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HomeMy WebLinkAboutBuilding Permit #134 - 30 MILL ROAD 8/20/2007 BUILDING PERMIT "°pT" qti TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: Date Received _ 9 0' • '�« Date Issued: O�T • -d cHus IMPO TANT Applicant must complete all items on this page r LQCATION w / .R ?S* ' PROPEI?TY 01NNER T t :fir ' _?. p. W - 4 � .. lachnne op Valla e _ 4 yes TYPE OF IMPROVEMENT PROPOSED USE Reside Non- Residential New BuildingOnefa_miI ddition Two or more family Industrial teration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other " Sept« Well �etla��is� �� �` ater � si�ed Dis#r�ct Wad'el:/ e.YY f-- DESCRIPTION OF WORK TO BE PREFORMED: n aP 01b ve -fnv,.",j Pn4 Identificatio Please T _ or rint Clearly) OWNER: Name: c7 Phone: 0) )I'_ (pt� Address: JW w y - n. a. �n� '� �.• '� ;�,, � m`� ��t CONTRI CTa Ty ri e Z ones 74 Address s r � r xP i r 77 � .2. ^ ' }Supervisor's Cons#r�act�o� L�cnse ��. _ I #e 77 N ? - p 'c't .c.,r`°� � -�3 Home I 'e ml ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BOLDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED 6N$125.00 PER S.F. Total Project Cost: $ noo FEE: $ / Await Check No.: CQO '3 0 S—/ 0 Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access o t c guaranty fund PAP ture of cor�tracto 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 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 ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic y 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 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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 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 ^E REJECTED DATE APPROVED CONSERVATIO (� COMMENTS VIA DATE REJECTED DATE P OVED HEALTH 29167 COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted ye; Planning Board Decision: Comments Conservation Decision: Comments Water $ Sewer Connection/Signature&Date Driveway Permit Located at 384 Osgood Street Ikf DEPARTMaNT TempDu tipster o site¢ fires`: j rio SY= Located at 1 z -barn Street Fire�eP Amerat°�ignature)c�atez .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 5 ❑ Notified for pickup - Date Doc.Building Pennit Revised 2007 Location 1P / j%?/' No. Date01 �� MORT" TOWN OF NORTH ANDOVER h A ' Certificate of Occupancy, $ CM <� Building/Frame Permit Fee $ r Foundation Permit Fee $ Other Permit Fee $ �- TOTAL $ .fir# Check # a 3 2 0 5 1 0 -----� Building Inspector NORTH 0VM O Tf And over No. 3 �y � T C% LAK O over, Mass., FS' y•0�' COCHIC FIE WICK ORATED P`P�t�� BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT I �ls �ej h.........1,��'d................................................ . ......... .... .... ................... .................................... Foundation has permission to erect........................................ buildings on ..130.......1-h1ut........10............................................ Rough u 'r to be occupied as..57 1(2.1....... . O �. �b 04��1.�l1.....�e.................................................. 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 PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTI ST TS ELECTRICAL INSPECTOR Rough ............... ...................................... . Service . .. ........................ ..... BUILDING INSPE 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. l jf f � • f � i I / i i i >/A/6/,/ .:2/-- esi • <<'TS j n f C IJ. W If f ;` �� •� ,� f Np 00 Q� 9�/V/(7 tl o - f ,oL � � c •��/ � 7 � D N f I o8. p� r • off j s. 9 � a;o MP OF E LINE ABOVE GROUND POOLS AT REASONABLE PRICESI t • The Industry's leading "ON-GROUND" Swimming Pool. • A Swimming Pool built to withstand the test of time! • Materials impervious to rusting or corroding! • Backed by the BEST Warranty available today! • Factory Installed (The only Swimming Pool Company offering a factory installation!) • A Service Department second to none, ready 24 hours a day to handle .all of your Swimming Pool needs! • A Swimming Pool awarded the Safest Pool Available! • Maintenance FREE! Eno our summers without the work of cleaning! Enjoy g • Flexible Finance-plans make it very affordable to own the very best! SIPEXRL DISCOUNTS FOR HOCKEY FAMIUES11 I CALL ARTIE 1E AT 781n7l"A" A'k252 -= 9. y 4 t OR SEE ME AT ANY "99" FREEZE GAME r� tt `WJ NH CT RI MA �,. . . c, VgINES. a DIAMOND POOLS m _ -S 11 0 Sfate Sfreet, Ste 7O0, Boston, MAO21O9 ' 428887"224, '21r7�Fax 85.6 773 pO`441` www Dfam�ndPool coin ©lamdnd Pekoes Inc (''Seiler") �, +�a � z. agrees to furnish a8 materials and labor necessary to do modern¢aUpn work:on the pr."emeses located"at the.followmg.address subtecfto verification.of the price of work by seller and to approval of Buyer s ire rt . ,. . �' Kn AAIM �+f Name.of Buyer Home,One — Work Phone Gell Phone + � Q Fax Address f5ate City /f/'r. �lJ StateJ Stix i. rwt `t✓ . l CARIBBEAN QUEEN ;sales>Pnce / 4✓ p ' t eposit x. SPECIFICATIONS AND F TUR S __.-.per--�^�._ a x -�+"' _ �+� Pa merit on Deliver $� ` 3 7 x 2,1=�,overa(I�k w y ¢ . yih � – —� n c1_.5 30}Swim fXea; r ` fF+ . � f 1.7 'jORD Aluaturn PatioDeck Y t )Payment i Color coordinated In aztareblue and white Payable$ per:rn6nth in install All;aluminum construction Q Aluminum walk an round deck surrounds entire pool. rnents be mai �da s after complefion g 9 f, y x Al qminumsqfety fence with privacypanelsy ;R r €� ;,,i y Heaver extruded`'a1uminum vertical supporfs •tNOT�CE TO BUYER Aluminurn:sidewalls.that.neveP need,pamting: 1 Do not:sl n this�a reement if"an of the s aces Vinyl acrylic finish O g g �' p rntentled for thexagree"dterrns to,'the extent of then _ Intl a #amatsklrxim°er - -T= available rnforma�ion are leftfilank (2)You are entitled to Aftaminum In pool ladder. y a dopy of this agreementat the time you sign it (3)You Self lockin aluminum eztenor ladder y M v 1 g rnay4 anytime pa�3 off the full unpaid balance cup;un er 20-gauge`vinyI liner Terrazzo Design bottomt - h is' andm so�domg you may receive apartial. Space age water purificatlo"n+systern s rebateof the financcharges. 30'year.transferrab, firnited factory warranter'; ` �w Pool Cover Not�lncluded y L SellerFiereby agrees tolrlrhish aborand:materials necessary to Complete the work ljerem agreed upon#and detailedabove for the sum ` � , specified t3erem and;accordmg to the terms embodied herein Fulfiillment is confmgent�tiowever upon stakes fires rnatenals and labor availability„ o:rotherconditionsbeyondcontroloftheCompany 'Seller}agrees'to}car�rlNORKMENSrCOIPENSATIONANDPU�LICLIABILITYINSURANCE on all work detailed tPereinmy ,F It is understood?and agreed that nonother bitails'Terms and''Conditlons expressed or irnphed flava been agreed`upon except those stated p 9 harem and that this Contractcouers;and sti ersedes all Conversations Statement or A reements between the Parties hereto,their Agents,or Representatives. Buyers)agree that;upon completion ofThe work,according to terms of the agreement that.paymert shall be.promptly made according.to those. terms or,inahe instance of firancmg arrangements to promptly provide a certrficate'evidencing comple""tion and whatever otfierdocumerits:as.may :beregwretl;bythelendinginstitution . g g g, ..,-, .,. E . y,...p., g„ , r the reverse side �. AGREEMENT You a ree to be bqund b the rovislons of this# reement IncludIn those on r YOU THE:BUYER MAY:CANCEL rHIS TRANSACION AT ANYTIMEPRIOR`T;O'MIDNIGHT,OFTHE THIRb BUSINESS IjAY AFTER THE DATE OF THIS TRANSACTION SEE THE ATTACHED NQTICE°OF CANCELLATf ONiFORM FOR AN EXPLANATION OF THE RIGHT." By si inn he a reement,you acknowled a recei t of a cgm letei felled m oo � g g g gL _ p p y py ,o>l his agreement,completed copies. the;attache8 noticeW cancellation and confirm that you have been orally informed-of your right totZancel Ali equipment and materia s delivered to the)ob site premises:;regardle'ssbf whether Inco"r.'porated in the property ornot remainsthe property of . the dealer-until fully:paitl for ,Qwner(sa, g`ee4 that the dealer shall have access to the same at all reasonable times untii:paymen't is full hereunder: Any materials not•incorporated into thework performetl Fiereunder'remain'ttieproperty ofthe dealer Owners)warrant that the pool sue is wifiiin property lines Viand agrees to assume responsibility to provide adequate:roadway ingress to working.area It is agreed-th.at the Owner(s)will<supply;viater to;fill thepooliat the Owner(s)_expense"..Installation shall be deemed complete when t pool is ready to be;filled with water The partes.hereto further agree that this contract doesnotanclude electncaliwiring,or landscaping of anykind. l� Gontractoragrees.to start above d cribed rk on or out and coin let :work on or about (SEAL) (SEAL) ' Nam f SO r ,! tura of Buyer) g i f -(SEAL) y ( _e) (Title) (Signature m ye r) AUG-07-2007 15:51 P.01/01CER PsaoucER INSURANCE GS Do DATE1Mi19,'DtNyYYTI Xnai:ranoe Ranagament T'fif3 CERifFICAl IS}55UI l]qS l -1 07 03 07 P 0 hose 7 79 ONLY AND CONFERS NO R1Gtlt���R OF INFO RMATiGN VoorhBe& NJ QSO43 �Ll3�;fii,THM GtRTfFiCA'(F DOFS Nt�r CPRTIFICATE Phonn. ALTERTHE co f2AGfw AFFORD M�idD,F-XTEN6 OR 855-784-Q7Da - -- — -•-.--�",.�'��f'�1CIESBELCfW,' -'^ - - ._.• - -• - NAlC tno Co a8-t1ia Mtrf=ae: �23TRO33C� I1 lI$� 7@S iN ti B._ ilu�Ce_rd uea,�wr{tare aa-- -•,..._..--- P2612 48th Street e. co,Pennsau kn N� {8209 INSURER - IrtsuRl�� .. COVERAGES RdP rOLiC013(IF iI4SURA ANY RFgilfRFMENT.T. NCE i'tSTfiD RFLOW HAVE t]E€N iS41JEJ)F(� .-- 1 RM ORLON;MN DF ANY CON tRACF DR('D T f 14MIRED NAMEO A80VE FCJ NlAY rERrAtN.Tf1E INSURANCE;ArE ER boGUM1 N'f wtri#FIRSPECT Tortw�i C}crcY�RtuU iNOICATFI).NOT r POLY 1E5.AC;ORFGATT LIMITS Si{QY1DgY��fhrflE POL(CiES bES wlT�i aFANDiMt3 _ _ CRtt3i=At1ElREiNi3SU&JP F •0 � fE FAtiFrA7FA. BEEN RFbUI;ED 8Y PN15 CLAEMS. MALI. IE TF+1Me,Fxu.0,KINS AND�ON��)NS o Y 13F jsgUpt)O51}CEE QTR NSR _ TYraa:or•iNSURANcE —,— — •—".--•—-- ("E FRAL LIADILirY POL CYi NUMER- Y X _ _ -�,L_ Ari At X CUM6tERC'4-GFAEERAL-LQMTr1' {-- I �^-- - - "� - - _. _... _ _ _J t-LAimes rAADE Z 3�g Y 4$5$ FACT i or,CURRFNCF~ DCCUR Qz/o�/oa ' 'I - 11 004) 000 mpo-• _. ._ —-- t acx„rmtcel:: 304,000 000, GLN'LAGGRCtgTFLIMETAPPLIESPI;R: 4 LIC '-�- Loc , iii AO.ORF-f3n7Ti'A_Dis ; F Y OD 0 Q()0 j2,000A $AUoMILE I.Mf ty orgic.1Od R. Oa�U,UQQ i x A14YAUTO -- - ALLOUVNLfJAfE1'OS 06/29/07 CEiNE'DSiNt}CF.EIMIT -•^`^- SCPEfIULF_DAUToS 06/29/ {FRmA*}ertt) 1{iRFO AUT OS 80Ut1Y iN.IURY "DN-OWNED AUTos iE'rnprtrsunl S GARAGE LraAlurY --"-'-' _.. _,_._---- - - •-- __ PftUPER1YDAA¢AOE-_ -ANY AUl O l' AUTDUNLY.- _ .. ... BA ACCIDENT T , FX'c- IERFLLA LtABICIrY o'rr }�THAN _ c `� - NLA: _ - UCf UR -�0,41MS�E ^- ! AUrta n - _ � Pitt_I9 0_Clr_URRF_NCF --• S i3EDit0tRLF AL'+CRF(zATE '- - ,-.._•--•- •- _ j - RCTt-NTION - - - - .- 10RI{ERS CO ~ MPENA77 S MrLOYERS'LIaRfLSON AND � �` __ _ _ - - $ .-•-. -- - l`FROPRILTORIP — - -• - _._._: T..i.�- - - -.. rI"'FlIBER CXACI Ub D7 ECUfIVE +tS,*nCMetnldar �2� YJ17f U2/lI 48 3t?R tfil- .. Eli' FCIAL PROVESfONS bMaw / I,L. — HFR - - _ $ ` — �•L.f)f5F,A8E•t:AEMpLDYEE E 50D�00 -- '-- SEA^aE_f+DL`�4Y� ION or lvZRArtgNg f LOCATIONS i MIC E4!@ftCLtESiON9 ppDED Hy ^ ENbDIgSEMByT_j3'ROVIStONs `--. --,-- ATE F3C►LitER -CANCEL-LApON D;AMON4 aHOUL"ANYar•TM ASOVc4* E1AT8 THEREOF TEES ISSUING rWs:y iO rOL'gG$BI"CANCEUM -^ Diamond Xnduatr3�8 IAF-Foq@Ti4E1exPEAnITOEK 32-0a 4 8th NOTIC4 TO TELE CER t +vDR 7t]MAIL 30 OA.Y3 WRETi'E!4 P@nhAa12 Street 17FICATEHAf,DERMAktEDTD kan NJ 08 309 lMPOgE ND OBLIGATION OR LIABILITY OF TE4E LEFTr 81P!FAELUE7E rD pq 54 SHARt. . e +MEY Etftan Q�af+caci4lATlVi g- ' - n r fiiytERER,iTS ABBNYei OR A t E2ED 5FI'4'ATI ,'2007/08} FAMILY DISCOUNT INSURANCE 170 BROADWAY METHUEN, MA 01844-3840 i FAMILY DISCOUNT INSURANCE 170 BROADWAY METHUEN, MA 01844-3840 The Commonwealth of Massachusetts Department of Industrial Accidents ' Office of Investigations 600 Washington Street N° Boston MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl Name (Business/Organization/Individual): — 'bhatp� Poo Lq Address: (Z� t 10 7 e S f re V9, 7 Q(_2 City/State/Zip: En MA. Phone #: Are you an employer?Check the appropriate box: Type of project(required): 1.� I am a emplo with 4. ❑ 1 am a general contractor and I 6. EJ New construction employees full d/orpart-time).* have hired the sub-contractors 2.❑ I am a sole prietor or partner- listed on the attached sheet. # Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp, insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its 10.E] Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself.[No workers' comp. c. 152,§1(4),and we have no 12.❑ Roof repairs insurance required.] t employees. [No workers' 131-1 Other comp. insurance required.] 'Any applicant that checks bot.#I 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 their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: I S 4 U 1Qt4 +(J Policy#or Self-ins. Lit. Ig /l Expiration Date: C� Job Site Address: City/State/Zip: AtAt - 4fidde) MA - 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 ce ify under the pains and penalties of perjury that the information provided above is true and correct. .Sianature: Gl /� Date: ' 07 � 7`i' Phone#: �b o� �^ 3 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#: Information and 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 person 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 or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such 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(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance 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 until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractor(s)name(s), address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to cant'workers' compensation 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 returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town 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/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license 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 pen-nits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank 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,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-72.74900 ext 406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 5-26-05 www.mass.gov/dia f a i s e o' F _ � I ' co j als 15 qi r , j