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Home My WebLink AboutBuilding Permit #163 - 50 BERKELEY ROAD 8/30/2007 NORTH BUILDING PERMIT 0?09`t`•0 04��OS^ TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION ~y ` n Permit NO: ((0 Date Received ""°R - Y 4SSACHU`�� Date Issued• IMPORTANT: Applicant must complete all items on this page L�CATItI j i i sea Y a^ Print 'ROPERTY OVUt<IEI �F ,.iu�AP I�I�Y �� P�CI� .t� zr�I��I�GQis�;��cT HIsO�zI�:DISTYRIG�` � yes�� _ TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building P-en family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial epair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other p �c F:xr ,r ✓ a * y �,,{� s.. -stn 4� Wa. 4 ,.,,p 16Y j, W�Ct'i e Sit u W1tr/ tft . , DESCRIPTION OF WORK TO BE PREFORMED: /fOtl e 1)-,o p z– — /J CS%/9LL pl6v 1e 0 D r-- Identification Please Typgor Print Clearly) OWNER: Name: Sl e-Ph e ri G�(.P.S ) Phone: -7' Address: cS6 1 L cS C1�T�AC7 tR Ime : . c c tl0httle" �`� �>5' b '2 �� err✓ �r r � � ` � t � ` � � �' ..e'' � � ✓at � ,s�`� , � � ✓� � `'s t� .tom ° ARCHITECT/ENGINEER Phone: Address: Reg. No. J FEE SCHEDULE.BULDING PE $12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.:j Total Project Cost: $ f� FEE: $ �6D Check No.: Receipt No.: v NOTE: Persons contracting with unregistered contractors do not have access to a uaranty fund Sign itute of`Agen#lt wne'r ' Signature of can#ractor' Location No. Dates ' N°RTM TOWN OF NORTH ANDOVER Certificate of Occupancy $ Eta Building/Frame Permit Fee $ s�cNus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 20 Building Inspector I Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ i 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 s Water & Sewer Connection/Signature &Date Driveway Permit Located at 384 Osgood Street Fll � pEPARTAAEN - Term I 'urripster cirl tore na: L4C�t@d at'1�4 i�nalll Sfwf:�t a' ar- s Dimension i 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 I 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 J ❑ 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 j 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 1 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 PP 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 2.2007 i/7e Lommonweacrn uJ 1vlus3ur11u-3 « Department of Industrial Accidents Office of Investigations . a 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Pluaa�lbers Applicant Information Please Print Legibly Name (Business/organization/Individual): Address: ,�� 195 � A] City/State/Zip: P/0 �� °�- �/� Phone #: Are you an employer? Check the appropriate bo Type of project(required): i. F-1 I am a employer with 4. I am a general contractor and I 6. ❑ New construction employees full and/or part-time).* have hired the sub-contractors ( p ) 7. F-1 Remodel' 2. ❑ 1 am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub-contractors have 8. ❑ Demolition s workers' com insurance. working for me in any capacity. P� 9. ❑ Building addition o workers' tom insurance 5. ❑ We are a corporation and its [N p 10.0 Electrical repairs or additions required.] officers have exercised their 3. F-1 I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions j c. 1 4 and we have no myself. [No workers 52 comp. � §1� ), 12. Roof repairs j insurance required] t employees. [No workers' 13.0 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. (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: fi )m VL /,YS Policy#or Self-ins. Lic. #: �/ /C� qd Expiration Date: /lhev to job Site Address: 156 ��/�/1 �Y S Cit•,/State,zi„ �ly A/k/,DDVC/Z /V/9- A/ t 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 insuzanc.e coverag.e.venfication. I do hereby cerci , under the pains and penalties ofpeijury that the information provided above is true and correct . Date: 36 O 7 Si�ature: C G Phone# Oficial use only. Do not write in this area, to be completed by city or town.official. City or Town: Per m;f_/T;cense i Issuing Authority (circle one): 1. Board of 1leilth.2_ wilding Department 3. City/Towu Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other F Contact Person: Phone #: t �. NORTH 0 of dover, Mass., R:' 3d • O�" Q COCHICHEWICK V ORATED 1"? .7 vv V ` BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT c ......................... ............... ...............4w�............. .....68PUA.�................ Foundation has permission to erect........................................ buildings onAl ........ ......... .....�... ...... Rough tobe occupied as.......... . . .........�....... ................................................................................. Chimney provided that the person acceptinghis permit shall in eve rconform to the terms of theapplication on file in this office, and to the provisions f the Codes and By-Laws relating to the Inspection, Alteration nConstruction of Final 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 CONSTRU S ARTS 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 (Nall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. f • .#AAf022680f T Me i sa y ` r- 'e`• a �.' c 5 yam- C711- � u Hoard of Building Re0lations and Standards HOME IMPIgyEMENT CONTRACTOR r I � Regist�atps403358 ,7ne.Pfl e COMOration J. WALS'H&S0 CERTIFICATE OF INSURANCE1SSUEDATE(MM/DD/YY) 812006 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE Samuel J Durso Insurance DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE Agency Inc POLICIES BELOW. 198 Mass Ave Suite 101B COMPANIES AFFORDING COVERAGE North Andover, MA 01845 INSURED Arthur Walsh COMPANY J A.I.M. Mutual Insurance Co dba A. J. Walsh &Sons LETTER A 55 Pleasant Street North Andover, MA 01845 COVERAGES THIS IS TO CERTIFY THAT 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 CONTRACTOR OTHER DOCUMENT WITH RESPECTTO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 1S SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LTR DATE(MM/DD/YY) DATE(MM/DD/YY) LIMITS GENERAL LIABILITY - GENERAL AGGREGATE S COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG. S ::::]CLAIMS MADE[:::jDCCUR PERSONAL&ADV.INJURY S OWNER'S&CONTRACTOR'S PROT. EACH OCCURRENCE $ FIRE DAMAGE(Any one lire) S MED.EXPENSE(Any one person) $ AUTOMOBILE LIABILITY COMBINED SINGLE ANY AUTO LIMIT S ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) S HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) $ GARAGE LIABILITY PROPERTY DAMAGE S EXCESS LIABILITY EACH OCCURRENCE S MBRELLA FORM AGGREGATE $ THER THAN UMBRELLA FORM WORKER'S COMPENSATION ANDWC STATU- 10TH- EMPLOYERS'LIABILITY X TORY LIMITS 7014648012006 11/14/2006 11/14/2007 S ER A THE PROPRIETOR/ INCLEL DISEASE--POLICY LIMIT $ PARTNERS/EXECUTIVE 500000 OFFICERS ARE: �XEXCL EL DISEASE--EA EMPLOYEE $ 100,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Town of North Andover EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 15 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO.MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Propoat Page# of pages CS # 022680 978-688-6737 HIC# 103358 A. J. Walsh & Sons or 55 Pleasant Street 1-866-AJWALSH North Andover, MA 01845 Proposal Submitted To: � Job NameJob# Address Job Location Date Date of Plans Phone# / / / F l lk�7 Fax# j Architect 101 rWe herebysubmitspecifications estimates for: _ .... _. ____ ______ -----_.___. __ ....... P ......_( _ _. .__- __ ___ . - _ -___ __�_ 01 _................_.__..._ --t- _ u _...................... .. . .... ......_._ ..._.._�� ..._... ..... _ ...----._._...__...__.........__...._........._.._._.-----------------._._._.._......_........__...........---------...._........._.._- _........................_.......____._................__..__.__._.__ _...____..._.._...._....__.._.---------------_-__._____. .__.__________.__________.__.__..__._._____.__._.___ ._______.___..___.__.__._________.__.__........._._...___...._......_......._..- _._... ....--� _ v._..._...... ._.._..� .. 4 ..... We propose hereby to furnish material and labor—complete in accordance with the above specifications for the sum of: $ 00 7D011ars V U 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 submitted above the estimate.All agreements contingent upon strikes,accidents,or delays �� - beyond our control. Note—this proposal may be withdrawn`fiy us if not accepted within days. 21cceptance of Propogai The above prices,specifications and conditions are satisfactory and are —Jlgnature hereby accepted.You are authorized to do the work as specified.. LDate nts will be made as outlined above. of Acceptance Signature