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Home My WebLink AboutBuilding Permit #594 - 20 HIGH WOOD WAY 4/5/2010 BUILDING PERMIT o` "°oTH qti TOWN OF NORTH ANDOVER oa APPLICATION FOR PLAN EXAMINATION Permit NO: Date ReceivedTEo � 9SSAGHU`�E� Date Issued: / IMPORTANT Applicant must complete all items on this page Mom two - � �*' f0 '" ff LOCATE PROP!TY OWNER rYl �r 4 , r MAI'214,x PARCEL s ��11�1G D15TR1CT` Hastonc O�sr�# � yes , �� 4� Machine ) ltllage fives 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 - Se tc Weld �� Flood Wnr!5— � 1JVaterlSewer DESCRIPTION OF WORK TO BE PREFORMED: .��T.�-�1� L��YL S'/D/�� f ti 11 �'y✓c+yrr�-•- Identification Please Type or Print Clearly) OWNER: Name: C, o2�� /t-c ��.:y - - Phone 9DP-f,Qt,:=� Address: De ix�71 a m CONTTOft Na m-' �� Phone: °�.."� ` ' g ;= -•cg po Address x� , 9 .Supewis is°Construct t r kens '$. ` .Exp .DOT ate HomeAfn ement"L d hse Q - EXp a .pate :... 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: $_7lno-06 - FEE: $ � Check No.: Receipt No.: c7v*,-� �-- NOTE: Persons contracting with unregistered contractors do not have ccess to the guaranty fu 5,ignature of.AgentlOinrner 5i nature uof contracto' . u . ,- g.._. . 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 DATE APPROVED PLANNING & DEVELOPMENT COMMENTS ' CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature L 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 DPW Town Engineer: Signature: Located 384 Osgood Street FIRE.YDEPARTMENT Temp Dumpster on siteyes _ �no L:ocated,at 124�Main'Street r a m ^ Fire.Depa°rtmen#.;signature%datem . .. n a COMMENTS b 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 . F - i l ❑ Notified for pickup - Date ......._._.__..........._...-..__...................................----._.........................................................................._......_...._.._...._................................................................_.__................................................................................._..__._..........................._.............................__. _._. Doc.Building Permit Revised 2010 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 m. ❑ 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 stampthe 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 2008 � ._. ..-. rvi+r+.-fn"Y"�`."'._:'�...---.+�f�%w*,'a.:a--:...e�•,vm.R.'y�/�J+j+:i/PRw.- 4Y.a'-v.+.•. -:'c4� .. i..i.....__,.�. -.,,�.,.. _.,a+':Y Location v No. f Date �OR,M TOWN OF NORTH ANDOVER 3? - OL ' Certificate of Occupancy $ s�cwu Building/Frame Permit Fee $ Foundation Permit Fee Other Permit Fee $ 4, TOTAL $ Check # ti 22902 `E41ding Inspector V40RThi Town of Andover * _ _ - LAKE dover, Mass., • COCHICHEWICK �d ORATED APa\ "♦y `s BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System I� BUILDING INSPECTOR THIS CERTIFIES THAT....... /I I� ��I�� Foundation. BUILD NS OR .... ...... .. ........ has permission to erectr.,, a ............ buildings on .........�........ .. .. �/1.».� ........... .�r.... Rough ,,/ to be occupied as.. . .......`�✓.!fir ... ... ........... L........ .. chimney provided that the pcepting this permit every respect corm to the terms of i�16 application.on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Final 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 CONS U O ST TS Rough ....... .......................................................... Service BUIL t R Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Roug .Display in a Conspicuous Place on the Premises — Do' Not Remove Finalh 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 Commonwealth of Massachusetts Department of industrial Accidents Office ofInvestigations 600 Washington Street Boston, MA 02111 www.mass govldia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Aimlicant Information Please Print Legibly - Name (Business/Organization/lndividual): , Address: ; s' 4L S i City/State/Zip: � i -��.��" �g r � Phone#: Are you an employer?Check the appropriate box: 1.[D-f-am a employer with Type of project(required): �� _ 4. I am a general contractor and I❑ employees(full and/or part-time).* have-hired the sub-contractors 6. 0 New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. x 7• ❑Remodeling ship and have no employees These sub=contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. [No workers' comp. insurance 5. 9 ❑Building addition i p• ❑ 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 insurance required.] t employees. [No workers12.❑Roof repairs ' comp..insurance required.] 13.0 Other `Any applicant that checks box.ui must alsq 311 out the section below showing their workers'com^'^--=on� :�.,:« Homeowners who submit this affidavit indicating they are doing all work and thre outside contractors must submit as new affidavit indicating such. $Contractors that check this box must attached as additional sheet showinen hig the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation information. insurance for my employees Below is the policy and job site Insurance Company Name:(/ AA a12= ZA Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: P 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 pains and penalties of perjury that the information provided above is true and correct Signature* Date- 1 Phone#: - Official use only. Do not write in 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]Inspect]or 6. Other Contact Person: Phone#: 4/5/2010 1:17 PM FROM: Foster Foster Insurance TO: 19786889542 PAGE: 002 OF 003 ACORD,, CERTIFICATE QF LIABILITY INSURANCE 04%05%201) PRODUCER (978) 686-2266 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE NORTH ANDOVER INSURANCE AGENCY, INC. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR M.J. FOSTER INSURANCE SERVICES ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 163 MAIN STREET NORTH ANDOVER MA 01845-2508 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A MERCHANTS INSURANCE GROUP STAN'S ALUMINUM HOME McROVP.MENT INSURER B:GUARD INSURANCE GROUP CENTER, INC. INSURER f- 89 89 SCHOOL STREET INSURER D: SAUGUS MA 01906- INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REOUIREMENT,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. OLICY EXPIRATION INSR DO'L TYPE OF INSURANCE POLICY NUMBER DATE jMMUDI PDATE(MMA M) LIMITS LTR INM A X GENERAL LIABILITY SOPI045104 01/12/2010 01/12/2011 EACHOCCURRENCE $ 1,000,000 DAMAX COMMERCIAL GENERAL LIABILITY PREMISES ETORENTED 500 000 PREMISES RENTED $ CLAIMS MADE fX OCCUR / / / / MEDEXP A ons erson $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGO $ 2,000,000 X POLICY PECT Loc AUTOMOBILE LIABILITY / / / / COMBINED SINGLE LIMIT (Ea accident) ANY AUTO ALL OWNED AUTOS / / / / BODILY IN,URY $ (Per person) SCHEDULED AUTOS HIREDAUTOS / / / / (Per dent)INIU $ PION-OWNED AUTOS (Per acddenl) PROPERTY DAMAGE (Per eodderd) GARAGE LIABILITY AUTO ONLY-EAACCIDENT $ ANY AUTO / / / / OTHER THAN EA ACC $ AUTO ONLY: AGO $ EXCESWMBRELLA LIABILITY / / / / EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE r $ RETENTION �,J $ B WORKERS COMPENSATIONAND M 0128983 01/26/2010 01/26/2011 X TO LATITs I I°a EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 5.00.000 OFFICERIMEMBEREXCLUDED? / / / / E.L.DISEASE-EA EMPLOYEE$ 100,000 It yes,describeunder 500,000 SPECIAL PROVISIONS below El.DISEASE-POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION ( ) - (978) 688-9542 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE BRIAN LEATHE — BLDG. INSP. EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAI. 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUi TOWN OF NORTH ANDOVER FAILURE TO 00 SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE 1600 OSGOOD STREET INSURER ITS AGENTS OR REPRESENTATIVES. AUTHDRUED REPRESENTATIVE NORTH ANDOVER MA 01845- ACORD 25(2001108) 0 ACORD CORPORATION 1988 INS025(oloe).os Page 1 ot2 >�lassachusetts- Department of Public SafetN Beard of Building; Reoulations-i hd Standards Construction Supervisor License gnISe: CS 8455 - Rpstric 'to: 00 THOMAS STANLEY ". ' 18 PINE STREET LYNNFIELD, MA 0.1940 Expiration: 8/18/2011 Commissioner Tr#: 2794 i HOME IMPROVEMENT CONTRACTOR Registration: 107352 Expiration17/31/2010 Tr# 0 . Type;Private Corporation ? STAN'S ALUMINUM HOME IMPROV CTR INC Thomas Stanley ° 89 School Street Saugus, MA 01906 Administrator ' € c - I Stan 's COMBINATION WINDOWS&DOORS CARPENTRY-ROOFING VINYL REPLACEMENT WINDOWS SIDINGS-GUTTERS CANOPIES-REPAIRS GENERAL CONTRACTOR HOME 6AflPR®VE�E�B°T INC. CUSTOM TRIM COVERAGE 89 School Street, Saugus, MA 01906--Telephone 781 233-1868 L1Cense No. 107352 IN AGREEMENT WITH 'lo!aa TEL.— ',J01 EL _ L \�C vQ � � DATEADDRESS U 11 t i t i CJ , i c.� V L'Se.-C 1 ✓Sy s ve�) ge- kc A i. A ccs .� SUS TOTAL $ c�7sfy� � SALES TAX $ 6 5-C),C)C) b t C, Soo TOTAL PRICE $ DOWN PAYMENT $ BALANCE DUE $ STAN'S GENERAL CONTRACTOR&HOME IMPROVEMENT,INC.does not offer or extend credit or financing services to its customers.No finance charges are imposed upon the out- standing,unpaid balance prior to completion of the work,however,full payment of the unpaid balance is due upon completion of the work and all instalin>ent payments shall be rendered promptly as each phase of the work is completed.In addition to the unpaid balance,Buyer shall be liable for and shall pay all costs and expenses incurred by the Seller to collect any unpaid balance due hereunder,including reasonable attorney's fees;the expenses of handling,storing,returning or restocking any materials rendered unusable on the job by reason of Buyer's de- fault;and Seller's cost of any custom-made or unreturnable materials.The seller shall not be responsible for damage or delay due to strike;fires,accident or other causes beyond his control. WARRANTY: Seller also guarantees that all work will be done in a workmanlike manner,free from defects and in accordance with the contract specifications. Any defects in materials or workmanship shall be repaired or replaced by Seller provided that Buyer has paid the contract price in full and provided that the same shall be communicated to Seller within I year after com- pletion of the work INSURANCE: Seller is insured for injury incurred by Seller or employee while they are working under this agreement RECORD OWNER; The Buyer represents and warrants that the record owner or the real estate on which the work is to be performed is authorized or is the owner. is the owner. Buyer understands and agrees that no agent or employee has authority to make any warranties,representations,promises or statements which are not specified herein. Further,Buyer ac- knowledges that no such warranties,representations,promises or statements have been made in connection with this contract other than those specified herein. All obligations of Buyer shall bind his/her executors,administrators,heirs or assigns. If any provision or part hereof shall be held invalid,the remainder shall not be thereby affected. It shall be the obligation of the contractor to obtain the construction related permit under normal conditions—if the homeowner secures their own construction related permit,they will be ex- cluded from guaranty fund. SELLER AND BUYER HEREBY AGREE TO THE ABOVE TERMS. You may cancel this agreement if it has been consummated by a party thereto at a place other than an address of the seller which may be his main office or brance thereof,by a written no- tice directed to the seller at his main or branch office by ordinary mail posted,by telegram sent or by delivery,not later than midnight of the third business day following the signing of this agreement IN WITNESS WHEREOF,thZha to s' it names this...._...................._....day af........._.W.._.._.._.._....._............ Z�'►t"' STAN'S GENERAL CONTR &IMPROVEMENT CENTERPer..._...____...._..__................. ..........-__._.............__.. ._........._.._ ..._._._ ..... Sig ....... ................... i� ..rJ.._........... Repre ntatnre Signed.__..........._............_.........._.......................................:...................................................... Owner