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Home My WebLink AboutBuilding Permit #30 - 3 ALCOTT WAY 7/13/2011 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: D Date Received Date Issued:_ 1 IMPORTANT:Applicant must complete all items on this page LOCATION A utfi wast Ptint PROPERTY OWNER Unit# Print MAP NO: �' PARCEL��ZONING DISTRICT: Historic District yeJno Machine Shop Village ye-A 100 year-old structure ye TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building 0 One family 11Addition El Two or more family El Industrial ❑ Iteration No. of units: El Commercial epair, replacement ❑Assessory Bldg ❑ Others: Demolition ❑ Other ❑ Septic ❑Well ❑Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTIO WORK TO BE PERFpRMED: AM 14 ti I' (Identification Please Type or Print Clearly) Phone: -7�" 2°g-7 ( OWNER: Name: L U Address: �cA W��I CONTRACTOR Name• d i ce i toldif Phone: V�- 7i{5- Y Address: 5 Bfl J4oJ >g j e , AqA 011-70 r Supervisor's Construction License: Exp. Date: 1013111 Home Improvement License: ! 62 722 Exp. Date: e4/1-11: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 7 3 1• y-5 FEE: $ Check No.: (aSpd �� ` �� 1 Receipt No.: NOTE: Persons contracting with nregistered co actors do not have access t t e guar d gnatu_re of Agent/Owne Signature_of contracto_ Location lea Z.-V No. C NORTH TOWN OF NORTH ANDOVER 3?O••",D • •hO O O � Certificate of Occupancy $ A Building/Frame/Frame Permit Fee $ a�cMust 9 Foundation Permit Fee $ Other Permit Fee $ _ TOTAL $ Check #67� 24 ;'j0 wilding 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 ❑ i i 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 ` d V Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments ' f 4 Conservation Decision: Comments Water& Sewer Connection/Suture& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT -Temp Dumpster on site yes no Located 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 i ❑ Notified for pickup - Date Doc:.Building Permit Revised 2011 June/mi i 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 1 ❑ 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 i ❑ Floor/Crossection/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 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 u 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: Doc.Building Permit Revised 2008mi i 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 i ❑ 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 i 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 ❑ Flo or/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) f ❑ 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) o Building Permit Application ❑ Certified Proposed Plot Plan o 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 j 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: Doc.Building Permit Revised 2008mi The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 1 Congress Street,Suite 100 Boston,IIIA 02114-2017 wpm mass.gov/dia f Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumoers Applicant Information -DeAPlease Print Ledbly Name(BusinesslOrganization/Individual): �p' Q fMI 11P Address: 5"tris+e0 :51-. City/State/Zip: �l d D Phone#: �� --71fS— 5 3LY Are you an employer?Check the appropriate box: E] I am a general contractor and I Type of project(required): 1.❑ I am a employer with 4. employees(full and/or part-time).* have hired the sub-contractors 6. New construction 2. I am a sole proprietor or partner- listed on the attached sheet 7. ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' [No workers'comp.insurance comp,insurance? 9. E]Building addition required.] 5. ❑ 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 MOL 12.❑Roof repairs insurance required.]t c.152,§1(4),and we have no employees.[No workers' 13-El Other comp.insurance required.] *Any applicant that checks box#I must also fill out the section below showing their workers'compensation atiom r Homeowners who submit this affidavit indicating they are doing all work and then hue outside contractors moust submit a new affidavit indicating such. 'Contractor,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. lam an employer that isproviding workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: ?axlll &P �� Policy#or Self-ins.Lic.#: Aj S U� 5 2(�,5 Expiration Date: °6 ll Job Site Address: ic_-JN W6, A^n City/State/Zip:_N./. naQr cr /"Ui of g`ts Attach a copy of the workers'compensatio policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL e. 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. d do hereby cern under a aln and ertaltles o er u that the in ormation provided above is true and correct Si ature: . D ate —.. Phone#: F fficial use only. Do not write in this area,to be completed by city or town official ity or Town: Permit/License# City Authority(circle one): I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other } u • °�:4:+ti.iii�il jil t'- U:'?E:.:•!ilt4't'S1 !t }i±;;,itJ' s.iti'�k . ��iiti"(t +i} i�.c2:lti7S3°� ?' ':• . - °>I,S?(�' l " MW License: C8 82193 Res(ricted t0: 00 ! ` I MICHAELT DEMILLE 5 BRISTOL ST SALEM, MA 01970 !" 1002011 8801 Board of Building Regulatioga and S3sndfirds ROME IMP ROVEMEh1T CONTRACTOR' { °_ Registration: 142722 EXP0440n: 4/6i20II i. Tei.. 282586• Type: Indtvidual MICHAEL THOMAS DEMILLE. .MICHAEL DEMILLE 513KISTOL ST SALEM,ASA 019'70 —'`"— Adminislrater t t?4Ats3 �,•�ealr�o,t�� Ir�t ar�u{�e�ts Office o1fCFonsnmcr airs Business ern t?oo License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return.to: Registration: .162722 Type: Office of Consumer Affairs and Business Regulation 'Expiratioer. 41612013 Individual 10 Park Plaza-Shite 5170 MICHAEL THOMAS DEWLLE Boston,MA 021I6 MICHAEL DEMILLE 5 BRISTOL 5T 4itotalid SALEM,MA D1970Undersecretary w �-d -1dV i h ' Ac;P 1Y./gyp'/p�O/p� . CERTIFICATE OF LIABILITY INSURANCE FFMOUCMso/zy/z0aa', 94 1 M AGO= AS A ONLY AND oOW M 1i M UM1 THE CWr TE 9� z STRM CEMFICATE OM HoT AMo, Ewa. OR � DRAWN, in 01960 ALTER COVER►dE AFFORDED BY THE Power sia4m f JN3URMAftRDMcovERwEt+wc AffRB >]>hr'rr_T•.Tr dba 2D caisTROCT7010 -mMM&'X0MTMMWUMUR = CO. 5 Bm"m MAD ats+ReTe RALMI Mk 01970 INSU RM tt OOVER INSUMP ' THE POUCIEB OF INSURANCE llsiED BELOW HAVE MM MSUED TO THE INSURED NAMED x MAY Rb4UpiEMENT. TERM! OR CONORIDN OF ANY OONP V&r OR MHER 00CMW THE POLICY 1 R1oD INDtCATEO. Nd1NfRHSTAl NG MAY PERTAkI, THE INBUIZANCE AFFORDED BY 7fiE POLIq� p D HEREIN IS M WHICH THIS CErt MATE MAY BE MWM OR POLICIES ATE UM1FM SHdMM MAY HAVE BEEN REDUCED BY PND OAM SUBJ TO ALL TFIE TERMS, EXCLlH;[ONS ANO CONMrgM$ OF kSUCH LTR wiup TYrEOF MMAmpcW ,NSR POII6Yf3FEniYE rater 8 oesrALUAsanY aftTEoaruonrf tans gCOMMEMALMMAJtwamF "�"00MMOCE6300 100" =045265 11/02/2010 11/02/2011 Mmur gAtifSmue ®ppaR (Eaamnn� S 50,000 AIEDO�fNC/anr f�sai0 i 5 r 000 $300,000* C@!lA 1TEUMrrAaPLf®P8t �GENSI�ALAGMMWM s b00,000: R pcuCY FRM Lao -COPAOG s 600,000.: jeryLVA nY AWAUrO �® �. - ALLdmAwAfrm c�°mewq s AUTW URY 04rpanad i NgEQA{fTQ$ . WN-01Vlm AUfbs 9001t.YfN uw O'QaaAtanq s .. i VAPAM PRIM pws� i MNAM AVO ONLY.MACC OW i OT►if�tTlfAN fiAA= s tulenm AMVKY. AM i 00MF7CLAHMMAM ffACMCCMRVMCE , AIX�AT6 6 , MENMN f]H711G71EtE i " g = TiDfai�itb 601iF71rIN10N AIfD ! L'iO60YERPlJA®LTFr Tref UMfIS ER 6 OI#Ri>ifts/satper? EL EACH Ao^,IOgW s ry.,dtia3s ober EL f� EA 6P�ALfe�, 94PLOYEf 3 ot» eLwMEe-P0=rUWr S ' UESGRIPfT0710POrERA710tl6/LOCAti101TiTVEIfIfi68f19iC[AANOaprr GlWRf9®IT18PE�ig6YRDlAmorfs i i CER7fRCATE HOLDER CANCELLATION TOM or Boxamm 7A mpommm 1w roman Aw CIO TM AMM f oUf:Bb rea CANCEi t� Ef3MM TME E7MKMM GTI! Tlomvq Tiff ®areas HILL rap"m To WAL 10 2027MW MA 01923L airs Warm Wm TO Tia CMTPMM NW-00 wmw To Tim aarr, 4w AA"M To ao so`.mtLL oroo� w OBUDATM OR Lr SKM OF Aff MM UPC* TM wwwmtna AflEW8 OR Tm I TO'd SO:ST 01w VT 32q JRq(;T•SgR)F,:XP4 xl�ftf�fncair �iharlu i )IIL-06-2011 (IJED) 14: 19 Diabetes & Lipid Research (FAX)314 362 4833 P 003!005 Rx Date/Time JUL-06-2011 (WED) 13:59 2011-07-06 06:58 P. 003 t , installs 7815375464 >> 314 362 4833 P 3/4 OQttY1901e0 dpDt t,RR Dt M*f,An xQryl,rosofwW..= i ' =CONIRAACT;g 0 0 0 0 8 8 9 MASSACHUSETTS EXTERIOR SOLUTIONS INSTALLED SALES CONTRACT w3rgLLED SALl9 SPCcw IST NUMBfiR cusTOM�q )) i tN E 21 aI,t 4.iv STORE NO. STREEYAOGRt:SS g$ L. �TQesTAo Kees AL,a d $TATO 21P GRY STATe ZIP /U �Kt�YKr mA TCLLaNpNE TELEPHONE CATER PQe�Qra C6NT6R5,INots Ma ICNo. 10601) r— � gesso II � Tfife only a Q010 fccft Marchand 4 and eeMan p"w bdow.Thb(Mea M2 M J CMMOC doeumenL tho Torma and Caul Included With M rt4rwftmt and Teta�n p&baa� Uson paY�6 the en1Va aQra.nyn<Mc4dlrtp pro spoelAr�ly aanpbled P0t7ae of it la PLEASE REAOALT5Am$ANA t:ON=ONS ON THE REVERSE SIDE of TM gep�MEMO t:o�OMNO A=BEFORC g G NG a �t1orL' INSTALLATION STREETAODRE$$ OT U,� W STATE 2rP 3 JA\ lov' I Sf�l3' raG 6 i�nta�' Yr♦�r.�...M ♦ A ILR Ntin.4, 1'1 � r, • � I t Ah c 11a .!t pr��. ,�.�t�.,ct , �s � PIV.�. fi s.4 CPA (.d-1 cC..A �...�, ►.., j Contract Total Ars permits required for this instabtion?:Iles l ]No applicable tax included I- i l.`{5 --------------------- NOTICE TO CUSTt91UlER: Fadoral law ra utros L p y OU With acknowledges haying rocalvad a copy of this pamphletabofowork bogs Inform/g Customo of the p tont/I rilsk ofthogning lload hazard oxetomor from renovation 2CVvI to be armed In Customor's dwolArt unit posuro PHOTO RELEASE,Customer grants to Lowe's and Lowe's omployaes tho right to tako photographs of ell work performed at the Premises related to this Contract,and irmvagbly Grants to Lawo's;w right,Udo Ond Intorost in and to the photographs for use in all markets and media,worldwldo,In porpotulty, Customer whorizzoo Lowe's to copydpht, m and publish the photogmpns in print and/or olactronlcally, Ong 09W$ that Lowe'6 may use such Photographs for any lawful purpose, including,but not limited to markoting, advortlsing, publlaty, inustratlon, training and Web content. B lnitlalin hero,Customer agrees to tho forogoing..(Customor to initial to tho roti). y g Work Is to COMmonCe upon reasonable availability of contractor andlor any spacial order or customer mado Geod(s)which is anrtcipat4d to bo �R ? (Me In date).EStlmated completion data Is T'F3 tfUt in date], Said ostimalod substantial completion date Is not et the essence. A statement of any contingencies t completion date is as follows; hat would malariaHy change said 9stirttatod substantial pf applicable,inseft-2 statrnent of such contingencies). IF TH CONTRACT TOTAL IS$1,000.00 OR LESS Customer must pay in full, CO 'ET THIS SECTION ONLY WHEN THE CONTRACT TOTAL�( moS 61,000,00: f Custemer to Pay In Full; OR ( ]Custamar 1115 use the follewing payment schedule: (T)Doposlt to be pard upon srging cpntraet,Ooposlt should bo 113 the total contract prtco:and (2)Payment of$ to be paid anytime after this Contraet Ig signed and hpfora commencement of installation,IlVtre authorize Lawa's to do one of the following(dleck aPPMpriat6 hex below): 1 J Chant)my/our cmdrt Card for the amount of the paymont Indlcatod aboveartytimo after the data this Contract is signed: ar � ' ORTfy TO" of �, _ Andover No. 0 .30 , .2o 4. * _ _ 0 - o y dower, Mass.,,71 • I'� 1 T O �COCK LAK > CICME WICK �d ADRATE D P P'V C5 S BOARD OF HEALTH PERMIT T Food/Kitchen Septic System • BUILDING INSPECTOR THIS CERTIFIES THAT .............. .......... i .s..........�. ................................... .. ............... ........................................... "" Foundation has permission to erect........................................ buildings on....a...................��. ........W.i...` .....#................. Rough to be occu ied as � ..,.... Chimney p" :.. :.. provided that the pe n a epfing 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 3 J . PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUC O ST LTS ELECTRICAL INSPECTOR ................... ......................................................................................... 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_jl Smoke Det. JUL-06-201 ] (WED)(DIED) 14: 19 201 ....,..,.,,. . Diabetes « 4 LiPid Research (FAX)314.,,• • .,,,,. ,) 14 36E 4833 P. 004!0n05 ( )Doposlt my/our chock for amount of te ft the pscatMabovo d � (3)Flnal payment of$100.00 to be Paid upon completion of the tallla on afta a bboth Pafime aftaadha daemul c3lon.te Ihis fact is signed:and NOTICE BE LaWE'S ANO OWNER HEREBY MUTUALLYAGREE IN ADVANCE THAT IN THE EVENT LOWE'S HA$A DISPUTE CONCERNING THIS CONTRACT,THAT LOWE'S MAY SUBMIT SUCH DISPUTE TO A PRIVATE:ARBITRATION SERVICE WHICH HAS BEEN APPROVED BY THE SECRETARY OF THE EXEC UT- EVE OFFICE OF CONSUMER AFFAIRS AND BUISNESS R6GULATlONSAND THE OWNi=R SHALL BE RQQUIREI�Tl?SUBMIT TO SUCH ARBITRATION AS PROVE IN M. , ,C.14 By: Lowo's Ho C tors, 0, Data: By, Owner S oturo Data: THE SIGNATURES OF E PARTIES ABOVE APPLY ONLY TO THEAGRE:FMENT OF THE PARTIES TO ALTERNATIVE DISPUTE RESOLUTION INITIATED BY TION Al OVE IS N TO MERA c 94ZA THE OWNER MAYBE PERMITTED TO INMATE ALTERNATIVE DISPUTE RESOLUTION EVEN WHERE THE SECTION ABQVa:IS N07 gEPERATELV SIGNED BY THE PARTIES, DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES AND UNTIL YOU HAVE READ THE TERMS AND CONDITIONS CONTAINED ON THE REVERSE SIDE OF THIS PAGE AND THE FOLLOWING PAGES OF THIS CONTRACT. � BY SIGNING BELOW,YOU ARE ACKNOWLEDGING THAT YOU HAVE READ,UNDERSTAND AND AGREE TO THE TERMS AND CONDITIONS SET FORTH ON THE REVERSE SIDE OF THIS PAGE AND THE FOLLOWING PAGES OF THIS CONTRACT_YOU ARE ENTITLED TO A COPY OEF'1 HIS CONTRACT AT THE TIME OF SIGNATURE. WITNESS OUR HAND(S)AND SEAL(S)BELOW THIS_9 PAY OP hVL Lowe' m C eters, i i I ' I