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Home My WebLink AboutBuilding Permit #829-12 - 88 HAY MEADOW ROAD 5/18/2012Permit NO:�y BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received J-11? ,b �SSACN Date Issued: I IMPORTANT: Applicant must complete all items on this page LZ r 7, � . --- Print P MAKv/ ZONING44MICT - .1J , is onciDistrict, • yesk -ri L.,..MachmelShop`,Villagel._.Yes' TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building OnP�:- y^ J-11? ,b �SSACN Date Issued: I IMPORTANT: Applicant must complete all items on this page LZ r 7, � . --- Print P MAKv/ ZONING44MICT - .1J , is onciDistrict, • yesk -ri L.,..MachmelShop`,Villagel._.Yes' TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building OnP�:- Addition Two or more family Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other 7Septic) We - Floodplami ; Wetlands a WatersfledjDistnct+5" , r DESCRIPTION OF WORK TO BE PREFORMED: r - Identification Please Type or Print Clearly) OWNER: Name: Address: - CONTRACTOR;'+Name �U/Li. �/ -�/�U / •--- ---- ��__-_ 3-T� �/�i� s ._'___..Exp; �D'ate SupervisoresjConstructionJ�'icense �J_ _ HomerinproyementLicerise -s �ExpE Date y1 U�_? 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: $,,-1 [ l FEE: $ 616 `aD /7 Check No.: C=J Receipt No.: �3 NOTE: Persons contracting with unregistered contractors do not have access 7the aranty fund Signattare;of Agent/Ovvner: �� 2. rSi,gnatureof:contractF Ta r n 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 PLANNING & DEVELOPMENT COMMENTS CONSERVATION COMMENTS HEALTH COMMENTS DATE REJECTED DATE APPROVED Reviewed on Signature Reviewed on Signature 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.DE-PARTMENT Temp pumpster on=site yes no Located •at• 124`Main,Street l 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 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 No 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: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 Location ?,,F- /r `� � /,-;, � 4,r, , le,J No. Date �/�1' TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ "Y Check # 25317 Building Inspector OP ID: L DATE (MMJDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 1 (15118112 ONLY AND CONFIERS NO THIS CERTIFICATE IS ISSUED AS A ER OF INFORM OR NO AFFIRMATIVELY YN GATIVELYION RIGHTS AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES CERTIFICATE DOES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORI ZED REPRESENTATIVE OR PRODUCER, AIVD THE CERTIFICATE HOLDER. IMPORTANT: if n e certificate is the policy, certain poliCOiesAmay regRuEreran endolrsement A statem n cy(igs) must be on this certificate does not confer rights to the the terms and ca certificate holder in lieu of such endomament 3). CON CT PRODUCER 3e05 reve & Hall Insur.AsSoc.Inc ;North Main St. 4ndover, MA 01810 Lawrence J. Hall INSURED Thomas Quinn dba Quinn's Construction 868 Mammoth Road Dracut, MA 01826 978-975-1300 978-979-7 A:Distal Group e:Hartford Ins C_ OVERAGES CERTIFICATE NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY FS OF I REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS DED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFOR EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, LtfA[rS T rc TYPE OF INSURANCE - eENERAL UABILfTY M021000227 01115112 01115!13 A X COMMERCIAL GENF,RAL LIABIL TY CLAIMS•MADE a OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PROLOC AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS 9CWEOULED AUTOS HIRED AUTOS NON -OWNED AUTOS UMBRELLA LIA9 OCCUR EXCESS LIA9 CLAIMS -MADE DEDUCTIBLE EACH 1 $ 1 PREMI S e occurrence MED EXP Any ono erso�) i PERSONAL a ADV INJURY S 1,C GENERAL AGGREGATE $ 2+( PROOUOTS . COMPIOP AGG $ _ 2,1 COMBINED SINGLE LIMIT $ (Es accident) BODILY INJURY (Per parson) $ BODILY INJURY (Per acclderd) f PROPERTY DAMAGE S (Per accidenl) a [WORKER9 COMPENSATION AND EMPLOYERS' LIABILITY 116PTO4 01!15!12 01115!13 E.L. EACH ACCIDENT $ B ANY PROPRIETORMARTNERIEXPCUTIVE NIA E.L. DISEASE • EA EMPLOYEE $ LJ 1 OFFICERIMEMBER EXCLUOED? L (Mande<ory in NM) E.L. DISEASE - POLICY LIMIT S 5 If as. deaorlse under D CRIPT NOF OPERATIONS below DESCRIPTION OF OPERATlON9 I LOCATIONS / V EMICLES (Attach ACORD 101, Addlflonal Remarks Sehedulo, if more space Is required) r-coTlFlr_aTF HOLDER _ CANCELLATION Town of North Andover 1900 Osgood Street North Andover, MA 01 BrIS ACORD 25 (2009109) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ®1988-2009 ACORD The ACORD name and logo are registered marks of ACORD . All rights reserved. T41 W; ® 6A o w cn aRi U) U 2 C7 C p w O w ^C U _m C w W C7cn W •� O w C w W W Wca p w �j y cn C w O cn C7 O w' czr C w in W (�z, C as z cn Q cn O �O Cn f r.� 2 O co cm CDG G_ V2 'C CO CO2 03 CID m CD CD CD 3� CD O co cc o a CL o�Q CO) G.0 o cc .� OCO2 ♦�,, C Z CD CL C.2 CO) cc G � G _cc �. 0 ui LLI Y♦ W W 19 LUW N o m c c o o ` . '®• 00 y C C : R W Z iA G �: m •— ca o a c co .r �mm a y cf ;c m '�. L� y =0 con �mo c, CL m \: ' y m T z �+-CD c ca Z CS A \\ C O V IM ` n--. c �O 07 c Q W" O C.2 - CD C •p = m -0 N H y0„ y Ws H O W O '00_"' t •dyJ y.., c OC O 1K •E . dt • yyO ®oma c=3v c' = o s N m � ��H•� O a=mom O �O Cn f r.� 2 O co cm CDG G_ V2 'C CO CO2 03 CID m CD CD CD 3� CD O co cc o a CL o�Q CO) G.0 o cc .� OCO2 ♦�,, C Z CD CL C.2 CO) cc G � G _cc �. 0 ui LLI Y♦ W W 19 LUW N QUINN'S CONSTRUCTION THOMAS QUINN 868 MAMMOTH RD. DRACUT, MA 01826 SCA 1 G 20M-05/11 nC��e Garnarrotrrcfcrclf� r.-/.Gf�r�.irrc�r%;e Office of Consumer Affairs & Busihess Regulation Q �-- —KOME IMPROVEMENT CONTRACTOR � ' e istration: a�5.__, ,,tti 9� 121604 Type: expiration: ,::5/24!2014._ DBA QUINN'S CONSTRUCTION THOMAS QUINN 868 MAMMOTH RD. g �o DRACUT, MA 01826 Undersecretary - = Massachusetts - Department of Public Jafet% Board of Building Regulations and Standards f Construction Supervisor License License: CS 39732 Restricted to: 00 THOMAS J .QUINN f 868 MAMMOTH RD = DRACUT, MA 01826 Expiration: 3/25/2012 ('Iuumissioner Tr-`: 18330 1 XV.410tl ativi 1. I e - I uu`! Type: DBA Expiration: 5/24/2014 Tr# 223332 Update Address and return card. Mark reason for change. E] Address F-1 Renewal ❑ Employment E] Lost Card License or registration valid for individul use only before the expiration date. H found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, MA 02116 Not valid without signature Restricted to: 00 00- Unrestricted 1G -1 2 Fainily Homes Failure to possess a current edition of the Massachusetts State Building Code is cause for -revocation of this license. Referto: WWW.Mass.Gov/DPS Qom- QP ID! JP �...- CERTIFICATE OF LIABILITY INSURANCE DAT03/1asrl DDfYYSryn zr1 2 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE; AFFORDED BY THE POLICIES BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERS}, AUTHORIZED REPRESENTATIVE OR PRODUCEN, AND THE CERTIFICATE HOLDER, IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the POHcYfies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terns and conditions of the Policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsemery s . PRODUCER 978-975-1300 ¢NTACT Segrave & Hall Insur.Assoc.lnC NAME: 3or� North Main St. 978-975 7396 "ONE FAX Andover, MA 01810 410 Na }'- - - IL " Edward Ramirez ACDRESS- CUSTOFAFR in �u•THOMA-3 INSURED Thomas Quirm INSURER A:Distel Group dba Quinn's Construction INSURER p: Hartford Ins Co. 868 Mammoth Road Dracut MA 01826 INSURER 0: INSURER D: INSURER E: NSLIRER F: COVERAGES CIERTIFICATE NUMBHR-, THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSUF INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBE EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BBEN REDUCIED BY PAID CLAIM; INS TYPE OF INSURANCE FOUGY NUMBER MIOD MMlDD GENE=RAL LIABILITY .A X I COMMERCIAL. GENERAI, LIABILITY M021000227 01115112 01115113 GL.41MS MADE � OCCUR GF-N'LAGGREGATE LIMIT APPLIES PER: n POLICYn PRO n LDC AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-Q� NED AUTOS UMBRELLA LIARHCLAIMS-MAD=- OCCUR EXCESS LIAR DF.:PUCTISLE WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERICXEOUTIVC Y!N 411SP704 01/15112 01/15/13 OFFICERMIPMBER EXCLUDCO. CI 0,4 (Mantlatory In NH) Ifyos, describe under DESCRIPTION OF DPERATONS I LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Romgr$M Sch°dul°, If,nore ep&cc Is mquIred) Sole Proprietor Thomas quinn is Excluded underWorkers Comp CERTIFICATE= HOLDER LOWELLC REVISION NUMBER: :ED NAMED ABOVE FOR THE POLICY PERIOD DOCUMENT WITH RESPECT TO WHICH THIS .D HEREIN IS SUBJECT TO ALL THE TERMS, 7, LIMITS EncW OCCURRENCE $ 1,000,00 IQ RENTED PREMI -£�(Eaoceu"nce), 5 100,00 S 5,00 MED EXP (Any one person) PERSONAL R ADV INJURY S 1,000,00 GENERAL AGGREGATE S 2,000,00 PRODUCTS -COMPIOPAGG $ 2,000,00 $ COMBINED SINGLE LIMIT S (Ee acclftd) BODILY INJURY (Per pown) S BODILY INJURY (Per exidemt) S PROPERTY DAMAGE S (Per accid°nt) T S EACH OCCURRENGF- S AGGREGATE ; 3 S X WC STATU- OTW tNi S 100,00 E.L. EACH ACCIDENT E.I I. DISEASE - EA EMPLOYEE $ 100,40 F& DISEASE -POLICY LIMIT I $ 500,00 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHOOR[RJIZ4,EL,DD REPRESENTATIVE Ccs 1988-2009 ACORD CORPORATION. All rights reserved. kOORD 25 (2009(09) The ACORD name and logo are registered marks of ACORD Tom Quinn (Contract (978) 265.2390 QUINN'S CONSTRUCTION 868 Mammoth Road - Dracut, Massachusetts 01826 Employer ID # Name Date Street Address (Not Post Office Box) I"I Job Name Cityfrown, State & Zipcode �-3�D6L-56Z 14-711 lJob Location Daytime P ne, Evening Phone: 4") � �, _ Eve 0/ Job Phone g Mailing address (if different from above) Salesperson(s): 2djZ-7 4;��/ Contractor Registration #: U Exp. Date: AAJ/ 0 We hereby submit specifications and estimates for: -9 6z S _S /45 3 f:>,_2 Z -OoLve 6;4-e-)�2=4_5 C;4Q� The following scheduled willbe adhered to unless circumstances beyond the contractor's control arise: Work scheduled to begin: Expected Date of Completion, (Date Contractor Will Be Contracted Work) (Date When Contracted Work Will Be Sustantially Completed) TOTAL CONTRACT PRICE AND PAYMENT SCHEDULE THE CONTRACTOR AGREES TO PERFORM THE WORK, FURNISH THE MATERIAL AND LABOR SPECIFIED ABOVE � FOR THE SUM OF: $ 411h-c'ludes all finance charges in this amount* Pa nts ill be made accordin to the following SCHEDULE: $ Mf upon signing contract (*Not to exceed 113 of the total contract price OR the cost of special order items, whichever is grea)tr*) * By or upon completion of $ O,0 00 By or upon completion of ------------------------- <: -, 7, (900 upon completion of the contract (*Law forbids demanding full payment until contract is completed to both parties' satisfaction in order to meet the completion schedule, the following material/equipment must be special ordered before the contracted work begins. (*Law requires that any deposit or down payment required by the contractor before work begins may not exceed the greater of (a) one-third of the total contractor price or (b) the actual cost of any special equipment or custom made material which must be ordered in advance to meet the completion schedule'): $ to be paid for DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES Identical copies .ofthe sh uld go to the homeowner and th�t tor Home Owners Signature: J Date: Contractors Signaturez� Date: You may cancel this agreement if it has been signed by a party thereto at a place other than an address of the seller, which may be his main office or branch thereof, provided you notify the seller in writing at his main office or branch by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the third business day following the signing of the agreement. 01 4