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Home My WebLink AboutBuilding Permit #779 - 16 DUFTON COURT 5/29/2007 BUILDING PERMIT ":oTH qti TOWN OF NORTH ANDOVER o? o APPLICATION FOR PLAN EXAMINATION Permit NO:-7? -7 Date Received �94o,Argo 01"I", '-'r SSACHUSE Date Issued: O IMPORTANT: Applicant must complete all items on this page LOCATION /� P Punt , G= '/ A. PROPER'T'Y OWNER � �`f" A", MAP N /(D PARCEL.. = ZONING 6i PrintRIC HIST ; TRICT yes ;o TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ne family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alt ration No. of units: ❑ Commercial epair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic-,,'. El Well « Floodplain Wetla€ds � . Watershed District , IaterfSewetl _.. �. a. DESCRIPTION OF WORK TO BE PREFORMED: Identification Please Type or Print Clearly) OWNER: Name: RDls-ed'e �,uV,ohI Phone: Address: /6 )D I/ r-7-0il`/ G f CONTRACTOR Na e:.,.., ~:F?hone: m Address: _.. Sutaervisor''s Cor,stru tion 'Licen e - 3 Exp. Date. � .46 Home Improvement.License: Ekp. "Gate: 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: $ Gd.� FEE: $ `1-`f I--- Check No.: Z O�� Receipt No.: v a` / NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signatureof centractor Location/4 � /-AII n T - No. Date MORTN TOWN OF NORTH ANDOVER 3? � SOL � 9 Certificate of Occupancy $ �'s'••° ;<�' Building/Frame Permit Fee $ q Lt .tCHUs Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 202 =; G 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 ❑ i 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 DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS r.. 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 Located at 384 Osgood Street FIRE DEPARTMENT Temp Dumpster on site fres: :..,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 i ❑ Notified for pickup - Date ............................................................................................................................... ........................... ......................................................................................._.................................... Doc.Building Permit Revised 2007 r 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 o Building Permit Application Li Workers Comp Affidavit Li Photo Copy Of H.I.C. And/Or C.S.L. Licenses a Copy of Contract o Floor Plan Or Proposed Interior Work o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks o Building Permit Application Li Certified Surveyed Plot Plan La Workers Comp Affidavit Li Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) Li 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) L3 Building Permit Application Li Certified Proposed Plot Plan a Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit Li Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract Li Mass check Energy Compliance Report o 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 DEPARTMENTMITORM07 Revised 2.2007 NORTH Andover Town of 0 VO No. 1�_ . ... ... Za 7 71 4 74 C, 4:2 L dover, Mass-,_ L COCH. K AD ATED BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT....... :�Af4len......./Gi wJ a A7 .......................................................................................................... Foundation has permission to erect........................................ buildings on .1.40-1 ......... ...... Rough .................. to be occupied as............. r Chimney i/zff. ......................................................................... provided that the person accepting permit shall in every respect 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 PERMIT EXPIRES IN 6 MONTHS IN ELECTRICAL INSPECTOR UNLESS CONSTRUfN S 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. CERTIFICATE OF INSURANCE rsuISSUEDATE(MM/DD/YY) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE Samuel J Durso Insurance DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Agency Inc 198 Mass Ave Suite 10113 COMPANIES AFFORDING COVERAGE North Andover, MA 01845 INSURED Arthur Walsh COMPANY dba A. J. Walsh&Sons LETTER A A.I.M. Mutual Insurance Co 55 Pleasant Street North Andover, MA 01845 COVERAGES 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 RESPECTTO 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. CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATIOP LIMITS LTR DATE(MM/DD/YY) DATE(MM/DD/YY) GENERAL LIABILITY GENERAL AGGREGATE $ COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG. $ LAIMS MADEE:�CCUR PERSONAL&ADV-INJURY $ OWNER'S&CONTRACTOR'S PROT. EACH OCCURRENCE $ FIRE DAMAGE(Any one Eire) $ MED.EXPENSE(Any one person) $ AUTOMOBILE LIABILITY COMBINED SINGLE ANY AUTO LIMIT $ ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIREDAUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) $ GARAGE LIABILITY PROPERTY DAMAGE $ EXCESS LIABILITY EACH OCCURRENCE $ MBRELLA FORM AGGREGATE $ THER THAN UMBRELLA FORM WORKER'S COMPENSATION AND X OTORY TH- WC STATU-LIMITS EMPLOYERS'LIABILITY 7014648012006 11/14/2006 11/14/2007 $ A THE PROPRIETOR/ INCL EL DISEASE--POLICY LIMIT $ 500,000 PARTNERSIEXECUTIVE OFFICERS ARE: X EXCL EL DISEASE--EA EMPLOYEE $ 100 000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Town of North Andover EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 15 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE G The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations d 600 Washington Street Boston, MA 02111 www-mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): � Address: P1k�S6,qf City/State/Zip: 1-76I Phone #: 9)k ''6,Z)7 Are you an employer? Check the appropriate Aram Type of project(required): 1. El am a employer with 4. general contractor and I 6. ❑ New construction employees (full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. I �� Fl. 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 10.❑ Electrical repairs or additions officers have.exercised their required.] 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.❑ 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 wbo submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating suc tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy inforrnatih on. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the.policy and job site information. f�. �/r�g` Insurance Company Name: / ��'/ l AIS �J 7 Policy#or Self-ins. Lic. #: 7�/ �l G 7 0 / D� ` Expiration Date: Job Site Address: i C / City/State/zip: /7� ✓y�Dl�O�. /�D� 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 insuzance coverage ,verification. Idoherebycerd under the pains and penalties of peijuty that the information provided above is true and correct Si afore: Date: 9 Phone#: 97thX733 7 Official use only. Do not write in this area, to be completed by city or town official. City or Town: Per mit/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 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 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 legalentity, 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 commonwealth 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 reauirements 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 carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. B.e 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 pernut 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 pplicantPlease be sure to fill in the pemu'Vlicease number which will be used as a reference number. In addition, an applicant that n.sst submit multiple permit/liceise 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 pernut to bum leaves etc.)said person 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 Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 5-26-05 www.mass.gov/dia Propo5al Pae# of pages PI CS # 022680 978-688-6737 ' HIC# 103358 A. J. Walsh & Sons or 55 Pleasant Street 1-866-AJWALSH North Andover, MA 01845 Proposal Submitted To: b Name Job# Yj Address � _ � // Job Location —Tate of Plans Phone# Fax# Architect rwe�herebysLbmitspeciflcatio and estimates for: } r We propose hereby to fursl h material and labor—complete in accordance with the above specifications br the sum of: $ dat o /"rte 13 6 9 J Dollars with payments to be made as follows: y 1 Any alteration or deviation from above specifications involving extra costs will be Respectfully executed only upon written order, and will become an extra charge over and submitted ` � above the estimate.All agreements contingent upon strikes,accidents,or delays ��.. beyond our control. Note—this proposal may be withdrawn by us if not accepted usithin days. Zcceptarice of Vropogal I�r- S The above prices,specifications and conditions are satisfactory and are Signature / t f hereby accepted.You are authorized to do the work as specified. Payments will be made as outlined above. Date of Acceptance Signature i � GTS -��,.e� �✓G��l Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 103358 Expiration: 7/7/2008 Type: Private Corporation A WAL.SH& SONS,INC. rl!lur.Walsh,Jr. 611845 i!1845 ✓1te C�o�rz�ncax veal a��/'�u�a c�u�e BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR r Number: CS 022680 ^• t Birthdate: 06/09/1939 EX Oes:,,06/09/2008 Tr.no: 28249 'r t Restricted: 00 ARTHUR J WALSH JR i 55 PLEASANT ST G— N ANDOVER, MA 01845 Commissioner