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Home My WebLink AboutBuilding Permit #23 - 451 ANDOVER STREET 7/8/2009 NORTF/ BUILDING PERMIT TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received �SSAGHU`�� Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION Y4 ? J~e r � I - r� Print � t PROPERTY OWNER 40 Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes6no =Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration No. of units: Commercial Repair, re lacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District i Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: �4 '4r Identifiction Please Type or Print Clearly) OWNER: Name:I .,. i L Phone: Address: Zd Akx It, a ev, A-vt J J ter' �o SS � one: CONTRACTOR Name: OLJ 1M }/ Address: Supervisor's Construction License::� ��L(a Exp. Date:Aa-Z _7_A1 0 Home t D E Improvement License: Exp. Date: P ARCHITECT/ENGINEER P 0& Phone: Address: _LJ jo �Gtw+Lv, , be- � . /40,02-1 1 ( Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. d Total Project Cost: $ S b FEE: $ t Check No.: Receipt No.: d NOTE: Persons contracting with unregistered contractors do not have access to the kuarantyfund Location yS b✓-(t �T ��' 20 No. Date , NORT1y TOWN OF NORTH ANDOVER Of t � e , '�ti0 f 9 i y : . Certificate of Occupancy $ �'�Ss•^°•E<n Building/Frame Permit Fee $ AC NUS f Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 22194 Building Inspector I Signature of_Agent/Owner 'Signatureof contra Wo;je 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 1 CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS C 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 DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - s --- Located at 124 Main Street Fire Department signature/date « 01/27/2002 16:18 9784757664 PAGE 01 Date: June 11, 2009 From: Uttam Reddi 451 Andover Street, Suite 206 North Andover, MA 01845 To, Town of North Andover North Andover, MA 01845 RE: Renovation of bathroom To whom it may concern This letter is to notify that we decided not to enlarge the bathroom at the present time, Please let me know if you have any questions. Regards, Uttam Reddi n � ]a ®6w LI LJ�� lSuU C on(c, 16 B Harry Brook Dr. Goffstown,NH 03045 Claude@Beaudoinfamily.com Phone or Fax(603) 384-2076 DATE: 06-03-09 THIS ESTIMATE HAS BEEN PREPARED FOR: Umass Memorial Labs WORK TO BE COMPLETED: North Andover Service Center. Permits 200.00 Electrical 3500.00 Plumbing 2500.00 Frame and sheetrock and repair and blocking 900.00 Ceilings 1000.00 Demo wall on plans and discard 700.00 New work surface and special bracket 480.00 Toilet accessories schedule installed 600.00 Hvac, painting, floors and base by others Insurance and Material included in price unless otherwise noted above. Total estimate for the work described above:$9880.00 We thank you for your interest in doing business with us. If I can be of any further assistance to you please contact me. Not valid after 60 days. \! J Please sign,date,and return upon acceptance of this estimate. V 7 /gra SIGVATURE DATE girely, aude J . Beaudoin CLAUDE J.BEAUDOIN ts=z=e Insurance. Mcmbcr of labvtc Mulu,IGmup INFORMATION PAGE DIRECT BILL Transn I'�Nimber 1fC 91 t Prior Policy 9119806 Date Issued: 09242008 I Cage Is Praided in PEERLESS SCE Cflt€7IPANY-A STOCK COMPANY NCCI Number: 11355 t.Narrkp lnsurEd and Mai'l`ing Ades Agent: j I ,UDOIN FAMILY EATON A BERUBE INS AGENCY INC - .EhITERPRISES INC 365 NASHUA ST C10CLAUDE BEAUDOIN PO BOX 37 .168HARRY BROOK DRIVE MILFORD NH 03055 GOi=FSTOWN NH 03045 Agent Code: 0410001 Agent Phone: (603)-673-0500 Federal Employer ID Number: 020473817 Filing Number:280241059 SIC Code: 1751 Other Workplaces not S shown above: REFER TO ADDTTtONAL WORKPLACES CHEDULE En*r:of Insured- CO.RPORATION 2. Policy Period. The Policy Period is from .09292008 . to 09292009 , 12:01 AM Standard Time at the insured's mailing address. 3. A. Worker's Compensation Insurance: Part One of the poli cy;applies to Workers Compensation Law of the states listed here: MA, NH B. Employers Liabilityinsurance: Part Two of the policy applies to work in each state listed in 3A.The limits of liability under Part Two are: Bodily Injury by Accident $ 5 00, 0 0 0 each accident Bodily Injury,by Disease $ 5 0 0, 0 0 0 policy limit Bodily Injury by Disease $ 5 0 0, 0 0 0 each employee C. Other States Insurance: Part Three of the policy applies to states,if any,listed here: All states except North Dakota,Ohio,Washington, Wyoming and states designated in item 3.A.on the Information Page; D. Endorsements and Schedules: This policy includes these endorsements and schedules: See Extension of Information Page 4. Premium: The premium for this policy will be determined by our Manuals of Rules,Classfications,Rates and Rating Plans.All infomnation'required be1oW I'Ssubject to verification and change by audit Premium Basis Rate Per Estimated Code Total Estimated $100 of Annual Number Class cations Annual Remuneration Remuneration Premium See Extension Ofr Information Page POLICY PREMIUMTOTALS Total Estimated Standard Premium $ 17, 913. 00 0900 Expense Constant $ 318. 00 Total Premium Discount $ -1 , 391 .0;0 Total Estimated Premium $ 16, 840. 00 Total Estimated Cost $ 16, 840. 00 Minimum Premium $ 900. 00 Deposit Premium $ 16, 840. 00 Adjustment Period: ANNUAL Date: Countersigned by: Authorized Signature Copyright 1987 National Council on Compensation Insurance. 25-190(07/08)(WC 00 00 01A)' INSURED COPY PGDMO60D 401695 :PCAFRPN 00020422 Page 7 The Commorzwealth of Massachuse#s na iDepartnreat of Industrial Accidents z ace of Investigations . 600 Nlashington Street ti 1 Boston, MA 02.111 t`Z www_j7uss.gov/dirt . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers A licant Information Please Print Legibi Name(Business/owiird6on/individual): :@(A-i Address: ��(ire 400y,A� City/state/Zip: Phone#.. . Are yo n employer?C mk.the appropriate box. anl"a employer whit 4. ❑ I am a gemeral contractor and I T project rep( °1 : employees(full and/or part-time).* have bred the sub-contractors 6. ❑'Naw construction . Pte- ) 2.❑ I am.a.sole proprietor or partner- listed on the attached sheet 3 7. ❑Remodeling ship and have no employees These sui3-contractots have workingfor me in g Q °im°n . any opacity. workers' comp.insurance. g Building[No workers'comp. insurance 5. ❑ We are a corporation and its ❑ ng addition required.] officers have exercised their I0.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MOL 11.❑ Plumbing repairs or additions myself [No•worken' comp. tri 152, §1(4),and we have no insurance required.].t 12.[]Roof repairs -employees.[No workers comp. insuranccmquired..] 13.❑.0ther t*Arry aMli=nt tient dtecks bo)ett t must also fin out the section below showing t Homeowners who their workers compensation oil info submit this affidavit' P icy enation. = indicating they are doing an work end then hire outside conuactors m Cootraetors that check this box must etterEtx sn additional shay showing.the name of tit-sub- ,their submtt a new affidavit indication such contractors and(heir workers'cer p.pal' iofraisdon. f an employer first is prn>uidmr:workers'compensadvin insurance or information. f my eMloyeec Below is titePolicy and job site . Insurance Company Name: f Policy#or Self-ins.Lie. �_ 7 Expiration Date- ��D Job Site Address: City/State2ip; Attach a copy of the workers' compensation poly declaration atiilon page(showing the policy number and expiration date}. Failure to secure coverage as requited.under Section 25A of MOL c. 152 can Iead to the imposition of crartinat fine up to$1,500.00 and/or one-year imprisonment;as well as civil pen#1ties in the form of a S penalties of a of up to$250.00 a day against the violator. Be advised that TOP WORK QR[3£R and a fine investigations of the DIA for insurance coverage verification.copy of this statement may be forwarded to the Office of Ido hereby jy nder the pains and p oJperjrcry that the information provided above is true and correct Signature., Date: -- Phone#: Of�`tcwl use nnLy. Do not write in!tris as ea,to be co 1 nw cted by city or town.ofcia( City or Town; Permit/License# Issuing Authority(circle on 1. Board of Heaitb 2. Building Department 3.City/To1wn Clerk 4. Electrical Inspector 5. Plumbing Inspector LIL'Otheertact Person: Phone#: i I � i Information a. nd Instructions Massachusetts General Laws chapter 152 requires all emp 3oyers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"..:every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,mc:wdiation,corporation or other legal entity,or any two ormore of the'fbmping engaged in a joint enterprise,and includirlkg the legal representatives of a docxased employer,or the receiver or trustee of an individual,partnership,associatiorn or other legal entity,employing employees.'However the owner of a dwelling house having not more than three apa--trnerrts and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence.of compliance with the insumoce'coverage required." Additionally, MOL chapter 152, §25C(7)states`(either the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until-acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the coritracfmg authority." Applicants Please fill out the workers'.compensation.affidavit compientely,by checking the boxes that apply to your situation and,if necessary, supply sub-contractor(s)name(s),addasss(es):Eund phone number(s)along with their certificates)of insurance. Limited Liability Companies (LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,ase not required to cant'workers'cfl=rtpensafion insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of industrial Accidents for confirmation of insurance coverage.. Also be sure to sign and'date the affidavit. The affidavit should be returned to the city.or town that the.application for.the permit or license is being requested,not'the Department of Industrial Accidents. Should you have any questions regar-ding the law or if you ase required to obtain a workers' compensation policy,please-call the Department at the number.fisted below. Self-insured companies should enter their seat-insurarce'licanae number on the'appropfiate fine. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department hes provided a space at the bottom of the affidavit for you to fill out in the event the Office of' has to contact you regarding the appli=t Please be mm to fill in the permit/license number which w-ill be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy;information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of-the affidavit that has been.officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT.required to complete this affidavit Thr Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. Tlie Departrnent's address,telephone and fax number. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Inv$stiptions 600 Washington Street Boston, MA 02111 TeL #617-727-4900 exit 406 or 1-977-MASSAFE Fax;9 617-727-7744 Revised 5-26-115 www.mass.gov/dia fie �¢c/ueael�b � , +- Bo�tl of nu ung """`o"'anStandards Constructtit ion Supervisor License 4 License:. CS 59666 * E plra on:- 125/2010 Tr# 1.6354 yny Fes �Etion, l CIAUDE J BEAUDN - 16B HARRY BROOK DR f Commissioner GOFFSTOW14,NH 03045 ' a t4ORTH TO" of _: t 4 over No. a3 A K E = dover, Mass., • COCMICKE WICK _ ADRATED PPS\ �5 `S BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.....V.X.......qv"..'G. .............................. ............................................. "' """""""" Foundation � ........ . ..... Rough permission to erect..................... buildings on.. ...... 1/1 •`► MAb i to be occupied as..$&N ... ........i �. .. ........ i�......................... Chimney provided that the person accepting this permit shall in every re pact 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 CONSTRUC STARTS 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 FREVERSE SIDE Smoke Det. i L COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. I Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No I DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— For department use ' I i I I I ❑ Notified for pickup - Date Doc:.Building Permit Revised 2008