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HomeMy WebLinkAboutBuilding Permit # 5/11/2015 TOWN OF NORTHA V APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: I,o IMPORTANT:Applicant must complete all items on this page LOCATION t . ' Print PROPERTY',OWNER '; , *` ?` Pnnt 100 Yea�;Old Structure yes' no IS/IAP NO: PARCEL> ZONING DISTRICT Histone«District. yes no Machine Shop Village yes no 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 0 Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: 6) 7-7 5 tO-/v' x,, cr 7— / Identification Please Type or Print Clearly) OWNER: Name: .,,L -k'_' L° Vic/✓//.-A/ A-,7- 7- Phone: Address: CONTRACTOR Name:�' ? , " Phone: Address:, Supervisor's Construction'License ��, Exp Date: L.. 777, 77 Home Improvement License °� � ' Exp: Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$1200 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ ✓ FEE: $ � Check No.: '`� Receipt No.: NOTE:( Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contracto e� j Plans Submitted ❑ Plans Waived ❑ Certified Plot Pian ❑ Stamped Plans ❑ Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools El Well ❑ Tobacco Sales ❑ Food Packaging/Sales 0 Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY k INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ( ❑ 4�k / � . CONSERVATION Reviewed on 5 / Si natur COMMENTS HEALTH Reviewed on.L, 'x Si nature COMMENTS � `~ i � :� �` �,�` , � �� 'i " `� " ' W )' "7 P .,.' ^... Zonll�-,,g 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 Town Engineer: Signature: I Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signatureldate COMMENTS tkORTH -11ft d o v le r I own at ® �-i .ti. No. 2lop .61 t) h Ver, Mass, coc"Mmew.cx �®A04ATE® S II BOARD OF HEALTH ERMIT T Food/Kitchen no Septic System to �° , 1�,.,�ift BUILDING INSPECTOR THISCERTIFIES THAT ..................... ........ ....................... ................ .......1..................... .................. Foundation has permission to erect .......................... buildings on ...... ... .. .. ......Il!r'...... ....... .......!................... to be occupied as .............................. ......:....:....... Chim oug .... .... ... ... ........: .l.•� .®.. n... .... ®�®�• 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRESI ON H ELECTRICAL INSPECTOR UNLESS CONSTRT S Rough Service .......... .......... ...................... -.�.. r.T .................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® 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. R�; C'--'O T E nN06 F 0 S T E (' S '1' ( ) M Bt) II_ DING + REMODF1- 1 NG This agreement made this 90'day of April,year Two thousand and Fifteen by and between Cote and Foster Contracting,Inc.hereinafter called the Contractor and Mary Honan dpi Matt Lombard,hereinafter called the Owners,witnesses that the Owners intend to add onto the existing deck and remove old at the address of 97 Saw Mill Rd.,North Andover,MA. Now,therefore,the Contractor and the Owner,for consideration hereinafter named, agree as follows: TICLE 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. W(',' )A— TICLE 2 ur,b"I(;t 41 In consideration of the performance of the contract,the Owner agrees to pay the Contractor,in current funds as compensation for his services hereunder$16,980.00 to be paid as follows: Payment 1 -$6,000.00 at start of decking removal Payment 2-$6,000.00 at start of composite decking to be installed Payment 3 -$4,980.00 at completion,of project T'ICLE 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 01844 Tel:978-682-6518 - Fax:978-682-1221 www.coteandfostei.com rd 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-48-OF In witness whereof they have executed this agreement the day and year first above written. ary Ilona, ner NIa t o ba , ner William T.Foster DBA Cote& Foster ~77 1 3Q2 r I 55 V kA bf ' u o 41 I-V S L1 _ a � Id 8 �'� � kA `'e co« Xk A K 'T K% ,LA' Lot # 45 Sawmill Ropd North Andover, MaAchusetts ' lit = 50f Buyer: Steven Leoni, 4,195® ,PWIr NE PD Soot 1423, Pave 239, and Plan 0 708 ' Av9 Q 4 �- W ... -bf 71. � niq Y _ / e-r '1CTE: This is not a survey and is to be used for mortgage purposes only. S90 1 iii '✓ 3®- Do not use offsets for establishing a lot lines for the erection of fences, wells, hedges, etc. r. = hereby certify that the building on this property is located as shown on plan and complies with the zoning set back requirements of the Town of North • '" Ando ver. P'CT i 2?tj CABLE F U-)OD ' LAIN ZONI=VC. fj^ C yR ENGINEERING SERVICES, INC. i 300 CANAL STREET LAWRE:dCE, 4fASSACHUSETTS The Commonwealth ofMassachusetts - - Department oflndustriglAccik7 is Office of Investigations 600 Washington Street Boston,MA 02111 www.massgov/ilia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electxiciansl.Plumbers Applicant Information Please Print JLedb Name(Business/OrganizationlTnd%vidual): e ` Address: City/State/ZiWt-_��( &rW, 1(,14 Phone#: Are you an employer?Check the appropriate b x: Type of project(required): 1.❑ I am a employer with 4I am a general contractor and I 6. F1 Now construction employees(full and/or part-time).* have hired the sub-contractors 7 ❑Remodeling 2,❑ I am a sole proprietor or partner- listed on the attached sheet.z ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9 �]Building addition [No workers' comp.insurance 5. F1 We are a corporation and its 10.[1 Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner,doing all work right of exemption per MGL 11.F1 Plumbing repairs or additions myself. [No workers' camp. c.152,§1(4),and we have no 12.[]Roof repairs insurance required.] employees.[No workers' 13,❑Other, comp.insurance required.] *Any applicant that checks box#1 mustalso 11 outthe sectionbelow showingtheir workers'compensation policy information. i 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 checkthis box must attached an additional sheet showing the name of the sub-contractors and their workers'comp,policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:. f,�! a Policy#or S elf-ins.Lic.#:ZAZ el e d/ r.R 9 JY Expiration Date: / Job Site Address:�� 1 /1..-`L R City/State/Zip: ✓ w / Attach a copy of the workers'compensation Policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder 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 cert under the pains and penalties ofperjury that the information provided above is true and correct. - Si ature: Date: 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 AC®/Z®® CERTIFICATEF LIABILITY INU N DATE(MM/DD/YYYY) 5/6/2015 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 FAX AC, C No:(978)681-5777 1320 Osgood StreetE-MAIL ADDRESS:vickiel@mtminsure.com INSURERS AFFORDING COVERAGE NAIC# North Andover MA 01845 INSURERA:State Auto Insurance INSURED INSURER B AIG Casualty Company Cote & Foster Contracting, Inc INSURERC: 20 Aegean Drive INSURER D: Unit 15 INSURER E: Methuen MA 01844 INSURER F: COVERAGES CERTIFICATE NUMBER:14-15 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 TYPE OF INSURANCE AD S POLICY EFF POLICY EXP LTR POLICY NUMBER IMMIDD/YYYY MMIDD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITYAMA E TORENTED- PREMISES E T DPREMI ES Ea occurrence $ 300,000 A CLAIMS-MADE FXI OCCUR BOP2722545 12/31/2014 2/31/2015 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 11000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY PRO LOC $ AUTOMOBILE LIABILITY EOMaBINEDtSINGLE LIMIT 1.000.000 A ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED BAP2370166 02 12/31/2014 12/31/2015 BODILY INJURY Per accident) $ AUTOSAUTOS HIRED AUTOS $ NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident Medical a ments $ 5,000 UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION X I WC STATIU OTH- AND EMPLOYERS'LIABILITY Y/NI ER ANY PROPRIETOR/PARTNER/EXECUTIVEE.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) 0004962937 6/20/2014 6/20/2015 E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 A Property Coverage BOP2722545 2/31/2014 12/31/2015 Business Personal Property $40,491 Scheduled Equipment 12/31/2014 12/31/2015 Contrctors Equipment $169,928 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. 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 AUTHORIZED REPRESENTATIVE North Andover, MA 01845 P MacDonald CPCU, CIC ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025 r)mnnss m Thm Annon name and Innn am rnnia*ara,l marlrc of annion