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Home My WebLink AboutBuilding Permit #299 - 160 BRIDLE PATH 10/29/2002 r4ORTH BUILDING PERMIT cFst�°' .6.'ao TOWN OF NORTH ANDOVER F APPLICATION FOR PLAN EXAMINATION 4 ; T - b n • O OC yq Permit NO: � Date Received4j �04Arcc'ra �SSACHUS�� Date Issued: IMPORTANT:Applicant must complete all items on this page 7j;LOCATION, -PROPERTY OWNER- - ►%� :` hh print 1V1AP NO ,Q PARCEL ZONING-DISTRICT -Historic District yes no Machine Shop Village yes no i TYPE OF IMPROVEMENT PROPOSED USE Res' Non- Residential New Building One famil Addition Two or more family Industrial teration No. of units: Commercial i 5%X�R�epair, replacement Assessory Bldg Others: Demolition Other Septic' Well _ Floodplain r Wetlands Water hed Distnct DESCR PTION O ORK RE . Psi i i 'ficatioP ase Type or Print Clearly) p OWNER: Name: Phone: Address: l7 In rt e c - - I -CQNTRACTOR N:aTne _ 4 Fhone. ` 4 Address. 4 ay . x r rEx Date: - Supervisors Construetion License � P r., Date:, - Homellmprovementicen'se, = P 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: $ in7 FEE: $ Receipt No.: ai b 143 Check No.: P NOTE: Persons contracting with unregistered contractors do not have access to a guaranty fund Signature o-Agent/Owner Signature of contractor Location No. Date ly ' U MpRTM TOWN OF NORTH ANDOVER f 9 ' Certificate of Occupancy $ s•••�•E�� Building/Frame Permit Fee $ S', CHU Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # r �J w Building Inspector i I i I '. i `1 ❑ Plans Waived-❑ Certified Plot Plan ❑ Stamped Plans ❑ Plans Submitted -T-yPE_OF--SEWERAGE DISPOSAL sage/Bod ❑' Swimming Pools ❑ Public Sewer ❑ Tanning/Massage/Body b Y Art Well ❑ Tobacco.Sales ❑ Food Packaging/Sales ❑ ❑. permanent Dum ster on Site ❑ _ . Private.(septic tank, etc.. P I THE FOLLOWING SECTIONS FOR OFFICE USE ONLY � INTERDEPARTMENTAL SIGN OFF - U FORD .DATE REJECTED: DATEAPPROVED PLANNING & DEVELOPMENT El E1 COMMENTS I i -CONSERVATION Reviewed on Signature i COMMENTS f HEALTH Reviewed on Si nature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes f Planning Board Decision: Comments Conservation Decision: Comments Water & Sevier Connection/s Drivewa Permit APW ToNNs Engineer: Signature: Located 384 Osgood Street FIREDEPAI Til =.i�T =TempDumpster on si e yes.. . no Located"at 124 Mair, 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.: ELECTRICAIL: Movement of Meter location, mast or service drop requires approval of Eloctr icallnsp Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine (For department use NOTES and ®�T�— �E � ) i ® Notified for pickup Call Email Date Time Contact Name = Doc.Building Permit Revised 2014 i I Building Department required forms to be filled out for the appropriate permit to be obtained. The following is a list of the q i i 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 Bldg Permit NOT p permits require si n off from Fire Department prior to issuance of g E: All dumpster q g Addition Or Decks ❑ Building Permit Application lication � g ❑ 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 4 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 I - - I I t jApRTly '9 Town of _ Andover No. Co dower, Mass.,/4 •• O z- Ln f COCMICMEWICK 7�p ADRATED `S BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.............. ... .... I....i..0.6............. J. � ............... ...... . Foundation has permission to erect....................................... buil Ings n ...l .Q........... . ............... ......... ........ Rough to be occupied as....... ...................... ............. ..... .......�........ . ................................................................ Chimney provided that the person ac pting this permit shall in a respect conf to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to co/nfto 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 CONSTRUC 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. f AGREEMENT Moon Assoc. Inc. d/blal Gutter Helmet order# 1257 Worcester Rd. 1137 Park East Drive 80 Coogan Blvd. .. PMB#177 Woonsocket,RI 02895 PMB#2 So I � Framingham, MA 01701 401 •671 -6400 Mystic,CT 06355 l MA Lic. 119535 RI Lic. 12259 CT Lic.00562725 115ate WFS 7-800-975-6666 . . >.. PROPOSAL SUBMITTED TO: WORK TO BE PERFORMED AT NA ADDRESS ADDRESS b O &L A4 4 SPECIAL INSTRUCTIONS PHONE NO. WORK PHONE OR CELL .a .a 1. Perform re-installation inspection of property for customer review and acknowledgment 2. Install New Roof Price Total Squares: 17 Color of Shingles: (RI NO RIP: D 3. Performpost-installation inspection of property for customer review and acknowledgement i Install in weather permitting I <#of Year>Product/Material Warranty on<Shin le Brand>; 2 Year Warranty on Labor t All material is guaranteed to be as specified, and the above work is to be performed in accordance with the drawings ands cifications submitted;an completed in a substanti I workman like manner for the sum of j Dollars($ � with payments to be made as follows posit, Check �'f:� WMCV,Sa Forde Credad j $ Balance due upon completion/No exceptions Exp. Date (Initial) Balance to be charged upon installation'to same credit card A late charge will be assessed at the rate of one and one-half percent(1.5%)per,month,annual percentage rate of 18%on the entire account if not paid when due as specified. Further,Buyer agrees to pay any and all fees related to collection of said account,including but not limited to court cost,collection agency fees and attorneys fees. *All agreements c ig nt upon strikes,accidents,or delays,beyond our control. Respectfully submitted by Co. Representative State law requires u to r fund all deposits' are notified in writing,within /J J 3 business days t yo wish4o ancel our oLderl - A EPTANCE"OF PROPOSAL The above prices,specifications and conditio are atisfactory and are'hereby accepted. This contract,specification sheet and customer acknowledgement include all agr,, ents between Moon Associates�and the customer.No of r agreements are suggested or implied. You are authorized to do the work as specified. Pay ents will be made as outlined above. This proposal may be withdrawn after inspection if Gutter Helmet determines that is n�tiinjhepest i ret of th homeowners or the safety of our technicians to have our product installed. IL ',! Signature it Date I FrortP.to sa Rev_fi-0 I The Commonwealth of Massachusetts Department of Industria!Accidents Office of Investigations 600 Washington Street Ili... 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: City/State/Zip: o1 Vone AA�youemployer?Check the appropriate box: Type of project(required): I. employer with I. D 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet $ 7. ❑ 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 10:0Firs repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 1 I.❑ repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12. insurance required.] t employees. [No workers' comp. insurance required.] 13.0 Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit.ihls a„�davit ttidieating iiiey arc L'it irk 5i` MIME hen;-,imp outside coniraclurs itimi submit a new amdavit indicating Such. xConttactors 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: w-L Policy#or Self-ins. Lie.#: �p Expiration Date: � Job Site Address:_ {��D471.JrI �� 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 fo surance coverage verification. 1 do hereby certify u ert pVad p nalfies ofperjurJ that the information provided above is rue a d correct Sisnature: Date: Phone#: Official use only. Do not write inn 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 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 inciudiing 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 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 requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit comps etely,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. Be advised that this affidavit maybe submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. Theaffidavit 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 lay=,or if you are required to obtain a workers' compensation policy,please call the Department at the namber.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/ficense 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 burn 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 Revised 5-26=05 Fax# 617-727-7749 vAvw-mass.gov/dia i I �la..achusctt� - Dcpartment of Public �:tFet, B��artl nF BUddin_ Rc•,ulatimu, anti sttuttl:tril. •• Construction Supervisor Specialty License ic License: CS SL 99840 rn Cl) g Restricted to: RF,WS M m H chl '•;'';,.'. o N JAMES MOON RI �. 48 PAINE ROAD c rn Q CUMBERLAND, RI 02864 Expiration: 3/23/2012 ri:. f;:yr $ c ,lnn�i..i n•r Tr=: 99840 Restricted to: RF,WS IA- Masonry only RF- Roof Covering WS-Windows and Siding SF- Solid Fuel Burning Devices DM-Demolition only Failure to possess a current edition of the ' Massachusetts State Building Code is cause for revocation of this license. Refer to: WWW.Mass.Gov/DPS i j l �tt`ti t31~wilding Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration. 110535 Expiretlo 7/24/2000 Tr# 130185 Type: Private Corporation I i tI I i 10/23/2006 15:26 FAX [M001/001 From 3hwm=RoWrOam MrdW WW WO&At HuntOr Ins—fam.Ino. F®dD: 70_DSn166 4MOO Da*9rA= 11;16 AM Page:2 a1 I1COR0„ CERTIFICATE OF LIABILITY INSURANCE MOoWA x`09/2` 29//09 PROWJM THIS CERTIFICATE IS ISSUED As A MATTER OF INFORMATION ONLY AND CONFQIt$NO RW W8 UPON TWO CERTIFICATE Hunter IASu ta=e, Inc. HOLDER.THIS CERTIFICATE DOES NOT Af16MO,EXTEND OR 389 014 River R04d, P-0- Sox l ALTER THE COVERAGE AFFORDED BY THE POUC196 9ELOW, Manville RI 02938-0002 kbone:601-769-9500 rax:601-769-930" W8URERSAFFORDING COVERAGE MAIC* krim l+doL'iALA n associates tne. " Mr ei.oa ft ,a 2FAw DEQ Gutter Helmet Name! *roes Mahal 2muzon"a.. DE�A►- a l � Aud4,r of RS IN4LM7471C TIBN PPaxIc Zast Drive � INLM0: Waousoaket Al 02895 INeuAPA� COVERAGES M pokoff tM Fopwmg lI>i1EO'miuM INV!IM MI&W 10 TR IMSURk•0 NAME6 AWW POR M POLICY PIMW W1CRW,NO1wr WANDIM MNREOU4WAWF,7ERMORCOMMMOMANYCWR%CTOR01FWCOWMWWnHNWW-IOVW4KMTMCEMT WE1NYBEI6 WOR WY PERrARL INE MRANCR AFF6 0E0 BY 7HP POUC45 CHOW HOW 6OULAff YO ALL M MO.E7(CMOM AND CMITI MS OF BLKIi POLICE4.AA4i4li1AlE LRiMIB StipnM MAY rNvE SEN R4DUC4D w PA o CLAS LTR 1YPE OF WMAPONCtI IuYiDQ1 oAIE LOMa4IwaLu4mm Esuaiooa +ae 41000000 31 g Cft*0C 11.*NM&LWLM M2826619 09/16/08 09/16/09 FRS courwa 4500000 *AM NOW ®MCM dm oft ww) 410000 PUMISLiAD MARY 41000000 a@F pU.AOODAW /9000400 &KAWWWOLIWAPPLUPOt PIMCUCM-COWRIPAOO 42000000 POLICY vEi.� LOC ALIMMOGUUMMM caellM 8rd"Lbe 11000000 AW AM' >l1S26618 09/16J08 09/16/09 Ix1 ALLOAMAN 09 GWLYRU4W 4 SCHOWD AWN Hp6DAUT0® tBOXiat4MASN 1 Nt+gAMM AKn09 iwraeela+eO�W 4 WARNLWLfTY Auraar�Y•EAAcc41ERI 4 ��p ANY A4lr0 EAACC 4AtJtG Or AN 1 A.+►U92LITY 04*1 nmmEr 41000000 mm [:]cLmmv = CUS26619 09/36/08 09/16/09 AGWAM--M 1 i Dedte7leLE 1 X REIEMIOH 810000 4 womu"cow "ION ANO g aw.dowimmnY 28596 10/01/08 10/01/02 L:LeAMAar.MEtr 4900000 ,�}®,ap,4xau0W� e1,o41RAsc,IA41APLorEE 6500000 nVOW MWb m Id w KILDIWASE-POLICNLW 16600000 oTHaR .iRA.r�i.JMY•- CERTIFICATE HOLDER . CANCELLATION J EHMLO ANY OFTMB ARM OUCRBRA FOLKW 96 CAMOEi l M BlPOlr M MRA74Mi CAIS 7 a=p.THE i041M N UIM WLLEHDEAvm Ta MIM. 10 DAYS WWM Building Cont. Req. Board mo-mmim VE CMTFMIV HOMR!VM TO THE LSTSV . T FAL"TO DO$0 nsiYLL .pt. of AckministZation arc=no oOU"TeN aR LIAM UTY OF AW MM uPOM IHR DMIM,TTS AOMM OR � One Capitol Sill RWATIMML psoovidiimce RZ 02908 ACORD 75 iWA IR1 0 ACORO COR RATION 1985