HomeMy WebLinkAboutBuilding Permit #165 - 32 PARK STREET 8/31/2009 BUILDING PERMIT of NORTH qti
TOWN OF NORTH ANDOVER
O 9
APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received Are
/ O 7�SSACHUS�t
Date Issued:
IMPORTANT:Applicant must complete all items on this page
a.
Pnnt,
-PROPERTY OWNER--` -�
Print
IIAP NO: 1 PAf2C1=L:.: _ZO +IING DSTICT:,Historic District yes 10
Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
New Building One family
Addi ' Two or more family Industrial
Alt No. of units: Commercial
Repair, replacement Assessory Bldg Others:
Demolition Other
'Septic . . 1Nell Fleodplain Wetlands Vklatetshed District
Water/Sewer
-pESCRIPTION OF WORK TQ BE PREFORMED:/
7-/t t9 /'-711 n�e ~t.,.*L �f U L d s l l/�v�� 4 S C'U l�vc/�S r�y �i1 S�t.,-
fi 194 L )—
Irfic on Please Type or Print Clearly)
OWNER: Name: V Phone:
Address:__a2 a 12,19->'lL ST
CONTRACTOR .Nam e: Ue✓ - t llr'e -honey "
.Address; 1 J � rr S1� f Ile,
Superv'isor's Construction Lcense. Exp. Date. ' ', '
HomeImprovementLicense: _ Exp. .Date: e-,20 14
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: $ o��,��o �l.(X> FEE: $ 15?L13- °C,
Check No.: Receipt No.: �2 3 1-7.:?_NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
._.�... �
S+gnatureof Agent/Owner Signature of contractor' .�..
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
HEALTH Reviewed on Signature
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 Dempster°-on site yes. no
Located-at 124 Malin Street.
,Fire ,Departmert.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
i
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
o Building Permit Application
❑ Workers Comp Affidavit
o 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
o 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
❑ Photo of H.I.C. And C.S.L. Licenses
o Workers Comp Affidavit
❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
❑ Copy of Contract
o 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 3a
No. Date 3//C,
NORTk TOWN OF NORTH ANDOVER
3 �c
a
s ^i y Certificate of Occupancy
$
J+.kNustt� Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
G TOTAL $
Check # �0 2
22s � a
/ building Inspector
08/31/2009 11:22 9787948570 TA SULLIVAN PAGE 02/02
ACORp CERTIFICATE OF LIABILITY INSURANCE OP ID °A �°°m"''
HCOzI-1 09/31/09
TION
OILY AND IS CERTCONFERS NO RIGHTS UPON THE CERTIFICATE
A. 9u1 livatr► I»nN2. 11gOy, Ica• HOLDER THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
T. A
344 , ul livXion Bt. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Lawrence, MA 01843
Phona: 978-683-4700 INSURERS AFFORDING COVERAGE NAIL 0
INSURED INSURER A! CNu Swfut{p,""w1wo See,
INSURER B'
1=6 revements by Bob INSURER C:
F�averhli� 01832 INSURER a,,
INSURER E;
COVERAGEB
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING
ANY REOWNEMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 16 SUBJECT TO ALL THE TERMS,FXCLVSIONS AND CONDITIONS OF SUCH
POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
TR NSR11 TYNE 0/INSUROMICE POLICY NUMBER DATE MMA A LMM
GENERALUABRttY EACMOCIUHIM.Z i 1000000
X COMMERCIAL GENERAL LIABILITY CLS1571163 03/28/09 03/28/10 PREMISES Eeeraurenee) 650000
CLAIMS MADE F_�OCCUR MED EXP(Any we pw—s 55000
PERSONAL 6 ADV INJURY $1000000
GENERAL AGGREGATE s2000000
GEML AGGREGATE LIMIT APPLIES PER; PRODUCTS-COMPrOP AGO $2000000
POLICYF71 ME LOC
AUTOMOBILE LIABLIITY COMBINED SINGLE LINT f
lE�wedoM)
ANY AUTO
ALL OWNED AUTOS BODILY INJURY f
SCHEDULED AUTOS (Par Pin)
HIRED AUTOS BODILY INJURY f
NWOWNEO AUTOS (Pw acatdeM)
PROPERTY DAMAGE _
(Per■cdIdent)
OARAU L IIAMUTY AUTO ONLY-EA ACCIDENT f
ANY AUTO OTHER THAN EA ACC i
AUTO ONLY: AOO i
etc IMOR1011A LIABILITY EACH OCCURRENCE 3 r
OCCUR CLAW"MADE AGGREGATE f
i
DEDUCTIBLE f
RETENTION f i
ORKBRB COW
ENATION AND TORY LIMRf ER
YY
EVLOVEM LA MM E,L EACH ACCIDENT S
ANY PROPRtETORJPARTNERUECUTNE
gOI:Frr,fRRMu1�EpoMEER EXCLUDED? E.L.DISEASE-EA EMPLOYEE S
gPEGAL PR0% IS ONS Mlwr E.L.DISEASE-POLICY LIMIT f
Own
A Commercial Applica CLO1571163 03/29/09 03/28/10
I MED I MUMON6 NVED BY ENDOMISPIMMIT r
Residential carpentry, mostly kitchens, trim work
CERTIFICATE HOLDER CANCELLATION
Twp SHOULD MY OF THE ABIMM OWCw D POUCIEA SS CANCUM BEFORE TRE FXPIRATON
DATE YINIMOV,THE ISSUING IMMMR WLL 1111MO AVOR TO MAR. 10 DAY!WRINTIN
TOM OF NORTH ANDOVER NOTICE TO THE CERWrATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO 90 BNALL
Gpthm >9POlgl1 IMPOSE NO OBLIGATION OR LIABILM OF ANY NAND UPON THE MOM ITS A0ENT6 OR
BORER AMOVER, Mh 01845 moa ATNVEA
AUTROR2®REPREBHITATIYE
Moraima Tavares
ACORD 26(2001m) O ACORD CORPORATION IONS
F NORTH
Town of Andover .
No.) 4,5
over, Mass.,
CO_C- C C
oR-ATED C7
BOARD OF HEALTH
Food/Kitchen
PERMIT T D Septic System
BUILDING INSPECTOR
THISCERTIFIES THAT............................................................................................................................................................... Foundation
has permission to erect........................................ buildings onsX 5,11--
Rough
..............................................................................................
to be occupied as...................... x 0 0 ...... Chimney
....... ....../............................... ............................................................................................
provided that the person accepting this permit shall in every respect conform to the terms of the application an 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
PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
UNLESS CONSTRUCTION STARTS Rough
�7
................................................................................................................ Service
BUILDING INSPECTOR
Final
Occupancy Permit Required to Omipy 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 ___Jj Smoke Det.
Home Improvements by Bob Tax ID#20#0905823 Date:07-18-09
157 Boardman Street Reg# 150927 home#978-687-9614
Haverhill,Ma 01830 cell#
978-374-6397 work#
email.Improvementsbybob*omcast net
Proposal submitted to: V.F.W.
Email:
Address: 32 Park ST
City,State,Zip code: N Andover MA, 01845
1 hereby submit specifications and estimates for: Roof
Strip 1 layer of shingles on roof and dispose of in a 30yd dumpster store on property. Any
areas to have more than 1 layer will be priced accordingly.
Remove antenna and heating lines. Re install heating lines.
New Bin drip edge will be installed around the entire perimeter. The first 6 feet will be ice and
water shield and tar paper on remainder.
Install a 50 yr. I.K.O. arcetecual style shingle with rolled ridge vent at peak.
Any areas of concern found during construction will be brought to customers attention and
priced accordingly.
Contractor will supply all neccecary permits.
Warranty will be 5 years under normal conditions from the day of completion.
I hereby propose to furnish material and labor complete in accordance with the specifications
for twenty thousand one hundred and seventy $20,169.00
Payment to be made as follows: $1,000 will be due on signing contract for permits. 2'
payment of$10,000 is due on day of construction. 3`°payment of$6,169 is due when roof is %2
completed. Last payment of$3,000 is due on day of completion.
All matter is guaranteed to be as specified. All work to be completed in a workman like
manner according to standard practices. Any alteration or deviation from specifications
involving extra work will become an extra charge over and above the estimate. All agreements
contingent upon accidents, or delays beyond my company. I carry all necessary liability
insurance.
Note: This proposal maybe withdrawn by my company if not accepted within days.
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES
Acceptance of proposal. The above prices and specifications are satisfactory and hereby
accepted. You are authorized to do the work as specified. Payment will be made as outlined
above.
X X
Signature S' at re
There will be clear and conspicuous notice stating:
*All home improvement contractors and subcontractors shall be registered and that any
inquiries about a contractor or subcontractor relating to a registration should be directed to
Registration Division,Program Coordinator
One Ashburton Place, Room 1301
Boston, Ma 02108
(617)727-3200 ext. 25239
*The contractors registration number should be on first page of the contract.
*The homeowners three day cancellation rights under MGL c 93 s 48; MGL c 10 or MGL c
255D s 14 as may be applicable.
*All warranties on the owner's rights under the provisions of 780 CMR R6 and MGL c 142A.
*Whether any lien or security interest is on the residence as a consequence of the contract.
Permit Notice:
*the owner was notified of any and all construction-related permits needed.
*it is the contractors obligation to obtain such permits as the owner's agent.
*owner's who secure their own permit or deal with unregistered contractor shall be excluded
from access to the Guarantee Fund.
*Acceleration of Payment:No contract shall contain an acceleration clause under which any
part or all of the balance not yet due may be declared due and payable because the holder
deems himself to be insecure. However,where the contractor deems to be insecure he may
require as a prerequisite to continuing work that the balance of funds due under the contract,
which are in possession of the owner, shall be place in a joint escrow account requiring the
signatures of the contractor and owner for withdrawal.
*No work shall begin prior to the signing of the contract and transmittal to the owner of a copy
of such contract.
*Arbitration: If the contractor determines that in the event of a dispute,the contractor wishes
the dispute to be settled by arbitration,this fact must be signified on the contract and both the
contractor and owner shall sign the clause separately.
"The contractor and the homeowner hereby mutually agree in advance that in the event
that the contractor has a dispute concerning this contract,the contractor may submit
such dispute to a private arbitration service which has been approved by the Office of
Consumer Affairs and Business Regulation and the consumer shall be required to
submit such arbitration asp ovided in MGL c 142A."
Owner
Contractor
NOTICE: The signatures of the parties a apply only to the agreement of the parties to
alternate dispute resolution initiated by'die contractor. The owner may initiate alternative
dispute resolution even where this section is not signed separately by the parties.
The Commonweaft of Mansachus
i efts
1 Department Of Industrial Accidenit•
t Ice o 'Q
�' f IRvestteatlons
600 Nraishington Street
Boston, MA 62111
c� .
wiww nas�gov/die .
Workers' Compensation Insetrance Affidavit: Builders/Cuntractors/Eiectriciaasipi�be
A licant Information rs
Please Print Leeibi
Na]3 a (Businesdorgoizadon/Individual):
Address: /Sll'�vvcl, ,gyl r
• Ciiy/State/ ' :�P l?�1� G d$[G�t�..e v�,'.1
Pbone k.
Are you as employerTChmkthe appropriate box:
I:(] I am a employer 4. ❑ I am a Type of pro,[ect(r nicontractor and I �:
employees(foil aart-time).* have hired the mob-corttractars b• ❑New construe ionam.e mole proprieor.mpartner. listed on the attached sheet,t 7.
ship and have no employees' 'These subcontractors have �Remodeling
working for me.in any capacity workers' comp.insurance. 8. Q Demolition
LEE3]
o workers'comp,insurance 5. [7 We are a corporation and its 9' Btulding addition
quired] officers have exercised their I O.�$lectriml
m a homeowner doing all work ri t of TeP or additions
b'h exemption per MGL 11. PIurnbinyself ENO•work='comp, c t52, §I(4),snd we have no g repairs or additionssurance•required.]t om to 12• Roof sire
P yee& [No workers�m'p• insurancerequired.] I3.[].Ome*Any applicant than checks butt#I must also fill out the section below showing theirworkacc'bo
t tiomeownw who submit this affidavit indicating they ars 8oin an mpensation policy infonnstion
ZContraemrc that aheck this box rnuat g W°rk'end then him outside cortttaeton most submit a naw affidavit indi
oheQ sn edcF.�tiaasl sheer showing.the name of the sub- It
d,,and Ebeir wott�ss'- T:- Ch
I an en plovy er thx is' r0 ,,,,, .pn_,infnmretion.
,t► .> strg:►vQr&r.� -_-nWe=atevne insurance or
information. J mj' P1aJ'e= Below is the Pow,.and job site .
Insurance Company Name:
Policy#or Self-ins.Lie.#:
Expirafiott Date:
Job Site Address:
Attach a copy of the workers'compenution polcy declaration CitylState/�rp
page(showing the policy number and expiration date}. .
Fail=nup
to secure coverage as required under Section 25A of MGL C. 152 can lead to the imposition of criminal
fine up to$1,SD0,00 and/or one-year impri'wnm pe-naltim of a,
Of up to$250.00 a i ;as well as civil penalties in the form of a STOP WORK ORD
ER mid day ago nst the violator. Be advised that a copy of this statement may be forwarded to the a fine
Investigations of the DIA for insurance coverage verification. Office of
I do hereby car*under the pains and penalties of e '
P rluy that the utformotion provided above is true and ttotreeL
Signature: Date: "-31-�
Phone#: -7 -7 y 3
Official use only, do not write is tfris
area,to he cnnipleted bj' or town ofj-=w
City or iTwn-, Permit/LiceaseIssuing o (circle one):
I. BoardHeh 2- Buildiug Department 3.City/Tova•n Clerk 4. Electrical Inspector S. Plumbing inspector
6.Othe'r
. Contact Person• •
Phone#:
Information a tad Instructions
Massachusetts General Laws chapter 152 requires all emp 3 oyers 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 ofhire, -- .
express or implied,oral or written." j
An employer is defined as"an individual,partnership,assc:)diation, corporation or other Ito entity,or any two at more
of the'foregoing engaged in a joint enterprise,and includi"g the legal representatives of a deceased employer,or the
receiver ortnrstee•of an individual,partnership,associatiori or other legal entity,employing employees However the
owner.of a dwelling house having not more than three apati-tments 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 b--ca=of such employment be deemed to be an employer."
MGL chapter 152,§25C(6)also states that"every state 0-Irlocal licensing agency shall withhold the issuance or
renewal of a license or permit to operate a baseness or ite construct building in the commonwealth for any
applicant who has not produced acceptable evidenceaV compliance with the insurance coverage required." •
Additionally, MOL chapter 15Z, §25C(7)states`Neither t1he commonwealth nor any of its political subdivisions shall
enter into any contract for the performance ofpublic woric- until•acceptablo evidence of compliance with the insraarice
requirements of this chapter have been presented to the corm•acting authority."
Applicants
Please fill out the workers'compensation•affidavit oompi4mtely,by checking the boxes that apply to your situation and,if
necessary, supply sub-contractors)name(s),address(es);a.•nd phone number(s)along with their cerdficate(s)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees otherthan the
members or partners,are not requiredito cavy workers'compensation insurance. Van LLC orUP does have
empioyees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage Also b-sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the.application forum permit or license is being requested,notthe Departrnam of
Industrial Accidents. Should you have any questions regal-ding the law or if you are required to obtain a workers'
compensation policy,pleawcall the Department at the nurmber.listed below, Self-insured companies-should enter their :.
Solt-insmuncc licanse);umber.on ftia appropi•'sste tine:
City or Town Officials
Piease be sure that the affidavit is complete and printed IzWbly. The Department hes 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 appli=t.
Please be sure to fill in the permit/license number which vviIl be used as a reference number. In addition,an applicant
that must submit multiple permit/licensc applications in any given year,need only submit one affidavit indicating current
Policy'infonnafion(if necessary)and under"Job Site Addr-ess"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
s.
applicant as proof that a valid affidavit is on file for futto 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 parson is NOT,mquimd to complete this affidavit
Thr,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 as a call.
The Department's address,telephone and fax number.
The Commonarealth of Massachusetts
Doparlment of Industrial Accidents
Office of Lnvestigatdons
600 Washington Street
Boston, IviA 02111
TeL 9 617-72.7-4900 ext 406 or 1-977-MASSAFE
Fax 4 617-727-7744
lttrvised 5-26-!15 wK'wmass.govidia
l
�� Z/JLi%77%h20721I1P.CllIIL"tO���QifY�►ts�s�` _.+
i SN
Board of Building Regulations and Standar&
HOME IMPROVEMENT CONTRACTOR
.rm
Registration':, 150927
i
Exp TU-111rl 518/2010 Tr# 266998
Type DBA'
HOME IMRPOVEMENTS..BY-BOB
ROBERT PELLETiER A.
157 BOARDMAN S1 REQ ET
HAVERHILL, MA 01830 Administrator
117_� ffie t7arr�nwouuea�Z ��
BOARD OF BUILDING REGULATIONS,
j, License: CC?NSTRUCTION SUPERVISOR
Number CS ' 093560
Birthdate 12/24/1969
Expires¢ 12/24/2009 Tr. no: 93560
? Restricted., 90
ROBERT G PELLER)ER JR
157 BOARDMAN ST rJ
HAUERHILL,jMA 01830 Commissioner