The URL can be used to link to this page

Home My WebLink AboutBuilding Permit #349 - 460 MAIN STREET 10/31/2006 TOWN OF NORTH ANDOVER N°RTFr APPLICATION FOR PLAN EXAMINATION Of o t * t Permit NO: � Date ecei ed i _ � r e 04 Qf q04 •,pP" �j Date Issued:00 a "Ss CHuss IMPORTANT: Applicant must complete all items on this page LOCATION Prin PROPERTY OWNER ? UXS Print MAP NO.: PARCEL: ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residents Non-Residential ❑New Building ne family ❑ Addition ❑Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Repair, replacement ❑Assessory Bldg ❑ Commercial ❑ Demolition I Moving(relocation) ❑ Other ❑ Others: ❑ Foundation only DESCRIPTION OF WOR TO BE PREFORMED Aftz tl Identification Please Type or Print Clearly) q OWNER: Name: �)G/J lteL crl?-q /S'k ( Phone: /7J-��—9S P7 Address: LI (o® /V)1+(N Is CONTRACTOR Name: 47i), IPA --y S6 VS Phone: , �e-60-,*f 737 Address: 145 l��! / 1 ��/�/,U4 U �— �I Supervisor's Construction License: C5 2,7,4f-a Exp. Date: c/g Igp Home Improvement License: A11 Exp. Date: �/ 6P-- ARCHITECT/ENGINEER Name: Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT.$12.00000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S F. Total Project Cost FEE:$ QJ Check No.: �� Receipt No.: S V Page Iof4 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 DEPAR'rMENTMFORM05 Pace 4 of 4 TYPE OF SEWERAGE DISPOSAL Tanning/Massage/Body Art ❑ Swimming Pools ❑ Public Sewer ❑ ` Well Tobacco Sales ❑ Food Packaging/Sales 11I ❑ ❑ Permanent Dumpster on Site ❑ Private(septic tank,etc. Electric Meter location to project NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund 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 DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ esCOMMENTS FIRE DEPARTMENT - Temp Dumpster on site yes no Fire Department signature/date „ fid_ j COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments I Water& Sewer connection/Signature&Date Driveway Permit Building Setback ( 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) t I Page 3 of 4 Doc:INSPECTIONAL SERVICES DEPARTMENTUTORM05 Created JMC.Jan._o06 I i I � Locationiy� �i� S� No. Date , _r-,/_ % of Hu eT�,h TOWN OF NORTH ANDOVER A t' s Certificate of Occupancy $ Building/Frame Permit Fee $ � �►cMus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 19750 Building Inspector NORTH Town 0 s over No. ail 9 -__ _ _ C, AKE dover, Mass., go 0 L COCHI 0RArEDPPS` C2 BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR ........... ...... SLA................................... . .... ......... L............ .,c'THIS CERTIFIES THAT........ .... lito.. rU#.j ......... Foundation Shas permission to ...................................... buildings on .. V.ft. tr%. ...... ...................... Rough Chimney to be occupied as. I-P ..of&. ......fr.o.n.+ (S ... ......IDAI... ................................... • provided that the person accepting permit shall in every respect conioJthe terms o application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Aftera 01on and Construction of Buildings In the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough 3� PERMITEXPIRES IN 6 MONTHS Final ELECTRICAL INSPECTOR UNLESS CONSTRU 0 S Rough TLt02% ............ . ...... ...... Service BUILDING i �ia5i 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. Wy- ib. 2UU5 9. 3A ASSOCIATED INSURANCE N0, 2708`/ P, 4/4 w,..., rE\M..... CERTIFICATE OF INSURANCE CE CATS Ismum A MATTER OF U MORMATI N ONLY AND PRODUCER CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE Landmark insurance Agency InC DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 198 Massachusetts Ave, Ste 101 COMPANIES AFFORDING COVERAGE North Andover, MA 01845 INSURED Arthur Walsh �,�� A A.I.M. Mutual Insurance CO dba A. J. Walsh 8t Sons i 55 Pleasant Street North Andover, MA 01845 COVERAGES THIS IS TO CERTIFY THAT TIIE POLICIES OP INSURANCB LISTRD BELOW HAVE BEEN ISSUED I THE IIVSURED NAMED ABOVE POR THE POLICY PERIOD INDICATED,NOTWITHSTANDING ANY RBQUIREMBNT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT Wrm RESPECTTO WHICH THIS CERTIFICATE MAY J3B ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, La[TrS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.. —^— —� POLICY I3I�ECfM POLICY Ex"r ATIO LIMITS CO TYPE OF INSURANCE POLICY NUMBER DATE(MtdIDD/YY) DATE(MWDD/YY) LT GENERAL AGGREGATE S YENERAL LIABILITY PRODUCTS-COMP/OP AGG, I COMMERCIAL GENERAL LIABILITY 6RSONAL R LAIMS MADEEUR � ADV,IWURY S• ,_, EACH OCCURR1sNC6 S OWNER'S&CONTRACTOR'S PROT• F1R8 DAMAOE(Mq one fin;) S �� MBD,p(PENSS(Ary one Dom) S AUTOMOBILE LIABILITY HINFiD SINGLE S LIMB NY AUTO BODILY INJURY ALL OWNED AUTOS S Pec portaN CHEDULED AUTOS AIRED AUTOS ODILY INIURY S (Per a�lden) NON.OWNED AUTOS GARAGELIAHfIdTY ROP£RTYDAMAGS S EACH OCCURRENCE S XCESS LIABILITY S AGGREGATE BRELLA FORM ER THAN UMBRELLA FORM STATUTORY LIMITS WORM'S COMPENSATION EACH ACCIDENT S 100,000 A Arm 70146480I2005 I1/14/2005 11/14/2006 DISEASE..POLICYLIMrr s 500,00-0 6MP1 OV><RS,ilABH11Y DISEASE••BACH EMPLOYEE S 1OO OOO 0THmR ESCRnMON OF OMIRAYIONSdACATION&MNMMS/SKCIAL ITEMS CLLATION CERTIFICATE HOLDER ANCE SHOULD ANY OP THE ABOVE DESCRIBED POLICIES BE CANCELLED BBPORE THE EXPIRATION DATE TIIEREOP, THE ISSUING COMPANY WILL ENDEAVOR TO TOWN OF ANDOVER MAIL 15 DAYS WRr TEN NOTICE TOM C)IRT1FiCATEHOLDER NAMED TO THE ATTN: BUILDING INSPECTOR LEFT,BUT FAILURE TO MAI.SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR 397 LOWELL STREET LtABu.rrY OF ANY WD UPON THE COMPANY. ITS AGENTS OR REPRESENTATIM. AUTHORIZED REJPRESENIATIVE ANDOVER, MA 01810 Pae# of pages CS # 022680 978-688-6737 HIC# 103358 A. J. Walsh A Sons or 55 Pleasant Street 1-866-AJWALSH North Andover, MA 01845 Proposal Submitted To: Job Name Job# L ,R�� Address1-4 o Job Location Or d Date '2 __ ,0)6,0� Date of Plans Phone#`„t�� ./ (,L,2 �, Fax# Architect We hereby submit sspQecif' tions and estimates for:___._..____._..___.._...._ ___ _ _. ___...— _.. ...._.._._.__.__ ---------------- We propose hereby to furnish material and labor—complete in accordance with the above specific Vons for the§Vm of: $ �� Dollars with payments to be made as follows: Any alteration or deviation from above specifications involving extra costs will be Respectfully executed only upon written order,and will become an extra charge over and above the estimate.All agreements contingent upon strikes,accidents,or delays submitted beyond our control. Note—this proposal may be withdrawn by us if not accepted within days. Scceptance of proposal ---�- , The above prices,specifications and conditions are satisfactory and are Signature hereby accepted.You are authorized to do the work as specified. Payments will be made as outlined above. Date of Acceptance /0 Signature 072 �, as Board or Building Regulations and Standards HOME IMPF�OVEMENT CONTRACTOR Registratiot�403358 Expi quo t 11712OQ8 Type lPri is Corporation A J.WALSH&SON �tN�C Arthur Walsh,Jr. 55 Pleasant St N Andover,MA 01845 Deputy Administrator f f i al1Jf l�a/� ,.Qtr E ? } Ti.Ap: 28Mi M1 c � 55 PW-X AL, $T t, I Q The Cotnnronwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 6Vashington Street Bostotl, .MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Coutractor-s/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): / �Gt/�j� �✓cSorys Address: -!53" s7— City/State/Zip: 1Vd 4� Phone —G 73 Are you an employer? Check the appropriat3?1--aam x: Type of project(required): I.El am demployer with 4. a general contractor and I 6. ❑ New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 1 2. ❑ Remodeling 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.E] Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plu bing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12. Roof repairs insurance required.] t employees.[No workers' 13.0 Other comp. insurance required.] 'My appliennt that checks box#I must also fill out the section below showing their workers'compensation rx)licy 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 lContractors that check this box must attached an additional sheet showing the name of the subcontractors 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 inforrnat ion. Insurance Company Name: � /��/ � /� ",/Vs CC) Policy#or Self-ins. Lic. #: 7121Y� 114C-�1�2 00 6 Expiration Date: Job Site Address: ✓ 191/LSI J/Q �/'��DTJLCity/State/Zip: 0 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 crintinal 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 die Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signazure: r� Lal� Date: Phone#: d ' �o �6 Oficial use only. Do not write in this area,to be completed by city or toren official. City or Town: PerntitlLiceuse# Issuing Authority (circle one): 1. Board of health 2.Building Department 3.Cityrrown Clerk 4. Electrical Inspector 5. Plumbing luspector 6. Other Contact Person: Phone#: