Loading...
HomeMy WebLinkAboutBuilding Permit #504 - 345 CHESTNUT STREET 3/6/2008TYPE 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 District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: Identifi ation Please Type or Print Clearly) OWNER: Name:�� 1 �� l�,u� Phone: 97t, FF d3'� Address: 3� LtiT �T CONTRACTOR Name: Gt A2h1 i u Ar Phone: '97t 77/ Address: 21 Z1,P/©115 kr,< G 1-- �f Supervisor.'s Construction License: 3 Exp. Date /////2-0,10 Home Improvement License: % Exp. Date -7 / Y ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE. BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COSTBASEDON $125.00 PER S.F. Total Project Cost: $(% FEE: $ laJ� Check No.: ® Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to toe guyran unA Location C hej4�- a •o�-- No. Date 26 �oRrM TOWN OF NORTH ANDOVER 3? ' 9 i a � �o Certificate of Occupancy $ Building/Frame /Frame Permit Fee $ s^CHust 9 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 20973 Building Inspector 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 i� COMMENTS DATE REJECTED DATE APPROVED HF,ALTH (3�OMMENTS 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 FIRE DEPARTMENT -- Temp Dumpster on site yes no Located at 124 MainStreet Fire Department signature/date COMMENTS Dimension Number of Stories: Total land area, sq. ft.: Total square feet of floor area, based on Exterior dimensions. 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 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 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 DEPARTMENTWITORM07 Revised 2.2007 m m m m cn m mm c -v C � d CACD n Z y CL O F• G CL? � O CO) aCO -0 loo C CD CD CL W�CD Er cco O CSD C CD y n0 co) co I CD 1 5 F 11� n 0 z C O z O •N,� Cr N S 0 am W O CDC09CD m • n Z N' m �� N• �. z�m N T n'1 1 o. o O �O O N p y O N O ?m m = = O N '•'I = cM OR� H 0 g . dp o =; M w0 w O m O °Q ro r Z m o oQ c a z 0 U cn R 0 x bo O d o 7d dp ,r ad 0 c rn m 0&x co a C m C7 �N> VZ� morn tD � > C17 NrC OM= O cn .I a M C7 C") ...{ O cnmz M rn,C �m—i =a �mz J? O Z� ~>LiH Ul Z m A ORtiNa y►rn7j0pZ' m'4-" a o'7mmNm " r7 O m . � � c da � !Al g 0 Nm M?Y cooeeJ� dm or r 010 m m O O m O C ti•� �+ r W on 'r x x a � Cb lb ae» mem M r cy m a «�Wo 0= 00 00=00m =wH an pRrC=x A ►- Wks a' N Z rr-4 worn �d r (� %q (q m 04.7 a Ap " m l► ... Z eoon 0 el O m qV o7z V +�o� --=r.0 ems tp% •.qey M&.. 3'rl. �,a N eercr ?a`4 ce Vr O �I m �m & /4�� 1. mr m:01 "13m"tA0 y 14 ���oa do ° ty,o c C) �� d �� 41 M.�O►.. C�cg Ra �vR .. m MW Ow naOlm ReMC as (� oo� ep m Z O d m 0nr0Z m��•.� N 0 �� woai caanin2 a' m 4 ddea 7INa v N moms rmie0 7 7 r.eT ~oa r U, `-baoc R0 CA0 f r Zd r as Rm 7»a pe rn ,qo�� arnrP. w� Z „off m n o* .. o� am o 9b' 0 -4JsC R do V R lb -to m NO Crd 7 crerm R =T d0 �+ ZRO 2 G N 0 g r rn� o Q ner..� e»oaaR = c� � !Al g ams A m C Onw ST a d0 RCTe R =0 C Z 7 r C= a� S- cl, OWI mann RCT ;rm Z + ae» 7r M r mmo9 am C) 0= %C a 00=00m =wH an pRrC=x A ►- N Z X worn �d r o �wera 7 (q m 04.7 a Ap " m l► ... ;�'` el O m qV o7z V +�o� --=r.0 a O Oei "'M ce eo mr To» "13m"tA0 y 14 a .d•+Sm ° ty,o c C) 9i CPO13 RORb000 m G Ra d0 Ra m aim %s r naOlm ReMC as (� eT ep o0 O d m 0nr0Z woai caanin2 O ddea 7INa s o. moms c Md 7 7 r.eT ~oa r R0 CA0 f r Zd r as Rm 7»a pe rn C arnrP. Z r1sm10w o� vor3 0 -4JsC R V R � Crd 7 crerm R d0 �+ ZRO U � U� �X 0� g r rn� o m m > rs m' -n o � !Al g C7 A g r o > -4 A C z Z o.�� FNM V rO CdA WOrn C) 0= o av =wH co cn N X worn 7 CDZ el n Z eo co rr 3 a m 7 i f 1.fn � i J Jt ' oz i f 1.fn � � i J Jt ' e 'C o . m h UJ m 0 � k �?� Eft I UI LA cn m -� Z Zco c G) ai I co m w v L n N ? C �LA C3 n Z 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: 5 Ll5 I-6 �- , � —/ Si 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: wrV— ZAX (l'1GL-v(' (Location of Facility) Signature of Permit Applicant J Date 3- 2 DUNDAS AVENUE, ANDOVER, MA 01810 470-2640 We Michael Scott H, z C, R-rG,t- /'136&3 Andover Renovations Additions - Carpentry • Remodeling Page / of PROPOSAL SUBMITTED TO JO Liorgov PHONE GATE % Q �f� t STREET 3 q6*C kip 5r 5*7— JOB NAME Xy. STATE AND IIP C E j�q Nvat77� � �V z PePEk°�e Get oqs JOB LOCATION %RCHITECT DATE OF PLANS JOB PHONE Ne hersttr propose to furnish matensb and labor necessary for the Consolation of Ar4iw�� . F.? A �V, Ia A4f (36c a IS el '7 iyd grr � TY °; Circ:. WAl4v o a- Ce "f—"e., 5 /770 fRA&w,' S vl c- 0,6 33 �`fi''�'�.r€,'� 6•" �j"k£ _� �{;,f `ar' E�9`T i F s�ii� F 3 Yp+ (i � �i aA � F� ,'"3 4:�+� � ,� 4'. Y',.-� 0� � � s - " ±: ,. i r eft- _.A # *-M/ . i t /4' of S* WE PROPOSE hereby to furnish material and labor — complete in accordance with above specifications, for the sum of: dollars tS �" All material Is guaranteed to be as specified. All work to be Completed In a sub- } stantial workmanlike manner according to specifications submitted, par standard Aethonttd practices. Any alteration or deviation from above speeltieatlons involving extra Slpbatun costs will be executed only upon written orders, and will become an extra charge over and above Ina estimate. All agreements contingent upon strikes, accidents or Note: Ihts pMpbsd may be delays beyond our control. Owner to carry tire, tornado and other necessary in. cat tl not ucepted within days. surance. Our workers are fully covered by Workmen's Compensation Insurance. .Imawan by ACCEPTANCE OF PROPOSAL The above prices, specifications and condi. 1 ,; . "i v tions are satisfactory and are nereby accepted. You are authorized to do the work / f as soaclfled. Payment will be made as outline above. W. Michael Scott 2 DUNDAS AVENUE, ANDOVER, MA 01810 Andover Renovations Page -IL of 470.2640 Additions a Carpentry • Remodeling PROPOSAL SUBMITTED TO I -V #W � PHONE 17? — z= 1$ DATE STREET i JON NAME :ITY• STATE AND IIP CODE JOS LOCATION %RCHIIECT DATE Of Pup JOB PHONE Na nt" propose io iwnnh malonais and labor necessary for the edmpiehtM 01. a / 4 er w,/ t4 --e 1 W% O IN1771k 1fIlY, 0211L r�l u �3 4 /Z 627r, 6,L' 2" s 0 RAL* 4!4 0, tt"- % d f3$�•e +V7 Io- / ,� y " !pig � F � �"{ i' -1 pr�+��.,,�`.e����°�'RqR 67K 1 ee, WE PROPOSE hereby to furnish material and labor — complete in aimordance with above specifications, for the sum of: dollars {S ant to be made as All material is guaranteed to be as specified. All work to be completed In a Sub. �. stantlal workmanlike manner according to specifications submitted, per standard Authonteds" Practices. Any alteration or deviation from above specifications involving extra � .. i costs will be executed drily upon written orders, and will become an extra charge e pSignature over and above the estimate. All agreements contingent upon strikes, accidents or Note: Ibis proposal may be delays beyond our control. Owner to carry fire. tornado and other necessary in• airnontel by as d eat accepted within days. surance. Our workers are fully cavereo by Workman's Compensation Insurance. ACCEPTANCE OF PROPOSAL The above prices, specifications and conal• tions are tatlsfactory and are hereby accepted. You are authorized to do the work as speciflao. Payment will be made as outline acove. The Commonwealth of Massachusetts Department of Industrial Accidents V Office of Investigations 600 Washington Street Boston, MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (BusinesslOrganization/individual): IM /G/ 75�, Address: o1 f)(_lh/ jl)/%f 1--t-y-6 City/State/Zip: 011&gL & ol?i u Phone #: '?7f 7 %/ F-'6 ff Are you an employer? Check the appropriate box: Type of project (required): l$4 -Lam a employer withy 4. ❑ I am a general contractor and I 6. ❑New construction employees (full and/or part-time).* 2. ❑ I am a sole proprietor or partner- have hired the sub -contractors listed on the attached sheet. 7. Q Remodeling ship and have no employees These sub -contractors have g. ❑ Demolition workingfor me in an capacity. y p �'• employees and have workers' 9. ❑Building addition [No workers' comp. insurance required.] comp. insurance.$ 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3. ❑ 1 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 13.❑ Other employees. [No workers' 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 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. Insurance Company Name: ,, / Policy # or Self -ins. Lic. #: 7 PJ_1' - 0 Q/ 7 B -39-A-07 Expiration Date: 10 - O / d Job Site Address: 345- 6 Ir 57' City/State/Zip: #0 4DOt1z%r-g- 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 i1 nder the p in nd allies of perjury that the information provid�/%e/d�a ve is true and correct. CianafiirP j ////"z A TiatP 17 , Phone #: !?-7 4 % % t F -V f" f 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 #: BO A.Mi ni�io sand 5tanc ar�&s ° Construction Supervisor License License: CS 44723 Expiratiiow. v1112010 Tr# 12250 Restrncfion 00 W MICHAEL SCOTT 2 DUNDAS AVE ANDOVER, MA 01810 Commissioner Boai?t'i�fla�7dn/andSfaii ar s HOME IMPROVEMENT CONTRACTOR Registration: 113863 Expiration: 7/19/2009 Tr# 130331 Type: Individual W MICHAEL SCOTT W MICHAEL SCOTT 2 DUNDAS AVEC ANDOVER, MA 01810 Administrator COMMERCIAL LINES POLICY - COMMON POLICY DECLARATIONS NAUTILUS INSURANCE COMPANY Scottsdale, Arizona Transaction Type: Renewal Renewal of Policy # NC534887 Inspection Ordered: Rewrite of Policy # ❑ Yes ® No Cross Ref. Policy # Named Insured and Mailing Address (No., Street, Town or City, County, State, Zip Code) W. Michael Scott DBA Andover Renovations 2 Dundas Avenue Andover MA 01810 - Auto • Home + nosiness • Life • Hedtth ' $YEITE ' INSURANCE 02006 - o AGENCY' - 853 Maid Street Tewksbury, KA QIS76 Phone (978) 851.6678 • Fax (978) 851-0106 Policy No. NC633833 Policy From 03/06/2007 to 03/05/2008 at 12:01 A.M. Standard Time at our mailing address shown above. Period: Y g Business Description: General Contractor Tax State MA Form of Business: M Individual ❑ Partnership ❑ Joint Venture ❑ Trust ❑ Limited Liability Company (LLC) ❑ Organization, including a Corporation (but not including a Partnership, Joint Venture or LLC) IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF THIS POLICY, WE AGREE WITH YOU TO PROVIDE THE INSURANCE STATED IN THIS POLICY. THIS POLICY CONSISTS OF THE FOLLOWING COVERAGE PARTS FOR WHICH A PREMIUM IS INDICATED, THIS PREMIUM MAY BE SUBJECT TO ADJUSTMENT, PREMIUM Commercial General Liability Coverage Part $ 8,207.00 Tax & Fee Schedule TOTAL ADVANCE PREMIUM State Tax $ 328.28 Minimum & Deposit TOTAL TAXES & FEES $ $ 8,207.00 $ 328.28 TOTAL $ 6,535.28 Form(s) and Endorsement(s) made a part of this policy at time of issue: Refer to S902. Schedule of Forms and Endorsements.: Countersigned: Worcester, MA By , �'j 03/22/07 RPI Count rsignature or Authorized Representative, whichever is applicable LJS THESE DECLARATIONS TOGETHER WITH THE COMMON POLICY CONDITIONS, COVERAGE PART DECLARATIONS; COVERAGE PART COVERAGE FORM(S) AND FORMS AND ENDORSEMENTS, IF ANY, ISSUED TO FORM A PART THEREOF, COMPLETE THE ABOVE NUMBERED POLICY. Includes copyrighted material of Insurance Services Office, Inc. with its permission. 5944 (10/04) ORIGINAL ,t:. NOTICE Qh EMPLOYEES NOTICE EMPLOYEES The Commonwealth of Massachusetts DEPARTMENT OF INDUSTRIAL ACCIDENTS 600 Washington Street, Boston, Massachusetts 02111 617-727-4900 — http://www.mass.gov/dia As required by Massachusetts General Law, Chapter 1.52, Sections 21, 22 & 30, this will give you notice that I (we) have provided for payment to our injured employees under the above mentioned chapter by insuring with: THE TRAVELERS INSURANCE COMPANIES NAME OF INSURANCE COMPANY ONE TOWER SQUARE HARTFORD CT 06183 ADDRESS OF INSURANCE COMPANY (7PUUB-0047B39-A-07) 10-01-07 TO 10-01-08 POLICY NUMBER EFFECTIVE DATES BYETTE INS AGCY 853 MAIN ST a TEWKSBURY MA 01876 <= NAME OF INSURANCE AGENT ADDRESS PHONE # SCOTT, W MICHAEL 2 DUNDAS AVENUE o= ANDOVER MA 01 810 m= EMPLOYER ADDRESS EMPLOYER'S WORKERS COMPENSATION OFFICER (IF ANY) DATE MEDICAL TREATMENT The above named insurer is required in cases of personal injuries arising out of and in the course of employment to furnish adequate and reasonable hospital and medical services in accordance with the provisions of the Workers' Compensation Act. A copy of the First Report of Injury must be given to the injured employee. The employee may select his or her own physician. The reasonable cost of the services provided by the treating physician will be paid by the insurer, if the treatment is necessary and reasonably connected to the work related injury. In cases requiring hospital attention, employees are hereby notified that the insurer has arranged for such attention at the NAME OF HOSPITAL ADDRESS 001449 W20PIG02 TO BE POSTED BY EMPLOYER