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Home My WebLink AboutBuilding Permit #447 - 31 QUAIL RUN LANE 12/27/2007 AORTi4 BUILDING PERMIT 0 V.D TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: IMPORTANT:Applicant must complete all items on this page E C AM -OWN TY11. PR,0PER eSlip V�Ilage. ,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 Septict ---- d'Didct`'. ers;b e ifst 'Job an ,.W DESCRIPTION OF WORK TO BE PREFORMED: -QU?NA OA R CY,�m yy!:6 Identification Please Type or Print Clearly)I -7B b 8 '8 Ca 4-7 OWNER: Name: Phone: Address: 3Q111JI'Le Y2V�,J NAv-zojer . "q, 0 c011 -T R.".-Nam 7- .Address �0-.- ��3 ��r�� `�:v�ae�` � F��B '°` � z ? TO T, Scpervisor -,dh bbbfidn Jce.nse t �cp D emerfiLicense_, , ARCHITECT/ENGINEER— )J/4 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: $ Is 1 1 ou FEE: $ ZZ5-000"- Check No.: 3 Sp 47 Z Receipt No.: Z040-0 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund SignaturefA �q- -J qem 1wner-4 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 DATE REJECTED DATE APPROVED CONSERVATION COMMENTS DATE REJECTED DATE APPROVED HEALTH COMMENTS J Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes C Planning Board Decision: Comments Conservation Decision: Comments Water $ Sewer Connection/Signature& Date Driveway Permit Located at 384 Osgood Street :FIRE DEPARTMEENT Temp Durnpster�on site yes - no Locatedaat 124>Main Street- _ . Eire Department igna'turelda#e -COMMENTS -Diiniansion 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 2 1 A—F and G min.$100-$1000 fine NOTES and DATA— (For department use ❑ Notified for pickup - Date Doc.Building Permit Revised 2007 Building Department 3 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/Crossection/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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 Location ,?/ r No. Y Date 1 ' NaRT� TOWN OF NORTH ANDOVER 3 •. OL 0 A Certificate of Occupancy $ �'�s''•° E1� Building/Frame Permit Fee $ wCNUs Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check 20G ,�, 0 Building Inspector t40RT#i T0VM of Andover 0 No. 0 LA 0 dover, Mass., aim; -4* ;L- COC Ho ICK Ic of'ATE D BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT........Qrte*-%...... .............................................................................................. Foundation ....... has permission to erect........................................ buildings on .-St.... RV .-s ........................... Rough ti ..ft4.... Rf AO �11A J%On to be occupied as... . .. ....... Chimney provided that the person accep/�j this permit shall in every.respect conform"tio'...the1...'*terms****i"**'*o*'f*'t'h'*e"**application***'*' ''*'' '"**'o'n'*filei *'*'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 CONSTRrON STARTS ELECTRICAL INSPECTOR Rough .................................................. ........................... Service BUILDIN OR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough 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. BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 082816 Birthdate: 06/16/1958 Expires: 06/16/2008 Tr.no: 27672 ` Restricted: 00 JOHN R LEEMAN JR 70 PILLON ROAD C MILTON, MA 02186 Commissioner ::�f:'': tr`(ti/i:•It�'stt!,7rrL�'f r./.:.'frn::.,aC: �.;:%� _. 130::rd of Building Regulations and Standards j 3 HOME IMPROVEMENT CONTRACTOR -10P _: t5p!--is- Registration: 137552 Expiration: 11/26/2008 Tri/ 124904 Type: Private Corporation NORTH ANDOVER BUILDING CORP. JOHN LEEMAN 70 PILL ON RDS` WLTON,MA 02186 Administrator ' ACORD, CERTIFICATE OF LIABILITY INSURANCE OATEIMIyppmYyl PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORATION0�007 M INTERNET INSURANCE AGENCY ONLY AND CONFERS NO MGHTS UPON THE CERTIFICATE 522 CHICKERING ROAD HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR NORTH ANDOVER,MA 01846 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. wBup" INSURERS AFFORDING COVERAGE NAIC B JOHN LEEMAN INSUEm A. im PO BOX 132 I� NORTH ANDOVER,MA 01845 If4 INeiICOVERAGES tN$U THE REQUIRE OF INSURANCE O CONDI BELIONO F HAVE C BEEN CT OR TO THE WSUkED NAMED ABOVE FOR THE POLICY PERIOD G1111) E 11�7WtPHSTANDI ANY AIN,THE INSURANCE TERM OR OODORION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO wHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,Tiff INSURANCE AFFORDED BYTHE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.EXCLUS POLICIE&AGGREGATE WHITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAW. IONS AND CONDITIONS OF SUCH TYPE OF GtbURANCI I POLICY NUYEER E A GENERAL Ll mny R0618286A 2117/07 2117!08 L cOMMERCK OENEPAL LYIBIIJTY EACH occwftxcE ! +Amom00 Cl�MA� D OCa1R PR ,smamIIo knExPww,n ;5.Omoo PERSONAL A Am W,uRY $ +.0KOW oo Irl.Af GATEUwAPFUESPER: V-WA LAftREGATE i 2,Woo00.00 POLICY Pimm LOC PROOUM-COWIM Aft i�,000.DOD.Op Al T011OBM UAMUN ANY AVrO �L"T s All OWVNEM O AUT08 SCHEINR.EDAUT08 ( Pwwn s HIRED AUTO$ NO FOWNED AUTOS (P Se Y = s C+ARAOE UL" ANY AUTO AUTO ONLY-EAACCWff s wow FAACC s EXCROUMMU A w►RRJTY AQa S OCCUR CLAW WN LMINCOXIR iENCE $ AWREGATI _ DEOUCT6LE i RETENTION s i 0037716 12/13J06 12/13/07 s B r E ICP',ewMEMa r�ao0ED9� PtL EACHACCOW S 100A OD :wdreaow F.L0WAft.rAWWVQ :+aaaoDoo HER EL DISEASE-POLICY s 'O OT __1muIKmlvm�mIeju;Lu6K= now HIM CERTIFICAT'!F HOLDER CANCELLATION MOULDWwr OF TME ADME 0E60Rl8w rQLK=W CojigEUMD MEPORE TNM EXFxlATWM DAM IREMW,THE OWN 14WM WKL MASAVOR 10 MAIL DAYS WRITTEN NOTICH TO TNI CERTIFICATE HOLM xAM M TO THE LEFT,BNr mum To no so sMAu NO OBIRATIDN OR LOSU Y OR ANY MW UPODI THE 110IRM ITE Aa MITE Co WrATRSL AUTHORIZED W WA aCORD ZS IEo01/08) 81A CORPORATION 1988 ......-...w.ua.w... �rrnaer netno• n-so�osn�an ..___. NABC General Contractors PO Box 132 N Andover,MA 01845 31 quale run division description total general conditions $ 1,020.00 permit Inc plans/engineering Inc insurance layout dumpster inc C.P tools equipment v� a,0 ,^ v heat,light.Power by owner 0 `� toilet by owner '�oo winter conditions demolition $ 1,280.00 y Inc y l�� A site building \ 'S sitework $ - none Inc excavation backfill driveway concrete $ - none inc footings foundation waterproofing slab walkways masonry chimney $ - none Inc -- walls steel beams $ - none inc decking rounh carpentry $ 2,054.00 framing inc roofing rubber roofing siding at window windows 1 In laundry sky lights fire door exterior doors garage doors trim at window finish carpentry $ 1,480.00 11/29/20075:05 PM NABC General Contractors PO Box 132 N Andover,MA 01845 base/trim match existing doors 1 double at closet,reuse 1 door stairs shelving allowance of 250 kitchen cabinets bathroom vanity supplied by owner countertops other cabinetry-mud room not included Insulation $ - flooring $ 2,700.00 bath floor,walls,laundry wood carpet the other finishes $ 2,530.00 drywall inc durarock at bath floor,tub and laundry paint exterior at window paint interior closet,laundry,bath wallpaper hvac $ 350.00 inc heat air conditioning Ip umbina $ 2,000.00 allowance 2000 electrical $ 900.00 washer,dryer,4 rec its $ 14,314.00 overhead profit $ - total $ 15,746.40 qualifications no unforeseen conditions no hazardous materials reuse 1 door owner to supply all plumbing fixtures owner responsible for shower door if any allowances plumbing-2000. "laundry shelving-250 11/29/20075:05 PM outline specification demolition of walls,flooring, ceiling, bathroom floor frame per plan furnish and install 1 window wire for washer, dryer,4 recessed lights plumbing for washer,tub-allowance-2000. install heat tile supplied by owner installed by nabc cabinets/shelving by owner-nabc to install install 1 vanity-to be supplied by owner strip paper in bath owner to supply all plumbing fixtures shelving allowance of 250 /r-Z-6" X-2"� 2'0"x4'-0" 2'-0"x2-0 2-0"x 4' • (0 % Cn M co m to -0 " 2'4•x6'-8• 2-4•x6'8" 12-7 7//'2. / 3-11 712"4 2=4"x6'-8" plan property of 31 quale run nabc north andover, ma 01845 po box 132 north andover, ma 01845 978-869-9616 The Commonwealth of Massachusetts Department of Industrial Accidents w Office of Investigations d 600 Washington Street t Boston, MA 02111 k www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): C Address: PO Qc:b( 13�: City/State/Zip: l J. A YJDOV C 4q 0146%1 S'Phone.#: Q'-7�)- F3 Q -9(,4/✓ Arun employer?Check the appropriate bog: Type of project(required):, 1. am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 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' 9. ❑Building addition [No workers' comp.insurance comp.insurance.$ 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 MGL 12.❑ Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp.insurance required.] *Any applicant that checks box#1 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. lContractors 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. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. a Insurance Company Name: Policy#or Self-ins. Lic.#: ( 3T1 I LG Expiration Date: Z 1310-7 Job Site Address:—S I LC_ 2L10 City/State/Zip: /J, 4IDUe.(— �Llq dl�y' f 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 here certify under the pains and penalties of perjury that the information provided above is true and correct. Signafore: Date: l c Phone#: L qcftyp Officialuse 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 carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may 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 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 bum 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. # 617-727-4900 ext,406 or 1-877-MASSAFE Revised 11-22-06 Fax# 617-727-7749 www.mass.gov/dia