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Home My WebLink AboutBuilding Permit #218 - 32 PARK STREET 9/22/2009 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: 2-1 Date Received Date Issued: • 2.2'C IMPORTANT:Applicant must complete all items on this page LOCATION 3a? ?4a 'SI Print PROPERTY OWNER V f'60 Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes o Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alterati No. of units: ommercia itreplacem Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) OWNER: Name: V FC& Phone: 975� - 796/41 Address: CONTRACTOR Name: 120 Lei's" Ili f'%ey Phone: 92 $' 73 60 4/& 7-0 Address: 1J t� ?-Id tic o-rt s ` lj r� V 4e Y4 . t 13 YYt t4 0I�� Supervisor's Construction License: 0 Exp. Date: Home improvement License: Exp. Date: 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: $ 1 Check No.: i161� Receipt No.: 22� NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contract Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL h Public Sewer Tanning/Massage/Body Art Swimming Pooh .y 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: Signaturg: Located 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 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 ❑ PhoAnd/Kr Copy Of H.I.C. And/ C.S.L Licenses Lw-"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: Doc.Building Permit Revised 2008 Location Z / rL' 1� No. 2J Date01 NORTIt TOWN OF NORTH ANDOVER 9 i y Certificate of Occupancy $ �'�s'••°'E�� Building/Frame Permit Fee $ �CMuS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check #2 2 _ Building Inspector NORTIy Town of _ over . No. o =- LAKE = dover, Mass., d a 9 COCHICHEWICK 7� ORATED `s BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System U..Flop.'3 BUILDING INSPECTOR THISCERTIFIES THAT....... ...................................................................................................................................... Foundation has permission to erect........................................ buildings on ....3Z......IOC A,��......5.(.... ............................... Rough 1 1. to be occupied as V t n'�.L -�4�'�`^ Chimney ...... ...U... ................... 1�...... .... .... .. . ........ ................................................... provided that the person accepting this permit shall in every conform to the terms of the application on file 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 2 PERMIT EXPIRES IN 6 MONTHS Final ELECTRICAL INSPECTOR UNLESS CONSTRC TARTS Rough -- --- BUILDINGService �CTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — -Do Not Remove RoughFinal No Lathing or Dory Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. 09/22!2009_08:32 9787948570 TA SULLIVAN PAGE 01/01 "11i ATE(m"oI m ACORo„ CERTIFICATE OF LIABILITY INSURANCE MAI'1 09/22/09 PRODUCER THIS CERTIf KATE a ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGM UPON THE CERTIFICATE . A. Sullivan Ins. Agcy, Inc. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR T T.A S. ulliA St.. ALTER THE COVERAGE AFFORDED B1f THE POLICIES SELOW, Lawrence, NA 01843 MAIC f>1 phone: 978-693-4700 INSURERS AFFORDING COVERAGE IVBUR INSURERA. emmettent Dneerrlltwe Inc. INSURER B: POmml9 OMMRA"0111 ZMUPANQR rMav�ts by Bob INSURER C. x Haver h 01832 MSVRERD: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURE HAWED ABOVE FOR THE POLICY PERIOD INDICATED,NOTWITHSTANDING ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WIYH 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. LT TYPEOFMBURANCE POLICY NUMBER DA DA M LNf� EACH OCCURRENCE 61000000 X DIED COMMERCIALOENERALLIABKITY CL81571163 03/28/09 03/28/10 PREMISESEs--'-'ar s50^ 000 _ eLA1►AS MADE OCCUR MED Exp(Any one P"m) s 5D00 PERSONAL&ADV INJURY 21000000 GEI,Z AGGREGATE s2000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS•CDM►IOP Am S'2000000 POLICY 33EGT LOC AUTOM0V0.E LIABILEIY CCMBMIED SINGLE LIMITf fEB Aeclda+) ANY AUTO ALL OWNED AUTOS BODILY INJURY s (PBI Oorson) SCHEDULED AUTOS HIRED AUTOS (PD�a�RV S WONAWNEO AUTOS PROPERTY DAMAGE tP+r sealW11 AUTO ONLY•CA ACCIDENT s GARAGE LIABILITY THAN EA ACC S ANY ALTO AUTO ONL AGG s EACH OCCURRENCE s ExcoBanAIeRELu 11ANILITY S OCCUR CLAIMS MADE AGGREGATE s f DEDUCTIBLE s RETENTION I: WORICPM COM"NSATION AND T Y UMTS ER S EM►LOYERVLIABILITY 19CHSR1�000005560 09/17/09 09/17/10 E,L.EACHACCIDENT 3100000 ANY PRWo ETOWPARTNER)EXECUTIVE E.L.0161=ASE•EA EMPLOYEE 3100000 OFFICE EXCLUp1;D NyeA•CBUIIIMBER E.LDISEABE•POLICVLIMIT s 500000 SpEf:lAL PROVISIONS bokm OTHER A Commercial Applica Cr.81571163 03/28/09 03/28/10 .HB DEyo p-T Deo TIONS/LOCAVOW/VEIBCII mKAA NS ADDIED BY EMDORseMEMT/aPEC1AL PRONe10 NS Residential carpentry, mostly ki.tabons, tris work CANCELLATION C6RITiFlCATE MOLDER xxxx SHOULDABIV OF THE ABOVE OWR)BED POUCISS BE OANCEU.ED BEFORE TNI VIP"TIOB DATE THEREOF.THE ISBUMO 9=RER WLL EmuvoR TO MAIL 20 DAYS vmmm TDMA of North AndoTrer NOTICE TO TH!CERTIFICATE HOLDER NAMED TO TWE LEFT,BUT FAILURE TO DO Bo SMALL Building rn"ator IMPOS!NO OSLIwflOM OR LIABILITY OF ANY KIND UPON THE INSURER.ITE AGENTS OR REMr.BENT AUTHo R ATNE ACORD 2$(2001106) ACORD CORP RATION 1931 T1ze -Pomvnzo.uuen;� a�✓��a�ac�ivaeC�6. . BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 093560 B i rt h d ate: 12/24/1969 Expires: 12/24/2009 Tr. no: 93560 Restricted: 00 ROBERT G PELLERIER JR , 157 BOARDMAN`� HAV!I:RHILL, MA 01e30 Commissioner f ✓� VG✓,7xm20IZ1!/CpAI/L O�i//�GCZQQ�LI[dP.�b - . 1 ate\ Board of Building Regulations and Standards I HOME IMPROVEMENT CONTRACTOR Registr4UP.l v 150927 j Expi ation;—S18/2010 Tr# 266998 r ry Type. ,Dee j HOME IMRPOVEM11MTS B�i OB ROBERT PELLETIERJR 157 BOARDMAN StR' HAVERHILL, MA 01830 Administrator Home Improvements by Bob Tax ID#20#0905823 Date: 09/16/09 157 Boardman Street Reg# 150927 home# Haverhill,Ma 01830 cell# 978-374-6397 work# email.Improvementsbybob@comcast.net Proposal submitted to: V.F.W. Email: Address: 32 Park St. City,State,Zip code: N. Andover,MA 01845 I hereby submit specifications and estimates fora Siding Strip and removal of old vinyl siding on building. Remove 2 dummy windows on north side of building. Install new white metal on all facia,racks, doors and windows. New tyvex will be installed prior to siding. Add new Monogram Light Maple siding. J channel and comers will match siding color. Replace 12 sets of shutters(hunter green). All material will be removed by contractor. I hereby propose to furnish material and labor complete in accordance with the specifications for thirteen thousand four hundred and eighty two $10,582.00 Payment to be made as follows: $500 prior to starting. 2'payment of$7,000 is due on day of construction. Last payment of$3,082 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. i X - X .� Signature Agnatur 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 Bus' ess Regulation and the consumer shall be required to submit such itratio provid in MGL c 142A." Owner Co/actor NOTICE: The signatures of the parties4bXc apply only to the agreement of the parties to alternate dispute resolution initiateoyl&contractor. The owner may initiate alternative dispute resolution even where thi ction is not signed separately by the parties. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 UT www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): f3 o S, Address: f�� G14-IC(P 1 1+sq S 7" City/State/Zip: H Ave11+-i`4/ MO- 0«30 Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.[ I am a employer withZ 4. E] I am a general contractor and I 6. ❑New construction employees(full and/ �p�artj have hired the sub-contractors 2.❑ I am a sole-proprietor 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 required.] officers have exercised their 10.❑Electrical repairs or additions .3.❑ I am a homeowner doing all work right of exemption per MGL II.❑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' 13.[:] Other 51 �r 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. $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: 1 Policy#or Self-ins. Lic.#: Expiration Date: Job Site Address: 3;2 P4//L 5T. City/State/Zip: /I,,- 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 certify under the pains and penalties of perjury that the information provided above is true and correct Si ature: Date: Phone#: 1' 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 carry 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 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. #617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax# 617-727-7749 www.mass.gov/dia