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Home My WebLink AboutBuilding Permit #774 - 23 UNION STREET 6/2/2010BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received v Sty.... �6• ry� °: 'A Resi i 4_ eb Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION c � Print PROPERTY OWNER_ �kQ x`f � Print% MAP 210_PARCEL:_0 ZONING DISTRICT: Historic District yesno Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Resi Non- Residential New Building e F Addition wo or more family Industrial ra io Commercial epai , replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: Identification Please Type or Print Clearly) OWNER: Name: L2) 11� VtyyY Opc-,)A a M CONTRACTOR N -7'�)� 4tC�- Q C'�C� Address: \W Supervisor's Construction License:Exp. Date: ��- Home Improvement License: - XUD(d�) Exp. Date: "7 ARCHITECT/ENGINEER Address:_ COZ Reg. No. d FEE SCHEDULE: BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ FEE: $ �(� Check No.: Receipt No.: 2 2 NOTE: Persons contracting with unre 'stere contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contrac - 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 COMMENTS Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Planning Board Decision: Comm Conservation Decision: Comments Zoning Decision/receipt submitted yes Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: FIRE DEPARTMENT, Temp Dur Located at 124 Alain Street Fire Department signatureldate COMMENTS Located ;3134 Usg000 Street on site yes no 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 2010 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: Building Permit Revised 2008 Location r3 Ute/ Ur 6r– No. _ Date ,jORTPI TOWN OF NORTH ANDOVER I O`'O ,,h•C Certificate of Occupancy Permit Fee $ $ fV// s�cHusE Building/Frame /Frame 9 F Foundation Permit Fee $ — Other Permit Fee $- TOTAL $ Check # 23241 U Building Inspector � A x c� u O w e v U) o U a z z A o O w O u: T U C x a o W � a p w' co x a W a u U w W p C2 v c� G x o H ¢ C7 p cG C twcn z A a w 7 o z v Q O O z M li O O co O z °' CL O h D C Ico cm O ca coO La co �E to m 0 0 CD � L O O � i e_vv o a M: cm< c c= c Cev CJ J .O O C z co CD C.) Na c C C C _cc d is LLI 0 LLI U) W W W CA =Eo �•m C o CIS CD ` C H O C Vci _ V •dam QC ' b W O c o o� EQ 4= J :CD rte o c co Es c :o sC E CO N N N m J93 C ON CO) y m a := c y O c C Em o R cmc �.: N O ' �t= O cm ;mov m V N O 42 W �� Z O d C Q C y O C •O CL N Z y... C C I -.-•N 'E dtO• N Z O U= V O p ® C_ COD = a m� O� v a O = j- CL � M li O O co O z °' CL O h D C Ico cm O ca coO La co �E to m 0 0 CD � L O O � i e_vv o a M: cm< c c= c Cev CJ J .O O C z co CD C.) Na c C C C _cc d is LLI 0 LLI U) W W W CA lephone: (603) 898-4468 Contract Cell: (603) 235-7624 Al Free: (800) 458-4468 Fax: (603) 898-6942 A.J. WOOD CONSTRUCTION, INC. P.O. Box 1769 Salem, New Hampshire 03079 Email: info@ajwoodconstruction.net Website: www.ajwoodconstruction.net ROOFING • SIDING • VINYL REPLACEMENT WINDOWS • DECKS Workmen's Compensation and Public Liability Carried on All Work Date: May 20, 2010 I (we), the undersigned, hereby accept your proposal to furnish Labor and Materials to perform the following work on premises located at the Following address: ' Flo. 23 Union St. N. Andover MA (Street) (City) (State) (Zipcode) owner's Name Bill Nears Tel. (781) 405-9004 Address SAME AS ABOVE Specifications of Contract 1 Install two (2) 12 foot dormers as per plans 2 Vinyl side dormers only 3 Roof on dormers only 4 Install four (4) windows 5 We guarantee our workmanship and provide a one (1) year Labor Only Warranty from date of completion ,?or the sum of _ $22,000.00 (Twenty Two Thousand Dollars and 00/100) deposit $7,300.00 (Seven Thousand Three Dollars and 00/100) Due with signed contract Additional Work 1 Re -roof main house only ;or the sum of $6,800.00 (Six Thousand Eight Hundred Dollars and 00/100) 3eposit $2,300.00(Two Thousand Three Dollars and 00/100 Due with signed contract honer agrees that the title or equity in this property is his and is security for this contract. N WITNESS WHEREOF the undersigned has (have) hereunto set his (their) hand(s) the day and year first above written. Buyer(s) Acknowledge Receiving a Completed Legible Copy of This Contract. Phis contract may be voided by the Owners giving written notice to the Contractor by ordinary mail within three full business days 'ollowing the date hereof. 3y §Wa4rdjr (Richard J. Smith, President) (Legal owner of pfropirty to be improved) or wife of legal owner) L. S. L. S. %07i"010/PRI 02:9 PM P. 001/001 1 _ p� CERTIFICATE OF LIABILITY INSURANCE 5;;/2010 PRODUCER (603) 432-6414 FAX: (603) 432-3852 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION E'inancial Insurance Services Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 1PO Box 950 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Derry NH 03038 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A; Peerless Insurance Co A J Wood Construction Inc INSURER B: PO Box 1769 INSURER C. INSURER D: Salem NH 03079 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO TH E INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTAN DING 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 SUBJECTTO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR D'L TYPEOFINSURANCE POLICY NUMBER POLICY EFFECTIVE TE (MMIDDIYYYY1 POLICYEXPIRATION XPI �NLTR YY1 LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1, 000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ma occurrence 5 100,000 A CLAItdSMA9E RX OCCUR CBP8706685 8/16/2009 8/16/2010 MED EXP (,anyone person) 5 15,000 PERSONAL & ADV INJJRY $ l.'000'000 GENERAL AGGREGATE $ 2,000,000 GENLAGGREGATE LVAITAPPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 X POLICY Wit° LOC AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LUrt1T $ 1,000,000 (Ee accident) BODILYINJJRY $ A X ALL OVVVED AUTOS SCHEDULED AUTOS(P=_rparson) EIA8693505 7/8/2009 7/8/2010 P.ODILY INJJRY (Peraccide_nt) X X HIRED AUTOS NON-ONdVEOAIJTOS PROPEP.TYDAMAGE $ (Per aceidant) GARAGE LIABILITY AUTOONLY-FAACCIOENT $ OTHER THAN EA ACC $ ANY AUTO AUTO ONLY: AGG EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE $ 1,000,000 OCCUR FICLAIMS MADE AGGREGATE $ $ $ A DEDUCTIBLE D8766767 4/14/2010 4/14/2011 $ RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORiPARTM5UEXECUTIVE R LIMIT- ER TORY LIMITS E_L_ EACH ACCIDENT t $ OFFICER(MEMBER EXCLUDED? ❑ (Mandatory in N14) E.L.OISEAaSE-EAEMPLO $ E.L_DISEASE-POLICYLWIT S yECALPROunder SPECIAL PROVISIONS belay S OTHER DESCRIPTION OF OPERATIONS I LOCATIONS) VEHICLES I EXCLUSIONS ADDED BY ENOORSEMIM/ SPECIAL PROVISIONS (6031898-6942 SHOULD ANY 0 FTHE 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. AUTHORIZE) REPRESENTATIVE Sam Fragala/DEBRi _ ACORD 25 (2009109) 01988-2009ACORD CORPORATION. All rights reseryed. INS025 poo9mi The ACORD name and logo are registered marks of ACORD t ORD CERTIFICATE of LIABILITY INSURANCE OATE(MMIOQIYYW) aaocucca 03/10!2010 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Matthews Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 182 Parker St HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Lawrence, MA 01843 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 978-681-1112 INSURERS AFFORDING, COVERAGE MAIC # INSURED A.J.Wood Construction, Inc. INSURER A: Liberty mutual Ins. P.O.Box 1 INSURER B. Salem, NH 03079 INSURER C: rAvFRA1r.I:c 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. NSR ADD' POLICY NUMBERDATE POLICY EFFECTIVE POLICY EXPIRATION (MMIDDIYYI LIMITS GENERAL LIABILITY EACH OCCURRENCE j S COMMERCIAL GENERAL LIABILITY I CLAIMS MADE OCCUR I UANUZPREMIE o grants S MED EXP (Any one pemon) S PERSONAL B AOV INJURY S GENERAL AGGREGATE $ GENL AGGREGATE LIMIT APPLIES PER POLICY PRO JFGT LOC ' PRODUCTS - COMP/OP AGG S AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMB (Ea accident) $ ALL OWNED AUTOS SCHEDULEOAUTOS BODILY INJURY S (Per persm) MIRED AUTOS NON -OWNED AUTOS BODILY INJURY $ (Peraccident) PROPERTY DAMAGE S (Per accident) i GARAGE LUI ; AUTO ONLY - EA ACCIDENT $ ANY AUTO i - OTHER THAN EA ACC S AUTO ONLY: AGG S EXCESSIUMBRELLALIABILITY OCCUR CLAIMS MADE EACH OCCURRENCE S AGGREGATE S S DEDUCTIBLE 1 S RETENTION S S WORKMS COMPENSATION AND EMPLOYERS' LIABILITYER WC231 S353819029 02/1312010 02/13/2011 T R �Ai O EL EACH ACCIDENT $ 500.000 ANY FROPRIETORIPARTNUMECUTNE OFFICERIMEMBER EXCLUDED? E.L. DISEASE - EA Q�dPLOYEE S J�00 000 U Yes �� EL DISEASE - POLICY LIMIT 5 500,000 SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS n�nriow arr a er.. w fie'{ ACORD 2S 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 IMPOSE NO OBLIGATION OR LIABILITY OF ANY POND UPON THE INSURER ITS AGENTS OR O ACORD CORPORATION i -d das:EO OI LT Jew 91teVeVa-�Boar o ui mgg ula%ons an SMnar s = One Ashburton Place - Room 1301 Boston, Massachusetts 02108 Home Improvement Contractor Registration AJ WOOD CONSTRUCTION, INC. Richard Smith PO SOX 1769 SALEM, NH 03079 DPS -CAI is 5OM-07/07-PC8490 ,per �lae �amrnreaauae� o�✓liaaaacluiaeda Board of Building Regulatiobbs and Standards HOME IMPROVEMENT CONTRACTOR Registration: 106603 Expiration: 7/24/2010 Tr# 270264 Type: Private Corporation Registration: 106603 Type: Private Corporation Expiration: 7/24/2010 Tr# 270264 Update Address and return card. Mark reason for change. Address F-� Renewal F-] Employment R Lost Card 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 Rm 1301 Boston, Ma. 02108 AJ WOOD CONSTRUCTION, INC. Richard Smith / 4 RUSTIC LANE C:;:)�., ✓ DERRY, NH 03038 Administrator Not valid witho-, ignature Commonwealth Of Massachusetts Division of Occupational Safety Laura M Marlin, Commissioner Deleader-Contractor RICHARD S. SMITH �W9 Eff. Date 07/01/09 Exp. Date 07/10/10 DC001721 Member of C.0_N.ES.T. BO BOSr RE )� ON RENEW '" tii.rssxcbusetts - Department uf' Public S; Bo,Ir•d Of Buildinrfch g Rc!ulations .Ind St. nd:►r- Construction Supervisor License ds License: Cg 70882 Restricted to: 00 RICHARD J SMITH PO BOX 1769 SALEM, NH 03079 � ��n11111��lU Expiration: 7/28/2011 OCI' 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: City/State/Zip: �� 0,N CJZC n -n Phone #: Are you an employer? Check the appropriate box: 1.(5I 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 These sub -contractors have working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its 3. ❑ I am a homeowner doing all work officers have exercised their myself. [No workers' comp. right of exemption per MGL insurance required.] t c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. Remodeling 8. E] Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 1 I. F1 Plumbing repairs or additions 12.❑ Roof repairs 13. ❑ Other *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 state whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: 1 QN00q Policy # or Self -ins. Lic. #: k,,:1i a)15'�'63' i R 0�P Expiration D.-11 0-) � Job Site Address: ) On ( oo City/State/Zip: 1J f-ff C1 W , U� 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 tl:e information provided above /is_ true and correct Signature• Date: use City or Town: not write in this area, to be completed by city or town official 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