HomeMy WebLinkAboutBuilding Permit #511-15 - 86 STAGE COACH ROAD 12/1/2014Permit No#:`
Date Issued:
LOCATION:
PROPERTY
MAP �`� _._ PARCEL: (p- _ ZONING DISTRICT:. Historic District
.— -
_ RAnr,hina Shnr's
BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
IMPORTANT:
Date Received
must complete all items on this
Vi
yes
�t
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
One family .
❑ Addition
❑ Two or more family
❑ Industrial
❑ Alteration
No. of units:
❑ Commercial
N,Pepair, replacement
❑ Asse'ssory Bldg
❑ Others:
❑ Demolition
❑ Other
❑ Septic El Well
❑ Floodplain ❑ Wetlands
❑ Watershed District
❑ Water/Sewer
DESCRIPTION OF WORK TO BE PERFORMED:
_RJcCe Pe l- -r;ren , Wi nc�a� si 1I x Sig] ncr 12e�mo r� e-� s+ nG
G coNA er5 1 u,)crd ,_-,S • R.e.a►qc�t_ brotAen Sash .
Identification - Please Type or Print Clearly
OWNER: Name: Phone: `
�-
Address:cS�C ?`e, Oaf �c�l NorAh
Contractor 'Name:liil iam l..•HC� hone'
Address:} �c7Wca+Jc' M ��� S dint 10� �md_, MIA of ai C�_
Supervisor's Construction !License- l4 g __. Exp. Date: c 1
Home. Improvement License: 19
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: $ 1 tI ;� •gcP FEE: $ 2-9-:>�
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contracthaTej
re
Z% -'?:>1Z.
to the guaranty fund
_--T
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
Y Building Permit Application
m,- Workers Comp Affidavit
&r,' Photo Copy Of H.I.C. And/Or C.S.L. Licenses
v' Copy of Contract
gi Floor Plan Or Proposed Interior Work
)k- 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/Cross Section/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
Doe: Building Permit Revised 2014
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
PLANNING & DEVELOPMENT Reviewed On
COMMENTS
CONSERVATION
COMMENTS
HEALTH
COMMENTS
Signature
Reviewed on Signature
Reviewed on Signature.
Zoning Board of Appeals: Variance, Petition No:
Planning Board Decision:
Comments
Zoning Decision/receipt submitted yes
Conservation Decision: Comments
Water & Sewer Connection/Signature & Date Driveway Permit
DPW Town Engineer: Signature:
COMMENTS
7- — --
1
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 Pen -nit Revised 2014
%Location Q (� j-'- 0.
No.Date
• TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee
TOTAL $
Check #
28372
Building Inspector
UNIT 101 978-361-6403
ANDOVER, MA 01810
PREPARED FOR:
STEVEN AND JANI MCKAY
86 STAGECOACH ROAD
NORTH ANDOVER, MA 01845
PROPOSAL NUMBER 45
PROPOSAL DATE November 3, 2014
TERMS PROPOSAL MUST BE
ACCEPTED WITHIN 10
DAYS OR PRICE IS
SUBJECT TO CHANGE
QUANTITY DESCRIPTION AMOUNT
1
REPAIR ROTTED WINDOW SILLS IN APPROX. 5 AREAS.
$500.00
1
REMOVE AND REPLACE WINDOW FRAMES W/ NEW PRESSURE
TREATED WOOD IN 2 AREAS. CLEAN AND REPLACE WELLS WITH
STONE
300.00
1
REPLACE ALL ROTTED TRIM AND WORN OUT SIDING AS WELL
AS REMOVE ALL EXISTING GUTTERS
6,400.00
1
INSTALLATION OF NEW GUTTERS
2,800.00
1
REPLACE 9 WINDOWS AND 1 SASH FOR BROKEN WINDOW PANE
3,200.00
1
ANDERSON WINDOWS
6,662.86
**NO PAINT AND R ANY AND ALL PERMIT FEES
SUBTOTAL
19,862.86
0.00
SIGN
TAX
X !/
OTHER
$19,862.86
DIRE TALL INQUIRIES TO: MAKE ALL CHECKS PAYABLE TO:
PAY THIS
Willia McKay William McKay Construction Mgmt,LLC.
AMOUNT
9/8-361-6403
email: 2514bmckay@gmail.com
Attn: William McKay
4 Powder Mill Sq Unit 101
Andover, MA 01810
THANK YOU FOR YOUR BUSINESS!
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Office of Consumer Affairs & Business Regulation
ME IMPROVEMENT CONTRACTORistration:1g04Type:
piration: _,11L19%2016 Individual
:;.
WILLIAM L. MCKAY
WILLIAM MCKAY
4 POWDER MILL UNIT -101-11
T_
ANDOVER, MA 01810 Undersecretary
License or registration valid for individul use only
before the expiration date. If found return to:
Office of Consumer Affairs and Business Regulation
10 Park Plaza - Suite 5170
Boston, MA 02116
Not valid without signature
A� v® CERTIFICATE OF LIABILITY INSURANCE
�1/3�i 14
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. 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).
PRODUCER
MTM Insurance Associates
1320 Osgood Street
North Andover MA 01845
CONTACT Lisa London
NAME:
PHONEAX
JAM No (g]8) 681-5700 F o: (978)681-5777
ADDR1ESS:certificates@mtIDinsure.com
INSURERS AFFORDING COVERAGE NAIC l
INSURER A .Travelers Casualty Ins Co of 19046
INSURED
William McKay Construction Management LLC
4 Powder Mill Sq.
.Suite 101
Andover MA 01810
INSURERB:Travelers Indemnity Company of 25682
INSURERC:
INSURER D:
INSURER E:
INSURER F :
COVERAGES CERTIFICATE NUMBER -14-15 REVISION NUMBER:
THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR
TYPE OF INSURANCE
ADDL
BR
POLICY NUMBER
POLICY EFF
MM/DD
POLICY EXP
MMIDD
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE $ 1,000,000
A
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE X❑ OCCUR
6802D8995351442
/31/2014
/31/2015
DAMAGE TO RENTED
PREMISES Ea occurrence) $ 300,000
MED EXP (Any one person) $ 5,000
PERSONAL & ADV INJURY $ 1,000,000
GENERAL AGGREGATE $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG $ 2,000,000
X POLICY PRO LOC
$
AUTOMOBILE
LIABILITY
EOMINED accidentSINGLE LIMIT 1,000,000
BODILY INJURY (Per person) $
AANY
AUTO
ALL OrSCHEDULED
AUTOS AUTOS
6802D8995351442
/31/2014
/31/2015
BODILY INJURY (Per accident) $
PROPERTY DAMAGE $
Per accident
X
HIRED AUTOS }{ NON -OWNED
AUTOS
UMBRELLA UAB
OCCUR
EACH OCCURRENCE $
_
AGGREGATE $
EXCESS LIAB
CLAIMS MADE
DED RETENTION$
$
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY y / N
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? ®
(Mandatory in NH)
N / A
/31/2014
/31/2015
X WC STATU- OTH-
m
E.L. EACH ACCIDENT $ 100,000
E.L. DISEASE - EA EMPLOYEE $ 100,000
If yes, describe under
DESCRIPTION OF OPERATIONS below
�EUB=93637514
E.L. DISEASE - POLICY LIMIT $ 500,000
DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
Certificate holder as listed below. This certificate of insurance represents coverage currently in effect
and may or may not be in compliance with any written contract.
l X3MI2[7G1l3iLplR113:4
Janet and Steven McKay
86 Stage Coach Road
North Andover, MA 01845
AGUKU L5 (LUIU/UD)
INS095 r7mnnsi ni
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
Laorenza/STEPH
U 1988-2070 ACORD CORPORATION. All rights reserved.
Tha ArnQr1 nama anA Inn^ aro rnni�farael mar4e of ARnpn
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listed on 6o attached sheet°
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woxlsang forme in any capac%ty,
wox�ers' comp. insurance.
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of(cexs have exexcisedtheir
xeguired.]
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right of exemption per MGL
myselT. [I+loworl�ers' comp.
c.152a §I{4}, ardwebavero
employees. LHawoxkexs'
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7. El Remodeling
S. �{ X?emoliizoxt
9. E] Buff&g addition
10.tj Electricalxepairs or ac pions
n.0 Plumbingxepairs or additions
12.p Roofxepairs
mEl 011ier
-------------
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ne :Z. Board of)ealth 2. Building)Department 3. CxtYROY M Clerk 4. Bleetrzealfnspetor S. Embingfuspector
f. Other
bfOrmatzon and -Instructions .
Massach4setb General Laws chapter 152xecpires altsmployexs tapxovidewoxl exs' compensationfortheipemplayees.
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renewal of a lieense or eg g �3' .
operate a busiusa or to comtruct lbuzldings k the comxmnwealtTx fob arty ;
upplicut who has not produced`accep�abla ev deuce of cobzpliaxtce With the insuraxtce caved age rec�uJi�ed"
Addiiionaily; II�CxL cha iex 152, §25C(1) stafeg,,Maither ke commonwealth nor any ofits political subdivisions sha11
enfexinto any eoniractfoxthepexfozznance ofpubiicvtorluntil acceptable evidence of compliance wiilz the insurance
xecluirements orthis chapterhavebeeztpxesenfedfatheconfxaciingautbozlty;"
Applicants
Please fill out the workers' compensation affidavit completely, by chec;kh g the boxes that apply to your sifaafion and, if
iieced=3& supply sub-conixacfox(s) name(.-), addxess(es) andPhonenumb ex(s) alongwiih their cer€ificate(s) of
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Members orpaxilzers, arenotxecluixec to caxryvtorT�exs' compensationinsuxance. IfanLLC o-rUP doeshave
employees, apoIicy%sxeg}rized. Be advhodthattbis a,� davitmaybe mbmitcedfo tbeDeparfnzenG of InrlusirzaZ
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be, xetuxnedto1hecityortcw.a.thattheapp7icaizonz"oxfbepermiEorlicer .eisbe7ngxecxesied,xto theDe aximezztox
Itxdustrial A.ccidenfs. shouldyou have any questions xegaxding the law ox iiyou axe required; to obtain a GYofts'
compe�sationpolicy, please call theTeparbmentattli munberlisted below: Self-:ba=edeoznpazues shouldenter the7r
self insuxaxtce If conga number on, the appxopxzafe line. I
pity or T07M Offtcials
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tow�i):'Acooiii�'adaittSia�7rasbeenociailystatnpedoxmaxkedbyibe`ciiyarfo!zzriarbel%rovxdedoEbe
applxeantasVXfthaEava7idafrzdavitYson le or ivxepP.m for ce es, new az davitmustbet<lledonteacb
year ere ahoxne owner or cifi�en is obtaining alicense ox aexmii notxelated to auybusiness or commercial veutuxe
(z,e. a dog license orpexmitta bmm leaves eta) saidperson b NC)Txogairedto complete this affidavit.
The Office ofl'nvestigatfoni would Mato thank you in advance for youx cooperation and shquldyou have any gtzesfions,
please do Mt hesitate to give us a call.
The Department's address, telephone and faxnuxnber.
Ac —IdMO fdb4a r14 Aceldoea
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Boaton,. 021 It
Revised s 26,os Fax # 617427"7749