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HomeMy WebLinkAboutBuilding Permit #253 - 219 FRENCH FARM ROAD 10/5/2007 BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION �. qo coc.nc.n Permit N0: Date Received 2 b Date Issued: ID IMPORTANT Applicant must complete all items on this page x p�. �. gg LOA fit$ � ��` �, �, ��, �i�, "`�" 3g�z�.....Ta,:. � � �_ -s� ��'ay • ,��a Cert l� w�� ���Gi TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building xOne family )CAddition ❑ Two or more family [I Industrial ❑ Alteration No. of units: ❑ Commercial ;<'2epair, replacement ❑ Assessory Bldg ❑- Others: ❑ Demolition ❑ Other IANr� t eller �tocla� e� d5 ' tet a11eG I'Ms ► � DESCRIPTION OF WORK TO B Alf p E PREFORMED: / Identification P se Type or Print Clearly) OWNER: Name: A, Phone: Address 1T��, 'UTst +�r 50�, u„ n. -aa� �" �sx .� �`� 3• � '� '°'r �� � �f z ,rap.� ��� � � „°'s� ..�? r ; < 'gym..: dt ,F� .d`.''` a R ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BpA�SED ON$125.00 PER S.F. Total Project Cost: $ 9,200 Obi FEE: $ �� D Check No.: �' Receipt No.: �o S NOTE: Persons contracting with unregistered contractors do not have access to the-guaranty fund S1 nature pf��gen�%C�wner� � Signature ofRpontr�ctor r .. �;. Location No. Date 40RTq TOWN OF NORTH ANDOVER f L Certificate of Occupancy $ .. Buildin /Frame Permit Fee $ s�cNust Building /Frame Permit Fee $ a: Other Permit Fee $ TOTAL $ Check # 20657 Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer K 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 DATE REJECT D DATE APPROVED CONSERVATI COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS f Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/signature $ Date Located at 384 Osgood Street Driveway Permit tTMEIT TriDtrpsternslts �- � „��c. A +F- . x -'r k'sA�1» 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.$1oo-sl000 fine 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 Rehabil,itation.Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. AndIdt 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 A ❑ 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 2.2007 T40RTIy Town of �.......r bAndover o �` dover, Mass.0 LAK ,�� •S" �' COCMICMEWICK 1.V �d ADRATED A?10 �5 `s BOARD OF HEALTH PERMIT D Food/Kitchen Septic System ` BUILDING INSPECTOR THIS CERTIFIES THAT.....* ..Avll.40%......4".660...................................................................................... Foundation has permission to erect........................................ buildings on .atj.... ...... ►f,IV`......... .....• Rough t0 be Occupied aS.R► ►...�1�.11....12.00.vh...rrvol.....D ....�i[!� ....� !' ....f.1.11C ney provided that the person accepting this permit shall in every respect conform to the ter sof 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 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUC T TS Rough ........ COT ..... ..................... Service BUILDING R 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. WfTHOUT CLOSED SOP"T a ��•' `` •` 2xf, SUS-FASCIA �x Y sods O.G. �"g;n WOOD FASCIA:SD. SEE MMV. FOR SIZE . soFFrr W/ CONT. VENT w�l �it.1`�•LS 5��� . SASt.MOULDING I/W O.S.B. HOARD SHEATHING LL MOWN L°°`ea u r a o .cNoC>�c ( ADR BOLTS SAsCHEDU(SEE r „ ` n V, 1111-=1� W. _ t._ Y _ T R 10 t1-5 0 y-O- t2-STORY? TYF WAL �. STIO / 3/4" . ' " i „0x1,0;£ „0x„0;£ „0x„0;£ \ T jiftic- „ G;C ,6-,e m -I/ G / I / I a 1, Cb m V_ 1 � O 1� p O off . o Cn -.a ro 1� O a Z-9#1 3'-2 _ 3'-2,► , --2'-10„ X-0”x 0" 3'•0"x 0" X-0"x 0" s „S Ho %A--S�e, 5-0- !,/era s ,4 4 -0- e n Gk— � G •rte cli �jGG The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 s� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: ' City/State/Zip: eV0 7 j' Phone #: Are you an employer? Check the appropriate box: Type of project(required): 1.❑ 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 workingfor me in an capacity. workers' comp. insurance. Y p tY• 9. M�Building addition [No workers' comp. insurance 5.�KWe are a corporation and its officers have exercised their 10.❑ Electrical repairs or additions required.] 3.❑ 1 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.❑ Roof repairs insurance required.] t employees. [No workers' 13.❑ 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. #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. Insurance Company Name: Policy#or Self-ins. Lic.#: Expiration Date: Job Site Address: 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under,Oe pains and pe alties of perj ry th the information provided above is true and correct. Signature: Date: 7' Q Phone#: c-, Q 3 —33 �T Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: PROPOSAL A0�ia6Ul�d/ MA Lic.#122153 ,g BERTHOLD CONSTRUCTION -.L.C. ,A FL Lic.#PT38 v •Int/Ext Painting �b03.). 339-1465 •Siding and Soffit •Windows .Carpentr •Doors •Renovations Fully Insured•Over 15 years Experience•Free Estimate PROPOSAL SUBMITTED TO PHONE DATE � ;• ". t � - - �� �S fig. { ..... 3� .. STREET JOB NAME CITY,STATE AND ZIP CODE JOB'LOCATION r- We hereby submRspecifications arid estimates for: : a: f s` E.Y. •€;:..c " e ..,�.". :£ t +. �, ...k V i a✓ mai " Vit= .•' '-.` '� # � : '`�C,A �f �.a� �� r°`� WE PRAPOSE hereby to fumish material and labor—complete in accordance with above specifications,for the sum of. Payment to'be made as follows:`. dollars{$ All material is guaranteed to be.as specified.All work to be completed in a 4uthorized workmanlike'manner according to standard practices. Any alteration or Signature: . deviation from above specifications involving extra costs will be executed only upon written.orders, and will become anlextre charge over and above the m estimate.All:agreeents contingent upon strikes,acciderds or delays beyond ote:This proposal may be 0 our soritrol. withdrawn by us if not accepted within days ACCEPTANCE OF PBOPO$AIrThe above prices,speafications and conditions are satisfactory,and are hereby accepted.You.are authorized to do the work as specified.Payment will be made as Y outlined above pt Signature: 1 1 c Date of Acce tante: . Y PROPOSAL �yv.,�• 777 v ayw MA Uc.#122153 A - - BERTHOLD CONSTRUCTION -. L•C•. FL Lic.#rr38 v •Int/Ext Painting (603) 339-1465 •Siding and Soffit •windows •Doors .Carpentry •Renovations Fully Insured•Over 15 years Experience•Free Estimate PROPOSAL SUBMITTED TO PHONE DATE y, STREET ' JOB NAME CITY,STATE AND ZIP cODE JOB iOCATION a We hereby submit specifications and:estimates for. ` Cr 1 2 i 4� m 5x r WE PRUPOSE fiereby to famish material and labor-complete m a ordance with above specifications,forthe sum of n i t + ` Payment to be mdde bE foil i°1.�,✓fr' �-.��3 � ..ytF'�' .d�C�t'!�"'L__- s''°�.1� �::$':�. -1 Glwa_�r>.�. #`tcd"a. ...�' ��. f.�!"'- `l.:e'.-''*-`€ _ - P J AII`matenat is. uaranteed to be as r` 9 specified.All work to be completed in a Aulhonzed: workmanlike manner according to standardpractices. Any alteration or Signature:`" �;:w r _-x� ,w:B •< deviation from above specifications involving extra costs wilt be executed only fir' upon written orders;.and will become an extra charge over and above the estimate.All agreements confihgent upon strikes,accidents or.delaysbeyond Note:This proposal may be our control. withdrawn by us if not accepted'within days. ACCEPTANCE OF PKOPOSAI.-The above prices,speafica6ons and conditions are satisfactory and are hereby accepted.You.are authorized to do the work as specified.Payment Mll* a made as outiined:ahove. Date of Acceptance: F'( i t = # : € r ��t Signature: t s' a- t , �"' a i . s . OP ID ACORD DATE(MM/DDIYYYY) CERTIFICATE OF LIABILITY INSURANCE JOOPID 07/13/07 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Santo Insurance - Salem HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 224 Main Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Salem NH 03079 Phone: 603-890-6439 Fax:603-890-0315 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Western World Insurance Co INSURER B: Nationwide Companies John Berthold Construction NSURERC: John Berthold 43 Ticklefancy Lane INSURER D. Salem NH 03079 INSURER E: COVERAGES 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. LTR NSRC TYPE OF INSURANCE POLICY NUMBER DATE(MMIDDlYY) DATE(MWDDlYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $500000 A X COMMERCIAL GENERAL LIABILITY NPP1111857 06/08/07 06/08/08 PREMISES(Eaoccurence) $50000 CLAIMS MADE F-1 OCCUR MED EXP(Any one person) $5000 PERSONAL&ADV INJURY $500000 GENERAL AGGREGATE $ 1000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOPAGG $500000 PO- POLICY JET LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $300,000 B ANY AUTO 51BA0073863001 09/03/06 09/03/07 (Ea accident) X ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) X HIRED AUTOS BODILY INJURY $ x NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ _ (Per accident) GARAGE LIABILITY - AUTO ONLY-EA ACCIDENT $ ANY AUTO _ OTHER THAN EA ACC $ . AUTO ONLY AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR ❑CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND TORY LIMITS ER EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS!LOCATIONS!VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT!SPECIAL PROVISIONS I CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Carlson GMAC IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR Attn: George Schruender REPRESENTATIVES. AUTHORIZED REPRESENTATIVE James A Santo ACORD 25(2001108) ©ACORD CORPORATION 1988 2xf. SUB-FASCIA .2x y soots rot WOOD FASCIA:SO. ' 5EE ELM FOR SME . r CLOSED. SOFFIT W/ GOVT. V"T " Ls SASU MOULOtNG j 't/w.O.S.$. SO-AM S .`�" SHEr4T(•iING - S. - ..�: _- ,. V.. LL Stifv! alt &(49WDiLl -IN IC -wit EALER 1/x v Come Mrd k - (SEE _ . �pr.MIL Tree 11 .. . .A o •• 4f' ~•9�- ��-io• (�-STORY 2t-0' 12 STORY) WA:LL ING { t. - .01 *SCALE: 3/4" _ .0 x I,O-,E "o x I,O-,E "o x I,O-,E \ „ ki; ii 0 L p o I I CD �� \� o co G L CC 2, 9" ;X-1 " 3,4" 2'-9" 3'-0"x 0" X-0"x 0" T-0 x 0" 58'-0" t CV � 8P` f✓ew �' � �I -L A/ PiP l&` N O V 14,_0"� 4GCi s ' . BOARD OF BUILDING REGULATIONS ,, r License: CONSTRUCTION' URERVISOR Number:;CS 054526 Birthdate 02/17/1969 - I Expires:}02/17/2608 Tr.no: 16920 .I Restrleted: 00 CHARLES E BESHAR'-r . 10 PINEWOOD RD SALEM, NH 03079 � ^,3' _/ , Commisslorier a , igi'fif5onval , HOME IMPROVEMENT CONTRACT6R RegistratronI122153 r Exp ration 7/26/2008 IOHN BERTHOI D 7 ffiTRU.0711 r ohn Berthold 43 TICKLE FANCY bv`, SALEM.,,NH 03079 ''N Deputy Adm�nzsl��lto 1 .3_µ