Loading...
HomeMy WebLinkAboutBuilding Permit #379 - 224 FOSTER STREET 11/16/2009 tom - apvv. TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: Date Received Date Issue . IMP RT ANT:Applicant must complete all items on this page LOCATION �4 �6SkK J 1%L4 PROPERTY OWNER �2 � ©i'i�Print cod(aS 2 i yl LIPF to 6aA TrwSV 1 Print MAP NO: ale PARCEL: 160 ZONING DISTRICT: Historic District yes Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building ne famil Addition wo or more family Industrial Alteration No. of units: Commercial Re air replacement Assessory Bldg Others: Demo litio Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: �, - Identification Please Tyne or P 'nt Clearly) OWNER: Name: t_FF4 R¢mI�r .nst, Te�Cre C },¢;h-T ��e phone: AA ll ,-9— Address: QQq T&S W ! �Ttz� 6� s- CONTRACTOR Name: rL; ,,V- v-cica C Phone: 9 log 00 Address: 3i� Vtnrr vw\oJC !AcR,j Wkc a[Sqq Supervisor's Construction License: W/ Exp. Date: Home Improvement License: Exp. Date:— ARCH ITECT/ENG I NEER ate:ARCHITECT/ENGINEER Ole Phone: ti/A Address: N ! f- Reg. No. N 16 FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ "�� ® Q11z FEE: $ v/ Check No.: , 3�/_ Receipt No.: oZ-lfo2 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund ,_ignature of AgentlOwner Signature of contractor J i. Location No. Date '90 '.. TOWN OF NORTH ANDOVER 16. A Certificate of Occupancy $ CNUS Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # �j 2204 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 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 . Reviewedon Signature f COI MENTS 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 signatureidate 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 21A—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 NORTH 0VV`n Of : t gAndover NoO3 o _ A K E = dover, Mass., l 4 C OCYU'HE ORATED C) `S BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System b. . � BUILDING INSPECTOR THIS CERTIFIES THAT................ ......... S.rJ.l.l ...... ................ . ................................. Foundation has permission to erect........................................ buildings on .......Slaq.................�5... ....... .................. Rough to be occupied as .. ....../ f!►�.0.4�!�......4) d L.. 2 v 7V rl r.G_ Chimney 70-014.0. . . . . . . .. . . . provided that the person accept! this permit shall in every re ect conform to the 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final ` ELECTRICAL INSPECTOR UNLESS CONSTR C STARTS Rough ........... .................................................................................................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RouFinagh 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. NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the rovision of MGL c 40 S 54, a condition of Building Permit at: is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150 A. Also, note Permits are required under Fire Prevention laws Chapter 148 Section 10A. The debris will be disposed of in: G�f �FO'Ct (Location of Facility) DA Signature of Permit Applicant Date 1200 Arlington Height Road, Suite 400, Itasca, Illinois 60143-2625 NORTH AMERICAN SPECIALTY 630/227-4700, Fax: 630/227-4817, 800/338-0753 INSURANCE COMPANY I CONTINUATION CERTIFICATE i KNOW ALL MEN BY THESE PRESENTS, THAT: In consideration of the payment of a renewal premium, NORTH AMERICAN SPECIALTY INSURANCE COMPANY, as SURETY, does hereby continue Bond Number : SUR 1623290 10 Effective Date : 09/21/2008 Amount of Bond : $10,000 Continued from : September 21, 2009 to September 21, 2010 On behalf of FRANK DELUCIA & SON, INC. i In favor of TOWN OF N. ANDOVER DEPT. OF PUBLIC WORKS i i Provided, however, that this Continuation Certificate does not create a new obligation and is executed upon the express condition and provision that the Surety's liability under said bond and this and all Continuation Certificates issued in connection therewith shall not be cumulative and that said Surety's aggregate liability under said bond and this and all such Continuation Certificates on account of all defaults committed during the period(regardless of the number of years) said bond has been and shall be in force, shall not in any event exceed the amount of said bond as hereinbefore set forth. Dated this i4 day of may 2009 I NORTH AMERICAN SPECIALTY INSURANCE COMPANY i By: Kay Hull, Attorney-in-Fact I i i � I i ... .... r Commonwealth of Massachusetts North Andover Board of Health «a 1600 OSGOOD STREET ec Zas MU BUILDING 20;SUITE 2-36 NORTH ANDOVER,MA 01845 DATE PRINTED: 10/22/2008 ESTABLISHMENT NAME: Rocci DeLucia,Jr. File Number:BHF-2003-000014 16 Ballard Lane SALEM NH 01844. LOCATED AT: , MA Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes Septic Disposal Works BHP-2009-0410 Jan 1,2009 Dec 31,2009 $80.00 Installer Total Fees: $80.00 PERMIT EXPIRES December 31,2009 Board of Health Page 1 ACORQ, CERTIFICATE OF LIABILITY INSURANCEDATE(MMIDDIYYYY) F11/13/2009 PRODUCER 603.224.2562 FAX 603.224.8012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION The Rowley Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 139 London Road HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 511 Concord, NH 03302-0511 INSURERS AFFORDING COVERAGE NAIC# INSURED Frank Delucia And Son, Inc. INSURER A: Hanover Ins - Maine 0004 386 Merrimack Street INSURERS: Teh Ins. Co. of the Stateof PA Methuen, MA 01844 INSURER C: INSURER D: 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. INSR D' POLICY EFFECTIVE POLICY EXPIRATION LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE(MM[DDNYM DATE MMIDD LIMITS GENERAL LIABILITY ZDP408061617 03/31/2009 03/31/2010 EACH OCCURRENCE $ 1,000,0001 X COMMERCIAL GENERAL LIABILITY DAMAGETO RENTED PREMISES Ea occurrence $ 100,000 CLAIMS MADE a OCCUR MED EXP(Any one person) $ 5,000 A R CG0001 PERSONAL BADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICYFX]JECT I X LOC AUTOMOBILE LIABILITY AMP507827713 03/31/2009 03/31/2010 COMBINED SINGLE LIMIT X ANY AUTO (Ea accident) $ 1,000,00 ALL OWNED AUTOS BODILY INJURY A SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) -- PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO EA ACC $ OTHER THAN AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY UNP410937217 03/31/2009 03/31/2010 EACH OCCURRENCE $ 2,000,00 OCCUR F] CLAIMS MADE AGGREGATE $ 2,000,00 A $ DEDUCTIBLE X RETENTION $ $ WORKERS COMPENSATION 045191701 08/01/2009 08/01/2010 X wCSTATU- 6TH- AND EMPLOYERS'LIABILITY Y/N TORY LIMBSI ER ANY PROPRIETOR/PARTNER/EXECUTIVE 3A STATES; MA. NH E.L.EACH ACCIDENT $ 500,000 B OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 ffes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 OTHER ZDP408061617 03/31/2009 03/31/2010 Limit - $225,000 A �eae Rented Equipment limit - $1,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS covering construction operations exce t 10 days for nonpayment of premium. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Town of North Andover DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN Health Dept. NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL 1600 Osgood Street IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR Bldg #20, Suite 2-36 REPRESENTATIVES. N Andover, MA 01845 AUTHORUED REPRESENTATIVE &Wz Christine Holman/CHH w �rx.,✓�.r ACORD 25(2009/01) ©1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 11/13/2009 16:58 978-937-6835 RADIATION ONCOLOGY PAGE 01103 FRANK T►eLUCIA & SON INC. GE,VERAL CONT"MRS 3,96 M MIMAM 5MET MXrMM,MASSACHUSE M 01844 (9n)696.8200(978)03.0666 FAX(978W34900 1161119 Jeff'&Orit Goldstein 224 Foster Street Nor.h Andover,Ma. Re: Filling of the Pool Estim2 ke N ate:After speaking to the Gerry at the Building department on 11/6!09,we disc overed ttiat they have am, rales. The entire pool structure must be removed and legally disposed of ot;site, This estimate reflects that change as the initial estii nate assumed that the sit acture would remain and simply be filled. This esti nate alar accounts for pn�tection of the existing utilities. Swe of Work; 1. "ake down and remove the 5ence around the pool 2, Provide Inrge steel plates ar d place them in the area where we arc told that the utilities that feed the hack house will b;crossed to protect them from beim damaged by truck traf is and construction equipn clot 3. Demo the cement concrete leek/patio,pool walls and pool(loot complete as required, ccu;h it up,load it out,and leg dly dispose of it offsite,then have the clean hole inspected by i he building department 4. Provide fi A materials to fill the pool up to subgrade allowing approximately 6"of spas x:for topsoil(see alternate N1 for loam and seed price estimate)Note:the fill mai mials are:provided free of-_Marge 5. .1frer the work its complete, pick up the steel plates and remove them from the site 6. 'We have tarried the a stimna ed cost and fee for the permit. 1t is calculated by the bui:ding department on the ba;is of$12.00 per thousand on the value of the contract. The y will require us to submit a signed agreementiconttact(between owner and con tractor)in order for them t,perform their calculations(we have carried$90.00) Exp elusions: I. ledge, unsuitable mate-ials,contaminated materials,snow,frost,boulders greater than 2 cubic.yards or a ay other unknown materials excavation or materials repla.mmeni; 2. removal of the pool fil er 3, electrical w)tk 4, irrigation work 5, loam,seed or landsca�:work(other than as Shown) 11/13/2009 16:58 978-937-6835 RADIATION ONCOLOGY PAGE 02103 1,9still:nated Cipst and Terms of Pn�,,.yment: 17 to estimated cost of the ab(ve described scope and exclusions is$7,5$0.00. A requ isition will be ptepamd anc issued at the time that the job is completed. Full payr resit is due within 15 days and is subject to interest charges for overdue balances as w01 as all lel;al Bees associated with collection of the some. Fern;sh and ins,711 sacerted topsoil(average thiokness ofd 1 then fine grad rakeand tosecd-$1 975.00 Nps r_the b .iermit appli ration will reed the signature of you as the owner,as this insti ument will also act as a"T,-each Permit"which is required far all excavations. 11'there am any ginstions,pl:ase feel free to ask. $iipw-erely, („A � E Ros ci DeLuca Jr. b 5 � Cep feral 11 tinge !Estimate 1Fr2 nk AeLucia& Soya lar- � Go!Weis pool fill Quote Q • f ' 1 • 1 ♦ * w w A i 1Sm � i ;'tt�'x'� ti�s`^'�"'-�: .._ RI" ^`f;...,-:S3ki�Y ?.r ISr• ��r �S�. .A ;':l::j.':.� it i S r r,�a.tL ��r cl � •° r* ° 4 S .i f y J -��, I _ y ';� _ r �._• "..'` rr i'�T)'tx r.V^ .Ji. �"++;L.�'� .i`. 1 ci..r� H ,r Y�' ? � {. �-' � r ...•'r�J + K u^'�:-�w }A!w ..1::1 ..,{;)J Y�'_n�Y :::ad-.�.�t.� •ra3C.c.w.1'r L. �L. -ee �.u.. ..:L-_1,�ii,�,,..c4n°.�i�,.`�..r.�.t � J.r K�.i+t.^'�cY>-r r• r ,a � -a .:. .or y�",+2+-�M �p� +LYS �'_F,vti.czP�cl ru �fti9ih t} S.K'Yf�A,1i ;'ti _ ''v.• .-� j �.� pp r�4'' •w f�.�� „�.;.:^'. ,:ry'adycGl. �'Nc„R �,c ..i ti...=. _.,,c�•,-��.f,,.uck:-.„n*-� • _` ,I t► « WNW .. 77FIMr! '�iy�V'N 1:'� �'Lnkt'� �7',-r�+��,, rr S - t r•rP'����ra}�� n r �',L + y!f 4..y�y til N 1 ,I ( J?t ] .} J t , 1 lyt _-}1 h r•'�t'�} ZZ; .r- "t��+`j,,i'�"]ry( .� �ti 1�r�! >r•n. �}. K, f Y = r�..r 'E S i= cy �� l S �•�-yam^ .uS. >v'v.��,. � - .�.,,�3. 'L. ��...ay,�4 f •� „�f Cpl}� `kQ � -+-.J. J.�1 t�J.xJ-� b �c �� -r J r � � 1 �sY� h�y`{t. ,.�•( `+r' .yi•Irl.. '�I t fN_, .�J 1:�,.'i•.: _;,",,;. - _,k.t�r�1�..is��s.Y-�w�..�..,� .G i Yw, T r w • I • / Fmw, - 1 1 • I f.� c - yL� :ct�" .r. �� t�c�'II"t - �jY'-rct r-:'n.3: �a.-�. �rp - - - r Location C> r5o Sd ems ' No. 3 Date NCRTp TOWN OF NORTH ANDOVER 3 •. _ OL F 9 " Certificate of Occupancy $ Building/Frame Permit Fee $ � �c�us Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 110 A, Check # � r 'i 7 5 U 7 v,fil� ` Building Inspector s ' TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT BEEN&RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: f DATE ISSUED: _ SIGNATURE: Building Commissioner/12gwor of Buildings Date Z SECTIO_ N 1-SITE INFORMATION O Property Address: 1.2 Assessors Map and Parcel Number: XVqzL -j,/ © © / Map Number Parcel Number ,d 1.3 Zoning Information: 1.4 Property Dimensions: r(wk Zonin District Proposed Use Lot Area Frontageft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide ReqWred Provided R red Provided v 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ J SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT �-t:,LMt DIStric.t. Ye's rn 2.1 Owner of Record w�- ►1� I gaol F q F ✓ o Name(Print) Address for Service Signature Telephone 2.2 Owner of Record: Name Print Address for Service: o m Signature Telephone M SECTION 3-CONSTRUCTION SERVICES 70 3.1 Licensed Construction Supervisor- Not Applicable ❑ C/tl--- .'s, 71),�,C--,,/'�,11c Licensed Construction Su isor: 6) (( 949 0 0 License Number Address Expiration Dae Signature clephone7 I I 3.2 Registered ome Improveme ntractor Not Applicable ❑ v /-.* r r� (� e L Co pang Name M Registration Number r ----�a - :-z - /)?, P' Address ` 6&570 .7 Expire o Date Signature Tel hone r SECTION 4-WORKERS COMPENSATION(M.G.L. C 152 § 25c(6) t Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building it. Signed affidavit Attached Yes.......❑ No.......❑ SECTION 5 Description of Proposed Work check sll a ble New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) Addition Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: Aq G-;fJ Z3 eo G� c6 ' n V1 .l p .p G co �j SECT N 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by 't applicant 1. Building (a) Building Permit Fee Multiplier 2 Electrical . (b) Estimated Total Cost of Construction 3 Plumbin I M619Building Permit fee(a) x (b) 4 Mechanical HVAC - j / Q 5 Fire Protection 6 Total 1+2+3+4+5 Check Number 61 SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING P T 1, V\ e as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date 0-2 SECTION 7b OWNER/AUTH ED AGENT DECLARATION v 1, as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief Print Name Si ature of Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS iST 2ND 3 RD SPAN DDAENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE - FORM U - LOT RELEASE FORM • 0 INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *******************APPLICANT FILLS OUT THIS SECTION*********************** APPLICANT�— PHONE QL ( 6 –C opo LOCATION: Assessor's Map Number `� PARCEL SUBDIVISION LOT (S) STREET g 4 ST. NUMBER_,22_q ***********OFFICIAL USE ONLY*************1 RECOMMENDATIONS OF TOWN AGENTS: ONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS A90 e'f�� E3� r�.enti"�-✓ 7�. TOWN PLANNER DATE APPROVED. DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED lS TIC INSPECTO -H LTH DATE APPROVED 2 c� DATE REJECTED COMMENTS /2z5 i ,.pa c� �`�ra ts•� s PUBLIC WORKS -SEWERIWATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9197 jm S Miriam Zwanziger 224 Foster Street North Andover, MA 01845 July 15, 2004 To Whom It May Concern: I hereby authorize Dowgiert Construction to perform the construction project on my home at 224 Foster Street according to G.S.D. Associates plans dated June 28th, 2004. The work will be performed on a time and materials basis. Please direct any questions you might have relative to this project to Tadeusz Dowgiert, our general contractor. He can be reached at 978-815-7292. Sincerely, h Miriam Z anziger North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, S150A. The debris will be disposed of in: �— / 1 c u (Location of Facility) t Tat �e—rof Permit Applicant >/ /4 �r Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector u The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02119 Workers'Compensation Insurance Affidavit Name Please Print Name: Location: City Phone # F1I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers'compensation for my employees working on this job. Company name: a� Address - L Citc. Phone'#. Insurance Co. Policy Company name: Address City Phone#: Insurance Co. Policv# Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of,a fine up to$1,500:00 and/or one years'imprisonment-as_wall_as_civiLpenattiesinthefarmof-a_STOPWORKORDERwW..afinenf.($1.QO.DA)-dayagainst.me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. 1 do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signatu e t Date I Print name�— / Phone# 2fALiL -0,5—40._C Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensing Building Dept [JCheck if immediate response is required C] Licensing Board p Selectman's Office Contact person: Phone#: F� Health Department Other tiOPttry Town of North Andover a°•' ``��° Building Department 27 Charles Street V - North Andover, MA. 01845 SSNCNttSE D. Robert Nicetta Building Commissioner (978) 688-9545 (978) 688-9542 Fax HOMEOWNER LICENSE EXEMPTION Please print. DATE JOB LOCATION Number Street Address Map/lot "HOMEOWNER Name Home Phone Work Phone PRESENT MAILING ADDRESS City Town State Zip Code The current exemption for"homeowners"was extended to include owner-occupied dwellings of two units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. (State Building Code Section 108.3.5.1) s DEFINITION OF HOMEWOWNER: Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two family dwelling, attached or detached structures ac- cessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other Applicable codes, by-laws;rules and regulations, The undersigned"homeowner'certifies that he/she understands the Town of No. Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL Workers' Compensation and Employer's Liability Policy t O U A R 0 NorGUARD Insurance Company INSURANCE Policy Number DOWC437480 Renewal of DOWC337340 GROUP NCCI No. [25844] [1] Named Insured and Mailing Address Agency DOWGIERT CONSTRUCTION COMPANY, INC. ROBERTS INSURANCE AGENCY 616 Essex Street 1060 Osgood St. Lawrence,MA 01841 North Andover, MA 01845 Agency Code: MAROBE10 Federal Employer's ID 04-3438231 Insured is Corporation Risk ID Number 000288185 Locations Other Than Above (L1) 8 Dundee Park,Andover, MA 01810 [2] Policy Period From October 26, 2003 to October 26, 2004, 12:01 AM, standard time at the insured's mailing address. [3] Coverage A. Workers' Compensation Insurance - Part One of this policy applies to the Workers' Compensation Law of the following states: Massachusetts B. Employer's Liability Insurance - Part Two of this policy applies to work in each of the states listed in item [3]A. The limits of our liability under Part Two are: Bodily Injury by Accident-each accident $500,000 Bodily Injury by Disease -each employee $500,000 Bodily Injury by Disease - policy limit $500,000 C. Other States Insurance - Part Three of this policy applies to all states, except any state listed in item [3]A. and the states of North Dakota, Ohio,Washington, West Virginia, and Wyoming. D. This policy includes these endorsements and schedules: See Extension of Information Page - Schedule of Endorsements [4] Premium The Premium Basis and, therefore, the premium will be determined by our Manual of Rules, Classifications, Rates, and Rating Plans. All required information is subject to verification and change by audit. (Continued on another page) Total Estimated Policy Premium $ 28,150 ' V Total Surcharges/Assessments $ 1,094 Total Estimated Cost $ 29,244 INTERNAL USE 00) Page- 1 - Information Page MGA : DOWC437480 WC 000001A Date : 10/27/2003 MANOTE P.O.BOX A-H,WILKES-BARRE,PENNSYLVANIA 18703 BOARD OF BUILDING REGULATIONS . License: CONSTRUCTION SUPERVISOR' ERVISO R' Number: CS 048040 Birthdate: 10129/.1.955 _._ Expires:.10129/2005 Tr.no: 8109.0 - Restricted- 00 TADEUSZ DOWGIEERT 171 BRADY AVE �i SALEM, NH 03079 Administrator i l II NORTfy Town of - - L over 0 No. 7:5 - - =- 7 _ ) q - o Y z- dover, Mass., COCWICKEWICK A0RATEO i5 BOARD OF HEALTH PERMIT T Food/Kitchen Septic System THIS CERTIFIES THAT ......... �/ �N Z ��� 1" BUILDING INSPECTOR ...Am �.r I.N.� ..................... .....:.................................. ..........4............................................ Foundation has permission to e�eCt.....N '� �� buildings on �. �•.... }............. Rough t r ...off... ... ..... b ......s ... ..... .... ... . .. to be occupied as Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By- s rel ting to the Inspecti n, Alteration and Construction of Buildings In the Town of North Andover. pt.�` D ; �� PLUMBING INSPECTOR ` '1 Ito VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION ARTS ELECTRICAL INSPECTOR t 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 Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. +ER£9T CERTIFY THAT T..S PLtrl . @V ME, UNOER MY DIRECT SUPERVIS10N THIS PLAN CONFORMS rC ME RULES H of THE REGtSTRy Of OEM' Q :u $URvEfING COnFORM£ rC rHE iE sB STSN04ROL FOR PROPERTY SURVEYS G 7r fr-12 B HELD rur AMERICAN CCHORESS ON SuRVEYu10 B � a 8q,0 , FIr r BLUNT 1 'A-.'C, 64GES $'Ste,,. 'N/i A 369A4• 4yf BccrH L.264 al' II rm od:yrs .c�' rec De to F 819CHO:F NIa Z� �I DENNIS 0 UH6ER PE CowARtl MSE. r„�'1 4. NO HEw RIGHT OF w4Y£ aRE ;EwO CR Of THIS PLAIT GHO THE RIGm*0 mY L 901OwN GRE Exa^flG :IID tA; ler BE ,>•�•`�?�• a�. 1d '• 66' ALrERCO Itl AIIY f4AI1NEA If THIS PLG 7166•_5-05w, C/i' ELHif1EY 7 �• C :BAP TOGO \ ti^ • 11}' LCT 123 i� Q,23C 26' O S B'S tt 4' r p rr 631,C43 SF I �• y, L•1744V 'FHO 6 HELD W = 1495Le• a a 8 Nip =Of.'E HARRIS I•b� -0'xr..,. NOsoulft t �---- �C' )IFth"'•� s ti OCT `9t :AAP 104 0 � 1 �._ .._• - '+ LOT 4? 300,334 SF- NIF 3' p— s f>r QO2] BENSON .v':;K,GB 1Y 1 --.1' 29+.g/v RIW/T C�'4� �.� 'P \\ \ R.9 MISC1 ,i PLAN OF LAND +�' •�` oHMIE.ECKI, IN ` NORTH ANDOVER , I.+f ,y`1^ Q • ` .'}y°� ,ate• ,4• ANEWRCD FOR '� ati ,y LAWRENCE X43. SAVINGS- BANK »£"� -`.••• - V t WF 6ta:ER ;C NG:$ C/t floRTH a12CvER. ML A •�' � '���'y�' / D?' , ' a-AN PREPtREO s'fY R`BB` ► RIVERSIDE ENGIN t^ sc, SERVICES INC, .2 44P.E £T. ,Vcsr t1ENBUAY MA ... yr E: T .;u fr. •SCrrl Ss!•3303