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Home My WebLink AboutBuilding Permit #451 - 210 ANDOVER BY-PASS 12/16/2009 o Q�- BUILDING PERMIT oltl,IG r10RTh,°q S TOWN OF NORTH ANDOVER 3? *`'° °� � t APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received �SSACHUS�� Date Issued: -0 IMPORTANT:Applicant must complete all items on this page LOCATION 27,0 AnL 4 e r iQl t nnt. PROPERTY OWNER Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village a Yes no i TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Buildinga famil 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: 00 -01ler exi,,s4 nCg road Ad ng0 rj,�ah /�Ljh.,7Jllg,� _ At2d r cin Identification Please Type or Print Clearly) OWNER: Name: /r P.,l G 0-b- - rr Phone: X 78 -68'1 - otid�7 Address: Z O ,.o CONTRACTOR Name: ervft,-, Phone 11-1 - 7O Address: 2 9 y �=,'c cs iso r� �5- } .; ►P t /11 A- 0 t f28 Supervisor's Construction License: F-) 'S L4 Exp. Date: y-d 8 - 1 Home Improvement License: Exp. Date: 2 - ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ > d �� O . o FEE: $ (�?� Check No.: 6652- Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Si nature of A en Owne _ i nature of contractor_ G' 110� _ 9_ g gw _ i Location 2Zp a zz �d!q!t" No. Date - N4RTM TOWN OF NORTH ANDOVER N oR 9 s ; ; Certificate of Occupancy $ , '� b"'••°'E�� CMUs Building/Frame Permit Fee $ Foundation Permit Fee $ f Other Permit Fee $ TOTAL $ ` Check # O } 22 % 02 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 I THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM i DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS s Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments I 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 I 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 ❑ Notified for pickup - Date Doc.Building Permit Revised 2008 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 i FORTH _ TO" Of : gAndover . No. _/1 - 0 o dover, Mass., /ct•l - o� �. LAKE COCMICKEWICK ADRATED `r BOARD OF HEALTH i PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT..........�....17. �-........... J.. -1 �-............................................... """"""""" Foundation has permission to erect........................................ buildings on ..� ...... .r!�d�?J .... .�.... .5............. .. Rough t0be OCCUpled as....... ....P G .. ........ Pq. - .....................................:...............:........................................................... Chimney provided that the person acce ng this permit shall in every respect conform to the terms of the application of 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 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIEW STARTS Rough ..................................................... Service BUILDING INSPECTOR Final 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 BeDone FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. tj ACORH CERTIFICATE OF LIABILITY INSURANCE' PRODUCER (617)471-1220 FAX: (617)479-5147 THIS CERTIFICATE IS ISSUED AS A MATiER•'OFINFORMATION Amity Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON...T}fE•dFATiFICATE HOLDER. THIS CERTIFICATE DOES NOT"AMEND;.bM. 0 OR 500 Victory Rd. ALTER THE COVERAGE AFFORDED-S.Y.THE-POLICIES BELOW.' Irina Bay Orth Quincy MA 02171 INSURERS AFFORDING COVERAGE NA1C# [Alpine URED INSURER Mercury InsuranC.e'Co. Property Services Co. , Inc. INSURER&Safety InSUranCG A Olympic INSURERCAtlantiC Charter MIrIa:"Group•.9 Boston Street INSURER D:Great Americanpsfie d MA 01983 INSURER I- ' COVERAGES THE POLICIES OF INSURANCE USTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD MIDtCA b.':N.6M'YiWANDING,, ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY'RE ISSUED'OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.EXCLUSIONS AND•CONQITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR A466D _ _-�- POLICY EFFECTIVE POLICY EXPIRATION TR INR TYPE OF INSURANCE1 POLICY NUMBER 1 IMWDDM= 1"I S'' GENERAL UASMM EACHOCCURR610E. •S• 1,0001-006, X I CON AERCWL GENER�A.LIABILRY DAMA1SES 19& UE S :501'000 A A CLAIMS MADE LJ OCCUR 01186-2 16/24/2009 6/14/2010 MEDEJN Ocie (a• S.: • ,�Excludsd X Ded X10,000 _ pEASONAIB/!C1/ItUURY s 1,4 _000 - GENERAL AGGRC-C,A1F' `'6 2,06 OO I . P _ roe OAO 0 •GEMLAGGESEGATE LiMRAPPLIES PER: ROOUCTS'COMP ACG' S• •"•.421 .00 ' I X POLICY X PRP LOC AUTOMOBII E LIABILITY I 'COMBINED sINGLELWI(f , (Fa��tl 's -:3;,.d00;00.,0ANY AUTO , B ; $ ALL OVAIEDAU`03 27026S1 1/9/2009 1 9 2010 / / BODILY INJURY 3 X I SCHEDULED AUTOS X HIRED AUTOS 1 BODILY INJURY 6, X NON-0WNEDAJTOS (Foraccde+q 7- 7 X Coll Ded $11000_ PROPERTY DAMAGE. I S X Coaly Dad $1,000 I, (Pa'cctlQiU GARAGE LIABILITY AUTO ONLY=EA ACCOEWT'•S.5 , ANVAUTO EAAC� 3 :'• [AO�T ERT}IANO ONLY: A EXCESS IUMBRELLA LIAMLRY I EACH OCCURRENCE : 'S $ 000 000' X OCCUR u CIAIMSHAOE . 000117-3 6/14/2009 6/14/2010 AGGREGATE S.- S 000 _000 DEDUCTIBLE X RETENTION $ 10,00C , C 'WORKERS COMPENSATION X VUC STATU I OTK_ AND EMPLOYERS•LIABUM ANYPROPRIETOR/pARTNER/EXECUTIvE YIN E.L.EACHACCICENT S SQ0,000' . OFRCF1WFmBER EXCLUDED•1 F pwadowyinNH) WCV00754902 1/5/2009 1/5/2010 E,L.DISEASE-FhEMPLo" S , : ' 500,000 SPECIAL PROVISIONS below EL DI E':POLICY LMT, 9 500,000 OTHER Inland Marine D Xiscellaneous Tools 567004801 2/28/2009 2/29/2010 ys,000 :'L•3mit & Equipment Deductibl6 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Evidence oP :rs�rsnce {n p7.ace. RTI CE FI CATS HOLDER R C ANCELLATION . SHOULD ANY OF THEABOVE DESCRIBED POLICIES SE CA4CB,LED;6EFOMTHE E7(PiRATtON' DATE THEREOF,THE ISSUING INSURER VVILL ENDEAVOR TO'"L''10 'DAYS•1lIIRtTiEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO TH£LEFr,BaT:F"r;TO DO SO SHALL IMPOSE NO OSUOATION OR LIABILITY OF ANY KIND UPON'YijVNSUF&k FiSAGENTS OR REPRESENTATIVES. AUTHOR®REPRESENTATIVE Lisa Polito/LP ACORD 25(2009101) 01988-2009 ACORD CORPORATIQN.'A i rights reserved: INS025(20DM) The ACORD name and logo are registered marks of ACORD , The Commonwealth of Massachusetts k 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 Please Print Legibly Name (Business/Organization/Individual): A 111 Q r 0 p r ` �t, ey'l eJ2 S- Address: 0?3 9 ps /-,)n S f City/State/Zip: 7—o os t` , Id Phone#: L P- 9�K7 — S5270 Are you an employer?Check the appropriate box: Type of project(required): 1.VJ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet 1 7• ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. g. ❑Building addition [No workers' comp. insurance 5• 11 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 12.aRoof repairs insurance required.] t employees. [No workers' comp.insurance required.] 13.❑ Other Any applicant that checks box 41 must also fill out the sectio^be^n,showing their workers'compensation policy info Watton. t 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 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. j Insurance Company Name: f�- f � u h �-, C_ C k(: i 44,✓' Policy#or Self-ins. Lic.#: Q 7 Expiration Date: Job Site Address: 1�0-0 r411dQ,leA. ,(3v D City/State/Zip: /V. 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 P 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 I do hereby certify unde the pains and allies ofperjury that the information provided above is true and correct Si ature: iiz t�C " L (�Date• %02 Phone#: 117 c6/yY 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 Inspector 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 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 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 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 returned to the city or torT.-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 Commonwealth 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 Fax#617-72.7-7749 Revised 5-26-05 www.mass.govfdia F OL YMPIC Painting,Roofing&Siding 515 Lowell Street—Peabod MA 01960 office 978-535-0943 facsimile 978-535-2008 Mark Gotobed Nexus 11 Carpentry and Construction Design P.O. Box2823 Woburn,Iv1A 01833 (781) 760-2031 or(781)760-2030 Job"cation: 220 Andover Bypass-North Andover,MA (Ar. C Ary . i Dear Mark, December 8,2009 The following estimate is for the roof installation for the property located at the above address. The following paragraphs describe the work that will be performed. Installation Procedure 4. Install new vent pipe flanges where needed 4. Install new 30-yr Architectural shingles over the existing roof shingles -4. Install new ridge vent system only to areas that call for ventilation and if it l. aheady exists - NOTE:Alpine will not remove,but win sea]the satellite dish brackets Additiorlat Sneciltctrtions J. Homeowner to choose color of shingles COLOR Slaters J. Trailer to be placed in an area that is designated by the homeowner i o Our trailers are sent to a recycling facility;therefore no additional trash may be placed in them. The transfer station will charge us a fee which will be passed on to the homeowner. A. We will remove all of the job related debris 4 All work will be done in a professional manner,and timely basis o Exception:weather �6 We are not responsible for any of the cracks that may arise in any walls or ceilings j, Please coverall your floors in your attic to protect from dust and debris 4. All Roofer are OSHA trained and Master Elite Installers from CAF L Permit costs arc not included in this bid,due to thevariation of cost from town to town sa �1;Ire brtosckpJt- 1-a edt . Cost for Labor&Material for Roof Go-Over. �%�aSl.• e f.4;500 00 �2 Payment Terms: to be paid in full aper completion of the job Remit to:Alpine Property Services Company,Ire, .0.Box 365 Topsfield,MA 01983 Please make payments to Alpine Property Services Company Inc.Alpine will hold this price for 90 days from the lasted date stated above Warranty-• ine Property YScrvir es Inc, guarantees all work performed for a period of one year. 1f any problems occur we will cover the cost of all labor and materia]to correct the problem and meet the customer' s satisfaction. David Ranson,Construction Manager Mark G �ed ' Alpine Property Svcs.Co., Inc.d/b/a Olympic Nexus II Carpentry L-d £9Z L 5L6 9L6 sem:• JS 11 snxeN dL0:Z0 60 L L 0el7 License or registration valid for individul use only before the expiration date. If found return to: \ � � � �✓ '°d '�OP t Board of Building Regulations and Standards Board of Building Regulations and Standards qi j One Ashburton Place Rm 1301 HOME IMPROVEMENT CONTRACTOR f� Boston,Ma.02108 Registrations, 154326 Expti'a£��t 2 ,.7./2011 �TyPO Sv�oolement Card ALPINE PROPER17YS�Rat1��5 Not valid without Signature . 6415 RANSON is 11 WILSON STREE`f:.;;.. SALEM, MA 01970 Administrator i 00-35,000 cf enclosed space Board of Bwldi g'Re ulatiosandSn4`;r�ds Construction Si ervisor License IA-Masonry only p 1G-1 2 Family Homes LitersCS 98534 Failure to possess a current edition of the �"` E. X8/2011 Tr# 98534 �I Massachusetts State Building Code is cause for revocation ofth'isaicense. h DAVID RANSON r a # j 12 RIGHARDSON Cdr` METHUEN,MA 01844 i r Commissioner i {