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Home My WebLink AboutBuilding Permit #770-15 - 301 RALEIGH TAVERN LANE 4/8/2015p10RTF/ AWR BUILDING PERMIT16 1✓V/ TOWN OF NORTH ANDOVER i +� APPLICATION FOR PLAN EXAMINATION Permit NO: �� "J Date Received` Date LOCA sued: 'IIb I�7 IMPORTANT: Applicant must complete all items on this page PROPERTY OWNER --A MAP NO: 167 PARCEL: IC Print ft✓ ZONING DISTRICT: Historic District yes Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential 0 New Building ❑ One family 0 Addition ❑ Two or more family 0 Industrial ❑61!! -,ration No. of units: ❑ Commercial Vl�epair, replacement ❑ Assessory Bldg ❑ Others: 0 Demolition ❑ Other 0 Septic 0 Well 0 Floodplain 0 Wetlands 0 Watershed District 0 Water/Sewer .1 - OWNER: Name: Address: CONTRACTOR N Identification Please Type or Print Clearly) Phone: Y7 Address: �l Supervisor's Construction License: Exp. Date: A) Home Improvement License:/ Exp. Date: ARCHITECT/ENGINEERPhone: 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: $ Z, 60 FEE: $ 35 Check No.: Receipt No.: V4Z2 NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund re of Aae 2 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOS4 Public Sewer L��/ 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 PLANNING & DEVELOPMENT ❑ COMENTS CONSERVATION ■ ■ COMMENTS HEALTH COMMENTS Zoning Board of Appeals: Variance, Petition No: Planning Board Decision: DATE APPROVED DATE REJECTED DATE APPROVED ❑ ❑ Comments Conservation Decision: Comments Zoning Decision/receipt submitted yes Water & Sewer Connection/Signature & Date Driveway Permit Located at 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 Exter or' 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.s100-s1000 fine Doc -Building Pen -nit Revised 2014 k? 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 ❑ 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 ❑ 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 ❑ 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 QJ w 2 LLZ O oOC m N Y -0 O LL N Ln O_ In G a N c� Z m 2 7 LL to_ = z > C E U LL O U LLJ N Z Z 00 J d t Z d' _ to LL 0 U a Vf Z a V J NJ .0 D d U Ln _ O LL OC 0 U a z H L = d' _ m LL Z W Q W O LLI LCL. N m z — N V) D N Y O N GN .� O R R O . V �, .Q 4) . * .o U) V rE Q CA dw V/ O W L 4 E v► �� p �Nc°��Q. � � O O,♦* •= E Cfl m CL,mom Z � N OR> LJ.I = 41 L- N O CN R Q x -a b1 O LLJ O OCL W r ch R � c C O = '•r � .> 0 w a o� a CL rLCD CD � r m L) ;c _ O ® R cn CD ti = c O F :�R� 0 o A�2m m WLJLJ = "a +M-+ O O " z m .Q O C -L D= .r � c. Z W i U m O p to m '> _ o o ;� c O OCL 0 > v v O w0 n E O o z C o � N Q •� m m O �+ 4) Im o O �. Q Q OM 0-0 U) Z � U U) c �CUL- 4)�- 67-76-a- yZ-5-�rV-)6 r a vlav�aa HIC # 136779 TWOMEY & LEGARE CONTRACTING INC. "Couldn't your home use a little TLC?" Specializing in Residential Additions 87 Belmont Street • North Andover, MA 01845 P: 978-685-7447 • F: 978-685,- j7-446 NAME OF OWNER ADRESS OF JOB ®� �I� . X/ TEL. (.��r Z� 7 DATE: / ' 2 20l .- We hereby submit estimates for: `� /�� ' ��✓ '` �% �� 12.E O Xis i rt lr Sj , j n S � 7 c i- .S' /�;'��rs � �-- mil ✓� ��`s We Propose herby to furnish material and labor - complete in accordance with above specifications, sspfor the sum of: dollars ($ Payment to be made as follows / tom^ S � ^T f h e b S S C c= d , r � eh J � d • tt�'1 � . � � i) ©. ! p Yt � Z i �Yl c Authorized Signature NOTE: This proposal may be withdrawn by us if not accepted with in _ days Acceptance of Proposal - The above prices, specifications and conditions are satisfactory and are herby accepted. You are authorized to do the work as specified. Payment will be made as outlined above. Signature Date of Acceptance: 1,2 2— Signature - The Commonwealth of Massachusetts Department of Ind"vstrial Accidents J Office of Investigations 600 Washington Street Boston, MA 02111 wwlv.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information f Please Print Legibly Name (Business/Or anization/Individual):.:�-n-- Ad&ess: City/Slate/Zi p #AV oee-;k-- /V;* • • Phone #: Are pc an employer? Check the- appropriate box: 1. I am a employer with __;2— 4- ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet I ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers'. comp. insurance 5. ❑ We•are a corporation and its required.] officers have exercised their 3. ❑ I am a homeowner doing aTil work right of exemption per MGL myself. [No workers' comp c. 152, § 1(4), and we have no insurance required.] t employees. [No workers' �- - comp. insurance required_] Type of project (required): 6. ❑ New construction 7. Remodeling 8. ❑ Demolition 9. ❑" Building addition 10.0 Electrical repairs or additions. 11.0 PIumbingrepairs or additions 12.❑ ofrepairs 13. Other �„ *Any applicant that checks box ml must also fill 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 mast 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 a?n' an employer that is providing x)orkers' compensation insurance for my employees. Below is the"policy and job. site information. 7j Insurance Company Name: IZA VCL &-7tj d mac' Policy # or Self -ins. Lic. #: i/6, -- D ih' y Expiration Dater Job Site Address: _/3— � �%G1 �'3 G' QCity/Stat-17 e/Zip Attach a copy of the workers' compen4gon 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 u- lw >rcp cover�g verification. Ido hereby cerdh nyder the pains andpenalties ofpetjury that the information provided above is true and correct- Date: orrect Date: 7� wlr"IMAOM Official use only. Do not write in this area, to be completed by city. or toxin offzciab 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 #: RightFax C3-1 1/13/2015 5:44:51 AM PAGE 2/002 Fax Server CERTIFICATE OF LIABILITY INSURANCE Arrvrsu v tzuTurvS) DATE(MM/DO/YYYY1 T- = IFICATE 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 ANO THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require and endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: PHONE FAX DOHERTY INS AGENCY INC PO BOX 1985 (A/C, No, Ext): (A/C, No): 21 ELM STREET ANDOVER, MA 01810 E-MAIL ADDRESS: 22YMX INSURER(S) AFFORDING COVERAGE NAIC INSURED INSURER A: TRAVELERS INDEMNITY COMPANY OF AMERICA TWOMEY & LEGARE CONTRACTING INC INSURER B: INSURER C: PO BOX 366 NORTH ANDOVER, MA 01845 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTFY 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 MAYBE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN G SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAD CLAIMS. INSR LTR TYPE OF INSURANCE ADD L SUB R POLICY NUMBER POLICY EFF DATE (MAIDDIYYYY) POLICY EXP DATE (MMIDDIYYYY) LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY FACH OCCURRENCE $ DAMAGE TO RENTED $ REMISES (Ea occurrence) CLAIMS MAGE OCCUR. ED EXP (Anyone person) $ If:: - GEN'L AGGREGATE LIMIT APPLIES PER: ERSONAL & ADV INJURY $ ENERAL AGGREGATE $ POLICY a PROJECT LOC RODUCTS - COMP/OP AGG $ AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE $ LIMIT (Ea accident) ALL OWNED AUTOS BODILY INJURY SCHEDULE AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DEDUCTIBLE $ $ RETENTION $ A WORKER'S COMPENSATION AND EMPLOYER'S LIABILITY YM UB -0290M994.14 09/18/2014 09/18/2015 X WC STATUTORY OTHER LIMITS ANY PROPERITOR/PARTNER/EXECUTIVE1�i 7 OFFICERIMEMBER EXCLUDED? 1 ' 1 N/A E. L. EACH ACCIDENT $ 500,000 (Mandatory in NMI It yes, describeunder E.L. DISEASE - EA EMPLOYEE $ 500,000 DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS belowE.L. DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICT] ONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. CERTIFICATE HOLDER CANCELLATION TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED l6OO OSGOOD ST. BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESEN 4 VE NORTH ANDOVER, MA 01845 _ o The AcvHu name ano logo are registered marks of ACORD 1988-2010 ACORD CORPORATION. All rights reserved. i'flanf I. 17901k ACORDnr CERTIFICATE OF LIABILITY INSURANCEDATE(M IFOR LTR � PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Doherty Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P.O. Box 1985 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 21 Elm Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Andover, MA 01810 06MV14 06122115 INSURERS AFFORDING COVERAGE NAIC # INSURED Twomey & Legare Contracting, Inc. INSURER A: Arbelia Protection Ins Company INSURER B: PO Box 366 INSURER C: North Andover, MA 01845 INSURER D: INSURER E: rnvll:oAr_tee 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 Ex?CUMENT 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IFOR LTR =a TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE PO C TION A GENERAL LIABILITY )( COMMERCIAL GENERAL LIABILITY CLAIMS MADE Q OCCUR 8500043255 06MV14 06122115 EACHOCCURRENCE S10001080 000 AMAGE TO RENTED $100,000 922==I MED EXP (Any one, person) $5 ,000 PERSONAL & ADV INJURY _",000,000 GENERAL AGGREGATE s2.000.000 ENT. GAGGREGATE LIMB APPLIES PER: POLICY PRO LOC XJECT PRODUCTS • COMPIOP AGG s2.000.000 AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea accident) S ALL OWNED AUTOS SCHEDULEDAUTOS BODILY INJURY (Porperson) $ HIRED AUTOS NON -OWNED AUTOS BODILY INJURY $ (Per accident) PROPERTY DAMAGE $ (Peraccident) LIABILITY AUTO ONLY - EA ACCIDENT S 7iARAGE ANY AUTO OTHER THAN EA ACC S AUTOONLY_ AGG E EXCESSIUMBRELLA LIABILITY OCCUR CLAIMS MADE EACH OCCURRENCE S AGGREGATE S S DEDUCTIBLE $ $ RETENTION S WORKERS COMPENSATION AND WC STATU OTH- EMPLOYERS' LIABILITY TORY I WITS FR E.L. EACH ACCIDENT g ANY PROPRiETORIPARTNERIEXECUTiVE OFFtCERIMEMBER EXCLUDED? II yyeess doscri6e Itnder SPECIAL PROVU1nS%S below E.L. DISEASE • EA EMPLOYEE S E.L. DISEASE • POLICY LIMIT I S OTHER DESCRIPTION OF OPERATIONS LOCATIONS/ VEHICLES !EXCLUSIONS ADDEO BY ENDORSEMENT/SPECIAL PROVISIONS Covering operations usual to Twomey & Legere Contracting, Inc... Town of North Andover 1600 Osgood Street North Andover, MA 01845 LD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION THEREOF. THE ISSUING INSURER WILL ENDEAVOR TO MAR I n DAYS WRITTEN ;E TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO DO SO SHALL ;E NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER. ITS AGENTS OR AUTHORQEO ACORD 25 (2001108)1 of 2 #S31415/M30577 DML g ACXF6 CORPORATION 1986 9 r��e �nnunnirurnll� r�^-7rrl�JrrP�rr.:e(f' t _Office of Consumer Affairs & Business Regulation `P ROME IMPROVEMENT CONTRACTOR registration: 136779 Type: piration: :.8/2612016Partnership TWOMEY + LEGARE CONTRACTING INC. SHAWN TWOMEY 87 BELMONT ST- N. ANDOVER, MA 01845. Undersecretan C�n�t;i7ttiun Staper�i+��r .tee CS -067560 SHAUN M TWOMEY 61 PATROIT ST N ANDOVER MA 01845 10/25/2015 9F, e255n.^.•..,._cam.., _._..a:. .a ._ .. .... .. -" '. construction uction Supeij- 3 4'v = � CS -055108 f DOUGLAS J LEGARE 79 GARY AVE - HAVERHILL MA 01830 - 0910212016 ..: Location (U0a ave" No.'TlGk C5 — Check # Date i TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $`�� Foundation Permit Fee $ Other Permit Fee $ TOTAL $ i"qn i' Building, Inspector 1