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Home My WebLink AboutBuilding Permit #819-15 - 144 WAVERLY ROAD 4/21/2015 ` BUILDING PERMIT o� NORT{� q qS\.ED /6 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: f Date Received �! Q�RwreD gSSACHU5�� Date Issued: PORTANT: Applicant must complete all items on this page LOCATION �__��' _ -- _ Wt. . _ f PROPERTY OWNER Print MAP'd, PARCEL , .,.0. . ZONING`DISTRICT-.. HistorcDist District yes nno t ,yesMachineShopVillge_ . YS _. TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ff"One family ❑Addition ❑Two or more family ❑ Industrial I14l'teration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other El Septic 11 Well. 0-floodplain El Wetlands, 1 Watershed District. f .or Water/Sewer . 1 DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: E�wm.�GaA� Phone: g713 895 U-3 Address: 1` S /vim SDo-pi V'I'fs Alb Contractor Name: Phone: q 1G 855 2231 Email: �e cc '►'l _ _ f CuyVi _� _. _ _ - - t Address. t(S 040v� �?Z Supervisor's Construction License t 1 -? _ _ _ .__ Exp. Date: . '"? Home Improvement License 1 ?I?3 3 ` _ _ Exp. pate: 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: $ f60D FEE: $ Check No.: Receipt No.: �� NOTE: Per ons ontracting with unregistered contractors do not have access to the guaranty fund ignature of Agent/Own Signature of contractor. i Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swi n ning 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 PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature C COMMENTS toning 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 DPW Town Engineer: Signature: Located 384 Osgood Street 1 kF1RE DEPARTMENT Tern p,RDumpsteron�s - -- ite eyes: n:oa,� Located at 124 Maid Street Fire Department signature/date _ COMME_NIMS 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) QA3 i i ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Pennit Revised 2014 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/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 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:Building Permit Revised 2014 Location No. Date . - TOWN OF NORTH ANDOVER F , Certificate of Occupancy $ Qi Building/Frame Permit Fees Foundation Permit Fee $ Other Permit Fee $ r z. TOTAL $ Check Off oq_ '� � > uildi g Inspector r 1 NORTH v e" 'o A. . .c 0 ,1 . :' to No. "h ver, Mass ' O COCNIC IWICN ��p�RAT E 0 I•P��5 S V BOARD OF HEALTH PER .MIT T LD Food/Kitchen Septic System ,�- �r BUILDING INSPECTOR THIS CERTIFIES THAT ............�IGa. .......�IwC... '..��1:! ,r. ............................... .�• �..,. nu Foundation has permission to erect .......................... buildings on ..... .. (,�' . ..... ............ �i Rough . �it.... & ` �e�i... Chimney be occupied as ..�. 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 1&fv"a �-( , - — PLUMBING INSPECTOR Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO ST TS Rough Service ............... ..... ........ ....... ............................... Final BUILDING INSPECTOR 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 DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 43,000.00 m $ - $ 516.00 Plumbing Fee $ 64.50 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 64.50 Total fees collected $ 745.00 147 Waverley Road 819-15 on 4/21/15 Kitchen remodel, 1/2 bath The Commonwealth of Massachusetts M Department of IndustrialAccidents t =t I Congress Street, Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/El.etricians/Plumbers. TO BE FILED WITH THE PERIVHTTING AUTHORITY. Applicant Information y Please Print.LeObly Name (Business/Organization/Individual): Address: � o City/State/Zip: DorVerS IUA 01 ct73 Phone#: Are you an,employer?Check the appropriate box: Type of project(required): 1.64a employer with employees(full and/or part-time).* 7. F1 New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.❑I am a homeowner doing all work myself[No workers'comp.insurance required.]t 10❑Building addition 4.F1 I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors 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.t 6.FJ We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] , *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. Homeowners 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 state whether or not,those entities have employees. Ifthe sub-contractors have employees,they,must provide their workers'comp.policy number. I din 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.#: Expiration Date:�� Job Site Address: / 7 /Ki w` City/State/Zip:,/l/d,A,, i/yer �, Attach a copy of the workers'comp ,sation 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 DIA for insurance coverage verification. I do hereby certify under the pains andpe alties of perjury that the information provided above is true and correct. Signature: r uJ�--- Date: L 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#: 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 ofhire, 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 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 commonNyealth.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 cant'workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this 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 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 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 Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel.# 617-727-4900 ext.7406 or 1-877-NUSS.AFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia A�f a ^E EDDIE-1 OP ID:DR CERTIFICATE OF LIABILITY INSURANCE r DATE(MMIDDIYYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. HIS 15 CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER HE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CQNTACT John J Doyle Insurance Agency NAME: 85 Constitution Lane Ste 2H PHONE FAX Danvers,MA 01923 C " Exit: A1C No: Sean P Doyle ADDRIE88: IN8l1RER 8 AFFORDING COVERAGE NAIL/ INSURER A:Safe Insurance 39454 INSURED Eddie Mac's Home Improvements 115 Sylvan St INSURER B Danvers, MA 01923 INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. (NSR ADDE LTR TYPE OF INSURANCEJIM POLICY NUMBER MNNppYt YYF MM OG YAP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A COMMERCIAL GENERAL LIABILITY 713MA0011770 0310612016 03/06/2016 PREM( ES Ea occurrence) $ CLAIMS-MADE OCCUR MED EXP Any one person) $ 10,00 PERSONAL 8 ADV INJURY $ GENERAL AGGREGATE $ 2,000,00 GENT AGGREGATE LIMIT APPLIES PER: POLICY PRO- LOC PRODUCTS-COMP/OP AGG $ fire lea $ 100,00 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea acc dent $ ANY AUTO ALL OWNED SCHEDULED BODILY INJURY(Per person) $ AUTOS AUTOS BODILY INJURY(Per accident) S HIRED AUTOS NON-OWNED AUTOS PR OPERTY DAMAGE AUTOS PER ACCIDENT $ UMBRELLA O OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION$ WORKERS COMPENSATION ES AND EMPLOYERS'LIABILITY WC STATU- OTH- TSJ ANY PROPItIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT OFFICER/MEMBER EXCLUDED? � N 1 A (Mandatory In NH) [fyas,describeunder E.L.DISEASE-F11EMPlOYEEDESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS!LOCATIONS/VEHICLES — — I (Attach ACORD 101,Additional Remarks Schedule,It more space Is required) CERTIFICATE HOLDER CANCELLATION NORTH11 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TOWN OF NORTH ANDOVER THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN BRIAN LEATHE ACCORDANCE WITH THE POLICY PROVISIONS. 1600 OSGOOD ST NORTH ANDOVER, MA 01845 AUTHORIZED REPRESENTATIVE Sean P Doyle ®1988-2010 ACORD CORPORATION. All rights reserved. ACORD 26(2010105) The ACORD name and logo are registered marks of ACORD Vfie�(ianvraaa�u�e�o�C/UGcca�aclu«eL�.,- ' , j Office of Consumer Affairs&Business Regulation i ._ MIMPROVEMENT CONTRACTOR E IMPROVi oegistration: (65633 Type: 3 - L i - xpiratiQn 3/10/2016, LLC ' EDDIE MACS HOME IMPROVEMENT'LLC �c EDWARD MACFARLANE I 115 SYLVAN ST DANVERS,MA 01923 l Undersecretary I Massachusetts -Department of Public Safety. Board of Building Regulations and Standards Construction Supervisor License: CS-101276 EDWARD L MAC ARIL-.Ani>F r � 115 SYLVAN ST DANVERS MA 619231 ' � r Expiration jCommissioner 06/20/2016