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Home My WebLink AboutBuilding Permit #891 - 1160 GREAT POND ROAD 6/19/2013 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: CJ I l Date Received Date Issued: o �� IMPORTANT: Applicant must complete all items on this page LOCATION_._ .. . 1_ _ Pnnt� i 1 PROPERTY QWNER: Print 100 Year bld Structure yes'. no- MAP NOt IU 7 PARCEL: DIS RIOT: Histone Districf yes o, Machine,Sl op.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 El S.,e tic: D Well ❑ Flood lain ❑Wetlands ElWatersheclGistrict; El Water%Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identi cation Please ype or rant Clearly) OWNER: Name: L �� Phone: Address: wpo �'^—� • CONTRACTOR' :Name: ��f%Phone: `,�,� ... Address: 72 Supervisor's,Construction License: <! Exp: Date: LHIotne Improyement1icense::. - l Exp. Dater / �L ARCHITECT/ENGINEER Phone: Address: Reg. No. 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.:4�� Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signaturehof Agent/Ovvner _ Signature of contractor Plans Submitted 0 Plans Waived ❑ Certified Plot Plan ❑ Stamped ans ❑ Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofinig, Siding, Interior Rehabilitation Permits ❑, Building pp Permit Application a 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 app,-al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm.tted with the building application Doc: Doc.Buiiding Permit Revised 2012 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 ❑ i 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 COMMENT 4p Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes i Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW To'vvi! Engineer: Signature: Located 384 Osgood Street FIRE DEPARTI E'NT - Temp Dumpster on site yes no Located at 124 Mair`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, roast 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 E Doe.Building Permit Revised 2010 Location l0 C'e.4_ w 1 da S No. Date1]- . TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ .— r Foundation Permit Fees $ Other Permit Fee $ TOTAL $ Check# 26541 Building Inspector r -I V NORTH - c . " ve" 'o 0 z. ... No. I _ - �` � hver, Mass l 3 [OC MIC ht WICK gORgTED PP��.(5 S U BOARD OF HEALTH Food/Kitchen P E T Septic System THIS CERTIFIES THATLI ` BUILDING INSPECTOR ...............N�..................... .... .... ..r.. .... ........... ...... .. .. . . . . ..... .. has permission to erect buildings onO Foundation ...... ... ............ ..... ......... ... ....... .. Rough to be occupied as ............Oa" it .....t..... ................ .. ... Chimney provided that the person ashall in every respect conform to t 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 a PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCT ST S Rough Service ............ ... .... ....... .............................................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz 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 The Commonwealth ofMassachusetts , .Department o,f Industrigl Accidents Office of-Investigations 600 Washington Street Boston,MA 02111 vmmassgov/dia Workers' Compensation Ynsurance Affidavit:Builders/Contractors/Electrricians/Plumbera Applicant Information Please Print-L—e�ibly Name usinessl0r ani'zation/lndividual' Address: - City/State/ZipPhone ih d ` Are you an employer?Check the appropriate box: Type of project(required): 1.0 I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time)* have liiredthe sub-contractors 2 am a sole proprietor or partner: listed on the attached sheet. �• ❑Remodeling ship and'have no employees These sub-contractors have 8, ❑Demolition working for me in any capacity. workers'comp.insurance. g, [].Building addition [No workers'comp.insurance 5. ❑ We area corporation and its 10.❑Electrical repairs or additions required,] officers have exercised their 3.❑I am a homeowner doing allwork xight of exemption per MGL 11.[]Plumbing repairs or additions myself.[No workers'comp. c.152,§1(4),andwehaveno 12.[]Roofrepairs insurance required.] employees.[No workers' q )" 13.[]Other comp.insurance required a "Any applicant that checks box#I must also fill out the section below showingtheir 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. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. lam an employer that is providing workers'compensation insurance forfny employees. Below is the policy and job site information. Insurance Company Name:. - �� ✓� Policy#or Self-ins.Lic.4: 1;9 7 1e </I "�z ExpirationDate: �L . lob Site Address: // 61adA City/State/Zip: PZ2 Attach a copy of the workers'compeusationpolicy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MCL c.152 can lead to the imposition of criminal penalties of a tine 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 ofup to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office sof 'Investigations of the DIA for insurance coverage verification. Ido Izerehy cert under the pains and penalfi of ' ry that the informationprovidded'abov�17 d correct. Si afore: Date: Phone#: Official use only. Do not write in this area,to he completed by city or town official. City or Town: Permit/Mcense# Issuing Authority(circle one): 1.Board of Health 2,Building Department 3.CitylTown Clerk 4.EIectrical Inspector 5.Plumbing Inspector 6.Other t PROPOSAL STAMP & SON CONSTRUCTION 37 Rumford Street Lowell, MA 01852 (978) 937-7455 May 29, 2013, Submitted to: rodks.Shool 1� b Grt Poricl 17oa orth An�ave� Mass�chuse�ts °01845 �,£a _ We hereby propose to furnish materials and labor necessary for the completion of. HETTENGER GARAGE— 1 LAYER 1. Strip entire roof of garage. 2. Repair any rotted wood. 3. Install 6 feet of ice and water shield on bottom edge of roof. 4. Install new drip edge around all edges of roof. •,5. Install 15 pound felt paper on entire roof. 6. Install 30 year Architectural Shingles. 7. Install ridge vent and cap shingles. 8. Removal of all debris. Contractor's registration #116404 E PROPOSE hereby to furnish material and labor, complete in accordance with above specifications. For the sum of$6,800.00 Six Thousand Eight Hundred Dollars & 00/100. Payment to be made as follows: Please make check payable to: Anthony R. Stamp $6,800.00 Total All material is guaranteed to be as specified. All work to be completed in a substantial workmanlike manner according t specifications submitted,per standard practices. Any alteration or deviation from above specifications involving extra costs will be executed only upon written orders and will become an extra charge over and above the estimate. ACCEPTANCE OF PROPOSAL' The b ve prices,specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. SIGNATURE: DATE CONTRACTORS SIGNATURE /G4 //i DATE NORFOLK & DEDHAM MUTUAL FIRE INSURANCE COMPANY SPECIAL BUSINESSOWNERS POLICY RENEWAL DECLARATIONS POliCy# R0639424A Named ANTHONY STAMP Agent BYETTE INS. AGENCY, INC. Insured 37 RUMFORD STREET LOWELI6 MA 01852 Phone (978) 851-6678 i_ Agent# 20434 FORM OF BUSINESS: OTHER Policy Period: 1 YEAR from 07/14/13 to 07/14/14 This declarations page together with the policy jacket, the policy form and any endorsements, completes this policy. Coverage begins at 12:01 A.M. Standard Time at the covered residence premises. . ` IS!D �TI: PO �tCY• Arro 4� Basic Annual Endorsements State Taxes Total Annual Additional/Retur Premium Premium or Fees Premium Premium $1,662 $ 197 $ 1,859 11: "1N..&VlkED.'- PR-E'MISES Building/Location 1 37 RUMFORD STREET LOWELL MA 01852 Address if Different Mortgagee Information Business Des;cription CONTRACTOR -CARPENTER- RESIDENTIALIL III. ` PRO ERTY COVERAGES Premium POLICY DEDUCTIBLE $250 OPT.COV./ XT. BLDG GLASS DEDUCTIBLE 500 BUILDING ( OV A) Limit ACV OPTION (Yes/No) NO AUTOMATIC INCREASE (%) 8% Included BUSINESS PERSONAL PROPERTY Limit $10,000 Included IV ,.O;P"T10NAL COVERAGES r, v 1. Premium OUTDOOR SIGNS Limit EMPLOYEE DISHONESTY Limit MONEY&SECURITIES Limit ACCOUNTS RECEIVABLES Limit VALUABLE PAPERS Limit FORGERY&ALTERATION Limit TOTAL PREMIUM PER BUILDING $ 1,859 V.. L I:A:B'I.,L I4T Y `A NSD: MJ E D I C`A L% P A°Y,M E�N T S .' EXCEPT FOR FIRE LEGAL LIABILITY, EACH PAID CLAIM FOR THE FOLLOWING COVERAGES REDUCES THE AMOUNT OF INSURANCE WE PROVIDE DURING THE APPLICABLE ANNUAL PERIOD. PLEASE REFER TO PARAGRAPH DA OF THE BUSINESS LIABILITY COVERAGE FROM LIMITSI PREMIUM , LIABILITY&MEDICAL EXPENSES OCCURENCE $ 1,000,000 Included GENERAL AGGREGATE $2,000,000 Included PRODUCTS COMPLETED OPERATIONS AGGREGATE $2,000,000 Included MEDICAL EXPENSES $5,000 Included DAMAGE TO PREMISES RENTED TO YOU $ 100,000 Included VI "' 'EN,D0RSEMENT:S Premium SEE ATTACHED PAGE HE{POLICY»PROVISIONS';REQUIR�'�THAT A;Si"�' r~550 # 5� : COUNTERSIGNEDBY AUTHORIZED REPRESENTATIVE `.INI UM�I�i 'M UMi CHS►I GE.NORMALLIftAP!?��ES#4� YOt1'G 1NGEfcti' Y '' {{ "` `• ' ,�: I - +�, .._ K.mt PRIOF2 7d EI�RII2AT�ON t YETAIN A ,WESIiA.LETtf BAST DAT i PT ERM 90P-1 INSURED COPY (REV.04/05) Type of Payment: DIRECT BILL NON EDP 10 E VDAC `'' � THIS IS A QUOTE , NOT A POLICY CNA ' WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY QUOTE PROFILE — VERSION 01 POLICY NUMBER: (6S59UB-41 93P65-4-1 3) RENEWAL OF (6S59UB-4193P65-4-12) r, �INSURED'S NAME AND ADDRESS WORKERS COMPENSATION •STAMP, ANTHONY DBA INSURANCE PLAN STAMP & SON CONSTRUCTION A/R (WCIP) # MA 37 RUMFORD STREET iOWELL MA 01862 POLICY PERIOD FROM: 04-16-13 TO 04-16-14 .TOTAL ESTIMATED ANNUAL STANDARD PREMIUM $ NONE PREMIUM DISCOUNT NONE 0900-20 EXPENSE CONSTANT 159 TOTAL ESTIMATED PREMIUM 500 DEPOSIT AMOUNT DUE 500MP Employer's Liability BI Limit: $ 100000 Each Accident 500000 Policy Limit 100000 Each Employee INSURER: CONTINENTAL CASUALTY COMPANY Adjustments of Premiums shall be made ANNUALLY Deposit Amount Due: $ 500 ****************************** POLICY NUMBER: (6S59UB-41 93P65-4-1 3) E DATE OF ISSUE:02-19-13 WC ST ASSIGN: MA OFFICE: CNA 04J PRODUCER: BYETTE INS AGENCY INC 25GSF •1 1 r • V • License or registration valid for individul use only ' before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Boston,MA 02116 I 'Not va I hout signature Ofiice-Alon mer warrs-fiu•3iness egn Ahon� i HOME IMPROVEMENT CONTRACTOR Registration: 416404 Type: Expiration: 6!1312014 DBA i S 8 PION CO �1 ANTHONY STAMP' f'j 37 RUMFORD ST LOWELL, MA 01852 Undersecretary Massachusetts -Department of Public Safety Board of Building Regulations and Standards f -noructirm Snpcnisnr License: CS-079082 `0 PRICE A PETERSAN ' 61 FARM POND RD DRACUT MA 01826 ; I Expiration G nnmissirnier 08/18/2014 Unrestricted -Buildings of any use group which contain less than 35,000 cubic feet(991M )of enclosed space. Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. Fnr DPS licensing information visit: www.Mass.Gnv/DPS