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Home My WebLink AboutBuilding Permit #319 - 105 BERKELEY ROAD 10/26/2007 NORTN BUILDING PERMIT 0*"'Lev ,bgti TOWN OF NORTH ANDOVER or ' "" " •6 0 APPLICATION FOR PLAN EXAMINATION * o s Permit NO: Date Received rr�� s yy SSAcmu Date Issued: V V - IMPORIANT:Applicant must complete all items on this page 2 .4. § 3 _ �. " K U .... n9 y P10PERT OWNER ' aa rfi �1t �� a stl t7 s < R: s nt xtrr "k- sH. .�vc.. -kt PyARCEL f 2 r 'NING DJ�T I T H�stor�c�s ract yes mor *, ih. ` ..�r�# �, e t'li 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 reatic? ��11e11 °tiFJoodpla�r /etlarads F=` �/Jlatersiaetl D�strct - •',t"-,`.s py,!1 c.3�e�y�py.x -,�. 1 y.k s: x atr 3 F ..*?`+.° c'r-LY z C 1. t t -i Y,4,,,R6- DESCRIPTION OF WORK TO BE PREFORMED: l Identification Please Type or Print Clearly) OWNER: Name: �� m� �� Phone: y�/ Address: (/� { t = iff CQ t;;�Narra�l . �f� � 7 's'� r } t r Phone Yk� - 's ff ;Id t: - •1 gg FSS.{ { t,f E 7M1 { Er °v 3pv 'S .,• qa.�"' r ' - �up�erv�sor'sCansh-uct�o , .�cerase` x h s f -Horace Jrr�•proarement �ace�se ',` ,.� �.'�:' �� {� Exp :[date "'S7'�'� � � ' k ARCHITECT/ENGINEER Phone: Address: Reg. No. r FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ �® `- Check No.: Receipt No.: �9,0 NOTE: Persons contracting registered.contractors do not have access to the guar my fu { Signiii ureof A t/Ouun ;� � Signa#ure of t;onractor- 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 DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— For department use ❑ Notified for pickup - Date I Doc.Building Permit Revised 2007 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 ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ 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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 Location No. 3!� Date �aRTh TOWN OF NORTH ANDOVER 9 i Certificate of Occupancy $ ss�cNustt Building/Frame_ Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 20729 Building Inspector 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 DATE REJECTED DATE APPROVED CONSERVATION COMMENTS DATE REJECTED DATE APPROVED HEALTH 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 DrivaVrav Permit Located at 384 Osgood Street FIREDEPART'MENT Temp Dumpster on site yes no Located at 124.I�lalp Street Fire xDepartment signatureldate 5 ' . 4 S 1 COMMENTS. r NORTH Town of . ? 4Andover O s No. 319 : - _ o Q �1 LA dover, Mass. o • CO CHICNEWICK y�. ADRATE D `s BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System �, ............. ......� I ' BUILDING INSPECTOR THIS CERTIFIES THAT.......04V.4......................... ....................................... ............ Foundation has permission to erect........................................ buildings or, ....... .,�.... .. ... ..................:... Rough • to be occupied as.. � ............ ......1 /. .... ...✓........ti�I.......... ......... Chimney provided that the person acce ng this permit shall in every respect conform to the terms of the lica ion 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 OF VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final O ELECTRICAL INSPECTOR UNLESS CONSTRP�STASRough Service BUILDING INSPECTOR 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. 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 1- Please Print Ledbly Name(Business/Organization/Individual): Address: \� �r10\--tbn ti \C� City/State/Zip: JC 1'v Phone.#: 7Q? / �?n Are-you an employer? Check the a propriate box: Type of project(required), 1. I am a employer with 4. ❑ I am a general contractor and I 6. E]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. 7. Remodeling ship and have no employees These sub-contractors have g, Demolition working for me in any capacity. employees and have workers' 9 ❑ Building addition [No workers' comp. insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their 11.0 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.F-1 Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy 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. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. -I Insurance Company Name: Policy#or Self-ins. Lic.#:� ! '/ ��\ODU�� /% Expiration Date: L)d Job Site Address: \65 �� 2 ie �� City/State/Zip: fJQIQVeP— Attach a copy of the workers'compensation polic 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 fper' ry that the information provided above is true and correct. Si ature: %� Date: O 6241�2�0 2- 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 Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employ6rs to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to,operate.-a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"'Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in_(city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. # 617-727-4900 ext.406 or 1-877-MAS SAFE Revised 1122-06 Fax#617-727-7749 wvvw.mass.gov/dia =rim L h0a Zr)'-iin Ac:Easter.:Slates inst r?nce Agenoy,hc. Fa-ID:761647367C To:Biil tAcGwri Oate: 'Gilll 12007 02:41 PIM Page of 2 DATE(IVIG VY'ro i ACOR � CERTIFICATE OF LIABILITY INSURANCE bfCGuR� I lD/17/o7 1'RODJC=_R THIS CERTIFICATE Is ISSUED AS A NATTER.OF INFORMATIOtd !Eastern States Insurance ONL; AND CONFERS NO RIGHTS U�C N THE CERTWICA'E j Agency, Inc. HOLDER.THIu C@RTIFICATE DOES NOT AMEND,EXTEND On 5D Frespect Street ALTER THE COVER.AGEAFFORDEC SY THE POLICIES BELCW. lWaltham MA 02453 `' Phcne: 781-6`42-9000 Far.:?81-"E47-3670 IINSURERS.AFFORDINGCO"V`ER1GE -- `NAICA {fi+SURER ---�--- _-_----- :NSUPER r: Guard Insurance Company ;I.>IIPEP a Ohio Casualty G:-cup T McGur3 Construction, Inc. 11 Morrison Road j D.Burlington MA 0180'3 -=— - --- -- � tr1>Tn�F I COVERAGES - -✓r'.,..=I I TFE?-1.1..."H-VP;•.F•t:. .:F^: _::.'...-..,...:'1=r1�r,,CI;._=:1: r-�'i.': r.- :IiJ:::�rFr. .. :.j�... I'rr15^'r'DC'L'-- . :,.•r �.. -- —�:. "_'_F�L�P-E'rFECT' `i?LiM E%Inn TOfr'------------ ------- ` 'ARG -'iFE OF.i•,5'.ARASJC:E _T— F- LiCY HLIF:IBER ,;TE;61Ev!DD!Y�; I DATE --- jr GENERAL uAelLlr; — i t== :,F.^- 2;00_0,000 g ancc i tiGEs=s- ' BE{O 07-53373695 ' Q2/01/07 02/01/08 ' -tet= 300 000-- ar`UF' 171,000,000 p2,000,000 J-_hI� ;a'— a•!-. _. ?FBF - - :�' ;Er7 l LOC i alrrmOSILF LIAVU7Y -�• �'�7 I I - ILED IL i j GARAGE LtkBILrrY , �ir IL r-E�.SCC:L .iT EXCESS'umaRm-A L"1LITi j:, WORKERS COMPFIJ3AT10N ANC. ; I x T<nY_�L'r:1T� EIAPL0YERS'LIr+BILITY rtCVICa76379 02/01/07 02/01/08 =�~=� ;=c:-=1;- l.;100000 `ri•=-!-Rr;�nE.+.6ER EXr'l"=' ! c' ^t`_:��sE_F__'.!�'C, FE: 100000-- 1 LI +g 500000 OTHER I � i I I I j I DESc'.4IPTION OF OPEPATOF4S±LOCATIO7 V NS EHICLES!!EAC WS!Otj�4DC.ED BY EKDORSEMENT1 SPE.Ir".L PR0v9SIqNS- I CERTIFICATE HOLDER CANCELLATION SHOULD ANYOF THE AEOV E DESCRIBED POLICIES BE CA—CEL'—ED BEvORE THE EXPIRATI�44 GATE THEREOF,THE I£El'It4G INSUP.5R-'+ILL EHDEA:.CR-0 MAIL OWS'WRITTEN 140TICE TO THE CEP.Ti'F:CA75 H%DER PIWOM 10 THE:EFT.8LTFWLURE TO DO SO SHAI.1_ McGurl Construction, Inc. W;'O3F NC C-RUG:TON OR I IABP I'�OF A^4Y WNO UP•OW TUG IN aURFR ITS n^3EN';Cl; i 11 Morrison Road N Burlington MF, 01803 ftEFFESE14TaTs:.S. — I,:ITHORI'Eli ACORD 25(Z001+08) C%aCURD CORPORATION 1133R McGurl Construction, Inc. 11 Morrison Rd. DATE ESTIMATE# Burlington, MA 01803-1910 10124/2007 323 Phone& Fax: 781-272-1385 JE-Mail: Mcciurlconstruction@verizon.net NAME/ADDRESS Arthur Middleton TERMS DUE DATE 105 Berkeley rd. North Andover Ma. i o/i4/2oo7 ITEM DESCRIPTION TOTAL Exterio..' Siding of entire house <.14,200.00 -Strip entire house all siding and corner boards -Inspect all plywood all areas -Repair all rotted plywood around house -Tyvek house wrap all walls -Install wide white corners to all -Install vinyl siding to entire house (RMC) -Install shutters to front of house -Remove all trash from site All material is guaranteed to be as specified. Any alteration or deviations from the above TOTAL $14,200.00 specifications involving extra costs will be done at additional cost. The costs will become an extra charge over and above the estimate. All elements of this agreement are contingent upon accidents or delays beyond our control. The estimate does not include material price increases, SIGNATURE or additional labor&materials which may be required should unforseen problems arise after the work has begun. We took forward to working with you in the future!! .'- - - aee ulations'and Standards m' Board of BuildingR a i5or L"icense construction Sup License: CS 59597 , Birthdate _1012411971 Tr# 5896 1 1 I —lration.':1012412008 - R�str�cUorae V t ji .,. 11 MORRISON RD — Commissioner BURLINGTON,MA 01803 - t - ,per Jlze -U�om�m¢aruuea,�C�o°�✓�'�dice�i"aeltta \ Board of Building Regulations and Standards, HOME IMPROVEMENT CONTRACTOR Registration 112667 129252 lug Expiration 4I1�512009 Trlk TYPe DBA!.{ MCGURL CONTRATIN,G WILLIAM McGURL ':,` � - 11 MORRISON RD BURLINGTON,MA 018.03 Administrator