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HomeMy WebLinkAboutBuilding Permit #700-11 - 890 DALE STREET 4/19/2011TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO --- v l I Date Received I-- -------T ` - * MIPORTANT: Applicant must complete all items on this -Daae --I LOCATION 8 ql O �5r Print PROPERTY OWNER 1#041 ;36Y N it-A4a,-c A4c--co-4w Print MAP NO: /d PARCEL:440q2- ZONING DISTRICT: Historic District yes no 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 cKRepair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other _ 1.y, _ s 1,,Watershed�Disr"ctOSPtc®Welldan t..=_�RWaier/Sewer<. -- -- • �— ---s - oj ��.�� �:_._._. ---------._....--"'--- ��.*�� ��_-�°'� ,F e �. � �,i�,��'� g �- '���, DESCRIPTION OF WORK TO BE PERFORMED: '540))A(6, y C IV6!W 'a"LIXII Identification Please Type or Print Clearly) OWNER: Name: St3 g aw'' Rle-lb�c f Iw-'Ir� Phone: 92 Fad -531, Address: 55�67 4, �T CONTRACTOR Name: t 1 M lCrl�t 51-10 Phone: .52f 7 7/ dFv may' Address: A D04 0" /4JO-0 azr-;V— y 1f,10 Supervisor's Construction License: 4)Z/77-3 Home Improvement License: 1134-63 Exp. Date: /l//lam iz I Exp. Date: -711 f 14o i/ ARCHITECT/ENGINEER Phon Address:. No. FEE SCHEDULE: BULDING PERMIT: $92.00 PER $9000,00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ 1 ? . FEE: $_ l sof r Receipt No.: Check No.: 35 P NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fulid Location eP a No. 0 0 Date r ,.ORTq TOWN OF NORTH ANDOVER O'�t.•e •,•�O � R 9 Certificate of Occupancy $ ° s,K�sE Buildin /Frame Permit Fee 9 $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 24U`i 2 Building Inspector Plans Submitted ❑ - Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ W elf ❑ Private (septic tank, etc. ❑ Tanning/MassageBody.Art ❑ Swimming Pools I ` ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ 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 HEALTH - _ Reviewed on Signature" COMMENTS i Zoning board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: - Comments Conservation Decision: Comm Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: FIRE DEPARTMENT - Temp Dhmpster on site yes Located at 124 Main Street Fire Department signature/date COMMENTS Located 384 Osgood Street . . no 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.$10041000 fine X2.7 Doc:.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 ❑ 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 OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals A the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. one copy and proof of recording ist be submitted with the building application Doe: Doe.Building Permit Revised 2008mi aTHE �-_MAIN .rREET AMERICA GROUP Policy Number: MPJ0418M BUSINESSOWNERS COMMON DECLARATIONS MAIN STREET AMERICA ASSURANCE COMPANY 4601 TOUCHTON ROAD EAST, SUITE 3400, JACKSONVILLE, FL 32245-6000 Item 1. Named Insured and Mailing Address Agent Name and Address ANDOVER RENOVATIONS BYETTE INS AGENCY INC 2 DUNDAS AVE ANDOVER MA 01810-6038 853 MAIN STREET TEWKSBURY, MA 01876 Agent Phone No. (978)851-6678 Agent No. 200113 Item 2. Policy Period From: 03-06-2011 To: 03-06-2012 at 12:01 A.M., Standard Time at your mailing address shown above. Item3. Form of Business: INDIVIDUAL Item 4. In return for the payment of the premium, and subject to all the terms of this policy, we agree with you to nrnvirie the insurance as stated in this policy. This policy consists of the following coverage parts for which a premium is indicated. Where no premium is snown, there is no coverage. This premium may be subject to adjustment. COVERAGE Section I — Property Section II —Liability Inland Marine Total Policy Premium: For Coverages subject to premium audit: Annual Audit Applies Item 5. Form(s) and Endorsement(s) made a part of this policy at time of issue: See Schedule of Forms and Endorsements Countersigned: Date: 1 PREMIUM $ 122.00 $ 1,495.00 $ 75.00 $ 1,692.00 77'ZLC Authorize Representative THIS BUSINESSOWNERS COMMON DECLARATIONS AND SUPPLEMENTAL DECLARATION(S), TOGETHER WITH SECTION III —COMMON POLICY CONDITIONS, COVERAGE PARTS, COVERAGE FORMS AND ENDORSEMENTS, IF ANY, COMPLETE THE ABOVE NUMBERED POLICY. BPM D 1 1207 INSURED COPY I Cofoo y O v _ Q H H C � accl Cr1 M 'n O v+oac O n CO2 � Cl) O C',O y CD a Z o O. .dm ? ml rcL 06 O �. r m c m a� CO) > C aCO -0M -0 m .79 = `° M O v CDO o .0 ,,X Yr CLw Q o m cp co). o CD CD .7. may: m �CD y CD y O �O CD O = .._ =r � y v O CD O N 10 CD Z CE O � C CD ... O O � d a CCD I Cofoo y O m _ Q I. Q d O & m H CO �, accl Cr1 M 'n O v+oac �. n 7y 0 aha x gr -p a- C',O y c ro• o O. .dm ? ml rcL cm T O m y y O Ohm: 0 _ N > C m CD .79 = co o .0 o ZE.C') •i Cl h ;�. 0 O : W .7. may: m � �r C= O = .._ =r CD O N :C CE d m �. C CCD H O � d a H C C. d =Cr �T O .}— a' COD .rt m m H N H c ; m O ' m w ' J2 » : s o C : 0 Er CAo: CD ,..� . Wim: pCD ;w CO) CD v = =r oC a m n'o C.7 c o moo: � co o cn E3 cn 40 T -x ro a- z �, P 0 x Cr1 M 'n 9d 0 arc x r� r z RL n 7y 0 aha x o � a 0 G7 rzr c ro• o O. O �mv y 0 9 0 c Coµ 5 T Rv CT- to ,%J Scc pG-R\'1S oA +� E r►P1�VEu► E=aET C C ATTRACT o K LlCrsE 04423 �Lc--►�srfr�lnz'N 1/3''63 ..� We Michael Scott ? DUNDAS AVENUE ANDOVER, MA 01810 Andover Renovations Page of Z 470-2640 Additions - Carpentry - Remodeling PROPOSAL SUBMITTED TO s I I� �J«,�,�tl PHONE `7e- &E__ DATE STREETJOB NAME Al n CITY. STATE AND ZIP COD s J�4)L'Ve-9 1? l C�t�V'i JOB LOCATION ARCHITECTl� /Y d DATE OF PLANS AAM �J/i�L>>Occ/ At '7i.>.9 a= C4;5iit1 JOB PHONf lpq we nffeby propose to lumten materials arc labor neceeaary for the completion of. O d Ho t% _ C&7,rf-rl Tt29[7 5 /iiN,( toi t2 ,,r lj,,y CA1-,;,v eke , bow " fw 11Lt i�✓i GL ; y fL 57-V,4 6 %, ted t? i?� ,� ' �`'' pig �% (7r5 �� 55 Gt�� ! S /NG �c7)Cl>7 l tytLa/I/t' (1-111A J3d' Vih! �ci~r��T ?/tV9z tLzy 7i7.>,'-'' �? f3✓ �u �� Ct' WE PROPOSE hereby to furnish material and labor — complete in accordance with above Specifications, for the sum of: dollars q l Payment to De mace as follows: All material Is guaranteed to De as specified. All work to be completed In a sub- stantial workmanlike manner according to specifications submitted, Per standard Authorized 7 Practices. Any alteration or deviation from above specifications involving extra Signature V ! l j costs will be executed only upon written orders, and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or Note: This proposal nusy be _ Coleys Doyono our control. Owner to carry fire, tornaoo and other necessary in. with drawn by Ys I not accepted within '' 1 —days. surance. Our workers are fully Covered by Workmen's Compensatldn Insurance. ACCEPTANCE OF PROPOSAL The above Prices, specifications and conal - tions are satisfactory and are nereDy accepted. You are authorizad to de the work as specified. Payment will be mace as outline &Dove. Si�flatYf e Date of Acceounce: Signature �Ei+l tt fJr 'psi'/n/C C1 t WAS/ G 1� SntilF 'T7ZL/L% �J/i�L>>Occ/ At '7i.>.9 a= C4;5iit1 u.; i Ll '12 g4yo vzgz_9 JG VAV;45 6�0 W6510 i6L IWWI/ < /5 T -V nlmss 'Tyy�iL f% 7*6 flanr� <11211t14 ©ice ;�'-��1 r/Al! l y,:Zyz-� n )& 0 Go F -S' ca%/ ic✓ / / L'D /C �T77 C 14 ALVA41" 14�` 7 az_�-e, _ GJi�G-IC WirLf9i� �(JIJttOG7L4' �fl�{S � S�LL S 6V�G�J%L -SY'71C � /'i �D//"'� �1`'!!J _ C&7,rf-rl Tt29[7 5 /iiN,( toi t2 ,,r lj,,y CA1-,;,v eke , bow " fw 11Lt i�✓i GL ; y fL 57-V,4 6 %, ted t? i?� ,� ' �`'' pig �% (7r5 �� 55 Gt�� ! S /NG �c7)Cl>7 l tytLa/I/t' (1-111A J3d' Vih! �ci~r��T ?/tV9z tLzy 7i7.>,'-'' �? f3✓ �u �� Ct' WE PROPOSE hereby to furnish material and labor — complete in accordance with above Specifications, for the sum of: dollars q l Payment to De mace as follows: All material Is guaranteed to De as specified. All work to be completed In a sub- stantial workmanlike manner according to specifications submitted, Per standard Authorized 7 Practices. Any alteration or deviation from above specifications involving extra Signature V ! l j costs will be executed only upon written orders, and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or Note: This proposal nusy be _ Coleys Doyono our control. Owner to carry fire, tornaoo and other necessary in. with drawn by Ys I not accepted within '' 1 —days. surance. Our workers are fully Covered by Workmen's Compensatldn Insurance. ACCEPTANCE OF PROPOSAL The above Prices, specifications and conal - tions are satisfactory and are nereDy accepted. You are authorizad to de the work as specified. Payment will be mace as outline &Dove. Si�flatYf e Date of Acceounce: Signature oN5TRUC-T(©,0 5-UPC-9\JISO(2" Ls F 14- 0 44'123 2 DUNDAS AVENUE ANDOVER, MA 01810 470-2640 H* -o pNtr --j tit PRaVEM Epi 7- C ON77RACT Q K We Michel Scott Andover Renovations Additions e Carpentry • Remodeling 1/3e'63 Page Z of 7 - PROPOSAL SUBMITTED TO Ni I Ic&- PHONE `)') L f11 �- 3 '� 3 6 DATE STREET108 0 f 0 0,W S - NAME CITY. STATE ANO I!P COOE JOB LOCATION ARCHITECT DATE OF PLANS — _ JOB PHONE we nwimw oroposa to lumen malenam arta taoor neceuary tot the completion 01. �1 riT ��Th�2'�- s 7f/ I fit? i%y� i;✓ / G c is �5' T7/a9 /s�.-j?1%� %�i-✓O � C�L% 1N i 7?� /�-S /�� L�X?�lr� �u l� ►lc/�i�2 w�tc ���/�f�J/►.i l l)7-7) B v i K-16 913`"tr u vu t3� t?�l Gor. r> �t tk Z i✓ �'�i - - i I. r•,,..s. , C., .� ®��.� • r%rro>4iiZ _ Gz,' t t �i su�55 u,26 SryG� LfSC� f K- C�ar'��sr1Z� 5:77ey—L. TT <t 0q&V4111/4-5 , s4! — _ Olt C Ll 1/161-06' t ml 72r -,D/S,�2t 5Al, ti-�/� T /C C� � ' 11 14- - c�t.2t (P>47/i7—I/✓4" //' iVcztFo�C�� iS ivCi l/t�Gvv17C�9� /�I/>Zi'�>V/ �t -7 i / �/ (, t��'� /LAG-L�'C.' e✓2t /'`�L� %S -/�A�' 7� l/t�L' l�C�JL� R- 3 3 ov WE PROPOSE hereby to furnish material and labor — complete in accorCsnes with aaove specifications, for the sum of: 'T F .` collars dollars tS , Payment to oil made as ruuu— -. //3 7r B� �•li } 3rc� –� 3>��v� A-� Flys/ All material Is guaranteed to De as specified. All work 10 be completed In a Wp- stantlal workmanlike manner according to speelflcatlons,submlttad, per standard praetices. Any alteration or deviation frOrlI'ADOve SPOClflcatlons involving extra costs wlll be executed only upon written orders, ano will become an extra charge over and above the estimate. All agreements contingent uponstrike%. accidents or delays beyond our control. Owner to carry fire, tornado and other necessary in- surance. Our workers are fully covered by Workmen's Compensatldn Insurance. ACCEPTANCE OF PROPOSAL The above prices, soacitications and condl- tlons are satisfactory and are nerany accepted. You are authorized to 00 the work as soecined. Payment will tse made as outline above. Authorized Signature Note: rhes proposal may be / _ flays. e tndreten by as it not Accepted Within Date of Acceounce: $t�naterr q.Issxchusetts - Department of Public Safet% Board of Builditu Reaulations and Standards Construction Supervisor License License: CS 44723 Restricted to: 00 W MICHAEL SCOTT 2 DUNDAS AVE_ ANDOVER, MA 01810 IF— -.I— Expiration: 1/11/2012 ('f num issione1, Tr#: 14570 t �� �v»vrntdruue�� c0 �l'%aa�acfivaelt Office of Consumer Affairs & ifusiness Regulation HOME IMPROVEMENT CONTRACTOR Registration: 113863 Expiration: 7/19/2011 Tr# 286934 Type: Individual W MICHAEL SCOTT W MICHAEL SCOTT 2 DUNDAS AVE ANDOVER, MA 01810 Undersecretary { www.mass.gov/dia . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): C -%GAEL C 4 tl Address:_,2 J tj ?SAS I City/State/Zip: o vi`c F'f A o l F Phone #: 07 T)) f"01 `Are you an employer? Check the appropriate box: The Commonwealth of Massachusetts 1. ❑ i am a employer with Department of Industrial Accidents 6. ❑ New construction Office of Investigations �i 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): C -%GAEL C 4 tl Address:_,2 J tj ?SAS I City/State/Zip: o vi`c F'f A o l F Phone #: 07 T)) f"01 `Are you an employer? Check the appropriate box: Type of project (required): 1. ❑ i am a employer with 4. ❑ 1 am a general contractor and 1 6. ❑ New construction employees (full and/or part-time).* 2.�I am a sole proprietor or partner - have hired the sub -contractors listed on. the attached sheet. x EJ Remodeling ship and have no employees These sub -contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. g, ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its ME] Electrical repairs or additions required.] officers have exercised their 3. ❑ 1 am a homeowner doing all work right of exemption per MGL 1 1.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, § 1(4), and we have no 12.0 Roof repairs insurance required.] t employees. [No workers' 13.KOtherQE-f'At0.°; siOW comp. insurance required..] *Any applicant that checks boz # 1 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 Policy # or Self -ins. Lic. #: Expiration Date: .rob Site Address: 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 thepains and allies o perjury that the information provided y above is true and correct / Signature- L��9 cI/lf.r�-�! Date- �/ f 91/ ?meq l / Phone #: 9) e �? I S v f q Official use only. Do not write in this area, to be completed by city or town ofciat 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 #: