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Home My WebLink AboutBuilding Permit #451 - 69 OAKES DRIVE 1/8/2008 BUILDING PERMIT o "O oT"qti TOWN OF NORTH ANDOVER 002t° '- APPLICATION FOR PLAN EXAMINATION Permit NO: l Date Received A�°°`°`"""'"" 7q �RA7eo►Pp,�'�� SS�CHUS� Date Issued: >d IMPORTANT: Applicant must complete all items on this page LOCATION / 0oD,- t.0 PROPERTY OWNER Print r► '�`-- l �r2 t41 Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration No. of units: Commercial Re air, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: Identification Please Type or Print Clearly) _ OWNER: Name: ►�cf v, Phone: 9 ig- l G` v-l( Address: 7 CONTRACTOR Name: w� 0is- Phone: Address: 7 �l t '1Yemo,Sb 1 , L t Supervisor's Construction License: Exp. Date: _ Home Improvement License: _I S-0 ca ~?C? Exp. 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: $ G,,Q 50 , OD FEE: $ Check No.: J 3 13 Receipt No.: Cti NOTE: Persons contracting with unregistered contractors do not have access to t e uaran fund ignature of Agent/Owner 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 DATE REJECTED DATE APPROVED CONSERVATION COMMENTS DATE REJECTED DATE APPROVED HEALTH COMMENTS Zonin 'gBoard of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Si-qnature &Date Driveway Permit Located at 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS 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 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 p P 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 I Revised 2.2007 Location�� No. S Date / D� NORTIy TOWN OF NORTH ANDOVER 3? •. • O AL F w A i www • s�oCertificate of Occupancy $ �L CHU <� Building/Frame Permit Fee $ } Foundation Permit Fee $ Other Permit Fee $ 'j TOTAL $ Check # �) J 2087 t Building Inspector i NpRTH Town of No. 4A VI _ 14 2 1yy �, o �` dover, Mass., ] T O LAKE I COC HICMEwICK y ADRATED `�C� S BOARD OF HEALTH Food/Kitchen Septic System PERMIT T D • BUILDING INSPECTOR THIS CERTIFIES THAT ..................................... . .......�.........�.�.!�............ ........... ...a.......� ..y.................................. Foundation has permission to erect...................................... buildings on .—.41.........C).p..L....... `..................... Rough to be occupied as........ ...... ' ....... .... ........�. Chimney provided that the person acts g this permit shall in every r ect 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 MON ELECTRICAL INSPECTOR UNLESS CONSTRU S 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. i The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street r Boston, MA 02111 www.mass.gov/dia ' Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Tie 'bl Name(Business/Organization/Individual):_D'10-,nE-et-} Address: 7 City/State/Zip:_�, � �-1 c Phone.#: q g— 6 Areyou an employer?Cheek the appropriate boa: eneral contractor and I w Type of project(required):., 1. I am a employer with ❑ I am a g employees(full and/or part-time).* have hired the sub-contractors 6. ❑ 4. New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, Demolition working for me in any capacity. employees and have workers' Buil 9. [No workers comp,insurance comp.insurance.$ ❑ ding addition required.] S. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doingall work officers have exercised,their . 11.❑Plumbing repairs or additions myself. [No workers' comp, right of exemption per MGL ,0 Roof repairs insurance required.]t c. 152, §1(4), and we have no 12 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 submit this afidavit 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 state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp,policy number. I am an employer that is rovidin workers'comp ensat ion insurance for my employees.—Below is the policy and job siteinformation. Insurance Company Name:PW,,S C lz�rt4 Policy#or Self-ins. Lic. Expiration Date:/- Z/-b Job Site Address:�� ocr 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. I do hereby cert% under the pains and penalties of perjury that the information provided above is true and correct Si atur`e:4f_ Phone#: 7 c�~ 6 -• d Official..use only. Do not write in this area,to be completed by chy 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"ever state or local licensing agency shall withhold the issuance or, renewal of a license orermit to,b erste�a business or to construct buildings in the commonwealth for an P P g Y ., applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25CO)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-contfactor(s)name(s),address(es) and phone numbers)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 maybe 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 permittlicense number which will be used as a reference number. In addition,an applicant that must submit multiple permittlicense 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 bum 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.#617-727-4400 ext.40b or 1-877-MASSAFE Fax# 617-727-7749 Revised 11.22-06 vrvmmass_gov/dia 01/07/2009 23:49 7913970115 TRAVLL F1UtN15 Ur Vu— AC-OR-0. CERTIFICATE OF LIABILITY INSURANCE iA V2008' PRODUCER (781)322-2350 FAX: THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Prescott and Son Insurance Agency,Inc. HOLDER.NLYNTS NOCERTWICATE DOES NOTNFERS AMEND. ENO RIGHTS UN THE XTEND RTIFICAOR 963 Eastern Avenue 7R/- 3a 50 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Malden MA 02148 INSURERS AFFORDING COVERAGE NAIC 4 INSURED !NSURERA:First Financial Insurance Dempsey Construction Roofing Specialists INSURER B: 7 Richardaon St INSURER C: INSURER D: Billerica MA 01821 INSURER E: WmOF 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 OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN I$ SUBJECT TO ALL THE TERM$• EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. TE LWITS SHOWN MAY HAVEN RE BY P0 CLAIMS INSR DD'I TYPE OF INSURANCE POLICY NUMBER PRAl MMfICY OR )PPOLICY mmON LIMITS GENERAL LIABILITY EACHOCCURRENCE f 1,000,000 X COMMERCIAL G6 NERAL LIABILITY PR DAMAGES RENTED = 100,000 A 7 CLAIMS MADE M OCCUR 554£S11703 9/4/2007 9/4/2008 MED P amp PereonIS 5,OT0- Prigs NAL t Apy IWuRv S 1,000,000 GENEFIAL AGGRE061E s 2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: PRODU0TB-COMPIOP AGQ S 1,000,000 X POLICY 0 IPETT 17 1 CC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S (Ea acd0enl) ANY AUTO ALL OWNED AUTOS BODILY INJURY s (Par person) SCM2DULEDAUTOS HIRED AUTOS BODILY INJURY (Per ecc onl) S NOW-OWNED AUTOS PROPERTY DAMAGE (Per seddwA) GARAGE UANUTY AUTO ONLY-EA ACCIDENT Z ANY AUTO OTHER THAN EA ACC3 AUTO ONLY: AGG _ EXCESSIUMBRELLA LIABILITY QQLamCP S OCCUR F7CLAIMS MADE AGGREGATE,--f Is Z s DEDUCTIBLE RETENTION WORKERS COMPENSATION AND EMPLOVER6'UABK.ITYa E.L.6A HA CIOENT S ANY PROPRIETOR/PARTNER/EXECUTIVE 0 S(/- OFFICERIMEMBEREXCLUDED? E.L.01 EASE-EAEMPLOYEE S If yes,describe under I P Y I IMIT SP9CIALPRVII N w / OTHER l/ i DESCRIPTION OF OPERATWNS/LOCATIONSMENICLE&EXCLUSIONS ADDED BY EmbOREEMENTISPECIAL PROVISIONS CANCELLATION CERTIFICATE HOLDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE CITX OF NORTH AMOVER EXPIRATION DATE THEREOF, THE ISSUING INSURER VOLL ENDEAVOR TO MAIL ATTN: JEANNIE McEvoy 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT 1600 OSGOOD STREET FAILURE TO DO SO SMALL IMPOSE NO OBLIOATION OR LIABILITY OF ANY KIND UPON THE NORTH ANDOVTA, Mh 01805 INSURER ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Joseph Scho1nirk/P,7R 1D ACORD CORPORATION 1989 ACORD 26(2001108) Pegg 1 of 2 INS025(mom i i ' ,-�'latsczclz�G;eCYd 1 t \ Boiirti of Building PLegulati,rrs:Ind Standard.,; HOME HOPROVE TENT CONTEcACTOR Registratior:, 150272 j .` Expiration; .3/21/2008 . ' .Type: Individual DEMPS,EY CCNST'&.R06FINv ERIC DEMPSEY - :=:JCHAi;DSON ST BiLLERICA. MA 01821 Dcp!.Y A Uaniilistritor I m� I FROM :DEMPSEY ROOFING FAX NO. :19783623102 Dec. 26 2007 03:38PM P2 Dempsey Construction & Roofing Specialists Proposal 1 strip 7 Richardson Street Billerica,Ma 01821 978-670-8904 Proposal Customer Name Christin Carey Date 12,18107 Address 69 Oak Drive Order No. city North Andover State Ma .ZIP Rep Phone 978-687-0774/fax:603-6224451 Attn Mike Carey FOB Qty Unit Price TOTAL Strip existing 1 layer down to plywood. Re-nail where necessary. Any broken or delaminated plywood wx4ae replaced at-an additional cost of time and material. install li of ice&water shield underlayment along all eves& valleys. Install 151b felt paper on remainder, Install 8"white aluminum drip edge around entire perimeter. Install 30 year roofing shingles(color&style determined by home owner), Flash and tar one chimney where necessary. Install one new 3"pipe flange. Cut in and install 1 new bathroom exhaust roof vent. Cut in and install shingle over ridge vent to ensure proper ventilation(soffit to ridge). The 2 existing skylights need to be replaced with new otherwise they will not be included in warrantee. Existing skylight sixe:491/2 x 33 1/2 R.O. Price for skylights will follow. Remove all roofing debris. this is a labor,materials,dump,and permit proposal. Five year warrantee on all workmanship. SubTotal Payment Details Shipping&Handling Taxes State Check -'--k,250.00 0) Payable to Eric Dempsey TOTAL. � $6,250.00 Office Use Only Signature of acceptance_/-�li•9 >' moi _