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HomeMy WebLinkAboutBuilding Permit #337 - 97 BERKELEY ROAD 10/31/2007 tkoRTh BUILDING PERMIT of .,,.•.D TOWN OF NORTH ANDOVER 3? '` � APPLICATION FOR PLAN EXAMINATION y 00 AL w Permit NO: Date Received DR4TlD•�'` Date Issued: IMPORTANT:Applicant must complete all items on this page -.." -:"'•r '�'r,.iH itYr�,:rr-- fi-.�. .�,:. `"'^i ,^: 5r�•t� 'k 3. k, +„-.' ^t-•�7 .?�- k. 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'��� y ���r�a. r;..v tv' s��"`y' ,�..,a' r�4'���'';°a�. �+a,;^�,,,�.5f„` y',�.''srksy'��f�W �YtM.�il;�,j���"'" ''��'' � 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 8r`?4nv,.F.sv.'D":'yi'S ._ o �3YTaltaar�r7s ��r y ��> x �,�� .�r��-•,��?a,y+��e�✓ter �.�� �°�'��1�;`�`E ''•,�� � �-"•U �`�, rn �4 r-��:�ea:��,rr x ����v�rw�'IYI��.��.��st Y n�,4 r.{ may_ _ ,�*" �^' !�' 3.rr�-�.4sY ,�'��� �. �K""-�``� r v°�,°�':' ^�". ,7�'r� '•yr�+.uf,f �� x '�tl4.e..,.:�x�,>,,.�F� £„ y y. r 7t�,z. .� (a�'r•��.�119Ye�' .�,5�-,�t�"�xs-'-`'•E��> •?'��ti�,-�r...`x��..a.� ��t?__'s�� hY v-a� �:e•��� ��'", _ '�' ti.,s..e�,^,?�?�� .0 v, •+��' p �y.;�_'" �L�.•�i:'� DESCRIPTION OF WORK TO BE PREFORMED: Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: ',tci3rrr�:uEs �'b'E :,5-.;.� ...ttya .2+rr�"t, '�Y',.�-„'.usrn' y.'"”,-�-.t..'s• r 'ta-," �rtc '�'`� "v �; 'tC� `G 'S"^'' ''n�,.,•'- .r�„ +^ ea k ,e,��.v� az.s+�;x '' t.....; -.` ,:. •t�,„a"�, ` >sl -cit °r�y 'v`4 6't w - ��u'' c f-r ;2' $ r. T+k' 10 +'A.+© * '+1.771fa �i r ,��.r'���;!e^ gcc,,'�i'x�at'�dr�"$ ?K '"'s _t.?•me�g2.>a'i,4S�.��'m4�t1.o...tr .iz a .�u.o-�rxu,r'F•'�.wr--... -A'a°.^��a..'.'"»r` -s� �,%�.�,,a'rb+sa'2, �Y -h .s.e - t t.pc+ z• 'd..ig-irp � £ .. stx�y9}w.�.✓.z"uR''�r"k1s�.?w(�> R-� Mv rrSi,r.,r�a �ly..x ."� '•'^ .a''t•�.n"`i"Gvr n'S-YA T�.I, „s..- 1,- w.•fr"G'�y,`�'�, 'F":¢ 0 1 ` � r �r `<^. KT. ,, .. 9 Y'*• .F,�..f: �t,.p.�„+. �'K}n'r 'cv��`5`�'7n k 5� F"'�r,��. ,`�"��/� y>''';�' s r w �'�^ Tja a ''�,-�- '•� :I .7G:1?.aYJdYa7Y •1.r-L�� � dM1lei •• gNa .k �^ .-.'�,''x,�e",�y�a4'' ..,*t"i `•x� �..f~-n'r x.xp.c.LL _.< .r%7'�,�`._^^g "fin, 7' r"':? - ,gnu - r ,s; .�,T.�C:` �' s -„'•• s tk+ x r M� n-e .•°'•�-"' �`�"'ri"� -��.F.'�'�” 'r'�s.” irnS���,-°. -`-� �.±. - .r rf� �u.!..,n'?ssvPk'- ...s, "a'nr a�'� ,�"�i� � '�r"uM1 v,in i '"z14 �3..'ba"'.�'rv-ttt'at# �.N'rire�-f�`� �.,�.��'+"�,. �,`1':�•'.�tisV"_."N�,'si -+�_:d*"i-.` zc a' ,c�C 3t 3 a :: ys 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: $ FEE: $ Check No.: k�O`i Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to theuaranty fund Location/ 7- No. 33Date " ,.aR,M TOWN OF NORTH ANDOVER O� t. ° . 14.0 � S Certificate of Occupancy $ ;�asuMU <� Building/Frame Permit Fee $ _ s Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 207 u `� Building Inspector 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 DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT I COMMENTS i DATE REJECTED DATE APPROVED CONSERVATION COMMENTS DATE REJECTED DATE APPROVED HEALTH COMMENTS I � Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/ Driveway Permit Located at 384 Osgood Street FIRE'OEP ►RTIVIET T°erx�p, UMpsterOra site des ,ocaed.at 1 �4 VJam Str@et 4 Y } , s rt.M, s�gaeae D1E.�iT x _; Y 7 r yw ix Jr T k XtHr S u F F ..._..... _ Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. h K 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 i ❑ Notified for pickup - Date 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 o 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 I o Building Permit Application o Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract o 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 o 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 .o 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 vet this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application E Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 iI Revised 2.2007 NORTH own o �. „ . Andover 0 5k No. -337 LAKE o dover, Mass.,�d�/• 'L O " COCMICKEWICK ADRATED S BOARD OF HEALTH PER IT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT........................................... ......................... ... """"""" Foundation has permission to erect............................... buildings on.q .......19. .r..IC.. ...... . ............ Rough to be occupied as:... '. .. ....�........... ...:...I[.kQ.. !!.................................................................................. Chimney provided that the person accepting this permit shall in eve spect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to 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 $3 PERMIT EXPIRES IN,6 NTHS ELECTRICAL INSPECTOR UNLESS.�CONSTR N ARTS Rough Service BUILD ECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or*Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by-the Building Inspector. Burner - Street No. SEE RPVERSE SIDE Smoke Det. Date ,/ - j/_0;7 N� FD 5 ...!��..................... T TOWN OF NORTH ANDOVER RECEIPT SSACHU This certifies that. .. ................. haspaid....j .............................................................................. for...Ox"w1o.arrei .................................................. Received by�,- . ..... ................................. Department ............. .............................................................. WHITE: Applicant CANARY:Department PINK:Treasurer The commonwealth of Massachusetts Department of Fire Services T Office of the State Fire Marshal P.O.Box.1025.State Road;St^ow,MA 0177 PERMI 1StDate: _,/d—,?/ -2Q North Andover �'ermitNo (Cily of Town) (Lf Applicable) ElDig Nmer Is accordance with the provisions ofM G L l Li$.Chap.terQ_as.provided in section5 7 7 SMR 3 4 Thrs Permit is granted to: `` Full name of person,Firm or Corporatiar�./ Permission to locate dumpster for construction/renovation/demolition of building. Comments:. dumps.ter must be . 25 ' from structure if unable to lace with. required Restrictions:Clearance dumpster must be covered with plywood or tarp end of work -day (Give location by street and or describe ins h m e as to pr d9adequate identification of location) Fee Paid 50.00 �9 ' Fire Chief This Permit brill exire p (Signature o offical granting permit) Oscal grantingpemut (Title) The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street tV Boston,MA 02111 e �M 5� www.mass.gov/dia ' Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl Name(Business/Organization/Individual): e-1( 001 Address: oZG (' L LIM Q •4tl (�I� City/State/Zip: qM$i11� 03N Phone.#: &63 o?(-(7 i D'6 g Are.you an employer?Check the appropriate box: Type of project(required):., 1.❑ I am a employer with 1, 4. ❑ 1 am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. E]New construction 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition workingfor me in an capacity. employees and have workers' y p n'• $ 9. ❑ Building addition [No workers' comp.insurance comp. insurance. 10.❑Electrical repairs or additions required.] 5. ❑ We are a corporation and its 3.El officers have exercised their I am a homeowner doing all work 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.V�-Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp.insurance required.] *Any applicant that checks box#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 state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: O l . kv6i�_&T-�d Policy#or Self-ins.Lic.#: -�iJ Ct�j�I I rJ� 12 Expiration Date: p d I 2 Job Site Address: q1 ��1 City/State/Zip. 0 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 herebyc i under the pains and penalties of perjury that the information provided above is true and correct Si afore: I /0��I- �� _ Date: Phone#: Og �/L/ p 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#: 10/31/2007 09:15 FAX 19766833147 M.P,ROBERTS INSURANCE 10001 i �► CERTIFICATE OF LIABILITY INSURANCE DATII(MMIDDIVYYY)IA/31/2007 PRODUCER THIS CERTIFICATE IS ISSUED AS A NUTTER OF INFORMATION j M.P. ROBERTS INS AGCY INC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE (I HOLDER. THIS CERTIFICATE DOES NOT ADDEND, EXTEND OR 1060 Osgood Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. North Andover, NA 01845 073 INSURERS AFFORDING COVERAGE "Co iINSURED ROBERT J FARRELL D/B/A INSURER A: ROBERTS J FARRELL ROOFING 6 SIDING INSURER 8: P.O. BOR 3162 INSURER C: EAST HAMPSTEAD, NH 03841 INsuRER D�A �TUIAL�NS CO INSURER E COVERAGES THE POLICIES OF INSURANCE USTED 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 15 SUBJECT TO ALL THE TERMS.EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, MR-0170. LTR PE QF INSURANCE POLICY NUMBER MMIDD/YY P C MMIPDID N LIMITS GENERALLIABILRY EACH OCGURRENCE t COMMERCIAL GENERAL LIABILITY PREMI Ea aw"enoo i CLAIMSMADs F OOCUR MEDEXP(AnyaneWam) S — PERSONAL A ADV INAMY_ S GENERAL AGGREGATE S GM AGGREGATE LIMIT APPLIES PER! PRODUCTS-COMPIOP AGO 11 PRM.ICYf—1 PRO- LOC AUTOMOBILEUABILRY COMBINED SINGLE LIMIT ANYAUTO (Eha=miam) S ALLOMCDAUT08 eoOILVIN.IURv a SCHEDULED AUTOS (Per PV6-) HIRED AUTOS NONOWNE (8P0eDreILrY INJURY)DAu108 (Peraafti) PROPERTY D AMAGE GARAGE LIABR.ITY AUTO OY-EAACCIDENT $S S ANYAUTO OTHERT'HAN EAACC $ AUTOONLY; AGO S EXCESSIUIMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMSMADE AGGREGATE $ DEDUCTIBLE t t RETENTION S = WOR10MCOMFENSATLONAND 7'OFRY'La M X ERS EMPLOYER$LIABum VWC6011521012007 02 15/07 02 15/08 EL•EACHACCIDENT : ANY°"°rr"Er°Rma'TMewexeCUTrie / / 500,000 D n�FFT�s As %lVA KCL ' EL DISEASE.EA EMPLOYE S 500.000 IIPE�IALPRba*ZOIRSbW w E.L.DISEASE-POLICY LIMIT S OTHER 500 OO DESCRIPTION OF OPERATIONS lLOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT r SPECIAL PROVLSN)NB *AIM M MAL WILL ISSUE A CERTIFICATE OF INSURANCE DIRECTLY TO YOU* FAX 978-688-9542 CERTIFICATE HOLDER CANCELLATION TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION ATTR., BRIAN LEATHE DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN 1600 OSGOOD STREET NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DD SO SHALL NORTH ANDOVER NA 01845 IMPOSE NO OBLIGATION OR LIABILITY OF ANY IOND UPON THE INSURED,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACOR025(2001I08) GAtORD CORDO TION 1988 MA Constroction,Supervisor#082056 Home Improvement Contractor#135385 ROB FARRELL ROOFING,SIDING &REPLACEMENT WINDOWS: . FREE- FULLY ESTIMATES 978-682-9449 No.Andover 663-378-0515 Hampstead 603-24746.68 Cell. INSURED . 29 Cortland Rd, E.Hampstead,NH 03826 rlwe,the owner(s)of the below mentioned premises,hereby contract with and authorize you as a contractor to supply all materials, labor,and perform all workmanship accordance with the following specifications,terms,and conditions on premises below. ll Owner's Name o P). Phone Q��-"�i�a 3 Job Address,-,°� :, � �21e,`� a CityT�. `I ,y State N'1�. x - SPECIFICATIONS PPI iSSi x ie T, ec WA70- ;S' ;,Ij -V bo,r e d5es I.> .��a Alt &pek' UAaCArCR,r- 0J. ,Cr,na�'�►d�� off. (�� to f}IuMirij ol QUIC AXT i 1 30. tiJ t f.,jT fife ArJJt., ,3) 1 FT eeplAC Aeffal/ KAKI $o1-1(d �1e,Ak c1,ir JSe�g PCc P��,�, p;,,` �X 6)4- [x3 e §. t "t {' ` g(IAC� 6-AJ 0p. Ck'010L, 0-T hJU11 t) C00(J1tt4'1f AS� Ck,' AK '' SCq t. ���U �Vr Tri TrJ. ��l Z ,„Secf,O <td�R IjQN� tApJ <)✓r all 6,1- l o! 5 ytA tn�eakK►�Aa ,; 6v�; .,r� �'r t o� W;i! Nor, be JJ - C-0,JTKAcTe Od F�+c s r Wa t'4 +SAY Materials and labor to cost-$, I� Payments to be made as follows O tions: Additional cost$ p Additional cost:$ The above costs,specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the ..,ork"-ars specified. Ownerbas 3 days from date signed to withdraw without any consequences. Respectfully Submitted: Signature S• 01 Qwner This proposal may be withdrawn by.us if Signature ��,. Date 9� not accepted within days, Owner Of gt)ILD►N UP r, BOARD --- TRUGTSERVISOR ION License: CANS 082056 ,. Birtt►datex 07!0811966 Tr.no' 27645 G s 812008 , '� Itestri�ted X00=�r;:` 1 ERT FARF�E►'L� •' (�' // 4 2g CORTLAND RD` — 4.1 '' Commissioner HAMPSTEAD, NH 038' icuealtt `�Y✓�°aczcLivaeG� ; Board of Building Re 911', 'twos and Scandal ds HOME IMPROVEMENT CONTRR:CTOR i Registration: 135385 Expiration:~.3/29/2008 t TYPe. �'BA ROBERT FARRELL ROOFING+;SIDING RgGERT FARRELL 'p 29 CORTLAND RD. HA&,4PSTEAD,NH 03826 Administrator ----- -i g$