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HomeMy WebLinkAboutMiscellaneous - 1160 GREAT POND ROAD 4/30/2018 (37) -s� • n �y s owip e� ,` ❑ J __� , ` �, Location /! 6 �� i N Pa No. Date �oRT� TOWN OF NORTH ANDOVER ►.41 n Certificate of Occupancy $ o Building/Frame Permit Fee $ 0MU ACS Foundation Permit Fee $ Other Permit Fee $ or 0 TOTAL $ 1 Check # RI & 3 17402 /��,14( �� Building Inspector f TOWN OF NORTH ANDOVER BUILDING DEPARTMENT LICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING MU s.-3^s .-.._a����•.�L4'a�'1�101���8i"�-�:��I :��,,.�,r<z- 1. �� r � i' �' J,DING PERMIT NUMBER: r7-/ -5— DATE ISSUED: / –a CQ :NATURE: Building Commissioner/I for of Buildings Date Z ;TION 1-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: !l D G �9 i �allo RZ� �� a8 j`e-W l�s >;'C bbd Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: n District Proposed Use Lot Area(sf) Frontage(ft) BUILDING SETBACKS ft Front Yard Side Yard Rear Yard R red Provide R red Provided Required Provided v rater Supply AG.I..C.4o.1 34) 1.3. Flood Zone Information: 1.8 Sewerage Disposal System: C ❑ private0 ZOne Outside Flood Zone 0 Municipal 0 Ou Site Disposal System 0 :TION2-PROPERTY OWNERSHIPIAUTHORMED AGENT ���iui�� v�SUi ,t: 2s 0 rn Dwnerof Record _1010 A. vio e ie Print) Address for Service vv tune Telephone Owner of Record: S � � , .1rr ame Print Address for Service: Z rn iature Telephone CTION 3-CONSTRUCTION SERVICES Licensed Construction Supervisor: Not Applicable ❑ ens Construction Supervisor. License Number tress J � � 7-77 Expiratiatt D e 4� nature Telephone r" Registered Home Improvement Contractor Not Applicable ❑ v npany Name ,7 7 �j y rn MA Registration Number r r ZZ—od i� Z j 7 �l 3 77 7 Expiration Itte nature, Telephone -4 SECTION 4-WORKERS COMPENSATION(M.G.L C 152 § 25c(6) Workers Compensation Insurance affidarit must be completed and submitted with this application. Failure to provide this affidavit will result e i in the denial of the issuance of the buil4lng permit. �. Signed affidavit Attached Yes.......V No.......0 SECTION 5 Description of Proposed Work cher applicable)— New licableNew Construction ❑ Existing Building e Repair(s) Alterations(s) ❑ Addition ❑ f Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: LZ elelC U,/9 A M 6 I SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY _ Completed by permit applicant _? 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of l Construction 3 Plumbing Building Permit fee(a)x (b) 4 Mechanical(HVAC) 5 Fire Protection C! 6 Total 1+2+3+4+5) Check Number SECTION 7a OWNER AUTHORIZATI N TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, d /L 're'd✓p= Q_ ve Vrbo ky 5--4001, er/Authorized Agent of subject property Hereby authorize Q ,LSV(J C TZ Q to act on al f ' matters relative to work authorized by this building permit application. i e of 6,Amer Date ION 7b OWNER/AUTHORIZED AGENT DECLARATION I, as Zer/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief h d t/yt e. Print 23 . e Si ature Owner/ ent Date NO. STORIES SIZE t BASEMENT OR SLAB SIZE OF FLOOR TEVIBERS 1 2 3 SPAN DMENSIONS OF SILLS DIMENSIONS OF POSTS DMENSIONS OF GIRDERS `r HEIGHT OF FOUNDATION THICKNESS = SIZE OF FOOTING X - MATERIAL OF CBM4EY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE - Y� PROPOSAL Nondooffeg snnct/on,/nc. P.8 golf 522 ©tecar,,0©loll Page # 1 of 1 Wages /9�8�m�am Date: May 17, 2004 Submitted To: job Location: Brooks School Same 1 160 Great Pond Road N. Andover, MA 01845 We hereby submit specifications and estimate for: Main House and Front Entry Only Existing shingles will be removed to boarding Roof decking will be re-secured as required r► Aluminum drip edge will be installed on all perimeter edges 6' of ice and water barrier shield will be installed at eaves �► 3' of barrier shield will be installed in all valleys 18" of barrier shield will be installed against all walls and around penetrations * Remainder of roof to be covered with a 15 lb. felt paper r► A self-sealing asphalt shingle in black blende will be applied over underlayments All wall and chimneys will be re-flashed as required �► All pipes will receive new collar flashings �! Valleys will be shingle woven �► Cap-over vents will be installed at all ridges All roof related debris will be removed daily Roof to carry a 25 year material and 5 year labor warranty We hereby propose to furnish labor and materials-complete in accordance with the above specifications,for the sum of: Five Thousand Six Hundred Sixtv dollars(S 5.660.00 )with payment to be made as follows: A deposit of$1800.00 and balance upon completion All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices. Any change or deviation from above specifications involving extra costs will be executed only upon written order and will become an extra charge above the estimate. All agreements contingent upon strikes,accident or delays beyond our control. This proposal subject to acceptance within 14 days and it is void thereafter at the option of the un Wed. Authorized Signature :2:2� �i'Ieir 77C S ACCEPTANCE OF PROPOSAL The above prices,specifications and conditions are hereby accepted. You are authorized to do the work as specified. Payments will be as outlined above. ACCEPTED: Signa®re Date 2 3 Q Signa North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, S150A. The debris will be disposed of in: IJ , (Location of Faci ' y) Signature of Permit Applicant D to NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector ��e -,»omrrw�z�uea� •�'� s a BOARD OF BUILDING REGULATIONS ` License: CONSTRUCTION SUPERVISOR i Number: CS 035313 Birthdate: 05/02/1962 Expires: 05/02/2006 "no: 24551Restricted: 00DONALD G RONDEAU PO BOX 522 DRACUT, MA 01826 Board of Buildln .� " F g egutations and Standards — HOME IMpROVEMENTyCONTRgC1~OR Registration:'i374.34 Expiration: .11% 2/2004 Type.--.-Private Corporation RONDEAU CONSTRUC_TIOiV iNG, DAVID RONDEAU �' 2020 LAKEVIEW AVE. DRACUT,MA 01826 4�_Administrator ' .:.: u r The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 0� Boston, Mass. 02191 Workers'Compensation Insurance Affidavit Name Please Print Name: Location: City Phone # I am a homeowner performing all work myself. 0 I am a sole proprietor and have no one working in any capacity 1 am an employer providing workers' compensation for my employees working on this job. / Company name: � UG 0e)NJ Address r Z.2— City: DR-eqC- Jt A gr 2 Phone#: Insurance.Co. .AA4,6Y21-At) Z Ue1C-!q Policv# ZZ66,13 Company name: Address City: Phone#: Insurance Co. Policv# Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of,a fine up to$1,500:00 and/or one years'imprisonment-as-well-as-civdi.penattles inke.lbrmof-a_STOP WORK_ORDER..and..aline of_(.$1.00.00.)-aday against-me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certi/y Mtnena/fies of erjury that the information provided above is true and correct. Signature Date L Print name L �JJ 4 7 7 // _ `� Phone# �'' '7 , Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensing Building Dept ❑Check if immediate response is required Licensing Board f-1 Selectman's Office Contact persona Phone#: F� Health Department Other MR1--17-2204 12;19 FROM:CLOUTIER INS RGC`r' 9709977230 710:9704592604 F.1'3 ACORD. CERTIFICATE OF LIABILITY INSURANCE PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE CLOUTIER INSURANCE AGENCY HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, 1470 LAKEVIEW AVENUE ORACUT o IMA 01826 INSURERS AFFORDING COVERAGE INSURED RONOEAU CONSTRUCTION INC INSURER A; , INSURER B: PO BOX 522 INSURER C: DRACUT, MA 01826 INSURER D: INSURER E COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOTWITHSTANDING ANY REOUIREMENT,TERM OR.CONDITION OF ANY CONTRACT OR'GIHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED kehEIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH PCUCIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, ILin NSR I TYPE OF INSURANCE POLICY NUMBER FOLIC L TIV£ POLICY EXPIRATIONLIM GENERAL IJAB3LITY EACH OCCURRENCE $ CCIAMERCIAL GENERAL LIABILITY FIRE DAMA3C(Any one SIe) $ CLAIMS MACE 7 OCCUR MED EXP(Any one person) $ 0 PERSONAL 8 ADV INJURY $, •-o _�- GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOPAGG $_0" POLICY PRC LOC AUTOMOBILE LIABILITY COMBINED ANY AUTO (Ea accident) SINGLE LIMIT $ ALL OWNED AUTOS i BODILY INJURY $ SCHEDULED AUTOS i (Per person) HIRED AUTOS BODILY INJURY NON-OWNED AUTOS I (Per BCCdaa1) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY.EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC b AUTO ONLY: AGG S EXCESS LIABILITY EACH OCCURRENCE OCCUR CLAIMS MADE AGGREGATE S $ DEDUCTIBLE - $ RETENTION = $ WORKERS COMPENSATION AND WC STAT'• GTN. EMPLOYERS'LIABILITY i I •.LI.I�(TEA, ioo.00124 El,EACH ACCIDENT $ 0 wo E.L.DISEASE•EA EMPLOYE $ E.L.DISEASE•POLICY UMIT $ OTHER i DESCRIPTION OFOPERATi0NSILOCATIONSNEHICLESMXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS CERTIFICATE HOLDER ADDITIONAL INSURED:INSURER LEITER: CANCELLATION BROOKS SCHOOL SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 1160 GREAT POND ROAD DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN NORTH ANDOVER, MA 01845 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 REPRESENTATIY AUTHORIZED E F ACORD 25-S(7197) ©ACORD CORPOMATION 1986 NORTH � o Town of No. f7 I Yw' -=; - � _�3 _ o y oOLAK dover, Mass., C OC MICMEWICK ADRATED `S G BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System ^�� As S C Ajo0 t Re +^y "13/... BUILDING INSPECTOR THISCERTIFIES THAT..... ..........................................................................I...................... ....... Foundation to erect. Q�... .......... buildings on .... Rough ............. ........ .... Rou h has permission ...� g � g to be occupied as .r r 0'0 S�.N /�+•'1i Chimney ...................... ... ..................................:.......... . ................................................................................ tProvided that the arson accepting this permit shall in every respect eonform to the terms of the application on file in his office, and to the provisions of the Codes and By ws relating to the IWection, Alteration and Construction of Final Buildings in the Town of North Andover. �40 3)B PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough ......... .. 00 �........... ...SPECTOR Service BUILDING IN 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 SIDE Smoke Det.