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Home My WebLink AboutBuilding Permit #521 - 10 WALKER ROAD 1/6/2012 NORTH BUILDING PERMIT 0�X41 ED ,6'gti• TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION * ,� f • h Permit N0: 21 Date Received ��p0RAr.0�Pp 49 9SSACH�1`�� Date Issued: r IMPORTANT:Applicant must complete all items on this page LOCATION !0 Print PROPERTY OWNER Qiao Print MAP No:�3 PARCEL ,Q ZONING DISTRICT: Historic District yes no Machine Shop Village yes o TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ErTwo or more family ❑ Industrial ❑Alteration No. of units: /2 Ung+5 ,ger iwi ❑ Commercial Yll�epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: 9�f-r OLP Cc&i^Lj5 wn A cotAA4--e r +v p 6 . Identification Please Type or Print Clearly) OWNER: Name: Nor (a,cin Phone: o Address: er R8 ,uni; J-L q17— ,40 �blp CONTRACTOR Name:Shc mJ ?,:c gecj rnwga emy\-'-Phone: Wo- 303 4/630 Address: 33 urnn:, ke 5 S x;+2- 22 I N• / rjover /hci, d l qYS Supervisor's Construction License:_ Cr, 91953 Exp. Date: �� /13 Horne Improvement License: _ _ __ _ Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 3000,60 FEE: $ 310.°0 Check No.: /2 4/, Receipt No.: Q 4q , NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner ...- - 10,,!-I Signature of contractor 0.5 12n Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL 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 ❑ ❑ COMMENTS i CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed-on Signature COMMENTS 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 Town Engineer: Signature: Located 384 Osgood Street_ FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department 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 f DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A-F and G min.$100-$1000 fine NOTES and DATA — For department use 1 i i i i i ❑ Notified for pickup - Date Doc.Building Permit Revised 2009 - - - - - r Building Department The following is a list of the required forms=to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits d Building Permit Application Y Workers Comp Affidavit V Photo Copy Of H.I.C. And/Or C.S.L. Licenses wK Copy of Contract ❑ Floor Plan Or Proposed Interior Work o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ 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) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ 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:Building Permit Revised 2008 Location 6 � � No. Date �oR,N TOWN OF NORTH ANDOVER f R 9 i » �a Certificate of Occupancy $ CMUst<�' Building/Frame Permit Fee $ Foundation Permit Fee $ i. Other Permit Fee $ TOTAL $ Check # 24931 Building Inspector SHAWMUT PROPERTY MANAGEMENT 733 Turnpike Street#221 North Andover, MA 01845 Phone: 978.685.2158 • To//Free:800.303.4030 • Fax: 978.687.8640 January 19,2012 To Whom It May Concern: With regard to the kitchen cabinet installation at 10 Walker Street, Unit 11,North Andover,MA, Shawmut Property Management temporarily installed the kitchen cabinets,with the intent to permanently secure said cabinets upon completion of the job. Prior to the completion of the job,the homeowner terminated the contract with Shawmut Property Management. Due to this,it is the homeowner's responsibility to ensure the cabinets are permanently installed. Shawmut Property management is not liable for any damages incurred due to the homeowner's negligence in the completion of this job. Sincerely, Stephen M.Judd, S . Visit us at www.shawmutpropertymanagement.com The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): P(' 72r n a 01 n Address: ,:7 3 3 Tures ��;ILP C/1;& 221 City/State/Zip: Al Anju✓c r root of Phone#: 2c)4 ' 3-05 1/O 3 O Are you an employer?Check the appropriate box: Type of project(required): 1. ffI am a employer with :3 G _ 4. ❑ I 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. 1 7. ❑Remodeling 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. ❑ We are a corporation and its required.] officers have exercised their 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑Roof repairs insurance required.]f employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. f 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 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: R4 kmct Policy#or Self-ins.Lic.#: (:QM M O jQ Expiration Date: U ig 12 Job Site Address: 11) w C,( City/State/Zip: IV19A6!a-e— 0,,ql Q/SYS 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,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 certify under the pains and penalties of perjury that the information provided above is true and correct. Siiznature: 06 Date: / 2 Phone#: iol __3 03 — 034 Official use only. Do not write in this area,to be completed by city or town official. Ci Town:City or P r e mit/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#: OP ID:SH CERTIFICATE OF LIABILITY INSURANCE DAT011051/YYYY) ovos112 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(les) 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 781-247-7800 CONTACT Rodman Insurance Agency, Inc. 781-444-0090 PHONE AX No 145 Rosemary St., Bldg.A E-MAIL Needham, MA 02494-3238 Jeffrey Grosser PROCER DU CUSTOMER ME .SHAWM-4 INSURER(S)AFFORDING COVERAGE NAIC f INSURED Shawmut Property ManagementCo INSURERA:StarInsurance Matt Dykem an INSURER B:Middlesex Mutual Assurance 200 Merrim ack St INSURER C Haverhill,MA 01830 INSURER D: INSURER E: INSURER 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 SHOVVN MAYHAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUB POLICY EFF POLICY EXP LTR lbrawa POLICY NUMBER LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 B X COMMERCIAL GENERAL LIABILITY CPP907840101 10N4111 10114/12 PREMISES Ea occurrence $ 100,00 CLAW SWADE I OCCUR MED EXP(Anyone person) $ 5,00 PERSONAL&ADV INJURY $ Not cov% GENERAL AGGREGATE $ 2,000,00 GEN'LAGGREGATELIMfrAPPLIES PER: PRODUCTS-COMP/OPAGG $ 1,000,00 POLICY PJFCT RO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMB $ (Ea acadent) ANY AUTO BODILY INJURY(Per person) $ ALL OWNEDAUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE $ H IRED AUTOS (Per accident) NON-OWNED AUTOS $ $ UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATIONX TWO STATU- OTH- AND EMPLOYERS'LIABILITY TORY LIMfrS ER A ANY PROPRIErOR/PARTNER/EXECUTIVE YIN C0378090 11/01/11 11/01112 E.L.EACH ACCIDENT $ 500,00 OFFICER/MEMBER EXCLUDED? NIA (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500,00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES ttach ACORD 101 Additional Remarks Schedule,If more space Is required) Employee Dishonesty w/Travelers#104791437 817109-12 $100 000; Errors& Omissions w/Mt Vernon#PM2002160$100,000 w/$10,000 Decd 1121/11-12 Steve Judd Is an employee of Shawmut Property Management comparry and under the workers'com D and GL Ifstbd above, CERTIFICATE HOLDER CANCELLATION NORTH— SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN North Andover,MA 01845 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED R EPRES ENTATI V E O 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD i 9 I V1 as sac husetts - Deh;u-tment of Puhlic Sat'et% Board of Buildinl- Re! and Standards Construction Supervisor License License: CS 97953 STEPHEN JUDD SR z 27 TREMWOOD ROAD j DRACUT, MA 01826x` .H r Expiration: 7/11/2013 Tr#: 19622 I , I I ' t I I XA0RT#j 0 of t over No. 0 m of , lover, Mass., , (V a Moo COCMICME.CK �. FATED P �5 BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT............ .........O.I.C46........................... "" """""'' Foundation has permission to erect......................................... buildings on ... . ..... + .............. ...................�.1............ Rough to be occupied as imn y lam-......... .... ........�`..�A. �-+.T.r..............`�N.1�.... �h e provided that the personaccep mg this permit shall in every respect conform to the terms of the application on file in Final, 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 CONSTRUCTI T S Rough ..................1.... .... ..................................................... ................. Service BUILDING INSPECTOR Final I Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final w No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. FIRE-DEPARTMENT. Burner Street No. SEE REVERSE SIDE Smoke Det. I Contractor Agreement THIS AGREEMENT made the day of 20 /L—,by and between S hccw muff i�sayo¢! vY1a n a�C e n�e1T Hereafter called the Contractor and t-1 U 1 &I-0,r) ,hereinafter called the Owner WITNESSETH that the Contractor and the Owner for the considerations named agree as follows: Scope of Work The Contractor shall furnish all materials and perform all of the work on the property at /0ylo. k2( i2j (A 61'+ 1 I N Andove r Work Performed -17r),S i<< Cub i neI6 and Counter IoP5 Contract Price The Owner shall pay the contractor for material and labor to be performed under the sum of QG U Gd Progress Payments Payments of Contract Price shall be made as follows Signed this day of Tckn u a 2012 ,/ f Owner ✓ 7'�-- `�---�_ Contractor �' t� a Prc),r,0( mcyv� cym e4 �� 06 Qy �-