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Home My WebLink AboutBuilding Permit #131 - 81 LISA LANE 8/20/2007 .ry BUILDING PERMIT- TOWN ERMIT TOWN OF NORTH ANDOVER< cr °°� APPLICATION FOR PLAN EXAMINATION #- h Permit NO: 5 '° 1 41 Date Received 9q` �� SSACHUS Date Issued: ' 0 IMPORTANT:Applicant must complete all items on this page m LOCATION L(..! q Print PROPERTY OWNER r _P' 'Print, MAP NO PARCEL: ZONING DISTRICT: Historic District yes no i '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 Repair, replacement Assessory Bldg Others: Demolition Other Septic 'Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFO MED: i Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: CONTRACTOR Name: IC)/V17 l Phone: b ` may Address: d Jia PGt c` i Supervisor's Construction License: 0 6 U 1 11.- Exp. Date: 03- Home 3Hoene Im rovement License: , i Improvement Exp. Date: ARCHITECT/ENGINEER Phone: r 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: $ j,� O FEE: $ 7D Check No.: L I t Receipt No.: NOTE: Persons contractiIi with unregistered contractors do not have access to the guaran g g t1'fand � G '� ignature of Agent/Owner Signature of contractor rr 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 o 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 E3 Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit o 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) o 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) o Building Permit Application ❑ Certified Proposed Plot Plan a 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) o 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 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 �I THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM j DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS DATE REJECTED DATE APPROVED CONSERVATION COMMENTS DATE REJECTED DATE APPROVED HEALTH 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 Drivd/wav Permit Located at 384 Osgood Street.o„ FIRE DEPARTMENT -Temp Dumpster on site yes 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 2 1 A—F and G min.$100-$1000 fine NOTES and DATA– For department use ❑ Notified for pickup - Date �....................- --_.................__...................—...-.......-._...... ......-............--..._.__............._-....._...............— - .................... - ....__.................._...----...................................._.. Doc.Building Permit Revised 2007 Location L(S t r+- No. Date NORTH TOWN OF NORTH ANDOVER to t Certificate of Occupancy $ sACMU 5Et� Building/Frame Permit Fee $ � f Foundation Permit Fee $ xy Other Permit Fee $ TOTAL $ Check # 205G6 k Building Inspector Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR License or:registration valid for individul use only beforf Registration the expiration date. If found return to: plratipn 4/28/128612 Board of Building Regulations and Standards ExTr# 129477 e 2009 One Ashburton Place Rm 1301YPe DBA Bosto:,11Ia.02108 THOMPSON S ROOFING THOMAS DOYLE` j - 8WEST ST SALEM,NH 03079 Administrator Not valid without sgnat 'e FFRODUCER RD�, CERTIFICATE�OF LIABILITY INSURANCE DATE(MM/DDlYYYY) - 04�26�2007 THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION nsurance Services, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 960 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 122 Bridge Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Pelham NH 03076 INSURED INSURERS AFFORDING COVERAGE NAIC# Thomas Doyle dba NEt usNated Ind of MAThompson's Construction 68 West St INSalem INSNH 03079COVERAGES NS 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-T111 q� THE INSURANCE AFFORDED BY-THE POLIL(E�_�Et%RiBEJ th�R€7V S SLiSJEl1 T0 A'—LL THE TERMS, EXCLUSIONS AND CONDITIONS ip DS VAY RE-R-f POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS NSR ADO'L LTR INSRO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION Y) ( YY) A GENERAL LIABILITY NC 644138 DATE(MM/DD/YDATE MM/DDILIMITS x COMMERCIAL GENERAL LIABILITY 09/15/2007 04/15/2008 EACHOCCURRENCE $ 1,000,000 CLAIMS MADE �OCCUR PREMISES OEs occurrrence $ 50,00o !' MED EXP(An one person) S 1,000 . PERSONAL&ADV INJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,00o,000 POLICY PRD JECT LDC PRODUCTS-COMP/OP AGG $ 11000,000 AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea accident) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY HIRED AUTOS (Per person) $ NON-OWNEU AUTOS _ BODILY INJURY (Per accident) $ I PROPERTY DAMAGE GARAGE LIABILITY (Per accident) $i ANY AUTO AUTO ONLY-EA ACCIDENT $ OTHER THAN EAACC $ - EXCESS/UMBRELLA LIABILITY ONLYAGG AGG $ - OCCUR CLAIMS MADE EACH OCCURRENCE $ AGGREGATE g I DEDUCTIBLE $ II RETENTION S $ B WORKERS COMPENSATION AND AWC 7012214012007 04 21 2007 04/21/2008 0TH- $ EMPLOYERS'LIABILITY / / WC STA7U- ANY PROPRIETOR/PARTNER/EXECUTIVE x TORY LIMITS ER OFFICER/MEMBER EXCLUDED? E.L.EACH ACCIDENT $ 100,000 It yes.describe under SPECIAL PROVISIONS below E.L DISEASE-EA EMPLOYEE$ 100,000 OTHER I E.L.DISEASE•POLICY LIMIT $ 500,000 I DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS roofing e 17 Knollcrest Dr. , Andover, MA for. Judith Brasseur CERTIFICATE HOLDER CANCELLATION 978 623-8320 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Town of Andover EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 1 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT 36 Bartlett St FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AU7H.RI�ED REPRESENTATIVE �� i�A^ 11 N0RTH Town of No. _ o dower, Mass., •2 a•o �- O COCr1'C.e"ICK 7,95°RATE o U BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT........ ...i: �rr'Rwe.. ..... G............................................................................ Foundation has permission to erect........................................ buildings on .........I......1-�. ..A......�.ogrw...A........................ Rough 0 '4 to be occupied as S ......* if �� Chimney ... ......... ........ .......... . ......... .................................................................... provided that the person accepting thi permit shall in every res conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relati o 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 CONSTRUCTIO TS Rough .. ... .. ...................... ................... Service BUILDING TOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final Nw Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Bumer Street No. SEE REVERSE SIDE Smoke Det. NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit at: is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, S150A. Also, note Permits are required under Fire Prevention laws.Chapter 148 Section I OA. The debris will be disposed of in: CaS (Location of Facility Signature of ermit Applicant Fire Department Sign off. Dumpster Permit Date The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street t Boston, MA 02111 s� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/individual): Ano Sl'"1 Pd F,,eo� Address: �O' S &,el 4 r f f 5 /4 City/State/Zip: Qui�Q ( h.c_-ems Phone #: 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 I 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. $ E] Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition workingfor me in an capacity. workers' comp. insurance. Y p Y• 9. E] 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 1 I.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §l(4),and we have no 12.❑ Roof repairs insurance required.] t employees. [No workers' 13.❑ Other comp. insurance required.] *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: �S5 "f&(&,5 Policy #or Self-ins. Lic.#: Q(A- L Z d/ L?.{Y 0 1 Lord 7 Expiration Date: <9 / v Job Site Address: a 4 c.S�r L't,`,a 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 certify under the pains�n�dpenalties of perjury that the information provided above is true and correct. Sig,nature: ti Date: 2d " 0? 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#: �rD�JDg��- Pags of. Free Estimates 105 Haverhill Street Fully Insured Methuen, MA 01844 THOMPSON'S ROOFING c978)691-1355 Shingles - Slate - Rubber Roof Single Ply - Copper_Work PROPOSAL SUBMITTED TO PHONE PATE STREET T JOB NAME r `% ��... �+i Y / a7J CITY,STATE AND ZIP CODE ` JOB LOCATION F a t i r' ARCHITECT DATE OF PLANS 7S 7 > .' JOB PHONE* LSF'tr �'�'s�-- ! "` J� ''`r' •�t tr'`� � ,�.,��''....L./......• We hereby submit specifications and estimates for C r✓ fl f�"Y C"J.`�, �FP+F t jn tF v. J�e .� ; �� i��a�•4 `t E•� ' i � S°�Cj� CA''> - s,::• �'-�f-`.z*T 1 ';2 •#�`' �. � .� � '*f.,(j• �e `�1n,,",.,arrc'� _f!�' X57 i �: `i��i i• �" .t i�. N� � €��tl t,�'E� r„ •4`;\tc%° �� _,• i �4 l.j.� 4 +9,..4, :it - rV "r G�>�_.�}' - .,��r t^ r �' �iti;�✓,�, f;`S�F/,r t,;.:"f,? 1-�-f,� r`_r, g_(�'4 �e � P rOpOgC hereby to fumish material and labor—complete in acxofdance with above Specifications,for the sum of: Payment to ben as fokr*s: dollars to t -'• �.. � C3 G�,; ;,�_`:/'d �J t ;"�r t, `-`.., t '. .,'}" :.,� tr ! - AN material is guaranteed to be as Specified All work to be a ipli to in a worlunar a rammer according to standard praeliees.Any Wwation or deviation from above apedfi,-I'm i ifrid ft AuttioAaed •` i� aft costs will be executed only upon mitten orders.and winh.,,, a an extra over and soul re ti, `l Lt - abova the estinate,M agreeno contingent upon at►W accidertI i or delays our J control. Owner to can fire,tornado and other=ewn iauance.Our workers ars fully Note:This propoW may be cow by Warkmen's Canparwation h=xanca wmwrawn by us if not accepted mtthkt .s dam• ftOf VrOpOlAt—The above prices,tlpwifications and �� < cond'iti'ons are satisfactoryand are hereby accepted.You am authorized to do the work as specrfred.Payrnent m0 be`made as coned above. signall t Date of Acceptances 4