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HomeMy WebLinkAboutBuilding Permit #568 - 113 BRIDGES LANE 4/29/2009 BUILDING PERMIT of "°or" qti TOWN OF NORTH ANDOVER toa`,�y`•- .tibtb o APPLICATION FOR PLAN EXAMINATION Permit'NO: Date Received p�gA7lD �gSSACHUs�� Date Issued: �� IMPORTANT!Applicant must complete all items on this page LOCATION . / 1.� =�S _. _ ✓ .3'"_. a_ � 5 1 1 — ,.Pint PROPERTY OWNER h ze, Print MAP,NO ,�PARCEL: ZONING DISTRICT Historic District yes no r achine Slop,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 epic 'W;;ell x Flood la►n " Wetlands ` p Watershed District t f DESCRIPTION OF WORK TO BE PREFORMED: Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: - .,� s '.=c.-fi- „ •,. G '.` ._, F- _'»^ ti +..,. '* y"°"a. ("ew F.}9,+sw.?� CONTRACTOR 'Name t� f. f _ Phone , . 78� �` `/y 11 �-- Address77t e Supervisor's Construction` at� Yf EL x3.=j icense p Date �3M ,.,-�-a�'«,. ' r��" • � t i;; e+�' 3� � e x y`- ^try a.-;'t .: F e«y•,+ Y� r,� �§ _� s i Hoix�elm;provement E ._ xp Date 'ri . w 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: $ FEE: Check No.: 3 Receipt No.: o2( I NOTE: Persons contracting with un egistered contractors do not have access to the guaranty fu d ^ "+✓- `� """ "'"m'Q of* 'a "�•• -'-""� :r' n.-,e-�`. �., "'.,", ,,.+.'"" .." ,.... .. r ;+.,,.. Signature of� ent/Owne _ Location No. �`+� ® Date ®! NORTM TOWN OF NORTH ANDOVER' s i r Certificate of Occupancy $ ;�s'••°•t<�' Building/Frame Permit Fee $ �l �cMus . Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check #� 2i9 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 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 Os ood Street st � T...3. �� �,u�-r- P s—s-� -.",�,v-ra`- ,.ar -ate f "�-' ..ca- �r-�n?r t-�-��.,,� .�•:: FIREDEPARTMENT TempDumpster on site yes ono "�a,4."Rp250 ''f '+ F' - Located at24�Mam Street � <" �� "" — G w• Fire Department§1gnature/dater S` 3 COMMENTS � �z ,. °" _ x Fit - .r- - - X..`.0e'i_A .. ' M'r:,x.+... •F � w +.t'K�.:r .+.�:.t 't,:Al '. 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 Doc.Building Permit Revised 2008 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 L3 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 2.2008 ItApRTH Town of 4Andover . No. 4? _1 _ ____ _ dover, Mass. I�O LA ICKEWICK 7 D RATED qS BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR j ...............THIS CERTIFIES THAT........ ' ............. ................................... Foundation fon ../ Rough has permission to?ere ..........0........................... buildings rlChimney to be occupied as.. ......*..... .....: + ..B . ........ ... provided that thers accepting this perm' ail 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 I PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTI STARTS Rough ................ ........................ ................................................... Service BUILDING INSPECTOR Final OCcuparwy 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. Smoke Det. SEE REVERSE SIDE a~s= Thi C��mmon ealth of Massachusetts Department of Fire Services Office of the State Fire Marshal P.O.Bo-1023 State Road,Stow,MA 0I775 PERMIT, Date: North Andover Permit NoDig SafeNnm er (Cityof Town) (If Applicable) In accordance with the provisions of Nt G.L14 8.Chap.ter1Q_as provided in section S 7 7 ('M R 3 4 g Date This Permit is granted to:. Full name of person,Frrm.or Corporation Permission to locate dumpster for construction/renovation/demolition of building. Comments: dumpster must be 25 ' from structure if unable to place with required Restrictions:clearance dumpster must be covered with 1 wood or tar end of work -day �9L0 d �.�►08S�IM31 o- =Qt/ GOOM130b9 111-(38'VM S 99,a030 ; at ls. a�oilsa21 _ r �� (Give location by street and o. o/r/cIts crn e M such er as to d adequate identification of location P Fire Chief sandx3f ' Fee Paid$ -50 .00 '' This Permit rrill.expire - -C� (Signature of offical Title granting permit) Offical granting permit ( ) jagtunNj1 y di 1 DD asiiaall � __� QOO0 Q -oagaastoltvP� f N\cJN�p\S IV Uo\�e�odjo 6p0Zj5lg"�Jo`�E�aS• a� Z8 o P?'6Oa l sUva"10 atl ' Oy sQ�uPuaiS pa /„ e • 't The Comnnonwealth of Massachusetts Department of Industria!Accidents s#� Office of Investigations 600 Washington Street • Boston, MA 02111 � 1 WWW_112wS.gOV1(Ila . Workers' Compensation Twitrance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lt:aibly Name(Business/0rganizafion/individual): C-;w lc( Address:_ City/State/Zip: Are you an employer?Cheek.the appropriate box: I.(E—C am a employer with I 4. ❑ I am a general contr7andT of project(regnir : employees(full and/or part-time).* have hired the sub-c6 ❑New construction2.(] I am.a:sole proprietor or partner. listed on the attache7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me.in any capacity, workers' comp.insurance. [No workers'comp. insurance 5. 9• [] Building addition p ❑ We are a corporation and its officers have exercised their I O ❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption MGL 11. per Plumbing n g airs or additions m self. p § reP rtrons y [No•workers'com . c, 152, 1(4),:and we have no insurance requiredIt .-employees. [No workers' 12❑ Roofrepairs J /•�-�S/ <L-�i comp. insurance required..] I 3.gOther *Any applicant that checks ba#l must also Tilt out the section below showing their workers'compensation policy information, t Homers eownwho submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating su ch. ;Contractors that check this box mustatteel�an additional shcstshowing the name of the sub-contractors and their workers'con p.,�licy irfamtatio n. I am an employer that is provrdtng:workers'compensation cnzsurance for my employees: Below is the policy and job site Information. Insurance.Company Name: Z �S"S- Policy#or Self-ins.Lie.#: 1A)c,—7Q f q 7.,-� go I Zoo Expiration Date: Job Site Address: 1 L4 City/%te/Zip.: I Attach a copy of the workers' compensation policy d Faileclaratiou page(showing the policy number and expiration date). ure 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 cert y un r the paints n penalties of perjury that the information provided OveisOneand correct Si tore: Phone#: -2 — D — �/S__ Official use only. Do not write in this area,to be completed by city or town official City orTown: 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 a nd Instructions Massachusetts General Laws chapter 152 requires all employers 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 ormore 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 shaU 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-contractors)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 be 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 nuanber 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 fire 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. When 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 bum leaves etc.)said person is NOT required to complete this affidavit The Office of Investigeations would bice 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 Basion, MA 02111 TeL#617-727-4900 ext 406 or I-8.77-MASSAFE Fax#617-727-774 Revised 5-26-05 www.mass.gov/dia 7 ® 74/29/09 MMIDDIYYYYACORO CERTIFICATE OF LIABILITY INSURANCE ' �� PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Judith Pinney Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 325 Main Street HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. North Reading, MA 01864 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA: Patrons Mutual G. W. Siding Inc INSURERB: Assoc. Industries of Mass. 54 Delwood Road INSURER C: Tewksbury, MA 01876 INSURER U INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L POLICY NUMBER POUCY EFFECTIVE POUCY EXPIRATIONTYPE OF INSURANCE UMTS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 TO RENTED A X CO MMERCIALGENERALLIABILITY CTR0040755 9/23/08 9/23/09 PREMSES(E.occurrence $ 50,000 CLAIMS MADE F-1 OOCUR MED EXP(Anyone person) $ 5,000 PERSONAL&ADV INJURY $ 11000,000 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATE LIMITAPPLIES PER PRODUCTS-ODMP/OPAGG $ 2,000,000 ECT POLICY PRO- LOC AUTOMOBILE UABI UTY COMBINED SINGLE LIMIT $ ANYAUTO (Ea accident) I ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUrOS (Per person) HIRED AUTOS BODILY INJURY NON-OWNEDAUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ EANYAUTO EAAOC $ OTHER THAN AUTO ONLY: AGG $ EXCESS IUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION WORKERS COMPENSATION XT WC STATU- I OTH- AND EMPLOYERS'LIABILITY FR B APROPRIETOR/PARTNER/EXECUTNE Y� NYAWC7019738012008 9/24/08 9/24/09 E.L.EACH ACCIDENr $ 100,000 OFFICE RUE MBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 100,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF T HE ABOVE DESCRIBED POLICIES BE CANCELLE D BEFORE THE E XPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN TOWN OF NORTH ANDOVER NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL OSGOOOD STREET IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR NORTH ANDOVER, MA 01845 REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2009/01) ©198 9 ORD CORPO All rights reserved. The AC ORD name and logo istered marks Proposal G. W. SIDING INC. 54 Delwood Road Tewksbury, Ma 01876 TEL: (978) 658-3065 CELL: (978)804-4445 4/15/09 To: job: Jeremy Freund Leftside gable and back wall 113 Bridges Ln. around sunroom only. N. Andover, Ma. (sunroom and rt.side not included) Labor and Materials to: *Remove all siding, 3 corner boards and trim on outside of garage doors *Cover area with Tyvek Housewrap *Install 3 new p.v.c. corner boards and trim around garage doors *Install new 5 1/4", primed and textured Hardiboard siding 4" t.t.w. *C#A all siding. *** Fixing any sheathing, window trim ect.because of water damage will be an extra charge not incl. with this estimate. ****Dumster w' tprovidedbyus V/9/5 ' TOTAL $9,950.00 d� 14