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Home My WebLink AboutBuilding Permit #726 - 145 BRADFORD STREET 6/24/2009 BUILDING PERMIT OttIORTN tIOR 32 ba,,, .6 O� TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION 9 Permit NO: Date Received * �" q�gA7lD PPP �5 �SSACHU`+�� Date Issued: ° IM ORTANT: Applicant must complete all items on this page ,LOCATION vC i Print PROPERTY OWNER �C) � Y"`u y" a Print MAP NO: 4-1—PARCEL- ZONING DISTRICT: Historic District yeV,' �no no Machine Shop Village ye TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial AI tion No. of units: Commercial Re repla eta Assessory Bldg Others: Dem'afti Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PRE FOR ED: Identification Please Type or Print Clearly) OWNER: Name: c v�D- Phone: 9)9- 886-Zqg 7 Address: CONTRACTOR Name: bJrt q'� "*e4`3 Phone: T29'-69`7_de--)+7 Address: 42/r1 L S"�; Supervisor's Construction License: JOICL3 Exp. 'Date: E /0 Home Improvement License: / -319542Exp. Date: doff 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: $ �J�/'�U FEE: $ s3 D Check No.: / Receipt No.: I NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fun Signature of Agent/Owner Signature of contractor _ y Location A r No. Date NORTH TOWN OF NORTH ANDOVER 3:0•'�« u •,MOOL 41 f' 9 Certificate of Occupancy $ Building/Frame Permit Fee $ GO Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 221 << b Building Inspector 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 CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning 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 FIRE DEPARTMENT Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS 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 Doc.Building Permit Revised 2008 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 ❑ 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) ❑ 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:INSPECTIONAL SERVICES DEPARTMENTMFORM07 Revised 2.2008 I NORTH Town of tAndover No. 72. (o T Q - LAKE dover, Mass., COCHIC)E WICK �� lei DRATE D C, '9S E BOARD OF HEALTH Food/Kitchen PER IT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT....... . .. ••.• 4!! � ......••mow Foundation has permission to ere p buildings on ..1J7. ........A.?.�.. .. • Rough to be occupied as.... .........,C........ i� ...t.....�........ .,D...... .. *W06!4`...... ��.Ifin imney Ch' 10 provided that the person accepting this permit shalrin every respect conform to a terms of the application on Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final 3d PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTR ST TS Rough ...... .................................................................................................. 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. The Commorz"Peaft of Massachusetts f i Department of Industrial Accidents . Off1ce of Investigations . . a 600 TTTashington Street �c Boston, MA #2111 www mzassgov/dia . Workers' Compensation Insurance Affidavit: Builders/C ontractorsXlectridans/plumbers A.00ficant Information. Please Print Legibly Name(Business/Organizafion/Individual):_ Address: Q1. - City/State/Zig:-/Ari� p WAA. O 1°SYS- Phone#: . ��(,e9-:d,,1 - A reemployer?Cheek.the appropriate box: em to er with F7. of Project(requites: P Y r 4, ❑ 1 am a general contractor and Iees(full and/or part-time).* have bred the sub-cant actors New construction ole proprietor or partner- listed ori the attached sheet i Remodeling ship and have no employees These sub-contractors have working for me in any capacity, workers' comp.insurance. g' Q Demolition [No workers'comp.. insurance 5. Q Building addition❑ We are a corporation and its 9. Bu 3.❑ required.] officers have exercised their 10•❑Electrical repairs or additions I am a homeowner doing all work right of exemption per MGL I LEI Plumbing repairs or additions myself [No-workers'comp. c, tS2, §1(4),and we have no insuranceuired. .t 12. Roof repairs nq ] .employees. [No workers' comp. insurance required_] 13.[]Other �f+nY aFtpiicatn that checks bo s ,must atao ful out the section below showing their workam'compensation poiicy information. ;Ary who submit this affidavit indicating they ars doing an work and than hila outside conuaetots most submit a new affidavit indictittias such 4Co MWft)rs that check this box must Amtobed sR addition)sheat show' ing•the nems ofthe soli-conttactom and&air work='co--—z.*-;irSomnation !am an erstpioyer tkat is protruiing:workers'cornperrsation insurance or information. mJ' P�YpPI Below is&ePVU 'l mrd job site . . Insurance Company Name: ' t [ (,L �i �- Policy#or Self--ins Lic.#'- (�t Q O LA j4 00./0 or Expiration Date: p Job Site Address: 1 y S g( �Cr ciry/staterzip: mw d/IYs- Attach a copy of the wo Failure to rkers' compensation policy declaration (showing pane( b the policy number and expiration date). secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal fine up to $1,500,00 and/or one-year imprisonment, Penalties of a, of up to$250.00 a day against the violator. Be advisedthata copy of this statement may be fore form of a warded dOP Oto the gfiiRK e of d a fine Investigations of the DIA for insurance coverage verification. Ido hereby cffgo,, der,t e p and penalties eetjrc y that the information provided above is tale and coned Si frac: 6 oZ � • p Date: Phone#: O?— pa(,/ EofHealth only. Do not write in.this area,m be c v { by�J' ff cid n?P et�ed or town o i ' Town: Permit/License# ffiority(circle one): Health 2. Building Department 3.City/TownClerk 4. Electrical Inspector 5. Plumbing Inspector son• Phone#: Information a ind I11structions Massachusetts General Laws chapter I S2 requires all emp 3 dyers 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'foregaing engaged in a joint enterprise,and includirzg the legal representatives of a deceased employer,or the receiver ortrustee-of an individual,partnership,associatioin or other legal entity,employing employees.'However the owneir•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 w6rlc m 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 flat"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or ato construct buildings in the commonwealth for any Applicant who has not produced acceptable evidence a-e compliance with the insurance coverage required." Additionally, MOL chaptrr 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public worse until-acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the cortracting 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)_Elrod phone number(s)along with their certificates)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not requiredito carry workers' cernpenssfion insurance. Ifan LLC or UP 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 pehni{or license is being requested,notthe Department of Industrial Accidents. Should you have any.questions regal-ding the law or if you are required to obtain a workers' compemtion policy,please—call the Department at the numberlisted below, Self-insured coanpanies should enter their self-insurance'ficense number on the'appropTiaie'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 swe to fill in the permit/Iicense number which will be used as a reference number. In addition,an appiimit that must submit multiple permit/iicenm applications in any given year,need only submit one affidavit indicating-cwrent policy infonnafion(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 futon permits or licenses. A now 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 persorn 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, Please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Lndust=ial Accidents Office of Investigations 600 Washington Sti=t Basfon, MA 02111 TeL#617-7274900 ext 406 or 1-8.77-MASSAFE Fax#617-727-7741 Revised 5-25-QS www.mass.gov/dia Proposal FULLYINSURED FREE ES77MATES NMGHT GUTTERS Specializing in Seamless a All Colors Available 350 BERRY ST. . NORTH ANDOVER, MA 01845 TELEPHONE 978-687-2247 PROPOSAL SUBMITTED TO, f PHONE yi Z -016 c? I DATE STREET JOB NAME I LOCATION iy5- BmJ4tY-J a CITY,STATE AND aP CODE JOB START DATE ltlv - 018Y5' /8 : fck k Al I've_vj P rk s5V r-e 17-"4ed 8-- 'q y Is iv i"01 y -foot ©�I oeMQ�ied ;rr or, S4&" lark 5- E G1�` - id f Y�-e"P 1�(so C,a- cae.ec k P lam fo ��ct�nc�t:TS 33 ' \�C3 if It f We Propose hereby to fumish material and labor-complete in accordance with above specifications,for the sum of:$ -A S� �►, Payment to be made as follows: ; I as r» � � 14100,00 �� w k oh�2 d #� 1� r_ 0/4S 34W eogYract-b-�- All material is guaranteed to be as specified.All work to be completed in a workmanlike Authorized manner according to standard practices. Any alteration or deviation from above Signature 00 specifications involving e)dra charge over and above the estimate.All agreements contingent upon strikes,accidents or delays beyond our control. Owner to carry fire,tomado and other necessary insurance.Our workers are fully covered by Workmen's Compensation NOTE: This proposal may be Insurance. withdrawn by us if not accept ithin days. Acceptance of Proposal - The above prices, specifications and conditions are satisfactory and are hereby accepted.You are authorized to do the Signature work as specified.Payment will be made as outlined above. Date of Acceptance: Signature i '^ Massachusetts-Department of Public Safeti � Board of Building Re-_,ulations and Standards Construction Supervisor License License: CS 10266 Restricted to: 00 r SCOTT WRIGHT 350 BERRY ST NORTH ANDOVER, MA 01845 Expiration: 8/12/2009 (unui�is�innt r Tf m: 10266 DATE(MM/DD/YYYY) OP ID S ACORD CERTIFICATE OF LIABILITY INSURANCE WRIGSCOP 06/23/09 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE T. A. Sullivan Ins. Agcy, Inc. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 344 S. Union St. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Lawrence, MA 01843 Phone: 978-683-4700 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Worcester Insurance Company INSURER B: Mass.Workers Comp.Assigned Scott Wright INSURER C: 350 Berry 5t INSURER D: N.Andover MA 01845 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IN POLICY EFFECTIVE POLICY EXPIRA N LTR NSRAUU TYPE OF INSURANCE POLICY NUMBER DATE MMIDD DATE MM/DDIYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1000000 A X COMMERCIAL GENERAL LIABILITY CB 3M6760 12/01/08 12/01/09 PREMISES(Ea occurence) $300000 CLAIMS MADE F-1 OCCUR MED EXP(Any one person) $50000 PERSONAL&ADV INJURY $ 1000000 GENERAL AGGREGATE $2000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $2000000 POLICY PRO LOC JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND TORY LIMITS ER B EMPLOYERS'LIABILITY WC 004460069 09/30/08 09/30/09 E.L.EACH ACCIDENT $ 100000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 100000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $500000 OTHER A Commercial Applica CB 3M6760 12/01/08 12/01/09 A Property Section CB 3M6760 12/01/08 12/01/09 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION xacoIX SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Building Inspector IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR North Andover REP ESE N TIVES. AUTHORIZED 7P NTATIV ACORD 25(2001/08) ©ACORD CORPORATION 1988 ;nsee Details Official Website of the Executive Office of Public Safety and Security (EOPS) s.Gov Home iblic Safety ......... .. artment of Public Safety Licensee Complaints icense Type Home Improvement Contractor icense# 138569 .estriction ompany Wright Gutters ame Scott Wright ddress 350 Berry St. ity, State, Zip No. Andover, MA, 01845 xpiration Date 4/14/2011 tatus Current > coM hints fouaid for this Licen.�e . ck ` o Search