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Home My WebLink AboutBuilding Permit #308 - 138 MOODY STREET 10/18/2006 L TOWN OF NORTH ANDOVER NORTh APPLICATION FOR PLAN EXAMINATION of,*�•' •�'t'o Permit NO: Date Received '�o .^ # �4.�....,.R. Date Issued: SAC HU`�t�gb IMPORTANT: Applicant must complete all items on this page LOCATION 13 on ST�• �N • �✓��UC Print _ PROPERTY OWNER /✓� ��/4" E d - d Print MAP NO.: PARCEL: ZONING DISTRICT: V, TYPE AND USE OF BUILDING HISTORIC DISTRICT YES 0 TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Buildings One family ❑ Addition ❑Two or more family ❑ Industrial ❑: Alteration No.of units: 5(Repair, replacement ❑ Assessory Bldg ❑Commercial Demolition Moving(relocation) 0 Other ❑ Others: i Foundation only DESCRIPTION OF WORK TO BE PREFORMED r St��►� X iSrl�l� G� -70-0f �l�l�lIGL�S r Identification Please Type or Print Clearly) OWNER: Name: ��9–i/I/l /1 f=- EQ Phone: ?7,q �� '��`�d I Address: i 3" 41/ ��r- sd.� �� ✓¢ CONTRACTOR Name: D/,1-y 1 ID Phone: Address: &(z F205 T 'Zto 12—eM -,WA Supervisor's Construction License: Exp. Date: Home Improvement License: /SoZ Exp. Date: ARCHITECT/ENGINEER Name: Phone: Wdress: Reg. No. FEE SCHEDULE:BULDING PERMIT:,512.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON 5125.00 PER S.F. Total Project Cost S t7 YC9e�). 0-6 FEES -9, , of Check No.:—/ Receipt No.: -4 I TYPE OF SEWERAGE DISPOSAL Tanning/Massage/Body Art ❑ Swimming Pools Public Sewer _; Well 7 Tobacco Sales Food Packaging/Sales Permanent Dumpster on Site Private(septic tank,etc. J Electric Meter location to project NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfun Signature of Agent/Owner Signature of contractor Plans Submitted ❑ Plans Waive Certified Plot Plan ❑ Stamped ans 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 ❑ ❑ CnMMENTS t F RE DEPARTMENT - Temp Dumpster on site yes no Fire Department signature/date �l .0 I COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes i Planning Board Decision: Comments Conservation Decision: Comments I Water& Sewer connection/Sinature& Date Driveway Permit h Building Setback ( Front Yard Side Yard Rear Yard Required Provided Required Provides Require Provided Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: NOTES and DATA— For department use C ��l�J►j c,-> I n i 1 S' cbn i i I ill 'I Page 3 of'4 DOC:INSPECTIONAL SERVICES DEPARTMENT:BPFoRM05 Cradled JNIC 1,111_01)6 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 Addition Or Decks ❑ Building Permit Application ❑ 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) 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 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 DEPAR'1'31EN'rMFORN105 Page 4 of 4 i i i Location , JAr- /77 V 0 No. Date � 4—/)� NORTH TOWN OF NORTH ANDOVER f w 9 * Certificate of Occupancy $ MUs t�' Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 19703 Building Inspector NORTH Town of :_t over No. 3o $ =t. C% 0 dover, Mass., —0 •l�•i �i 0 LAKE COC ..r ME WICK V OA?ArED Pk? C2 BOARD OF HEALTH Food/Kitchen S PERMIT T D kptic System THIS CERTIFIES THAT.......J.A .............. f BUILDING INSPECTOR ...................................... Foundation j...*—....—*—*—***-----...*....—* has permission to erect........................................ buildings on .......5)"........................ Rough to be occupied as.... Chimney ev re provided that the per§22%ev�Pag is perm shalt i!k spect conform I to the terms of the application an 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 CONSTRU N S rTSRough . 40 Service -.... .....0��............................. 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. b 1 W 0W Byrne Col p 135 Maii ZCL Winthrop, 1 Q 0. " I O c a) _ 1� `a E ti Z .r To: Sam Baffo LLo a- E 138 Moody Street O o E a U _ N. Andover, MA Z �? o E a. 0 • Stripped Roof r � U m O • Removed Antenna 04111 •»♦ • Removed and repaired existing roof 1 M �° ••.,G : • tri .` M • Installed 8"white aluminum drip ed F o o; e o • Cut in new ridge vent �� p\ J Z Mot .rt•� U • Renailed plywood • Applied 6 feet ice and water shield a • Applied 15 lb felt paper to remaindel • Roofed house with 30-year architectural shingles • Installed ridge vent • Capped roof • Roofed shed with 30-year architectural shingles • Total $7,800 i Contractor: )"e- Customer: i AnW.4 i Board of Building Regulations and Standards License or registration valid for indietul use only r HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Board of Building Regulations and Standards Registration"152586 One Ashburton Place Rm 1301 Expiration 911:2/2008 Boston,Ma.02108 F. Type; IndNidual S� DAVID J BYRNE i DAVID BYRNE ` 4 66 FROST RD. " Not va withou gnature TYNGSBORO,MA 01879 Deputy Administrator I DATE ACORD,M CERTIFICATE OF LIABILITY INSURANCE 10/18/200613:22W) PRODUCER (800)225-1865 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Fred C.Church ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 41 Wellman Street Connector Park HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Lowell,MA 01851 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Commerce Insurance Company David J Byrne 66 Frost Road INSURER B: Tyngsboro,MA 01879 INSURER C: INSURER D: 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 DD' POLICY NUMBER POLICYEFFECTIVE POLICY EXPI RATION M(y) DATE(MMIDDIYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $1,000,000.00 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES Ea oCcurence $50,000.00 CLAIMS MADE FKOCCUR MED EXP(Any one person) $5,000.00 A HHH279 11/2/2005 11/2/2006 PERSONAL&ADV INJURY $ GENERAL AGGREGATE $2,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 17 POLICY PRO LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANYAUTO (Ea accident) $ ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) F1 PROPERTYDAMAGE $ (Per accident) GARAGELIABILITY AUTO ONLY-EA ACCIDENT $ ANYAUTO EA ACC $ OTHER THAN AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ TH- WORKERS COMPENSATION AND WC STATU IQRY IMIT ER EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT!SPECIAL PROVISIONS Commercial General Liability for Interior and Exterior Painting. CERTIFICATE HOLDER CANCELLATION Sam Baffo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN 138 Moody Street NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL N.Andover,MA 01845 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2001108) Client# 1996 Mat# 81 Cert# O ACORD CORPORATION 1988 �N The Commonwealth of Massachusetts ' - Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 f www.mass.gov/din Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): DA-0 Address:- City/State/Zip: V,,41/�� ,4,V Q/gVPhone #: Are you an employer?Check the appropriate box: Type of project(required): 1.❑ 1 am a employer with 4. ❑ 1 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. 1 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 10.❑ Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12 ] Roof repairs insurance required.] 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 this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 'C'ontractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic.#: Expiration Date: Job Site Address: City/State/Zip: 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 tine 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. do hereby certify a ler the pr 'ns and pe rlties of perjury that the informatlo�t provided above i true and correct. Si mature: Date: V Phone#: 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#: