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Home My WebLink AboutBuilding Permit #108 - 34 WEST WOODBRIDGE ROAD 8/10/2007 NORTH q BUILDING PERMIT ° do TOWN OF NORTH ANDOVER F p APPLICATION FOR PLAN EXAMINATION Permit NO: /0r Date Received 9 � S AT.° 9SAC M1`+�� Date Issued: /0/0-7 IMPORTANT Applicant must complete all items on this page AIL 3 I N �1 S # � T e 2 n acI011, AN'SQallyls , o TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition El Two or more family ❑ Industrial - ❑ Alteration No. of units: D Commercial 9-Ptepair--replacement ❑ Assessory Bldg ❑ Others 11Demol'ion ❑ Other shied CRN, Alar 3i trt i DESCRIPTION OF WORK TO BE PREFORMED: I c P C'R Ls 111Nj6 4k--t P rA-t•N �r I t57, pL" syri.lm Type or Print Clearly)Identification Please YP Y) Phone: Vg`�52' 3a�� OWNER: Name: Address 2�. �i `� r 1-' 4 105 'N AA"cld res , S tl e SOr'S" ,00"Ps t i lCti 3i 1 L1{+ tl FlE No e In�r rduernr>i ,..:may. 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: $ 6( °0 FEE: $ Check No.: Receipt No.: o2 6 W6 NOTE: Persons contracting with unregistered contractors do not have acc s to the guaranty fund 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 ❑ ❑ a COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ 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 Located at 384 Osgood Street F�R� fPARl`MENT� Vern°p D rnps�tefon, sate yes �� o Locatee at124 MainStreet` r � a 1=rreepartment signfatulref:.date� a i �COIUIIUIE�I�TS ,� - � � 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 2 1 A—F and G min.$100-$1000 fine NOTES and DATA— For department use j . �I ❑ Notified for pickup - Date .................................---........................................ ... ............................................................_...................................... ..............................._..................................................................... ..........._....................................................... Doc.Building Permit Revised 2007 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/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 i 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: Revised 2.2007 Location 3 No. �"6 Date 1G G I / g M RTM °, t�,° ,•�� TOWN OR NORTH ANDOVER Certificate of Occupancy $ E<t' Building/Frame Permit Fee $ s�cwus u Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 4 Check # y�/ 20480 h d Building Inspector NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit at: Woc ru;�,�is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150 A. Also, note Permits are required under Fire Prevention laws.Chapter 148 Section 10A. The debris will be disposed of in: L16Y'?'jn evrz -t- )2e-z, C lL(Z-- 47v-(tv./0114 N� (Location ofacifity) V66"tL,,,j Signature of Permit Applicant Fire Department Sign off: Dumpster Permit Date NORTH Town of 0 No. Ilk a? y o dover, Mass. T O — LAKE \ co MIC HE WICK ry1 ADRATE D i` �� `r BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THISCERTIFIES THAT ............. /.....I......4..................................................................................................... """"' Foundation • has permission to erect.............. buildings on .... Rough • to be occupied as.......14WQQ: Chimney-.0..... ... ie....A- A provided that the person accepting this permit shal 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. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PENT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUC7000,0WO, ARTS Rough .. ... ... Service . ..... .... . .................. ..... BUILD R 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. SEE REVERSE SIDE Smoke Det. WAWAd887 111:14 PH A.tlme9 D.ii...a.— F_ ie 9786889547. P.O.I ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(NMUDIYYYY) �B 08/07 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION I'SuranceNOOdle, I-c ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 222 S. Riverside Plaza 17th Flocr HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Cc_icajO, 11, 50.05 INSURERS AFFORDING COVERAGE NAIL N INSURED W-URERA: Na_iOtt::l Gx allyr MuL_al LnSw:auC, MI-HAEL J LAW D=A BETTER HOM18 WLNDOW AND SILL=NG 18 BATES ROAD INSURCOB: HAVERHILL, YA 0=832 INEURERG: INSURER D: INSURER C COVERAGES 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 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 SHOWNMAY HAVE BEEN REDUCED BY PAID CLAIMS. INSA WL OFiNSURANCIPPOLICY NUMBER POLICYEFFECTIVE POLICYEXPIRATION LIMITS GC GENERAL LIABILITY (+1LY10?OB 05/21/2001 06/21/2008 CAL OL UFMAUL IUKLN -U _ $ _,D0 =,000 COMVEHGIALGENE�AL LL481_ITY PRE LS=S a-�cur n- .� $ GLAIMSM.4DE �OCCUO ME�EMP IAnymep.mm) $ _ -,9D0 A PERSONALaADVINJUPY 6 - ,OOC,000 GENERALAGGREGATE $ 7,001,000 GEN'LAmREGATELNITAPPLIES PEP: PRODUCTS-C:,\1PtOPAGG $ 2,00_,000 PP.' J PGLIGY E 7 LOG AUTOMOBILE LIABILITY GOV BI\E D S N n LE_IMIT ANY AUTO I I=eaceidenC $ ALL OWNC AUTOS I BOUILY IN_U,Y SGHED_LEDAUTOS I-erperswl) $ HIR=DAUTOS BODILYIN.0;Y NON-OWNCDAUTOS I=mo acadent) $ i PROPERTY DAMAGE $ I (-a ac:adel',t) GARAGE LIABILITY AUTO ONLY-[AA:;cIDCNT $ ANY AUTO OTH=R--AN EA.4CC $ , AU IoUNLY. AGG $ EXGESSAAYBRELLALIABILITY CAL: Occ:UR';CNCC $ OGGUR F1 GLAIMSMA�E AGGREGA $ — $ DCDUGTIBLC $ RETENTION $ $ WORKERS COMPENSATION AND TORY LIV ITS ER EMPLOYERS'LIABILITY ANY WLL'IaEOB OS/03/200r 0S/03/i00R C E4c.I,AL'GIDCN- $ SOJ0�0 , A .A OFFICERNEMBER EXCLUDED? E._.DISEASE-EA EMPLOYEE $ S00,0=0 qyes.descibe under SPEC IAL P:OVISION5 celcw E._.DISEAS=-POLICY LIMN- 1$ OTHER DESCRIPTION OF OPERATIONS I LOCATIONS!VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL - _DAYS WRITTEN Town nf Cert= Andover NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TODD SO SHALL 1600 Osgcod at N AndOVe'', MA ^18 4 5 IMPOSE NO OBLIGATION OR LIABLITY OF ANY KING UPON THE INSURER,175 AGENTS OR REPRESENTATIVES. AUTHOWPREPRESENT V9 ACORD 26(2001108) IpQ ACORD CORPORATION 1988 The Commonwealth of Massachusetts Department of Industrial Accidents W..I I• ; Office of Investigations 600 Washington Street Boston, MA 02111 `i www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl Name (Business/Organization/Individual): l Gtr+*I- L4,-) Address: i�3 BATr3 City/State/Zip: 40(V-1,Phone #: Are yo n employer?Checkthe appropriate box: Type of project(required): 1. I am a employer with t� 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 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 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 1 1.❑ 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 comp. insurance required.] 13.❑ Other *Any applicant that checks box#I 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: '� �y !�I(� a v E LstY` Policy#or Self-ins. Lic.#: d Xp /0 f®0 Expiration Date: r,�21, 8 Job Site Address: ,3 (AJddf W fs-4m 13 V24 V&c City/State/Zip: GVH �irC1� 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 hereb certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: b Phone 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. # 617-7274900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax# 617-727-7749 www.mass.gov/dia Board of Building Regulations and Standards HOME IMT) ROVEMENT CONTRACTOR Registrd4on. 122318 _Expiration 8Y16/2008 BETTER HOMES,WINDOW&S,I�D`iNG MICHAEL LAW 18 BATES RD HAVERHILL,MA 01832 Deputy Administrator BETTER HOMES WINDOW AND SIDING THE EXCLUSIVE WINDOW AND SIDING CONTRACTOR 978-372-6385r TOLL FREE 1-800-668-3505 MASS REGISTRATION #122318 DATE 3/Zib/ O`7 SOURCE &(-r-,N r'-rA- CONSULTANT HOME TEL. ' OJ-78—&81-36WORK TEL. MR./MRS. THIS AGREEMENT, m�de and entered into between BETTER HOMES WINDOWS AND SIDING hereafter referred to as a contractor AND �t�-ou:L, ape ADDRESS/STREET '34 WeSV WOObSt?kV-,C 1210ITY N,A1,001je,r STATE ZIP hereafter referred to as owner. THE SAID CONTRACTOR hereby agrees that it will furnish all labor and materials necessary to install the following described work at premises located at: JOB ADDRESS "SWy-A CONTRACTOR agrees to start described work on/or about � �' ' weeks after final measure and complete described work in about 3-- 57� working days. In addition to manufacturer's warranty, Better Homes Window and Siding guarantees our workmanship for ten years. ALL HOME IMPROVEMENT CONTRACTORS AND SUBCONTRACTORS SHALL BE REGISTERED IN MA.INQUIRIES RELATING TO A REGISTRATION SHOULD BE MADE TO:DIRECTOR,HOME IMPROVEMENT CONTRACTOR REGISTRATION,ONE ASHBURTON PLACE,ROOM 1301,BOSTON,MA 02108,TEL.617-727-8598. We hereby submit specifications and estimates for: 'LC�►'� 3 It,15PME PT--V-D <> vC- Ccs PA=K 'FLP-9\1 d N C-- LA 1Z ; LP SIA 4-t AD s k C G A-tj D lAJAT-i'� S 111 gml P, ! Q-06 P I�vfp 1�i-�� 'T 12AT t u t� l -+P�L� 1 Com; .► A►-�'CYt.SYt t - �� FST �-J P �R�1A V-- 06F e13&S 1'f,-L- N CUA ►I --&kM(E TtEvz M E Tom- C-7) �N S ipr� �Z\0 A PP� A;ii 3T'46 20L)A N 6, vv~i,prx, C—-VLS`R-Nro CdLyi? X- Phu E-(=� -T7� 9C- Cb&APLe"'CL=ID 0,4 0tce_i)(2\-)Plta ce W i.-th Piv POSAL L' Frk WE PROPOSE HEREBY TO FURNISH TOTAL INVESTMENT 1 0, Cid0 r — MATERIAL AND LABOR (IF SPECIFIED) — ZOO &hr-/a'7 DEPOSIT 0(36, , COMPLETE IN FULL ACCORDANCE WITH ABOVE SPECIFICATIONS FOR THE SUM OF: BALANCE UPON COMPLETION i 9oe� ANY WORK NOT LISTED ON THIS CONTRACT WILL BE AT ADDITIONAL CHARGE.BETTER HOMES WINDOW AND SIDING DOES NOT INCLUDE PAINTING OR STAINING ON ANY PROJECT UNLESS SPECIFIED ON THIS CONTRACT. You may cancel this agreement if it has been signed by a party thereto at a place other than the address of the seller, provided that you notify the seller in writing at 18 Bates Road, Haverhill, MA 01832, by ordinary mail posted, by telegram sent, or by delivery, not later than midnight of the third business day following the signing of this agreement. ALL MATERIAL IS GUARANTEED TO BE AS SPECIFIED.ALL WORK TO BE COMPLETED IN A WORKMANLIKE MANNER ACCORDING TO STANDARD PRACTICES.ANY ALTERATIONS OR DEVIATION FROM THE ABOVE SPECIFICATIONS INVOLVING EXTR COSTS WILL BE EXECUTED ONLY UPON WRITTEN WORK ORDER AND WILL BECOME AN EXTRA CHARGE OVER AND ABOVE THE ESTIMATE.THIS IS TO INCLUDE, UT IS NOT LIMITED TO,HIDDEN DAMAGES THAT ARE UNCOVERED DURING THE COURSE OF THE JOB AND ADDITIONAL WORK REQUIRED BY LOCAL BUILDING 1 ECTORS.ALL ELEMENTS OF THIS AGREEMENT ARE CONTING NT UPON STRIKES,ACCIDENTS,OR DELAYS BEYOND OUR CONTROL. NOTE,THIS PROPOSAL MAY BE WITHDRAWN BY CONTRACTORP-7 IF NOT ACCEPTED WITHIN DAYS. AUTHORIZED SIGNATURE DATE ACCEPTANCE: THE ABOVE PRICES,SPECIFICATIONS,AND CONDITIONS ARE SATISFACTORY AND ARE HEREBY ACCEPTED.YOU ARE AUTHORIZED TO DO THE WORK AS SPECIFIED.PAYMENT WILL BE MADE AS OUTLINED ABOVE. AN INTEREST CHARGE OF 1-1/2%PER MONTH(18%PER YEAR)WILL BE ADDED TO ANY AMOUNT UNPAID AFTER 30 DAYS FROM INVOICE DATE. DO NOT SIGN THIS COr4TCT IF THERE ARE ANY BLANK SPACES SIGNATURE TE2�/_ SIGNATURE DATE