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Home My WebLink AboutBuilding Permit #240 - 41 HERRICK ROAD 9/27/2007 _ BUILDING PERMIT TOWN OF NORTH ANDOVER ? APPLICATION FOR PLAN EXAMINATION Permit N0: C>- Date Received 90 q,T.o SACHU`-'� Date Issued: -U IMPORTANT:Applicant must complete all items on this page LOCATION C c -- Print - PROPERTY OWNER ` I"' `/_:L Print .,:MAP N0: PARCEL: Z01�1ING"DISTRICT: Historic District yes no , Machine Shop Village es 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 Sepfib WeilFloodplain Wetlands V�/atershed district Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: Identification Please Type or Print Clearly) OWNER: Name: ` I j c�- X+ rLL� Phone: g ZS- C? ��LS Address: 17 / 1- -L� �c c l� ►�. ' o 1 CONTR4CTOR Name: <Z tt P,hone:(Cy, � Supe rvisor'.s Construction J_icense; 192 '`,. Exp. Date: Fv I orae tlmptAvement License: _ Exp, Date: L . 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: $ Z!� --- -- FEE: $_moo Check No.: Receipt No.: &o &3� NOTE:, Persons contracting with unregistered contractors do not have access to the guaranty fund ��nature of�lgent!_Owner- - S�gnafure of 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 THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS DATE REJECTED DATE APPROVED CONSERVATION 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/Si nature&Date Drivewa Permit— Located at 384 Osgood Street FIRE DEPARTMi=NT: Temp Dumpster-on site yes no x Located-at 124:Main:Street ,Fliie Dopartment signature/date 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 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 Li Building Permit Application ❑ 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 u Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks a Building Permit Application ❑ Certified Surveyed Plot Plan Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) u 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 o 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:BPFORM07 Revised 2.2007 Location �r �T v�-�G A� No. r v Date `0�� .d NORTH TOWN OF NORTH ANDOVER O 9 * ; ; Certificate of Occupancy $ s,Cwus Building/Frame Permit Fee $ `..� Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 206 , ; Building Inspector x.10 R TH Town of And 0 No. Z, - - - - - ,, , _ o LAK - dover> 1V�ass.- > O COCHIC EV WICK 1' ORATE D 1 BOARD OF HEALTH Food/Kitchen PERMIT T Septic System BUILDING INSPECTOR THIS CERTIFIES THAT...... . �i.h........... .............................�i .. Foundation ....................... Rough has permission to erect........:............................... buildings on ....yjr..� ..�!�!�..�...... g to be occupied as..../ ��N'� � �..i......... fde W Chimney provided that the person accepting this permit shall 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 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION TARTS Rough ........ ... . ............... .................................................................... Service BUILDING INSPECTOR 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. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 y sY www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): 3--C) Address: �v� �v� ✓1 " City/State/Zip:,: C�=�� Phone #: ZU;S 3 `�r�� Are you an employer? Check the appropriate box: Type of project(required): I.❑ I a a employer with 4. ❑ I am a general contractor and I 6. ❑ New construction mployees(full and/or part-time).* have hired the sub-contractors 7. ❑ Remodeling listed on the I g _ e attache 2., I am a sole proprietor or partner d sheet. 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.El Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL l 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' 13.❑ Other 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 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: ,� AI ►"'1 c L T_)c) L) A_S D Policy#or Self-sins. Lic.#: Expiration Date: u Job 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 WORK ORDER and a fine of up to$250.00'a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of'the DIA for insur ce coverage verification. I do hereby cer ' under the pains a d penalti of perjury that the information provided above is true and correct. Si nature: Date: y Phone 42 ficial use only. Do not write in this area, to be completed by city or town official City or Town:' Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6. Other w Contact Person: Phone#: 1 =—SAFEGUARD BUSINESS SYSTEMS (E02)M-1277 PRODUCT 118 - Page No. of Pages i XZ SRAD!Vjo Vinyl and Aluminum Siding and Roofing 7 Moulton Drive, Post Office Box 448 East Hampstead, NH 03826-2416 k Office (603) 893-4599 Residence (603) 382-1868 PROPOSAL SUBMITTED TO� PHONE � DATE ; A � STREET JOB NAME CITY,STATE and ZIP CODE JOB LOCATION /'v r/ i ARCHITECT DATE OF PLANS JOB PHONE J I We hereby submit specifications and estimates for: c. . i P proPOSP hereby to furnish material and labor—complete in accordance with above specifications, for the sum of: ). Payment to be made as follows: dollars($ k r All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices.Any alteration or deviation from above specifications Authorized involving extra costs will be executed only upon written orders, and will become an extra Signature charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control.Owner to carry fire,tornado and other necessary insurance. Note:This proposal may Our workers are fully covered by Workman's Compensation Insurance. wit awn by us if not accepted w' In days. , Arcrptaurr of Proposal —The above prices,specifications and conditions are satisfactory and are hereby accepted. You are authorized Signature to do the work as specified. Payment will be made as outlined above. Date of Acceptance: Signature I Od Siaffida or of$oid T-coo Board o�EMEN, I HOME,\Mp ,020g� i+sVol, Re01200$ n ;613, Ex'P'rat+O e• 1nd��idua\ A-, 7 f;; pN p•BRp,(?`w� � j'lf �`''miaistra+�r JOSE Bradish, 448'i° Ver°iy Na J°Seph rival 6°X 7 to(,St ad.NN p3g26 - E• _ -Q J - italteS 1. D OF T�pN SupERVIS � �: 130 cp 0229 N�maer CS:� 2t142 p512 ��g45 Tr`�0: BiHhaate 0512112p4a, -. cted 00 �,`fyl y PHp 6RPDISLTQpR�d commissioner 4481f7 M N p38 P NBMPS VEND, N E E ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID D DATE(MM/DD/YYYY) BRADI-1 08/04/06 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Samuel J. Durso Insurance Agcy ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Charles S. Randone HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 198 Massachusetts Avenue ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. North Andover MA 01845 Phone: 978-682-5175 Fax:978-794-0313 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: NCCI-New Hampshire Ins. Plan INSURER B: Joseph Bradish Siding, Inc INSURER C: P.O. BOX 448 INSURER D: East Hampstead NH 03826 INSURER E: 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 ^JLlCIES.ACCREOATE L!.%!!TS SHO%NfN MAY HAVE BEEN REDUCED BY PAID C ,A!Mq LTR NSR TYPE OF INSURANCE POLICY NUMBER POLICY(MM/FFECDDA)I) POLICY MM/DDEXPIRTIO DATE MM/DDIYY DATE MM/DDIYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurence) $ CLAIMS MADE F—] OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PRO LOC JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR EICLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $' WORKERS COMPENSATION AND 'TORY LIMITS ER A ANYP YERIETORI I'FYAR NCCI ASSISTED 08/02/06 08/02/07 E.L.EACH ACCIDENT $ 100000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 100000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SA14PLE1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL J_S. DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Sample for bidding purposes IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Charles S. Randone ACORD 25(2001/08) ©ACORD CORPORATION 1988