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HomeMy WebLinkAboutBuilding Permit #403-12 - 39 PADDOCK LANE 11/14/2012 pORTy BUILDING PERMIT of TOWN OF NORTH ANDOVER 3? � ''•- .�_: '6 oL APPLICATION FOR PLAN EXAMINATIONIL �p e" _I_4I I I6�)1,- Date Received Permit NO: � �4ApQw7Ep P•Pp`y'�y SC us Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATIONtq PROPERTY/O,WNER' MAP'NQ'. �_ PARCE ZONINGIDISTRICT:: Historic District yes no lMachineShop;Village1 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 Septic.' Well : :V Floodplain : W Lands: Watershed'01sfrict'. Water'/Sewer, .5 DESCRIPTION OF WORK TO BE PREFORMED: Identification Please T yp a or Print Clearly) OWNER: Name: Phone: Address: CQNTRACs fOR Name: Phone: _ ,Address:3n ._ l}�. iiolak=2L - • Supervi'sor's.Cons-truction''License, Exp. Date: . 711,3M ,Home Improvement Liberise:., 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: $ �DU. FEE: $ L�>D L Check No.: Receipt No.: �5 NOTE: Persons contracting with unregistered contractors do not have access toguaranty fund Signature ofAgent/Owner 'Signaturebf,contractor 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 i 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 Con nection/Sicinature&Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE IDEPARTMENT L6c6td_d`at,,124iMam:Sfreet a Fire-'Departinentsignature/dater til,' � `� �"'��. � -. 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 E _ __.__. 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 o Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses o 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 o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract E3 Mass check Energy Compliance Report L3 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:BPFORM07 Revised 2.2008 Location �) 1 PAMoeLLj . No. - Date • • TOWN OF NORTH ANDOVER • �,�.cn t,ru 1Qs Certificate of Occupancy $ Building/Frame Permit Fee $ � x=w ' Foundation Permit Fee $ Other Permit Fee $ TOTAL �. Check#� l� 25953 Building Inspector : 6"0 lation office of COnsuine>r Affair and'��si>rless Rego 10 Park Plaza.o Su to 51170 Boston,Miassachusetts 0211E , r, ..� . Home jmproveontractor Ytegistration- __ Registration: 162111 TVPe: Supplement Card "= r. Expiration: 1•!1412013 NEXT STEP 41VING INC. "�_� N'r`H_ BRIAN HESSION '' 25 DRYDOCK AVE_ 5TH FL BOSTON, MA 02210 `;�, - ur•:n card.mark-reason for change. Update Address and ret Address [�•Renewal;'Q ]Emplo�rmeni 0Lost Card �a 'lOO7I7/117.rijLrf�r•"•.....O�.✓4O.fI�ZtCG' .Q' ' rice of Consumer Affairs�Business Regulation ]License or.registration valid Ior individul use only . - beton:the expiration date..If found return to: ME IMPROVEMEIaT COIyTRACTOR Office of Cansnmer Affairs and Business Ragulation Type: - .egistratiori�r fs�11.1_ 10 Yarkflaza-Suite 5170• - - "-"'"- Su lement F�cpirabvit=-•off��1�4f;13; PP Card 16aston,'1VIA 02116 - SSION CK PAVE;5Ff liFt Qo� �-- .7Z:�"at " AA 02210 1` s•1 L�Tgtvalihoutsiaiure Undersecretary 4 Massachusetts Department of Public Safety i Board of-Building Regulations and Standards Construction Supp n-kor Specialh License: CSSL-102811 ; ROGER A OVELLETTE. 55 STANMORE ROAD Warwick RI 02889 Expir,�tirt Commissioner 09/13/2014 _ Restricted To: CSSL-IC- Insulation Contractor I i E f i f fE I I i Failure topossess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For DPS Licensing information visit: www.Mass.Gov/DPS i i f , E f r. NEXTS-1 OP ID: BS ��acoRo CERTIFICATE OF LIABILITY INSURANCE DATE I1/09/YYYY) 11/09/12 THIS CERTIFICATE 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 INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Phone:781-665-2775 NAME CT McLaughlin Insurance AgencyFax 781-665-0295 PHONE FAX 828 Lynn Fells Parkway A/c No Ext): A/c No): Melrose,MA 02176 E-MAIL John E.McLaughlin Jr. ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:OneBeacon Insurance Group INSURED Next Step Living,Inc. INSURER B:Hartford Insurance Company 19682 Mr.Brian Greenfield 21 Drydock Avenue,2nd Floor INSURERC:A.I.M.Mutual Insurance Co. Boston,MA 02210 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. /LTR TYPE OF INSURANCE R POLICY NUMBER POLICY EFF POLICY M UDS LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY 7920005600001 11/11/12 11/11/13 PREMISES Ea occurrence $ 100,000 CLAIMS-MADE OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COM P/OPAGG $ 1,000,000 POLICY X JERC0j r7 LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1 000,000 Ea accident $ AANY AUTO 3900012090001 11/11/12 11111/13 BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS Ix HIRED AUTOS X NON-OWNED PROPERTYDAMAGE $ AUTOS Per accident X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 5,000,00 A EXCESS LIAB HCLAIMS-MADE 7920005610001 11/11/12 11/11/13 AGGREGATE $ 5,000,00 DED I X I RETENTION$ $ WORKERS COMPENSATIONIN WC STATU- 7TH- AND EMPLOYERS'LIABILITY TORY LIM TS _ ER C ANY PROPRIETOR/PARTNER/EXECUTIVE YX NIA TO BE ISSUED BY CARRIER 11/11/12 11/11/13 E.L.EACH ACCIDENT $ 500,00 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 A Property 08UUMHX6485 11/11/12 11/11/13 BPP 1,033,89 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Office CERTIFICATE HOLDER CANCELLATION INFO-01 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE For Information Only THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN y ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE VcLltii32 A�C{/1�/ ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD CERTIFICATE OF LIABILITY INSURANCE TEi The Commonwealth ofMassachusetts print corm � Department ofIndustrial Accidents Office oaf°Investigations 1 Congress Street, Suite 100 Boston,MA ®2114 2017 wue9w.massogov/dla Workers' Compensation Insurance Affidavit: Builders/Co ntractors/Electricians/Plunmbe rs A2011cint Information Please Mat Legibly NaMe (Business/Organization/Individual): Next Step Living Address: 21 Drydock Ave City/State/Zip: Boston, MA 02210 Phone#: (617)850-9101 Are your an employer?Check the appropriate bom Type of pro]ect(requnired):. 1.B I am a employer with 400 4. 1 am a general contractor and I employees Mull and/or part-time).* have hired the sub-contractors New construction 2.® I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. ® Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers'comp.insurance comp.insurance# required.] 5. ® ale are a corporation and its IO.®Electrical repairs or additions 3.® I 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 employees. [No workers' 13.0 Other Insulation 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. lam an em ployer tiaat ns provi ding workers'compensation insurancefor my employees. Below is Qua policy can djob sante informadom Insurance Company Name: A.I.M Mutual Insurance Company Policy#or Self-ins.Lac.#: 7025153012012 Expiration Date:11/11/2013 Yob Site Address: City/State/Zip: 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 VSTORIS 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 c2=verification. Ar gado hereb ffr asaeaaler telae aaliap endltaes g[EfjrLu2 that the ani ormadona provided)above is trace and correct Si afore: -�`"� Date:=--- ------ - Phone#: Official agse only. Do not write in this area,to be completed by city or town of ciaL City or Town.. Permit/License# Issuing Authority(circle one): Ile Board of Health 2.Building Department 3.City/Town(Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other (Contact Person. Phone#e 40 next step living home efficiency,made easy . PARfidPlfflN& CONISACT'alt This agreement is made by and among Lawrence Ragone Next step Living,Inc.('NSL") 39 Paddock Ln 21 Drydock Avenue 2M floor Boston,MA 02210 North Andover,MA 01845-6311 Customer ED:000000096714 Contract ID:20121023 WORK Site ID:500002086686 — 1. DESCRIPTION OF WORK TO BE PERFORMED NSL will perform or cause to be performed the following work on the.customer's address above,in a professional manner and in accordance with the terms of this Conbad,Including the attached recommendationsMrork order describing the work in detail(the'Work")which are incorporated herein by reference: Description Quantity Location _Attic Floor Open Blow Celluiose 7".._.--..------------_---._._._.._._._..__. 899 Livl _ee_-- $1258.60 �P?_.. -............................... _Replace_Bath_Fan Bose $22_00 . ---------------------- ------------... Damming _ _ 68 N/A $125.89.-._ 60 Attic $21D.00 Sub Total: $1,616.40 Energy Efficiency Incentive $1,212.30 Net Sales Tax After Incentive $0.00 Total $404.10 I • f Printed,10/23/2012 Pagel of 1 2. PAYMENT:CUSTOMER agrees to pay NSL for the work as follows: Payment'#1:$ 1-00 -Credit Card or E-check deposit is due at the time the Work is scheduled.Required payment information will be collected over the phone by a customer service representative at the time of scheduling. Deposit is not to exceed 1/3 of the total retail costs.This contract is not in effect until this deposit is paid by the Customer.(Note,Mastercard,Visa,and Discover accepted) Additional Payments and Final Invoice:$- 30q. t - -Additional payments for the Works be due upon completion of the Work. Customer Signature Date NSL Signature Date Name of NSL Representative The Terms of this Agreement are contained on both sides of this page ` Next Step Living 21 Drydock Avenue^2W floor=Boston,MA 02210>(866)867.8729 inquiry@nexfstepiivinginc.com www.nexfsteplivirginc.com NORTH own of E ndover 0 No. t qah ver, Mass, � coc"Ic„ewrcK _1' A04ATE o I P0 ,`'�5 S V BOARD OF HEALTH PER T T LD Food/Kitchen Septic System THIS CERTIFIES THAT . �'.��. ° :�!e................. BUILDING INSPECTOR .. g ,,, cj„�,G,� ,. Foundation has permission to erect .......................... buildings ..... Q ....�............................ ` Rough to be occupied as ... ..���. .Cr�l :... S/ f��., ��.., ... :Y ........ y ............. .... .. ........... ... r�t.r f.. i�V.6 ...... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the a0plication 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 CONSTRUCTION STA TS Rough Service ................... ...... : .. ... ...................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building 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. SEE REVERSE SIDE