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Home My WebLink AboutBuilding Permit #920-15 - 37 BUCKLIN ROAD 5/14/2015 i t%ORTH q _ r O Es - BUILDING PERMIT TOWN OF NORTH ANDOVER ° t APPLICATION FOR PLAN EXAMINATION Permit NO: , Date Received �•9 A°RA7lD�PP�(�J Datelssued: ) SSAc"use I ORTANT:Applicant must complete all items on this page LOCATION � G �t +%r Print PROPERTY OWNER, Print MAP NO: c7� -PARCEL: ZONING DISTRICT. Historic District yes Machine.Shop Village yes o TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building One family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial gAepair, replacement 0 Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic. Well ❑ Floodplain ff 0,lNetlands ❑ 1Natershed District ❑ Water/Sewer Identification Please Type or Print Clearly) OWNER: Name: a Phone: -&V-29� Address: CONTRACT Name: Phone: & 90�46-114 e Address _ _ 3 euue: �1 � 'Supervisors Construction License Exp Date: Home7 Improvement License: Exp Date: 1 ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COS ED ON$125.00 PER S.F. Total Project Cost: $ �. S C�O FEE: $ / z Check No.: I Upto Receipt No.: NOTE: Persont's%Aontracting with unregistered contractors do not have access to theguarantyfiund Signature�of°Agent/Owner Signature of contracto tIORT11 BUILDING PERMIT 0��"ED ,b 6 . TOWN OF NORTH ANDOVER � - APPLICATION FOR PLAN EXAMINATION _ Permit No#: Date Received �qs R,rEo Cl �ACOUS Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION Print PROPERTY OWNER Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes. no TYPE 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 _ ® Flo.otl Iain �. 0 Septic ®UVell `�' - ®We11 tlands - ® 171/atershed ®'istnct 4j �' ®VUaterd>Sewer N DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: Contractor Name: Phone: Email: Address: Supervisor's Construction License: Exp.. Date Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ FEE: $ 3 Che ek`No.: Receipt No.: NOTt: Persons contracting with unregistered contractors do not have access to the guaranty fund I Location V G IG 1 r tz v,,L- No. D— Date } e — • ' TOWN OF NORTH ANDOVER ` Certificate of Occupancy $ Building/Frame Permit Fee $ �' Foundation Permit Fee $ q Other Permit Fee $ TOTAL $ r r Check# t �D i �-� . : �, teAr, 2 � Building Inspector Flans Submitted ❑ flans 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 m U FORM PLANNING DEVELOPMENT Reviewed On Signature COMMENTS CONSERI9AT'IO1\I Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS I Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes I 1 Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/S'rgnafure ®ate Drivewav Permit DPW Tpwn Engineer: Signature: Located 384 Osgood Street FIRE DEP, R�TNjENT "Temp Dumpsfer on situ es, t �f . n o � +;Located,at124 Mam Street ,y . } �4� ` >� �' 'Em z4 F c... r," x r k G„ d t �k r Fire Department si nature/ciate� x'` , s �» jz� ,Y '" da §'��++ '` dqq •.y .� ...,�a» „ter s-.- s ��j,�Ty�+F r•�+l 4, '� � � .c s fAy <n ' 4 �a• � 'Y .rt �A *y °v.m.. 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.$1oo-$1o6o fine NOTES and DATA— (For department use) 0 Notified for pickup Call Email Date_ Time Contact Name „Doc.Building Pennit Revised 2014 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 1�10TE: 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/Cross Section/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 ISIOTE: 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 -- - 16 2012 IECC Energy code -, Engineering Affidavits for Engineered products OTE: 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:Building Permit Revised 2014 NORTH own Of EAndover 0 No. q26 115 h ver, Mass, �i9s RATED ►P�,��(5 U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System �ao LTHIS CERTIFIES THAT ........ ftde ........... BUILDING INSPECTOR has permission to erect buildings on 8%)(��,;.. Foundation .......................... .... ..... I.�.: ........ Rough tobe occupied as ......<I.P........ .. .. ...... ............................................................. Chimney it provided that the person accepting this permshall in a respect conform to the terms of the application Final on file in 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 CONSTRUC N T RTS Rough Service ......... .... ............................................................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy.Buildin 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. Smoke Det. Woodland Homew Works 101 Middlesex Ave. Vihnington,MA :01887 ;ell(938)804-0374 Office(978)604-6455 lunc 285 2014 Paul Miller 37 Budklin Rd N Andover Ma'01845 Price of roof s $6,500.00 1J2 duo prior to start 1/2 due upon completion Price includes Stock,Labor,Dumpstcr and Permit Strip entire roof down to boards.Lay six feet of Grace ioc&water shield from fascia up,remaining boards will be covered with Synthetic undcrlayment.Run 8"drip edge and starter shingle around entire perimeter. Install ccrtaintced architect roof shingle(color of choice). Shinglevent II:ridge vent over entire ridge,all pipe boots will be replaced.If there arc roof boards found loose,rotted or broken you will be notified and they will be:replaced or re-nailed at a cost of$40.00 per man-hour labor only.House will fully tarpCd while being stripped yard will be cleaned and magnetized for any nails at the end of each work day. lob will take two days depending on weather.If you have an cstions lease feel free to call anytime y g y y� p .. 978-804-0374. 10 year warranty on all workmanship Thank you, Donald R.Woodland. Owner Licenscdtlnsurcd Hic#151655 CS SL#99489 S/41-i )� The Commonwealth of Massachusetts UDepartment of IndustrialAccidents I Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Aimlicant Information c Please Print Leizibl Name (Business/Organization/Individual): Address: (ak c'r\5��G �V City/State/Zip: Mq. &WPhone#: el-la, 8014- 0—�:2y Are you an employer?Check the appropriate box: Type of project(required): 1. ' I am a employer with employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in $, []Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.Q I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 E]Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.t 6.Q We are a corporation and its officers have exercised their right of'exemption per MGL c. 14.Q Other i 152,§1(4),and we have no 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. tContractors 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 I am an employer•that is providing workers'compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name: ` S C S C Gi✓1 C-E, Policy#or Self-ins.Lia 4S 1-7LI "(-3 JL( Expiration Date: ' e Job Site Address: City/State/Zip: l) Nf� �OQ,0,( �4 j Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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 j day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DTA for insurance coverage verification. I do hereby certify un the pains and p ties of peijuyy that the information provided above is true and correct. Signature: Date: 9 1 Phone#: IR�Llv 0"3 7q 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#: ACORV CER �► �,,,� CERTIFICATE OF LIABILITY INSURANCE "11100'r'r"� 03/30/2015 THIS CER7IFlCATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INsURANGE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INBURER(S),AUTHORQED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE FOLDER. IMPORTANT: If the eerWle0%holder is an ADDITIONAL INSURED,the pollcy(les)mast be endorsed. If SUBROGATION IS WANED,subject to MID terms and conditions of the policy.certain policies may require an endorsement. A Statement on this certify does not confer rights to the Certificate holder In lieu of such endtrrsem s. PRODUCER Rrown50n Insurance Agency CONTACT Maureen Pullman 139 Albion St PItoRE (761)245.22922 .(781)24S-3826 P.O.Box 349r�+rAtt Wakefield MA 01880 mo@bmwnsonlnsurance_com RER AFF C Y Northland Insurance Company a�su�D Donald Woodland m.Comerce insurance Co. Woodland Home Works ImangEg r.LM Insurance Corporation 101 Middlesex Av RMWER 1, Wilmington MA 01887-2712 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER- THIS Is TO CERTIFY THAT THE POLICIES OF WSURANCE 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 PE=RTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INN TYPE OF INSURANCE ADOL SUB R UNUM POLICY BPF POLIC exp COMMERCIAL GENERAL LIA01U T A X Y aminn uuns WS236124 12J1212014 12/1212015 1,000,000 CLAIMSMMDE ®OCCUR DAMAGE O RENTfiD 100,000 X Sod.InJ.B Prop.Drng EN'bed.$500 per Clsim MED Orn Am me pcaant 51000 ERSONAL h AoV w: 1.000,000 GL AGCR LIMIT AfPLIEs PER: WREQATE 2.000,000 X POLICY ECT ❑Loc CTS-COAR+/OP AG 2,Ooolow AUT E OMOBILE LMIMBDTCWZ 10117/2014 1011 T/2015 COMBINED StNOLE LIMrT $ ANY AaSA °u AN OWBODILY INJURY(par p~) S 100,000 AUTOST013 BODILY INJURY per eatidem S H� wOWNEo ) 300,000 RED T08 100,000 UNINS/UNDERINS b 20!40 UMBRROCCUREACH0' CE mctgCLAIMSAME AGGREGUI WONOC nym "0EMiLOWR IJAILF WCS•31S-367174-014 8128/2D14 /28/2015 X 0 AND ENPLOYErt9 UABiIlrY ANY PROPRIET0R/pATtTNER8(ECUTNE FOR INFORMATION ONLY E.L. CIp 100,000 OFFICER(MEMBER EXCLUDED? N/A U�deftmw,rKIM E.LDISEA9E-EAEIUP ti 500,000 EL DieEA _ LIMIT 100.000 _T DEBCRIPTM of OPCRAY MS I LOCATUM I VEUEgM(ACORp 161 Addtomw Remi khed%.,,,ey be attaeh�d it c �, , ) COrpentry Operetions, Liberty Mutual Will Esaue the Certf gte for Workers'CornpenGMn coverage.x/50/15,rob: 20 Wolcott St.,Tewksbury MA 01876. CENTIFICAMHOLDER CANCELI-ATtON At 095766 SHOULD ANY OF THE ABOVE DESCRIBED PDUCIES 13E CANCELLED BEFORE THE EXPIRATION DATE THEREOF.NOTICE WILL BE DE:LP49RED W ACCORDANCE WITH THE POLICY PROVIIHDNS. AMORI120 REPRESENTATIVE_ Fax:(978 ®1988.2014 ACORD CORPORATION. All rights reserve ACORD 25(2014101) The ACORD name and logo are registermarks of maof ACORD 9 d. Office of Consumer Affairs&Business Regulation License or registration valid for individul use only l� rOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: 151655 Type: / Once of Consumer Affairs and Business.Regulation Expiration: . 6/20%2616. DBA 10 Park Plaza-Suite 5170 Boston,MA 02116 WOODLAND HOME-W6RKS;::. r + I DONALD WOODLAND 101 MIDDLESEX AVE WILMINGTON,MA 01887 Undersecretary Not valid without signature V Massacnuse•t'ts -Department o ;^ub!i.0 So,re'v " Board o•/Building•Regudatjons and S �;ri.-,:i-ci,s - .ni1�ils`uCt'ion hujicl'1•iti(II `yjlrti'ia11y - 1_iceilse: CSSL-099489 ° DONALD R WOODLAND •' �, 101 MIDDLESEXAVENUE WILMINGTON NA Commissioner 10/27/2015 • a