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Home My WebLink AboutBuilding Permit #220 - 152 ANDOVER BY-PASS 9/21/2007 BUILDING I'LKMI 1 o 2 bf.;��, ._.ro._,6 O TOWN OF NORTH ANDOVER F - p APPLICATION FOR PLAN EXAMINATION Permit N0: Date Received �( �'°SSgCHus�`�� Date Issued: —2 IMPORTANT Ap licant must complete all items on this page v{x � 4 v��fi°k x •�': Ali10 �'• 35 rav3 PM 7 Yl �L fes. . r• -`,' z' ' ,' ^, ,-sY, �; r +..'� y'� c.. �r' .'°� sa °r� m .:"R �. ": p- rr r,y ' q � � '?, ,r �F}}�JY'� ,��-��'� ^� u'• � ��t. _.z x:,.... n� rg �� { � T i� ..,.. .��•.y _ � £k':' �3},,:SF.'." y�r TYPE OF IMPROVEMENT PROPOSED USE Resi(VA:ttial Non- Residential ❑ New Building One family KAddition ❑ Two or more family ❑ Industrial ❑ Alteration No. of u6its: 0 Commercial ❑ Repair, replacement ❑ Assessory Bldg 0 Others: ❑ Demolition ❑ Other �{il,,., all 4 4P xz`ri"v,€,{:£�.�'"„ .� a rr,` �' " ?, _,e,. �J DESCRIPTION OF WORK TO BE PREFORMED: Identification Please Type or Print Clearly) OWNER: Name: ZSZ VV S Phone: 9`78� 8�d �f Address �2 s r x s € 3r u t f`� 7M" '1 � Mr A+3+ ea,r4. �h��' btz' 'iia d-p �.. r �J i '�t� ':�"" � L 'z �„ �..F' f� �F .a! 9 5� 'e• `�'�.-+'R* r; ,. askC f x' D-00 �G •s sr.7"' "':r3d�' ` ' ' '"' '"� S W� ' ..,,a ARCHITECT/ENGINEERS Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ ��000 0 d FEE: $ Check No.: �f Receipt No.: X661,7 NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund ei V Location t<� ��'��` `447 No. Date ��d �oRT� TOWN OF NORTH ANDOVER F? • • OR 9 ` . Certificate of Occupancy $ i , �ssACHusE<�' Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ �79 Check # 206 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 [IPrivate(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 DATE REJECTED DATE APPROVED CONSERVATION ❑ . ❑ COMMENTS i I DATE REJECTED DATE APPROVED HEALTH ❑ ❑ 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 Located at 384 Osgood StreetRR Driveway Permit NOes . �...# ��'�_.._„�� fl..*+ S i SL 'YM li S fraFc+xyo- sy�� 7-7 "', ^+.:x7147 ° Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: I ELECTRICAL: Movement of Meter location, mast or service dro re Electrical Inspector Yes P quires approval of No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.s100-s1000 fine i I NOTES and DATA— (For department use M r ❑ Notified for pickup - Date 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 -u 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 thea appeal period is over. The applicant must then et this recorded at the Registry of Deeds. One co and roof of recording PP P PP g g Y PY P � must be submitted with the building application Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 NORTH Town of No. 2. 2,C) o . dover, Mass., Q LAKE �• COC HICHEWICK RATED v BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT...............................st.. .v .... ►................................................ has permission to erect........................................ buildings on .../..rZ,........ ..... ough to be occupied as �/1�� .. ......�� Chimney . . . .Y" erky .. . . . . . .. . . . . . .. . .. .. . . . . provided that the person accepts this permit s all irespect conform to the terms of the application on file in 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 )c1� PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO ARTS Rough ..................... Service BUIL SPECTOR 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 Commo0wealth of Massachusetts Department-of Industrial Accidents Office of Investigations 600 Washington Street t Boston, MA 02111 www.M,.,.Rov1dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): & L. /'C Address: `� /7/ ,G-Z-i'S 5 City/State/Zip: �e c-?�j d� )0,7 Phone #: G Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑ New construction *11yees(full and/or part-time).* have hired the sub-contractors 2. 1 am a sole proprietor or partner- listed on the attached sheet. t E] 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. Contractors 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: Policy#or Self-ins. Lic. #: Expiration Date: Job Site Address: 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 under the ins and penalties of perjury that the information provided above is true and correct. Si nature: d✓�-- Date: / Phone#: Official use only. Do not write in this area,to be completed by city or town official I 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#: Page#�_of �—pages Best Choice Home Improvement ,(978} 564-4969 Licensed& Insured Satisfaction Guaranteed Peabody, MA 01960 i Proposal Submitted To: Sob Name Sob# � Address Job Location Ga' Date Da of, ans Phone# 4slubmit Fax# Architect Weherebs ecifications and es{ ...._..........._.....----__-..__ ___...................._._...._._.........._........___-_-_--__-.------------------_.___._...__....... __�_____. OF t .... FZ .............. --._ -._ �- --- _-........ .. ...._._..---.._..__.._._...._ #�r - ._..__......._ t{ y _... _ _ _ ___ ....... .... ._...__._. ....-... 47 . el _ --- _ We propose hereby to furnish material and labor—complete in accordance with the above specifications for the sum of: Dollars A+ with payments to be ma0e as slows: Any alteration or deviation from above specificatid involving extra costs will be Respectfully executed only upon written order, and will become an extra charge over and submitted f above the estimate.Ali agreements contingent upon strikes,acckdents,or delays beyond our control. Note—this proposal may be withdrawn by us 9 not accepted within ays. 2creptance of The above prices,specifications and conditions are satisfactory and are signature �' hereby accepted.You are authorized to do the work as specified. 7f1. lo"� / Payments will be made as outline dA6 ove. Board of Building Regulations and Standards , License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Board of Building Regulations and Standards RegistrAtim, 136633 ipt# 88/2008 Tr# 132508 One Ashburton Place Rm 1301 a�pi(�t Boston,Ma.02108 E>� �Tjrpe DS (J I--. BEST CHOICE HMBsIMPROI/EMENT RENZI TEJEDA 7 HARRIS PEABODY, MA 01960 Administrator Not va without signature ACORD CERTIFICATE OF LIABILITY INSURANCE T09/10/2007 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION FRIENDLY INSURANCE AGENCY, INC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 471 WESTERN AVENUE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. LYNN, MA 01904 781-593-4344 INSURERS AFFORDING COVERAGE NAIC# BRED INWRERA WESTERN WORLD INSURANCE COMPANY BEST CHOICE HOME IMPROVEMENT INSURER B: 7 HARRIS STREET INSURER C: PEABODY, MA 01960 INSURER a 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. LTR RLSRD TYPE OF INSUR NLCE POLICY NUMBER POLICY AN UNITS A GERERALLIAOILITY TBD 09/06/2007 09/06/2007 EACHOcCURREINCE $1,000,000 -10mome 10 X COMMERCIAL GENERAL LIABILITY PREMISES="=W—) s 50,000 CLAIMS MADE OCCUR MED EXP Wq one person) $5,000 PERSONAL III ADV INJURY $1,000,000 GENERAL AGGREGATE s2,000,000 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPUOP AGO $1,000,000 POLICYLl PA Ll LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Es eeo"m S ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Perpww) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS ) I PROPERTY DAMAGE $ ' mw accidem GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC S AM ONLY- AGO $ EXCESSIUMBRELMLYAINUTY EACH OCCURRENCE i OCCUR ❑CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION s $ WORKERS COMPENSATION AND TORY LIMITS I I ER EMPLOYERS LIABILITY E.LEACH ACCIDENT ANY PROPRVEMRIPARTHER40MCUTNE s OFFICEWMEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE S . I Yes.desems Ieidef E.L DISEASE-POLICY LIMIT S SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIM CERTIFICATE HOLDER CANCELLATION SHOULD AMU OF THE ABOVE OESCRIM POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE MOUING MUM WM.L ENDEAVOR TO MAL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER. ITS AGENTS OR REPRESENTATIVE-. AVTIIORIZED REPRESENTATIVE ACORD 25(2001108) 0 ACORD CORPORATION 1988