The URL can be used to link to this page

Home My WebLink AboutBuilding Permit #569 - 21 DUDLEY STREET 3/24/2010 BUILDING PERMIT °* N°RTry q TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION � v— /o Permit NO: Date Receive Date Issued: - �SSACHUS�� IMPORTANT:Applicant must complete all items on this page LOCATION Dol-Pl" t" 0, AQ,-� Print PROPERTY OWNER 4:5k ► P kov-)ra —' Print MAP 210 PARCEL ZONING DISTRICT: Historic District yes n 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 Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: P6 61C I en ' cat}'on PleaseTypeor Print Clearly) OWNER: Name: 1. Phone.gi n Address: rJ 6Q U, �2�- CONTRACTORNa p 4 Phone: 7 -Gr�- 'cl Address: i G ✓ �'>cI t r^ O Supervisor's Construction License 191 Exp. Date:5'-� 3- I Home Improvement License: ? Exp. Dater-a, 1 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: $ J FEE: $ Check No.: ( 6 F / Receipt No.: Oca NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contractor j Location li �i s No. S Date �v i NORTH TOWN OF NORTH ANDOVER 3? i • O F 9 A c Certificate of Occupancy $ �i�s'•^"E<� us Building/Frame Permit Fee $ s�cM Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # w D 2 ' 6 `/ x} --- 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 g 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 applicantmust 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 i4ORTH Town ofAndover- S O F ; ti"�;` ;..... �' " No. 6 - �,o A K E y dover, Mass., ';• a��• COCKICHEWICK V ADRATED PPS` Gj '9S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System. BUILDING INSPECTOR THIS CERTIFIES THAT.........".'*,.. ......... .... . / . .. .......... ................................................... Foundation has permission to erect........................................ buildings on .... .........��. . . ......I�....?.................. Rough to be occupied as........ p� ..I..... . v �/t.......r/............ Chimney provided that the person ac�46ji this permit shall in every respect co arm to the terms of the application on file in 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 loo PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTR STARTS Rough ..................... Service BUIL SPECTOR ` Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal 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. a Dempsey Construction & Roofing Specialists Proposal 7 Richardson Street Billerica,Ma 01821 978-670-8904 - 1 --- 'A Proposal — Customer Name Gail Apkarian Date :No. 3/4/10 Address 23 Dudley Street Order City North Andover State Ma ZIP 01845 FOB Phone 978-807-3229 Qty Price for left side and right side. Job Site#19&20 Unit Price TOTAL Strip existing 2 layers down to roof deck and re-nail where necessary. Any broken or rotten plywood/roof boards will be replaced at a cost of time and material. Install 3'of ice&water shield underlayment along all eves&valleys. Install 15LB felt paper on remainder. Install 8"aluminum drip edge around entire perimeter(white, mill or brown finish). Install 30 yr,3 tab,or architect roofing shingles(color and style chosen by homeowner) Counter flash and tar chimney where necessary. Install 1 new 2"pipe flanges,left side&1-3"right. Install two new roof vents on left side. Remove all roofing debris. This is a labor, material,dump and permit proposal. Proposal price is valid for 30 days from above date. Five year warrantee on all workmanship Payment Details Q Right side price $6,000.00 Qi Check Left side price 5.2 Q Payable to Eric Dempsey TOTAL $2,000.00 down for materials remainder due upon completion Office Use Only 0 Signature of acceptance i Ata.%.wachus-ctts-Department of Public Safety Board of Building Regulations and Standards Construction Supemsor Speciz!ty License License: CS SL 99681 Restricted to: RF,WS,DM ERIC DEMPSEY ' 7 RICHARDSON STREET BILLERICA,MA 01821 ' --G— —� Expisatio r: 523(201?, K..minis<ie�ner Tr-,— 99681 I� ✓�i4�e i�i:Aweowtaaa�[a�..^��a�twiedfd Office of Consumer Affairs&Business Re6uhtioi HOME IMPROVEMENT CONTRACTOR Re9istmn-: ,, 50272 Expiratiow;-3 Z4M12 Tr# 292627 Type' n ftkk ai r DEMPSEY CONST;W RZiOFiNG"." ERIC DEMPSEfr,�- 7 RICHARDSON STS `' — BILLERICA,MA 01821'?`}: - Undersecretary I t DATE ACDRD., CERTIFICATE OF LIABILITY INSURANCE FXSDNYM 02/24/2010 PRODU(3 R 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 k Malden, MA 02148 ALTERTHE COVERAGE AFFORDED BYTHEPOUCIE3 BELOW. INSURERS AFFORDING COVERAGE NAIC B NSUREO �I Savers Property&Casualty Insurance Company 31771 Dempsey, Eric INSL4"6 7 Richardson Sreet Billerica, MA 01821 , INSDRHR F- f COVERAGES i THE POLICIES OF W SLIRANCE LISTED E UOW W 4L BEEN ISSUED TO THE?NS1..4iED NAMED ABOEIE FOR TI-E POL CY PER OD i NDIC&-,ED.NOT`?F-rtSTrIND NG ANY REODUWAENT.TERMORC(XC4IONUF"ANY CW11RAC.ORviTERDOt,-MIINTrmaiawGG=i ;F"sCR-ch1AY-^E SSSI i:.iitdAY}" i;.34, 7HE INSURANCE AFFORDED BY TH£POUCES DESCR".BED HEREIN;S SLSJECT 1D ALL�iE ER61S.EXCLUSIONS AND CONOrnONS OFSUS IPOL-d C-S. AGGREGATE LNtta'TS SHD•AW MAY I-KVE BEEN REDUCED BY PAD CL'krMS ItRSR ADO TYLE OF faSTDRANCE POUCYaALMBER POLPr-YEFFECRVE PODGY EMRATILNI LTR WSRO DATE(LOl.UN VY( DATE(LIMMEMYI U.:A S GENERAL LIABILITY FACR OCC UR 1rtKT I 'a CCa:I4MCMJ-GENERJ.L"tf i P.41VG-E TO REWED PREWES:E- C__- .- f CP.�1LL LL�DE CC' MED L P:Art am pr sD-S i Lit PERSQHAL"AM m:CW GEHEW,LFC--W-G-ISE '.3-".ifL AyG+2EGATEI APPLE PLR: PRCI)VC�S--XAW,.TA!C_ 1 � . .P^a.FCYI .IE^T. .. AUTOMOBILE LIABILITY =AMNED�TGLE i et i7T Mn PAKC ` 4 idl C'i'TJLI:4(T-CS 'I BOGL-r IR:UtRY _ 15-01MUL r.AUTOS ISG AUTO$ y BOGII.Y OLiURY HCAia:STRfD.4UiC` (PCvsw,'dCTJ? � i to PRCPGR Y D.AW-GE i T-e+ de:Y; ( 3; GARAGE LL4BRM f.1TTC ONt'r-E.:t La' g ur.nU'c C-TSERTIVJI �A C - r.UTC ONLY: 3 A t D DICESSIUMBRELLA LIABILITY EACH OC UIMENCE $ --CUR ❑ CLAII.4S LVDE AGOWCATE 1 $ CEClCTELE S (�1FlT,101i ; 3 WORKERS COMENSATiTSNAND :scsrAnr:cat OSIER EMPLOYERS L MIUTY ur ris PMT PR-OPWETORPAFU"ER EXEaf,M1'E , Or'Fr-E RTENM EXCLUCED? E.L FJ: I r.L-�Dr;Tr s 100,000 ■ = � � AR0426077 09/16/2009 09/16/2010 E-LCF".E.4SE-E-I-1.7LO4T1 + $ 500.000 SFE0AL PTI-aL9CNS(n°:= OTHER E.LGISEASE-P3n.'.YLIM a 100,000 DESCWTION OF UPERAIMNS!LOCATIDRS i VEMLFS!EXCLUSIONS ADDED BY ENGURSEgERF d WMAL PROIA.iONS CERTIFICATE HOLDER -. SHOOL D ANY OF TME ABOVE DESGiDBED POLM ES DE GWOCELLED BEFORE THE E%rNATx2N DATE THEREOF.THE ISSUING INSURER WILL ENDEAVOR TO MAIL 1Q DAYS WRNPTEN NOTICE TO THE CEFt lFLCATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SWILL IMPOSE NO OBLIGATION OR LIABRITY OF AttyaK=UPON THE INSURER. 93 AGENTS OR REPRER ATIVES. Af) AUTHORQED RF_PRF-1A3TA7WE I i The Commonwealth of Massachusetts Department of Industrial Accidents Office of investigations 600 ff'ashington Street Boston, AL4 02111 ww`w.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LeQibl Name (Business/Organization/Individual): + Address: Qr ��- City/State/Zip: ,J� ✓`Cel a 192 1 Phone#: od Are you an employer?Check the appropriate box: 1.�I am a employer with 4. ❑ I am a general contractor and I77. �Ej oject(required): employees(full and/or part-time).* have hired the sub-contractors construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet odeling ship and have no employees These sub-contractors have working for me in any capacity. . ❑Demolition workers' comp.insurance. [No workers' comp, insurance 5. ❑ 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 11.0 Plumbing repairs or additions myself. [No workers'comp. c. 152,§1(4),and we have no insurance required.] t employees_ [No workers' 12.❑Roof repairs Pomp.insurance required.] 13.❑Other :.L y applicant that checks box ut must also HE out the se•-tia-below shoe�z g their workers'come sao fc:�a - Homeowners who submit this affidavit indicating they are doing 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 workerscompensation infoormation. insurance for my employees. Below is the policy and job site Insurance Company Name: Sq V-e K ) 0-cZL,, l Policy#or Self-ins.Lie.#:A t�Q �) �� 017 � n _) (�e C Expiration Date: Job Site Address: 2 3 U �� 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 for insurance coverage verification. I do hereby certogunder a ns and penalties of perjury that the information provided above is true and correct Si ature: Phone#: 'g Official use only. Do not write in this area, to be completed by city or town off ciaL City or Town Permit/License# Issuing Authority(circle one): I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.PlumbingJInspector 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 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 bean 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 4 Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if t' necessary, supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of M 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 bee returned to the city or town that the application for the pernait 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 h 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 permitllicense 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 t town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the t 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 Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. # 617-727-4900 eat406 or 1-877-NIASSAFE Revised 5-26-05 Fax#617-727-7749 )Arwu7.mass..g ov/di a