The URL can be used to link to this page

Home My WebLink AboutBuilding Permit # 9/17/2015 BUILDING PERMIT ',o� TO o'�� TOWN OF NORTH ANDOVER 0� APPLICATION FOR PLAN EXAMINATION Permit No � Date Receivedp01-.. Date Issued: � Ss�c►�u5�� IlVIPO Alv I: Applicant must complete all items on this page LOCATION2 PROPERTY OWNER fi0otes Print Print 100 Year Structure yes MAP PARCEL n ZONING DISTRICT: Historic District yes n Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial Iteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic 0 Well ❑ Floodplain p Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: ax Location pate IentiN OWNER: Name: No. „i Address: TOWN OF NORTH AND OVER ' �� i� ancy .____.________ Contractor Name: �� w . �' Certificate of Occup Email:` ,J, 1 �„� �i,,, ermit Fee ' Address: o-x Aft . * Building/Frame P Foundation Permit Fee $--- S ------------ Supervisor's Construction Licen' Other Permit Fee TOTAL Home Improvement License: , ARCHITECT/ENGINEER _ Check# � Address: Building Inspector FEE SCHEDULE:BOLDING PERMIT:$12A' „,2 �-• � r Total Project Cost: $ a. � Check No.: C Receipt No.: NOTE: Persons con ting with unregistered contractors do not have access to ty and Signature of Agent/Owner Signature of contracto AM FORTH r e"u'e_ UW1.1 U1 d O"w V I ® �O LAKE h b ver, ass, COCHIC ME WICK y1" RATED U BOARD OF HEALTH Food/Kitchen PER LD Septic System THIS CERTIFIES THAT f!l yr BUILDING INSPECTOR ................ .. ..... .. .... .. ........... Foundation has permission to erect .......................... buildings on . . ....6...° .................................. Rough tobe occupied as ..®..... .. .... .. ......... ............ .. .......................................................ft t M40 Chimney provided that the person accepting this permit shall in every res t 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 PERMITI IN 6 MONTHS ELECTRICAL INSPECTOR 1&d UNLESS I TA T Rough Service .............. ....... ............. ............................... Final BUILDING INSPECTOR GAS INSPECTOR ccupancE 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 Approvedthe Building Inspector. Burner Street No. Smoke Det. X-he Commonwealth ofMassachusetts Department oflradzts-ialAceldents Z Congress Street,Suite 100 µ ' -Boston,Am 02Y�2017 sy4>,K w w w.m ass.go v1dia, %3ke&Compensation Insurance Affidavit:Builders/Contractors/EIectrlcians/Pluml'oexs. TO BH FILED WITH THE PERMTTING A.UTHOMTY Applicant Information Please Print T-gibly NaMo(BiX /In siaess/OxganizaRondividual): l/C., i� / GU .A.ddxess: D 0-�, f3�,C �iU City/state/Zip: M-C--tt1vru vuf. 0/1?`1 ci° Phone#: Axeyou an employer?check the appropriate box: 'Type of project )Vequired): 1�1 am a employer with-.7 employees(full and/or part-time).* 7. ❑New construction 2. 1 am a sole proprietor or partnership and have no employees working for me in &. Fj Remo deliAg any capacity.[No workers'comp.insurance required.] 9. U Demolition 3. 1 am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 F1 Building addition 4.❑lam a homeowner andwill be hiring contractors to conduct all work on my property. 1 will. ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions pro'p'rietors with no employees. 12.Q Plumbing repairs or additions 5.❑1 am a general contractor and 1 have hired the sub-contractors listed on the attached sheet. 13.0 Roof repairs These sub-contractors have employees and have workers'comp.insuraace.T 6.[]We are a corporation audits offlcers have exercised their right of exemption perMGL C. 14.El Other 152,§1(4),and we have nq employees.[No workers'comp.insurance required.] *.Any applicant that checks box 4l must also fill out the section below showingtheirworkers'compensation policy information. T Homeowners who submiti this affidavit indicating they are doing all work andthea hire outside contractors must submit a new affidavit indicating such. YContractors tbat checkthis box must-attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. Jf the sub con6cfors have employees,they rimst provide their workers'comp.policy number. am an employer tliatispi'ovidingtvorlcers'compensation ir2surancefor my employees.'Below is thepolicy artdjob site information. Insurance Company Name: 77 Policy#or Self-ins,Lie.4: C /U 16 3 U� Expiration Date: Job Site Address: 1 G 0 &ttu }7 r V" City/State/Zip: /�` ,(9 L-t Attach.a.copy of the workers'coxnpensation•policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c.152,§25A is a criminal violation punishable by 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.A.copy ofthis statement maybe forwarded to the Office of Investigations of tb o DTA.for insurance coverage verification. Y do Iter'eby eun er at ndpena qfs ofperyury that the information provided above is true and correct Signature: Date: Cl tl Phone 4: F 3 Official use only. Do not-write in this area,to be completed by city or'toren official. City or Town: Permit/License 0 Issuing Authority(circle one): 1.Board.of health 2.Building Department 3.Cityffown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.other Contact Person: ]Phone 4: r M i i f Chi y, f� , Iry v 1 � 02 BRIDLE PATH E RICHARD FLUET OANRACTING, INC PROPOSAL METHUEN, MA 01844 Date Estimate# 6/29/2015 527 Name/Address BROOKS SCHOOL 1160 GREAT POND RD. N.ANDOVER,MA.01845 THORNE Description THORN • CONSTRUCT NEW ROOFS OVER TWO ENTRANCES SUPPORTED BY 8"ROUND FIBERGLASS COLUMNS..CUT ADS AND INSTALL 4'DEEP X 10"SAUNA TUBES,2"X 8"TRIPLE HEADERS,2"X 6"RAFTERS 16"O.C.,5/8"FIR PLYWOOD, 8"ALUMINUM DRIP EDGE,LIFETIME CERTAINTEED SHINGLES.TRIM EXPOSED AREAS WITH AZEK,INSTALL WHITE VINYL SIDING WITH A BEADBOARD CEILING,PAINT COLUMNS.SUPPLY PERMIT AND TRASH REMOVAL.$7600.00 EACH $15,200.00 TOTAL PROPOSAL IS VALID FOR 30 DAYS. EXTRAS OR CHANGES TO BE COMPLETED AT A RATE OF$85.00/HR/MAN. MA.LIC.#50710 HIC.# 106620 FINANCE CHARGE OF 1& 1/2%PER MONTH FOR UNPAID BALANCES. AS WORK PROGRESSES. Total $15,200.00 Signa fe Phone# Fax# E-mail 978-685-7010 978-685-7010 RFC102@verizon.net -7 00CI xv, Ij Vv') .oc J)v Pvttn? 01 it OP ID:CH CERTIFICATE OF LIABILITY r DATE(MMIDDIYYYY) INSURANCE 09/10/2015 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 CONTACT Segreve&Hall Insur.Assoc.inc NAME: 6 North Main St. PHONE rAlc Na Exa' aC No Andover,MA 01810 E-MAIL Michael L.Segreve ADDRESS: CCup mgg I /r,FLUET-1 INSURERS N AFFORDING COVERAGE NAIL INSURED Richard Fluetcting Inc, wsuRERA:Arbella Protection Ins.Co. 41360 Met huen,MA 01844 Bridle Pathh Lane INSURER B:Commerce Insurance Co. 34754 Met INSURER C: INSURER D: INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: 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 Tffima LTR TYPE OF INSURANCE S POLICY NUMBER tgLSX YYY POLICY LIMITS GENERAL LIABILITY `_ EACH OCCURRENCE S 1,000,000 A X COMMERCIAL GENERAL LIABILITY 8600034727 06/12/2015 06/12/2016 PREM SES(Ey a'RTE CLAIMS-MADE occurrence) $ 100,000 �OCCUR MED EXP(Any one person) $ 6,000 PERSONAL&ADV INJURY S 1,000,000 GENERAL AGGREGAE12 ,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRO- PRODUCTS-COMPIO ,000 X POLICY LOC AUTOMOBILE LIABILITY COMBINED SINGLE LANYAUTO (Ea accident)ALL OWNED AUTOS BODILYINJURY(Parp ,000Ei X SCHEDULEDAUTOS BODILY INJURY(Par a000X HIREDAUTOS XV1460 12/01/2014 12/01/2016 (PER ACC ENT)PROPERTY ER GETY 000X NON-OWNEDAUTOS R BRELLA LIAB OCCUR T:] EACH OCCURRENCE $ CESS LIAR CLAIMS-MADE AGGREGATE $ DUCTIBLE - $ TENTION 5 RS COMPENSATION $ AND EMPLOYERS,LIABILITY gEL.EACHACCf1DENT TOTH- A ANY OFFICERIMEMEREXCLUDED?ECLITIVE Y® NIA0104340312 03/31/2015 Q3/31/2016 $ 500,000(Mandatary In NH) - MPLOYEE $ 500,000 -POLICY LIMIT S 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Romarks Schedule,It more space Is requtrod) CERTIFICATE HOLDER CANCELLATION 0000000 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 Michael L.Segreve - O 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 26(2009/09) The ACORD name and logo are registered marks of ACORD Office of Consumer Affairs&Business Regulation OME IMPROVEMENT CONTRACTOR I J 7egistratic 106620 Type: ^= xpiration 7124%2016; Private Corporatiw RICHARD FLUET COJTPAQTING INC. Richard Fluet 102 Bridle Path Lane Methuen, MA 01844 �' w Undersecretary Massachusetts -Department of Public Safety l Board of Building Regulations and Standards iin- i. gir iiCii6i� oii peiviifii License: CS-050710r� RICHARDA.FLUI 102 BRIDLE PAIR METRUEN MA B184 V'N 04/22/2017 Commissioner