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HomeMy WebLinkAboutBuilding Permit #455 - 2 UNION STREET 2/24/2009 r ' BUILDING PERMIT o "°oT"�ti TOWN OF NORTH ANDOVER c2 4t •a v APPLICATION FOR PLAN EXAMINATION J Date Received �'✓�� i Permit NO: ssArep ACNusE�� r Date Issu ` v IMPORTANT: Applicant must complete all items on this page LOCATION a 1�1 e ?L /U. AnC uolal Print PROPERTY OWNER Oqlle- / / /J/- A- 01-7 Print MAP NO: f PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District i Water/Sewer DESCRI)pTION OF WORK TO BE PREFORMED: / ✓ 16 fi c, e✓ ,cT I d , Imo c) I Identific on Please Type or Print Clearly) °¢ OWNER: Name: 40 tkn S-C I Phone: 72F-- 3-- y Address: f� CONTRACTOR Name:am L X w4Phone: 7a Address? jf,C4' s-� lC '.�i fir 1 /'/ t7� ✓ } I Supervisor's Construction License: Exp. Date: J Home Improvement License: /il,00 7 Exp. Date: ARCHITECT/ENGINEER Phone: 1 Address: Reg. No. i FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ /1) yd• FEE: $ Check No.: � � Receipt No.:C)/P,)`)- NOTE: "NOTE: Persons contracting with unregistered contractors do not have access to the guars fund signature of Agent/Owrier _ Signature of contractor 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 INTERDEPART4ENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS I CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Y 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) I ❑ Notified for pickup - Date Doc.Building Permit Revised 2008 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 ❑ 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:BPFORM07 Revised 2.2008 Location--) Sly No. Date MaRTM TOWN OF NORTH ANDOVER O: • • Ow ( _ Certificate of Occupancy $ ♦ i A. • cNus CH E<� Building/Frame Permit Fee $ 3 s� Foundation Permit Fee $ t Other Permit Fee $ 0 TOTAL $ Check #,5 23 U �� { Building Inspector NORTH c Town of &/dd C' o y�` over, Mass., • O �( = = y T O LAKE 1. T COCMICKE WICK V ADRATED S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING.INSPECTOR THISCERTIFIES THAT.....O .4.4.......M.0. ... ................................................................ ........................................ Foundation has permission to erect......... ............................. buildings n ..Q�......... 0>.r Nlas.achu.ett.-Depat-tmcnt ur Public S:kret' Board ar Suildinu Re---ulations and Standards Construction Supervisor Specialty License License: CS SL 99681 Restricted to: RF,WS,DM ERIC DEMPSEY 7 RICHARDSON STREET BILLERICA, MA 01821 Expiration: 5/2312012 ('numi..ioncr Tr-1, 99631 ✓/e�ocyivra�o�ca�aa�a�.�•>faesaa�i�eelta.. Board of BuUdiog Regulations amt Standirds- HOME IMPROVEMENT-CONTRACTOR Registration: 150272 Expiration: 3/21/2010 TO 265638 Type: Individual DEMPSEY CONST&ROOFING ERIC DEMPSEY 7 RICHARDSON ST ,�,,am.,` BILLERICA,MA 01821 . Administrator L'd VOWOL9-9L6 E%130021 A3S&Ua eLCZO 60 OZ 983 i DATE ACORDTM CERTIFICATE OF LIABILITY INSURANCE 2/20/220000 02/209 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Prescott & Son Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 963 Eastern Avenue HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR Malden, MA 02148 ALTERTHE COVERAGE AFFORDED BYTHE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC# INSURED -. - INSURER A:Savers Property&Casualty Insurance Company 31771 Dempsey, Eric INSURER B: 7 Richardson Sreet INSURER C: Billerica, MA 01821 INSURER D: 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 SUCHPOLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L TYPE OF INSURANCE POLICY NUMBER POLICYEFFECTIVE POLICY EXPIRATION LIMITS LTR INSRO DATE(MMIDDIYY) DATE iMMIDDA'Y) GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ PRE MSES(Each Occu rence) CLAIMS MADE❑OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GENT AGGREGATE LIMITAPPLIES PER: - PRODUCTS-COMP/OP AGG $ PRO POLICY JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMB $- (Each accident) ANY AUTO AL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILYINJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EAACCiDENT $ ANY AUTO OTHER THAN EAACC $ AU C ONLY: AGG EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR ❑ CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND we STATUTORY I OTHER EMPLOYERS LIABILITY LIMITS ANY PROPRIETOPoPARTNER/EXECUTNE E.L.EACH ACCIDENT OFFICERIMEMBER EXCLUDED? $ 100,000 If yes,describe under AR0426077 09/16/2008 09/16/2009 E.L.DISEASE—EA EMPLOYEE $ 500000 SPECIAL PROVISIONS Below E.L DISEASE—POLICY LIMIT 100,000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS CERTIFICATE HOLDER City of North Andover SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF;THE Y ISSUING INSURER WILL ENDEAVOR TO MAIL 10_DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO 1600 Osgood Street THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGAT OR LIA IUTY OF KIN,UPON THE INSURER, ITS AGENTS S. Oaf North Andover, MA 01845 AUTHORIZED REPRESENTATIVE ACORD 25(2001/08)0 ACORD CORPORATION 1988 DATE 2/20 ACORDTM CERTIFICATE OF LIABILITY INSURANCE / 1 02/20/2200009 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Prescott & Son Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 963 Eastern Avenue HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR Malden, MA 02148 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A:Savers Property&Casualty Insurance Company 31771 Dempsey, Eric INSURER B: 7 Richardson Sreet INSURER C: Billerica, MA 01821 INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTINITHSTANDING 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 SUCHPOLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR ADD'L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR INSRD DATE(MMIDDlYY) DATE(WMD/YY) GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ PREMISES(Each Occurence) CLAIMS MADE❑OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ PRO- POUCY JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMB $ (Each accident) ANY AUTO ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTYDAMAGE $ (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 WC STATUTORY I OTHER EMPLOYERS LIABILITY LIMITS ANY PROPRIETOR/PARTNERIEXECUTIVE EACH ACCIDENTOFFICER/MEMBER EXCLUDED? E.L. $ 100,000 If yes,describe under AR0426077 09/16/2008 09/16/2009 E.L DISEASE-EA EMPLOYEE $ 500,000 SPECIAL PROVISIONS Be- E.L.DISEASE-POLICY LIMIT 100,000 OTHER DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS CERTIFICATE HOLDER City of North Andover SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE y ISSUING INSURER WILL ENDEAVOR TO MAIL 10_DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO 1600 Osgood Street THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. .Oft 0 09* Ok North Andover, MA 01845 AUTHORIZED REPRESENTATIVE AVAGWAW— ACORD 25(2001/08)0 ACORD CORPORATION 1988 �,. 1 R�' t,Dl�thzonwealeh of Massachusetts' ' 1 Department of Industrial Accidents �" ' Office of.investigations WashineQton Street fel f' \L Piostoli .,' , 1VIt! 0111 r wwFc:mass.gov/dia Workers' Compensation Insurance Affidavit. Builders/Contractors/Electricians/P}um Ao Iica.nt Information bens P}e$se Prinf Leaib}v N3TIle (13usiness/Org2ni2ation/individual); y Address: —7 i City/State/Zig:, e e I 'a . �t� - — � Phone#: Are you an employer?Check the appropriate box: l. 1 an a employer with _ 4. ❑ I : a trA _ Type of project(required): mployees(full and/or part-time).* have hired the sub-con ractorstorand l 6. ❑Naw construction 2.❑ I am a sole proprietor or partner_ Iisted on the attached sheet ; 7. ❑ Rernodeiing. ship and have no employees These sub-con working forme in any capacity, tractors have 8. ❑ Demolition workers, comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its 9. 7 Building addition 3.❑ required.] officers have exercised their 1 Q:❑ E}ectrical I am a homeowner doing ELI]work right rs exemption rept or additions myself. [No workers' comp. G 15� P�MGL I l.❑ Plumbing repairs or additions insurance required.] t �rt1 io a 1(4),and we have no -employees.s [No workers t24�Roof repairs COMP. insurance required.] 13.7 Other `Any appficant.that checks boa#1.must also�fill out the section below showing tt�:ir workers'compensation policy information. :Any wlte submii.iltis affidavit indicatint,ii'eey are mooing t:,tvpr;�:tcf Eisen hire outside ountraTnP=s do mint submit a new affidavit 7Conttat tors that ch l this box must aztsciled an additional sheet showing the name of the sub oottttactors and their woricets'comp.policy information. ind:;`tirtg sca.�. I am an eM10Ter that is providing workers'compensation i information assurance for ng'employees. Below is the poPicy and job site Insurance Company Name: VAC C.,.1•' cy t — Poli #or Self t 1-51 vll� . ms. Lid.#: TV J Expiration Date:_ Job Site Address: U-4n 4 IQ [i ' �1 ` Attach a copy of the workers' compensation]policy IdecEara#�Iftstate/zip:_ ona Me(showing the policy number and expiration.Failure to secure coverage as required P n date under Section 25A of MGL c. 152 P )' fine up to X1,500.00 and/or one year imprisonment,as well as civil penalties in the forme of a STOP WORD ORDERanda a of up to.S250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office y Investigations of.the DIA for insurance coverage verification. of I do herebji certzJ, nd. Penalties o erre that the cnforn�afion Provided above true L /� °"d IP l d correct Si�rtature: a n / Phone#: -I_7 Of ficial use only. Do not write in this areg to be conWleted bT city or town offxial City or Town: Issuing Authority(circle one): Permit/License I. Board of Health 2. Building Department 3. City/Town 6.Other Clerk 4. Electrical Inspector S. Plumbing Inspector Contact Person: Phone t �~t Dempsey Construction & Roofing Specialists 7 Richardson Street Proposal Go-over Billerica, Ma 01821 978-670-8904 Proposal — Customer Name Dave Morton Date 1/15/09 Address P.O. Box 322 Order No. City West Boxford State Ma ZIP 01885 Rep Phone 978-352-2905/W:781-981-3186 FOB Qty Job site: #2 Union Street, North Andover Unit Price TOTAL Install 8" white.aluminum drip edge around entire peri eter. Install 30yr architect roofing shingles over exisitng laye 'I Job is to start mid Feb.to March and to be completed in 1 day. Remove all roofing debris. This is a material, labor,dump, dump fees and permit proposal. 5 year warrantee on all workmanship SubTotal Payment Details Shipping&Handling O Taxes State O Check O Payable to Eric Dempsey TOTAL $1,440.00 Payment due in full upon completion Office Use Only Signature of acceptance Date. ,7...... .. ,�ORTIy pF ��i o ,,1'l�0 TOWN OF NORTH AN9 VER f D • PERMIT FOR GA'S INXfALLATION hLX �9SSACMU5 1 ` P�This certifies that . . f. C!!.4:� E? �:. . . 4. . . . . . . . . . . . . . . . . . has permission for gas installation . l . . . . . . . . . . . . . . . . . . . . . in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . lot Jkat . . ?. . .... .. .. .`.. . . . .. . . . . . . . . . ., North Andover, Mass. Fee. ILic. No. ASINSPECTOR�� Check# 61,9 7 623U MASSACHUSETTS UNIMRM APPUCATON FOR PERMIT TO DO GAS FITTING (Type or print) Date ///,0/ 'D NORTH ANDOVER,MASSACHUSETTS Building Locations C UAJ t 0/41 6 L-3j- Amount O Permit# 1113 Amount$ �L Owner's Name New Renovation Replacement ® Plans Submitted C7 �_ W � Q o F" a zo z p [- a z m x z U w x ti z a G a > W G7 F z E� d F F W C7 > rs, Fw. U a W z w > z a Q d o o w o x x o x x 3 0 a u x > a a F o SUB-BASEMENT BASEM ENT 1ST. FLOOR 2ND . FLOOR 3RD . FLOOR 4TH . FLOOR 5TH . FLOOR 6TH . FLOOR 7TH . FLOOR 8TH . FLOOR 1 (Print or type) Che k one: Certificate Installing Company Name H&Lto(cA R/ pLcJ/!4 �/t✓ Corp. Address P6 J3.057-2--� 5� � Partner. Z�Ga/'�f'svlt ��. O/��.2 BusinessTelephone Firm/Co. Name of Licensed Plumber or Gas Fitter Tjof 1111/1elfff/+- INSURANCE COVERAGE Check one: 1 have a current liability Insurance policy or it's substantial equivalent. YesNoO If you have checked Les,please indicate the type coverage by checking the appropriate box. Liability insurance policy 0 Other type of indemnity Bond 13 Owner's Insurance Waiver: 1 am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass.General Laws,and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner 13 Agent 0 1 hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapt 142 of the General Laws. By: SA 01 ignature Signature of Licensed Plumber Or Gas Fitter Title Plumber acf b'� City/Town Gas Fitter License Number Master APPROVED(OFFICE USE ONLY) ® Journeyman Date NaRT" TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING y ,SSACMUSE� This certifies that . . . . . . . . . . . . . . has permission to perform . . . . .. . . . . . . . . . . . . . . . . . . . . plumbing in the buildings of . . `-. . . . . . . . . . . . . . . . . . . . . at . . . .!4 !.o . . " . . . . . . . . . . . . . . . .. North Andover, Mass. Fee. . . . .Lic. No..?. !J-.?}. �� . . -�-:°�:.,.�--�:. . . . . . .. PLUMBING INSPECTOR Check # 7579 1 -m. MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS 1 1-16 . / * Wd��l'la/L� Date Building Location � U��f�/j S7 Owners Name y Permit#_"� 7 y � Amount Z --- Type Type of Occupancy New El Renovation Replacement ® Plans Submitted Yes No FIXTURES w a >+ Ln a a w d w A w x A a A x H a pro W d a SMBM 8��11')HNT A lSl:FLDQt ?rD FifM 3M HIM 4IH 11" SIH HIM 6IH II+lJQt Mi IIm2 SIIi FIOQt (Print or type) Check one: Certificate Installing Company Name A j(,0 kA 1-11 El Corp. Address 1 P© ' T'7h M Partner. Business Telephone_ �j'�j> 61 ff-15'-f S© Firm/Co. Name of Licensed Plumber: 7;;;,., Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy ® Other type of indemnity 0 Bond ❑ Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner 1-1 Agent M I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Cod and Chapter 142 of the General Laws. By: Signature of Licenseo um er Type of Plumbing License Title `' Y-U.3 . City/Town icenseum eller Master Journeyman APPROVED(OFFICE USE ONLY