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Home My WebLink AboutBuilding Permit #11 - 49 BRADSTREET ROAD 7/2/2002 BUILDING PERMITo�"°oT bgti TOWN OF NORTH ANDOVER ?`� �' -� '' op APPLICATION FOR PLAN EXAMINATION / H Permit NO:, _ � Date Received ��SSACHUS�� Date Issued: oP/ IMPORTANT: Applicant must complete all items on this page �qr&r, -• '� xt,w�,l-'�#'w a F .� era: .,��y» kr.*,-.res "�"gyp`^.• .p. ,„.,h ----c s a,••�y �."�„3 ,. '}T�. �S'-- ^r a a+,W'x .. 9� e �• pa LOCATION A: t y ��r�, � ; [moi ;_ >'c"z"�- �-rn�-"�- �.�� ,�.,a.- �-�rtr"` r,-�-. ''. azy� -';�- r•»� sem- �`�ri s ;. a c e ;• Pnt d ac f t �PF20PERTYOWNER �e u=� r �dy�� y . �,:,T�'� p .r..*r "� < m-_ «A`* 4pnnt �yy. .. i ',e ."` �, -MAP PARCE'L' ZONING�DISTRICT rHistonc�Dist"ict yes no Mac,hme Shop Village yes =no k =r 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} t oodplarn �; WetlandsY `' �, Watershed District N y, }A �, - via a RFs.�, y. :�,, 3 S. '# ,J+ t X. Water/Sewer ,, .r��.� F._ �� M:.$ 3_f3 .� :� _ �� 3. _; ku DESCRIPTION OF WORK TO BE PREFORMED: Identification Please Type or Print Clearly) OWNER: Name: Phone: -2S6- 42,4 ' Address: ZIA 3 sF, ..+,� x ,y''' cL- ,'"'`"= x c: �,a •..x "�� ` ."'-p 'S`, s'+.,_�i -' "�' w "r .`yam, CONTRACTORxName - "C O CTO., - 4 ��.-.•` SL+,F+=� »- �' "�:€A � ;f'L"5 zc-�"s ct ..--� �' '��''a"r.F ._,a.;y -� � oaM m t x""} 4';J" -es ?s 2 'h't'. n pry �'' '- -�# ^G+x,- _�,,; , "� ''-" C- k .� fi•S�i, r�.' �.- ��'�c.�`°`� < AF Addressa lOs_fi� ✓P%1� ��( S 7L �,� ' j�2 §`l4�K }� � g� 3 .-� .tl t ,g.�q'� "� �„�,� � ��. r�� g x R .�� "` a �s=- � '� �t aS`.�'�c' a'�a-a v�:is-4 ��4�x�xx 4�'x"" �t�„`A �. w.�•- w�- 't �-.a. z .k. n;+.- A-A y4:. '3z-r A''�'- .pec �a .,t�,� r1 � "" �'�R.4� �"a. a�'� � Y t"'� �,•*a Pr �`' ' $Yt � t -. �.��'ia�--F Home Improvernent"`License �" �W 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: $_L1066 FEE: $ ' Check No.: '�/� 2r Receipt No.: 6?)&L/.2 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Si 99 :nature of A ent/Owne� j = Si nature ofcontract * ' x " _ _._., Location No. Date kORTN TOWN OF NORTH ANDOVER _ O Fw D s Certificate of Occupancy $ s,cHust� Building/Frame Permit Fee $ s Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # G � � 2 ; 3 00 Building Inspector I I 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 CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS 8 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 r � .� FIRE DEPAR {MENT#£ TempDurnpster on siteyes= ;; � `,no� � _ 1 � 3 � Located atA 24 �"�G Fire De�partrnents'ignature/date ; 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) w ❑ Notified for pickup - Date Doc.Building Permit Revised 2008 I 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 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 ❑ 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 2.2008 NORTH ToVM Of Andover `No. O ` *7 1 - Q:7 dover, Mass., LAK �. COCHICHEWICK V ORATED BOARD OF HEALTH Food/Kitchen PERMIT T Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.......... �.�.�/1�! .... ............ ........................................................ Foundation has permission to erect..........0............................ buildings on ........., x.............. 4 .....• Rough • to be occupied as.. ...... .........P.........#� in . . !.................................................................... Chimney provided that the persona pting this permit svery res onform 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 6 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRU STS Rough ......... Service B E TOR 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. NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit at: is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150 A. Also, note Permits are required under Fire Prevention laws Chapter 148 Section I OA. The debris will be disposed of in: (Location of Facility) Signature of Penni Applicant o�- Date 49NI The Commonwealth of Massachusetts ! Department of Industrial Accidents Office of Investigations �•'`' 600 Washington Street ° Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): ,,tAc�—,`kid � Address: City/State/Zip: M .p (,�,,,.�, 1/l2 c, Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and 1 .6. ❑ New construction employees(full and/or part-time).* have hired the sub-contractors 2.El 1 am a sole proprietor or partner- listed on the attached sheet. 7• ❑ 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 .❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL l LEI Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no 12,❑- oof 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 subniit this affidavit Indicaiing they arc doing ail work and then'hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: , Policy#or Self-ins. Lic.#: al"_ _7y 12- 21 Y V�d � Expiration Date: Z$' Job Site Address: A t e e-� 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 insurance coverage verification. 1 do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Simature: e^ cc,�f Date: 7 d� Phone#: e91 — Official 91 —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#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers 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,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments 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 insurance coverage required." Additionally, MGL chapter 152, §25C(7)states"Neither 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 contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation 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 regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will 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 burn leaves etc.)said person is NOT required to complete this affidavit. The 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. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-7274900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 5-26-05 www.mass.gov/dia Pegs of Free Estimates 105 Haverhill Street Fully Insured Methuen, MA 01844 THOMPSON'S ROOFING X978) 691-1355 Shingles - Slate - Rubber Roof Single Ply - Copper Work PROPOSAL SUBMITTED TO PHONE DATE Karla Kooken -),�-SS - �Z 6-3-08 STREET JOB NAME 49 Bradstreet Road CITY.STATE AND VP CODE JOB LOCATION North Andover PIA 01845 ARCHITECT DATE OF PLANS pa PHONE We hereby submit specifications and estimates for. Strip off rest of roof shingles on house (not new addi-cion) Renail all loose boards Apply ice and water shield 6 ft. up all along edge and in valleys Apply 15 lb. felt paper on rest of roof area Reshingle with a 25 year 3 tab shingle to match addition Install new flange around soil pipe Sea! around chimney flashing Cut in 2 roof vents on back side l Remove all work related debris 25 year warranty on material 5 year guarantee on labor construction lic. #060112 improvement #128612 Ue PrOP00 hereby to furnish material and labor—complete in accordance with above specifications,for the sum of: Six thousand three hundred 6 .300 . 00 Payment to be made as follows: dollars($ $2 :300 . 00 start of job balance upon completion AO material is guaranteed to be as specified.All work to be completed In a vmrkm ke manner tj according to standard practices.Arty alteration or deviation from above spedfications RN&Ag Authorized extra costs will be exroaxted ony upon written orders,and wfil beonnxe an extra charge over and furs above the estimate.AO agreements contingent upon strikes,sociderts or delays beyond our control. Owner to can fire,tomado and outer necessary insurance.Our workers are fully Note:This pmposal may be covered by Workman's Comperaation insurance. whhdravm by us H not aot opted wum of ZLcce tance r ogat—The above �1 � � prices,specifications and conditions are satisfactory and are hereby accepted.You are authorized to do the work as specified.Payment will be made as outlined above. _ "�i_' . Date of Acceptance: . -= wtuire • 3 Board of Building Regulations and StairdarJs (_ = HOME IMPROVEMENT CONTRACTOR Registration: 128612 Expiration 4%28%2009 TO 129477 Type DBA THOMPSON'S ROOFIIy ;r THOMAS DOYLE t :' 8 WEST ST SALEM,NH 03079 ------- Adminisfrator. BOARDeCta 'I j UIL'p1 6 BVG REwPAT10NS i Ltcen'se COIaIQSTRUCTiON- y SUPERUFSOR i I Nurntier CS, 060112 BrrtP,0Ri. 08/Q4/1956 — Exptres 08/04/2008 Tr. no; 28784 Restrrc ed�, ,r' THOMAS 7 DOYLE < ; 8 WEST ST. r SALEM NH, H 03079 ' �.-.- Cor mrs§loner ACORD FDATE(MM/DD/YYYY CERTIFICATE OF LIABILITY INSURANCE ) PRODUCER /14/2008 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Pelham Insurance Services, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P.0- Box 960 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 122 Bridge Street Pelham NH 03076 INSURED INSURERS AFFORDING COVERAGE NAIC# INSURER A:Nautilus Thomas Doyle INSURER B:St Paul dba Thompson Construction & INSURER C:AIM 8 West St. INSURER D. Salem NH 03079 INSURER COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABCVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L LTR INSRD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION DATE(MM/DD/YY) DATE(MM/DD/YY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $ 50,000 CLAIMS MADE 11 OCCUR MED EXPAn ( y one person) $ 1,000 PERSONAL&ADV INJURY $ 1,000,000 B Ownerls& contractors St Paul to be issued 04/15/2008 04/15/2009 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRO- PRODUCTS-COMP/OP AGG $ 2,000,000 POLICYD JECT LOC AUTOMOBILE LIABILITY i I COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY NON-ObUNEDAUTOS (Per accident) $ PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY _ ANY AUTO AUTO ONLY-EA ACCIDENT $ I OTHER THAN EA ACC $ AUTO ONLY: AGG $ I EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR EICLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION S f(� WORKERS COMPENSATION AND $ AwC7012214012007 04/21/2007 04/21/2008 g we - � EMPLOYERS'LIABILITY TORY LIMITS ER ER I ANY PROPRIETORIPARTNER/EXECUTIVE 04/21/2008 04/21/2009 E.L.EACH ACCIDENT $ 100,000 OFFICERIMEMBER EXCLUDED? if yes.describe under E.L.DISEASE-EA EMPLOYEE$ 100,000 SPECIAL PROVISIONS be,,, OTHER E.L.DISEASE-POLICY LIMIT $ 500,000 I DESCRIPTION OF OPERATIONSILOCATIONSfVEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Roofing and Carpentry CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Town Of AndOVer,Ma EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT Community Development & Planning FAILURE TO DO SO SHALL IMPOSE NO OBLIG ON LI ILkTY OF ANY KIND UPON THE 36 Bartlett Street INSURER,ITS AG NTS OR REPgESE 1 AUTHORIZE E NTATIV Andover, Ma 01810 (� ACORD 25(2001/08) OAC D CORPORATION 1988