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Home My WebLink AboutBuilding Permit #197 - 31 LINCOLN STREET 9/19/2008 MORTH BUILDING PERMIT o tt��o ti TOWN OF NORTH ANDOVER or `_4`'° APPLICATION FOR PLAN EXAMINATION Permit NO. Date Received 4p ��SSACHUS t Date Issued: -O IMPORTANT:Applicant must complete all items on this page LOCATION 3_ 1 x Print -a PROPERTY OWNER 6TG i e r IC+J'lco r Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Villije yes �no 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 Distric# Water/Sewer _1 DESCRIPTI N O WOR TO BE PREFORMED: o P o0 ��5f� 11 � �t�►�occ�S . � f Identification Please Type or Print Clearly) ' OWNER: Name: Phone: Address: f1 CONTRACTOR Name: JJ �/�11 i i A1 e/, phone; z � Address: �� 0 Supervisor's Construction License: Exp. :Date:/ -Ez , L L p. Date; Home Improvement License: v ExC� 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: $_� FEE: $ Check No.: Receipt No.: .cmc l NOTE: Persons c ntracting with unregistered contractors do not have accesrtie guaranty nd ignature ofAgent/Owner Signature of contractor r�n® 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 CONSERVATION Reviewed on Signature COMMENTS s HEALTH Reviewed on Signature r 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 Osgood Street FIRE=DEPARTMENT Temp Dumpster onsite, yes 'no Located:at 124Main 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 - Date Doc.Building Permit Revised 2008 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 o Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.-L. Licenses o Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And _Hydraulic Calculationslicable If Applicable) P ) ❑ 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) ❑ BuildingPermit 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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 Location No. Date ( ' 0.r NaRTM TOWN OF NORTH ANDOVER lee � a + ; : Certificate of Occupancy $ " �'�s'•^ tt�' Building/Frame Permit Fee $ ��; �CMus r Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # k 21541- U Building Inspector _ The Commonwealth of Massachusetts '�tl ,1/ Department of Industrial Accidents ._..� Office of Investigations 600 Washington Street Boston, MA 02111 t;w www.rnass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information AA Please Print Legiblv Name (Business/Organization/individual): Address: 5 �� City/State/Zip: -tbe4fi (1�q(_/ Phone#: 3 Are you an employer?Check the appropriate box: Type of project(required): ] I am a employer with4. El am a general contractor and I 6. E] New construction employees(full and/or p time).* have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 1 7• ❑.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 required.] officers have exercised their ]0.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 1 ITPlumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12;93400f repairs insurance required.] t employees. [No workers' comp. insurance required.] 13.0 Other *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. +homeowners who submit ihis a,iidavii indicating they are doii-19 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. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: t(��,pe yl�j (/ �(/yl Ce G ro up Policy#or Self-ins. Lie.#: �' y(�("� j 60 Expiration Date: -�5 Zo p� p /- _5 1_00' Job Site Address: City/State/Zip: 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 cert' u derth=paindpenalties of perjury that the information provided above is true and correct. i Sig-nature: Gil Date: / D Phone#: Official use only. Do not write in this area,to be completed by city or town official. i City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. p 6.Other Electrical Inspector 5. PlumbingInspector 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.deemedIto 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 ance 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 pen-nit/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 permits 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. # 617-7274900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax#617-727-7749 www.mass.gov/dia DATE jMM)DDIYYYTI .ACS, CERTIFICATE OF LIABILITY INSURANCE 03/18/2008 :oma (978)774-8040 FAX (978)774-3581 TMS CERTIFICATE IS ISSUED ASA 1WATrER OF INFORMATIONTH arpey Insurance Group Inc ONLY ANO CONFERS NO R10NTS UPOTHECERTIPICAI'E HOLDER.THIS CERTIFICATE I)OES NOT AMEND,EXMNO OR t:91 Maple St (Rt 62)-Suite 304 AL R E COVERAGE APFO BY E POLICIES L W Box ]83 INSURERS AFFORDING COVERAGE NAIL# )anvers, MA 01923-0383 sulu:p !�&3Home 7nprovements I.0 INSUW A.Nautilus Insurance Ga� 225 Grove St. wsumRv: Atlantic Charter It Co Methuen, MA 01844 INSUHERC. MISURER D. INSURER E' .o THE POLICIES OF INSURANCETERM OR CONDITION OF HAVE CONTRACT OR OTHER DOCUM7=NT WITH REED SPECT TO WW CHfORTHE LITHISPCERTIFICATE MAY BE ISSUED OR ANG ANY REQUIREMENT, ANY MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT 70 AL1.THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED 13Y PAID CLAIMS. UNrrS ZR— D' POLICY NUMBER POLICY EFFE POU E7fPIRATION TYPE OF INSURANCE GENERAL LIABILITY TBA 03/13/2008 03/13/2009 PACHOCCURENTF s 1 000, 0 DAMAGE TO RENTED g so, X COMMERCIAL GENERAL LIABILITY CLAIMS MADE t• .I OCCUR MEO EXP(Any tom pam0f1) $ S OO PERSONAL a ADV INJURY $ 11000,000 A — GENERAL AGGREGATE 3 2.000 00 PRODUCTS-COMPIOP AGC- $ 19000 0010 GEML AGGREGATE:UMIT APPUES PER: POLICY J6CT toe AUTOMOBILE UABIUITY COMBINED SINGLE LIMIT 3 (Ee aca:dent) ANY AUTO ALL OWNEO AUTOS BODILY INJURY $ (Wer person) SCHEOULEO AUTOS HIRED AUTOS BODILY INJURY q (Pct atxda'A NON.OWNED AUTOS PROPERTY DAMAGE $ (Paraccident) AUTO ONLY-FA ACCIDENT GARAGE LIASILIYY 0114fRTHAN FA ACC S ANY AUTO AUTO ONLY: AGG $ EACH OCCURRENCE $ _ EXCES 11161RE1.LA LIABILITY AGOIEGATE $ OCCUR CLAIMS MADE s S DEDIICTtaLE $ RETENTIONWCVO $ WATU- OTFI WORMERS COW-91=1ION AND / El766601 0 /15/2008 03/15/2009 X EMPLOYERS'LIABILITY `� E.L.EACH ACCIDENT $ 100-00 B ANY PROPRIETORIPARTNERIEXECUTNE \\� E.L.niSMF•EA F,.MPLOYE $ 100,006 OFFICERlMEMBER EXCLUDED It yos,aezcnI,e under E.L.615EASE-POLICY IT S 500.000 SPECIAL PROVISfONs pofew OTHER DESCRIPTION OF OPERATIONS !LOCAYIONS I VEHICLES f EXCLUSIONS ADDFA BY EHDORSEMENTI SPECIAL PROVISfON>r ome Improvement Contractor CEgrFjEHOLDER CANCELLATTION SHOULD ANY OF THE ABOVE DeScRIDED POIAC1ES BE CANCELLED BF.FORB THE EXPIRAITON DATE THEREOf.THE 1A9U1NG INSURER MILL ENDEAVOR TO MAIL _,Q -DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO TH5 LEFT. N & ) Home Improvement Inc. WT FAILUI'&To uAIL SUCH kdY=SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURM ITS AGENTS OR RE"ESENTATIVES. 225 Broadway AUTHOR�'vn kRESENTAmfE Methuen, MA 01844 James Tar CIC. V Pres ACORD 26(2001!08) FAX: (978)327-5885 C?AGORD CORPORATION 1988 T001}j SIS �Q SHI AHd2IV,L T89C LL 8L6 %V,3 W ST 800Z/8T/t0 _ NORTH 'q Tovm o Andover , 0 No. _ dover, Mass., ' •Q COCMICKEWICK ��• 7 ORATED p �Cy qS BOARD OF HEALTH Food/Kitchen Septic System .PERMIT T D BUILDING INSPECTOR THIS CERTIFIES THAT........... ..�1.. ..... ........k/.AAl,.A*NW..(amo.+...r...................................................................... Foundation ... has permission to erect...: L�IK .................................... buildings on ..�.......:. vt.6 . .......S."'......................... Rough ��4...�...:...?.,..... .. ...... ..�.. .. Chimney to be occupied as.. 1�.`...gA04 ... i.�1!� '�.. provided that the person acceptin is 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. N 0 PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT E)PIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRU..:. .. N TARTS Rough . ... ..... Service BUILDING INSPEC 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. Smoke Det. SEE REVERSE SIDE f N&J Home improvement LLC Residential & Commercial Service August 16,2008 Peter Vaillancourt 31 Lincoln St N.Andover,Ma.01845 Dear Peter, Thank.you for givingN&J)=Tome Improvement the opportunity to quote your homes improvements. Scope of Work. • Exterior Work: • Scrape old roof • Install black paper#30 • Install.aluminum.edges around the roof top,F8 • Install 30 year slate architectural shingle's • Install.two sky lights • Remove and install tree new windows Cost:$4,900.00 The above listed services will be provided at a cost of$4,900.00 which includes labor and material.For roof only,two sky light and tree windows will supply be customer Fifty percent down_is required on.the first day of the job,and the other fifty percent is due on the day of completion. If you have any questions or would like to discuss any of this further,please don't hesitate to give me a call. 7S*, rely, Omar Loaiza Cell 978-857-6443 Approve by Peter Vaillancourt omarloaiza@grnaii.com 225 Broadway Suite 201.Methuen,MA.01844 ✓fie-V°rivnwouueccccs o�.//�Ggq�p,�'�.cc6elZ6�°^:. f Board of Building Regulations and Standards i HOME IMPROVEMENT CONTRACTOR Registration 144561 rknExpiraton 10/1.4/2008 Tr# 126659 T, 06. DBA' N&J HOME IMF�130VEMENT LLQ . OMAR LOAIZA r f 10 STERNS AVE ` l LAWRENCE, MA 01841 Administrator