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Home My WebLink AboutBuilding Permit #285 - 135 ACADEMY ROAD 10/15/2007 BUILDING PERMIT of "°RrM q �T.lD 16 TOWN OF NORTH ANDOVER p APPLICATION FOR PLAN EXAMINATION Permit NO:o� Date Received °gAf[D \ s- 9SSACHUS�� Date Issued: IMPORTANT:Applicant must complete all items on this page L�t✓7'1��0� b��1� Y .`L,� � # ''rT 4 y � w".:.3 a,� ;.�, Y4 r a„ �11AP X10 PARCEL° ZOIT�G L3iSTIT -I�storlc Dis#nc# s achene Sfiop 4 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 fi r Septic 1lell 4Floodpla�ra �llle#landsA. Na#ersiitl Distrrct t 6 DESCRIPTION OF WORK TO BE PREFORMED: Rlelow ve d/6/ /40'r y xl�ekv boa F Identification Please Type or Print Clearly) OWNER: Name: Phone: 9,'5"G Address: v,�/ 'ONT# CTOR w Address . .r� .rte!.. ` ? ✓, .. 7 x � f r Supervisor"s moons#ru �on .acer�5e �, Esc Date 3 z � � 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: $ 0 y, ° a FEE: $ Check No.: * Receipt No.: c�2D(a5 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Sgnafiure of Agent/L wnerry'� Signature of contractor - Location •3S �/�� ' No. Date NORTh TOWN OF NORTH ANDOVER � a Certificate of Occupancy $ Jj �Sa4CNU5Et� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # `-' 20651 Building Inspector ' i 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 Driveway Permit Located at 384 Osgood Street P _ FIRE DEPARTMENT =Tem Dempster bn pi yes rio Located at 12 Mam.Street> Fire.$Depa'rtrnt ens%gnatureXc�ate ra. ; co . t_ 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) I ❑ Notified for pickup - Date Doc.Building Permit Revised 2007 i 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 r ❑ Workers Comp Affidavit 71-- 0 o Copy Of H.I.C. And/Or C.S.L. Licenses Copy of Contract ❑ Or Proposed Interior Work eefHg-*ffidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit I 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 NORTH Town of And do No. o dower, Mass. COCKICKEWICK ADRATED P.?�� `S BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System • BUILDING INSPECTOR THIS CERTIFIES THAT...... ............ ..(.fir..�i......L................................... "' "' Foundation has permission to erect....................a.................. b ' ings on ....� ........... ........ .. .. Rough to be occupied as.......... �,h'� ...... Chimney .. . . . . . tr ............................................................................ provided that the person accepting tPi�pormft shall in every respecform 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 Kermit. Rough Final S 6 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS-CONSTR S Rough ............. .............................................................................................. 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. • Authorized q. you Can test SNse ion-.ftw ausoa smtmmmt Baerim mslaltm America's urmt bang manub m a US 815 Main t. Dunstab e,MA 01827 INVOICE NO. INVOICE DATE 976-649-6617 GAFMC LICENSE 9AU03434 10/09/07 i; SOLD TO: David Pickle 13 5 Academy Road Andover,Mass. 0., ORDERED. .' , d , NOTESATESALESPERSONTERMS O Detailed job description: Labor: Remove old roof system and apply new roof system using Grace Ice& Water shield, GAF Grand Sequoia shingles, 16 oz. cold red copper for drip edge and valleys—3500 square feet @$8.00 per square foot. Labor fee: $28,000.00 Stock: All shingles and ice& water shield $8,000.00 Stock: 16oz Cold red copper $5,000.00 Waste fee: $2,000.00 Please note this does not include chimney and gutter repair yet to be estimated MESSAGE: SUBTOT SALESTAX Payment to be made as follows:.Al1 stock and V2 labor to start - $33,000.00 with$10,000.00 due at completion TOTAL .00 rMGo PRODUCT 13'e T FOLD AT TO m 00k P 10N 93DS DU-OWE ENVELOPE. PRINTED M USA A ®To Reorder. 800-225-6380 or nabs corn i i ACORLI CERTIFICATE OF LIABILITY INSURANCE °A10/10/2007 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION CLOUTIER INSURANCE AGENCY ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 1470 LAKEVIEW AVENUE SUITE#1 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR DRACUT,MA 01826 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. PHONE#: 978-957-4881 FAX#: 978-957-7230 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A WESTERN WORLD STEVE SMITH DBA SJS CONSTRUCTION INSURER B: 815 MAIN STREET INSURER C: DUNSTABLE,MA 01827 INSURER D: INSURER E: GRANITE STATE INS 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. POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMBS LTR NSR TYPE OF INSURANCE DATE MM/DD DATE MWDD GENERAL LIABILITY NPPI054065 11/02/2006 11/02/2007 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILI PRM�G ET ERENTEDn $ 50,000 CLAIMS MADE❑OCCUR MED EXP(Any one person) $ 1,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ .1,000,000 POLICY PRO R JECT 7 LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND WC 162-94-35 11/07/2006 11/07/2007 x ORY uMWC lTs ER EMPLOYERS'LIABILITY 100,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 100,000 If es,describe under 500 000 SPECIAL PROVISIONS below - E.L.DISEASE-POLICY LIMIT $ , OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION DAVID PICKLE MD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 135 ACADEMY RD DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN NO ANDOVER MA NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED SENTATIVE y ACORD 25(2001108) D CORPORATION 1988 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 Please Print LeVibly Name (Business/Organizationllndividual): Address: City/State/Zip: l�`a3 /L ,OV1 V 7 Phone #: !7 8' Are you an employer? Check the-appropriate box: Type of project(required): l..1�( I am a employer with 2 4. ❑ I am a general contractor and I 6. ❑ 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. 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 10.0 Electrical repairs or additions required.] officers have.exercised their 3.F1 I am a hoineoavner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4), and we have no, 12.[�Roofrepairs insurance required.] f employees. [No workers' 13.0 Other c,)mp.insurance required.] *Any applicant that checks box tt l mirst 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 tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I ani art employer that is providing workers'compensation insurance for my employees. Below is the.policy and job site information / _ Insurance Company Name: W e<7e eN AV a k lO' - �YAA,) Te -C,)"f/'G Policy#or Self-ins.Lic. it: N P0P10- - L/0 (, S" Expiration Date: Job Site Address: /3 s X c 4yle O�/ I-e • City/State/zip: ND.•4wolovr, A44. 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 far insuzance covera.g.r verification. I do hereby certify under the pains andpenalties of perjury that the information provided above is true and correct Sie�natu-Tc: Phone#: S� 9 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Perr:it/License# Issuing Authority (circle one): 1. Board of Health 2,Building Department 3. City/ToFva Clerk 4. Electrical Inspector 5.Plumbing Inspector 6, Other Contact Person: Phone#: Information and Instructi®ns 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 legalentity, 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 ernployei." 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..Re advised thatthis 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 pemut/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 bum 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-MASSAFE Fax # 617-727-7749 Revised 5-26-05 vwvw.mass.gov/dia r GJP - Board of Builds �� a� uae ^ Building Regulations and Standards m ){ HOME IMPRO✓EAAENT CONTRACTOR Licensr r registration Registratia : before llie expir;ition da r±- 122519 Board i:f Building Regu r Exptration }r q/1272008 . One A :rourton)'lace Ri 4 TYPe: Indroidual !3nston?;,la.,721 ... STEPHEN j,,SMITH' y + STEPHEN SMITH 'f s .815 MAIN ST. WW 'DUNSTABLE, MA 01827 llepuh'Administrator. .. I.- _-_.___ -- Not valid with,, TOWN OF NORTH ANDOVER MASSACHUSETTS NORTH ANDOVER OLD CENTER HISTORIC DISTRICT COMMISSION October 12,2007 Building Inspection Town of North Andover North Andover, MA 01845 TO WHOM IT MIGHT CONCERN: Please be advised that replacing the roof at 135 Academy Road does not need approval of the Historical Commission. Section 6 B 1 & B 6 exempts Roof replacements and ordinary maintenance and repair from the bylaws.. It therefore does not need approval from the Olde Center Historical District Commission. Any questions please call me at 978 685 5000. Sincerely, George H. Schruender,rr. Chairman North Andover Historical District Commission