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Home My WebLink AboutBuilding Permit #1150-2016 - 14 BIXBY AVENUE 5/4/2016 NORTH (t'e BUILDI G ERM o�<=ig° �6'No TOWN OF NORTH ANDOVER � APPLICATION FOR PLAN EXAMINATION �� !�° Permit No#• � Date Received �,y'°�R,7E° SS•vCHoS Date Issued: MPORTANT: Applicant must compitems on this page LOCATION 4e/,a, G 14 Print PROPERTY OWNER & /� � �/ 116 Print 100 Year structure yes no MAP 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 wo or more family ❑ Industrial ❑ AI ion No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands 0 Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: �7 //�� lX�•,i � Phone:/47� Address: Contractor Name:6;/7W� ' ^�/�.- Phone: �/�� Email: �/1'� Address: j 10 Supervisor's Construction License:Gso S� Exp. Date: Home Improvement License: f Exp. Date: �"•� 3�.2�'�� ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COSTBASEDON$125.00 PER S.F. Total Project Cost: $ 6, FEE: $ l (P Check No.: Receipt No.: 12)6 32 NOTE: Persons contracting with unregistered ontractor not fftfve Ocess to the guaranty fund - gibLocation A/C- No. — tl Date�— • TOWN OF NORTH ANDOVER � a � Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $\ Check# J �j 3 Building Inspector � k Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL F Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ l ! Private(septic tank,etc. ❑ Pennanent Dumpster on Site ❑ { THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM I PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature I COMMENTS s I HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments f Y, Conservation Decision: Comments Water & Sewer Connection/Signature Date Driveway Permit DPW Town Engineer: Signature: tFIREDEPARTMENT TemDurnpster�on ife4 - Located384 Osgood Street f - - - ELocate�at�124tMain�Street tFi'r`eD'epamentsignature/date _ _ COMMENTS, ___ Dimension I Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, rust 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 I I NOTES and DATA— (For department use) ® Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 r Building Department i 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 OTE: All durnster permits require sign off from Fire Department prior to issuance of Bldg Permit p 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/Cross Section/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 lN OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ,;6 Building Permit Application Certified Proposed Plot Plan j 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 2012 IECC Energy code Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit l 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 in ust be submitted with the building application I Doc:Building Permit Revised 2014 4 !I I -f ` :NORTH Town of 0 No. W, •• _T - s - oh ver, Mass, 4 A- COc...WICK y� 7,95�4gTEO 11kh"r 5 U BOARD OF HEALTH PERMIT L D Food/Kitchen Septic System t 1 THIS CERTIFIES THAT Wow!T........ ��' ~ ............... BUILDING INSPECTOR ,. t Foundation has permission to erect ........ ................ buildings on ..�. .... ... .. .. .. ..`........ ' Rough � g tobe occupied as ......." .............1 ...... .. . ... . ........, ................................................. Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONS TIO Rough Service .. . .. ... ..... .... Final 4iBUILD61iN�VGiS`Pi?6CiT60R GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMEr Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. !r �yORTp OE�t�se �e4tiQ Town of North Andover *_ Machine Shop Village Neighborhood Conservation District Commission 1600 Osgood Street North Andover, MA 01845 �i +OR+rio✓�• gACHUSE Application For EXCLUSION From Certificate to Alter Certain alterations are excluded from review by the Machine Shop Village Neighborhood Conservation District Commission in accordance with the Bylaw. Applicants for exempt projects must fill out the form bellow and submit to the Commission Chairperson(contact info below). Date: ;�, / l Contact Name&Address: PO cyK X5,K Project Address: Project Description (attach additional pages,if needed): '4 Y7' Gt C;2. X41 o Q i y, rj t/i yJ !, owl' Exclusion From Review Requested For: ❑ 1.Interior Alterations ... existing conditions including materials, design and dimensions. ❑ 2. Storm windows and doors,screen windows and doors. ❑ 9.Replacement of existing substitute doors,substitute siding or substitute ❑ 3.Removal,replacement or installation of windows with new materials that are gutters and downspouts. substantially similar to the existing condition. ❑ 4.Removal,replacement or installation of window and door shutters. 10.Replacement of original fabric r windows or doors with substitute ❑ 5.Accessory buildings of less than 100 windows or doors that maintain the square feet of floor area. architectural integrity with respect to form,fit and function of the original ❑ 6.Removal of substitute siding. windows or doors. ❑ 7.Alterations not visible from a public ❑ 11.Reconstruction,substantially similar in way exterior design,of a building,damaged or destroyed by fire,storm or other disaster, ❑ 8. Ordinary maintenance and repair of provided such reconstruction is begun architectural features that match the within one year thereafter. MSV NCDC Page 1 Current Chair:Liz Fennessy,77 Elm Street,lizettafennessv@va —uxum,978-688-2915 NORTk �O41ilED 'ef��Op. -' Totem of North Andover +K Machine Shop Village Neighborhood Conservation District Commission �1.gs°A•rco,r•t.� 1600 Osgood Street North Andover,MA 01845 SACHUSS A hcation For EXCLUSION From Certificate to Alter For Items 9,10 or 11,provide the following documentation: Photos/drawings of existing doors,windows or siding,as applicable �,_Description/Catalog Cuts of proposed materials to be used for doors, windows or siding Plan and elevation of reconstruction for Item 11 Determination: This proiect is determined to be exempt O not exempt from review by the Machine Shop Village Neighborhood Conservation District Commission, Projects that are not exempt must complete the Application for Certificate to Alter, available from the Building Department and be reviewed by the Commission. Determination made by: Signature Neighborhood Conservation District Commission Date MSV NCDC_Page 2 Current Chair:Liz Fennessy;77 Elm street,iiiettafennessv@yahoo.com,978-688-2915 FIRST ENVIRONMENTAL CONTRACTORS, INC. 4 BOSTON ROAD SOUTHBOROUGH, MA. 01772 PH 978.549.2200 E MAIL GARY.ONEILL1010na,GMAIL.COM MARCH 2, 2016 STEVE KIMBALL 5712 TIMER LAKE CIR. SARASOTA, FL. 34243 CONTRACT FOR WINDOW REPLACEMENTS AT 18 & 20 BIXBY AVE. NORTH ANDOVER, MA. 01845 REMOVE AND REPLACE 14 LEAD BASED WINDOWS INSTALL NEW WHITE VINYL REPLACEMENT WINDOWS WITH 6/6 INTERNAL GRIDS AND SCREENS. WINDOWS � MEET STATE ENERGY CODE o(ol, COST $6300.00 DEPOSIT TO ORDER WINDOWS $2,000.00 BALANCE UPON COMPLETION $4,300.00 SCOPE OF WORK AND TERMS OF PAYMENT AGREED FIRKT EIS V O M D AL STEVEN KIMBALL CONTRACTORS, INC. The Commonwealth of Massachusetts F Department of IndustrialAccidents ¢ tl 1 Congress Street,Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERIVIITTING AUTHORITY. . Applicant Information Please Print Legibly Name(Business/Organization&dividual): �hA/ Address: � �� /� ��11� City/State/Zip: 1 Phone#: �` 6 Are you an employer?Check&e appropriate box: Type of project()Vequired): l.❑I am a employer with i employees(full and/or part-time).* 7. ❑New construction 2.E.]I am a sole proprietor.or partnership and have no employees working for me in 8. E!Remodeling any capacity.[No workers'comp.insurance required.] • 9. EA Demolition 3..❑I am a homeowner doing all work myself[No workers'comp..insurance required.]t 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 E]Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions propiietors with no employees. 12..[f Plumbing repairs or additions 5. I am a general contractor and I have hired the sub-contractors listed on the attached sheet. ❑ 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.1 6.❑We are a corporation and its ofcers have exercised their tight of exemption per MGL c. 14.❑Other 152,§1(4),and we have no emgloyees.[No workers'comp.insurance required.] -. t; *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. Homeowners who sulimit•this affidavit indicating they are doing all work and 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 state whether or not those entities have employees. If the sub-contractors t w employees,they must provide their workeis'comp.policy number.' T 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.Lie.#: LL/ y�� / � Gpiration Date: Job Site Address:�1e"ge o969 City/State/Zip:- Iva ` � � • Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DTA for insurance coverage verification. Y do hereby cert er the pans and penalties ope ' ry that the information provided above is true and correct. d -�-/r�_:7 Signafore: Date: Phone Official use only. Do not write in this area,to he completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): i 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: AC:URDF UEKTIFI.CATE OF LIABILITY INSURANCE UA7CIMMIBUITYYYI �..�• 1. 10101/2016 THIS CERTIFICATE 13 ISSUED A8 A MATTER F INFORMATION ONLY AND CONFERS NO RIGUPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND EXTEND .OR ALTER THE COVERAGE AFFORDED BY THE POLICIES RELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITJTE A CONTRACT BETWEEN THE ISSUING INSURER(&), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder Is sn ApDITIONAI INSURED,the p0 icy(Les)must be endorsed. If SUBROGATION 19 WANED subject to the terms and conditions of the policy,certain polloieo may"Utre an endorsement.A statement on this certificate does not confer rights to the cern/Icate holder'in lieu of ouch endoreament(s).. PRODUCER 01807-001 Choice Insurance Agency Inc ,�1; (978)343-4853 1 W.N.- 376 Summer Street Fitchburg,MA 01420 sa; INSURED INSURER A A.LM.Mutual insurance Company First Environ"Atal CorLtractoza Inc P O Box 88 INSURE RCi Southborough; MA DIM INSURER 9, COVERAGES `CERTACATE,MBERi " ,... .:� .,..... 1'tEYFSIQN..NUMe _..... THIS IS TQ CERTIFY THAT THE POLLOIE8 OF IN&URANCE LISTER BEL¢W HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY.REOUIREMENT TERM. CONDITION ,F'=ANY CONTRACT OREOTHER DOCUMENT WITH.RESPECT TO WHICH THIS CERTIFICATE Mfi4'B$`ISSCJEp"OR MAY-PERTAIN;°r�1Elp INCE 7CFFORDED`bY TRE POLICIES OSCRIHED"HER'Eit!---SUBJECT'-Ta AL'C-Tt E-TERMS,' EXCLUSIONS AND QONDITION8 OF SUCH POLICIE.$,.LIMITS SHOWN MAY HAYS BEEN REDUCED BY PAID CLAIMS. I TYPE OF INSURAN¢E -AWE 1 ROLR:YNUMBER LIMITS 0@NERAL UA8IUTY EACH OCCURRENCE ; COMMERCIAL GENERAL UA8ILITY RENTED 8 CLAIMS MApE OCCUR E TO MED EXP(Any one portion) i PERSONALSADYINJURY 8 a. ap,L AGGREGATE 6 EN'L AGGREGATE LIMITAPPLIES PERI PRODUCTS-COMPJOPAGO. S AU.TO MOBILE LIABILITY, LIMIT ANY AUTO C accidentl ON E .. S. ALL OWNED SCHEDULED BODILY INJURY(Per person) E AUTO 9 AUTOS BODILY INJURY(Per accident) S HIRED AUTOSNO O V6NEO 0 B t UMBRELLA UAB OCCUR. EACH OCCURRENCE S E4 CE89 UAB.• CLAIMSMADE AGGREGATE It OED RETENTION S A OI FICER/MEMBER EXCLUDEO7 ECUTII/E1 1 NIA AWC-400-7019883-2016A 9/29!2016 9129/2016 El EACH ACCIDENT s 100,000.00 . I(Mandatory In NH)' E.L.DISEASE 4 EA EMPLOYEE1 E 100,000.00 D!ti�ftIPT10 .OF PE S ha aw E•L,.OISEASE•POLICY LIMIT E 600,000.00 DESCRIPTJQN7OF,RPEIJATIONS'/j 0CAY1bN8'I UE J' $S(71'Mgot"Ac III;AildlUdhel RertfSPlta 9o118d Ie;if mare apace a required) r CERTIFICATE OLDER CANCELLATION THEUEXPIRRA IONHDATBEVTTHDEREOF, NOTIICE WILLS CANCELLED BEFORE DIN ACCORDANCE MTN THE POLICY PROVISIONS. AunHowzEo.Repal>JlreNrA'r►ve. ACORD 26 2010106 ®1980.20 . D'CORPORAI rights reserved. ( ) The ACORD name and logo are registered marks of,ACORD Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5.170 Boston, Massachusetts 02116 Home Improvement C for Registration Registralton: 118004 Type: Individual m Expiration: 1113J2017 Tr# 262432 GARY P. OWEILL GARY OWEILL , P.O. BOX 88 SOUTH BOROUGH, MA 01772 Update Address.and-return.card.Mark reason for change. SCA 1 a 20W06/1I ❑,Addryw E Renewal Employment Lost Card . C�/ee .ranu�alde�C�aaQaa�iraell'a Office of Consumer Affairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Istratlon: 8004 Office of Consumer affairs and Busines's Regulation Expiration:==: Z7 IndWual 10 Park Plaza Suite 5170 (� GARY P OWEILL _ �_7-� ;."y i Boston.MA 42116 = . - . I� GARYNEI .YG ' O LL 4 BO r" STON RD A.. SOUTH BOROUGH,MA 01T Uadersecretiry Not valid without signature Massachusetts Department of public Safety ' f Board ofBuilding.Regulations and.Standards 1 License: CS-057877 Construction Supervisor ' GARY.P ONEILL, c r Y 4 BOSTON ROAD SOUTHBOROUGH'"E tit Expiration: 70104/2017 Commissioner