work and completed in a substantial workmanlike manner. for the sum of 13 690 00Lo013�fr�0 1t�Mb/ %Ifs Dollars ($ with payments to be made as follows:6hEQ�CZ 1,5 Cvm Anb 13111)"ee- -31 Out UP9915 Co ,e `o Parties agree that any change order/amendments to this agreement made at the request of the Customer/ Homeowner, shall be made in writing, sent by certified mail to Contractor's address: 101 Everett Street, Lawrence, MA 01843. Parties agree that Contractor shall charge/bill Customer $ /hr. to incorporate said changes. Thereafter, all changes/amendments shall be incorporated into this agreement and shall be treated as part of the original agreement, dating back to its original signing. Any alteration or deviation from above specifications involving extra costs, will be executed only upon written orders, and will become an extra charge over and above estimate. Owner to carry fire, tornado and other necessary insurance up n a ove work. r Respectfully submitted b vj Note - This proposal may be withdrawn by us if not accepted within 30 days. ACCEPTANCE OF PROPOSAL The above prices, specifications and conditions are satisfactory and are here cepted. You re authorized to do the work as specified. Payment will be made as outlined above. 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