HomeMy WebLinkAboutBuilding Permit #723 - 83 ACADEMY ROAD 6/24/2009x
BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit N0: Z Date Received
Date Issued: 2W
10
I IMPORTANT: Applicant must complete all items on this pace I
LOCA
PROPERTY OW
Q. 10
MAP NO: Q..% 0
Print
ING DISTRICT: Historic District
no
TYPE OF IMPROVEMENT
PROPOSED USE
Exp.
Date: 3/2 -?z v
Residential
Non- Residential
New Building
I IMPORTANT: Applicant must complete all items on this pace I
LOCA
PROPERTY OW
Q. 10
MAP NO: Q..% 0
Print
ING DISTRICT: Historic District
no
TYPE OF IMPROVEMENT
PROPOSED USE
Exp.
Date: 3/2 -?z v
Residential
Non- Residential
New Building
One family
Date: 61W ,-aaf0
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 Bf PREFORMED:
C-(cs ;A 111 _-\ 5.c' C r.'l. ll_ mic
C
Identification Please 7
OWNER: Name:
Address:
or Print Clearly)
.ksi
Phone:
CONTRACTOR Name: ,AqWr1-'s.•,n,a Phone: 9/ G - 7'
Address: /Z f f ,�r/o, ilN o✓ of Y
3
Supervisor's Construction License:
"7; Y,f
Exp.
Date: 3/2 -?z v
Home Improvement Licenser' 4/,3/
D
Exp.
Date: 61W ,-aaf0
, 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: $_ 0,90 FEE: $-<'2, Ce � ---
Check No.: S Receipt No.: (Dc)'k
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
X _ignature
Location SS A -z a
No. -)2-3 Date a
TOWN OF NORTH ANDOVER
r
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check # 7 SS -3
22,► 45
Building Inspector
Plans Submitted Plans Waived Certified Plot Plan Stamped Plans
TYPE OF SEW GE 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
i
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT i
COMMENTS
CONSERVATION Reviewed on Signature
COIJIMENTS
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 Drivewav Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street
FIRE DEPARTMENT - Temp Dumpstterroo(i site yes c- 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
Doe.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
❑ Building Permit Application
Li 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
a Certified Proposed Plot Plan
❑ Photo of H.I.C. And C.S.L. Licenses
❑ Workers Comp Affidavit
Li 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
C
N
0
z
rA
W
r�
S`.
ID
m C
.
O
F
U
C Crt
pC
O
U
U
a
c C N
O
Z
w
Ca
C
w O
d
=
o
w°
V
U)
V
m
C
w°
a°'
U
_
cd
w
a
a
w
w
r�
W
'
pp
R a
a°'
u
cn
u:
a°'
w
G
w�
V)
v
C/)—
n
ui
CL
I
co
O
co
oc
z
O
D
C4
co
L
CL
CD
c
0
CD
Q
ey
CL
h
O
.y
C
O
V
O
0
ts
CD
CL
W
C
O CM
C 0.-
D 'D
CD
m m
3�
as
016-
Q
L- Ac
r..i
cnQ
c�
co
�p.0 C
J
O
Z tj
C.
CO)
C
ro"I
LLI
N
LLI
U)
W
W
W
N
m C
.
C Crt
c C N
O
C
w O
V
V CL
M�
WOO -= o
4D
..
di C2 a
E
:om
.r
CD
v$
E
vDID
v
It
a.
O
V
�y
m
C,
C.1
p
`CJ
�
_
m
>
>
jo
_
y O
y
C
O
a
y m ;
�
swo
cm
��
ircoQ
•�
V: acs
m O
m
:_.��Z
`o
E .
as
Q
� CLO
o
i m C
C
p
x
m-3
a 0
H
~
O
D
W
••'
•+ C t
�
� m •y
z
O
w
E
C3 CD o
9
g
CH
x
O'
W
• O fl
.0 0 H .'
0am
I
co
O
co
oc
z
O
D
C4
co
L
CL
CD
c
0
CD
Q
ey
CL
h
O
.y
C
O
V
O
0
ts
CD
CL
W
C
O CM
C 0.-
D 'D
CD
m m
3�
as
016-
Q
L- Ac
r..i
cnQ
c�
co
�p.0 C
J
O
Z tj
C.
CO)
C
ro"I
LLI
N
LLI
U)
W
W
W
N
PROPOSAL
Desmond Construction, Inc,
P. 0. Box 41
North Andover, MA. 01845
(978) 882-2279
Date: 5/31/09 Page 1 of 2
TO: Job Site:
Kathy Stevens same
83 Academy Road
North Andover, MA 01845
978-683-5522
�-t
;:.
DESCRIPTION TOTAL
SIDING INSIALLATION
Remove all e)dsting clap board, comer board and window trim. All debris to be removed from site in
construction dum ster. Siding on front of barn to remain.
Install Tyvek house wrap over e)dsbng sheathing. Window trim and comer board to be primed board.
Install primed, finger jointed cedar clap board, 4 - 41/2" reveal, using stainless steel.
MQM
No window sill replacement.
11 painting by others.
Any areas found to be rotted and in need of repair to be additional cost. Time and Material.
Door trim to be additional.
All electrical work by Homeownees electrician.
$22,000.00
r -
PROPOSAL
Desmond Construction, Inc,
Date: 5131/09 Page 2 of 2
TO: Job Site:
Kathy Stevens same
83 Academy Road
North Andover, MA 01845
978-683-5522
All material is guaranteed to be as specified, and the above work to be performed in accordance with the drawings and
specifications submitted for above work and completed in a substantial workmanlike manner for the sum of
$22,000.00 with payments to be made as follows:
25% upon signing
25% upon start of project
Remaining upon request per project progress
$5,500.00
$5,500.00
$11,000.00
An interest charge of 1.5 % per month will be applied to any balance due 30 days after completion of this project.
Any alteration or deviation from above specifications involving extra costs will be executed only upon written orders,
and will become an extra charge over an above the estimate. All agreements contingent upon strikes, accidents
or delays beyond our control. Owner to carry fire, tornado and other necessary insurance upon above work.
Workmen's Compensation and Public Liability Insurance on the above work to be taken out by DCI.
Respectfully submitted
Per Desmond Construction, Inc.
NOTE: This proposal may be withdrawn by us if not
accepted with days.
ACCEPTANCE OF PROPOSAL
The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do
the work as sped iod. Payment will me made as outlined above.
Signature: <-2- Date:
Signature: Date:
06/20/2009 10:18 9786850000 CARLSONRE PAGE 01/01
.tun It U�) U1:ubp 5tevens 970-683-5522 p,2
TO: Mr. Matt Desmond, Contractor
Kathy' Stevens, Home owner
-+AX: 978-682-2279
%E: Proposed Repairs to Ban at 83 Academy RCL
The proposed repairs to the barn are xeplacem ent of the wood clapboards with Dew preprirned wood
clapboards, repair of the window trim and any structural, repairs that might be needed. Tlresc repairs are
reg nQar rnauttenance. Therefore, they do not require review by the Historic District COMB-liss olL
George S chruender, Chair Pjune2009
Historic District CoixiyIdssion
North ,Andover
ACORO� CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YY
5/29/20099
PRODUCER (978) 372-2790 FAX: (978) 373-2281
William C. Sullivan Insurance Agency, Inc
487 Groveland Street
Haverhill MA 01830
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE
NAIC #
INSURED
Desmond Construction, Inc.
19 Upland Street
North dover MA 01845
INSURER A: Commerce Insurance
34754
INSURER B: AIM Mutual Insurance Company
33758
Y
INSURER C:
_
INSURER D:
INSURER E:
r49a1VA y:7•Tei Xy
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 BEEN REDUCED BY PAID CLAIMS.
INSR
LTR
DD'
INSRD.
TYPE OF INSURANCE
POLICYNUMBER
POLICY EFFECTIVE
POLICY EXPIRATION
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$ 500,000_
—
A
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE r-1 OCCUR
ZS1282
7/7/2006
7/7/2009
DAMAGE TO RENTED
PREMISES (Ea occurrence)
$ 50,000
MED EXP (Any one person)
$ 51000
PERSONAL 8 ADV INJURY
$ 500,000
GENERAL AGGREGATE
$ 500,_900
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
$ 500,000
X1 POLICY PRO LOC
AUTOMOBILE
LIABILITY
ANY AUTO
COMBINED SINGLE LIMIT
(Ea accident)
$ 100,000
A
X
ALL OWNED AUTOS
SCHEDULED AUTOS
T90224
9/12/2008
9/12/2009
BODILY INJURY
(Per person)
$ 300,000
BODILY INJURY
Per accident
( )
$ 100,000
HIRED AUTOS
NON -OWNED AUTOS
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
$
ANY AUTO
—
$
AUTO ONLY: AGG
EXCESS/UMBRELLA LIABILITY
EACH OCCURRENCE
$
AGGREGATE
$
OCCUR u CLAIMS MADE
$
DEDUCTIBLE
$
RETENTION $
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOR/PARTNER/EXECUTIVE ❑E.L.
OFFICER/MEMBER EXCLUDED?
WC STATU- OTH-
TORY_LI_MLTS ER_-,
$ 100 ,000
---� --
EACH ACCIDENT
El DISEASE - EA EMPLOYE
$ 100, 000
(Mandatory In NH)
If yes, describe under
WC7019598
8/23/2008
8/23/2009
E.L. DISEASE - POLICY LIMIT
$ 500,000
SPECIAL PROVISIONS below
OTHER
DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES/ EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS
Construction Operations
TOWN OF NORTH ANDOVER
MAIN STREET
NORTH ANDOVER, MA 01845
SHOULD ANY OFTHEABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 20 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
AUTHORIZED REPRESENTATIVE
Diane Fraioli/DNF zg_i� --;�r.
wvnv w (wwarvr1 U 7950-2W9 ACORD CORPORATION. All rights reserved.
IN3025(200901) The ACORD name and logo are registered marks ofACORD
The Commonwealth of Massachusetts
Department of Industrial Accidents
0fffce of Invesdg ations
600 Mashington Street
Boston, Mr4 02111
Www massgov/dia .
Workers' Compensation Insurance Afffidavir
3-pIicant Information Builders/Contractors/Eiectriciaas/Piambers
- --� a • IEEILc"aUj
Name (Business/Orgwization/Individual);S Vy 0,,J C0sf/% JC- o� -�-
Address:_l 1. a <
City/5tate/Zip:610 A k" A Q/Uy-
Phone
Ayou an employer? Check the appropriate box:
I. [ I rim a employer with i
4, ❑ I am a general contractor and I
employees (foil and/or part-time).*
2• C31 am.a.soie Proprietor or
have hired the sub -contractors
listed
partner-
ship and have no employees
on the attached sheet. _
These stab -contractors have
working for me in any capacity.
[No workers' comp, firm ance
workers' comp. insurance.
5. [3 We are a corporation and its
required.]
3. ❑ I am a homeowner doing
officers have exercised their
all work
right of exemption per MGL
myse3C [No -workers' comp.
.c. 152, § 1(4), and we have no
insurance required.].t
employees. [No workers'
comp insurance fired
Type of project (require:
6. ❑ New construction .
7. ❑ Remodeling
8. Q Demoiition
9. Q Building addition
10.0 Electrical repairs or additions
11.Q Plumbing repairs or additions
12.[] Roof repairs
13.g Other-S%a„✓c. I
*Any aPPli-nt that checks box *I muse 11190 fru out the section below showing their workets' compensation piroy mn.form11tio
t 140meowncin who submit this affidavit indicating they am diciing an woric and then him outside contractors must submit a new affidavit indicating such
4Caatractors that check this box mLWAMw1ked an edditioasl shmrshowi
rrg the name of the suG-contrwmm and their workers'
Ion, an epi ADYer teaf is Pro ' - r r Pc.. � srfnrm9ison.
viautg workers compensation insurance for RV enployees: Below is &e PO
&y P hc3' and yob site .
Insurance Company Name: i ty ✓ v� G c .
Policy # or Self -ins. Lie. #:_ . A ul C i 01 q S 4
Expiration Bate:_ fr d” -I % n q
Job Site Address:
City/State/Lip:.ya. ur/�.. rN�3 0/. yr
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 penahies of a
fine up to $1,500.00 and/or one-year imprisonment; as well es 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 th and pe"aW= o.1 fPerlf'ry Mar the information Provided above is true and conte
Simture:
O}j`icurl use only. Do not write in tins area, to be completed by ply or town. nfciae
City or Town: Permit/License #
Issuing Authority (circle one):
I. Board of Healtb 2. Building Department 3. City/Town Clerk 4- Electrical Inspector 5. Plumbing Ins
6. Other g pector
Contact Person•
Phone #
Information a nd Instructions `^
Massachusetts General Laws chapter 152 requires all emp 3 oyers 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." r'
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 includirig the legal rcpresentativcs of a deceased employer, br the
receiver or trust= of an individual, partnership, associatioz7 or other legal entity, employing employees. 'lioweverthe
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 w6r3 an such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employmtent be deemed to be an employer."
-
MGL chapter 152, §25C(6) also states that. "every state ow- local Ficensing agency shall withhold the issuance or
renew al.ofa license or permit to operate a busfmas or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence.of compliance with the insurance Icoverage required"
Additionally, MOL chapter 152, §25C(7) states "Neither the commonwealth nor any of its polifical subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of wmpliance with the insurmcx
requirements of this chapter have been presented to the coaltracting authority."
Applicants
Please fill out the workers' compensation. affidavit compimtely, by checking the boxes that apply to your situation and, if
necessary, supply sub-contractor(s) name(s), addresses) and phone number(s) along with their certificate(s) of
insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the
members orpa tn=, 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 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'
oompensation policy, please call the Department at the number listed below, Self-insured companies should enter their
self-insurance iieense mintier on the'appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Departmerrt 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 vvilI 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
policyinfonnation (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
appiicant as proof that a valid affidavit is on file for f itum permits or licenses. A new affidavit must be filled out each
year. When 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 tb complete this affidavit
The Office of Investigations would lace to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Depmtment's address; teiephone and fax number.
The Commonwca lth of Massachusem
Department of 13ndustrial Accidents
Office of Investlaigstions
600 Washington Street
Boston, MA 42111
TeL # 617-7274900 ext 406 or I-8.77-MASSAFE
Fax # 617-727-7744
Revised 5-26-05 www.mass.gov/dia