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HomeMy WebLinkAboutBuilding Permit #226-14 - 92 BONNY LANE 9/10/2013 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N . (� Date Received Date Issued: :71- IMPORTANT:Applicant must complete all items on this page LOCATION rint PROPERTY OWNER Print 100 Year Old Structure yes nno MAP NO: �PARCEL�ZONING DISTRICT: Historic District yes Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building XOne 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 PERFORMED: 37 1 £1 'Ay /2.ai 5,- -4Y-19-f 45 Identification Please Type or Print Clearly) OWNER: Name:p ;D,5' 7-F,L ev 4 2:REf Phone: Address: 7a 60AIIY-Y 1-9^/e %✓G,e-7,w A-��elvr� pl CONTRACTOR Name: (f4I`-£ ✓ /=dmf t4e Phone: Address: Supervisor's Construction License: �y `�J Exp. Date: Home Improvement License: Exp. 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: $ A7 A00 FEE: $�2 Check No.: Receipt No.:- NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature ofAgent/Owner Signature of contracto �A Ith— Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Sta ped Plans ❑ Location�C�4ji( �C! No. Date �v . - TOWN OF NORTH ANDOVER . Certificate of Occupancy $ Building/Frame Permit Fee $� � Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL I 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 !240 3 COMM E NTS—kepajt1GCc exl��i h G�� • G,C �Yt ! ,h D�f�y1 CONSERVATION Reviewed on l " 10 " Si natur COMMENTS ti llioz HEALTH Reviewed on Signature COMMENTS A 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 Towa Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Departiner t signatureldate 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 No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use El Notified for pickup - Date Doc.Building Permit Revised 2010 Building Department The folEowing is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits o Building Permit Application o Workers Comp Affidavit o Photo CopY Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract o Floor Plan Or Proposed Interior Work o Engineering Affidavits for Engineered products NOTE: All dumpster permits re�,. a sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks o Building Permit Application o Certified Surveyed Plot Plan Li Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o 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) Li Building Permit Application o Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract Li Mass check Energy Compliance Report o 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: Doc.Building Permit Revised 2012 Stap e a dejS IIII IIII IIIA VIII VIII VIII VIII VIII VIII IIIIII r NORTH - • • �. I. - 2 4 E ve' . 0 No. - ,� o4-q. .A. 'h , ver, Mass, . COCHIC-ock �1. ADRATED P'Pa� 7 S u BOARD OF HEALTH Food/Kitchen PERMIT LD Septic System THIS CERTIFIES THAT ..! �.�. i. ..... .... BUILDING INSPECTOR ............... ................. ..... .... .............................. Foundation has permission to erect .......................... buildings on ... ....... ...... w ..................9 g Rou h tobe occupied as ...... .. 1....... ......� ...................................................................... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in 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 IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIOTA S Rough Service .................... ...................................................... BUILDING INSPECTOR Final GAS INSPECTOR Occupancy Permit Required to Occupy Building 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. Smoke Det. SEE REVERSE SIDE The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations I Congress Street,Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Anulicant Information Please Print Legibly Name(Business/Organization/Individual): Address: 1-9 A/ Z)�e U V1 T- City/State/Zips-{C r6Vf/f, /-61- Q /,W,�/ Phone#: �/7 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. 0I 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. 7. ❑Remodeling ship and have no employees These sub-contractors have g. Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers'comp.insurance comp.insurance.t required.] 5. We are a corporation and its 10.El Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no employees. [No workers' 13.0 Other comp.insurance required.] "Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: COM -C J a Svc > US t-"e Policy#or Self-ins.Lic.#: D O /�P16 g 2 Expiration Date: Job Site Address: / c� rG �✓ City/State/Zip: 14-IV-0 e Vf Je 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,aswell 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 certi un r the airs and enalties gtEdua that the ormation provided above is true and correct Si ature: _ -._. ------ ------ ._.._._...- ------. ----- /- ---=Dat ✓ . Phone#: 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#: ACO® DATE(MM/DD/YYYY) ` 40 CERTIFICATE OF LIABILITY INSURANCE 6/6/2013 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 NAME: victoria Lowes, CISR MTM Insurance Associates PHONE (978)681-5700 FAC(A19-No.Extlt No:(978)681-5777 1320 Osgood Street E-MAILDC) •vickiel@mtminsure.com INSURERS AFFORDING COVERAGE NAIC# North Andover MA 01845 INSURERA:State Auto Insurance INSURED INSURER B:Commerce & Industry Insurance Cote & Foster Contracting, Inc INSURERC: 20 Aegean Drive INSURER D: Unit 15 INSURER E: Methuen MA 01844 INSURER F: COVERAGES CERTIFICATE NUMBER:12-13 GL/Auto 13-14 WC 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. ICTR TYPE OF INSURANCE DL R I=WVD POLICY NUMBER MM/DDY EFF MMIDPfY CY YY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 -DAWE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMIE Ea occurrence $ 300,000 A I CLAIMS-MADE R OCCUR BOP2722545 2/31/2012 2/31/2013 MED EXP(Any one person) $ 10,000 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 S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT accident $ A ANY AUTO BODILY INJURY(Per person) $ 1,000,000 ALL OWNED X SCHEDULED BAP2370166 2/31/2012 2/31/2013 BODILY INJURY(Per accident) $ AUTOS AUTOS X NON-OWNED PROPERTY DAMAGE HIRED AUTOS X AUTOS Per accident $ Medical payments $ 5,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ a WORKERS COMPENSATION X We STATU O R AND EMPLOYERS'LIABILITY Y/NLIM ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT S 5'500 000 OFFICER/MEMBER EXCLUDED? N I A (Mandatory in NH) 004962937 6/20/2013 6/20/2014 E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT 1$ 500,000 A Property Coverage BOP2722545 2/31/201212/31/2013 Busienss Personal Property $37,853 Scheduled Equipment BOP2722545 2/31/2012 2/31/2013 Contractors Equipment $166,928 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Certificate holder as listed below CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. 384 Osgood Street North Andover, MA 01845 AUTHORIZED REPRESENTATIVE P MacDonald CPCU, CIC ACORD 26(2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025(2o1oo5).o1 The ACORD name and logo are registered marks of ACORD 0- 9( f� hh P n Ss 1 -d � �! i f8,1F0STER?s COTE CUSTOM BUILDING + REMODELING This agreement made this 9`"day of September,year Two thousand and Thirteen by and between Cote and Foster Contracting, Inc. hereinafter called the Contractor and Peter& Lisa Reed, hereinafter called the Owners,witnesses that the Owners intend to reconstruct a 26'0"x 16'0"deck at the address of 92 Bonny Lane,North Andover,MA. Now,therefore, the Contractor and the Owner, for consideration hereinafter named, agree as follows: ARTICLE 1 The Contractor agrees to provide all the labor and materials to do all things necessary for the proper construction and completion of the work shown and described on drawings. The drawings and specifications are the basis of the contract. ARTICLE 2 In consideration of the performance of the contract,the Owner agrees to pay the Contractor,in current funds as compensation for his services hereunder$27,200.00 to be paid as follows: Payment 1 -$2,200.00 at signing of contract Payment 2 - $5,000.00 at start of demo work Payment 3 -$5,000.00 at completion of frame Payment 4- $5,000.00 at completion of decking Payment 5 -$5,000.00 at completion of railings Payment 6 -$5,000.00 at completion of trim and stairs ARTICLE 3 Final payment on contract amount as agreed above to be paid within ten(10)days of project completion or occupancy. If final payment has not been made within this time a 10% charge per month on the balance due will be charged. All minor punchlist items will be complete as part of the one year warranty on the finish product. Failure to pay balance within ninety(90)days may result in legal action. Initials:, 20 Aegean Drive - Unit 15 - Methuen, MA 01 844 Tel: 978-682-6518 - Fax: 978-682-1221 www.coteandfoster.com ARTICLE 4 Additional work above and beyond the contract agreement: All additional work done to be quoted at the time the client requests the work. The work will be done and billable at its completion. The client has ten(10) days to pay the additional cost after he or she has been billed for it. Initials In witness whereof they have executed this agreement the day and year first above written. Peter Reed, Owner Lisa Reed, Owner ZQZ 'r� William T.Foster DBA Cote & Foster 67/� Office of Consumer Affairs&Bu mess Regulation _ - OME IMPROVEMENT CONTRACTOR j t Registration:.Y_107602 Type:" Expiration: 8/5/2012 Supplement f COTE&FOSTER CONT. WILLIAM FOSTER ,-.. � 20 Aegean Dr Unit 15 Methuen, MA 01844 "' Undersecretary t Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor` � License: CS-085173 W II.LL&M T FOSTER, 65 COACH DR ; ^ o , DRACUT MA 01$26 t t� 954— JJf.�[�c. " 1411 Expiration Commissioner 11/10/2014 1