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Home My WebLink AboutBuilding Permit # 3/4/2015 1 TOWN OF NORTHA VE APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued1- 4m�v�ORTANT: Applicant must complete all items on this page :r./ v e r - r / r rrr, ro . / ✓ r i r r / /r /!�1 r/ �/ /, - /PROPERTY / �� ,/, r r / r r r, r .rr r r,r r,,,✓.rrr i /, r✓,...,/,o r ,J..r / r /,it MAP.r N(O//� ,, ,.PARCEL� , „r,,�,ZONING;DISTRICT /,, �,/,,�Histonc;Dis{ract/��, yes ,,nO r II , n°,,,, r �,,/,`ri/, „i,,,;.w rn, ,,,,ir,,.,, yr ,,,i-,, ,,,-c,.✓, ,, ri% Lr� ;, TYPE OF IMPROVEMENT PROPOSED USE 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, , 1Nater/S 'Wer e, DESCRIPTION OF WORK TO BE PERFORMED: C 0-v5 c W i. �.4 69 % z>e r 1 '1 rte” Identification Please Type or Print Clearly) OWNER: Name: / 1 .114-- 5 7-e ^r r Phone: 41 Address: / f CONTRACTOR Name Ad"dress;, °; / r ^" r S/up'ervisor's Construction p Horne"Improvement License r ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$1200 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ ° ' FEE: $ Check No.: Receipt No.: _.-)-4 NOTE: .Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owne'r Signature of contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ t%ORTH 41 1-. 1,% dover own Of ma 0 lab �y Z y T O LAME h ♦er, ass, _Zi COCKICMEWICK 1• � SAO RATeo S U BOARD OF HEALTH Food/Kitchen PERMI La Septic System THIS CERTIFIES THAT ............. .. .. ..... ................ BUILDING INSPECTOR ... ..i. .... ............... .. ........... .. has permission to erect .......................... buildings on ....tor... . ...�.�......... +............ Foundation & A 1111210110 .................................................... Rough to be occupied as ....... ,�q!Y�-........6^ .. . 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 MON ELECTRICAL INSPECTOR a UNLESS CONSTRUCTIO T S Rough Service ................ ... ............ .................... Final BUILDING INSPECTOR 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 Approvedy the Building Inspector. Burner Street No. Smoke Det. November 13, 2014 Proposal submitted to Heidi Gladstone to repair damage sheetrock,change basement windows, remove and replace carpet, strip bathroom wallpaper,paint all in the basement and update electric at the address 105 Fox Hill Rd.,North Andover,MA. Details of project are outlined as follows: 1. Debris Removal—All debris generated by construction to be removed by Contractor. Remove 5 windows, glue down carpet and damaged sheetrock. 2. Repair of Sheetrock-Remove damage sheetrock around columns,beams and misc. wall repairs. 3. Interior Trim—Blend in basement around repaired columns. 4. Windows -Remove existing 5 windows and install Harvey basement vinyl windows. J 5. Fan Vent for Boiler Room - ® Install new Fields CAS-4 combustion make up air fan for gas boiler&hot water heater ® Install water heater inter lock kit CK-20FV/FG ® Install 4"make up air duct from outdoor termination kit to indoor fan ® Associated materials and labor ® System startup 6. Electrical-per enclosed listing. 7. Plumbing—No plumbing work figured into this proposal. 8. Flooring-Main space and stairs to be carpet over concrete with an allowance of $30. /yd. to include removing existing carpet and install of new. Allowance $4,920.00. 9. Paint—All woodwork to be painted with two coats of finish paint. All walls to be primed and two coats of finish paint,remove existing bathroom wallpaper. Smooth ceilings to be primed and two coats of finish paint. All colors to be chosen by homeowner.Natural woodwork such as banister, handrail and thresholds to be natural urethane finish. Total cost to complete- $26,240.00 Thank you for the opportunity to quote your project. Should you have any questions or would like to take your project to the next step,please contact us. Sincerely, William T.Foster Cote and Foster The Commonwealth of Massachusetts _ Deparhnent of IndustrialAccidents - _ Office of Investigations a 1 Congress Street,Suite 100 Boston,YM 02114-2017 v rrms.gov/dire Workers' Compensation Insurance.Affidavit: Buflders/Contractors/Electricians/Plumbers AnT li�ant Information Please Print Leelbly Dame (Business/OrganizationdnIdividual): A?, Address: 4e 6 A' Cid/State/Zip./U t�t 0 /?41 Phone#: Are you an employer?Check the appropriate box: ',Type of project(required): 1.® I am a employer with 4. I am a general contractor and 1 employees (full and/or part-time).* have hired the sub-contractors 6. ®New construction 2.® I am a sole proprietor or partner listed on the attached sheet. 7. ZRemodeling ship and have no employees Tllese sub-contra'ttors have g, ❑Demolition working for mein any capacitY• employees and have workers' 9, El Building addition [No workers'comp.insurance comp.insurance.t required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3,0 1 am a homeowner doing all work officers have exercised their 11,❑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.❑ Other comp.insurance required.] *Any applicant that checks box#1 must also M out the section below showing their workers'compensation polioy 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. $Contractors 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. £ara an employer that is providing workers I compensation insurance for.stay eWloyees. -below is the policy and job sate information. Insurance Company Name: v/r1 r al .V Policy#or Self-ins.Lic.#: r '° Expiration Date: Job Site Address: ' /7-0 Y IL 4- City/State/Zip: / " ' - ,� �' Attach a copy of the workers'compensation policy declaration page(showin 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 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 cer ` sander Pheains and enah es o,f' a 'ury that the ittfonna ion provided above is true and correct. Si afore: -= _ -____ _ -- _ _ Date: _ - — - Phone# '- - wo e — Oaffecial use only. Do not write in this area,to be completed by city or town offrciaZ 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#: <<p1' &XI Z(rrzcnzalrroealLl� ;2/��l;1Jcc^�uJc%l; ffice of Consumer Affairs&Business Regulation j! ME IMPROVEMENT CONTRACTOR ) egistration 107602 Type* e:i I ' Expiration g/5/2016. Supplement C COTE&FOSTER CONT. - WILLIAM FOSTER 20 Aegean Dr Unit 15 Methuen, MA 01844 Undersecretary � I Massachusetts - Department of Public Sa ety vvu ^� Rc^y Corl ii uCtion supei i lii License: CS-035173 WELLIAM T FOSOR i 65 COACH DR r . DRACUT MA 0 ld26 ��`.•�,.. ,1J �. 'i i\ Expiration Commissioner 11/10/2016 1 ,acoCERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD � 12i11i2013o13 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 CONTACT NAME: Victoria Lowes, CISR MTM Insurance Associates PHONE (978)681-5700 FAXAIC No (978)681-5777 1320 Osgood Street E-MAILss:v. k* @mtminsure.com -ADDREINSURER(S)AFFORDING COVERAGE NAIC# North Andover MA 01845 INSURERA:State Auto Insurance INSURED INSURER B:Commerce & Industry Insurance Cote & Poster Contracting, Inc INSURERC: 20 Aegean Drive INSURER D: Unit 15 INSURER E: Methuen MA 01844 INSURER F: COVERAGES CERTIFICATE NUMBER:13-14 Master List 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE T RENTED PREMISES(Ea occurrence) $ 300,000 A CLAIMS-MADE FxI OCCUR BOP2722545 12/31/201312/31/2014 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 $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident 1,000,000 ANY AUTO BODILY INJURY(Per person) $ A ALLOtMJEDSCHEDULED BAP2370166 12/31/2013 12/31/2014 AUTOS X AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident Medical payments $ 5 00O UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ $ WORKERS COMPENSATIONX WC STATU- 0TH- AND EMPLOYERS'LIABILITY Y/N IL ANY PROPRIETOR/PARTNER/EXECUTIVEE.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? E N/A (Mandatory in NH) 0004962937 6/20/2014 6/20/2015 E.L.DISEASE-EA EMPLOYE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 A Property Coverage OP2722545 12/31/2013 12/31/2014 Business Personal Property $39,367 A Scheduled Equipment OP2722545 12/31/2013 12/31/2014 Contractors Equipment $169,928 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. North Andover Town Hall Main St. AUTHORIZED REPRESENTATIVE N Andover, MA 01845 n , P MacDonald CPCU, CIC ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025(201005).01 The ACORD name and logo are registered marks of ACORD