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Home My WebLink AboutBuilding Permit #118-12 - 21 WEST BRADSTREET ROAD 8/10/2011 BUILDING PERMIT of *%c t TOWN OF NORTH ANDOVER Fr a`�- APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received re g) l VSs �� Date Issued: acHus IMPORTANT: Applicant must complete all items on this page �t, x �' CCyy� r „ + of _ .�.�� n - I� i .,x _��Js ,+t r'� "t 'i _ P a•t•;n P NN ER + tii n aPf,�CIL1NU iTFkkiT� tstorac�asttat y r 'D r°: 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 c 7lJill p�lalrkletlarads atersfedlstrct� "'F;a V ater4Seuler k. DESCRIPTION OF WORK TO BE PREFORMED: _oo E ®tyL)� 51J-1v4tK VS ow=- T—eK Y- WA rxx- Z_�tom,�,�� ,� S'j�'�,•�[r Gr�,�a� .¢S'J�-v ZT,�a/�'<�r �'�v��,•.L:� Identification Please Type or Print Clearly) OWNER: Name: /4 G-L T,<,/ �v#N 2 Phone: 77� Address WW'5 r 9AA A 7- r �1 OR (/PT � 11%J alai k •+ ;;i ti� l: �' -P rre� �•'+f *:, H r �.: L ..�J y ' ",: #r KY.r 'i �, 4: t rk .as, .i , .,� � r YrSr+ � }tqF •.i orriie drrraerrcenset� ;date ;. *'4 t ARCHITECT/ENGINEER `.... Phone: Address: Reg, No. FEE SCHEDULE:BULDING PERMIT.,$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $_ FEE: $_ Check No.: Receipt No.: ' 1 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Sie of AgenflOwrer Signa ue ocontractor _ II � - ` Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SfiWERAGE 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 Decisionlreceipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer ConnectionlSiclnature &Date Driveway Permit DPW.Town Engineer: Signature: Located 384 Osgood Street =.DEi 1#F;;T ENT Temp Duar�pster on ate :yes-at 124—Mari Street Fire De part-m_, gnatucefrlate COMMENTS 02 � 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 2 1 A—F and G min.$10041000 fine NOTES and DATA— For department use ❑ Notified for pickup - Date i Doc.Building Pemit Revised 2010 J 1 • 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 4Q Location C3 No. Date AOWTN TOWN OF NORTH ANDOVER 3�Oi��•o I� hOO _ F i y • � .: . Certificate of Occupancy $ �ss•►CNusEt� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # � 24461 Building Inspector 4ORTH n-down ® , .. ®ver 0 ..... tiw•�4'. •i�. 'I:.i....� No. �( odover, Mass., �' ° T 0 — LAKE ' d� COCHICHEWICK V ORATED P`P�X�� Y V U BOARD OF HEALTH Food/Kitchen Septic System . .PERMIT T D BUILDING INSPECTOR THIS CERTIFIES THAT.........Al ........... iA ............................................................................ Foundation 4has permission to erect buil ings on ....a.l........ . ......... S. Rough • Chimney to be occupied as..... ... .. f........ ... ..... ..............................V.... ...... ......................................................... provided that the per on accepting this p rmit shall ' every respect conform toa 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 �I VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN b MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUC QN , TARTS -- Rough ............... ................................................................................................ Service BUILDING INSPECTOR it Final II Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final 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. NEW ENGLAND CUSTOM DESIGN, INC. 226 LOWELL STREET WILMINGTON,MA 01887 #978-658-0881 Home Improvement Contract Registration No. 102467 ROOFING AND SIDING AGREEMENT This is a legally binding contract.Make sure you read this Agreement and understand it before signing it.Do not sign this contract if there are any blank space NOTICE:All home improvement contractors and subcontractors,unless specifically exempted by Massachusetts law,must be registered with the Commonwealth of Massachusetts.All inquiries about registration should be directed to: DIRECTOR-HOME IMPROVEMENT CONTRACTOR REGISTRATION One Ashburton Place,Room 1301 Boston,Massachusetts 02108 Telephone:#617 727-8598 This Agreement is made on �� 20�,by and between New England Custom Design,Inc.(hereinafter,"Contract., and owner�A ("o `;&:C (hereinafter,"Owner"), City /Town A W 6 C1 tlrdf State o0OVOL Zip (H)Phone 97d00 Job Address("The Premises") .O� �JleLE Z?I- d�"l`�z� (�Phone W=�gy` a3rs7 New England Custom Design,Inc.Salesperson Roofing will be�applied �only qp slope roof surfaces below,over present roofing shingles unless specified under REMARKS. W E MATERIAL, lf(�0 t tM-_t,3 o � ,'�'/9 4 114� Color Jy4 L 8 ' a , Q Main Roof V-e,5 4V va- iffliv Bay Windows J--law-e Extensions 'yy �-+ Porches:Front V eS Side ► Rear _ , � L/ Other Roofs NOTE:Roof board replacement cost rid per foot OR L?j'- 0e' per 4'x 8'sheet of Ta—inch CDX plywoc REMARKS/EXTRAS:Missing or-defective lumber is notlincluded;in any category of work.unlessspecified here. ^' fCi / / e-1 cC' oS mac/ ti" .4 ri' ��eJ� X1� t' fedn,S a."/f/ 6 e A-z- at,r OIa 004-e,,11) / G G'fa�t-c- G�7c�. 'b4 Lj a(/ d✓'�" G� c'° 7'��d �rinffT�rPf/<s�i ��. 79te Conuactoragrees to peTmm in agood and workmanlike rnannerall work detailed above. CASH PRICE $ �� DU ac DOWN PAYMENT$ r o(' — PAYABLE ON START OF WORK $ 1s U f r, PAYABLE $ PAYABLE ON CO. PL TION$ I Sia. v -0-0 r� ~ DATE: <J-- 20 ,L' . RIGHT TO CANCEL The Owner may cancel this agreement if it has been signed by the Owner at a place other than the address of the Contractor,which may be his main office or branch thereof,provided that the O nobles the Contractor in writing at his main office or branch by ordinary mail posted,by telegram sent o€ley delivery,not later than midnight of the third business day following the signing of this i+ ment.See attached Notice of Cancellation.A cancellation fee representing 30%of the contract price will be in effect if cancellation is requested after the legally allotted time has elapsed. The Owner hereby certifies that he has read this Agreement,that:the terms and conditions and the meaning thereof have-been eapltl him,and that he fully understands them and that there understanding between the parties,verbal or otherwise,than that which is contained in this Agreement,and agrees that the said Contractor of responsible nor bound by any representations not tained in this Agreement,made by any of its agents,unless the same be reduced to writing and signed by the Contractor. ATTENTION HOMEO O NOT SIGN THIS CONTRACT THERE ARE ANY BL. M S ACES-.-..,- r�, Z. Owner s Signature Date r5,nd Custom Desi ,Inc. Date Owner's Signature- Date QJ/28/2Q11 10: 51 9785319442 #0584 P. 001/001 4009-. CERTIFICATE OF LIABILITY INSURANCE OP ID KC DATE(MMIDD/YYYY) ,PRODUCER NEWEN-1 03 2B 11 THIS CERTIFICATE IS 13SUEO AS A MATTER OF INFORMATION Kilgore Insurance Agee ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 5 Centennial Drive HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR Peabody MA 01960 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. ------ Phone-. 978-531-65$0 Fax:978-531-9442 INSURERS AFFORDING COVERAGE MAIC# INSURED � .. .---•--.—.._..____ _ .............-- INSURER A: ftStorn World Inauranaa Cowan New England Custom. Design INSURER 8: Safety Indomnity Ins Co Ron Welnberg INSURER C: Trawlers ercwrt,}Lc CasualCy,-, 226 Lowell stre t S unit R4-A INSURER D: Wilmington MA 0 88 COVERAGES II . ...... 3 INSURER E: •- -- THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN 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 DESCRIBER HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLIGIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PARD CLAIMS, INSR pp' "--- -'POLICYEFFEC VE POLICY EXPIRATION LTR NSR TYPE OF INSU NCE POLICY NUMBER pp Dpi Mppryy LIMITS _ GENERALUARtILITY . EACH OCCURRENCE $1000 000.._. A X cOAAMERCIALGENERALLIABILkTY NPP1265260 03/14/11 03/14/x2 PREMS s F�.aoccurE o o $50000 CLAIMS MADE �OCCUR MFD FXP(Any ene person) $2 500 I _ I - - ---- i PERSONAL&ADV INJURY 1 $x,000000 GeNERALAGGREGATE f�2000000 GEN LAGGRErG—A-T�E LIMIT APPLIES PER: PRODUCTS•COMP/OP AGG $1000000 POLtCY !JECOT LOC I AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT H ANYAUTO 5054921 04/05/11 04/05/12 (Ea accident) $ ALL OWNED AUTOS —_.._.._ -.. ....... _. BODILY INJURY }[ SCHEPULEpAUTOS (Perporson) $250000 HIRED AUTOS :- ._..—_. ............_......j_..... BODILY INJURY NON-0WNEpAUTOS ,(Poeaegdept) $500000 i PROPERTY $ x00000 (Per accident) GARAGE LIABjury - AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGO $ EXCESSIUMSRELLA IJABILITY EACH OCOURR_ENCE $ OCCUR j CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ I$ WORKERS COMPENSATION AND I X,TORY,LIITS-,•— FR- ANY R ' C ; EMPLOYERS LIABILITY ANY PROPRIETOR/AARTNI=R/E%!CUTIVE 7P�-0239N23-2-+11 03/14/11 03/14/12 E.LEACHACCIDENT $100000 OFFICERIMEMBER EXGLURE07 It es,deseribeunder E•L DISEASE•EA EMPLOYE $x,00000 SI�ECIALPROVI51ONSbolow E,I,DtSEASE-POLICYuM17 $500000 07rirrt DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES I EXCLUSIONS ADDED 13Y ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION 3.111111 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIO DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO So SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AuTHO R RESENTATIVE ACORD 25(2001l08) �Off RD CORPORATION 1988 Massachusetts- Department of Public Safet3 . , Rrstrictedto: 00 ! Board of Building Regulations and Standards 00- Unrestricted Construction Supervisor License 1G-1 2 Family Homes i License: CS 8828 Restricted to: 00 VAL J LANZA t Failure tb possess a cpt rent edition of the 34 BIXBY.ST Massachusetts State Building Code f REVERE, MA 02151 is cause forrevo cation of this license: I Refer to: WWW.Mass.Gov/DPS Expiration: 4/20/2012 C onuuissioner Trt#: 20843 . ; License or regi trat!bwvalid for ufdividul use only ,'p e TDan»ianureii o�`✓ adda�/uiae before the expiration date..If found>eturn tot \ Office of Consumer Affairs&Business Regulation Office of Consumer Affairs and$usiness Regulation HOME IMPROVEMENT CONTRACTOR I Astra on OR Reg ti 2467 �TYPB Boston,MA 02116 NEW ENGLAND INC. !! 1 ' f � Val Lanza ov 226 LOWELL ST. �.•��/1 Not valid withou nature '-�- a 4. WILMINGTON,MA 0'5 9�r= Undersecretary L' Th`e Commonwealth of Massachusetts Department of Industrial Accidents ~ Office ofinvestigations 600 Washington Street Boston,MA 02111 www.massgov/dia Workers'.Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print.LeLibly Name (Business/Organization/Individual):�/� _ e V r_Lc h_t 10 S7G��r' LN C Address: OwtTiLL 9 t City/State/Zip: L /17 A 0 f 9 x-7 Phone#: '7 10�. G 1!�'9_ 0 g-R/ Are you as employe1.r? Check the appropriate box: Type of project(required): 1: am a-employer,wlth _ 4. ❑ I am a general contractor and I employees(full,and/or part-time). * have hired the sub-contractors 6. El New construction 2. I`am a sole proprietor'orpartner- listed on the attached sheet. 7. E] Remodeling ship and have no employees These sub-contractors have g, E] Demolition working for me in any capacity. employees:and have workers' .9. ❑Building addition [No workers' comp. insurance comp.insurance.$ required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions officers have exercised their 11. Plumbing repairs or additions 3.� I am a homeowner doing.all work ❑ g P � , myself, [No.workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.0 Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional.sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their.workers'comp.policy number. I am an employer that is providing workers'compensation insurance for:my employees. Below is the policy and job site information. ^�- Insurance Company Name: ! , l/& L awt s- — Policy#or Sel f ius } #: ru ` ®5 391 A(a / Expiration Date: 3—I Ll- Job Site Address':�2 g ar t v K Q City/State/Zip: Al.�9 sl4&„Za )41-r& . Attach a copy of tl�workers'compensation policy declaration page(showing the policy number and expiration date), Failure to secure colbrags k,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/o`lj.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 thatt-a copy of this statement maybe forwarded to.the Office of Investigations of the DIA for insurance coverage verification. I do herebyertj under the pains and penalties ofperjury that the information provided above is true--fid correct �' Signature: " Date: I. Phone# ;Z Officialuse onl y: Do not write in this area,to be com leted b ci or to � yry wn official, � . s . . ff City.or:Town:, Permit/License# Issuing Authority(circle one) 1 ,.Board,ofHealth.2.Building D. partment 3..City/T'.own.Clerk 4..:Electrical Inspector 5.Plumbing Inspector 6.Other, . Gontact.Person Phone#: