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Home My WebLink AboutBuilding Permit #503 - 187 OLD CART WAY 3/25/2009BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: , o Date Received Date Issued: S IMPORTANT: ADDlicant must complete all items on this D*a2e TYPE OF IMPROVEMENT PROPOSED USE Residential . Non- Residential ❑ New Building 9-Cfne family 0 Addition 0 Two or more family 0 Industrial ❑ Alteration No. of units: 0 Commercial epair, replacement 0 Assessory Bldg 0 Others: 0 Demolition ❑ Other Yi 7 Sepfc >VU�IC ` a > Ftcio�la�n CI1le€latads d�tlfaersl�ed This#pct" DESCRIPTION OF WORK TO BE PREFORMED: < . L - 1 2 Identification Please Type or Print Clearly) OWNER: Name: 6&t6& a.- Nwl;,nh Phone: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE: BULDING PERMIT: t$12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST.BASED ON $125.00 PER S.F. to . Total Project Cost: $ 00950 FEE: Check No.: . Receipt No.: NOTE: Persons contradting with unregistered contractors do not have acceslto the, guIran y f j 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 PLANNING. &_DEVELOPMENT ❑ COMMENTS CONSERVATION COMMENTS DATE REJECTED El - DATE APPROVED El DATE APPROVED 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 Driveway Permit Located at 384 Osgood Street 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 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 5( 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 DEPARTMENT:BPPORM07 Revised 2.2007 Location j 1 "T i 'A— No. 017 Date NORTIy f � TOWN OF NORTH ANDOVER ' OL Certificate of Occupancy $ o� .. . • Building/Frame Permit Fee � s�CNus $ 1 Foundation Permit Fee Other Permit Fee TOTAL Check # 14�iell ec�/ v , 21 b9 $ Building Inspector � A O w v cn o A O w O a U C x o P-4 m p w' C w 0 w � w ,.a w � p w' g cn C X. o U o O R: C ii W A w ,. 7 c0 z b cn Q v o E cn m c ;;c o CD N C O i In V CL R A �. m= � = o co o co E a c w.+ ts cr u, ;i F oma O _ •�- N Z r ,•� �3 E c 0.1 �mm C3 �� 3 o cm ---; —FD C C � CA C A A N CL y m m Q,CZ VN O m "a • C � O = m mLp MH o : a o f- �Q V • ui � •N �O.t O C y... 4=1 'E c, �cm,a- CJN O F cm L3 0 h d m-.8 O :� /'--� Z �C ob � '� 7 F- Z $ a Z m E d N O N C 0 ca m C: CI C m O cm C �C N m s y.r 0 Z 0 J O 5 F'! C/) z w a co O co CC O s Z co C. O y G C O Q! ! Q co Ag co O m m •� O O L co w L !O O d Cl. C Q CO3 c O O v J .� �C ' t CD V L y c C C c CLCO2 0 LLI N W W W U) APEX CARPENTRY, LLC GENERAL CONTRACTING s COMMERCIAL: RESIDENTIAL s SPECIALIZING IN FINISH CARPENTRY PROPOSAL Client: Mrs. Barbara Dowling September 26, 2008 187 Old Cart Path Way North Andover, MA 01845 Job Description: RE: Bathroom Vanity JOB # PO# • Disconnect all plumbing to vanity. • Removal and disposal of mirrors. o If mirror can be removed when new is delivered then $100.00 can be deducted from price. • Removal of existing master bathroom vanity. • Skimming of walls, if necessary, where mirror is removed to prepare for painting by others. • Installation of owners supplied vanity into same location. • Connection of all plumbing for new sinks and faucets. o Price provided that we connect to existing supply and drain lines. • Client to provide all plumbing fixtures and valves. • Supply & install new 103" x 42" mirror over vanity. • Supply & installation of poplar trim along top edge of vanity backsplash. • Supply & installation of poplar trim around mirror. • Client to do all painting. * * Fully licensed and insured. ** All references will be supplied upon request. ** All utility costs supplied by owner. ** All construction will meet local building codes. ** Excludes cost of unforeseen ground conditions ** Excludes replacement of any topsoil, grass, or plantings. Proposed Price $ 2,850.00 Any alterations or deviations from the above the above specifications with regard to price or style will be allowed through both written & or verbal communication. Payment will be 1/2 due to secure work and order stock followed by progress payments. CLIENT: DATE: LIC #024784-----29 Bates Rd. Swampscott, Ma. 01907 * (781) 592-6997 Fax (781) 584-4121 ----- HIC #123150 AZO -R& CERTIFICATE QE LIABILITY INSURANCE 0Bzp DnYE(41MJDDrIrr Y) APERC�20; 124 09 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMAIION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Soderberg TO,surance Servicers HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND -;iR 200 Broadway ALTER THE COVERAGE AFFORDED BY THE POLICIES BEL OW, Lynnfield MA, 01940 -599-7339 INS P2�one:781-593 9393 Fax:781URERS AFFORDING COVE _ RAGE INSURED INSURER A: Western World NAZI. # POC Spagn f i ??,l.0 II oha 5pagooli 29 Sates Road Srrampecocott MA 01907 31754 - INSURER B: conmerce Insurance INSURER C: Guard Insurance Group INSURER D; INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POI.ICY 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 AFBORDED COY 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 NSR TYPE OF INSURANCE POLICY NUMBE7Z DATE M ATE MMlD LIMITS A GENERAL UABtldiY X COMMFIyCUiL@ENERALI,IgBIIITY CLAIMS MADE OCCUR NPP1179032 09/22/08 09!22/09;PREMISESIEaocclermcq EACH OCCURRENCE S 1 , Q ; 0,000 �50,r)00 MED EXP (Ary erre peracn) S 5 , 0 I) 0 PERSONAL & ADV INJURY 3 1 0110 , 0 0 0 GENERAL AGGREGATE S 2 000,000 GEN'L ADOREGA7'E uMIT APPLIES PER: 101 POLICY 7 jpteT 117 LOC I PRODUCTS • COMPIOP AGG $2 r 0 O 00 Pl AUTOMOBILE LIABILITY ANY AUTO 11 i vP1935 05/21/08 05/21/09 COMBINED SINGLE LIMIT , (Ea accident) B X ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY S 100 D00 (Per pri'mm) X 3( HIRED AUTOS NON•OWNED AUTOS BODILY INJURY $300,300 (Per acddenl) PROPERTY DAMAGE (Perammidern) G 100, )00 GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO I { OTHER THAN EA ACC X — AUTO ONLY! ACGs EXCESSIUMBRELLA LIABLRY P OCCUR C CLAIMMADE I EACH OCCURRENCE rr � AGGREGATE Is I DEDUCTIBLE $ = RETENTION & s C I WORKERS COMPENSATION AND ENPLOYEW LIA89jTY ANY PROPRIETORIPARTNEI4lEXECUTNE i oFFICFRlMEMBER ExcLUDED9 It yyaa drindbe under SPEGIIAL PROVISIONS below OTHER APWCIB07496 I 06/01/08 ,• i 06/01/09. R TaI;sY. LIMITS i Jul E.L.EACHACCIDENT 1100,!700 E.L. DISEASE - EA EIJPLOVEE, S 100 (400 E.L. DISEASE. - POLICY LIMIT ; $ SQ Q (100 ESCRIP'}1pN i OF OPERATIONS /LOCATIONS / VEHICLES f EXCLUSIONS ADDBC 9Y ENDetlCFUnur i r see�w vonv�anu� ERTIFICATE HOLDER CANCELLA-nON TOWNNAN Town of North Andover 1600 Osgood Street N. Andover MA 01845 Ab IWVultoo) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TH 6 EXPIRATICI DATE THEREOF, THE ISSUING MSURER WILI. ENDEAVOR TO MAIL 20 DA1,7; WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO C o SO SHALL IWPOSE NO OBLIGATION OR LIABILITY OF ANY POND UPON THE INSURER, ITS AG I:NTS Oti R6PRESENTATWRS, 1UTHORUED REPRRSWTATfVE 1 10/30/2006 14:11 7615997338 SODERBERG INSURANCE PAGE 01/01 ACORD, CERTIFICATE OF LIABILITY INSURANCE OP ID DS DATE(MNVDD/YYYY) APZXC-2 1 10/30/09 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Soderberg Insurance Servicers HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 0 Broadway ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. nntield MA 01940 Phone:781-593-9393 Fax: 781y599-7338 �INSURERS AFFORDING COVERAGE I14AIC9 INSURED INSURER A; Western World INSURER B' Conunerce Insurance 34754 Ap�ex Carpentry, LLC ---� - --~ Tohn Spagnoli INSURER C: Guard Insurance Group 29 Bates Road INSURER D: Swampscott MA 01907 -- -- _ __..— INSURER F.; COVERAGES THE POLICIES OF INsUR^NCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY AROUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE, MAY BE 16SUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 18 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSR TYPE OF INSURANCE POLICY NUMBER YEFFECTTVP DATE AlMDIYY DATE M IDDlYY LIMITS P► GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLA(M5 MADEX71 OCCUR GEN'L AGGREGATE LIMIT APPLIES PER, POLICY 7 PRO. LOC i NPPI179032 09/22/08 i 09/22/09 I EACH OCCURRENCE a 1 000,000 PREMISE3,(Eeoccurenca) MED EXP (Any enn pgMon) y 150,000 $5,000 $1,000 000 PERSONAL A ADV INJURY_ GENERAL AGGREGATE s2,000,000 s2,000 , 000 PRODUCTS, COMP/OP AGG B AUTOMOBILE X x r-- R LIABILITY ANY AUTO ALL OWNED AUTOS SCHFDULF.0 AUTOS HIRED AUTOS NOWOWNFDAUTOS I VP1935 ( 05/21/08 05/21/09 i COMBINED SINGLE, LIMIT I (E8'eddeN) $ BODILY INJURY (Ftx pereon) l 1 100,000 BODIL (Peso cLmt)INJU (Potcuad�ntl 300 OOfl 1 f PROPERTY DAMAGE (PorReddenq ] O0 OOO , ---. GARAGE LIABILITY ANY AUTO j I AUTO ONLY - EA ACCIDENT T OTHER THAN EA ACL AUTO ONLY, AGG LL S -- t EXCF,SS UMBRELLA LIAMTY I i OCCUR CLAIMS MADE ` DEDUCTIBLE RETENTION I EACH OCCURRENCE I --° g. AGGREGATE r $ _. re S c WORKLRS COMPRINSAT1ON AND EMPLOYERS'rr ANY PROPRKTORMTORJPAR7NFRlF.XFCUTNE OFFICER/MEMSER EXCLUDED? S yyoc, Al. PR o ISI Of SP£GIAI. PROVISIONS I�nlaw APWC807496 � 06/01/08 06/01/09 I X TORT LIARS ER EACH ' S ],Qa OQQ , E.L. DISEASE - EA EMPLOYE $ 100 0 00_ 1 Kj OQ Q 0 Q E.L. DISEASE - POLICY LIMIT OTHER i DRSCRIPTION OF OPERATIW I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Faxed to 781-584=4121 CERTIFICATE HOLDER City of. Boston, MA ,Boston MA 02101 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIaM POLICIES BE CANCELLED BEFORE THE EXPIRATID. DATE THEREOF, THE ISSUINO INSURER WILL ENDEAVOR TO MAIL 20 DAYS W WTTEN NOTICE TO THE CERTIFICATE HOLDER NAMLD TO THE LEFT, BUT FAILURE TO DO 30 SHALL IMPOSE NO OBLIOATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATA/E9, G. Soderberg '" Q (DACORD CORPORATION 1988 ✓L e.a' ,r Board of Building Regulations and Standards Construction Supervlsor License License:CS •24784 Ems: 1/21/2010 TrB 16900 miction: 00 LOUIS A` SPAGNOLI JR 71 EVANS RD c MARBLEHEAD, MA 01945 _ Commksioner Licensee Details The Official Website of the Executive Office of Public Safety and Security (EOPS) Mass.Gov Home Public Safety Department of Public Safety Licensee Complaints License Type Home Improvement Contractor License # 123150 Restriction Company Apex Carpentry Llc Name John Spagnoli Address 29 Bates Rd City, State, Zip Swampscott, MA, 01907 Expiration Date 12/17/2010 Status Current No complaints found for this Licensee. Back To Search Page 1 of 1 http://db.state.ma.us/dps/licdetails.asp?txtSearchLN=HIC123150 3/24/2009 s� The Commonwealth or1Vlassachrrsettc Department o ' f Industriall4ccitlentc H;� Office of Investigations "`11 600 Wasfzineton Street ` Bosto1Z , lll4 0111 c www. rMass.gOvIdia Workers' Compensation Insurance.Affidavit: guilders/Contractors/Electricians/Plumbers App icant Information Name (Business/Organization/individual): Address: ? 9 City/Stat-aip Lv►4o ►9 u' -r Let Phone #: --I� i _ _ b99 ? Are 'you an employer? Check the appropriate 1. box: L71 am a employer with ___(,L_ . 4. ❑ I am a general contractor employees (Hill and/or part-time).* 2. ❑ I and l have hir d thsub-con tractors am a sole proprietor or partner- listed ori the attached sheet I ship and have no employees These Sub -contractors have working for me in any capacity. [No workers' comp, insurance workers' comp. insurance. 5. [] We are a corporation 3. Elrequired ] I am a homeowner doing and its officers have exercised.their all work Myself [No workers' comp. right of exemption per MGL c. 152 § I (4), and we have insurance required_] t no employees. [No -workers' comp. insuranc Type of Project (required): -6• ❑ New construction 7. Erkemodeiing . 8. ❑ Demolition 9. ❑ Building addition 10:❑ Electrical repairs or additions 1 I .❑ Plumbing repairs or additions 12:❑'Roof repairs _ e requred) I 13 ❑ Other 1 ;-ion cawnerstwlau sub nk fl� afiida tt udicfltliuut the 1! ee, section doing, low showing their workers' compensation pof�c} mrormat�an. IContrac[ars Iha1 cheok this 'oox'musi attached an additional sheet showirtc the name aft. outs onnwaoi wand tneiuwnrv— rt amdnvir indi�tirt the g s ch. r urns LAG. "P"J" Inas IS providing workem I CO enation L __.r..•••••.•.' ..uu,et HJIt. information° nsurarrce for my employees. Belo►v is the policy and job sire Insurance Company Name:_ (%.e.r k .T. • , e /— Policy # or Self .ins. Lir,. #: jj>WC gp-714% 11 Expiration Date: G) 1 Job Site Address.—N.7 Dom, W �Y Attach a copy of the workers' compensation- Policy decla City/State/Zip: P y ration page (showing the policy number and expiration bate). .Failure to secure coverage as required under Section 25A of MGL c. I52 can lead to the imposition of criminal penalties of a fine up to 51,500.00 and/or one-year imprisonment as well as civil of up to 5250.00 a day against the violator. Be advised that a co penalties in the form of a STOP WORK ORDER and a fine Investigations of the DIA for insurance coverage verification. copy of this statement may be forwarded to the Office of .I .i„ L.. --L r c,- Lee pauzc and penalties oJperjrcrJ' that the informafion provided above is tree and correeC 1-51")-1_94-r Officio! use only. Do not write in this area' to be completed by CiO, or town ofd Ciq or Town;: Issuing Authority (circle one): Permit(License 4 1. Board of Health 2. Building Department 3. CiiylToh,n Clerk 4. Electrical Inspector $. Plumbiao 6. Other b Inspector Contact Person: Phone P Information 2_ .nd 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 includiaz.g 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. maintmance, 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 a r local licensing agency -.shall withhold the issuance or renewal of a license or permitto operate a business or to construct buildings in the commonwealth for -any applicant who has not produced acceptable evidence GN -T 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 worTEc 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 comp7<-etely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) name(s), address(es) and phone numbers) along with their ceriificate(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. 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 regrELrding the 1XV, or if you are required to obtain a workers' compensation policy, please call the Department at the nu-rnber.listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officiais Please be sure that the affidavit :is complete and printed leg�i�ly. The Department has provided a space at the bottom of the .affidavit for you to fill out in the event th.e 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 permitthcense applications in arty 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 a (city or town)." A copy of the affidavit that has been officially siarnped 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 Iicenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a licenste� or permit not related to any business or commercial venture (i.e. a dog license or permit to burnleaves 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 l industrial Accidents. Office of favestigaiioas 600 Washington street Boston; MA 62111 Tel. # 617-727-4100 *rt 406 or 1-877-MASSAFE Revised 5-26=05 Fax # 617-7-227-7749 wv° ,-Mass.gov/dia