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Home My WebLink AboutBuilding Permit #312 - 14 BEECH STREET 10/22/2007 OORTH BUILDING PERMIT 0`1��o qti TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION 1• Permit NO: Date Received �4"�RArto �SSACHUS�� Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION ? �Gs ;Orpri' PROP.ERTY,'OWNER / nt ,Pant MAP NO.,_� _PARC1=1_: ZONING DISTRICT "Ir"' Historic District yes no Machine Ship Vill;3ge yes o TYPE OF IMPROVEMENT PROPOSED USE Residenti Non- Residential New Building One fami Addition Two or more family Industrial Alteration No. of units: Commercial Repair, eplacement Assessory Bldg Others: Demolition Other Septio: Well '1'loodplin V1�etlans 1Naters#iel District Wafer/Sewer- DESCRIPTION OF WORK TO BE PREFORMED: Ida Identification Please Type or Print Clearly) OWNER: Name: &ze:z c4,4 Phone: 978, 666`8917/7 Address: /U o - CONTRACTOR Marne; �' '` Phone: 97$. 3 ® Address. S.upervisor�s Constr-uctiori,ZEcense ;: ''� _ Exp. Date: Z. , Home Improveqent:L�cense . Exp Date ARCHITECT NGINEER Phone: 9 78. 7-04. 3 95'3 Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000000 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 0 70 2� / FEE: $ Check No.: /19 7A Receipt No.: .?0 71Z NOTE: Persons contracting with unregistered contractors do not have access to the uar fund Si nature of A ent/Owner � aH' Si nature ofcontractor Y y.. ._ _.49_ .. _ _9_..v_.r w. _.. Location f y /J t` n^l No. 71Z Date /6-)/121, Of pORTq TOWN OF NORTH ANDOVER t`•e .•,�O a ♦ /(/ Certificate of Occupancy $ p cMus E<� Building/Frame Permit Fee $ a s� Foundation Permit Fee $ Other Permit Fee $ TOTAL $ �. Check # 7� • 20719 fBup6ngInspector 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 O E REJECTED DATE APPROVED CONSERVATION zda2n� 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: Comment Water $ Sewer Connection/Si nature&Date Driveway Permit Located at 384 Osgood Street FIRE DE; FARTMENT emp Ddrnpster-on,slte; YeS __-no: .'Located-at 124Marn Street. Fire 1D,,epartmennature/late 0MMENTTS 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 t Doc.Building Permit Revised 2007 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 o 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) o 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) rl ❑ Copy of Contract o 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 R NO i11 CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 312(10/22/2007) Date: March 28, 2008 THIS CERTIFIES THAT THE BUILDING LOCATED ON 14 Beech Street MAY BE OCCUPIED AS Sinele Family Dwelling IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH R. OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: David Walsh 14 Beech Street North Andover MA 01845 Building In ector V40RTH ` ovm Of :- 6 over No. o �= L o dover, Mass., /o2 > COCHICHEWICK �1. L %d 0"RATED 1`s ARD OF HEALTH PERMIT . T D Food/Kitchen is S stem I G�� THIS CERTIFIES THATI4............................................................ oundation J has permission to erect........................................ buildings on ��.. E ...5�.............................................. Rough to be occupied as................. 11!L rh... G � _...na provided that the person accepting this permit shall in e ry respect conform to the terms of the application on file in Final —a this office, and to the provisions of the Codes and By ws 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. .71'2-/-7-/00' i 3 � . i'ERMIT EXPIRES IN 6 MONTHS ka �G ELECTRICAL INSPECTOR UNLESS CONSTRUCTION TARTS ' or--- 100 ......................... ................................... ......................... r"i Gly _ 9^os BUILDING TOR .5-P-I—®g 1''17 OccuPancy Permit Required to Ocmpy Building GAS i Y GAS INSPECTOR v f Rough -j U Display in a Conspicuous Place on the Premises — Do Not Remove No Lathing or Dry Wall To Be Done Until Inspected and AP Proved by the Building Inspector. Burner FIRE DEPARTMENTStreet No. ` � SEE REVERSE SIDE Smoke Det. i March 28,2008 Mr.Gerald Brown Inspector of Buildings Town of North Andover 1600 Osgood Street North Andover,MA 01845 Re: 14 Beech Ave Temporary Occupancy Permit Mr.Brown, Per our conversation yesterday,I am writing you this letter in order to obtain a Temporary Occupancy Permit for my customer at 14 Beech Ave,North Andover,MA. Both Chestnut Way Construction,LLC.and the customer/homeowner,David A.Walsh,agree to the respective terms below so that the Temporary Occupancy permit can be issued. Chestnut Way Construction,LLC.hereby agrees to remove its inactive temporary electric pole structure,seed the yard,and install a paved driveway at 14 Beech Ave,North Andover,MA on or before July 1,2008 provided the homeowner,David A.Walsh,grants the necessary access for workers and equ mmeent to the property so that all work may be completed in the allotted time. Steven Pouliot,Manager Chestnut Way Construction,LLC. 1,David A.Walsh hereby agree to grant Chestnut Way Construction,their subcontractors and their equipment the necessary access to the property located at 14 Beech Ave,North Andover, MA to remove their temporary electric pole,seed the lawn,and install a paved driveway so that the work can be completed by July 1,2008. I further agree that it is my responsibility to remove any other debris including by not limited to brush,scrap wood,and fencing by July 1,2008 or any ierI 7osed by the Town of North Andover. David A.Walsh I appreciate your cooperation in allowing my customer to start enjoying his new home. Thank you, 9 Steven Pouliot,Manager Chestnut Way Construction,LLC. • �tORTM Of��4•o •�ti0 O IL - i n Sq S� APPLICATION FOR CERTIFICATE OF OCCUPANCYIINSPECTION Buildina Permit# ADDRESS/LOCATION OF PROPERTY 14 Map Parcel Lot Number SUBDIVISION DATE REQUESTED FILED/READY FOR INSPECTION 3: Z7r 0 CLOSING DATE ON PROPERTY: FIVE(5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN-OFFS MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE- INSPECTION FEE OF TWENTY DOLLARS$20.00)WILL BE CHARGED IF THE STRUCTURE DOES NOT MEET ALL APPLICABLE CODES. Permit Issued to: Address SIGNED- ROUTING CONSERVATION PLANNING O DPW-WATER METER SEWER/WATER CONNECTION E NOTE DPW MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO SUBMITTAL OF THE OCCUPANCY/INSPECTION REQUEST DPW _ o„i,.r _� 11,A-�_ `7 )gol) Signature Fife: Application for OC form revised Jan 2007 14 BEECH AVE, NORTH ANDOVER Bonding of Ground Wire for Chestnut Way Construction 978.337.7839 ' Licensed Electrician bonding20+ft. of - ` wire to rebar in footings r 1 w-:.�17 1 _.�_ .. •Sy„iy`- r dr L11: fit,.,•. .P7• .._ / - Y tr - / O, \ ”�` ; Y § r�+3� RtR-S�� W'x kr. � M T31•�y�M� Y- � ',r 'M l.Tfi � �;p Bond in footings prior to concrete with 20+ft. excess outside i" .. 1 - e �' 7• r�*+,le:%1��T�' f�s� ti':J i. '`�•l P ,�mm k ^c1 -�----�";,� Close up of bonding _ <. y ~ Bonded wire set in concrete during pour of footings -ORTH Town of _ _ Andover No. j .L - �`y o dover, Mass.,- T O LA �. ' COCMICMEWICK V 7�ADRATED OARD OF HEALTH Food/Kitchen PERMIT T D 1. is S stem THIS CERTIFIES THAT`>0' ...W 6c .5' ............................................................:...:................................................. oundation�/ log C _ 7 has permission to erect........................................ buildings on ..��EE..�.1.....5 .............................................. Rough tobe occupied as................�.. r!�!,f. .6... .. «'' ......-............................................................................................ provided that the person accepting this perm shall in e ry respect conform to the terms of the application on file in Fin this office, and to the provisions of the'Codes and By- ws 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. 609 7 i 3 ��G . PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSP CTOR UNLESS CONSTRUCTION . TARTS = � r�. ough 04� /' '.. (� � ............... BUILDING TOR ern_ Occupancy Permit Required to Occupy Building �t "'r GAS INSPECTOR y►• ��/� Rough d'�l U ('S^ Display in a Conspicuous Place on the Premises — Do Not Remove _ r No Lathing or Dry wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. <� Smoke Det. 47 SEE REVERSE SIDE CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 312 ,10/22/20071 Date: March 28, 2008 THIS CERTIFIES THAT _ THE BUILDING LOCATED ON 14 Beech Street MAY BE OCCUPIED AS Sinele Family Dwellinj IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: David Walsh 14 Beech Street - North Andover MA 01845 Building Inspector Commonwealth of Massachusetts _ ' 100062476 4 . Asbestos Notification Form ANF-001 Decal Number I B. Facility Description (cont.) CHESTNUT WAY CONSTRUCTION 12 CHESTNUT WAY 5' a.Name of General Contractor b.Address METHUEN, MA 01844 978-337-7839 c.Ci /Town d.Zip Code e.Telephone Number area code and extension f.Contractor's Worker's Comp.Insurer g.Policy Number h.Exp.Date mm/dd/ 6. What is the size:cFffais facility? a.Square Feet b.Number of floors C. Asbestos Transportation and Disposal 1. Transporter ofrontaining material from site to temporary storage site (if necessary): AIR QUALITY EXPERTS,INC. Note:Transfer a.Name of Trans oris F b.Address Stations must comply with the Solid Waste c.City/Town d.Zip Code e.Telephone Number Division 2. Transporter of asbestos-containing waste material from removal/temporary site to final disposal site: Regulations 310 CMR 19.000 SERVICE TRANSPORT GROUP, INC. PO BOX 2132 a.Name of Transom b.Address BRISTOL, PA 19007 1 1(877)999-9559 c.Cit /Town d.Zip Code e.Telephone Number 3. F- a.Refuse Transfer Starnrrand Owner b.Address c.Cit /Town d.Zip Code e.Telephone Number 4. A&L SALVAGE' a.Final Disposal Ste' flame b.Final Disposal Site Location Owner's Name 11225 STATE LISBON c.Final Dis osal Sike: � d.Cit /Town OH44432 co e.State f.Zip Code g.Telephone Number �o D. Certification N The undersigned.heF--i,,y sus, under the JCHRISTOPHER THOMPF �o penalties of perjury,the=tis read the a.Name b.Authorized Signature �o Commonwealth of Maw regulations PRESIDENT 10/03/2007 for the Removal, Co�of Encapsulation of Asbestos,4-53 CMR 6.00 and C.Position/Title d.Date(mm/dd/vvw) 310 CMR 7.15, and thatf'ra �ormation (603)894-6465 1 JAIR QUALITY EXPERTS contained in this notificstion L-1rue and correct e.Telephone Number f.Representing �o to the best of his/her knoxand belief. 40 LOWELL ROAD, UNIT ONE o q.Address _ �u SALEM, NH 03079 -� Z h.City/Town i.Zip Code anf001 ap.doc•10/02 Asbestos Notification Form•Page 3 of 3 1 Commonwealth of Massachusetts 100062476 Asbestos Notification Form ANF-001 Decal Number Important: When filling out A. Asbestos Abatement Description forms on the computer,use 1. a. Is this facility fee exempt-city, town, district, municipal housing authority, owner-occupied only the tab key residence of four units or less?Q Yes ❑No to move your cursor- not use the return b. Provide blanket decal number if applicable: Blanket Decal Number key. 2. Facility Location: +� DAVID WALSH 14 BEECH AVENUE a.Name of Facility b.Street Address _ north andover 101845 �— " c.City/Town d.State e.Zip Code f.Telephone Number INSTRUCTIONS 3. Worksite Location: 1.All sections of this THROUGHOUT form must be a.Building Name/Building Location b.Building# c.Wing d.Floor e.Room completed in order to comply with 4. Is the facility occupied? ❑✓ Yes ❑No DEP notification requirements of 310 CMR 7.15 5. Asbestos Contractor: and the Division of occupational JAIR QUALITY EXPERTS INC 40 LOWELL RD UNIT 1 Safety(DOS) a.Name b.Address notification ISALEM 03079 6038946465 requirements of 453 CMR 6.12 c.Cit /Town d.Zip Code e.Telephone Number AC000167 f.DOS License Number g. Contract Type: ❑✓ Written ❑Verbal h.Facility Contact Person i.Contact Person's Title 6' ABEL J SANTILLANA SR I JAS032998 a.Name of On-Site Supervisor/Foreman b.Supervisor/Foreman DOS Certification Number N/A a.Name of Pro ect Monitor b.Project Monitor DOS Certification Number 8' N/A aa.�N�am�� eof�of—�Asbestos Analvtical ab b.Asbestos Anal tic I�abiDnS Certification Number 0 9. A"MW20m� I� J'A 1 _ 110-177T007 _6 r7; ro'ect Start Date mm/dd/ b.End Date mm/dd/ 0 M-3PM � rn �N c.Work hours Mon-Fri. d.Work hour Sat-Suri. �o 10. a. What type of project is this? =o ❑ Demolition ❑✓ Renovation —r . ❑ Repair ❑ Other, please specify: b.Describe 11. a. Check abatement procedures: O ❑✓ Glove bag ❑ Encapsulation —o ❑ Enclosure ❑ Disposal only �U_ ❑ Cleanup ❑✓ Other, specify: WHOLE PIECE REMOVAL -- ❑ Full containment b.Describe --z =Q 12. Is the job being conducted: FVJ Indoors? Outdoors? anf001.ap.doc•10/02, Asbestos Notification Form•Page 1 of 3 Commonwealth of Massachusetts __ M 100062476 y Asbestos Notification Form-ANF-001 Decal Number A. Asbestos Abatement Description (cont.) 13. Total amount of each type of Asbestos Containing Materials(ACM)to be removed, enclosed, or encapsulated: 20 1 12000 a.Total pipes or ducts(linear ft) b. I ofalotrier su acessquare r c.Boiler,breaching,duct,tank d.Insulating cement L--� surface coatings Lin.ft. Sq.ft. Lin Sql_� e.Corrugated or layered paper 20 f.Trowel/Sprayer coatings pipe insulation Lin.ft. Sq.ft. Lin.ft. Sq.ft. g.Spray-on fireproofing h.Transite board,wall board Lin.ft. Sq.ft. Lin.ft. i.Cloths,woven fabrics Lin.ft. I.Other,please specify: (_. 2000 S .ft. Lin.ft. S .ft. k.Thermal,solid core pipe ISIDING insulation Lin.ft. Sq.ft. I.Specify 14. Describe the decontamination system(s)to be used: WHOLE PIECE REMOVAL AND GLOVE BAG PROCEDURES 15. Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2) (g): WET 2 PLY POLY 16. For Emergency Asbestos Operations, the DEP and DOS officials who evaluated the emergency: a.Name of DEP Official b.Title c.Date(mm/dd/ )of Authorization d.DEP Waiver# e.Name of DOS Official t.DOS OMcialTitle g.Date(mm/dd/yyyy)of Authorization h.DOS Waiver# N 0 17. Do prevailing wage rates as per M.G.L. c. 149, §26, 27 or 27A—F apply to this project? 0 Yes 0✓ No B. Facility Description N �o 1. Current or prior use of facility: RESIDENTIAL �o 2. Is the facility owner-occupied residential with 4 units or less? 0✓ Yes ❑No —� DAVID WALSH 14 BEECH AVENUE 3' a.Facility Owner Name b.Address NORTH ANDOVER, MA 01845 o C.City/Town d.Zip Code e.Telephone Number(area code and extension) u. 4. a.Name of Facility Owner's On-Site Manager b.On-Site Manager Address Q c.City/Town dd.Zip Code e.Telephone Number(area code and extension) anf001ap.doc 10/02 Asbestos Notification Form•Pa e 2 of 3 (603) 894-6465 Asbestos Removal (800) 621-1189 23 Hall Farm Road Residential-Commercial-Industrial (603) 894-7044 FAX Atkinson, NH 03811 AirQualityExperts@AQENH.com October 5, 2007 RE -EVP1® � ?f 18 2007 N.Andover Health Department l TOWN OF NORTH ANDOVER 146 Main Street + HEALTH DEPARTA„ENT North Andover, MA 01845 Dear Sir: Enclosed please find a copy of notification sent to the state for an Asbestos Abatement Project. Jc, k--) II�, fY� .� The job will take place on-1 987. Project: David Walsh 14 Beech Avenue Any questions concerning this matter should be directed to my attention. Sincerely, Christopher Thompson President } 1 Date... Y f pORT►Y, TOWN OF NORTH ANDOVER ' PERMIT FOR WIRING �SS CHU This certifies that ............ A/L ` .... Z4('.Twf.G...................... has permission to perform ...... t.c�.K........... .......................... wiring in the building of... rtiG !. 14 v�:'.....�°�.�.. ......... ........ .... ..... �/ f3f e'( By at.................�............. ..................�................ North Andover,Mass. Fee...-� .' Lic.No..�.5..2 ................... ... . .. /� ELECTRICAL INSPECTOR Check # F31 7764 Commonwealth of Massachusetts Oficial Use Only -77Z Ll Department of Fire Services Permit No. BOARD OF FIRE PREVENTION REGULATIONSOccupancy and Fee Checked [Rev. 1/07] (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT WINK OR TYPE ALL INFORMATION) Date: tom .. C '7 City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives n tice of hi or her intention to perform the electrical work described below. Location(Street&Number) Owner or Tenant At J Telephone No. Owner's Address Is this permit in conjunction with a buildin permit? Yes ❑ No ❑ (Check Appropriate Boa) Purpose of Building Utility Authorization No.-2 Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters V New Service y Amps I/c, / Z2c-- Volts Overhead Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: �—' _ l�h„ A Completion of the ollowintable may be waived b the Ins ector o Wires. No,of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fanso.of Total Transformers KVA ' No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- o. o mergency ig g L-rnd. d. ❑ Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners o.of etection and Initiatin Devices No.of Ranges No.of Air Cond. otal Tons No.of Alerting Devices No.of Waste Disposers eat ump Number Tons ._.. No.of e - ontained Totals: - "'"""'""""""' Detection/Alertine Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal Connection ❑ Other No.of Dryers Heating Appliances KW Security Systems:* No.of WaterNo.of Devices or Equivalent Heaters KW S No.of No.of i s Ballasts . DataNo.of Wiring:vces or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: OTHER: No.of Devices or E uivalent Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start:/,e;' •-30 Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE K- BOND ❑ OTHER ❑ (Specify:) I certify, under th ains nd penalties o perju , that the in ormation on this application is true and complete. FIRM NAME:AQJd LIC.NO.: I3 Licensee: Signature LIC.NO.: Q (If applicable, enter W MP--Ft"iii the lic nse number line Bus.Tel.No.: j Address: �( c/ Alt.Tel.No.: *Per M.G.L c. 147,s.57-61,security work requires Department of PubO lic afety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one) ❑owner ❑owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE:$ I e' The Common wealth of Massachusetts k� ! Department of Industrial Accidents �. a Office of Investigations Vilt t 600 Washington Street ` �� Boston, MA 02111 www.mass.gov/dia . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leib! Name (Business/Organizationlindividuat), Le,,4 Address: City/State/Zip: C'1 Phone#:_. c/ Are you an employer?Check.the appropriate box: 1.Z,I am a employer with 4. El taut a general contractor and I Type of project(required): L tom full and/or 6. ❑New construction P Y ( part-time).* have hired the sub-contractors 2.[] I am.a.sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These su&contractors have 8. ❑Demolition working for me.in any capacity, workers' comp.insurance. g, ❑Building addition [No workers'comp,insurance 5. ❑ We are a corporation and its w required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MOL 11.❑ Plumbing repairs or additions myself,[No•worke'rs'comp. c. 1.52, §I(4),'and we have no r 12.❑ repairsinsurance required.]t employees. [No workers' Roof comp. insurance required_] 1.3.[]Other "Any applieaut that checks bort#1 must also fin out the section below showing their workers'oumpensation policy information. t Homeowners who submit this affidavit indicating they are doing all wotk and then hire outside contractors must submit a new affidavit indicating such. ;Contractors that check this box mustattached an additional sheashowing•the name of the sub-contractors and their workers'comp.policy informadon. I am an employer that ts.prgvMingworkerscompensation insurance for my employees: Below is the policy and job site information. Insurance Company Name:_' Policy#or Self-ins. Lie,#: Expiration Date: Sob Site Address-ALL Pr"h ,�,Zt/�� —City/State/Zip- Attach a copy of the workers'compensation policy declaration page(showing the policy outnber and expiration date Failure to secure coverage as.required under Section 25A of MGL c. 152 can lead to the imposition of ctaminal 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 coverage verification. .r I do hereby certify under the pal andpena/ties ofperjury that the information provided above is true and correct Si afore: Date: G�v Phone#• t Q � 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 S. Plumbing Inspector 6.Other Contact Person: Phone#: 4 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 tnrstee-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 Icoverage 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-contractors)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 cavy workers'compensation insurance. if an LLC or LLP does have f employees,a policy is required. Be advised that this affidavit-may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage.. Aiso'be sure to sign and date the affidavit. The affidavit should be returned to the city,or town that the app3ication 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 dine, 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 ofthe 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 pers6n 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, r 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 Offiee of Investigations 600 Washington Street Boston, MA 02111 Tel. #617-7274900 ext 406 or 1-$77-MA.SSAFE Revised 5-26-05 Fax#617-727-7744 www.mass.gov/dia The Commonwealth of Massachusetts kiDepartment of Industrial Accidents Office of Investigations 600 Washington Street wi Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: City/State/Zip: �Zfy�: !�- � Eti Phone #: 9>$. 3-7. -7d 3g Are you an employer? Check the appropriate box: Typ of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. A New construction employees(full and/or part-time).* have hired the sub-contractors 2.1 I am a sole proprietor or partner- listed on the attached sheet. t 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.❑ Electrical repairs or additions 3.❑ I am a homeowner 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.❑ Roof repairs insurance required.] t employees. [No workers' 13.0 Other comp. insurance required.] Any applicant that checks box#1 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. xContractors 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: A/ Tem-/1"_ toy-, LGA Policy#or Self-ins. Lic.#: _ L O✓yl 30Jr-7 Expiration Date: 0/ . 05 IA.) L lv 5 lo0L) � S7o Z &C Ss--B-0'7 Job Site Address: / e/ 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 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 coverage verification. I do hereby certify un the pan penalties of perjury that the information provided above is true and correct St nature: Date: /p Z v''7 Phone#: 7g-3 3 -7, 0_?-) 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#: t. Residential Home Construction Contract Parties: This 7`s day of October,2007 David Walsh,sole owner of 14 Beech Ave,North Andover,MA hereinafter called the HOMEOWNER,and Chestnut Way Construction, Steven Pouliot,Manager,hereinafter called the BUILDER, Description: The BUILDER will demolish and remove the existing structures on the HOMEOWNER'S property and will construct a single family dwelling of 1,860 square feet including a 2 car attached garage(24'x28'main box with 2'x8'bump out and 6' farmers porch,and 22'x22'attached garage)within the specifications provided in Addendum"A". Construction Price: The agreed upon construction price,for labor and materials,is$231,580(Two hundred Thirty One Thousand Five Hundred Eighty dollars) $100,000.00 to be paid at signing of contract this day $110,000.00 to be paid when plywood is on roof and windows are installed $21,580.00 balance due upon completion $231,580.00 Sub Total ($8,600.00 Credit to HOMEOWNER for roofing and siding $222,980.00 Total HOMEOWNER will receive credits at BUILDERS discretion for other materials provided by HOMEOWNER or monies will be put towards extras for construction. Change Orders: All changes for materials and construction must be in writing,signed by both parties,and state any change in pricing. Failure to Execute: If for any reason the HOMEOWNER does not provide funds in a timely fashion the BUILDER,at his discretion,may decide to end the project Should the project be terminated the BUILDER will return all funds received less amounts for which BUILDER can show documented proof of expenses including a portion of BUILDER fees as follows: Project started&permit(s)obtained: Builder retains$5,000.00 Foundation in ground: Builder retains$10,000.00 Plywood roof&install windows: Builder retains$20,000.00 Sheetrock&plaster installed: Builder retains$30,000.00 Final electric&plumbing: Builder retains$40,000.00 Insurance: It is the responsibility of the HOMEOWNER to maintain insurance for the property throughout the duration of construction. The BUILDER carries his own liability and workers compensation policy. Brokers: The BUILDER and HOMEOWNER each represent and warrant to the other that neither has contacted any real estate broker in connection with this transaction. Therefore,no brokerage commission or fee exists with this transaction. �`s {! 1 Land Access: The HOMEOWNER agrees to grant BUILDER and his subcontractors full access to the site throughout the duration of the construction process so that all work may be completed. Additional Provisions: a)HOMEOWNER agrees to return all phone calls by BUILDER in a timely fashion so as to not delay or prevent the progress of the project. b)HOMEOWNER agrees to pay for removal of all asbestos on site. c)HOMEOWNER agrees to provide access and or pay for water as needed during the demolition process and removal of asbestos. d)HOMEOWNER agrees to pay additional funds for construction if ledge,water,or other hazard is encountered during construction. e)HOMEOWNER agrees to pay for any and all fees imposed by Town except for demolition permit,building permit,water/sewer permit,dumpster permit,and certificate of occupancy. f)HOMEOWNER agrees to pay additional fees for street opening in the event that the Town requires street to be opened a second time to connect water/sewer utilities. Review of Plans: BUILDER agrees to allow HOMEOWNER the opportunity to review design plans and make changes twice. There will be no additional costs to HOMEOWNER for changes provided changes do not require additional costs to builder. Warranties and Representations The HOMEOWNER acknowledges that the HOMEOWNER has not been influenced to enter into this transaction nor has he relied upon any warranties or representations not set forth or incorporated in this agreement or previously made in writing. NOTICE:This is a legal document that creates binding obligations. If not understood,consult attorney. 1�/li�C r V j HOMEOWNER,David Walsh B DER,Chests Way Construction Steven Pouliot,Manager ADDENDUM"A" Specifications for 14 Beech Ave,North Andover October 7,2007 Foundation: • 10-inch thick poured concrete(3,000#mix) • External Heavy Duty waterproofing with Manufacturer's Warranty of 15 years • Complete peripheral drain system around entire house and garage • 4 inch poured concrete garage floor • Twelve inches of crushed stone and structural fill under entire basement floor • Six inches of crushed stone and structural fill under garage floor Structure: • 2x6 Quality framing • Sub-floors comprised of T&G,W9 plywood • Ice and water shield provided along all soffits and valleys Landscaping: • All disturbed areas to be raked and seeded • Driveway:gravel base with 3"of asphalt Exterior: • 30 Year Architectural shingles on roof • Exterior energy efficient house wrap on all sheathing • Low Maintenance Vinyl siding • Exterior decorative lights provided at front door Windows and Doors: • All windows are energy efficient Harvey Vicon Double Hung with between glass grids,Low E glass and easy clean tilt capability 17 Double hung,&2 larger(18-4046 for Family room) • Harvey 6' Slider with Low E safety glass • Front entranceway single door with double side lights • Garage doors:2 Quiet Drive,insulated,vinyl doors Utilities: • Forced Hot Air by High Efficiency(90 Plus%)Gas heating system with 2 zones • 2 Zone Commercial Grade Central A/C(Larger more efficient ducts&Insulation) • 40 Gallon Power Vented Hot water heater Kitchen: • High quality Maple Kitchen cabinets o All wood boxes o Dovetail joints o Raised Panels o Lazy Susan o Crown Molding • Granite counter tops • Under mount kitchen sink • Appliances provided by owner Bathrooms: • I"floor%:bathroom—Vanity with sink,toilet • Master bathroom-3'shower,vanity with sink,toilet !J • 2nd floor family bath-5 foot tub and shower,vanity with sink,toilet Electrical: • Approximately 8 recessed lights included • Hardwired smoke detectors • Washer and dryer hook-ups-220V • Dryer venting • Fan/lights in bathrooms • 4 cable jacks • CATS wiring • 3 phone jacks • All bedrooms include over-head lighting • All bedroom closets include lighting • Door chimes • Two electrical garage door openers provided(quiet track) Interior: • Blueboard and plastered throughout house with smooth finish • Trim package includes: • Ceramic tile -all baths and laundry room • Family room carpet,hardwood throughout balance of first floor • Ceiling fan provided in family room • Carpet in all bedrooms(carpet has 51b pad or better) • Oak stairs and rails with volute and bull nose at bottom • Closets to have wire shelving • All hardware to be brushed nickel • Walls,doors and trim are primed and painted with two coats of semi gloss(2 color choices allotted throughout house) ❖ All homes come with 1-year Builder's guarantee ❖ All changes processed after signing of the Residential Home Construction Contract must be in writing and signed by both Buyer and Seller ❖ Admin.fee of$50 for each change ❖ Builder reserves right to substitute materials with equal products ❖ Options and allowances are only available if selections are made in a timely fashion i.e.prior to installation t A , � r Terms—14 Beech Ave.North Andover October 7,2007 Contract Price $231,580.00 • $100,000 at signing of construction contract • $110,000 deposit when roof and windows are installed • Balance due when complete • Roofing and Siding credit of$8,600.00(owner to provide) Not included: • Drainage Pits • Deck,patio,or walkway • Additional work associated with hitting ledge or water • Asbestos removal • Appliances or appliance book up by plumber • Fencing • Tree removal CHESTNUT WAY' -COR,UCTION NORTIy Town of No. L ;+ — o _ dover, Mass., L A-O COCMICKEWICK 7� ORATED P'? C2 S BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR �d' Uj C4,1 .r� THIS CERTIFIES THAT_� ..:........... ..... ........................................................ .... ..... ..�................................................................. Foundation c>�.............................................. Rough has permission to erect........................................ buildings on Z1�.�...AEE.. . ................:. to be occupied as................. 1�v .6.. ''cKk / Chimney provided that the person accepting this permit shall in e ry respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By- ws 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 CONSTRUCTION TARTS Rough Service .................. .................. BUILDING TOR 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. ra + Y Tti'� S. y � �M�r r"j•�+�y��yj%iae}:;�+N�. ,yam � .1� �` . P: Ryl •N' Y Y tl'TIA .t 01 't j�V[�]9• �� ' '�� 00 W LLJ c0Alil AA- `` p ZLU p V 1 = p rV. rl , LU W ei N i _- t LM U r y `i .L4' Sent By: H & K Insurance Agency, Inc.; 617-926-0912; Oct-17-07 14:57; Page 2/2 DATEI�slroDmm7 ACQPD,,, CERTIFICATE OF LIABILITY INSURANCE 10/17/07 T C FK:ATE iSISSIEDASA MA ROFINiORMATDN PRODUCBt ONLYAt1DCONERSNOMGH�StiPE�1 HECERCIFICATE H & K Ins. Agency, Znc• Houm His canIFICATEDOES NOT �R EXT P.O. Baa 344 ALTER THECOVEMGEAFiORD®B1� EFULICI�BB.OMf. 182 Main Stmt Watertown, INA 02472 INSLpaM AFFO_ NG COVERAGE INSURED Harleysville Group/W_ roaster E � ar Chestnut Way Construction LLC :LNSURER&Hartford Insurance 12 Chestnut Way INSURERC_ - Methuen, MA 01844 INSURERO- INSURER COVE RAGl5 THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAKED ABOVE FOR THE POLICY PERIOD I NOTWITHSTANDINGDILATNOTWITHSTANDING ANY REQUIREMENT.WAM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT VATH RESPECT TO WHICH THIS CERTIFI ATE Mitt BE ISSUED OR I Ay PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUELXCT TO ALL THE TERM&E)CLUSION S AND CONDITIONS OF SUCH POLICIES AGGREGATE LILVM SHOVM MAY HAVE BEEN REDUCED BY PAID CLAIMS. _ INSIi%IDD' - - POde-yE*Nzil E I R3UCY�RA DN LIMITS �� POLiGYNUtiSER GENERAL LIABKJTY ' EACH OCC ;ENCE is 1,000,000 CO;4MEERCW GENERALUAmffY FCL OX3991 9/1/07 911108�°PREESIS ocasecL ;S 100,000 A :S 5,000 CLAMS MADE R€OCCUR! - `Id�ExPt ap9D ) PERSONALE WVINJURY s 1,000,000 GENERALAG 3REGATE s 2,000,000 GEKLAGGREGATE LVIITaPwJESPER- -PRODUCTS-1coMP1oPAGG :s 2,000,000 POLICYMT - .-�LOC - JWTDM�REUABtLFTY COMBINED LIMIT ;S (Ea a=K%M ANY AUTO - i ALLOVNEDAUTOS EWLY��') S SCHEDULED AUTOS _ NREO AUTOS I I(perE ) Y .S • NON-OV&JEDAUTOS - ! PROPERTY E AMAGE S i (Per a=gWO GARAGELINBtCITY {AUTO ONLY EAACC(DENT S ANYAUTO - OTHER T EA/�C ! :AUT ONLY: nGG'S ERCESNUMBRELLAUASUTY :EACH OCC E S -OCCUR CLAIMS MADE AGGREGA !S :S ?DEDUCTIZU S RETENTION S S - H- WORKEiSCOMPBNSRK]NAND TORY ITS; ER B .EMPLOVOWLIABLTTY 6S6017B-5626C35-8-07_ 9/12/07 9/12/081 E-LEACH CIOENT s 100,000 ArLr PROs R lEreswPrATNERkxbcuT€uE OiF,PERRYEM�R iRTNEE2}I _.L DISEASE EAEmPLOYEE €s 100.000 s}es,des:rtoettber El -POUCYWAIT -S 500,000 .SPEQALPROVISQNSbebw OTHER f i € I I DESCRWI HOF OPERATIONSILOCAIMSIVEH1CLES/E71CLUPONSFDDEDBYEND OREMENTISPECIAL PROVI=NS i i f i i CERTIFICATE HOLDER CAMELLATIOM S"OULDANY OFTHE ABOVEOMCRISEiIPomm - ECAHCELLW BEFORE THE EXPIRATION }I DATETHERMF,THEISSUaIGINSURERWLLETQD RTOMAIL 20 DAVSWRTT-mN F Tovm of North Andover €UTP_'ETOTHiEGERTIFtCATEHOLDERNAUEDTo 'HE LEFT.BUT FAILURE TODOSOSNALL { Im-005"0 r8�--ol OR s tammtlw ANY KW d UPON THE INSURER.LIS ALTS OR I ALfTI#£SzL�RIE.St:3NTP.TYFtE € —� , r_- H._ JchHerlihy � _1 ACORD 2€(2001JOR) ACS CORPORATION 1989 i E F: j ✓/:e T�a7xnzo�uuec��i a�✓�aaaac�uceelta 13oard of Building Regulations and Standards Constructipp- pervisor License Su LlgG t g,CS 85446 lafr�2"h21/1972 � a On 1J2009 Tr# 10773 STEVENE POULQf 'f 12 CHESTNUT WAY� METHUEN,MA 01844 Commissioner lam_