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Home My WebLink AboutBuilding Permit #683-16 - 249 REA STREET 12/3/2015BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: �[(� Date Received 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 Septics .. D Well��• ` URI loodpla n ��Wetlands. �, xr;�s� VVafeshed Disf`r t ��Wat r/� we erg• : , ,. n _ � DESCRIPTION O WORK l U kit V'--K-UK"'tu: Identification - Please Type or Print Clearly OWNER: Name: gA±!�A DJZAMA1a-1A Phone: o,1r4rAcc' 2gcf )49.1#- SPW-F , rVy>'t* wdp-r �••� V:- � � •• w, sj..�s..1 . . '�a�.+ lY.,/n�'•r k�� 1.3u'r M �1T .„i � ♦ jFtr . ij . _, y_.�..�Ai P tactor, N rn��It:Ph-o,ne 4}.Sf�^�",."..�Tf""'nri1 :53{'x � w � 1'•a a -"""ate '"�.'�_`� � _ -.,1..<,i � .4.,� r• A -� .. � �-� -.rte. per�v„isorrrs>onstruL cion Lic�`ens�e�''_.�Exp� Date: tiY �..r.•x —..:,^ .-f��li�:`_` r �:-"'J'��'•:, ,�%[lSC_*�..+7�",i +,7 ai+t ' ry�i� +a...,�] {=::vr•_ .�' o? .. ' /� �� ` z ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE: BULDING PERMIT.' $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $925.00 PER S.F. Total Project Cost: $ ?5 �, 5 FEE: $ y Check No.: -J --Xi✓ Z-- Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agenf/Ovvner; Signafiure of.coritraet:. ` 1 * it 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 PLANNING & DEVELOPMENT COMMENTS Reviewed On Signature CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Siq�nature &Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE; DEf?ARTMENT - Temp.: Dumpster on sife no yes - ,.:. - Located at li2AP08in;:Street. Fire Departnrient signature/date _ COMMENTS �i 1�c�i�sic•�i� Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.:, ELEGTRIGAL: 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 Doc.Building Pemit Revised 2014 :l (�C�IiiC�` Lri��,t11G'flt 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 DTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Deeks • Building Permit Application o Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (if Applicable) ❑ Mass check Energy Compliance Report (If Applicable) o Engineering Affidavits for Engineered products )TE: 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 )TE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit n all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals hat the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording dust be submitted with the building application Doc: Building Permit ]Revised 2014 Location �r jj ,. � No Date 1 Check # e3 -30z 29767 r - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ r Building Inspector _v, C @ N n O �o-0 (Q. Cl)CL 0 O vClD CD o cr CD O w CD �CDa Q O y. S^' = to M ' � v O -0 Z n O �CD 0 CD m -1 X cn Z O Cl) O O o O —nl 4 CD O � C7 o �_C-C Z O ? � .a cn' --I p, to fl; CD• C 'A .► O O C � 0CD cn p ca CD CD CD 0 O O =rCD� CD o < (Q co CD 0(n + �co � Z o+ a rt .� r► C O = =r Xo. 7 n CD N EL U) 0=: CL O _ cm O O C y Q CD N O N CD � Q CDN Q CD C W CD FL. U CD tN � 0 O cc O O O rF e•�F � C CD O nnAA C O N O -. - D CD -0 r o CLF � o N 3 rD O (D Ln — N ,f D-. Z W .� m y � m z T pOj W . C.RL � CA vZi o m 0 T VI rD .Z7 m m r _ Z m T cu ;:o c O 3 rte- C W Z Gln Z m T :3 °- _S 3 O UQ O � Di0-r) O W C C Z Z m 0 fD a. Ln m 3 O Q s m W G O T m 2 0 0 O 1p s y 0 0�_ 6 L�- 2 20 V Thomas Burke & Sons Roofing & Gutters A Family Business Since 1941 781-246-5622 www.BurkeRoofs.com P.O. Bog 2152 Wakefield, MA 01880 CONST. SUPERVISOR LICENSE 98861 FULLY INSURED HIC LICENSE #102540 M#jN Contract price for labor and materials to re -roof tt p4ete roof by removing the existing shingles and re -roofing , over 3 0LB felt by using Certianteed 30 year architect roof shingles. To install Grace Ice and Water Shield to lower s ll - feet of all roofs and in valleys. To install an aluminium-- wh%A drip -edge onto all lower roof edges. To replace any broken or rotted roof boards where needed. To open all flashing and to re -flash where needed. To. remove all trash. % � fX`/ K, �C--44rli -10>JN P C016K 13wor STennA Total Cost: $ ? 5Tr5, The first payment of 11lbv Is due as a deposit. The second payment o S5'85, Is due when the materials are delivered and the work is started. The third payment of $ r-- Is due when the work is 75% completed. The balance of $J000. Is due when the work is complete and the trash is removed from the yard. Owner Contra Please make checks payable to Thomas Burke Please cover articles in the attic with sheets or plastic Due to the dust that can filter in. RefeTences available upon request. certifi°ate of insurance available upon request. ww\,.b getter Business Bureau 508-652-4888 .woston.bbb.or The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia ljrorkers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Prtnt Leetbly Name (Business/Organization/Individua!): rjT Al 1,C 6UAJC ,,, Address: p6G- L*/t 1t City/State/Zip: tti� y S ' N i{ -C 3 Zl nhnnP iE 17SrJ z 4�—_ 517— 2 Are you an employer? Check the appropriate box: 1.� 1 am a employer with _employees (full and/or part-time).* 2.Q I am a sole proprietor or partnership and have no employees working for me in any capacity. f No workers' comp. insurance required.) 3.E] I am a homeowner doing all work myself. [No workers' comp. insurance required.]' 4.❑ I am a homeowner and will be hiring contractors to conduct all work on my property. 1 will ensure that all contractors either have workers' compensation insurance or are sole proprietors with no employees. 5.a I am a general contractor and 1 have hired the sub -contractors listed on the attached sheet. These sub -contractors have employees and have workers' comp- insurance.: 6.n 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): 7. ❑ New construction S. Remodeling 9. ❑ Demolition 100 Building addition I I - Electrical repairs or additions 12. Q Plumbing repairs or additions 13. U.Roof repairs 14. n Other t- -••,_r, •--••• ••� • �•CC— — B 1 rnum also nn 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. tContractors 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. am an employer tltat is providing workers' compensation insurance for myemployees. Below is the policy and job site information. Insurance Company Name: TRigV S Policy # or Self -ins. Lie. #: � (! 04 33 AU 9 ri 3 Expiration Date: �—/% 3 e• Job Site Address: 2— Lf % -�Q �' - —City/State/Zip:�}✓f 1' � Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by 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. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 do hereby certify under 1ie pains and penalties of perjury that the information provided above is true and correct. Signature: Date /L Phone #: `% el 2.44& 5 6 ZZ Official use only. Do trot write in this area, to be completed by city or town official City or Town: Permit/License # Issuing Authority (circle one): I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: ACORO° CERTIFICATE OF LIABILITY INSURANCE F DATE(MWDDIYYYY) l� 1 10/30/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVEIII, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME. Office ACCOurit Cassidy Associates Insurance Agency PHONE,FAX H NE ,Ext): (978) 777-8880 (A/C, No): (978)177-9280 JA/67 High Street E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC a Danvers MA 01923 I INSURERA Penn America @ Surplex INSURED INSURER 8 :Cltatlon I Thomas B. Burke INSURER C :Travelers 25 Bishop Lane INSURER D . INSURER E Lynnf field MA 01940 INSURER F COVERAGES CERTIFICATE NUMBER:CL1592211108 REVISION NUMBER: THIS IS TO CERTIFY THAT 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 LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUERPOLICY EFF POLICY EXP LTR TYPE OF INSURANCE DPOLICY NUMBER MMIDDIYYYY MMIODNYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,00C A CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) S 100,00C PAV0055409 4/12/2015 4/12/2016 MED EXP (Any one person l S 5,000 PERSONAL .4 ADV INJURY $ i 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE S 2,000,000 X POLICY PRO- JECT LOC PRODUCTS COMP/OPAGG S 2,000,000 OTHER S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT SI (Ea accident) 1,000,000 B ANY AU r0 BODILY INJURY Per persom S AUTOS _✓ X AUTOSH~_V RVH584 12/7/2014 12/7/2015 BODILY INJURYIPer accidenit S NON -OWNED' PROPERTY DAMAGE S X HIRED AUTOS X AUTOS +Per accident) $ UMBRELLA LIAR OCCUR EACH OCCURRENCE S EXCESS LIAB CI,AIMS-MADE AGGREGATE S DED RETENTIONS 5 WORKERS COMPENSATION X PER OTH- AND EMPLOYERS' LIABILITY YIN STATUTE ER ANY PROPRIETORIPARTNERIEXECUTIVE E L EACH ACCIDENT $ 100,000 OFFICERIMEMBER EXCLUDED? y N / A C (Mandatory in NH) 6KUB0237MO9514 9/8/2015 9/8/2016 E L DISEASE - EA EMPLOYEE SI 100 , 000 n yes describe undel DESCRIPTION OF OPERATIONS aero. E L DISEASE - POLICY LIMIT $ I 500,000 2 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORO 101. Additional Remarks Schedule. may be attached ,f more space Is required) Sole proprietor not covered by workers comp'ensat.ion. Coverages, exclusions, terms and conditios as set forth by the actual policy. il CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CAP THE EXPIRATION DATE THEREOF, NOTICE WILL BE ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRES A 4988=2014AbCG0 PO Ti;ON. All ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025.201401 BEFORE RED IN reserved. I office of ('onsumer .%ffairs d Business Regulation ME IMPROVEMENT CONTRACTOR F egistrafaon: 102540 Type: xpiration: 72/2016 DBA THOMAS BURKE ROOFING & GUTTERS Thomas Burke 4 PARTRIDGE LANE EAST KINGSTON. NH 03827 t ndersecretary E • } l 'J 1� License or registration valid for individul use only , before the expiration data If found return to: Office of Consumer Affairs and Business Regulation f ! 10 Paris Plaza - Suite 5170 Boston, MA 02116 ; Not valid without signature UL I Massacriusens - Jeaartment o, Pum.. wery Boase Of u.r:c:ng Rcyu.... Ons anc License CSSL-098861 y Thomas 8 Burke 4 Partridee LAne (,'` C.4 U, ~_ East Kingston NEF V�',"l £Apirat♦on Commissioner 03/08/2017 Restricted To: CSSL-RF - Roofing Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For OPS Licensing information visit: www.Mass.Gov/DPS • a