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Home My WebLink AboutBuilding Permit #628 - 2245 TURNPIKE STREET 3/28/2007k TOWN OF NORTH ANDOVER APP)Ja FOR PLAN EXAMINATION vL, 3 Permit NO: �9,2� __KDate Received Date Issued: �Z, iro9 IMPOrRTANT: LOCATION �aY!� .ltu, nl Awl PROPERTY OWNER I -r- a f MAP NO.:// z .A6 PARCEL: </ 'IVDU A XTn 7TQ "U RTTTT "U%19-_ plicant must complete all items on this page (l�. CiQlG((q) , A/- Ancley-en Print ZONING DISTRICT: NTCTnRTC DISTRICT VFS F1 0- F0- e 01 V �9SSAC HU`A�y TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential -New Building ❑ Addition ❑ Alteration yTOne family ❑ Two or more family No. of units: ❑ Industrial 0 Repair, replacement ❑ Demolition ❑ Assessory Bldg ❑ Commercial ❑ Moving (relocation) ❑ Other ❑ Others: ❑ Foundation only DESCRIPTION OF WORK TO BE PRE UKMEL) S-�tt t ( � (k 4 3 � V �'�t JI k� Stn! k1M W Identification Please Type or Print Clearly) q OWNER: Name: At& + Are" �k�^'�t-� Phone: f `-7c" Address:. �inrh nf(!,� lid. ►y- � r, /AJS. CONTRACTOR Name: Phone: Address: gn irn W aA, �� u� tom — ll1�CtSS u Supervisor's Construction License: 010330 Exp. Date:?'I 7 Home Improvement License: /I Zt��' Exp. Date: fit - (3 -a 7 ARCHITECT/ENGINEER Name: Phone: Address: Reg. No. FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost :$ Z- I °I ,SSV �_ �` FEE:$ Check No.: �%-Receipt No.: 200 1'_ Page I of 4 TYPE OF SEWERAGE DISPOSAL Tanning/Massage/Body Art E] Swimming Pools Public Sewer ❑ Well Tobacco Sales ElFood _ Packaging/Sales ❑ Permanent Dumpster on Site ❑ Private (septic tank, etc. Electric Meter location.to project t L , ' NOTE: Persons contracting with unregist ed contractors do not have access to the guarantyfund Signature of Agent/Owner Signature of contract r Plans Submitted Plans Waived ❑ Certified Plot Plan r -f7- Stamped Plans THE FOLLOWING SECTIONS FOR OFFICE USE ONLY r INTERDEPARTMENTAL SIGN OFF - U FORM � 1 PLANNING & DEVELOPMENT �K•7u1u111�i�.y DATE REJECTED ❑■ C ❑ Water Shed Special Permit ❑ Site Plan Special Permit ❑ Other DATE APPROVED REJECTED DATE APPROVED CONSERVATION�,'�,!:2 COMMENTS HEALTH COMMENTS Zoning Board of Appeals: Variance, Petition Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: DATE REJECTED Comments Comments DATE Water & Sewer connection/Signature & Date Driveway Permit . _ L. Temp Dumpster on—site yesno_ Fire Department signature/date / VED Building Setback (ft.) Front Yard Side Yard Rear Yard Required Provided Required Provides Required Provided , Dimension Number of Stories: Total land area, sq. ft.: NOTES and DATA — (For department use) Total square feet of floor area, based on Exterior dimensions. Page 3 of 4 Doc: INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 Created 1MC. Jan2006 Building Department in is a list of the required forms to be filled out for the appropriate permit to be The following obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work Addition Or Decks ❑ Building Permit Application ❑ Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ f Proposed Work With Sprinkler Plan An Floor/Crossection/Elevation Plan O Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) 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 In all cases if a variance or special permit was required the Town ant mush then get this recorded erks office must stamp atethedecision Reg Registry of Deeds. the Board of Appeals that the appeal period is over. The applicant One copy and proof of recording must be submitted with the building Application lication Doc: INSPECTIONAL SERVICES DEPARTMENT:BPFORMOS Pipe 4 44 W � Location <2 41 No. Date ,AORTN TOWN OF NORTH ANDOVER ilillIFFM Certificate of Occupancy $ 41 ACHUS Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL Check #713 A 2 0 0 7 Budbing Inspector H W W W W Y IL z F N N � W U � v� ma � W �a a` �0 �c ®o C31 0 0 to O O Y U O J m T O O r a O O O O C31 CD4 q to O O N o:o SS N N to O I� riO Go r - t0, m vt` J O 1 W tD, (D, m 1®OO YY O m w v'r�f a 3;N 22 0a)�:� r-:'6 ;CD r_ ;, CL CL�Q00 Qp ' C sou l o "C oCO O Z . 1 �, O r- ill r� z o_ Z c t' o O Q ov � iC r o CW Z;`� OJJ Y zoo s' a� O] Z ' z06 t �� q 3 0 cn co cn — 0 oP to o p u. -co z N •Q M Q QQ J m at (� O; > m m x in r, m imco 0000 00 z C14 00 Y, m O Mal Zt O cc�� W' OO a N_ y j w m pJ t d = z"A N U a. N,i �----v 00 P 0 eD,m,a ;o t to to m.co;� m !(d, tAtA Wt7� X J(D'id m °tet of Q y J vlm �,4j� ry Q c o ��' E �°� E';- Z Q m LL 'CO: ,d' �M cc U9,1181 A UsQ;Q;P m Q J z Q*fp � !co .P p �o'. tp P tD p �C4 C4 VUfr LL.Jfi a i ,., ai m0 �NOO, X m, N' `(p �� 94 ��.1- H F- . W t6 � . tp # � a � m LL W 74 Q m .Oi ':. 'C.O'd rn CfQ ¢ �:Q m o E' IL LL,z LL,0 w '�..' I} cc N C. ;u av C,o' m �.0;� z z W t71, -e ;in rdi ` rw O p F d?to!LL ; Q In W rn a rn tri it U U) J i E EELME'M > >.�, @cn o'm O W o ta LL LuR0' g"rumop ca CJg 1--` Z J OCZ o m m,x,co,- x� mm=V W F -Q, Hm�li2tllmY;W m:m.;Q N J Q W r lu E V v Y O U C4 0 Ui. tt)1 = C7 P F' : � r . i Q Z Z OL 0! Q t r W 7= rn p' .:.mrm U' _ H ro' ca ANO .:� ®� c. W 240 oNz yT0 O iXR O s Q fco)fn QC W m LL : iLL;LL;U;i CO) w 0 m t� t0 a m O 00 0 0 0 0 0 U 0 W a The Commonwealth of Massachusetts 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): Address: 10 So T rV City/State/Zip: �=kw re-�-c e S Phone #: ( ? 9r 6 f�-- 9--76-7 Are.you an employer? Check the appropriate box: 1. I am a employer with - 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet ship and have no employees working for me in any capacity. [No workers' comp. insurance required. ] 3: ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t These sub -contractors have workers' comp. insurance. ❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no 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 11.❑ Plumbing repairs- or additions 12.❑ Roof repairs 13. ❑ Other L,.r .. *Any applicant that checks box #I must also fill out the section below showing their workers' compensation policy information: f 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. #: WC— 49 (3 6 ? � s� Expiration Date: 0 4 or�Ys'' I Job Site Address: t� 1"��'^ P�< lc C° City/State/Zip: 41"d We -T 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 the pains and penalties of perjury that the information provided above is true and correct- (_.&1'- -,\ 0 Phone #: q 2 k - C- --70 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,'partaership, 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. # 617-727-4900 ext 406 or 1-877-NMSSAFE Fax # 617-727-7749 Revised 5-26-05 www.mass.gov/dia ._ _ .. ......__ ... _..._._.._..._.. ----- , valc, 11.14vVv vo.' VV^Ivl rayc: 1 (n AC®RD CERTIFICATE OF LIABILITY INSURANCEF OP ID DAO 1 IOD PRODUCER HUB International New England 299 Ballardvale St, Wilmington MA 01887 06 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Phone:978-657-5100 F'ax:978-988-0038 INSURERS AFFORDING COVERAGE NAIC9 INSURED INSURER A Safety Insurance Company POLICY NUMBER DATE (MMIDD/YY) INSURER 3 A.I. G LIMITS Family Pools & Patio Inc. 70 S. ce NA DYp Lawrence MA 01843 INSURER C: Scottsdale Insurance Company GENERAL LIABILITY INSURER D: Lloyds of London I" Y INSURER = EACH OCCURRENCE 81000000 nnire, a .'.ems w THE POLICIES OF NSURANCE LISTED 3ELOW HAVE BEEN ISSUED TO TAE INSUREC NAMED ABOVE =OR THE PrAICY PERIOD INDICATED NCTA1IT4£TANDIPIG ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER. DC ICUMENT IhITH RESPECT TC \'\A-iICH -4iS CER9IFICATE <ttY BE IS:SLED OF. MA'i PERTAIN, THE INSURANCE AFFORCED BY THE FOLIC ES DESCRIBED 1EREIN IS _,'_RJECT -0 .ALL -HE -ERNS, E`•CC_USIOVS A1•ID C01•IDITIO'd5 CF SUCF POLICIES AGGREGATE LIMITS SHONVN MAY HAVE EEEV REDUCED EY PAID CLWNiS. LTRINSRO TYPE OF INSURANCE POLICY NUMBER DATE (MMIDD/YY) DATE IMM/DDlYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE 81000000 X CO WERCIALGENE=A _ABILITY BINDER 12/31/05 12/31/06 N... I PREIhe>E ;Eat'osuh ne; s 100000 MED ::F (Pny cm Person} S 2XC1 CLAIMS MADE ®GCCUP PER" CPIALB,AD':'6dJUn^Y 51000000 - X Blanket Al I GENERAL AGGREGATE ,;2000000 GENLAGGREGATELIMIT APP -IES PER: v PRODUCTS-C0fiF!0PA3; S2000000 I I 17 POLICY X JEC LOC I Ben. 1000000 AUTOMOBILE LIABILITY A AravALrc 3947232 12/31/05 12/31/06 COMBINED tiINGLE LItd!T (Eeesoloen:) S1000000 ALL OWNED AUTOS BODIL" IN_m hY X SCHEDULED AUTOS (P=.r person, X HIRcD P.LR03 EODIi" IN.AJ7i S X NON-OVTIED AUTOS F'=r o,,OJInti PROERTY C,4vAGE I (F'ar accidgri: GARAGE LIABILITY ALTO ONLY - EA ACCIDENT S ANY AU -0 EA A :':' S OTHER 7HWV AUTO 014LY. AC;G S EXCESSIUMBRELLA LIABILITY EACH OCC UP ENCE S OCCUR CLAINIS MADE ~- `-_------- - — AGGF.=.-AT_ S 5 DEDUCTIBLE RETENT ON $ 13 WORKERS COMPENSATION AND at„ 'j- - ' EMPLOYERS' LIABILITY TCR'i Li?d ITS ER EL EACHACCL'r=V.IT q100000 B MYFROFi?IETOR'PPRTNER/E(ECU-I'VE WC8936745 12/31/05 12/31/06 CF=ICERrMEMBER' EXCLLCED? E L. DISEASE - EAE',P'_OYEE S 100000 If yes, describe under E.L_DC=EASE-FOLIC,LIMIT 5500000 SP=CALPRCVISIONSDobvi OTHER DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES) EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS Loc #1: 7D S Broadway Lawrence MA 01843; Loc #2: 45 Route 125_, Unit 3, Kingston NH 03848. I IVP! NOMORT* SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL ,IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. (2001/08) r D CORPORATIONI 1 RRR Mons and Standards e - Room 1301 zsetts 02108 (tractor Registration Update Address and return card. Mark reason for change 5` r Not valid without sF' l aiK; x�{ Y r { iF 1 ; f• �h . r � ✓1ze -�c�nvmoxuncrl� ✓i�uvoacluiaella BOARD OF BU L -E f=GULATION$ License. CONSTRUCTION SUPERVISOR Number CS 010330 Birthtla�t)7/7971960 � Ek�sres 07119/20¢7 Tr. no: 14273 jot WILLIAM C ;POOL 70 8113k6 ADWA- Y 1 s LAWRENCE, MA 01843 s; `'!/. Commissioner l �i urea/,moi a�'�Qa�1,,cae� Board of Building Regulations and Standards CONT License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before. the expiration date. If found return to: lug �--_ Registratl6n a 118204 TE prraton Board of Building Regulations and Standards 211312007 Ij„ ; One Ashburton Place Rm 1301 TYh? Ptd; A to Corporation Boston, Ma. 02108 FAMILY POOLS ;f Iv WILLIAM GIANOPOULUS., 70 S. BROADWAY -' LAWRENCE,MA 01843 _ - - Administrator• � ,...- Not valid wV itt' _ e A m , sy - e o• ^ A SO4 c� 1 TL N p0 o OZ T r �m p III ml g mg o �$_ A A S a � 4 N O .� Z7 D DG 3 g m d as rn N° z� aaga� $�=aha E�o=> SUN �4m�� Zoit�gSs^a ZI S O e -TJ �. 0 z a C L) � ® O x r i t a a a W D C A" ( s m , sy - e o• ^ A A O c� 1 TL N p0 o OZ T r �m p III ml g mg o A A S a � N r. i