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Home My WebLink AboutBuilding Permit #303 - 5 WALKER ROAD 10/31/2008 BUILDING PERMIT N°RTH qti TOWN OF NORTH ANDOVER 3? �s A. °=6 oL F APPLICATION FOR PLAN EXAMINATION Permit NO: A Date Received p°H.ITlG Date Issued: - ad IMPORTANT:Applicant must complete all items on this page LOCATION ✓ � ' t/! /'/ , �� Print PROPERTY OWNER_ IG/`� aYV v � Print MAP NO PARCEL: ZONING DISTRICT:.Historic District yes (Tno Machine ShopVillage g yes i TYPE OF IMPROVEMENT PROPOSED USE Residential - Non- Residential New Building One family Addition Two or more family Industrial Alteration No. of units: Commercial epair, replacemen Assessory Bldg Others: Demo i ion Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: AP -5 evc s7r:�2S � is .vU-- ,�,n2,e-- Identification flease Type or Print Clearly) OWNER: Name: �/1 l�i ,l✓/ �/,ri�� SSSy e', Phone:f" � ��4d Address: CONTRACTOR Name: z�lC Phone: - G Address: t Gv !� Supervisor's Construction License: / 1 1 --- Exp. Date: �/O 3112— Home Improvement Licenses � Exp. Date: / ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDINGPE IT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project C''ost: $ FEE: $ Check No.: `t Receipt No.:� 4 NOTE: Persons contracts with unre ist ed contractors do not have access to a ;�a�rtylfd ,Signature of Agent/Own Signature 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 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 Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on yes no Located:at 124 Main Street Fire Department signature/date COMMENTS i 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 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 ❑ Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks o Building Permit Application o 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 a 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 Location 11-/,6741✓41 No. Date 0?/. Od MORT1y TOWN OF NORTH ANDOVER Certificate of Occupancy $ ��s',^°•'<� 9 Buildin /Frame Permit Fee $ s�cMust Foundation Permit Fee $ ' Other Permit Fee $ TOTAL $ Check # KJ 2 U Building Inspector ` NORT11 T. own of No. 303 -__ r -.0 -1 . Deal 0AW01 o dover, Mass.,/ D T Q L- LAKE A- cocHICHEWICK V ORATED '9S BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING .INSPECTOR THIS CERTIFIES THAT.........�� dw 144111%) .................. .................. ......................9.14 ................................. ..........................................�....... Foundation has permission to erect........................................ buildings on ..... ...... ......... .............. Rough to be occupied as �rgft......�rr.....�. .... ......A................ Chimney . . . . . . .... . . . . ... . . . provided that the person ecce ing this permit shall in every respect conform to 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 SO PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONS TR QTS 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 of \\ II If 11 If Boston, MA 02111 t : www.mass.gov/dia Workers' Compensation Insurance.Alfficlavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Ledbi Name (Business/Organization/Individual): Address: p� City/State/Zip: !/�. Phone #: ��G� ..�'2c� Are y an employer?Check the appropriate box: Type of project(required): 1 I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. E]New construction 2.❑ I am a sole ro rietor or artner- Ii sted on theattached sheet7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its 9. ❑ Building addition required.] officers have exercised.their WE Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.7 Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no 12.❑ R39frepairs insurance required.] t employees. [No workers' com . insurance 1 Other P e re uired. ] +Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. Homeowners Who submii•l-his affidavit indicating they 81t uuin,g w_n work a_id the-hi c owsiCtb COntraL'iUrB IIILLSL SUOmIt a new a171USVlC indicating such. xContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workerscomp.policy information. 1 am an,employer that is providing workers'compensation insurance for information my employees. Below is the policy and job site Insurance Company Name: Policy#or Self-.ins. Lie.#: vV( . ' �- rV -DQ Expiration Date: Job Site Address: 4�z, ` City/State/Zip: Gl�C 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 er t e pa' aqd enalties of perjury that the information provided above ' true and correct Si--nature: Date: Phone#: 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 permitto 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 nuxnber.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 permittficense 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 tothank 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 Tnvestigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26=05 Fax 4 617-727-7749 www.mass.gov/dia Fax: 978-475-6482 Cell 978-604-5243 7 Harold Parker Road ndover,MA 01810 acehomemedics.com HIC Lic.#153165 Construction Super.Lic.#100212 Proposal Submitted To: Ade Meadowview Condo.Assoc. Estimate/Agreement#: 1233HomeMedics North Andover,MA Estimate/Agreement Date: .lob Location: October 20, 2008 Handyman House Calfs Split Entry House/Rental Meadowview Condos .� For Your Home ! North Andover,MA VISA 1-877-5 ODD JOB Cost Estimate/Agreement for Services: Construction of Stairs: Construction On the split entry home,on Meadowview property,we will construct a set of steps from the existing deck on the S975 right side of the house to the ground,towards the parking lot.Steps will be built of pressure treated wood.It will sit n a concrete pad.The stairs will have handrails and balusters.Materials Included. Total:S975 I Thank you very much for considering us for your remodeling projects. We appreciate it very much and look forward to working for you.If you have any questions about this proposal,please don't hesitate to let me know. Should you decide to work with us,we can complete the work by the end of October. When you have a chance,please let me know how you would like toP roceed. Thank you very much for this opportunity. We hope to have the opportunity to work for you. Sincerely, Mat Previte 978-604-5243(cell) r t!,.'- t-.el d!iF 7 ed , --yol PS,if the board cannot provide a deposit check prior to start,we willforgo the deposit and will accept full payment upon completion.I understand that this is short notice. i -onsiderin-Ace Hone.Ifedt' i. P't' ':v ;r ; t 0i," business and look.fc)nvard to ;e!t otic SS onal, neut. tirne1v and eniClt'11? QYh'gUaf LS 1'Uul'COIl1pIPlP SUMS%(?C. Qt1. The above prices, specificatiol,s are satisfactory and are i��l trt :� ) gate 1 t • � _.... 1� RItiA -•r - ,,..Qp1ed. Home Medics is autrLarizeci 1 specified. Payment+tri? . �--�- --- ��iined above. � �.F� r,c 3 tie t - t fl o C� � i Acadia Insurance Company Administered by Berkley Risk Administrators Company,LLC P.C.Box 939, Pierre,SD 57501-0939 2510 E. Irwin, Pierre, SD 57501 Phone(605)945.21,44 Fax(605)945-2048 Toll Free(800)6344589 Acadia Insurance NCCI Carrier Code 33391 INFORMATION PAGE Renewal Of No. WC-20-20-00085400 1.The Insured: Normal A/R Policy Number:WC-20-20-000854-01 Mathew Previte Risk ID:0746866 dba: Ace Home Medics Tax ID#:F 562616033 57 Harold Parker Road Andover,MA 01810 Date of Mailing:9/23/2008 Other workplaces not shown above: XX individual M Partnership See Schedule ❑Corporation 00ther 2.The policy period is from 12:01 a.m.9/2912008 to 12:01 a.m.9/2912009 at the insured's malling .addressi A.W 3 orkers'Compensation Insurance:Part One of the policy applies to the Waiters'Compensation Law of the states fisted here: MA B.Employers Liability Insurance:Part Two of the policy applies to work in each state listed in Item 3.A. The limits of our liability under Part Two are: Bodily Injury By Accident $100,000 each accident. Bodily Injury By Disease $500,000 policy limit. Bodily Injury By Disease $100,000. eacb employee. C.Other States Insurance:Part Three of the policy applies to the states,I any,listed here: SEE WC 00-03-26(A) D.This policy Includes these endorsements and schedules: WC000308 WC000403 WC000404 WC000414 WC200101 WC200301 WC200302A WC200303C WC200306A WC200307 WC200401 WC200403 WC200405 WC200601A WC200604 WC990001A WC990601 4.The premium for this policy will be determined by our Manuals of Rules,Classifications,Rates and Rating Plans, All Informatlon required below is subject to verification and change by audit PREMIUM BASIS RATES ENTRIES IN THIS ITEM,EXCEPT AS SPECIFICALLY PROVIDED ESTIMATED ESTIMATED TOTAL PER$100 OF CODE ELSEWHERE IN THIS CONTRACT;DO NOT MODIFY ANY OF ANNUAL ANNUAL REMUNERATION NO. THE OTHER PROVISIONS OF THIS POLICY. PREMIUM REMUNERATION Manual Premium $2,363.00 See Schedule subject Premium S2,M,00 Modified Premium $2,363.00 Minimum Premium: $500.00 Standard Premium :21383,00 xpense Constant $338.00 Foreign Terrorism Stat Code 9740 $9.00 IE n Total shmsted Annual Premium >12,710.00 DLA Assessment 1.063 $149.00 Total Fees 6 Premium $2.858.00 Alaencv Name and Address Piet Deposit Premium Required $2,859.00 Premium Paid to Date ($2,859.00) Durso Samuel J insurance Agency Total Pn*nlum Due $0.00 198 Massachusetts Ave Andover,MA 01845 DATE: 9/23/2008 Signature: Includes copyright material of the National Council on Compensation Insurance used with Its permission. WC 99-00-01 01983_@ 1991 National Council Compensation Insurance ennr nneton