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HomeMy WebLinkAboutBuilding Permit #89 - 210 BLUE RIDGE ROAD 8/4/2008BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received --7-1- 0 I Date Issued: IMPORTANT: Applicant must complete all items on this pate LOCATION ZtO Zw -Q -L = FZ0, Print PROPERTY OWNER q i C.T-pa- ?.>Ae fS4vZA Fi,^-C-` 0'5, e Print MAP NO: !4q PARCEL: ZONING DISTRICT: Historic District yes Machine Shop Village yes o pDRATED ♦Pay.�5 �SSACH�1S no 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 &�AZ4-RZ� k Kd'► "TOPS Septic Well _, ,� Floodplain Wetlands Watershed District _ Water/Sever' ` °' l _` tel ,ORI T y ON OF WORK TO BE PREFORMED: > C OA) C.fLeL-T '<S OA.) CreA Identification Please Type or Print Clearly) OWNER: Name: \/i cTo � %,kQ CA 21.E Ce,,>,a c- f- Phone: 1179 - G& - (0 311 Address: Uc3 2D be:7t k� CONTRACTOR Name: eh i -r celfe, oo o Phone: Address: /59 yPcn,�9 S X10. A.v2624r1 MA.. O/Pyf Supervisor's Construction License: Cy 72-41P7 Exp. Date: 3/22/,peia Home ImDrovement License: 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: $ i 9 9%S.oa FEE: $ Check No.: Receipt No.:_1 3 NOTE: Persons contracti7/-�, unre - red contractors do not have access to the guaranty fund ' Signature of Agent/Own _ Signature of contractor Location 4Ae No. 00 Date TOWN OF NORTH ANDOVER 0 41 Certificate of Occupancy $ qjBuilding/Frame Permit Fee $ Mu Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # ] p () 2 1 6 b Building Inspector O Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF ERAGE DISPOSAL Public Sewer Tanning/MassageBody 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 PLANNING & DEVELOPMENT COMMENTS DATE REJECTED DATE APPROVED CONSERVATION Reviewed on j 1 AM A /, , IJ /� mo l/ /il n I TH Reviewed on Signature v COMMENTS, Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: Comments Comments Water & Sewer Connection/Signature & Date Drivewav Permit DPW Town Engineer: Sjgnatgre: Located 384 Osgood Street FIRE DEPARTMENT Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COM 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 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: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 m CA Cl) CD 0 Ni C-)• r � CO e O CD CDCL o Q CD CCD o CD C CD CO). CD CL ® Ni Co C=D S C O C 0 �• o CD 0 CD l FA V • n 0 V G� C/) 2 0 O d oCD d z ':� �• C/F cr CA d < ED n w x C aam9 co0 w ei O c) m z G7 m co a m o comm a•® m T a C c (� nto -d m C) ce o CD v �CD 0CD C, H O C o CL W '� � EE :N co m CA y ® mCaD A 4 d :c �cc, C =CD O C43 QH o 0 0CD d CD a3 CD o 6S -w CD w : _ :. CO)0 a co' 0 — O d oCD d z w GO 1-0 d < C n w x C r n O C U) b ITI C C G7 n DESMOND LANDSCAPE CONTRACTORS, INC. P.O. BOX 756 NORTH ANDOVER, MA. 01845 (978) 682-1106 NAME DATE Mr. & Mrs. Franciose 7/1/2008 STREET PHONE 210 Blue Ridge Road 978-686-6317 ADDRESS PROJECT North Andover, MA. 01845 ATTENTION: PHONE Gazebo Construction Furnish and install a 15' Classic Summerhouse Gazebo as manufactured by Dalton Pavillions, Inc. Approx dimension 14'x 20' Includes: Screening package with one double door ( location to be determined); electrical channel and switch box. Not included - Wood floor, staining, lighting. Also includes :concrete footings; 6" reinforced concrete floor and pad for hot tub and gazebo; electrical service from house panel to gazebo and hot tub. NOTES: Additional cost for - engineering and permits, staining or painting, lighting, steps into hot tub. Not responsible for unforseen obstructions such as ledge or unsuitable soils. We Propose hereby to furnish materials and labor - complete in accordance with above specifications, for the sum of: Thirty three thousand three hundred forty five payment to oe made as follows: 25"%, upon signing, 2Yo upon beginning work, balance due upon cc All material is guaranteed to be as specified. All work to be completed in a workmanlike Authorized manner according to standard practices. Any alteration or deviation from above specifications involving extra costs will be executed signature only upon written 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 other necessary insurance. ACCEPTANCE OF PROPOSAL The above prices,sp cif,cations and conditions are satisfactory and are hereby accepted. You are authorized do the ork as specified. Payment will be made as outlined above. Date of Acceptance: 0 Signature dollars $33.345.00 withdrawnkft us if not ac ptedwithin THIRTY days CERTIFIED PLOT PLAN LOCATED IN NORTHANDOVER,MASS. SCALE. 1 "= 40' DATE. 7/3/2008 7/30/2008 Scott L. Giles R.P.L.S. Frank. S. Giles R.P.L.S. 50 Deer Meadow Road North Andover, Mass. x C c I CERTIFY THAT THE OFFSETS SHOWN COMPLY WITH THE ZONING BYLAWS OF NORTH ANDOVER WHEN BUILT BLUE RIDGE ROAD OFFSETS SHOWN ARE FOR THE USE OF THE BUILDING INSPECTOR ONLY AND SUCH USE IS FOR THE DETERMINATION OF ZONING CONFORMITY OR NON -CONFORMITY WHEN CONSTRUCTED. AL POOL `µ o� 0.13972 p '�F�rStE��o z i\.i1 r � ,� �� t� `s 4 � t Z. ,•t 1 ,� •.�1,`1 S 1 7 , •�, � , � �"''S �i i 7.' �,:, `; r 1� 4 '�, �� � � f+a� i r, ;-;Pi y�f c r^ _ � k:;a ( �y°' �� ,i�}r�� ''.s ,�a4t�` f�'' ,fir �-','� �'; � �'• I ' 'r tt • � � r � �-� `� P a..'1 S .�., a P� r''` rock - c � iM1- p� d • ', 1 >)�9 a! s X. 1 el ePA''; s'f•+;\ A° q;. i \w r''}�`ry� .• i r ' b 14. • , � � ' � �... Jy� � � tw� k j � �@y n��P ,' t i �R v b 1 ' '.. ;�{� �"�° A'r tt���;�yi >,Itd. �._ a 4{ v � w �.r$ y��`,� ��"i�^ � ° 4 '_ 5,•is3 i� ai'�r V til' . x � x �t�, `� r %'dw.�j"�i�•� d 5311. ..v ty �n ,x + ' h a"r 58d j S+'�tKt , � r s � t �,„��� y�s: • „r r 4•%'S.t,ii f�.t�.C`�''L,{kt%',�t��� r..v kry �E' 7��W ; atwi.,�1��«a4: • ..cul'„� .t x� ..f. 6•',u .., 7h.b<�'-�,..:e` Tfie Model G �L82 has comfortable. seating for five' With a performance lounge .,incl a ”. standard I uiioe:i,llow'in6 you to unwind together. The unique design.offers a conversation area, The leluxe and prmi.um therapy package provides the Foot Relief Zone''" and Zane r. r tar,geting both, the upper and lovs%er Darts' 6f the feet an. Gt back. MODEL C48� DELUXE THERAPY, PACKAGE OPTIONAL FEATURES FOR ELUXEPREMIUM STRUCrURA FEATURES . Pumpl:•.................:..:3.OHp/5.9bHp,230V,2Sp CleanZoneSystem .... .:.........................Yes Dirnensions. 92"x 92 Pump2. . • .3,OHp/5.9bHp,230V,2Sp Clean Zone 11 System with UV Light. .......Yes ... ........ ..... •..... Depth......,...... ...35" Electrical Requirements 4-Wire 240/40A/60A After Hours Light Package, DLX Seating Capa ity........ ............................5 Foot Relief Zone ,........ ....... Yes Remote Control ....................... .. .Yes AverageWate Capacity 445' Comfort Collar .2 Deluxe Stainless Steel Accent Package .....................Yes Weight.(ernp y/full)....................•785/4345 Head Cushions...:.............. .... ......2 Lounges... ,. ............Yes/Double Illuminated Waterfall Feature ...............:... .Yes . Premium Model shown Barrier Free Seating •....•.........•.........•........:..Yes Digital Color Optic Lighting (interior only).—Yes Drink Holder ............•... .3 Jet Total .. :................. 43 Molded Grab Bars:............. ......2 Linccoated S eel Sub-Structure ...................Yes PREMIUM PACKAGE' . Freedo DuraWAX111, Cabinetry Yes (INCLUDES DELUXE FEATURES Blower 1.5hp one spd................. ......:............Yes STANDARD UTILITY FEATURES Aux.2-Sutton Controller ............. :................. Yes Thermolock U Insulation., ..........................Yes Digital Color Optic lighting (int. and ext.) :..Yes Programmable Filter Cycles ...:......:................Yes After Hours Light Package ......,.............:......:.Yes 5" Underwat r light.......• ............................Yes v MI J". . ,:.,4r f^ "F' ,JI• s M'. a v d +M` S '�`{' ♦+i F v ..`� g a •�� r..p,w.ypuy 3w^n. ' •�Rra�`�lwlPviantir�M.aJF?!11WF'araww, .....'ry :�;;• a- h i n �r 33 +� tk ow! I v a d r � f �1 O v� R3 O . Z" r to p Y o c C ^- -, g N � �O ^O ice.+. to d E as O M hhO�r+ o W O CD N zo yU$ w d C a W it U H O © ui c z > W C _C :; i� 2 ..t Q vs ! co co t0 N c O 0 0 O N m c c ci 0 0 2 L '� H 'a W "Iss I MWM4 �V O C4 �1 O v� R3 O to p c,* U o c ago � �O ^O ice.+. Ot"y as O M hhO�r+ I> Masa 7. Z _o O Zco M Q OaaCO 0WQO V?F—�Z Q a 2 , z 7 E E U) N x o - a U cc d 0 N E CF) a� uuz N r^ VJ Z o E 0 LL$ 0��0 EQ^c 0 Q QEa QEF" 7 E E U) N x o - a 0 cc d 0 N E CF) a� � t` ; W www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): - e c, >) Address: i'o,�;- xAA<> S fky City/State/Zip: XOZk-•K A,_,b,-v0Z A -t 006Phone #: 1/0 G Armee you an employer? Check the appropriate box: The Commonwealth of Massachusetts 4. ❑ I am a general contractor and I Department of Industrial Accidents �,` t• Office of Investigations �•'L II if 11 I 600 Washington Street These sub -contractors have Boston MA 02111 t` ; W www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): - e c, >) Address: i'o,�;- xAA<> S fky City/State/Zip: XOZk-•K A,_,b,-v0Z A -t 006Phone #: 1/0 G Armee you an employer? Check the appropriate box: 1. [R 1 am a employer with _ 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ 1 am a sole proprietor or partner- listed on the attached sheet. I ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5• ❑ We are a corporation and its required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 1 LEI Plumbing repairs or additions 12.❑ Roof repairs 13.00ther6 AZ -moo T POT'ru3 -r+ny appncanr mar cnecKs box of I must also till 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. lContractors 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. Insurance Company Name: Policy # or Self -ins. Lic. #: hl9C 8 2 Expiration Date: j Job Site Address: 21 O &Uf (2-: D City/State/Zip: A Zto rvAar<z A/+ Ot $cs 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 ce ify unde the 'ins �d enalti of perjury that the information provided above is true and correct Si ature: Date: 0� Phone #: n7 — (v Z •— lav G 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): I. 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 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 burn 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. # 617-7274900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax # 617-727-7749 www.mass.gov/dia ORD DATE CERTIFICATE OF LIABILITY INSURANCE 07/0M/DD/Y08 07/o8/zoos PRODUCER (978)372-2790 FAX (978)373-2281 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Sullivan Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 487 Grovel and Street Haverhill, MA 01830 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. TYPE OF INSURANCE INSURERS AFFORDING COVERAGE NAIC # INSURED Desmond Landscape Contractor Inc. P.O. Box 756 No. Andover, MA 01845 INSURERA: Safety Insurance Company 39454 INSURERB: Savers And Property Ins. 16551 INSURER C: INSURER D: INSURER E: 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 RESPECT TO 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR NSRI DD' TYPE OF INSURANCE POLICY NUMBER POLICY Amm 09/30/2007 POLICY EXPIRATION ImWDDrrA 09/30/2008 LIMITS A GENERAL LIABILITYBP00006160 X COMMERCIAL GENERAL LIABILITY CLAIMS MADE a OCCUR EACH OCCURRENCE $ 11000,00 DAMAGE TO RENTED $ lOO, OO MED EXP (Any one person) $ 10,00 PERSONAL & ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,001 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO- JECT LOC PRODUCTS - COMP/OP AGG $ 2,000,000 AUTOMOBILE LIABILITY ANY AUTO 2433512 09/30/2007 09/30/2008 COMBINED SINGLE LIMIT (Ea accident) $ ALL OWNED AUTOS A X SCHEDULED AUTOS X HIRED AUTOS BODILY INJURY $ (Per person) 250,000 X NON-0WNEDAUTOS BODILY INJURY $ (Per accident) S00,000 PROPERTY DAMAGE $ (Per accident) 100,000 AUTO ONLY - EA ACCIDENT $ GARAGE LIABILITY ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY OCCUR F1 CLAIMS MADE EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITYFR WC0000825 05/23/2008 05/23/2009WC STATdU X OTH- E.L. EACH ACCIDENT $ 1,000,00 B ANY PROPRIETOR/PARTNERIEXECUTIVE OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under SPECIAL PROVISIONS below OTHER E.L. DISEASE - POLICY LIMIT $ i, 000 , OO DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Landscape, Gardening & Plowing Operations Town of North Andover 120 Main Street North Andover, MA 01845 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 20 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 INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Kevin Sullivan/KPS �"I CACORD CORPORATION 1988