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Home My WebLink AboutBuilding Permit #840 - 80 HOLLY RIDGE ROAD 6/20/2007BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: &-0- Date Received , t -a Date Issued: jo --2,4) v tT�.c.. �bt--�•� T `� ��4_� h •.fie */ .P/( 1r DESCRIPTION OF WORKTO BE PREFORMED: X It, G a VA7 i , bl ba4\n OLXVv , &C )Awc Yn ak c c,� 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: $ / �,; CTT FEE: $ , Check No.: Receipt No.:�/ NOTE: .Persons contracting with unregistered contractors do not have access to the guaranty fund Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOS L 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 PLANNING & DEVELOPMENT ❑ COMMENTS CONSERVATIO;j;Z��v.TE REJECTED COMMENTS FJEALTH DATE APPROVED El COMMENTS ■' DATE REJECTED DATE APPROVED 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 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 21 A —F and G min.$100-$1000 fine NOTES and DATA — For department use ❑ Notified for pickup - Date ................................. ............ . 1111---- .............................................. -- ......................... .............................. ............ ....................... ............... ................................... .............. .......................... ......................... ..................... ............... ................ .................. 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 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 Permit Application Ce 'fie urveyed Plot Plan �9o-to s Comp Affidavit _.Copy of H.I.C. And C.S.L. Licenses 0ggy Of Contract loor/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 2.2007 LocationEL) f�j-&3 e(d,,(— N o. Date &0*T#j TOWN OF NORTH ANDOVER i Certificate of Occupancy $ -Z Building/Frame Permit Fee $ -1 CHUS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 203'19 R.K. Anderson Co.. 126 Washington Street P.O. Box 433 West Boxford, MA 01885 President: Richard K. Anderson Massachusetts Construction Supervisor License # 036148 Home Improvement Contractors License # 116589 Contract agreement This Agreement was made on ( �-/ r v�, ) between R.K. Anderson Co. and ( d y� Jc,�poh R.K. Anderson Co. /agrees to perform thefollowing services: GU/6'- rI ,S1 STi Sc,� d" 14-e -t �1'odov C lGs�, . R.K. Anderson Co. agrees to complete these services on the date agreed upon between both parties. Payments: In consideration of Contractors services, clients agree to pay contractor as follows, an amount for total job will be determined or agreed upon between homeowner and contractor. The agreed upon amount will only change if Contractor come across any unforeseen obstacles in t _ which this will immediately be brought to the homeowners attention: First Payment: (deposit): Second Payment:, Final Payment: Do upon completion of job 40aa Permits: Contractor will obtain any permits required Invoices: Contractor will submit invoices for all services performed. Contractor will prese. invoices, receipts for all materials used. Independent Contractor: The parties intend Contractor to be an independent contractor in the performance of these services, Client shall not have the right to control or determine such method or means. Other Clients: Contractor retains the right to perform services for other clients. Assistants: Contractor may employ such assistants, as contractors deems appropriate to carry out this agreement. Contractor will be responsible for paying such assistant, on the hourly rate quoted to homeowner. Homeowner owner will pay Contractor leaving it the Contractors responsibity for paying assistants. Equipment and Supplies: Contractor, will provide all equipment, tools and supplies necessary to perform the above services, and will be responsible for the cleaning of all debris after completion of job. " The Contactor and the homeowner herby mutually agree in advance on the agreement of work to be performed as written above" The homeowner has a three day cancellation right under MGL c 93 s 48; MGL c 140D s 10 or MGL c 255D s 14 as may be applicable. Massachusetts Regulations (CMR) in the Massachusetts State Building Code as 780 CMR R6. 4 Homeowner. Date l yl lJ C 6 ` J 3z Contractor: Date / BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 036148 Birthdate: 02/22/1960 Expires: 02/22/2.008 Tr. no: 18781 Restricted:00 j RICHARD K ANDERSON PO BOX 433 W BOXFORD, MA 01885 Commissioner � ;/fie U/ O�l129720'J2ccPl0001L 6� '�"�aadC�ciuGieit6 \ Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 116589 - - Expiration: 6/28/2008 Type: DBA R K ANDERSON RICHARD ANDERSON 126 WASHINGTON ST W. BOXFORD. MA 01885 Deputy Administrator License or registration valid for individul use only before the expiration date. If found return to: Board of Building Regulations and Standards One Ashburton Place Rm 1301 Boston, Ma. 02108 �e Not valid without signature From: Kathleen At: Norwood Insuranoe Agency, Inc FaXID: Norwood Insurance Ag To: Building Inspestor Date: 6/152007 05:35 AM Page: 1 of 2 ACCRD CERTIFICATE OF LIABILITY INSURANCE CSR 17OE6/15/07 RiCAtID-1 (MMIOD PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION LTR ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Norwood Ins. Agency, Inc. 293 Main Street HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. POLICY EFF DATE (MMIDD/YY) Groveland, MA 01834 Phone:978-372-5921 rax:978-521-0242 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: The Travelars insurance co. INSURER B: National Grange Mutual AUTHORED REPRESENTATIVE R. K, Anderson Richard K Anderson INSURER C: INSURER D: PO BOX 433 Vest Boxford MA 01885 INSURER E: COMMERCIAL GENERAL LIABILITY rnvaoercc THE POLICIES OF INSUPA14CE 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 BEEN REDUCED BY PAID CLAIMS. LTR S Ij TYPE OF INSURANCE POLICY NUMBER POLICY EFF DATE (MMIDD/YY) DATE (MMIDDIYI'{ LIMITS GENERAL LIABILITY North Andover MA 01945 AUTHORED REPRESENTATIVE EACH OCCURRENCE s2000000 PREMISES (Ea occurence) $ 500000 B COMMERCIAL GENERAL LIABILITY MPS88750 CLAIMS MADE ❑ OCCUR MED EXP (Any one person) $ 10000 PERSONAL &ADV INJURY $ X Business owners 05/04/07 05/04/09 GENERAL AGGREGATE $ 4000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ POLICY JPE0. LOC AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT $ ,Ea accident) BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCI DENT $ OTHER THAN EA. ACC $ ANY ALTO AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR EICLAIMS MADE AGGREGATE $ $ $ DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION ANDTORY LIMITS I ER A EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNE.RlEXECUTIVE 6Ki;iB-7917Al2-9-04 07/31/06 07/31/07 E.L. EACH ACCIDENT $500000 E.L. DISEASE - EA EMPLOYEE $ 100000 OFFICER/MEMBER EXCLUDED? Syes,If describe ISIO SPECIAL PROVISIONS CeIPx E.L. DISEASE -POLICY LIMIT $500000 OTHER PROPERTY 50000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Carpentry/Interior CERTIFICATE HOLnER CANCELLATION TONOAND SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 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 Town of North Andover IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR Building Inspector REPRESENTATIVES. North Andover MA 01945 AUTHORED REPRESENTATIVE ACORD 25 (2001/08) 0ACORD CORPORATION 1999 The Commonwealth of Massachusetts Department of Industrial Accidents Office ofInvestigations 600 Washington Street U1 Boston, MA 02m www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers rs licant Information Name (Business/Organization/lndividual): Address: L4 AjGs City/State/Zip: G,/, s7L Phone #:. �,7 5f- 3.0-7611 Are you an employer? Check the e ppropriate box: 1. ❑ I am a employer with 4. E3I am a general contractor mployees (full and/or part-time).• 2. c I am a sole proprietor or and I have hired the sub -contractors listed partner- ship and have no employees on the attached sheet. 2 These sub -contractors have working for me in any capacity. [No workers' comp. insurance workers' comp. insurance. 5. ❑ We are a corporation 3. ❑required.] 1 am a homeowner doing and its officers have exercised their all work myself. [No workers' comp. right of exemptibti per MGL c. 152 1(4), ), and have insurance required.] t no employ, m loy ees. P Y [No workers, comp ins" Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs lance require(l.] I 13 ❑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 anew affidavit indicating such. iContractors that check this box must attached an additional sheet showing the name of the sub contractors and their wnrle—, - -•-- -•• —•p—ycr snia is providing workers' com information. nsurance fpensation ior my employees Below is the policy a»d job site Insurance Company Name:_ I( Policy # or Self -ins. Lie. #: ` Expiration Date: S_ Job Site Address: 9-a / / � City/State/Zip:_ Attach a copy of the workers' compensation policy declaration page showing the policy number andexpiration Failure to secure coverage as required under Section 25A of MGL . 152canlead to the imposition of criminal e datea fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties of a of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded toof a STOP WORK hORDER e Office of d a fine Investigations of the DIA for insurance coverage verification e ` a trd penal les ofper ur3' that the information provided above !s true and correcit 11�6e _ Date: G 112/ -e'.7 Official use only. Do not write in thls area, to be completed by city or town oJyiciaL City or Town: PermidLicense # Issuing Authority (circle one): I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: R.K. ANDERSON COMPANY JOB CARPENTRY SHEET NO. OF_ P.O. Box 433 CALCULATED BY DATE WEST BOXFORD, MA 01885 (978) 352-7034 FAX (978) 352-7534 CHECKED BY DATE SC:AI F J i - ti R.K. ANDERSON COMPANY CARPENTRY P.O. Box 433 WEST BOXFORD, MA 01885 (978) 352-7034 FAX (978) 352-7534 SHEET NO. OF CALCULATED BY DATE CHECKED BY SCALE DATE vnnnurr 9n -1 mannan 0O z rA W tv A \ o w° a v) o z w° w°' U ca w x w Rr cG° Ta w x a v 0.4 a W w°' uGj w a�' w A z cn ac o cn :ca pG C h O c C.2 C.) 06 : A A A Cc t "J O CD W) V 0 CF On D :... o a. E= Z m O C •=.r O O O C • j�,� H r E CD m U y �3 O O .3 N C c � _ m .0 f-1 H W H O a AmooU cm . o m c Cf) 5 .00 C W m p PC m F�1 C.3 a Z p 'mow o► ts c ao c Q4D`mc .o = m �o m - 3 N ~ r y - m W .0 �C.. Z w C ++ atL3 4D 0 �c Z COLU C3 10 cm .a m� C� _ � y p M CL.- m � ill 2 O cm CA O y � � 'E m m Z �.O CD 3� as i em o a CL. Ca o c ev CL 0 CD C co 0 CL V y R C _c �. CO2 C2 LU I�Iw LLI to W W V9 W