HomeMy WebLinkAboutBuilding Permit #061-2011 - 28 BEACON HILL BOULEVARD 7/14/2010 BUILDING PERMIT o� NorrrH
TOWN OF NORTH ANDOVER �2 bty,"- "_ °a
APPLICATION FOR PLAN EXAMINATION
Permit NO: °4 • »�:. : .. •
� Date Received
��SSACHUS
�
Date Issued: _;/ ��
T
uOI RrT_.tAN`,r TL. Applicant
p'?�,.,ldG"ic'a5rntsmust
ust cto-m��n. p`-'le[tx ae-Kr+sairl,-tl,iJitems
ijosn, tu..t,va4is+.sw-prS.�-a"g'.r�•e
ni_ §
ri is-Kv 3a
55ZEN i r�e� a'
a--�!
HIM--*�k"�"`' u -: s.cx+sc Z. �F�y..F L > -.worJrT�wa�: a< e: r - 's" —s ',3,za .y•�,
�.�3xi' rdtt. ... -u5•.. ,y� "'"r�
E�a.,d'g`� r' . ate 'a 1- t3;�i „rF r � �- �k '�s,�s•�.� x„v
�Y r��`. .i
r� `°-'a aiy. �T. :�'�" <•m'-,-a n 3'�'�5 a�.s ✓a...�� r:r •"�in'`�w v 3a,7 i �.� r ,h bk- -r
..«Yw.Y«�+v...,��ts'__..a_,x*ii:u',�-x'n��n?-�aci��-mrd-ter%' y d i;.:!.Y��� _���i��r�'�'-T s. ,.�."�nry.�.�,e�,�`,.fe. 'a��>Itl��a. J����,� ?'�"'r"37�',��`�����•�{'"k'°:..3
_ Mt
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
New Building One family
Addition Two or more family Industrial
Alteration No. of units: Commercial
e a' replacement Assessory Bldg Others:
Demolition Other
'"� Y �' ���` �*9� 5 �!� r`�� � �7�1."��� -� .fir acs �•�r �1' g x
wi•}ry .F,vF, tt �
J�� " r ""���
�/ lJ DESCRIPTION OF WORK TO BE
JrTriPREFORMED:
Q S
`,
Identiification Please Type or Print Clearly) _
OWNER: Name: INwte /Lr Phone: 97,&- L�3" ya6S
Address: 8 Bea CGS''! Hi# jolt' in dal e✓
n � a mow"^"`�sr. �. ��.^r"��m � �Au. " 'Y�,�e� Lr�S��%.-,.x'�n��'�@��-r����`• �i�Er�:—ir�+����i�n��� .
� -t'•� 4aa. ���� ks' ""{'' _ €_:'ter:-rx'w'4' x8,. � 3t' � -rs _
�� �: � �-. . �i�i 7a'• si , f � "� Pa g d'ir'sa6A -sfi�.,..a,�'��'v.�.l.:Y v�'�5;3-'a+C Asea Fk� �
`} M y�q��p��xfr�w ?(�I� ` .r `5'r�c � y�- q,` r 3'"r ru., rs.�fy s.+.r•,,r ^+,.E ...''"s'�''?�a.f� -~
�W �i ,�Iz r't 71 �K.ru�.�••�.6�171r�i .' 7 .h"IJw� xya
,_...�.
ARCHITECT/ENGINEER 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: $ 0 FEE: $
f
Check No.: ���.� Receipt No.: co/oz
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty.fund
S�raturef�Aenl/Omer stgnatureF con ractr�r
Location RF
No. (�? f a b// Date
�oR,h TOWN OF NORTH ANDOVER
0 a
' Certificate of Occupancy $
Building/Frame Permit Fee $MU
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check # �J 2
n
f
2 3'1 02
Building Inspector
Plans Submitted Plans Waived Certified Plot Pian 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 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/Signature& Date Driveway Permit
DPW Town Engineer: Signature:
Located 384 Os ood Street
� E1P ► 1 ra �Drstrrte 3 des
Locaterlt"ill�la�tatr�et r=
t x}
A
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.s1oo-s1000 fine
NOTES and DATA— For department use)
❑ Notified for pickup - Date
I
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 Pian 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
NORTH
TO" Of
®61. 02oi I o - .
CN
_w o, dover, Mass.,
-COC HICHEWICK V
7�A0RATEO
`s BOARD OF HEALTH
Food/Kitchen
PERMIT T D Septic System
BUILDING INSPECTOR
THIS CERTIFIES THAT G SCG . ��= t.%`�.......,
............................................................ Foundation
has permission to erect............ /... buildings oD .o;& 6 .00r
..'�...... ....�..1.�......... /4 ........................ Rough
L'
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-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
Final
PERMIT EXPIRES IN 6 MONTHS
ELECTRICAL INSPECTOR
UNLESS CONSTRUCTION STARTS 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.
Page# of_�pages
�iG���l Jr'4f�tVGN ��7►K7Y4G�D!/ ,c�afJ�,3�7" ��/g
1_ic - # GSSG 9r�85�
tic - � el $ 3�4�
Proposal Submitted To: Job Name Job#
44
Address ,,// 1 ] ,/, /f Job Location
a. 4t ON 1 11 R/Mj Cls: AgA4/lft_J' S¢14f r
Date 'C' �U Date of Plans
Phone 7g y / 8 3 /�a d 5 Fax# 7 Architect
We herebysubmit specifications and estimates for:
49T . . •�K►Nglt,s O of _ ...G' b*Vp /r--7
r004' _.? �[ K5 4,f� GtlGSTr Qwa
If
_.62414t'i_ ,����. .4l. 0-_C
f
Gt _...�_,r �- _Gt.bl _ lj �r•G%G _fG ±�r_ .!✓.4G.4/l�5.__. ._
self
i
rr7eproposehereby
Jto furnish material and labor—I complete in accordance with the above specifications for the sum of:
I $ l4T �"�Gdr sGh� S r k fj�4Kdp • Dollars
with
with payments to be made as follows: 5e 570 �`a Sy{a�7' 4� O&.G4
i
Any alteration or deviation from above specifications involving extra costs will be Respectfully
executed only upon written order, and will become an extra charge over and
above the estimate.All agreements contingent upon strikes,accidents,or delays submitted
bOAjVj
eyond our control. Note'—this proposal may be withdrawn by us if not accepted within days.
Ofcceptance of iropool
The above prices,specifications and conditions are satisfactory and are Signature
hereby accepted.You are authorized to do the work as specified.
Payments will be made as outlined bove.
Date of Acceptance 4?d/d Signature
V
NC3819 MADE IN MEXICO
The Commonwealth of Massachusetts
Department of Industrial_4ccidents
Office ofInvesbi,ad ns
600 N,avhi bion Street
BO
X4 02111
11r{VIV,fj1.QSSe OV�dLQ
"A'orkers' Compensation Insurance Affidavit: Briers/Cont--actors/Electricians/PI
Applicant Information
umbers .
Name(Business/Organization/individual): PIease Print Leo-ibly
Address: ! ec,
City/State/Zip: vcr/
c�d ,
Uk Phone#: 978-�7r,/_l3/
Are you an employer?Cheep the appropriate boa:
1•❑ I am a employer with 4. I am Type of project(required):
❑ a general contractor and I
?. q �)'
employees(full and/or part-time).* have hired the sub-contractors 6. ❑Neu,construction
LJ 1 am a.sole proprietor or partner- listed on the attached sheet Remodeling
# 7. ❑
ship and have no employees These sub-conttac
working for me in any capacity. workers' tors have 8. El Demolition
[No workers'comp;insurance 5. 13 We area cemP•insurance. 9 11$ui3
required.) WPoration and its ding edition
3.❑ I am a homeowner doing all work off'ceright n have exercised their 10.❑Electrical
reP�or additions
Myself [No workers'comp• c. ht o emption per MGL 11.❑Plumbing repairs or additions
ice required.]t 1(4),and we have no
employees. [No workers' 17 �' oof repairs
Pomp.msurance required j 13•❑Other
`:-uv a�aIicaat that checkh box#! must also uet out the se tio` toQ•snot+:--..�z
vit indicating they ar` , . a — aorl as'come ^tion
tContractoIs that check doing aL work and ihed hire o r '
this box must attached an additional sheet showing the utside contxactms mast submit a
name of the seb couua urn and their work new indicating such.
I ani an employer the2 is providing workers'compensation insurance or �� power
infor natiolL f my employees. Below is P l+Lthe o '
y and job site
Insurance Company Name:
Policy#or Self-ins.Lic.#
Expiration Date:
Job Site Address:
Attach a copy of the workers'compemsataoa policy declaration age sho 'C� /S� /Zip:
Failure to secure coverage as required under Section 25A of MGL Page
lead to ththe e policy
umber and expiration date).
fine up to$1,500.00 and/or one-year imprisonment as well as c' imposition of criminal
_ualOf up to$250:00 a day against the violator. Be advised that a cc y penalties the form of a STOP WORK ORDER and tr of fine
Investigations of the DIA for insurance covers e v Py of statement may be forwarded to the
g erification Office of
I do hereby cerfify under the pains and
penalties of perjury that the inform.provided above is true and correct
Siffiature:
Phone#: M - 7 IV �
Official use only. Do not write in this area, to be completed bj,cyi�,or toxm offzciaL
City or Town:
Permit/License#
Ess
umig Authority(circle one):
L Board of Health 2.Buiidimb Department 3.CitylT own p
6. Other Clerk 4.Electrical Imp ector S. Dlumbin.
e Inspector
Contact Person:
Phone;
Information an- d 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 pe_.rson 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,partnership,association ox-other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartroLents and who resides therein,or the occupant of the
dwelling house of another who employs persons to do maintcmance,construction or repair work on sucb 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(17 also states that"every state or local licensing asency shall withhold the issuance or
renewal of a license or,permit to operate a business or to h=onstruct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of co-mpifance 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 un:-til acceptableevidence of compliance with the inCu—nce
requirements of this chapter have been presented to the cont—acting authority." ^
Applicants
Please fill out the workers'compensation afndavit completely,by checking the boxes that apply to your situation and,if
necessary,supply sub-contractors)name(s),addresses)and phone number(s)along with their cerdficate(s)of
inur=e. Limited Liability Companies(LIC)or Limited Liability partnerships(LLP)with no employees other than the
members or partners,are not required to carry workers'comp enation 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 mturnned to the vitt'or wmrn drat the al7plicat ion for the peirmrtor license is being uesFwd not the.Department of
Industrial Accidents. Should you have any questions regardirgg the law or if you are required to obtain a worlmrs'
compensation policy,please call the Department at tiie.number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Towa 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/hcewe number which will be used as a-reference number. In addition,an applicant
that must submit multiple permit/hcense 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 pits or licenses. A new affidavit mast be filled out each
year.VJhere a home owner or citizen is obtaining a license or permit not related to any business or commercial ve�rre
(i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit.
The Office oflnvestigations would like to drank 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,.mlephonc.and,fax-number._...- _
The Commonwealth of Massachusetts
Depar mmit of hidugtrial Accidents
Office of II esti nations
600 Washington Street
$fin,�LA 02111
Tel. #617-727-4900 est 406 os 1-1577-1vLkSSAFE
Revised 5-26-05
Fan 4 617-72.7-7749
uCrV1V?.MaSS._s Ov%dia
i
✓1� Z76'I)7/)77.(YILC//P� 2L✓/iLQ���
Board of Building Regulatio sand Standards
F HOME IMPROVEMENT CONTRACTOR
Registration 118384 i
ExpiratiPD-L3/7/2011 Tr# 281099
k 7f_t zrype IndiVidual ? I
MICHAEL J.SULLIVAN
MICHAEL SULLIVAN {
919 E.BROADWAY
E; HAVERHILL,MA 01830
Administrator i 1
- =---
'4 Massachusetts-.Department of Public Safety
Board of Building Rcllulations and.$tandards
Construction Supervisor Specialty License
-License:-CS SL 98853
Restricted to.- .RF
! ,.'MICHAEL`SULLIVAN
919 EAST BROADWAY '
HAVERHILL, MA 01830
Expiration: 5/19/20:
Commissioner' Tr#: 98853
,4co CERTIFICATE OF LIABILITY INSURANCE DA'E`""°MA°"Y"'Y)
7/9/10
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Barry J. Kittredge Ins Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
81 South Main Street HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
PO Box 5206
Bradford, MA 01835 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURERA: Western World Ins. Co
Michael J 'Sullivan Roofing, LL INSURER B:
919 East Broadway INSURER C:
Haverhill, MA 01830 -INSURER Or
INSURER E:
COVERAGES
THE POLICIESOF INSURANCE LISTED BELOW HAVE BEEN ISSUEDTO THE INSURED NAMED ABOVE FORTHE POLICY PERIOD INDICATED.NOTWITHSTANDING
ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MY 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 PAIDCLAIMS.
INSR ADD' POLICY EFFECTIVE POLICY EXPIRATION
POLICY NUMBER LIMITS
GENERAL LIABILITY EACH OCCURRENCE $ 300,000
DAMAGE TO RENTED
A X COMMERCIAL GENERAL LIABILITY 14PP1167127-2 4/28/10 4/2811 PREMISES(a occurrence) $ 50,000
CLAIMS MADE [i]OCCUR MED EXP(Anyone person) $ 5,000
PERSONAL&ADV INJURY $ 30Q .000
GENERAL AGGREGATE $ 600,000
GEN'LAGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OPAGG $ 600,000
POLICY D PRO LOC
AUTOMOBILE LIA13 UTY COMB INED SINGLE L IMIT $
ANYAUTO (Ea accident)
ALLOWNEDAUTOS
i BODILY INJURY $
SCHEDULED AUTOS (Per person)
i
HIRED AUTOS
BODILY INJURY $
NON-OWNED AUTOS (Per accident)
I
PROPERTY DAMAGE
I
(Peraccidert) $
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $
ANYAUTO EA ACC $
OTHER THAN —_
AUTO ONLY: AGG $
EXCESS I UMBRELLALIABILITY EACH OCCURRENCE $
OCCUR CLAIMS MADE AGGREGATE $
$
DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION WC STATU- OTH-
AND EMPLOYERS'LIABILITY y/N 11M _
ANY PROPRIETOR/PARTNERIEXECUTNE
OFFICERMIEMBER EXCLUDED? E.L.EACH ACGDENT $
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $
If yyes,describe under
SPECIALPROVISIONSbelow E.L.DISEASE-POLICY LIMIT $
OTHER
I
DESCRIPTION OF OPERATIONS!LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Roofinq
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OFT HE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THEE XPI RATION
DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 20 DAYS WRITTEN
Nancy Melvin NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL
28 Beacon Hill Blvd IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR
North Andover, MA REPRESENTATIVES.
AUTHORIZED X PRESENT THE
ACORD 25(2009101) V9f2000 PICORD CORP TION. All rights reserved.
The AC ORD name and logo are registered marks of ACORD