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HomeMy WebLinkAboutBuilding Permit #191 - 55 HARWOOD STREET 9/7/2007 BUILDING PERMIT rp�ett�e° *ery p TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION � z e � Permit N0: Date ReceivedM °RST.°•°" �� �SSACHUS�� Date Issued: IMPORTANT:Applicant must complete all items on this age k Y 1 P l��A"T10f� xf >:lM S l'RCPERO 11F�11=R � 'Y ']... yMAP NO': FA`Rll. ZONING D1TRICT ;no 1 c hop F I F" TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building One family ❑ Addition '❑ wo or more family ❑ Industrial [I Alteration No. of units: Commercial Repair, replacement ❑Assessory Bldg Ij Others: ❑ Demolition ❑ Other peptic k�111we1i Flaodrl �r� » 111/etlands T ID 1Nters`hed listr�ct K= DESCRIPTION OF WORK O BE PREFORMED: Identification Please Type or Print Clearly,) t N ,A 1 Phone: 10 O l OWNER: Name: V P Address w : x zp- j c � G,OIkITFAG � R Nme� Phone 1 e�Uls�rsartstrko License d� �- exp �Da#e borne lmprouement license �� _ Fxp„ Date, 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: $ 1 Q 20-(Q FEE: $ 1 �Z Check No.: Receipt No.: 111,7 NOTE: Persons contracting with unregistered contractors do not have access t zead Sgnu gene err ` . 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 DATE REJECTED DATE APPROVED CONSERVATION ❑ . ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS t t 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 Located at 384 Osgood Street :DT. TEF 77 W7 .. R"77#11�� '1 �.y'iT�emp �u {, •'CJ'e. I l A�t�r �e Loca#etl # 1:2 Y �` „F. f.. re DepaRIM ena-'S gnatUr<efia�e� '�,;� '�' �...._;.��, r ' �'�:'�' , s. r�, "• � -t �.u. -v' p s s 4 C"r �� --mw- r s- _ � 4 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 2007 Building Department The following is a list of the required forms to be filled out for the appropriate-permit to be obtained. i 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 li 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 Location 557 dwjm/ No. Date -� NORTH TOWN OF NORTH ANDOVER Oft � o , ,ti 3: .6 0 F41 9 Certificate of Occupancy $ �'�S''•°'Eta'' Building/Frame Permit Fee $ a S4CMus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 20579 Building Inspector The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/di a Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information (� Please Print Legibly Name (Business/Organization/Individual): C. J�/�i 'C L �- � Address: 20� U)k City/State/Zip: N,9 1l Phone #: .60 (Ce,7 ZD_0�2 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. I am a sole proprietor or partner- listed on the attached sheet. # modeling hip and have no employees These sub-contractors have 8. Fftmolition 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 1].❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no 12.❑ Roof repairs insurance required.] t employees. [No workers' comp. insurance required.] 13.F1 Other *Any applicant that checks box#I 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. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:A rl 91- Policy#or Self-ins. Lich. #: Expiration Date: Job Site Address: �� 1l�'�`���( :� City/State/Zip: } j 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 ' ran e coverage verification. I do hereby certify un a he pain and pe t es of perjury that the information provided boy is true nd correct. Si nature: Date: Phone#: Official use only. Do not write in this area,to be completed by city or town official. I 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#: NORTH Town of O vm %0 No. 191 4 - _ _- - o dover, M0 LA ass.,• ' o COCHICHEWICK %p ADRATED p? CO S BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System yN�,w� BUILDING INSPECTOR THIS CERTIFIES THAT....... , !`.(,(- H................. ....... I........................................................................ Foundation !�!! 4. ..... has permission to erect........................................ buildings on ....� .......Na.r Mi .4. ..�............................. Rough to be occupied as...... Chimney p -....... 1a...r.. . ............................................................................................ provided that the person accepting this permit shall in every respect 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 J )/7 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSN N T Rough ........................ Service BUILDIN 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 SEE�EVE�SES\OE sm������� Rpr 24 07 12: 02p JB Insurance Agency, Inc. 6178848310 p. 1 �4CORD­_ a/2a/QCERTIFICATE OF LIABILITY INSURANCE DATEIr24/0M1 7 PRODUCER THE; CERTIFICATE ISISSLEDASA MATTER OF INFORMATION JB Insurance Agency, Inc. ONLYAND CONFERS NO R1GHIM UPONTHECERTIFICATE 16 Washington Av© HOLDER.THIS CERTIFICAT5DOESNOT AMEND,EXTEND OR Chelsea, MA 02150 ALTER THE COVERAGE AFFORDED BY THE POLICIES iB9AOW. INSURERS AFFORDING COVERAGE NAIC# INSURED j INSURERA. SCOTTSOAI.E INS. SURE—LAK HOMES LLC INSURER H AMERICAN INTERNATION COMPANIE 2 PUMPKIN PINE ROAD INSURER C NATICK, MA 01760 INSRFR D COVERAGES 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 CONTRACT OR OTIIER DOCUMENT WITH RC:,PCCT'10 WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY vER fA1N,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUnJrCTT0 ALL THE TERMS.EXCLUSIONS AND CONDITIONS OF SUCH VOLfCIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PND CLAIMS. INSR D' POLICYFFFVCnW POLICY EXPIRATION TYPE OF INSURANcr POLICY NUMBER LIMITS GENERAL LIABILITY TACH OCCU.I.NCF 1 1,000,000 DAMAGF TO RENTED A �[ 'COMMTRCIALC�NTRALLIADILITY CLS1181060 I 11/x/06 11/d/Q7 EACHSE3(Eeocclrerre) b 50,000 CIAMS MADE I X:OCCUR MED EXP(ArvomD5rea) s 5,000 IPERSONAL&ADV INJURY S I,000,OOO GENERAL AGGREGATE S 1,000,000 CI'N'LACCKh(AI1:LIM1IgNNi,n$PI:K' PRODUCTS-COMP/OP AUG S 1,000,000 POIICY PFO- LOC 7 I AUTONOOILELIADILITY I COMBINED SINGLE LIMIT S ANY AUTO (Ea wx)(I n) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS, I I PFs<DFf 60f1) HIRED AUTOS I BOUILY INJURY y NON-OWNED AUTOS � (Yer eCC�02M) 5 I PROPERTY DAMAGE (Pef emidwt) 2 GARAGE LIABILITY - AUTO ONLY.CA ACCIDENT ,$ ANYAUTO rAAC,C '2 I I QTHrR THAN ZTO ONLY ACC 2 EKCESSIUMBRELLALIABILITY EACH OCCUKNENCE 1 OCCUR CLAIMSMADE I AGGREGATE S 5 DEDUCTIBLE i RETENTION Z WO RK ER 5 COMPENSA7[ON AND ' X � %AC STA IT,g C 14-TQRYLW B EMPLOYEF?5'L.IABILITY WC. 032-d3-41 d/23/07 d/23/06 E.LEACH ACCIDENT S 100,000 ANY PROM ILTORIP/R TN CRf[X CCUTNC i OFFICERIMEMBER EXCLU DEW I C.LDISEASE-CACMPLOYCC .2 100,000 Ir�9 a emA be unser SFCCIALPROMU NSbebw EL DISEASE-POLICY LIMIT S 5500,000 OTHE R I I FSC5CRIPTION OF O PERATIONS f LOCATIONS I VER CLES/EXCL USIONS AD DEO 8Y END CRSEM ENT 1 SPECIAL PROV1510 NS ;ERTIFICATEHOLDER CANCELLATION SHOUL D ANY OF TH E A80VE D ESCRI BED POLICIES BE CANC ELLED BEFORE THE EXPIRATION DATE THEREOF.THE ISSUING INSURER W ILL ENDEAVOR TO MNL 30 DAYS W RITTEN CITY OF BOSTON NOTICETO THE CERTIFICATE HOLDER NAMED TO THE LEFT,DUT FAJLURE TO 00505HALL ATTN:BUILDING DEPT IMPOSE NO OBLIGATION OR LIABILITYOF ANY KIND UPON THE INSURER,ITSAGENTS OR MEDWAX, MA RF.PRE'$ENTAYIVES. AUTHORIZED REPRESENTATIVE JAMES BAROOSHIAN , (CORD 25(2001106) D ACORD CORPORATION 1988 h n�,— Board of Building Regulations and Standards i HOME IMPROVEMENT CONTRACTOR Registration: 144687 Q, Expiration -1 012812008 Type DBA SURE LOK HOMES COMPANY RONALD LEWISf � � •L 2 PUMKIN PINE RD'. Deputy Administrator NATICK,MA 01760 h i NORTFI ® of over 0 No. - '� o dover, Mass.,LAK • ' a O COCHICHEWICK �d ORATED S BOARD OF HEALTH Food/Kitchen PERMIT T Septic,System BUILDING INSPECTOR THIS CERTIFIES THAT....... l!v .. ....... I........................................................................ Foundation has permission to erect........................................ buildings on .... ....... ............................. Rough QChimney tobe occupied as.....c�. ..... ..........." .......l.�.A..rl. .............................................................................................. provided that the person acce ting this permit shall In every respect 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 I � ELECTRICAL INSPECTOR UNLESS CONSNN T Rough ....................................... ...................... Service BUILDIN TOR Final Occupancy Permit Required to Ocmpy 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. I ! SURE-LOK HOMES 2 Pumpkin Pine Road Mass. Registration#144687 Natick, MA 01760 Toll Free in New England 1-800-916-9438 sore-loM Bomes rluswc@hotmaii.com www.sure-lokhomes.com I/We the owner(s) of the premises mentioned below, hereby contract with and authorize Sure-Lok Homes (hereinafter referred to as the"Contractor") to furnish all necessary materials, labor and workmanship,to install, construct and place the improvements according to the following specifications, terms and conditions on premises below described with reference to which I/we warrant that I/we ianre the record holder(s) of title: q- ' b0 5l� Owner's NameEb�' Job Address ce&<1N�D CitY �#-- j ,- State SPECIFICATIONS: � `` I� (�r� ) t t� ' Ai,- A4 Q 'e 0 L S `) -- " � 'J_42_�.6)l -1:0 _ Qom"-- ns-3' r i ,i In consideration-6)the labor and materials furnished by the Contractor; the Owner(s) agree(s)to ay the Con actor the su of 34ni Balance Due$ / TV I $ Deposit not to exceed 33 1/3% $ Est. Start `" � t U .� —Est. Comp. d Y� �,l Security Interest Yes ❑ No It shall be the obligation of the Home Improvement Contractor to obtain such permits as the Owner's Agent.The Owners who secure theirown construction-related permits,ordeal with unregistered Contractors will be excluded fromthe guaranty find provisions of MGLC, 142A. Q` }�►V cL�. L� 66 All Home Improvement Contractors and Subcontractors shall be registered by the Director and that any inquiries about a Contractor or Subcontractor relatingregistration should be directed to: to a 9 Director G it -1-) 0 U,eo l f1 Home Improvement Contractor Registration a-vAu h�-z�0(- One Ashburton Place, Room 1301 C-[CS Boston, MA 02108 t�C1 �k� "` (617) 727-8595 THE OWNER SHALL PAY FOR THE WORK BY THE FOLLOWING METHOD: CASH UPON COMPLETION BY MODERNIZATION LOAN ( ) Notwithstanding acceptance of this contract by Contracto ,this contract shall be cancellable by the Contractor if the home owner is unable to finance the payment of this work through an established bank or other financial institution or within fifteen (15) days. All work performed by the Contractor is fully covered by Workmen's Compensation and liability insurance. NOTICE TO THE OWNER(S): If it will be necessary for you to obtain a bank Modernization Loan in order to enable you to pay for said improvements. 1. You will be given a completely filled-in copy of this Agreement. This Agreement constitutes the entire agreement of the parties and no other agreements, representations and/or warranties, expressed or implied, shall be binding on either party hereto unless in writing and signed by both parties. Any alteration or deviation on the specifications listed above involving extra costs of materials or labor will be furnished and performed only upon written order and will be in addition to the cost price of this contract. The Owner(s)hereby certify(ies)that he has(they have)read this Agreement,that the terms and conditions and the meaning thereof have been explained to him (them) and he (they) fully understand(s)them. The Owner(s)acknowledge(s) the receipt of an executed copy of this Agreement at the time of execution hereof. If any provisions of this agreement are in conflict with any statute, regulation, ordinance or rule of law,then such provisions shall be deemed null and void to the extent that they may conflict therewith, but without invalidating the remaining provisions hereof. COMPANY'S GUARANTEE: The Company guarantees its workmanship for Tk( ct V years. It will replace defective material within the period of guarantee free of charge. All requests for service must be in writing! This agreement may be cancelled by an officer of the Contractor,but only within three(3)business days from the date of execution and in a similar manner of the Owner(s)' right of cancellation. You may cancel this Agreement without any liability to you, provided that you send a written notice to the Contractor by midnight of the third business day following your signing of this Agreement, by ordinAjy mail, posted, by telegram, or sent by delivery. WITNESS our hands as als this day of Z4�/s 200 SURE - LOK HOM Do not sign this Agreement before you read it. (SUBJECT TO H OFF PROVAL) f By: I A\ eprese tative' wner) Accepted By: ( wner) Authorized Officer (Owner) I