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Home My WebLink AboutBuilding Permit #857 - 126 PRESCOTT STREET 6/28/2007 BUILDING PERMIT NOL, ��t�ao, 61ti RTH TOWN OF NORTH ANDOVER 0 L APPLICATION FOR PLAN EXAMINATION p ,. s Permit NO: Date Received G `020 _O 3gSs^cHus Date Issued: ' - 0 IMPORTANT: Applicant must complete all items on this page LOCATION 1.2 SZ` Print PROPERTY OWNER r7uIwzzAv r,.s Print MAP NO: PARCEL: ZONING DISTRICT: HISTORIC DISTRICT yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building kOne family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial X Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain D Wetlands ❑ Watershed District ❑ Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: ` c r� -�f'iy�,. ReA!o&a�Z A4yl &:P � .� turhl 60AL PO51t Identification Please Type or Print Clearly) OWNER: Name: C,4.#; AAMMAltnS Phone: Address: t G /��rgycg S� CONTRACTOR Name: Phone: 4M Address: t"1416 6&- 0196 r �a Supervisor's Construction License: _ Exp. Date: 6 -6d - o7 Home Improvement License: (6 1?11?/ 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: $ q@11N2. 'OD O . FEE: $ Check No.: C! Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund r Signature of Agent/Owner' ignature of contractor T` i Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF- U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT EI-1 ❑ COMMENTS I - DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS i DATE REJECTED DATE APPROVED HEALTH. ❑ ❑ COMMENTS TYPE OF SEWERAGE DISPOSAL i Public Sewer ❑ Tanning/Massage/Body Art •❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ -. FoodTackaging/S'ales ❑ Private(septic tank,etc. ❑ permanent Dumpst Ir on Site ❑ Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes % 4 . 4. I r G Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/signature& Date I Driveway Permit Located at 384 Osgood Street FERE DEPARTMENT' Temp 0; 01-m- ' ;Dum- er on site yes _ nb k`= %Located at 124 Main Street. - ✓� st F�re�Department srgnature/date x� r „ _ .„� ,;;�, 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 --.................-...........-- --.....__... -.._._._—..... 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 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 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 9 9 9 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 Doe:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 Location No. d�5 7— Date C; NaRTN TOWN OF NORTH ANDOVER IIFIFI,, M � A t i # Certificate of Occupancy $ Building/Frame Permit Fee $ fv sACNus Foundation Permit Fee $ "� Other Permit Fee $ t< TOTAL $ Check #(05/s 2031; 2 �•- Building Inspector NORTH '9 Town of sAndover No. 96-17 0- 0111.1dover, Mass., LA COCMICMEWICK �d ORATED S ` BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System /� BUILDING INSPECTOR THIS CERTIFIES THAT �:.�\AA...*....... F40V.%\ a • ........................... .. . Foundation has permission to erect........................................ buildings on ..la. � ........ Rough . ...... ............... to be occupied as..... �......eq.�.` a......IL........RiZ6tms ......�y Chimney ..............provided that the person accepting this permit shall in every respeof the appli tion 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 06 OOVPERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRU ST S Rough same .............................. 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 BeDone 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 Invesdgations 600Washington Street Boston,MA 02111 Workers' Compensation Insurance Affidavit: Bu ders/Contractors/ A licant Information Electricians/Plumbers Please Print Le 'bl Name(Business/Organization/Individual):_��_rr �{ �_ r Address: City/State/Zip: , a�,�-us Y4 Phone#:_�� rye o Are you an employer?Check the appropriate box: 1. I am a employer with 4. ❑ I am a general contractor and I Type of project(required): 2.❑ employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 1 am a sole proprietor or partner- listed on the attached sheet.1 ship and have no employees ? Remodeling ship These sub-contractors have working for me in any capacity. workers'com . ' g C]Demolition . P insurance. [No workers'com insurance nsurance 5. ❑ We area corporation and its 9. ❑Building addition required.] officers have exercised their 10•❑Electrical repairs or additions 3.❑ I a homeowner doing all work myself.[No workers'comp, right of exemptibri per MGL 11.❑Plumbing repairs or additions c. 152 1 4ave no insurance required]t 'e ( )'and we h 12.❑Roof repairs employees. [No workers' comp,insurance required,] 13•0 Other *Any applicant that checks box#I must also fill out the section blow showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they art doing all work and then hire outside contractors must submit a new affidavit indicatings Contractors that check this box must attached an additional sheet showing the name of the subcontractors and their workers'com . li cY information. such. I am an employer that is providing workers'compensation insurance for my employees: Below is the Policy cy and'ob site information. • J Insurance Company Name: 0 Policy#or Self-ins. Lic.#: Expiration Date: _��-G9 Job Site Address: l"21G' ST Attach a copy of the workers'compensation policy declarationa e(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL . 152 can lead to the imposition of criminal fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WOE{ORDER and a of up to$250.00 a day against the violator. Be advised that a copyof this statement may be forty Penalties of a Investigations of the DIA for insurance coverage verification fine Y aided to the.Office of herebyI do cer.yy vender the pains and penalties ofperjury that the r»formation provided above is true and correct Sienature �_ ��Qa e• -� -� Phon # OJylcial use only. Do not write in this area,to be completed by city or town o eiaL City or Town: Permit/License# Issuing Authority(circle one): I. Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing lambing Inspector i Contact Person: Phone#: �1 05/09/07 05:50pm P. 001 A ORD CERTIFICATE OF LIABILITY INSURANCEDATE(MMAJD(YY" 05/09/2007 PI+OGUCER THI$ CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Williams & Alley Insuratnee Agency Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 837 Main Street HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 760957 — _-- Melrose, MA 02176-0904 INSURERS AFFORDING COVERAGE NAIC 4 INSURED i IN.'WHER A:2 sac)x Xn Company Ldward J. Whyte Construction _.._..._.......... INCURERB: Associated Industries of Mnc' Mutu u King Street --- -- --._. .. INNURER(:• Saugus, MA 01906 INSURER IN"URF-R E: COVERAGES THE POLICI_S OF INSURANCE L ISTFO RF.LOW HAVE BEEN INNUED TO TIM IN$I)RF,Q NAMF„O ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY RFQIIIRFMFNT. TERM OR CONDITION Or ANY CONTRACT OR OTHER OOCUMFNT WITII RF.,$PFCT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PFRTAIN, TI•IF INSI)RANCF AFFORDED BY THE POLICIES UESORIBEC HEREIN IS fiIIB.IrC.T TO All THF TFRMR, FXCIII.SICIN: ANPI Cr)NnlTlr)NS r)F !211CH Wt N Ir2F>: nt?RHF6:n1'h I lura 3Hr'IWN MAV HAVF RFFN RFMICFn RY PAIt1 Cl AIM; MIA Ana•t.IPOIICV NUPEDCR PULK Y Chf CCI•IVr- POLICY LXfr 011GN P. tN9RD TYPE OF INSURANCE GATE(MMIDIIIYY) DATE(MM/DD/YY) LIMRR j GENERAL LIABILITY 07/15/2005 07/15/2006 EACH OCCURRENCE - }1,000,000 T)AMA(AF.TO RrNTEO X �CUMMERCIAL GENERnL unoILJTY 3CR9528 07/.15/2006 07/15/2007 PRFMISFS(F:��w„vr.+w�:) S50,000 .. I CLAIMS MADP -1 CK;CUR I MED F.XP(Any Mw p5lanq) S$,000 PCR30NAL 8 n(jv IN.IuHY ;;1,0 0 0,0 00 _ _........---- —...—_._...--..•.__._. . .-_-------- - -.t.......__...._...----- - C:FNFRAI.Af,C:RFCATF. !s2,000,000 .......__...._ __...-- ....._.._... .------- -�---.—.... _ GCNI.AGGREGATE:UVIY APPLIES PLR: ; PRODUCIS COMP/OP ALG I51,000,000 I..._..I ._....- , I!01 ICS+ ;.IF,T If. I i AUTOMOBILE LIABILITY COMUINGU SINGLE LIMIT ANY AUTf) ; (En v.0NM1) I ALL OWNED AUTOS 1 I [DOILY INJURY 'c ECHEODUW AUTOS (Pre person) E.......-......--.._.............. I TIRED AUi(iG BODILY IN.JI TRY I NUN-OWN[0 AUTOS (Pf;W,150(-A) PROPERTYDAMAGL• 1 I(Frr wOtlrnll GARAGE LIABILITY ,AUTO ONLY-EA ACCIDENT } ANY AI ITE • OTHER THAN EA 4GC. '{ AUTO ONLY. AGC µ�•F.XP,F991LIMRRF•I,LAI.(ARILRY F.AGH(1f,(:IJRPFNCF --••.I._----- -- I glr.LlR I C•JIMSMnDC j AGGREGATE r } DEDUCTIOLC } RCTLNTICIN S S D WORHrR$COMrrNnATIONAND AWC7009148012006 � 09/05/2006 ITK IiMPLOYER"i LIABILITY I _, TORY LIMITS_ LH ANY PROPRIETORIPARTNERMXECUTTVE EA F.A(`,H ACI'InFNT f 500,000 O=FICF.RM.ENRE9 E)MAAMED7 � C.L.GISDISE EnElaV+LUvee 5500,0D0 If YCa.dI::F111x under 75FFcIA1.PROVISIt 1(g(rmw E L.O15CAaF•POUCY LIMIT s 500,000 I OTHCR I , I i I ,'IRRCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES I EXCLUSIONS ADDED BY ENOORSBMGNT I SPECIAL PROVIWON'u CERTIFICATE HOLDER CANCELLATION M WHYTE CONSTRUCTION SHOLII•n ANY OF THF AROVE OESCRISED POLICIES OC CANCELLED BEFORE THE EXPIRATION j VERNON STREET DATE TIIEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10_ DAYS WRITTEN !I 14A.v.F,FIELD, I'LL 01880 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. Al1T PAII,IIRF TO DO VO VHAI I, IMPWE NO OBLIGATION OR LIABILITY OF AHY KIND IIPON THP- INSIIPFR, RR ACF.NT4 OR Rf•rRCZEN1'ATIVCf. AUTHORIZED REPREiENTATNE 1 ACORD 25(2007!00) Q ACORD CORPORATION 1989 Board of Building Regulati ns and Standards _ One Ashburton Place - Room 1301 Boston, Massachusetts 02108 Home Improvement Contractor Registration Registration: 108181 Type: Individual Expiration: 8/13/2008 EDWARD J. WHYTE Edward Whyte 6 King St. Saugus, MA 01906 Update Address and return card. Mark reason for change. ! Address Renewal Employment Lost Card DPS-CAI 0 50M-05/06-PC8490 - � Board of Buildin ReCC��ulations -- One Ashburton P ace, Fpm 1301 Boston, Ma 02108-1618 License: CONSTRUCTION SUPERVISOR LICENSE Number: CS 005575 Expires:06/30/2007 Birthdate: 06/30/1945 Restricted To: 00 EDWARD J WHYTE 6 KING ST SAUGUS, IMA .01906 Tr. no: 15198 S-CA1 60M-04/p5•PC8698 Keep top for receipt and change of address notification. ' C�