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Home My WebLink AboutBuilding Permit #581 - 200 BLUE RIDGE ROAD 3/30/2010 BUILDING PERMIT o* p►ORT►1 t�bo TOWN OF NORTH ANDOVER 0� APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received 4,9°cRAr.0 9SSACHUS�� Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION r rM VIC l \ yJ PROPERTY OWNER �L) nt Print MAP 210 log d PARCEL: �_ZONING DISTRICT: Historic District yes Machine Shop Village yes r CO 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 Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: CONTRACTOR Name: uC U Phone: Address: 0C'_fJL � Supervisor's Construction License: 7�-. Exp. Dater r-- Home Improvement License: 'Q Exp. Date: 767J60/ ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$100Q.Q6 QF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ 0U Check No.:—&- Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the ra ty nd Signature of Agent/Owner Signature of contractor Location No. Date &ORT" TOWN OF NORTH ANDOVER F j • • OR • ; , Certificate of Occupancy $ �'7s'••°''t�' Building/Frame Permit Fee $ p �- s,KMusE Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check #k!71 22t-, Un 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 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 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 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) ❑ 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 ❑ 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 2008 �.1ORTIy Town of 4Andover . -kvo No. _ AKE dover, Mass.,_ - COCHICMEWICK AERATED C2 `s BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System ^ sBUILDING INSPECTOR THIS CERTIFIES THAT.............. .Q,.d..f.......J..0 . ... ........G. ............................ Foundation has permission to erect.................................. .. . buildings on................. .......S/ ... .. ............................., Rough to be occupied as........... ....49%...... Chimney provided that the person accepting this p shall eve respect conform rm t he terms of the application ' every P pp cation on file m 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 ( 06z PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUC T TS � Rough ................ ...................................................:.::::................................. Service BUILDING INSPECTOR Final Occupancy Permit Required to Ocmpy Building GAS INSPECTOR 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 of Investigations 600 Washington Street Boston, MA 02111 www-mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information r, Please Print Legibly Name (Business/Organization/Individual):- Address: 1� r\ l� City/State/Zip: C rj �(o Phone Are you an employer?Check the appropriate box: 1•❑ I am a employer with 4. ❑ I am a general7shieet Type of project(required): employees(full and/or part-time).* have hired the 6• ❑New construction 2.❑ I am a sole proprietor or partner- listed on the at �• ❑Remodeling ship and have no employees These sub-contractors have working for me in any capacity, workers' comp.insurance• 8• E]Demolition [No workers' comp. insurance 5. El We are a corporation and its 9 ❑Building addition 3.❑ required.] officers have exercised their 10.❑Electrical repairs or additions 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 workers' 17•0 Roof repairs Pomp.insurance required.] 13.❑Other L y applicant that check:_-box ril must also i r t _: iE ou-the secto-b_iaY.'-0R2n�+-'n•-:- _ I3omeowners who submit this affidavit indicating they are doing' _ oing Y..Hcinfa..ation. all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I an employer that is providing workers'compensation ininformation. insurance for my employee& Below is the policy and job site Insurance Company Name: R- �---(J Policy#or Self-ins.Lic.#: VO ^^ )5r- ` y Expiration Date: �p p�� Q Job Site Address: vc- City/State/Zip: C Attach a copy of the workers'compensation policy eclaration 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby c u e e p ins d penalties of perju?Y that the information provide abov is true and correc Si afore: �r1 t Date.: 0 Phone#: Official use only. Do not write in this area, to be completed by city or town official City or Town: Issuing Authority(circle one): Permit/License# L Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5Plumbing 6. Other . umbinbg Inspector Contact Person: Phone#: i �Z7�sig :u01Jp„dx3 .I aun,5.r £9810 bW Oy O��jmv ,0 80Mp0 H0 N Jo 8 3,�bN�W utlr^�a h Zo8$ �0 '�pa��t�Js yhd.lo�u U -1/017-11 as aa!� a 'vr;l,'ay 11,n-`1'0 8 1 fiW Bofo ” HOME'r'PROVEMCNT CONTRACTOR • Registration: 108052 Expiration: 8/27;2010 l Pe ..individuai T 274351 BUSHNELL CONStR(g--FlON Michael Bushnell 89 MEADOWBROOK'Rfj' _ Chelmsford, MA 01863 ' Adnrinistr':rt[u- i . CO- m CERTIFICATE OF L44BIUTY INSURANCE PRODUCER DATE{IwNvOD/YYYYT @ 3 8/10 CONNOLLY INS AGCY THIS CHti IRCA7 E IS 83311®AS A WATTBt CIF INFOI2ABAT�B 7 LincojA Street ONLY AND COQ NUR {iS lel THE CB>tTIFlCATE TER�� ATE DSS NQT AM-m- Ensor OR PO Box x08 FPOtiDED i3Y THE POLICits4 BH.OW. ftstford, MA 01896 INSUREDWUR1MARKRbMC0VEPAGE NAIL S MICHAEL AUSHNELL D$A IN911REA A CObMRCE INSURANCE CO BUSHNELL CONS'T'RUCTION INSURER 9: z ES 99 MSADOW8R40K ROAD INSURERC:TjL.+RmONT M11� uAL INS. CO. N CHELMSFORD, � MA 01863 IN$UR@R D:WESTERN � � INS. Go COVERAGE'S INSURER I- THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIRIWIINT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT To WHICH THIS CERTIFICATE MAY o ISSUED OR MAY PERTAIN,TIRE INSURANCE AFFOrDED 0Y THIS POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE UMRS SHOYIM MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY NUMBER POLICY EFFECTIVE EIIP1RAnoN GENERAL LIA81U'}y � 1.EpITS A X col RcrAl( JNERALLwBIInv NPP1203624 FACHOCCURMNCE 3 1 00 000 x/26/09 4/26/10 DAMAOETOR9i 50 000 CU1aA9N'ADE 51OCCURA MEDEXP one a 1,000 aERsoNALanbvaNJRARY $ 1 000 Q00 OEN'LAGGREGATSMMITAPPLIeSPER! GENE011ALA00RIDATE S 0 POLICY PRO. Loc MODUCTS.COAP/01A(:G s 1._000,000 AUTONOSLLE NA8ILJTY A ANVAUTO 1?59@31 COMBNBD8NGLEUMIT ALL DOMED AUTOS 9/13/09 9/13/10 (81salm I 2 SCHEDULED AUTOS 8DDRY NJURY X HNGDAUTOS (Rlrpwam) $ 100,000 NOIr41WEDAUT08 80 CI LY NJUR Y (Par=dd") f 300,000 FROPER GARAGE LIABILITY d*f�� 100,000 ANYAUTO AITOONLY-EAACCDENT S OTWRTHAN EA ACC $ EXCESSIUMBRELLALUIBA.tTY A) ONLY: A(% $ OCCUR CLAIMS MADE FACHOCCURRENCE 4 AO(R93ATE s DEDUCTAIM $ RETENTION SWORKERS s ILumSI1rry ANp s I3 Twc sTn� oTt7. ANYPROPR1ETtPOPAls cL WC005857339 6/25/09 6/25/10 EL HACGDENT fOPF=4L EXCLUDED? $ 500,000 SPEC "'' yam„ EL.01 AT-EAewurEE $ 500,000 EL DISEAS •POUCV LMIT 8 500 000 DESCRB'TiON OF OPERATIONS!LOCARONS/VE7tlCLEg I ETCLU91ONS ADbED BY ENOOR=Ng NT/9PECIN,PROVISIONS iob: 10 IRONWOOD ROAD NORTH 1MOVER, MA CBII'IFICATE HOI,pR CANCELLATION TOWN OF NORTH ANDOVr R, SHOULD ANYOF THE ASOVEOEBCRIBED POLICIES BE CANr;ELLQD BEpORETHE EXPIRATION 1600 OSGOOD STREET DATE TNEREOP.TRE 199ONO MSIBRER WILL ENDEAVOR TO MAa.30 DAYS WmrreN BLDG 20 STE: 2-36 NCRICE TO THE CER71PICATE HOLDER NAMED TO THE LEFT,BUT FAILURe TO oO SO SNA NORTH ANDOVEg, MA tMPOBE NO OBUGaM OR L)MUTY OF ANY KIND UPON THE INSURER,ITS AGENTS OR LL ATTN: BLDG. DEPT. , REI�RE9ENTAIINM if AUTHO RED Rep seNTAnvE AC0wi25(2001108) NANCY A, RIVRT ®ACMk;WKW TION ION 4 I l �---'" � .---- .-� i � � �� yam,, i � �� --�� -p �� v BUSHNELL CONSTRUCTION 89 Meadowbrook Rd. (978)256-4388 Chelmsford,MA 01824 Fed ID.#04 385762 Registration#108952 1/11/10 PROPOSAL SUBMITTED TO _WORK PERFORMED AT Judy Epstein 200 Blue Ridge Rd North Andover,MA 01845 same SCOPE OF WORK Finish off existing basement according to conversation with owner will meet prior to start of job to confirm. This proposal will include the following: 1. Frame -Frame in walls as discussed according to building code - Frame in soffits around duct work and pipes in order to have a plastered ceiling 2. Insulation - All exterior walls will be insulated with 31/2" insulation 3. Electrical - 4 recessed cans,computer wire,telephone and cable 4. Wall finishes -all walls will be insulated - 1/2" blueboard will be installed on walls and ceilings - Scimcoat plaster with textured ceilings will be applied to walls and ceilings 5. Woodwork finishes - All baseboard and door casings to match existing paint grade - All doors will be paint grade supply and install 6. Windows and doors -All doors will match existing styles 7. Painting - Paint all new walls and woodwork prime and 2 coats of paint 8. Miscellaneous - Obtain building permit - remove all construction debris Total Estimate $8,500.00 Work will commence week of March 24 2010 and will be completeed week of April 25 2010 Payment Plan 25% deposit $2125.00 25% completion framing $2125.00 25% completion Plaster $2125.00 Balance upon completion $2125.00 All contractors shall be registered with the state of Massachusetts any inquiries shall be forwarded to Office oof Consumer Affairs Ten Park Plaza.Suite 02116 Boston,MA 02116 (617)973-8700 All warranties on the owners rights under the provisions of MGL c. 142A Owner has the right of 3 day rescission on this contract Any alteration or deviations from above specifications involving additional costs will be executed only upon written work orders and will become an extra charge over and above the estimate. All agreements contingent upon strikes,accidents or delays beyond our control. Owner to carry fire,tornado and all other necessary insurance upon above work. Workmans compensation and public liability insurance on above work to be carried by Bushnell Construction Do not sign this contract if there are blank spaces Owners Acceptance Respectfull- Sub tte y icl~iaeushnell Vin/ Information ann d 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 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 coinpliance 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 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. Be 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 retuned 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 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 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/license 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 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 Commonweal& 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 vvwu,.mass.gov/dia