Loading...
HomeMy WebLinkAboutBuilding Permit #689 - 21 WAVERLY ROAD 4/25/2007BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: tlolf 1. Date Received Date Date Issued: TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Ad ' ' n ❑ Two or more family ❑ Industrial Iteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other tBety�}tt Q ielN� ,' at P�{�ijj`ba�;.b �� 4^.^,.kKN.S^�i.TM �� �'¢^ ' Q� j .��� Y.4�''�' °` 3«^i" - ., �*s t .r �`3 �l. �3nmx •.r *, DESCRIPTION OF WORK TO BE PREFORMED; ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE: BULDING P $12.00PE13$1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ 13W FEE: $ Check No.: /off 53 Receipt No.: ;o i NOTE: Persons contracting with unregistered contractors do not have access to the euaranty fund 8 - Plans Submitted ❑ Plans Waived [I Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL FIRE DEPAR,1MEN '; ie [ tati ste o °ltd yes' Public Sewer ❑Swimming Tanning/Massage/Body Art ❑ Pools=:;i ` ,❑ Well ❑ Tobacco Sales ❑ Food Packaging/Salesy. '1] Private (septic tank, etc. ❑El Permanent Dumpster on Site < THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS C010I�6714* -A' 907`l COMMENTS HEALTH COMMENTS DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED ❑ ❑ 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 FIRE DEPAR,1MEN '; ie [ tati ste o °ltd yes' s 4q o, 4, Located 4124 `y a MaHt Sttei w ■ ` Department S1j�rratureldat,R g S a a < , w r -" Dimension Number of Stories: Total land area, sq. ft.: Total square feet of floor area, based on Exterior dimensions. ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine No 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 ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses o 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 o 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 2.2007 Location x�'l�'��! No. �� Date 2 40RTN TOWN OF NORTH ANDOVER Ot.•° ,•rya Certificate of Occupancy $ '�s "•••° •E<� s�cNus Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 20*1 46 Building Inspector m m x m m m v m C) y C d d CD az y CD CL O CC'J � � O C. = y O C.) o p CD CD O CLQ CD W O � co W �. C O y �. CLO CO) CD I C2 CA O z 0 CD CD O O 0 O Z .0 m m O C CL m m U2 0 H CLO H US Ewac I= d z do Sowa 0 CO) O = m0 m n, z0 p 7 L O C OM n b 0m m n'Z CL "' W 4mmim O w IE CD"coD CD a c o+ O y n .m :1 CL =r _'� m m '% �om�' 0 E s omq 0 9 A 01 d POO ro p z0 p 7' O C OM n b 0 E s omq 0 9 A 01 CERTIFICATE`. OF NSURAA � C �1 ISSUE DATE (MM/DD/YY) PRODUCER Samuel J Durso Insurance THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE Agency Inc POLICIES BELOW. 198 Mass Ave Suite 101B COMPANIES AFFORDING COVERAGE North Andover, MA 01845 INSURED Arthur Walsh dba A. J. Walsh & Sons COMPANY A.I.M. Mutual Insurance Co LETTER A 55 Pleasant Street North Andover, MA 01845 jj COVERAGES THIS IS TO CERTIFY THAT 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 RESPECTTO 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO LT TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE(MM/DDIYY) POLICY EXPIRATIONLIMITS DATE(MMIDD/YY) GENERAL LIABILITY GENERAL AGGREGATE $ COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG. $ LAIMS MADE[�DCCUR PERSONAL & ADV. INJURY $ EACH OCCURRENCE $ OWNER'S& CONTRACTOR'SPROT. FIRE DAMAGE (Any one fire) $ F1 MED. EXPENSE (Any one person) $ AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS GARAGE LIABILITY PROPERTY DAMAGE S EXCESS LIABILITY EACH OCCURRENCE $ AGGREGATE $ MBRELLA FORM THER THAN UMBRELLA FORM WORKER'S COMPENSATION AND EMPLOYERS' LIABILMY X WC STATU- OTH- TORY LIMITS EL EACH ACCIDENT $ + A THE PROPRIETOR/ INCL PARTNERSJEXECUTIVE OFFICERS ARE: X EXCL 7014648012006 11/14/2006 11/14/2007 EL DISEASE -POLICY LIMIT $ 5W.000 EL DISEASE—EA EMPLOYEE $ 100,000 OTHER . " 1 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS CERTIFICATE:HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Town Of North Andover EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 15 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE i' �r i' ns y Board of t3 uilding.lRi6iations and Standards HOW IMP VEMENT CONTRACTOR Rego ist_ 3358 8 Ge; 1i Corporation -- . A J 1NALa�ii & S0 w Artriar WaisI6r r r €}, { CS # 022680 HIC# 103358 ro owd A. J. Walsh A Sons 55 Pleasant Street North Andover, MA 01845 # of pag 978-688-6737 or 1-866-AJWALSH Proposal Submitted To: ,a Job Nameu' Job # 0 Address i Job Location G /__,, l Date of Plans Fax # I Architect We hereby submit specifications and estimates for: We propose hereby to furnish material and labor — complete in accordance with the above specifics ' ns for the sum of: 122) $ 3—ft Dollars with payments to be made as follows: Any alteration or deviation from above specifications involving extra costs will be Respectfully !,l executed only upon written order, and will become an extra charge over and submitted � Al above the estimate. All agreements contingent upon strikes, accidents, or delays beyond our control. Note — this proposal may be withdrawn by s if not accepted within days. Rcaptance of iroplogat The above prices, specifications and conditions are satisfactory and areS g ature hereby accepted. You are authorized to do the work as specified. V Payments will be made as outlined above. Date of Acceptance Signature the Commotmealth of Alassachusetts Dcpat-irment of Irtditstrial Aceiderrts _ Office of Ittvestigatiotts 600 FVashitigtott Street Boston, MA 02111 wlvw.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Corllractoi-s/Electricians/Pluij.ibei-s Applicant Information Please Print Le0bly Name (Business/Organization/Individual): Aj &46'-Q'17LI 1,S01i S Address:teffS*f SI City/State/Zip: #d 14 0( 60& /''i Phone it:_ 9)P _6737 Are you an employer? Check the appropriate bo 1. ❑ 1 am a'employer with 4. l am a general contractor and I employees (full and/or part-time).* 2. ❑ I am a sole proprietor or partner- ship and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t have hired the sub -contractors listed on the attached sheet. t These sub -contractors have workers' comp. insurance. ❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 100 Electrical repairs or additions I 11 PI nlg repairs or additions 12.Roof repairs I3.❑ Other */any applicant thnt checks box HI mus! also fill out tate section below slowing their workers' congrensation policy information: t IJonreowners who submit this affidavit indicating they ate doing all work and then hire outside contractors must submit a new affidavit indicating such. iConhnctors that check this box must attached an additional sheet showing the name of the subcontractors and their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my ernplopees. Below is the poliq and job site information. /,�^ Insurance Company Name: /7 fM 1 g / uA_L' IN, Cd Policy # or Self -ins. Lic. #: '70 % /P `t Fol 2ae27 Expiration Date jrl"L(L07 Job Site Address: �/ � � ("/ l�� CityiStatefZip: A(d A 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 tine 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 tip to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to IIIc Office of Investigations of the DIA for insurance coverage verification. I do hereby ce�y under the pains and penalties of perjury that the inror►nation provided above is true and correct. Siguature: C44 /� �ff/ _ .—Date: Phone #: �� `l°�r� -6737 — — fl O fficial um only. Do no( write in this area, to he completed by city or tv»}n of�ciat. n: 1'ermit/License # — hority (circle one): Ilealth 2. Building Department 3. CityrTown Clerk 4. Electrical Inspector 5. Ptun+binR inspector rson: Phone #: eip/no�ss�u7nnnln� Q-gZ-S PasInad 6VLL-LZL-LI9 # XEJ 3JdSSVIN-LL2-1 10 90b 1X9 006t,-LZL-LI9 # T)i I I I Z0 FTI `uolsog Iain s U012 m {srm 009 sa©rle2tlsanaI JO 33WO sIn3pi0od Ieuasnpul Jo IuamgmdaQ sllasmlMsscIN JO rpiromuou moj aq L :13garna xuj pue auogdala, `ssarppe s,IaaanledaQ aqj llea a sn ant3 07 awjm q jou op aseald `saoctsanb due aneq no,C PIU6ttg-PtT-uo ooa moA J0J aauenpe m nog pegj of aTl pinom suoue2UsanulJo aayJO aql 11nepUie srgl :oIdwoo of parrfbaJ ION sl uoslad piss ( ala saneal runq of truuad 10 asu33q top a -o-i) aJnauan IM'3unu00 10 ssaursnq due o, pa,ep, lou,ruuad to asaaorC e 2mmelgo si uazgta z0 laamo awoq e alagM 1eaA gaea)no pally aq,sn' IrnepWu Mau V -sasuaoil 10 s,iauad a1n,nJ 1oJ aly uo sr arnepgJe poen a leg) Joo1d se;uearldde aql of papinold aq XL"u unno, 10'C,13 arl,,Cq p9jim 10 padwms X11malUo aaaq seq aega Itneprjle agljo Xdoa V juMol so fjta} u► suot,eaol Ile,,a,rJM pinogs,ueorldde aq „ssalppV a,rS qor,, lapun pae {,Cressaaaa J�) uogeuuojar hilod ;uallna 2u1je31pr11 uneprlje auo ltwgns �luo paau `lea( uWA Cue u7 suoiworldde asuaarl]anwad aldUlnw litugns lsnw jegj laearldde ae `uogrppe al laqurnu aoualajal e se pasn aq Ilan gartim lagwna asuaarlA!uuad aql a1 Ilq of ams aq aseald 3uuarldde a[p ftpj61 not ;ae,uoa o, seq su0r,e21,sanalJ0 aagJG aq, taana aqj at -Ino II9 01 nod 1oJ irneplJJe aqj J0 wolloq aril le Q39 -ds e paprnold seq 7uaug1ed3Q aq_L pa,aud pue a,aldwaa si Itnepyje aq, leq, ams aq aseald sietaw0 umoJi 10 Xll3 -Qml ajeudo.rdde aqj uo laquma asaaatl aaaemsm blas 1'3q1 lama pinogs sainedwoa palnsur JIaS -mopq pastl laqurna aglit! ,uau4ndaQ aql Ilea aseald `f.arlod uogesuadtum ,siasltom a uielgo oy pannbai aie nog{ jr 10 mel aql 2mple2al suousanb Cue aneq nod pinogs •s,uappod ler.nsnpal Jo luaurxledoG aqa jou `paisanbai 2maq sr asuaarl 10 Iu )d ag, loj aoueaildde aql aegl uMol 10 bra aq, o, paulmal aq pinogs icnep!.Ue ag1 •;IncpWe ariz alep pue uBrs oy alns aq osld a�elanoa aauemsm jo uol,ew11juoa 1oj slaapiaaV leulsnpal JO Min]-te6cl aq, o, p3murgns aq Xew IrnepyJe srgl;egl pasinpe ag -pannbaJ sr Xoilod a `=4oldwa grey scop d"I"I 10 J t ae jl aauLmsin uogesuidwoo ,slaxlom A'11ea of pannbal boa ale `slaalted 10 slaquraur Xp ueq, tatllo saa�oldwa on giim (d -1-I) sdrgsiauiled fulrqurj Parra!'! 10 (D'Irl) sataedwoD fQrliget7 pa�rwr-1 -aaaentsur jo (s)a,eayr�raa Iraq, gJIM �uole (s)laqumu auogd pue (sa)ssQ ppe `(s)aweu (s)lolaelaaoa-qns flddns `tiessaaau J! `pue uopemis 1rM of Xldde ,em sowq aql 2cri joaga Aq `XIa,aldtuoo imepyje aogesmdwoa ,sialiom aql )no CIU aseald sjuvallddV „ /,iuoq,ne 3atimnuoo xp o, pa,aasald aa -3q aneq 1mjdega sigl Jo s,uawannbal aauelnsul arp pm aauetldwoo Jo aauaprna algeldaaae Itiun 110m arlgndJo aaaeuu0j1ad aqj io} 3aelluoa Iae 0qui 1aJua llegs suoisrnlpgns leorulod s,r JO Xue Jou q,leamuouiuroa aqj 1agjpN„ sa,e,s WD) Z§ `ZSI 1a*V -19W `XIleuor11PPV -paainb3i aBeuanoa a:m"nsu► ag; qj!m a3ue►iduioa jo a3uaptaa a[ge#da33e paanpold jou seq oqm we3lldde SUe ioj glleamuoururo3 aq) ul s2alplInq ,3ni)suo3 o' ao ssauisnq a a;elado o) Zlwaad to asua3tl a jo Cutitaua.l .10 aaaenssl aq; plotltlllhl hells ,S3uAe 2ursua3ll 1e301.10 alels Jana„ aegl satels osle (9)DSZ§ `ZS 11aldega -IDW „'ia,ioldwa pe aq o, pawaap aq ruaru/oldrua goes jo osneoaq,oa Reqs o)ojgql weagimdde 2mplcnq 10 spunoi2 aq, ao 10 asnoq 2ulllamp guns no �iom nedol Jo uoljolu,suoo 'aaueualurew op m saomd sXoldwa oqm lagjoueJo asnoq 2urllamp Q41 30 wednaao aqj 10 `U1313T saprsal oqm pue s,uaurjjude ;) lNj ueq, 310M IOU �]mneq asnoq 2milamp E! jo laumo arl1 .ranamoH -=4oldwa 2u!Xoldwa `k]gaa le&al 1aglo 10 aogeraosse 'df lslau:ped `lenprnrpu[ aeJo 331snq Yo 191119991 010 10 `1aXoldwa paseaaap eJo sMlejuasaldaJ legal aql �?arpnpai pue `asudm la�aa,ote m po2E:2= 2mo2a1oj aq,Jo mw 10 om, ,Cue 10 `I,gua legal 19[11010 uoguodioo `umgeraosse 'drgslaujled `lenprnrpm ue„ se pamJap s► 1adoldi"a �' „'uailum jo, lelo `palldun to ssaldxa `91111 Jo jounnoo,Cue lapun lagioue jo aainlas aqa m uoslad [1ana� ,, se paayap sr aadoid'wa ae `a;rqujs srgj o, )aensmd saa,ColduJa 11911) 10j uorresuadwoa ,S13110m aPrnold of s1axoldwa Ile sannbal ZSl 1aldega sme-T le13u3D s )asngoesseW suo►pn.tlsuI pug uo[ju[u.joj[jj a ZI N b b �a 11 r b a n a O' C7 J r r b y b � a p s rt W p � yo � 01 rt G � 010 0ac Z [np a rt G � b rt a o� a N ] o W p a a• p co Iw rt N• O a w m O N' y rt P. O C7 O z� CD 0-- 0 O O O T �CD �J y CD rh O r+ � 9-n N -� o I�A Y I d