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Home My WebLink AboutBuilding Permit #410-2016 - 28 WOOD AVENUE 10/1/2015 NORTH Olt 4U10 r BUILDING PERMIT o TOWN OF NORTH ANDOVER ° , o APPLICATION FOR PLAN EXAMINATION, Permit NO: I/� �� Date Received �� '� C. Arm f, Date Issued: I IS SSACHUS� IMPORTANT:Applicant must complete all items on this page LOCATION_J5 11) PROPERTY OWNER 'J;,e_1/y 4a.VNl Print MAP NO:n_PARCEL: ZONING DISTRICT: Historic District yes o Machine Shop Village yes 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 ❑ Septic ❑ Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer Identification Please Type or Print Clearly) OWNER: Name: Irl)cpm)►? -r �,Yi 8te- l 'Dl C K Phone: CP&03- R-Wa Address: A AYf- N)Gi'rei ArdoV er HA QIP-15' CONTRACTOR Name: a Phone: /7^ 7 . Address: T� Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: _ cr 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: $ I a�'l 6. FEE-. $ �� Check NO.: /32/1 Receipt No.: 21'A10 NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund Signature of Agent/Ownerrl(D Signature of contrac J v ~ ~ d Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swirmning Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales El Private(septic tank,etc. ❑ Pennanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY � INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS t CONSERVATION Reviewed on Siqnature i COMMENTS i HEALTH Reviewed on Signature b COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments r Conservation Decision: Comments Water& Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE:DEPARTMENT - TempaDumpster on site> yes;._ _ _ _ _ no, tLocated at 124 Main-Street Fire Department signature/date 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 Call Email Date Time Contact Name Doc.Building Permit Revised 2014 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 a 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) ❑ 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 o 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 2014 } - N r Location '4-e- No. bate . • TOWN OF NORTH ANDOVER . Certificate of Occupancy $ Building/Frame Permit Fee $ jq( Foundation Permit Fee $ 'A �^ Other Permit Fee $ TOTAL $ Check# Building Inspector 2 440 NORT11 Town of t E 11, Andover z i No. Q - �oh ver, Mass, LAK§ row C OCHICMWICK y1• �d AERATED �'P¢,`�y S u BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT ................� w'' .......... .,, BUILDING INSPECTOR has permission to erect ....... buildings on ..;A.......&0amd.-1 Foundation p ... Q� ......+.....1� .. . ....... .... Rough y to be occupied as .. ..rt. Chimney provided that the person ccepting this permit shall in every respect conform to the terms of the lication Final on file in 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 Rough Service ................... ... ................................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building 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. Smoke Det. North Andover MIMAP September 30, 2015 Y 01) x: x k I O � A' , y 5� � rf R MVPC Bo Interstates Horizontal Datum:MA Stateplane Coordinate Sysstem,Datum NAD83, —I Meters Data Sources:The data for this map waproduced by Memmack —SR gORTM Valley Planning Commission(MVPC)using data provided by the Town of Roads Qf ae qNonh Andover.Additional data provided by the Executive Office of ,Easements _�� r�>•��p Environmental Affairs/MassGIS.The information depicted an this map is ❑Parcels 3 _ C for planning purposes only.It may not be adequate for legal boundary N :-^ '"` 9 definition or regulatory interpretation.THE TOWN OF NORTH ANDOVER MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING t # THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY OF THESE DATA,THE TOWN OF NORTH ANDOVER DOES NOT #0 _ >� # ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF THIS INFORMATION HU 1" 1"=51 ft ^�° W A I TE CUSTOM BUILDER P.O. Box 1056 Bedford,MA 01730 781-275-7755 Benjamin and Kristen Dick 28 Wood Ave. North Andover, MA September 24, 2015 Replace 2 Doors and Install Under Deck Shield Permit 280.00 Doors 3,525.00 This includes a new rear door, hardware and storm and a new front, hardware and storm. Certainteed Under Shield 2,580.00 This includes materials for under the deck shield by Certainteed. Labor 5,600.00 Labor to install doors and under deck shield . Demo Removal 225.00 Total 12,210.00 ti Let me know if you have any questions. Thank you. Regards, William H Waite Jr Accepted: , �,, t,^ Date: A Deposit: 4,070.00 Doors Installed 4,070.00 Balance on Completion i 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 Le `bl Name(Business/Organization/Individual): gyt Address City/State/Zi' Phone M 11742 AWI 7ama employer. Checkeck the ropnate bog: Type of project(required): 1. employer with 4. I am a general contractor and I 6. 0 New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. emodeling ship and have no employees These sub-contractors have g, E]Demolition workingfor me in an capacity. employees and have workers' Y P tY• $ 9. ❑Building addition [No workers'comp.insurance comp.insurance. required.] 5. E] We are a corporation and its 10.[]Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself.[No workers'comp. right of exemption per MGL 12.0 Roof repairs . insurance required.].t c. 152,§1(4),and we have no 13.❑Other employees.[No workers' comp.insurance required.] *Any applicant that checks box#1 mast 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. tContractors that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have employees. If the subcontractors 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 sue information. Insurance Company Name: rI y -- Policy#or Self-ins.Lic. � e, D Expiration Date: Job Site Address: U �nt J City/State/Zip. njl� /-{k d l'e — 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 carfih ut er the wins nd penalties of perjury that the information provided above is true and correct. Si ature: Date: v r� Phone# �� `1 � ' 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#• 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(les)must be endorsed.If SUBROGATION IS WAIVED,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 Ileu of such endorsement(s). PRODUCER CONTACT NAME: HUB int'I New England(WILSB) PHO,NEo, Ext: A/C,No 978 657-5100 978-988-0038 ,VC N 299 Ballardvale St E-MAIL ADDRESS: Wilmington,MA 01887 INSURER(S)AFFORDING COVERAGE NAICd INSURER A,Essex Insurance Company INSURED INSURERS:Safety Insurance Co 39454 William H.Waite Jr.,Inc. INSURER C:AEIC P.O.Box 1056 INSURER 0: Bedford,MA 01730 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: 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 CONTRACTOR 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 TYPE OF INSURANCE ADDL UBR POLICY EFF POLICY EXP /DLIMITS LTR INSR WVD POLICY NUMBER MMD MM/D A GENERAL LIABILITY 3EA5413 6/11/2015 06/11/2016 EACH OCCURRENCE $1,000,000 COMMERCIAL GENERAL LIABILITY PREMISES Ea o.Tur ence $100,000 CLAIMS-MADE N OCCUR MED EXP(Any one person) s5,000 X BVPD Ded:1,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $1,000,000 POLICY X PRCT O JELOC _ _ _ $ B AUTOMOBILE LIABILITY 3800078 5/01accident !2015 05/01/201 COMBINED SINGLE LIMIT Ea ANY AUTO BODILY INJURY(Per person) $250,000 ALL OWNEDSCHEDULED BODILY INJURY(Per accident) $5500,000 AUTOS X AUTOS X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTOS Per accident $100,000 $ UMBRELLA LIAR HOCCUR EACH OCCURRENCE $ EXCESS LI►B CLAIMS-MADE AGGREGATE $ DED I RETENTION$ $ A WORKERS COMPENSATION WCC50050149492015A 8122015 08122016 X W RYTLMR ERH AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $500,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $500 OO If yes,describe under 5 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMrr I$500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,it more space is required) CERTIFICATE HOLDER CANCELLATION Town of North Andover SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1600 Osgood Street,Building 20, ACCORDANCE WITH THE POLICY PROVISIONS. II Suite 2035 North Andover,MA 01845 AUTHORIZED REPRESENTATIVE (6/10 egaw"12,0wareall oa�ac�ivaeG i + Office of Consumer Affairs&Business Regulation License or registration valid For individul use only ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Type: Office of Consumer Affairs and Business Regulation gistration: 19065 10 Park Plaza-Suite 5170 xpiration: _61.81201:6�- Private Corporation Bostoh,MA 02116 1 ® 1W-1a 1 WILLIAM H.WAITE JR INC OR i William Waite ! ,! G � ,fit)Great Rd i ga< F� Bedford,MA 01730 �Y f Undersecretary 44E.lid without Signa l Massachusetts -Department of Public Safety ing.Regulations and Standards Board of Build Construction Supervisor 1 License: CS-007381 I WLi,LIAM H WADE JR'" 6C DORIS RD - I6173 � BEDFORD MA al ltA•x Expiration i �,.G. 12/10/2015 1 Commissioner r _