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Home My WebLink AboutBuilding Permit #654 - 35 MAGNOLIA DRIVE 4/9/2007PermitNO: Date Issued: TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received IMPORTANT: Applicant must complete all items on this page LOCATION 3,-'� / 6G 71el- /-'#- 5C Print PROPERTY OWNER C�hly? LAS 41fL3'e� Print MAP NO.:16 � PARCEL: t ly ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Resident Non- Residential ❑ New Building ❑ Addition Iteration 410ne family ❑ Two or more family No. of units: ❑ Industrial ❑ Repair, replacement ❑ Demolition ❑ Assessory Bldg ❑ Commercial ❑ Moving (relocation) ❑ Other ❑ Others: ❑ Foundation only DESCRIPTION OF WORK TO BE PREFORMED r Identification Please Type or Print Clearly) OWNER: Name: lV%`%/ G�� .� / '�''�� Z �- Phone: : (o�- a 733✓ Address: CONTRACTOR Name: /�,�1� saN Phone: ?073% Address: � �L�/ &,N7- %~ �/Q %glld aoznA Supervisor's Construction License: 0 217/4H Exp. Date: Ad> Home Improvement License: ��`�� Exp. Date: ARCHITECT/ENGINEER Name: Phone: Address: Reg. No. FEE SCHEDULE. BULDING P I�i$1 z0 PE $1000.00 OF THE TOTAL ESTIMATED CO T B4'ED,ON $125.00 PER S.F. Total Project Cost :$ d" D1 FEE:$ �CqO' Check No.: 1. %3 7 Page l of 4 Receipt No.: �5e 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 Addition Or Decks ❑ Building Permit Application ❑ 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) 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 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:BPFORM05 TYPE OF SEWERAGE DISPOSAL Public Sewer 11Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales 11 Private (septic tank, etc. ❑ Permanent Dumpster on Site ❑ Electric Meter location to project - — _ "uvssw wsssrucling wnn unregisterea contractors ao not have access to the guaranty fund Signature of Agent/Owner Signature of contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION COMMENTS HEALTH COMMENTS DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED ❑ ❑ FIRE DEPARTMENT - Temp Dumpster on site Fire Department signature/date 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 Building Setback (ft.) Front Yard Side Yard Rear Yard Required Provided Required Provides Required Provided Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: NOTES and DATA — For department use) Page 3 of 4 Doc: INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 Created JMC. Jan.2006 Locaxion No. Date TOWN OF NORTH ANDOVER Certificate of Occupancy B uilding/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ $ TOTAL Check # 20*1 09 v" building lnspectdrj CA m m m Icm m CA y v m z y d S7 CD C7 st Z y CL o �, c O 0. y aCc o M O cp CD O CL c� =r �d CD CD CD C CD y, �d CD a0 y Soo CD I C2 H O 'CD Z o CD C CD zro C 0 CPO ?-0O m = FL- o :: CO) m�m� c 9 =r -o c 'stow La Fi CD polo ?� �mo�` e m : 0 Al m =r :. a � CL mm a� I d! 7 d m w = me C7 CA �m m o •"o o •m a3 dd CL -0: : z O t omi 0 9 0' 4 r o "C G 0 3 �• D 0 ir r v C/) W w r o "C G CS # 022680 H I C# 103358 _ ro oml == A. J. Walsh & Sons 55 Pleasant Street North Andover, MA 01845 of 978-688-6737 or 1-866-AJWALSH Proposal Submitted To: Job Name'... Job # Address 'r t Job Location Akld"'� Date Dateof Plan/ /, D Phone)X �i � 1i� - Q. fax # Architect We hereby submit specifications and estimates for: .... _..... ........._ ._ We propose hereby to furnish material and labor — complete in accordance with the above specifications for the sum of: $ - X44 Dollars F with payments to be made as follows: Any alteration or deviation from above specifications involving extra costs will be Respectfully G2� Com/ executed only upon written order, and will become an extra charge over and submitted ( t above the estimate. All agreements contingent upon strikes, accidents, or delays beyond our control. Note — this proposal may be withdrawn by us if not accIpted within days. ZIcceptance . of propoot The above prices, specifications and conditions are satisfactory and are ✓�Snature/"A)An_ hereby accepted. You are authorized to do the work as specified. Payments will be made as outlined above. Date of Acceptance Signature I Lee �o�runo�,�uec� o� i�iaaaaclauae�a Board of Building Regulations and :standards z HOME IMPROVEMENT CONTRACTOR ` Registration: 103358 Expiration: 7/7/2008 Type: Private Corporation A J WAL.SH 8 SONS,INC. ',rihur..Walsh,Jr. r,�, r k:f• r 1845 Vy • BOARD OF BUILDING REGULATIONS Ille - License: CONSTRUCTION SUPERVISOR ;s r; Number: CS 022680 t • Birthdate: -.06/09/1939 gym;, Expires -!06/09/2008 Tr. no: 28249 Restricted: 00 ARTHUR J WALSHJR- i 55 PLEASANT ST N ANDOVER, MA 01845�Gy:� Commissioner a. 1 CERTIFICATE OF INSURANCE ISSUE DATE (MM/DD/YY) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND Samuel CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE J Durso Insurance DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, Agency Inc 198 Mass Ave Suite 101E COMPARES AFFORDING COVERAGE North Andover, MA 01845 INSURED Arthur Walsh I COMPANY A.I.M. Mutual Insurance Co A dba A, J. Walsh & Sons LETTER 55 Pleasant Street i North Andover, MA 01845 I I COVERAGES THIS IS TO CERTIFY THNT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED r1AME0 ABOVE FOR THE POLICY PERiCSD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECTTO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 1S SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, CO POLIGY LTR TYPE OF INSURANCE POLICY NUMBER EFFECTIVE OLICY EIRATIO �;DATE(1V%711DD/YY) LIMITS DATE(MM/DD/YY) GENERAL LIABILITY GENERAL AGGREGATE $ )COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG, S MADE�CCUR� PERSONAL& ADV. INJURY1.�,':,21.AIMS S& CONTRACTOR'SPROT. i �i EACttOC�URRENCF S I FIRE DAMAGE (Any one fire) $ t MED. EXPENSE iAny one Porson) $ AUTOMOBILE LIABILITY COMBINED SINGLE ANY AUTO I LIMIT $ ALL OWNED AUTOS � (BODILY INIURY SCHEDULED AUTOS ! �(Pcr person) I $ HIRED AUTOS BODILY INJURY — j NUN -OWNED AUTOS � � (Per accident) $ GARAGE LIABILITY i (PROPERTY DAMAGE $ I (EXCESS LIABILITY j (EACH OCCURRENCE i $ MBRELLA FORM I y f (AGGREGATE $ — ]OTHER THAN UMBRELLA FORM WORKER'S COMPENSATION AND I WC STATU 0TH - x EMPLOYERS' LIABILITY ` TQ LIMIT EACHE $ 100,000 ATHE PROPRIETOR! 7014648012006 {{ 11/14/2006 11 / 14/2007EL INC( PhRTAiERB)EXECl7S1VE Rx EL DISEASE—POLICY Ll.viiT $ 500 .000 . El. DISEASE—EA EMPLOYEE $ 100,000 OFFICERS ARE: EXCt l I I (OTHER I 1 i i DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Town of North Andover EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 15 DAYS WRITTES NOTICETO THE CERTIFICATEtIOLDERt1AMED TQ THH LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE �J The Commonwealth of ,Massachusetts Department of Industrial Accidents � :• ! '�t I t Office of Investigations 600 Washington Street Boston, ,VIA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (l3usmess/Urganir.atiOil/ III (Ii VldUilh: l�� /��//>y Address:— C ity/State/Zip: �`��%�Qj%G'!Z Phone #: �7� - 73 7 Are you an employer? Check the appropriate box I . ❑ I am a employer with 4. 911 -am a general contractor and 1 employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. i ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, §1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7.emodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions I I .❑ Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other *:any applicant that checks box A I must also fill out the section below showing their workers' compensation policy information. i I lomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. Contractors that check this box nwst attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I um an employer that is providing workers' compensation insurancefir r my employees. Below is the policy and job site information. Insurance Company Name:_ -- Policy 0 or Self -ins. Lic. 9: 7'0/ y(p ofd 6 7 _ D Expiration Date:_ Job Site Address 36/i6I,71q —'Ne9L 111-- D4 CityiState/zip:_ h1J AV/,40P,&2 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 tine tip to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a tine 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 cert' under the pains andpenalties of per iry amt the rnjormanon provraea anove rs rrae triol corr-1. ciI,n-itiirr• f fO `i//�� VL��(/LC"_ 14 Date: / 6 ! — QlJic•ial use only. no not write in this arca, In be completed by cith or tome 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 #: