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Home My WebLink AboutBuilding Permit #203 - 717 FOSTER STREET 9/19/2008 BUILDING PERMIT o�No Dr",�� TOWN OF NORTH ANDOVER �? � ''`- -'` �0 APPLICATION FOR PLAN EXAMINATION * yy,� h T Permit NO: 40 Date Received /+ oAgo "'"Arno oP`,�e* r �`9SSACHUS�� Date Issued: IMPORTANT:Applicant must complete,all items on this page t I LOCATION Print PROPERTY OWNER r ovHA 4-0a 0 dV Print MAP NO: _ IPARCEL ZONING DISTRICT'Histonc District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building ne fam-iI Addition Two or more family Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: D olition Other tic --Well' Floodplaim Wetlands Watershed District- Water/Sewer j DESCRIPTION OF WORK TO BE PREFORMED: ' core 57-ev Cr� ` x 3 0 r a ` L4 L., a- 004 i't-C� C'v�c rre s' _ Identification Please T��Pne or Print Clearly) OWNER: Name: L.��,*- 130 C? ]1v14c�fiaPhone:92 Address: 5 T— ► CONTRACTOR Name: VI s Phone:. ' - 1 ' / Address: -n-\1+,u, l �` Supervisor's-Construction License: CJ °7.2P 3. Exp. Date: „ 1 Home Improvement License: Exp., Date: ! , ARCHITECT/ENGINEER . Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ ` /, s-zO FEE: $ 1 Sir Check No.: '/Ii/ No.: off-+ 5a� NOTE: Persons c, ntracting with unregistered contractors do not have ac ss to t guar VJ nd %griature of Agent/Owner Signa#ure of contract Location �� No. =2o,3 Date U NORTM TOWN OF NORTH ANDOVER C? • pw ►. 9 Certificate of Occupancy $ Building/Frame Permit Fee $ ACNUS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # M91 2 15 6 Building Inspector 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 ' V/4- (� Si nature l COMMENTS I HEALTH Reviewed on lylq Signature COMMENTS -Y\��- 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 site yes no Located:at 124 Main Street � Fire Department signatureldate 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 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 o Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. An 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 --o Certified Surveyed Plot Plan -a-Workers Comp Affidavit b- Photo Copy of H.I.C. And C.S.L. Licenses b- 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 Town of Andover . Oyew l•~ ly.�•4••, '/"�„.:,M _ No. � � i _ - L n © dover, Mass., a COCHICHEMCK 9�AD'S'ATED PPS` ,Cy `IT BOARD OF HEALTH Food/Kitchen PERMIT . T D Septic System BUILDING .INSPECTOR THIS CERTIFIES THAT......&:;6........ ...U'r-6 .................... .......................... ............................................ Foundation has permission to erect........................................ buildings on ... .......5.9... .. ....W':4” Rough to be occupied asqt!�.. .. xq .. ... ........ .. S. r Chimney provided that the person accepting this permit shall in every res ect conform to�he 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 UNLESS CONS TRU ON STARTS ELECTRICAL INSPECTOR Rough .... ...... ............... .............. ....... .... ..... ......... ... Service BUILDING INSP 1� 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. r \ � v 11 \ 1 Lot 4 111 87, 122 S.F. 1 1 � 2.00 Acres C.B.A. = 87, 122 S.F. I (100X Of Zoned Area) tP II rIn 11 I a 11 � ,01 X11 -T\ 1 � 1 \ J \ 1500 Gallon Sep tic Tank ete Go, E A Xistir9dati�t°"� D—Box E F0U o f Foiynd°k��1 \ ,�8 OP Oevotl� \ �- a H �\ Leach Bed Sr stem: %�� (24' X46'/ \ t w Construction Easement of 934 S.F. 0.02 A cres For The Benefit Of Lot 4 ; e p97 For The Future Grading Of A Septic Reserve Area 00 << 234.75' >> % 205.70'-k� �%% ------------------ - 3 p, $etbac 175.00' \ 143.1 �` 67.92' �---' o s t e rr ; able P u b l i _ V a ' ✓fze �'omvnaauuP,cz�f.! a�../�i�.aaac✓zc��el�a 4 Board of Building Regulations and Standards 1 Construction Supervisor License License, CS 87229 Expiration: 2!:14!2010 Tr# 16421 Restriction: 00°' }' RAYMOND G PARKHURST 44 BATEMAN ST ''"�" HAVERHILL,MA 01832 Commissioner �� pp ie "lDoor�nzo�nureal./.� o�..i�'lizvattc�u�veft�4 a 111 Board of.Building Regulations and Standards I ug HOME IMPROVEMENT CONTRACTOR Registration: 142387 Expiration: 4%1/2010 Tr# 265525 l Type: DBA RAY PARKHURST REMODELING RAYMOND PARKHURST 44 BATEMAN ST. � "'� L. r HAVERHILL,MA 01832 Administrator j, Prow[ RAY PARKHURST REMODELING a HAVERHILL, MA 0 No Job Too Smoll MA Lic, #CS087229 Tel.978-521-7512 MA Lic. #142387 Cell.978-609-5473 PROPOSAL SUBMITTED TO j t PHONE DATE ,r �? L - f, w+ j STREET JOB NAME I CITY,STATE AND/ZIP CODE JOB LOCATION ARCHITECT DATE OF PLANS F JOB PHONE We hereby submit specifications and estimates for: .................................................................................................................................................... .................................................................................................................... 1�1 ..�.. ' rc t I1 ....i ._ ... ..r..f.T.c�... ... ...... .c. _....G....t..... ..."................ e `.... .. -.... C �.... .....t........................................................... .................. ...�.. ........ ...:.. ............ . .......... ... .....%f...............E-r•................ ... . .:..-.....c. .........+... ...C...,... E.....................,rr . `... ..................0...z. :........... ... ..<:......:.. . ?.....'.`...(.<....!S................ .''.!:...k........................1.�-<..._..... . '.� _ ...............r'..... .,.................................... .......,................. ...................:........��.....................................-...'...................................................... ...........................t:.:............ ..... 4................................................................................................................................................................................................................................................................. ............... ........................................................................................................................................................................................................................................................................................................................................... ........................................................................................................................................................................................................................................................................................................................................... ........................................................................................................................................I.................................................................................................................................................................................................. ........................................................................................................................................................................................................................................................................................................................................... ........................................................................................................................................................................................................................................................................................................................................... ..........)............................................................................................I............................................................................................................................................................................................................................... t .. r^ , .. t >� T..(,� 4. . r t ........�..."..`"...4...�"`...'..........✓ ................................................................................................................................................. ..............................................................................................:................................ .................................................................................................................................'........................................................................................................................................................................................................ ........................................................................................................................................................................................................................................................................................................................................... lVe Vr0pOOC hereby to furnish material and labor--complete in accordance with above specifications,for the sum of: t�� / i & t/.! lif(f t,r- 4 U') , V tr / i 0,•r dollars($ - "t�f�+---t+*" ). Payment'fo be made as follows: All material is guaranteed to be as specified.All work to be completed in a workmanlike manner AuthorizedZ�- according to standard practices.Any alteration or deviation from above specifications involving Signature extra costs will be executed only upon written orders,and will become an extra charge over and r above the estimate.All agreements contingent upon strikes,accidents or delays beyond our control.Owner to carry fire,tornado,and other necessary insurance.Our workers are fully cov- Note: area by Workmen's Compensation Insurance. This proposal may be withdrawn by us if not accepted within days. 2eceptanee Of pr0�lOnt —The above prices,specifications and conditions are satisfactory and are hereby accepted.You are authorized to do the Signature r work as specified.Payment will be made as outlined above. Date ofAcceptance: Signature � y The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.nzass.g ov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): rt VK V Address: y 2131-e nv4,-, S j City/State/Zip: t4i%6n ff)/k-f( Phone #: Are you an employer?Check the appropriate box: Type of project(required): 1.2�1 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.❑ 1 am a sole proprietor or partner- listed on the attached sheet. t 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.❑ 1 am a homeowner doing all work right of exemption per MGL 11.❑ 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' 13.&Other il),ec C compAnsurance required.] *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. Homeowners who subniit_!his of f idavii indicating ihey arc uuing all work and then hire outside contractors muni submit a new affidavit indicating such. lContractors 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: ��ry C C I. Policy#or Self-ins. Lic.#: t,6, C L rod (,{� �bl jai � Expiration Date:—V 01 Job Site Address: / J e-/c 5i� City/State/Zip:_Nokr/ ,�,..�o uc�c mon 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 certify under the pai s 4adenalties of perjury that the information provided above is true and correct Si ature: Date: LL d 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 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-contractors name(s),address es and hone numbers along with the' O ( it certificate (s)( ) sof g insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carr 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. . 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 �W.mass.gov/dia IDE NCE GENERAL LIABILITY DECLARATION PAGE The Providence Mutual Fire Insurance Company P.O. Box 6066 Providence, Rhode Island 02940-6066 Policy Nu . ber CPP 0064260 02 Policy Period From 09/11/2008 To 09/11/2009 Ren Nal of CPP 0064260 12:01 A.M.Standard Time at the Named Insured's Address Transaction RENEWAL Direct Bill Nine Payments Named Insured and Address Agent PARKHURST, RAY DBA COWAN INSURANCE AGENCY, INC. 854 RAY PARKHURST REMODELING 359 MAIN STREET 44 BATEMAN STREET HAVERHILL, MA 01830 HAVERHILL MA 01832 Telephone: 978-372-1451 Business Description Type of Business Audit Period ' CARPENTRY INDIV Not Applicable IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF THIS POLICY, WE AGREE v WITH YOU TO PROVIDE THE INSURANCE AS STATED IN THIS POLICY. LIMITS OF INSURANCE General Aggregate Limit (Other than Products-Completed Operations) $ 2,000,000 Products - Completed Operations Aggregate Limit $ 2,000,000 Each Occurrence Limit $ 1,000,000 Personal and Advertising Injury Limit $ 1,000,000 Medical Expense Limit, any one person $ 5,000 Fire Damage Limit, any one fire $ S0,000 AMENDED LIMITS OF LIABILITY Refer to attached schedule, if any. LOCATIONS OF ALL PREMISES YOU OWN, RENT OR OCCUPY Refer to attached schedule. CLASSIFICATIONS Refer to attached schedule POLICY PREMIUM $ 2,057.00 DEPOSIT PREMIUM $ TAXES AND SURCHARGES $ TOTAL DEPOSIT PREMIUM 5 ADDITIONALIRETURN PREMIUM $ THREE YEAR PREMIUM $ Forms and Endorsements Applicable to this Policy See Attached Schedule These Declarations together with the common policy conditions,cove ge clarations, coverage form(s) and forms) and endorsements, if any, issued , complete the above numbered policy. f Countersigned this Day q66 46,6 fr - t% Authorized Representative Issued Date: 08/13/2008 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY INFORMATION PAGE Associated Employers Insurance Company Burlington,Massachusetts (800)876-2765 NCCI NO 40959 POLICY NO. I WCC 5006506012008 PRIOR N0. I WCC 5006506012007 ITEM 1. The Insured Ray Parkhurst Mailing Address: 44 Bateman Street Haverhill MA 01832 (No. Street Town or City County State Zip Code Individual 0 Partnership corporation Other FEIN 01-3427106 0 Other workplaces not shown above: 2. The policy period is frorrP9/28/2008 t009/28/2009 12:01 a.m.standard time at the insured's mailing address. 3. A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed 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 $ 5 0 0,0 0 0 each accident Bodily Injury by Disease $ 500,000 policy limit Bodily Injury by Disease $ 500,000 eachemployee C. Other States Insurance: COVERAGE REPLACED BY ENDORSEMENT WC 20 03 06 A D. This policy includes these endorsements and schedules: SEE SCHEDULE 4. The premium for this policy will be determined by our Manuals of Rules,Classifications, Rates and Rating plans. All information required below is subject to verification and change by audit. Classifications Premium Basis Rates Code Estimated Per$100 Estimated Total Annual of Annual No. Remuneration Remuneration Premium INTRA 367690 SEE EXTENSION OF INFORI 4ATION PAGE Minimum premium$ 500.00 Total Estimated Annual Premium $ 4,342.00 As indicated,interim adjustments of premium shall be made: Deposit Premium $ 1,148.00 ❑ Annually ❑ Semi Annually ® Quarterly ❑ Monthly MA Assessment Chg. $3,938.00 x 6.3000% $248.00 This policy,including all endorsements,is hereby countersigned by 07/23/2008 Authorized Signature Date GOV GOV I KIND PLACING CLAIM NAME SAFETY STATE CLASS AUDIT OFFICE OFFICE CHECK GROUP The Fairway Agency Inc MA 5645 114 1505 1 1 1 305 Forest Street WC 00 00 01 A(11-88) Bridgewater,MA 02324 Includes copyrighted material of the National Council on Compensation Insurance, used with its permission. CUSTOM VIEW CUSTOMER -- GENERIC CUSTOMER DATE 09/09/08 REF Deck08253 3 ' +F R v £ b z 1 .. JACKSON LUMBER 215 MARKET ST LAWRENCE MA (800) 555 1212 BEAM LAYOUT JACKSON LUMBER CUSTOMER -- GENERIC CUSTOMER 215 MARKET ST DATE 09/09/08 REF Deck08253 LAWRENCE MA (800) 555 1212 6' 1/4" C 14' 3 1/2" 4' 6 1/4" D 1' 11 1/4" E 2' T 5' 63/4" A 11 1/2" 11° B F �- cu iv cu cu BEAM BEAM POST POST LABEL LENGTH COUNT SPACING A 6' 6" 2 5' 1 1/2" B 4' 1/4" 2 2' 7 3/4" C 29' 5 1/2" 5 7' 3 1/2" D 5' 1 1/2" 2 4' 10" E 4' 1 1/2" 2 3' 10" F 20' 1 1/2" 4 6' 7 1/4" Post spacing is measured center-to-center. Depth of post-in-concrete footers --- 48 inches. Z6 Y, 237.631 88.85' 148.78' / v ti r 4 •CO Lot 4 01 0 87, 122 S.F. 1 2.00 A Cres I I '� C.B.A. = 87, 122 S.F. (1009 Of Zoned Area) II � of I z 1 1 i -13 Ck °D \ - tpp of Folin 4 on � Y,1 M Elevation Doncrate dat►on \ \ \ co \ CIA � 1 Construction Easement . II 934 S F. I '0.02 A cres I For The Benefit Of Lot 4 For The Future Groding Of A Septic Reserve Area �o o 205_•70-- \ \ �` - 3 ' $etback \ � ,----------------- 0 \ cA , \ \ . , 175.00' �%' ' � 143.83' .�-- 67.92' � �--- S' t r e e 315 00' ----- d t h yy i 0 s t e r ,� � riabe