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Home My WebLink AboutBuilding Permit #309 - 22 DAVIS STREET 10/15/2009 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: JO I Date Received Date Issued: L'l�"O q IMPORTANT:Applicant must complete all items on this page LOCATION PROPERTY OWNER Zost1,l• Print ,^ /So Print MAP NO: PARCEL ZONING DISTRICT: Historic District yes o Machine Shop Village yes o 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 Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BEP FORMED, Iden fication Please Type or Print Clearly) OWNER: Name:_ ti✓�y%d'f'�5o� Phone: Address: � CONTRACTOR N m�� w� � Ph Phone: Address: J Supervisor's Construction License: j�1,7, Exp. Date: Home Improvement License: /. 4%7 Exp. Date: /z 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: $ �'�` - m ' FEE: $ _�- Check No.: �� -- Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the uaran fund Signature of Agent/Owner Signature of contractor LocationS -57r— No. '3� Date tr Na�TM TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ ' s�CHU + Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # T1 i !i 22 Building Inspector Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEW GE 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 � a HEALTH Reviewed on Signature COMMENTS A 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 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 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 21 A—F and G min.$100-$1000 fine NOTES and DATA— For department use ❑ 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: Doc.Building Permit Revised 2008 F NORT►y TO" Of : 4Andover No. ,3c(? - �`y dover, Mass., 09' T Q LAKE A. COCMICMEWICK V 7,p A0f? TE D P`? �C `S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THISCERTIFIES THAT.......L-c-2-4-i-s.......Co..r..I.CgD.A%............................................................................................................................................. Foundation has permission to erect. ...................................... buildings on . . . . ........D. .1 .... Rough to be occupied as.... Chimney provided that the person accepting this permit shall in every respect cenorm to the terms of the application �..'. 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 �I ` UNLESS CONSTRUC ST S Rough ........ Service BUILDING INSPEC I�R 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 Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. i iA/6 Qn�b✓er j Board oA.[Bu�tding Rc� or Licee � - Construction SuPer'('s ` CS 67560 Tr# 6403 Bjrthdate 1966 --.-. Eit{sira�gn 1012512009 ` Restrl !bn 00- SHA UN M TWOMEY •� 61 PATROIT ST Commissioner N ANDOVER,MA()1845 ✓lze�anr�:all n�,,�f�aac/u�e� ate\ Board Of Bm'ldiog BegGlate ns and St ndarc[s HOME 110FROVEMENT CONTRACTOR Fte�ristrati": 136779 E)i iration:_ X6010 Tri:= 272934 - Fye: ?artritrs��ip mollmy+LEt3ARE CONTit 'r7Nv.INC: SHAM, RNOMEY: 61 r TRIOT ST: N.ANDOVER.MA 01846 _ Adn trator . tiiassachusetts- Depailment()i•Pu h4ic Safety Board of Building Re-ulationc and Standat•ds Construction Supervisor License License: CS 55108 Restricted to: OD 's DOUGLAS J LEGARE " ' �`' 79 GARY AVE "c HAVERHILL, MA 01830 = Expiration: 9/2/2010 <'onunissiuncr Tr#: 3242 ClEenift.13298 TWOMEY6 ACORD- CERTIFICATE OF LIABILITY INSURANCE o , PROMICER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Doherty Insurance Agency.Inc. ONLY AND CONFERS NO treet ED HOLDEIL THIS CERTIFICATE DOES NOT AMEND.EXTEND OR MS UPON THE CERTIFICATE 21 Elm S P.O.Box Shoot ALTER THE COVERAGE AFFORDBY THE POLICIES BELOW. Andover.MA 01810 INSURERS AFFORDING COVERAGE NAIL S INSURED INSMRA: Arbella Protection Ins Company Twomey 3 Legere Contracting,Inc. INSRraER& PO Boa 366 North Andover.MA 01845 INSURER C_ INSURER D. INSURER E COVERAGES THE POLICIES OF INSURMdCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT.TERM OR CON0ITION OF ANY CONTRACT OR OTHER OOCUMF IT WITH RESPECT TO WNCH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE M6URANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO All THE TOM.OCCLUSIONS AND CONDEMNS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAMS. L TIME OF N9IAIAMCE POUCY MIMIBER DAYER111111001M Lam" A DENERALLIAennY 8500043255 0022109 OW22/10 EACH OCCURRENCE S1,800,000 )t COMMERCIAL GENERAI.MXITY Manz"RENTED S100 000 CLAMS MADE a OCCUR MED EXP(Any a m pan" SSAOO PERSONAL i ADV RLRIRV S1 000 GENERAL AGGREGATE s2,000,000 GENL AGGREGATE UMR APPLIES PER: PRODUCTS-COMPIOP AGG, 52M,000 X POUCH PRO. LOC AUTOMOBILE UAMUIY COMBINED S9rX;LE LMR S ANV AUTO (Ea acdAeN) ALL OWNED AUTOS BOpLYUI,ftIRY S SCHEDULED AUTOS 40V Ram) HMO AUTOS BOOBY DUURY NO�NED AUTOS perPROPERTYDAMAGE S S GARAGELIABRJTY AUTO ONLY-EA ACCIDENT S ANYAUTO EAACC S OMEN THAN AUTOONLY: AGG S LG1111M EACH OCCURRHICE S OCCUR CLANG MADE AGGREGATE S S DEDUCTIBLE S RETENTION S S WORKERS COMPENSATION AND MLC STAID. BMLOYEw LIABILITY '� ANY PROPRIETORWARTNEREXECURVE El.EACH ACCIDENT is OFFICERf ER EXCLUDED? EA-DISEASE-EA qWLoyEd S film.dasai0s uRdw dALPRONSIONS' Ei.DISEASE-POLICY LRBT S OTHER OESCRPTWN OF OPERATIONS I LOCATIONS/VEHICLES/EXCLUSIONS ADDED BYENDORSEMEMT I SPECIAL;=M Covering operations usual to the Insured— CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBEDPOUCIES BE CANC U.M BEFGiE THE MUMATIM Town Of North Andover DAMMMOF.TMMSUMGNSUMMMLDMAVORTOWL _11L. DAYS VIRIrTEN 1600 Osgood Strad MGM TOTHE CERTRICATE HOUNM HAMED TOUS I.M.BUT FARAIRE TODD SD SHALL North Andover.MA 01845 WPOSE NOOBUBAI)WI OR UABLM OF ANY MW UPOM UM DOURER,IIs AGEOTS OR Afl1AEe. ACORD 25(?001!08)1 of 2 6SZ5239/M25234 L 0 ACORD CORPORATION 1988 RightFax N2-1 7/10/2009 11 :04: 11 AM PAGE 2/002 Fax Server J ACORD. CERTIFICATE OF INSURANCE DATE(MMIDDWY) 07-10-09 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE DOHERT'Y INS AGENCY HOLDER. THIS CERTIFICATE DOES NOT AMEND,EXTEND OR PO BOX 1985 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 1 ELM COMPANIES AFFORDING COVERAGE ANDOVER,�!A UISIC COMPANY 2YNJX A 1RAVELERR INDEMNr[Y COMPANY INSURED COMPANY 8 TWOMEY&LEGARE CONTRACTING fNC COMPANY PO BOX 366 C NORTH ANDOVER,MA 01 345 COMPANY D COVERAGE THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LSTFU 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 15 SUBJECT TO ALL THE I ERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. GO POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER DATE(MMOD',YY) DATE LIMITS GENERAL LIABILITY GENERALAGGREGATE $ COMMERCIALGENF-RAL PRODUCTS-COM°/OP AGG. $ CLAIMS MADE OCCUR PERSONAL&&ADV.INJURY $ OWNER'S&&CONTRACTOR'S PROT. EACH OCCURRENCE FIRE DAMAGE IAnvore lire; $ MED.EXPENSE;Any one person) 3 AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT ALL OWNED AUTOS BODILY INJURY(Per Pelsor) $ SCHEDULE AUTOS BODILY INJURY(Par Accident? HIRED AUTOS PROPERTY DAMAGE $ NON-OWNED AUTOS GARAGE LIABILITY ANY AUTOS AUTO ONLY-EA ACCIDENT $ OTHER THAN.AUTO ONLY: EACH ACCIDENT $ AGREGATE $ EXCESS LIABILITY UMBRELLA FORM EACH OCCURRENCE $ OTHER THAN UMBRELLA FORM AGGREGATE $ WORKER'S COMPENSATION AND A EMPOLYER'S LIABILITY UB-0290M9u4-08 09-18-08 09-18-09 STATUTORY LIMITS X THE PROPRIFTOW EACH ACCIDENT $ 500,000 DARTNERSiEXECUTIVE INCL DISEASE-POLICY LIMIT $ 5001000 OFFICERSARE: X EXCL DISEASE-EACHEMIPLOYEE $ 500,000 OTNER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLESiRESTRICTIONSi$PECIAL ITEMS THIS REPLACES ANY PRIORCEKIIRC.A'TE ISSUED'11)'FRE.CERTIFICATE?HCILDLR AFFEC II.N0%V0PKEKS C0.WCOVLR.kGL CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE UESCRIBEI,POLICIES BE CANCELLED BEFORE THE MOWN OF NORTH ANDOVER EXPIRATION DATE THEREOF,THE ISSUING COMPANY h'IL'-ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO TME CERTIFICATE HOLDER NAMED TO THE LEFT.SLIT I(0)OSGOOD STREET FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY MND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES NORTH ANDOVER,MA 01845 AUTHORITED REPRESENTATIVE ACORD 25.5(3/93) Charles J Clark i TRAVELERS J WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY TYPE AR INFORMATION PAGE WC 00 00 01 ( A) POLICY NUMBER: (6KUB-029OM99-4-09) RENEWAL OF (6KUB-029OM99-4-08) INSURER: THE TRAVELERS INDEMNITY COMPANY 1. NCCI CO CODE: 11347 INSURED: PRODUCER: TWOMEY & LEGARE CONTRACTING DOHERTY INS AGENCY INC PO BOX 1985 PO BOX 366 21 ELM NORTH ANDOVER MA 01845 ANDOVER MA 01810 Insured is A CORPORATION Other work places and Identification numbers are shown In the schedule(s) attached. 2. The policy period is from 09-18-09 to 09-18-10 12:01 A.M.at the Insured's mailing address. 3. A. WORKERS COMPENSATION INSURANCE: Part One of the policy applies to the Workers Compensation Law of the state(s)listed here: MA n! B. EMPLOYERS LIABILITY INSURANCE: Part Two of the policy applies to work in each state listed in o� Item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident: $ 500000 Each Accident Bodily Injury by Disease: S 500000 Policy Limit Bodily Injury by Disease: $ 500000 Each Employee C. OTHER STATES INSURANCE: Part Three of the policy applies to the states, 9 any, listed here: COVERAGE REPLACED BY ENDORSEMENT WC 20 03 06A o. D. This policy includes these endorsements and schedules: SEE LISTING OF ENDORSEMENTS - EXTENSION OF INFO PAGE o 4. The premium for this policy will be dateradned by our Manuals of Rhes.Classlfkutians, Rates and Rating R Pians. All required information Is subject to verification and change by audit to be made ANNUALLY. DATE OF ISSUE: 09-04-09 WC ST ASSIGN: MA OFFICE: ORLANDO INDUS AFF 161 PRODUCER: DOHERTY INS AGENCY 22YM =343 The Commonwealth of Massachusetts Department of Industrial Accidents Ogee of Investigations 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Apalicant Information Please Print Lembly Name(Business/OrganizatioNlndividual): Address: J City/State/Zi p:� �/��/,�/� �/� Phone#: g7V-�� -7Yy7 AVIen an employer?Check the appropriate box: 1. am a employer with�_ 4. ElI am a general contractor and I Type of project(required): employees(full and/or part-time).* have hired the subcontractors 6. 2/Nt-w' construction 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet.t 7• Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers'comp,insurance. [No workers'comp,insurance 5. El We are a corporation and its 9' ❑Building addition required.] officers have exercised their 10-E] Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.❑Phunbing 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. 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. nformation am an employer that is providing workers'compensation insurance for my employees Below rs the policy and job site information. Insurance Company Name:_ Policy#or Ste:;rta. , #; f Expiration Date: Job Site Address: i/,ZeCity/State/Zip: Attach a copy of the workers'c "pensation 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. do hereby certify under the pains and pen aldes of perjury that the information provided above is true and correct Signa D e• Official use only.:Doot write in this area,to be completed by city or town o,�ciaL City or Town: Permit/License# Issuing Authorityle one):1. Board of HealtBuilding Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#• Proposal rWOMEY& Professional Building /Remodeling RO.Box 366 . Ol7CU No.Andover,MA 01845 FRS 878-88; 7447 97&685-7446 - 97&551547 NAME OF 011 /ER ADDRESS OF JOB ✓�� + _ (� ! -li? ► � ! r+rf -� -' - ; TEL. DATE: 0 /—,1 r We hereby submit estimates for: �. J✓�t� (;, ' I S re s Y4)-i j 4 4I G e a-j-!1 R oto J 19-e pi vg -;ei, )4 L f{ _ -.•k'. j c.a �� .- -��y; -�_ f � ;} . .._ � _ � ,�.�.w - fir. — v Ki�2 j 2• 7 z" ';>v }i.?-5 . l We Propose hereby to furnish material and labor-complete in accordance with above specifications,for the sum of: dollars($ .S��'1 •.'' j Paymeno be made as follows: ' - t6-t-1 - ,j . n. f V 00 Authorized Signature NOTE:This proposal may be withdrawn by us if not accepted within days. Accea!'tance of Proposal - The above prices, specifications and conditions are satisfactory and are hereby accepted.You are authorized to do the work as specified.Payment will be made as outlined above. Signature"emstrAP-71i Date of Acceptance: _' 1 't' a Signature I I I I ( • I I i i I I � , I I i I I i I I I I i I 1 I I r i i I I I I I I J I j 1 1 1 I I I I I I I I I I I i r I ' I I I I I , I I I I ✓� i iI f•- �-j--� I. I 1 1 I I I I I I I r L _--_.I 1 _ �,r� I ;�J�- ' I-I'- I i I I I I I op I�- I ' IT� I I 1 I I I-- I I I I � �✓��`A OA I ' ' I i I I I I S I � ; , • I ( I I I I I I ---1- -� I � I I � I I - I .J I- ♦-I I I l �. I I l i � I I � I I I I