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Home My WebLink AboutBuilding Permit #54 - 23 GARDEN STREET 7/20/2009Permit NO: Date BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received O' �tLeD '6�•�VC TYPE OF IMPROVEMENT PROPOSED USE OWNER: Name: h f%.0 r Residential Non- Residential New Building One family Addition Two or more family, Industrial Alteration No. of units: 2- Commercial Repair, replacement Assessory Bldg Others: Demolition Other .Address: f &d Septic Well Floodplain Wetlands Watershed :District Wbter/S.ewer DESCRIPTION OF WORK TO BE PREFORMED: 0 c(+ w V C) vh CJS vw� �U ti v` eMo-dems, Identification Please Type or Print Clearly) Td h 'b � e 7 0 OWNER: Name: h f%.0 r Phone:17k- 7.k Address: -e h Address: �S f -,- o tea. N e r (Y C L 16 �s-H Le, v CONTRACTOR Name:. L(�-v Ls 6 o 4ap o cL�S I i c- Phone.: .Address: f &d o J-1 pl� 1-� U S'upervisor's Construction License. Exp. Date.: ' 1-7- -7^Horne ,'Home- lmproveme:nt- License: t 6� '7 "7 � Exp Date: ARCHITECT/ENGINEER Phone: Address: Reg. No FEE SCHEDULE: BOLDING PERMIT: $1200 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ /� ; 0 d 0'/ FEE: $ &0 Check No.: / 6 3?0 Receipt No.: ZZZZ-� NOTE: Persons contracting with unregistered spntractors do not have access to the guaranty fund *1 Location r a Is No. Date O MORTh TOWN OF NORTH ANDOVER f 1,r 3?O'•t`'o ,• O O ` Certificate of Occupancy $ JV roe Building/Frame Permit Fee $ ACMUS Foundation Permit Fee $ 3 Other Permit Fee $ TOTAL $ Check # 1 6 3 3 6 2MB AG 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 DATE REJECTED DATE APPROVED CONSERVATION COMMENTS DATE REJECTED DATE APPROVED HEALTH COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments FIRE.DEPARTMENT =Temp Dumpsterorysite- st, no Located at.124-Maid, Street Frre aepartment.siignaturefdate 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 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 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 2.2007 N m m m C m X cnm y mm C) y d C � � d 'O O CD C) Z CO) CL n� r C CL �' y nCC2 o C.) C p CD CD CL rF Q CD CD o CD C: O y� CZ p y �■ O CD I C2 CO2 O CD Z O O O � • CD O - CCD I 5?�o a .y�a y nom•to � o' m 0 o C) • o yma� Z -4 CL Er o =rd = y O O m H p O =rm •p O CD m C9 O O •-► O O ZS. INP O VJ C2 C =rO .mowa- 0 CL VJ 31, 0m m c s � CL ' C 1 d m H CLW C V o _ Q CL o m :� ' ^ .�► V) m h ? H '� O CID d H m �C.) ►y o 0 O mo_wl Z �3 y � O a C O O CD C a3 N d o'?CD: dm: o 'o CL= C.) d o C-3 h 0 0 . 0=3 0 9 cn ccnp7 qo cn ; ro n ►n cn "i7 S. r n a M Z z d M Z x H ro M n I ACORD. CERTIFICATE OF LIABILITY INSURANCE OP ID S DATE (60NIDDIYYYyI";. PRODUCER :. LEMS -1 05 28 O9 '. TYPE OF INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Michaud, Rowe And sca .Ruk Ins . ONLY AND CONFERS NO RIGHTS UPON THE CERTIFlCATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR r P .O. = Box 188 . , _. • North Andover' -MA 01845 'ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.:: Phone: 978 688 8829 ."Fax: 978 557 2130 INSURERS AFFORDING COVERAGE NAIC# WsuAFM INSURER A: Safety Insurance- Co any 12808 .Levis Companies Inc. INSURER B: Guard Insurance Gro Joseph Levis 160 Pleasant Street INSURER C: Preferr.d Mat:nal Iaaurane. Co. 15024 North Andover MA 01845 INSURER D: INSURER E: C�VFRAP,FC 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 SR TYPE OF INSURANCE POLICY NUMBER CY EFF ECTIVE DATE MM/DD POLICY PTA -A 0 DATE M LIMITS C GENERALL.IABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR CPP012058905910/26/08 10/26/09 EACH OCCURRENCE $ 1000000 UAMAU:PREMISEIUKt:ecurence) $ 50000 MED EXP (Any one person) $5000 PERSONAL BADV INJURY $1000000 GENERALAGGREGATE s2000000 GENIAGGREGATE LIMIT APPLIES PER: POLICY F1 F ECT LOC PRODUCTS -COMP/OPAGG $1000000 AUTOMOBILE LIABILITY A ANY AUTO 821254 01/01/09 O1/O1/10 COMBINED SINGLE LIMIT $ (Ea accident) ALL OWNED AUTOS X SCHEDULED AUTOS BODILY (Per 5 500000 (Per person) X HIRED AUTOS X NON -OWNED AUTOS _ BODILY INJURY $SOOOOO (Per accident) PROPERTY DAMAGE (S 250000 (Per accident) GARAGE LIABILITY ANY AUTO AU70 ONLY - EA ACCIDENT I S OTHER THAN EA ACC S AUTO ONLY: AGG $ EXCESSNMBRELLA LIABILITY OCCUR CLAIMS MADE EACH OCCURRENCE I $ AGGREGATE ( S S DEDUCTIBLE S RETENTION S S WORKERS COMPENSATION AND _ B EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNER/EXECUTWE OFFICER/MEMBER EXCLUDED? LEWC009404 02 /27/09 02/27/10 TORY LIMITS ER E.LEACHACCIDFNT $100000 E.L. DISEASE - EA EMPLOYE4 S 10 0 000 ayes, describe under SPECIAL PROVISIONS below OTHER E.L. DIS EASE - POLICY LIMIT 5 5O O OOO DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS CFRTIPVtATC unt neo IJUMEN3 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. • _ - •- -- AUTHOR RESENTAll ACORD 25 (2001/08) 0 ACORD CORPORATION 1988 4, r �� two ;' . ti� i The Commonwealth ofMassachusetts Department of Industrial Accidents Office of Invesfig ations . 600 Mrashington Street Boston, MA 02111 www_nwssgov/dia . Workers' Campelasation Insurance Affidavit: Builders/Confx^actors/EiectriciaaslPiumbers A licant Inforacation Please Print LeQibl Name (Business/Dwirationnndividual): a (' ' � yl•f; Adore S5. Citystatn/Zip: %1 d fi •�. {�] r� G w M •� Phone #:..-�-�- 7,A8reyouemployer? Cheek -the appropriate box: employer with 4. I am a general contractor and Iees TYPe of prreject (requite: (full and/or part-time).* I am .a.sole proprietor. or have bird the s&contractors listed 6..❑ New construction. partner- ship and have no employees . ori the attached sheet, t These stl&contractors have 7. ❑ Remodeling working for me .in any capacity. [No workers' comp, iasurarnce .. workers' comp. insurance. 5. ❑ we aro a corporation and its 8- Q Demolition 9• ❑ Building addition *squired.] 3.0 I am a homeowner doing all work myself officers have exercised tficir right Of exemption per MGL 10-0 Electrical 11. repairs or additions Plumbing repa.madditions (No•workers' com . P insurance required.] t c iS 2, § 1(4},•snd-we have no .employees. [No workers' 12. Roof ❑ repairs comp. insurance required.] *aury epp[ieant that checks botC must ansa fill out the section We ow ohowing their workers' compensetion r Homeowners who submit this afiiiiavit indjcat:ng I3.❑.pm policy information, th ms _ 4comractors that check this box must 8mng W0 end �= hrte orasitie contractors must submit a new affidavit indi such etn'ok�� an addiftioasl sheet showing• the narrtc of the sub. coaftemm and their aitis �Gi eanplO,j�er that i4 ro information.;17a�Crrg:workers' workzr&' ce:„, , pel�c,; n jorrnatian. compensation insurancefor►try amploye • Below is the policy aad job site . lnstn=ce Company Name: Vt-Q i- e v%4 Th, a ra-w Policy # or Self -ins. Lie. #: W C U .G . of 'fid - Expiration Date: Job Site Address;_ City/State/Zipo[ a v h Attach a copy of the workers' coatpeQsatiou 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 fine up to $1,500,00 and/or ,year im Penahits of a - of up to $250.00 a day against -the violator. Beadviseddida cas opy o vil statemen may be fos in the fbrm of 11 rwarded d WORK d t ORDER and a fine investigations of the D1A for insurance coverage verification. Office of ! do hereby cert?• fy under the pains j*at the information provided above is true and oe trect L.Board d use only. Do not write in this area, to be completed or town o by �' f— r Town: Permit/License # g Authority (circle one): of Health L Snllding Department 3. City/Tvwn Clerk 4, Electrical Inspector 5. Flnmhing lnspec%r rt Person - Phone #: Information a end Instructions Massachusetts General Laws chapter 152 requires all emp I oyers 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, assc)diation, corporation or other legal entity, or any two or mom of the'foregoing engaged in a joint enterprise, and includirig the legal representatives of a deceased employer, or the receiver ortrustecof an individual, partnership, associaboiu or other legal entity, employing employees. 'However the owner• of a dwelling house having not more than three aparimerrts and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work an 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 fist "every state or local licensing agency shag withhold the issuance or renewal of a license or permit to operate a businesstt or v construct buildings in the commonwealth for any appricant who has not produced acceptable evidenceAf compliance with the insurance'coverage required." Additional} , MGL chapter 152, §25C(7) states `Neither the commonwealth nor any of its political subdivisions shall enter into any comm$ for the performance of public work- until-acceptableevidence of compliance with the insurmc e em requirents of this chapter have been presented to the coTTtrscting authority." Applicants Please fill out the workers' .compensation, affidavit completely, by checking the boxes that apply to your situation and, if necessary, supplysub-contractors) name(s), addws(es):sand 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' mrnpmsation insurance. If an LLC or UP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Depwtmmt of Industrial .Accidents for confirmation of insurance coverage.. Also 'be sure to sign and -date the affidavit. The affidavit should be .returned w the city or town that the .application for the permit or license is being requested, notice Department of Industrial Accidents, Should you have $;ny .questions regar-ding 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 shouict enter their self -i nsurance'lieensc number on tl e'appropnate line. City or Town Officials Pie= be sure that the affidavit is complete and printed iegibly..Thc Department has provided a space at the bottom of the affidavit for yon 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 pmrnit/iicm= applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "lob Site Addr-ess" 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 affidavitis an file for fidwe permits or licenses. A now affidavit must be fined out each year. When 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 bum leaves etc.) said person is NOT.nequired to compiete this afndaviL 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 Cornmonwtadth of Massachusetts Department ofbzdiuustrial Accidents Officeoaf Investigations 600 Washington Street Boston, MA 02111 TeL # 617-7274900 ext 406 or 1-9-77-MASSAFE Fax # 617-727-7741 Revised 5 -26 -QS wwwmass.gov/dia .We hereby submit specifications and estimates tor:; ".'Strip out existing Bathroom and Pantry dispose of all debris'Install 'new batoom hr"fixtures anc s. .kitchen cabinets as specified,install new countertops and flooring owner,to choose aTl.colors',-{ cabinets , fixtures and faucets within budget" • .. ° any r '� x i. We Propose hereby to furnish material and labor — complete in accordance with the above specifications, for the sum of: Fifte6n Thousand and 00/100 Dollars dollars ($ 15, 000.00 i Payment to be made as follows: Five Thousand deposit Five Thousand after rough inspections balance due at completion All material is guaranteed to be as specified. All work to be completed in a professional manner according to standard practices. Any alteration or deviation from above specifications involving extra costs will be executed 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. Our workers are fully covered by Worker's Compensation Insurance. Authorized Signature Note: This proposal may be withdrawn by us if not accepted within 14 days. Acceptance of Proposal—The above prices, specifications and con- ditions are satisfactory and are hereby accepted. You are authorized to do the work as (� specified. Payment will be made as outlined above. Signature Signature Date of Acceptance: 7 ZG 61 - i 4_.\L. f ' ES 1 row INC-- .: " ''j A. Property Management, ':Maintenance & Construction 65 Salem St. P.O. Box 952 R Lawrence, MA 01842 (978) 687-2783 OFFICE ,. (978) 687-3042 FAX To... John''Morgan 23..Garden4Street. � 4 i } N6rth',Aiidover-MA%01845 .We hereby submit specifications and estimates tor:; ".'Strip out existing Bathroom and Pantry dispose of all debris'Install 'new batoom hr"fixtures anc s. .kitchen cabinets as specified,install new countertops and flooring owner,to choose aTl.colors',-{ cabinets , fixtures and faucets within budget" • .. ° any r '� x i. We Propose hereby to furnish material and labor — complete in accordance with the above specifications, for the sum of: Fifte6n Thousand and 00/100 Dollars dollars ($ 15, 000.00 i Payment to be made as follows: Five Thousand deposit Five Thousand after rough inspections balance due at completion All material is guaranteed to be as specified. All work to be completed in a professional manner according to standard practices. Any alteration or deviation from above specifications involving extra costs will be executed 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. Our workers are fully covered by Worker's Compensation Insurance. Authorized Signature Note: This proposal may be withdrawn by us if not accepted within 14 days. Acceptance of Proposal—The above prices, specifications and con- ditions are satisfactory and are hereby accepted. You are authorized to do the work as (� specified. Payment will be made as outlined above. Signature Signature Date of Acceptance: 7 ZG 61 HOME IMPROVEMENT CONTRACTOR }' Registrqtj rK 103772 Expirallonb 7//2010 TO 0 gam- al JOSEPH G. LEVI JOSEPH LEVIS. -- 160 ,PLEASANT n NORTH ANDOVER, Administrator License or registration valid for individul use only before the expiration date. If found return to: Board of Building Regulations and Standards One Ashburton Place Rin 1301 Boston, Ma. 02108 Not valid i lout signature _71ce 1°Oa�xinca�:urea�lf a�,aaaar/ucae�ld Board of Building Regulatio6hs and Standards Construction Supervisor License I Licit&e: CS 30651 1 ;� a /2010 Tr✓r! 11968 r a JOSEPH G LEVI 1 ? • 160 PLEASANT Ste- N ANDOVER, MA 0184 Commissioner