Loading...
HomeMy WebLinkAboutBuilding Permit #555 - 142 BERKELEY ROAD 3/1/2006 NORTH 0p TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION SSA US Date Received:=:�—/-0(-, Permit NO: Date Visucd: IMPORTANT: Applicant Inuq Complete all Items on this Page LOCATION 1-e v PROPERTYCIWNER print 1AP NO.: PARCEL ZONING DISTRicr: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES 0 TYPE OF INFPROV' NILNT-E PROPOSED USE Residential Non- Residential - New Building I I One family Addition Two or more familyhidUstrial ; AlterationNo.of units:Repair, replacernerit--- Assessory Bldg Commercial Demolition 11oving(relocation) Other = Others: Foundation only DESCRIPTION OF WORK TO BE PREI'MIMED Z& Identification I'llease'rype or Print Clearly) OWNER: Name: Phone: S Address: CONTRACTOR Name: P h o n-c: =rS4 63 g 7 o4 Address:-1R'-z &'e&�Luew Yeg 1,a2 A- ic Supervisor's Construction License: 0o —Exp. Date: H,onic lnipro-,.Q:mcnt I-icC113C:_ /0 00 5 9 —Exp. Ditc: te--5 �R('I IH 17C'711 FEESCHEDULE. 3t LDUG PERMIT. S10.(if)PER SIO UM OF THETOT IL ESTIMATED COST B.OED OA S 125.0 0 PE R S.F. N 1 NI Total x1().00 FEESCheck No.: --Receipt No.:_,19'rell Location Y No. Date��" J2— TOWN 2-TOWN OF NORTH ANDOVER ` Certificate of Occupancy $ Building/Frame Permit Fee $— Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check#tllG,r1 25018 Building Inspector I —I II TYPE OF SEw ARGE DISPOS,' j TanningAlassa,u Bod} Art Se%inurting Pools Public Sewer Tobacco Sales Well 1 Food Packaging.Sales P Permanent Dumpster on Site Private ate(septic tank,etc. I NOTE: Persoin contrac•linl; with unre isteretl contmelors (Io not have access to the tivarunt{'fond Si"nature of Agent,Owner Signature of Contractor Plans Submitted Plans Waived i! Ccrtirted Plot Plan Stamped Plans I THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF- U FORM I DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT Ff J I i Water Shed Special Pen-nit jJ Site Plan Special Pemlit ❑ Other COMMENTS DATE REJECTED DATE APPROVED CONSERVATION C'OMN,IENTS DATE REJECTED DATE APPROVED HEALTH COMIMENTS %onin, Board of Appeals: N"ariance. Petition No: Lonin,Derision.receipt stibntitted yes 11:11wim_ Board Decision r ;,mments C,>nsenation Derision: %kate;-a Seg+er a nnertion si�nattnc(�t date__ _ I cntp Duntp�tcr on site ;es _no Fire Department si`nature'date _ f3uildiq Permit A .roved and Issuc�l b�• V,4�. 6,, ""�------------ Pp - — I Building Setback (ft.) II Front Yard j Side Yard Rear Yard Required Providcd Rcquircd Provides Required Provided ------------- DIMENSION `umber of Stories: —Total square feet of floor area. based on Exterior dimensions. I Total land area,sq. ft.: 1401 and I)A I A—(1-or deportnicm use) i I i i i iI - - --- - - - —---------- 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 Debris Removal Form j Workers Comp Affidavit j Photo Copy Of H.I.C. And/Or C.S.L. Licenses i Copy of Contract Floor Plan Or Proposed Interior Work Addition Or Decks Building Permit Application Form U Surveyed Plot Plan Debris Removal Form a Workers Comp Affidavit o 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 Constructiong n Sile and Two Family) ( j Building Permit Application j Form U j Certified Proposed Plot Plan :i Photo of H.I.C. And C.S.L. Licenses j Workers Comp Affidavit :j Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraul Calculations (lf Applicable) :1 Copy of Contract -1 Mass check Ener,.;,, Compliance Report n .III«t.ses il'a %a ria lice or special per±nil was r%.qi ired ;he Foie)C[eAs office nest.41n)p the de:�"600 (roil) Lhe'34 oil ')I' peals that the appeal period is over. The applicant must then;;et this 1 ccorded-,it '9te Registry+,f )ce(Is. One cnp�' tad prn) 'recording must he submitted with the building inplication 1(F.F IIF.PAR P]F.\'1:ln'FQRA!05 James Jones Art Michaud Lic#061615 PROFESSIONAL EXTERIORS Lic#007469 82 Bellflower Road- Billerica, Massachusetts•01821 • (978) 663-8744 Exclusive Distributor of Professional Products- Residential Exterior Siding Specialists• Insurance Coverage Interior Work, Large or Small Registration#100099 (fL=Z L_ �?7Z_ 7� � Uwe, the owners of the premises mentioned below,hereby contract with and authorize you as contractor,to furnish all neces- sary materials and lab orandinstall the improvements on said premises according to the following specifications: Owner's Name iv t Le_Ss A Af 0/?4) T,I. ��' ` 9 Job Address City A101 f�n10�UE'62 State C'ct1e�� // Lcr.,its Ong,lCO.0 44 LJ A4_1&Z, ID CC 4L Cao I 0s qA,?2f /0-re%o S f' S s 1 NS?¢f1 l/ t1!6L( _) A--& cam.✓ `TrIM rrJ�lc�rze �X�sti� — L _ZV stall ire d A R k Geevr,*1 5WO-7 �.� Approx.Start3/ /o Approx.Completion/.30/D In consideration of the labor and materials supplied by the Contractor, the Owner(s)agree(s)to pay to Contractor the sum of 16 1W LYt Dollars THE OWNER SHALL PAY FOR THE WORK: I! by Check made payable to Profes 'onal Exteriors ❑ y Bank Modernization Loan Aexn TO THE OWNER: If it will be necessary for you to obtain a bank modernization loan in order to enable you to pay for said improve. ments, please see attached form for financial disclosures. Manufactumes,Limited Warranty, plus 12 Months ALL Service Warranty where applicable. The contractor is not liable for any damage incurred upon the buyers shrubs or landscaping while in the fulfillment of his ordinary manner of installation of materials described in this contract. The contractor shall be paid by the owner(s),all cost,attorney fees and expenses,in addition to the amount unpaid,that shall be incurred in enforcing the terms and conditions of this contract and/or any lien in connection therewith. Owner agrees that in the event of cancellation of this contract before work is started, but after expiration of recission period, owner shall pay to contractor on demand all costs incurred by the contractor plus twenty-five percent of the face amount of the contract. No work to be done on this property other than that specified herein without additional charge. All parties by their signatures hereto covenant and agree with each other that there are no representations or promises work of any nature other than what appears within the four corners of this instrument. Receipt of a copy of this contract is hereby acknowledged. Company agrees to furnish guarantee upon request. This Contract is subject to strikes, accidents or other delays beyond our control. You may cancel this agreement If it has been signed by a party thereto at a place other than an address of the seller, which may be his main office or branch thereof, provided you notify the seller in writing at his main office or branch thereof, provided you notify the seller in writing at his main office or branch by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the third business day following the signing of this agreement. See the attached notice of cancellation form for an explanation of this right. IN WITNESS WHE OF,the parties have hereunto signed their names this _day of 'l;6 2006 an pled e -'bitratc-dis to that may arise from this agreement through the Better Business Bureeaaju` , J1/7 / d `A"„aor sr Signed Representative OWNER Accepted: ;�'� W X By: Signed OWNER Warranty, Terms and Conditions and Effect of Rescission on Reverse Side NORTIy Town of over ss *� LA doveT, Mass., COC MICKEWICK e x.95 RATED G BOARD OF HEALTH PERMIT T Food/Kitchen Septic System /� , ♦ BUILDING INSPECTOR THIS CERTIFIES THAT v e........ ... ......INNOW.. ........................... . ...................................... Foundation Lhas permission to erect............,I.......................... buildings on...�y............. ... ....... .. ............ ... ..... ... Rough to be occupied as... .. . . Chimney . . . . ...................................................................... provided that the person accepting t ' ermit she m every respect rm to the terms of the application on file in Final this office, and to the provisions of t Codes and By-Laws relating lie 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 S Rough TS ...........................:............. 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. NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit at: 1$'2 0-�f a levis that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, S150A. Also, note Permits are required under Fire Prevention laws Chapter 148 Section 10A. The debris will be disposed of in: 14 (Location of Fac' ' Signature of Permit Applicant Fire Department Sign off Dumpster Permit -o? �/-e% Date i AC-01 M 02/24/2006 PAOMWAR (781) 245-0100 THIS CEERTIFICATE 43 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO Qkf?HTS UPON THE CERTIFICATE LnMKM INSURARCIe AGENCY HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR I 607 IMRTH AV 'M DOOR 12 ALTER THE 001VERICEL AFFORDED BY THE POLICIES BELOW, LAKESIDE OFFICE PARK NXIMFIELD ffiA 018$0— INSURERS APPORDING COVERAGE( MAIC III 41mKmD INSURER A FROVIDB.'17iCE MUTAT. THIS lbl MUD k ARTE;UR G wsvAER B.CONTI AL CJI MALTY — —� 82 BELLE`ICraR RD WSURERG: l MJ$URER 6: , BILL&RICA xx 01821- INSURER E COVERAGES T THE POLICIES OF INSUPRANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMM ABOVE FOR I'de POLICY PERIOD INClIC'ATEM.NOTWITHSTANDING ANY REQUIRENAEhiT,T1ERm OA OOt4 iITION OF ANY C*NTRACT OR O/►iER U=L)MEN{iji,4 RES,^-€CT,--«'HI.^-.E TIPSS CI R-IFICW-E MAY BE ISSUED OR MAY PFRTa(N YHE WSUpANCE AFFORDED BY THEE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITI{?NS OF SUCH POLICIES, I AGGREGATE LI>uM SHOWN MAY HAVE BEEN RtOUCED BY PAID CLAIMS. --� INSR ADVIL TYPE OF INSURA.NGE POLICY TNMBlA ���M�.A+1Tm LTR - LIMITS A GENEFALUAWLITY c" 0050174 02 04/24/2005 04/24/2005 Ep,GnpGGuRRE=rvCL 3 1,000,000 µAMAGE TORE cD� 9 COMMERCWLtIEA1ER,+4LLIA81{;IT1' PREM1�8 EsacwraRn� 100,000 CLAIMS MADE OCCUR ! ! ! / MED EXP(Any ane perkn) PERSONAL R ADV INJURY Is m GENERAL AGGREGATE —' s 1-1000,000 GEN'L AGGREGATE LIMIT APPLIES IES R: MDUCTS-COMPlOP AG43 S 1,000,000 LICv I t JET I !LOC . .. ---- AUTOMURLY LIABILITY ! ! -•• f _r I COMBINED SINGLE LIMIT I$ i ANY AUTO (Ee a mkwvt) ALL OWNED AUTOS ! ! ! / BODILY INJURY (Per person) L $CIiEpULEo AUTOS 1 AIRED AUTOS l I / / BODILY INJURY s I u 1(Per eco wo) I �1sy;7,1En AUTO? Ir r ! r PRgi pt_ix-v DAMAC19 (PE' ent) dA1(AQX_LIAMInY -` AUTO ONLY-EA AGGCENT S ANYAUTO I / ! / I OTNER THAN EA ACI~ S AUTO ONLY: AGC S IAFA%lTY CCCUR CLAIMS MADE � AGOR£CLATE R7<iT:N;iC)N s n :n,"'n"I•=CCOUPc.`�. 111--NAND 9954CB '59'.x76 A :4 ii!02/200511110212006 rnraYi4 DNPLOYEW LIAB(UTY Il00,LT00 ANY M0PRLEYOWPARTNERF-XEGUTTVE Cb_ EA A0['IDENT 9 OFFICER/MEMBER EXCLUDED? ! I I I I EL,DIB ACr,9AEMPLOYEE S 100,000 "Iml"101 . I LPba10. i I F-LDISEASE-POLICY LIMIT S 500,000 CPR ! ! ! r CERTIFICATE HOLDER GA—MC€L''.ATION QLD A.W. Or RF A004E DE---M= POLICIES RE GANtKLLED BEFORE TNF VnmmwM DATE ,ser.aF TOE MMoura k!41'REa >a!!tl Fu[ 45toRTO MAIL 7 h THE.µms nan y fl T� LEFTeJjT u _DAYS TmmicEN W1 I4[' fV.T hm UCRlis�w� .Ari�` VINCI= D`AIaI ZSSA DRO I FARBIVE TO DO t?1 'NO OGLIGATICIN OR LiAnej-1.CW ANYT •:-'-'T.•F 142 mk3amY STRtZT IOdURM ftS AjGEVft -`itETA i At,isw��a �� �•i3 I NORTH ANDOML DIA ACORD 25(20WITIO) C AC-ORD CORPORATION 1149-8 INS025(0ios)-es a€GTI NIC LASER FORMS,INC .(eoe1,327-e5a P6pe i a(z 1-IN The Commonwealth of Massachusetts Department of Industrial Accidents 1.5,L. Office of Investigations 600 Washington Street Boston, MA 02111 www.ntass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information j� Please Print Lezibly Name(IIusincss/Organizationilnclividual): &7TO✓� ° `'XL Address: R'7- &/`;/l3 40if e,�' W, City/State/Zip: f3t'ff gj'c 4 ,414Phone 7 �V Are you an employer?Check the appropriate box: Type of project(required): 1.9 1 am a employer with f 4. ❑ I am a general contractor and l 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors listed on the attached sheet.* 7. ❑ Remodeling 2.❑ t am a sole proprietor or partner These sub-contractors have 8. ❑ Demolition ship and have no employees working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers'comp. insurance 5. [1 We are a corporation and its officers have exercised their 10.❑ Electrical repairs or additions required.] 3.❑ 1 am a homeowner doing all work right of exemption per MGL I LF] Plumbing repairs or additions myself.[No workers' comp. c. 152,§l(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#I most also fill out the section below slowing their workers'compensation policy information. Ilomeowners who submit 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 their workers'comp.policy information. I ain nn employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Policy#or Self-ins.Lic.#: _ Expiration Date: — — Job Site Address: Z City/State/Zip: Nk kAdew v l Attach a copy of the workers'compen�npolicy 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby r the pains m r nalties of perjury that the information provided above is true and correct. Sionature: 0 Date: l Z d Pht°ne.k: – Official use only. Do not write in this area,to be completed by oily or town ojfrcial. City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: �yx� a��r,� v�{tP lG'6%IYFf)LU l7C[Mll+:�1t dt.�:�Zf7af6lC/t2Gd8lAS . x.i,- BOARD OF BUILDING REGULATIONS`' '1 License: CONSTRUCTION SUPERVISOR r Number: CS 007469 Birthdate:*15/1940 " _ { A "` Expires:0611512006 Tr.no: 25014 Restricted: 00 ARTHUR G MICHAUD 82 BELLFLOWER RD 0;4— BILLERICA, MA 01821 Commissioner Board of Building Regulations and Standards I HOME IMPROVEMENT CONTRACTOR Registration: 100099 Expiration: 6/9/2006 Type: DBA PROFESSIONAL EXTERIORS Arthur Michaud 82 Bellflower Rd 6 � Billerica,MA 01821 Administrator Date.�l. /�; 'i.... . R NORTH OF ..ao ,° 'O 0 L TOWN OF NORTH ANDOVER jo ..,. 1 • PERMIT FOR GAS INSTALLATION CMUSEt�h This certifies that . .,r .C'.c.� "` . . � has permission for gas installation . . .,l f?.l: . . . . . . . . . . . . in the buildings of . . . . .. .s�'� ` at North Andover, Mass. Fee. .0 . Lic. No.. j.�. . .� �.--.._. . . . GA INSPECTOR Check# 2 L 4245 MASSACHUSETTS UNIFORM APPLICATON FOR PERNVHT TO DO GAS FITTING (Type or print) Date NORTH ANDOVER,MASSACHUSETTS Ww Building Locations 2/�j /e Permit# � Amount$ Owner's Name 1. �2'Aleguzq= New Renovation ❑ Replacement ❑ Plans Submitted ❑ o � p E+ O �s. E3+ A cd7 uQ a w o SUB-BASEMENT BASEMENT 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH. FLOOR 5TH. FLOOR 6TH. FLOOR 7TH. FLOOR STH. FLOOR (Print ortype). e: eft!rte Installing Company Name '/1►2 d�VGY (�/�t I� K�'I tt f�`ei n a l,e s 1 rrr - off, Address Q �� q Partner. ©/1�11 Business Telephone f J fj �S .3 3 ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter C7 1a r g e /-.a INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ No❑ If you have checked L,please igglicate the type verage by checking the appropriate box. Liability insurance policy caOther type of indemnity ❑ Bond ❑ Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass.General Laws,and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Code and Chapter 142 of the General Laws. gnature o icensed Plumber Or Gaps.Fitter FCitY/Townas le L:rJ Plumb J ©MFitter ricense Nummr aster APPROVED(OFFICE USE ONLY) ❑ Journeyman