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HomeMy WebLinkAboutBuilding Permit #119-11 - 725 BOXFORD STREET 8/11/2010 "ORT/1 BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION � Permit NO: ��, Date Received f Date Issued: .� �SSACHIJ IMPORTANT:Applicant must complete all items on this page :LOCATION 5- --Print PROPERTY OWNER ,/. Print MAP 21n_�� PARCEL:_2 Z©N1NG DISTRICT: District yes no , Machine Shop Village yes ' no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One famil Addition Two or more family Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District WaterlSewer _DESCRIPTION OF WORK TO BE PREFORMED: Cts �✓ i / j, -�L T/Lt— AS Uo,,,419-c Id ntification Please Type or Print Clearly) OWNER: Name: To N C-4+s km Phone Address: a-$ 9d /-d S J N. ArIv1017 1.1704 CONTRACTOR Name: Mr-h/ i4'r / Phone: f� - Address: Supervisor's Construction License: —Exp. Date: :47 -f.�. Home Improvement License: Exp. Date:_ 7 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: $ 4 �a "— FEE: $ 10 �7 Check No.: �Iep— Receipt No.: 9-3u� NOTE: Persons contracting with unregistered contractors do not have access W the guaran fund - _ Signature of Agent/Owner Signature of contractor Location ZS ?,� �y� sr Ngo. �"'" Date NpRTM TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ s�CMUs Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Chea*/ T 23Ju7 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 Signature COMMENTS i 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: L ated 384 Osgood Street FIRE DEPARTMENT r Tempurlpster an ysite Yes__ no Losed-at 424 Main Streetm _ Fire Dep�rtrnotft slignj 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 I i ❑ Notified for pickup - Date Doc.Building Permit Revised 2010 .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 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:Building Permit Revised 2008 NORTIy ToVM of Andover 0 . C, - AK o '� dover, Mass,, COC HICHEWICK y� ADRATED S U BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THISCERTIFIES THAT.......... . .t ...... s ��sL. ........................................................................................... Foundation has permission to erect........................................ buildings on���i �. ...... ....... .1 �............... Rough g to be occupied as...... Chimney p ......... ...........�-x�......... ........................................................................provided that the person acceptin this permit shall in every respect crm 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 ELECTRICAL INSPECTOR UNLESS CONS O STARTS Rough ....... ................................. ......... Service .. . ...................... ....................... e BUILD OR 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. -__...__"`_—'- __.. ,�_..�/jj .-110497/YJLO�IZCU'^^'.,..'L.d�✓(�(,ClddCl�lA.LdLLW Offlee of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Type: Registration:, 102467 - .+ °-`rExpiratiorr 7/2/20 12 - Private:Corporati NEW ENGLAND CUSTOM DESIGN`INC. 4 Val Lanza 226 LOWELL ST. ': WILMINGTON,MA 01887 . Undersecretary } *= iYiassachutietts- Dcir<u tment of Public Si . Board of Buildin- Regulations and Standards Construction Supervisor License License: CS 8828 Restricted to: 00 VAL J LANZA 34 BIXBY ST d REVERE, MA 02151 ' - i I Expiration: 4/20/2012 C'rnunisiuncr Tr#: 20843 ACORD- . CERTIFICATE OF LIABILITY INSURANCE OP ID KC DATE(MM/DD/YYYY) NEWEN-1 03/22/10 PRODucER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Kilgore Insurance Agency HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ' 5 Centennial Drive ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Peabody MA 01960 Phone: 978-531-6550^ Pax:978-531-9442 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: western world in Compan New England Custom Design INSURER B: Safety Insurance Company 39454 —t Incor grted Ron Weinberg a Val Lanza INSURER C: Travelers Prperty& casualty 226 Lowell Street / Unit B4-A INSURER D: Wilmington MA 01887 INSURER E: 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 OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN-MAY HAVE_@EEN REDUCED BY PAID CLAIMS. LTR NSR TYPE OF INSURANCE POLICY NUMBER DD POLICY EFFECTIVE POLIC EXPI TI DATE MMIDD DATE MMIDWYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $1000000 -UMWMURA X COMMERCIAL GENERAL LIABILITY NPP1203241 03/;14/10 03/14/11 PREMISES Eaoccurence $50000 CLAIMS MADE XX OCCUR MED EXP(Anyone person) $2500 PERSONAL&ADV INJURY $1-000000 GENERAL AGGREGATE $2000000 I 1 GEN L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO .$1000000 POLICY 0 PRO- JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMB B I ANYAUTO 0062853 04/'05/09 04/05/10 «accident $ ALL OWNED AUTOS POLICY RENEWS 04/05/10 04/05/11 BODILY INJURY $250000 X SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $500000 i NDN OWNED AUTOS (Per accident) PROPERTY DAMAGE $ 100000 (Per aWdent) GARAGE LIABILITY ., AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO:ONLY; AGO $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ _ OCCUR n.CLAIMS MADE.. AGGREGATE $ DEDUCTIBLE _• $ RETENTION $ $ WORKERS COMPENSATION ANDX TORY LIMITS ER B ANY PROPRIETORIIETORIEMP..�OYERLITYPARTNERIFXECUTNE •7PJUB0239N232-10 03/14/10 03/14/11 E.L.EACH ACCIDENT $100000 OFFICER/MEMBERE(CLUDEDT E.L.DISEASE.-F,AEMPLOYEE $100000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $500000 OTHER I i I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CA,NI EL4F�D BEFORE THE.EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE'HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES, _ - AUTHORI SENTATIVE f ACORD 25(2001/08) ©ACORD C RPORATION 1988 The Commonwealth of Massachusetts Department of Industribl Accidents !� Office of Investigations ] 600 Washington Street Boston MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): _ L S jGi,er 9/5,5 IcAll, Address: l 1-O€fvr;,GL t City/State/Zip: . p Q Phone#: o 5-6p. ®9 % Are Y9u an employer?Check th appropriate box: Type of project(required): 1. II aln a employer' _ _ 4. ❑ I am a general contractor and I employees(full,and/or part-time). �u have hired the sub-contractors 6. ❑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 gt ❑ Demolition working for me in any capacity, employees and have workers' insurance. 9. F] Building addition coinP• [No workers'comp,insurance required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their 1 L❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required,]t c. 152,§1(4),and we have no employees. [No workers' 13.0 Other comp.insurance required.] *Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. t llnmenwner:whr,c thmit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 'Contractor,that check this box must attached an additional sheet showing the naive 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 providing workers'comp=--an-on .:.y err:;,l: information. Policy#or Self-.ins..Lic.#: U/2,> Q .'j 9 �/` �� /(j Expiration Date: y Attacha copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to sccitrc coverage as required tin dcrS'-1to4,15A o fh5t_;L.c. 152 can lead to the ;.n-:nosition of criminal nenalties of V 1—ID of lin to S25000 a da„onai„ot tt,o rsyG._Nl.it+r_i.i.lttiiSt_iluir_,l,�,yint trstifanc�c.- ---- .................... f%fig 11)we fh n r'- :c nd nennlfir+,4 nfteorii,rRr PlrCrl the[nfnttn[rtinn provided[[Is[1ve is trite an[l rnrrnrt, ZJ 0/ 7 Official use onty. Do of write in this area,to he completed by city or town official. �f !I City or Twom: asstiinh Authority(circle i 1..Board of Health 2. Building Department 1.Citi'/T owr Clerk 4. Electrical Inspector g. Plumbing Inspecto• �1 i9 €7.Other, _ �t NEW ENGLAND CUSTOM DESIGN, INC. 226 LOWELL STREET WILMINGTON,MA 01887 #978-658-0881 Home Improvement Contract Registration No.102467 • .ROOFING AND SIDING AGREEMENT 'his is a legally binding contract.Make sure you read this Agreement and understand it before signing it.Do not sign this contract if there are any blank spaces. NOTICE.All home improvement contractors and subcontractors,unless specifically exempted by Massachusetts law,must be registered with the Commonwealth of Massachusetts.All inquiries about registration should be directed to: DIRECTOR-HOME IMPROVEMENT CONTRACTOR REGISTRATION One Ashburton Place,Room 1301 Boston,Massachusetts 02108 s Agreement�ison 20Telephone:#677 727-8598 ,/0 _,by and between New England Custom Design,Inc.(hereinafter,"Contractor') .owner a M9 (hereinafter,"Owner'),of /Town e��/ fZ�/1'/2 State Inc, —ZipdZe&& (H)Phone 9��'0220-90U-3 Address("The Premises') 7-.-2,!(— Be), Fol D sr M Phone w England Custom Design,Inc.Salesperson Roofing will be applied only on slope roof surfaces below,over present roofing shingles unless specified under REMARKS. WLL MATERIAL.22!!�7 t kfi Qiyr-t jr) Y.? /Y2 Color Q Main Roof j Bay Windows Almlir Extensions </,9,1/-,0 �+ Porches:Front Side AIrMI Rear 11IDY1 r Other Roofs /!/rl NOTE:Roofboaz replacement cost 3.-,)J— per foot OR 510 per 4'x 8'sheet of 3/ inch CDX plywood. gr•: - d r a'�<:1ar i5 �nt;e ,,, KAM/EXTRAS:Missing or defective lumber is not included in any category of work unless specified here. trot - AS. Zt X$/ r it d Y oe4rAg / . f Wu f A iN A// VW -5eI l�.c �I >S'��. I t�l—� �rsna;�:✓i:t�r � d 1}iP �cfi.!rc%s• /4Gt ��'airc c��l/ lam 2c�r�V 4,q. aT. Vie Contractoragreppct roo00pedimm in agoW and,wrkinadil a mameran wont detail above. CASH PRICE$ /[/- DOWNPAYMENTS 00. 1V rill oofiigCt+sra PAYABLE ON START OF WORK$ C �S�Uf E�lg BRW RIONlQnt3cbe PAYABLE $ s tkield` 5rtsesIardnsc atSdt ib��1ti�s�� 911 ro,Flc $� PAYABLE ON COMPLETION$ �02 f/f oV lYrN 1, j �e or�o�4i`Yaluablcstr DATE: 20 L RIGHT TO CANCEL )wner may caned this agreement ifit has been signed by the Owner at a place other than the address of the Contractor,which may be his main office or branch thereof,provided that the Owner s the Contractor in writingat his main office orbmnch by ordinary mail posted,by telegram sent orby delivery,not later than midnight of the third business day followingthe signing of this Agree- See attached Notice of Cancellation.A cancellation fee representing 30%of the contract price will be in effect if cancellation is requested after the legally allotted time has elapsed. Nmer hereby certifies that he has read this Agreement,that the terms and conditions and the meaning thereofhave been explained to him,and that he fully understands them and that there is no standingbetween the patties,verbal or otherwise,than that which is contained in this Agreement,and agrees that the�S 'ontmclo,is not responsible nor bound by any representations not con- i inthis Agro ment,made by any of its agents,unless the same be reduced to writing and signed by the Conus THIS CONTRACT IF THERE ARE ANY SPA 09/03/16 v ignatt Date a England ISustom Design,htc. Date er's Signature Date - -