The URL can be used to link to this page

Home My WebLink AboutBuilding Permit #117 - 122 FOREST STREET 8/13/2008 OORTH BUILDING PERMIT O 1"o TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received ��5 A go � �SSACHU`+�( Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION 17 Z. rr-ee> te Pri L-1 PROPERTY OWNER +- L4 Pr Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop 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 Septic Well Floodplain Wetlands Watershed District Water/Sewer DEStCR,,IPTION OF W RK TO BE PREFORMED: =denicatio Please Type or Print Clearly) OWNER: Name: Phone: Address: _ CONTRACTOR Name: " +-Co � ne ? ?Z-Z -d?Z Address: ' Supervisor's Construction License: 0-5 54. J00/:5 Exp. Date: �/'/' rZ I If Home Improvement License: it;C rz9/'70 Exp. Date: 1z/C2 ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:MOO PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 6J15'-171- FEE: $ '7 Check No.: Receipt No.: / NOTE: Persons contracAwiregisd ontractors do not have access to the guaranty fund gnature of Agent/Owne ure of contractor Location No. , Date MORTM TOWN OF NORTH ANDOVER F: • • L9 + s r * ; . Certificate of Occupancy $ °'�<�' Building/Frame Permit Fee $ 3 ^MU Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 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 4 HEALTH Reviewed on Signature . l `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: Si"M Located 384 Osgood Street FIRE DEPARTMENT Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date 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 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 ❑ 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 �ORTii Town of 0 No. LAKE dover, Mass., �'" 3- /� COCMICMEWICK 7�S RATED BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System L/ BUILDING INSPECTOR THIS CERTIFIES THAT............` ..?... .............__.lj. ...5.... .... ............................................. " •"•••""""""""' Foundation g 1 Z /Yt.s.�.. .....`S..T-..................... Rough has permission to erect....................................... buildings on .. ......z........./...r'..!........ to be occupied as .. �--�-�........"1.1QCd w f....".......................................................... Chimney provided that the person accepting this perm d 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 CONSTR S Rough ....... ..... ................................................................................................. Service BUILDING INSPECTOR Final Occupancy Permit Required to Ocmpy 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. SELF INSURED LUMBER BUSINESSES ASSOCIATION NCCI CARRIER CODE NO. WC 00 00 01A WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY INFORMATION PAGE 1. The Insured: Gove Lumber Company Policy No. WC 000806-8 Renewal of: WC 000806-7 Mailing address: P. 0. Box 12 X Individual Partnership Beverly, MA 01915 Corporation or Federal Employers I.D.# 04-1382050 Inter/Intrastate Risk I.D. # 012217 Other I.D. # Other workplaces not shown above: See Schedule 2. The policy period is from 01/01/2 0 0 8 12:01 a.m. to 01/01/2 0 0 9 12:01 a.m. standard time at the Insured's mailing address. 3. A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: MA B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident $ 500, 0 0 0 each accident Bodily Injury by Disease $ 500, 0 0 0 policy limit Bodily Injury by Disease $ 50n, 000 each employee C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here: COVERAGE REPLACED BY ENDORSEMENT WC 20 03 06 A D. This policy includes these endorsements and schedules: See Schedule 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. Premium Basis Rate Per Code Total Estimated $100 of Estimated Classification No. Annual Remuneration Remuneration Annual Premium See Item 4 . Extension WC 00 00 01A Deposit Premium $ 7 Total Estimated Annual Premium $ 29, 930 Minimum Premium $ ' 482 500 (MA) 5645 Expense Constant $ 318 NIA - DIA Assessment 0 . 016 392 . 00 Premium Adjustment Period: A.r i n u a 1 Countersigned by: Servicing Office: SELF INLUPED LUMBER BUSINESSES ASSOCIATION 11106/200'J Date: Producer: Copyright 1987 National Council on Compensation Insurance. O r.i_q i n,j I s� The Commonwealth of Massachusetts Department of Industrial Accidents -= 1 Office of Investigations 600 Washington Street Boston, MA 02111 c w - www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): 01-r-)Ue e_J_ C-0 Address: City/State/Zip: ev ��. hone 9 9 Z Are you an employer?Check the appropriate box: Type of project(required): 1.❑.I am a employer with 4. ❑ I am a general contractor and 1 6. ❑ New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. $ 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 10.7 Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL 1 I.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.] t employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit titis affidavit indicating ilia are;doiiig all work slid 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. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. � p Insurance Company Name: Policy 9 or Self-ins. Lic.#: 0 00 Q Cl/—& l/ Expiration Date::z, GJob Site Address:_ l Z Z �Ou.�C 51r � - City/State/Zip: A� zci_ 4/d4 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 coverag erification. I do hereby certify ae a pains an pe alt s of perjury that the information provided abo a is t ue and correct. Date: Simature: e�3 Phone#: 9`Z Z 9' r` 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 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 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 cant'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 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. ## 617-7274900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax##617-727-7749 www.mass.gov/dia `��Board o ui m e u at �5ns an g g tan ar s One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Home Improvement Contractor Registration Reqistration: 129170 Type: Private Corporation Expiration: 7/19/2009 Tr# 131584 Gove Lumber Company, Inc. Bruce Gove 80 Colon Street ---- -- - - - Beverly, MA 01915 Update Address and return card. Mark reason for change. I. 1 Address Renewal Employment Lost Card PS-CA1 is 5OM-05/06-�(Pj�C��8//490pQ ✓1tC t/JO�177/I)7.QI'LLl�C2LCiL Oy✓!/(.Q.00Q�Y2C6e�6 -- --- Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: 9 Registration: 129170 Board of Building Regulations and Standards Expiration: 7/19/2009 Tr# 131584 One Ashburton Place Rm 1301 Boston,Ma.02108 Type: Private Corporation Gove Lumber Company, Inc. Bruce Gove 80 Colon Street Beverly, MA 01915 Administrator Not alid without signature Installation - Marvin Window & Door Showcase by GLC Quote 100-B Newbury Street Route 1 South 978-762-0007 Danvers, MA 01923 978-762-0008 fax CUSTOMER Mr&Mrs Baftersby REVISION DATE 06/09/08 ADDRESS Forest St PROJECT NAME CITY,STATE,zip Norh Andover,Ma ADDRESS DAY TIME TEL CITY,STATE,ZIP SALESPERSON Sandy Gove DAY TIME TEL REV 08/04 LABEL QUANTITY DESCRIPTIONPRICE TOTAL All Units Are Marvin Hampton Sage Exterior Bare Interior 7/8 Simulated Divided Light Satin Taupe Hardware Wood Screen Low E II Glass w/Argon 1 1 CCM 2024-3 4 Lite Casement Window 111110-2-6-9 1 102.69 R.O.61"X23-5/8 maw Install new window Put new trim inside and out. 1 1 CCM 2448-4 Casement Window. 2,526.99 2,526.99 R.O. 103"X47-5/8" Units have 2" Space mull to fit opening Replace existing 4 wide in living room. 1 Building Permit Fee 116.00 116.00 1 Installation Flat Labor Charge 1,850.00 1,850.00 1 Miscellaneous Materials 225.00 225.00 1 Rubbish Removal Fee 50.00 50.00 All installations will be left broom clean at the end of the day. All painting is by others. Gove Lumber warrantees the installation labor only. All materials are covered under the Manufacturers warranty. Any rot found or extra work not specifically mentioned in this work order will be billed at an hourly rate plus the cost of materials. Customer will supply electrical power and water when necessary. Customer will prepare the work area by removing all furnishings and provide easy access to area. Massachusetts Home Improvement Contractor Registration#129170 TERMS DEPOSIT OF $2,190.96 REQUIRED PRIOR TO PLACING ORDER SUB TOTAL 5,870.68 $2,074.96 DUE WHEN MATERIALS TO BE INSTALLED ARE DELIVERED. DELV CHARGE 50.00 $1,850.00 FINAL BALANCE DUE ON THE LAST DAY OF INSTALLATION. 5%MA TAX 195.24 MAKE ALL CHECKS PAYABLE TO GOVE LUMBER CO., INC. TOTAL $6,115.92 ORDER ACCEPTED AS WRITTEN X NO RETURNS ARE ALLOWED ON WINDOWS,DOORS,AND SPECIAL ORDER MILLWORK. IF YOU HAVE ANY QUESTIONS REGARDING YOUR INSTALLATION PLEASE CALL BARRY GOVE AT 978-922-0921 Massachusetts- Department of Public Safety Board of Building Re-ulations and Standards Construction Supervisor Specialty License License: CS SL 100150 Restricted to: WS BARRY GOVE 46 LINCOLN AVENUE HAMILTON, MA 01982 Expiration: 4/11/2012 ('onunissi'mer Tr#: 100150 a c