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Home My WebLink AboutBuilding Permit #567 - 99 AMBERVILLE ROAD 2/28/2007 BUILDING PERMIT of "ORT`' TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION ' Permit NO: J Date Received l �9SS�cHu E'�`k f Date Issued: - ,b IMPORTANT:Applicant must complete all items on this page LOCATION 9 q �,"C le d Print PROPERTY OWNER` tJ fl- _ Print MAP NO: PARCEL: ZONING DISTRICT; HISTORIC DISTRICT yes n: TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building -One family ❑Addition ❑Two or more family ❑Industrial Alteration No. of units: ❑Commercial 0 Repair, replacement ❑Assessory Bldg ❑ Others: olition 0 Other Public Sewe <` ❑Water d flood lam Wetlnds ` • ❑ Watershed District DESCRIPTION OF WORK TO BE PREFORMED: t Identification Please Type or Print Clearly) OWNER: Name: _11.' SJ v �� Q Phone' Address: CONTRACTOR Name k t i� )AJtzk Phone g 3j` -'ey' Address—1;._ t.rt�, 1 Supervisor's Construction License: ;� Exp Date F ..-.k .. or Home Improvement License 1d 539/ 67 Exp Date.�! � 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: $ 3a)'7`T 51 100 FEE: $�� S� Check No.: l Receipt No.:�� NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund Signature of Agent/Owner-4.,- Signature of contractor 2ww' Location Ah No. � Date C a-6 NORTH TOWN OF NORTH ANDOVER to n Certificate of Occupancy $ s'•^�•Eta Building/Frame Permit Fee $ sA�MUs Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 20012 Building Inspector Plans Submitted ❑ Plans Waived ❑__ Certified Plot Plan ❑ Stamped Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF-U FORM DATE REJECTED DATE APPROVED I PLANNING & DEVELOPMENT ❑ ❑ MM NT CO E S DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS 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 ❑ N 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 Located at 384 Osgood Street FIRE DEPARTMENT.-Temp Dumpster on site yes no Located at 124 Main Street Fire Department signatureldate 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 t ❑ Notified for pickup - Date i 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 uilding Permit Application workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses spy of Contract a Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products Addition Or Decks a Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit i-- ' ❑ Photo Copy of H.I.C. And C.S.L. Licenses o 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 New Construction (Single and Two Family) o Building Permit Application ❑ Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses o 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 a Engineering Affidavits for Engineered products 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 NORTFI Town of 4 over . No. b � _ � o dover, Mass.,�•,+�'`• COCMICNEWICK V Ids RATED 1 BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT---,0.................th--O�o*........... .. .�� ......................... .......... ................ Foundation y has permission to erect. ........................ ... ...... buildings on. �........�Ml ... � g ...... .... ......... Rough to be occupied as...... ... ....... l.... r. . Chimney provided that the person accepting this permit shall in every respect 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 rOs� PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRU ST S ELECTRICAL INSPECTOR Rough . ... .. .. .. .. . ... .... ................................. Service L ECTOR Final Occupancy Permit Required to Ocatpy 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 REVERSE SIDE_jl Smoke Det. $lie. Q FSeC�i oQ 000 L--J New )l, S- BGy t 4 ran �. v j -.. BOARD%BUILDING R ;( ' License: CONSTRUCTION S _ humbdr: CS 046517 Birthdate: 09/1.311948 g _4 M Expires..,:"OW13/2007 Restricted: 00 'y ,- ROBERT R PERRY 150 GRANDVIEW AVE 1 REVERE, MA 02161 _ p Cammi"oner„ s � g g�ula o an an ars � HOME IMPROVEMENT CONTRACTOR Registration 105454 i Expiration�';7h7/2008 '-Type lndiyidual - i 'RUSE�T R.PERRY Robert Perry ttr '0��arrdview Avenue; .RE Are; NIAO 02151 l__'__ pepnty Administrator i w White -'WoU7 Building -A-Ind Remoci��i><� P.O.Box 1087 Westford,Ma. 01886 Tel.800-310-7744 Fax. 978-392-8401 To: Mr. &Mrs.Iyer Date: February 5,2007 Phone: 978-621-8438 C 99 Amberville Rd. North Andover,Ma. mailto:vid)-aiyer,c�yahoo.com Insurance: License:046517 Registration#105454 All work involved within the following proposal is covered by Workmen's Compensation,Public Liability,Property Damage, Products Liability,and Completed Operations Insurance. Half Bathroom Basement: • Obtain all necessary permits. • Break trough concrete floor and dig to create well area for ejector and trenches for pipes.Install ejector and underground pipes to support half bath. • Build frame for half bath in storage area of basement. (Approximate size 4'x5') • Tap into existing hot and cold water supply and bring to new bathroom. • Install GFI electric outlet,combination fan-light unit and wall light over sink area. • Install insulation to walls. • Install %blue board and skim coat plaster to the interior walls and ceiling of the bathroom. • Create opening from existing finished area of basement for access to bathroom. Install door to match existing doors. • Install toilet and vanity with sink and faucet. • Install toilet accessories and medicine cabinet or mirror. (client to supply this material). • Install ceramic tile to floor. • Install baseboard moldings. • Apply one coat primer and two coats finish paint to walls and ceiling. • Clean up and remove all work related debris. Price: $8,745 Allowances: Toilet,vanity, sink faucet, light over sink$400 Tile$3 per sq. ft. Payment Schedule To Be Set Up All work is guaranteed to be as specified. All work to be completed in a professional Authorized manner according to standard practices. Any alterations or deviation from above Signature specifications involving extra cost will be executed only upon written orders,and will become an extra charge over and above the estimate. All agreements contingent upon NOTE:This proposal may be strikes,accident,or delays beyond our control. withdrawn by us if not accepted within 30 days. ACCEPTANCE OF PROPOSAL The above prices specifications and conditions are satisfactory and are here by accepted. You are authorized to do the work as specified. Payment is outlined above. SIGNATURE:''r - "" I SIGNATURE: �PSZE0.N A(,SS9 z � osa 33M m N � H MEMBER ucr 4Ui caul uv;,).) rAA. 2110 041 4001 b n ACLAKIhi 10- UUL Client# 13605 WHITU. ACORam CERTIFICATE OF LIABILITY INSURANCE -T DATE - - o2r1�ro7 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION B-K.McCarthy Ins.Agey.Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 10 Centennial driv® HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Peabody ,MA 01960 , 978 532-5+45 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A; Conexco Insurance.Agency 14788 White-Wolf Building and Remodeling Inc. INSURER B: NOM Insurance Company P4 Box 9087 INSURER-c� Westford,MA D9 O36 11,1404A D; INSURM>< COVERAGVS THEPOLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE.INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATEO.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THI$CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BYTHE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALLTHE TERMS,EXCLUSIONS AND CONDITION5 OF SUCH POLICIES_AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR N TYPE 13F IN$yRAHCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION DATE'IMM1hQ1YYI DATE IMNf1n0NYI LIMITS A sEN€R ldaILITY NPP1054746 07124/06 67124107 EA04ECCURReNEE 51 o8flow X COMMERCIAL GENERAL LIABILITY DAMAGE T4 RENTED 5100 000 CLANS MADE 11 OCCUR MEG EXP ZAny ora pw-,onj s5 000 PERSONAL 8 AoV INJURY $1,000,000 6�!�AwR€OATO s2,000,000 UEN'L AGGREGATE LIMIT AFFUE$PER; PRODUCTS-COMP(OP AGO $1 DOD 000 POLIOV F1 PRO- Ize- B AUTOMOBILE LIABILITY M9H67939 09/14106 09114/07 COMBINED SINGLE LIMIT ANY AUTOjFa awdent) $ ALL OWNED AUTOS BODILY INJURY X SCHEDULED AUTOr, cPer paron) $250,000 X HIREQALTTas aQQ1LYINJURY S�OOr000 X NOWM14EGAUTM if-or pedoenlj PROPERTY OAMAGE 5100,000 (Por,wwontj GARAGE LIABILITY AUTO ONLY-EA ACYIDENT 5 AMY AUTO OTHER THAN EA A" 5 AUTO ONLY: AGG S 9XC=ftnfflRWLtA UAMLITY EA'CRIOCCIIMMML-E $ OCCUR CLAIMS MADE AGGREGATE S f DEDUCTIBLE S REiENTtON 5 S WORKERS COMPENSATION AND WC STAT L CTH- ECIIPLOYER�'UASILITT TORY ANY PROPRIET0RIPARTNER/FXECUTNE E.L.EACKACCMENT E OFFICERAAEMBI-R 0CLU4ED7 E.L.015EASE-EA EMPLOYEE 5 nyaa,4eelxlue vn4a�- E,L, IoEASE-POLICYLIfdR 5 OTI4ER DESMIFTION OF OPERATIONS 1 LOCA71M I VEH16L£5-I OCC=IMONS A69E9 By ENDORSEMENT I5PECH1i6FROVIS ONS Regarding:Iyer.99 Amberville Road,North Andover,MA 01845 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OP THE ABOVE DEOCRIBED POLICIES BE CANCELLED BEFORE YHE EXPIRATION Town of North Andover DATE THEREOF,THE ISSUING MSUPARWILLENDEAVOR TOMAIL 10_ DAYS WRITTEN NOTICE TO THE CERTIFICATE MOLDER NAMED TO THE LEFT.BUT FAILURE TO DO 90 SHALL North Andover,AIA 01545 MP05E NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INsurRrR,IT%AGENTS OR REPRESENTATIVES. A%I THORIZED REPRESENTATIVE � .4- k ACORD 25(2m=) bf 2 #535lo fiau a ACORD coI4PoRATION isee VG!cu/LVU 1 021;J4 rAe V10 041 4801 b A NCI:AXIM WJ UU4 'FEB. 1'9. 2007 2.40PM ASSOCIATED INSURANCE NO. 1417—F, 3/3' CERTIFICATE OF INSURANCE ` "' ' TMS CEMMCMM 15 WMD AS PRd0t3M CONF'EHB NO RIGH UPON TIS CATS ROI . TSS NFOMU'rXWLY RMWATE B K McCarthy knsuranw Age�nny DOl?S No >�7r �OP.AY1t'l�[T=Dov ►GE A ot�rn�D BY THE Inc 1Q Centennial Drive C "ANM AU03� NG COVERAGE Peabody,MA 01960 white-wolf Building andRYA A.I.M. Mumal hmurae Co sn R� Wing Inc F 0 Bax 1087 Westford, Ma 01886 COVFYA TO CERTIFY TWKAr i;5EM" lur bMMW HAVE BEEN ISSUF.D TO THE 1NSl]REI►NOM ABOVE POR T1IE PULTCYPBRR?b INDTCATHb_NOTWITHSTANDING ANY REQUMMENT,TERM OR CONDnTON OF ANY CONTRACr OR DIMERDOCUA�M WrrK RESPYsCPTD wmcK TRI8 �RTIPlGATRMAY PIP.TS9UID OR MAY•P'rs81'AIAI,THE IIVSURASTG`fi�N61tDED BY'IH6pMJ=D)nBQiiBTSU EI�REW IS SU IECr—r0 ALL TSE MUM IXMUSTONS AND CONDrrmm or SUCH rol.1EB. LIb is SROWN MAY gAVB MN MMUCZD gY PAID CLAW te4LrClt��nvE Peai1Cv�JCPI7.e r.Qu><s f TYPE OYTNBII POLICXI Xbm DAWRA U1D Nn. DATROAMIDDIVY) ti1iN►`JtALL1ADi[17Y UNIMALAGGPINATE S �YIMMdWIAIXANGRALLIeIElII,1TY mcove4b ¢M wmw pwwWALA ADv 1NIURY $ •t1WNfR'XR4UNTRAr?OR•2qPROT, DAMaCifi(A,% 3 (AID ano palled S VJ'I1M(1IlttkL1A]IR17'Y MBDVGDS�IIGL17 S IJMIT ANY AUTO AIJ.OWNED AUIM LTY ukv S IEDULEU AUVU KIARD Allm AY � NeWOWNW AVUA uARAOR IJADILITr DnIdAGb S X7CAC40Rkb'NCE MHIIGLA ILOW AtiUREGAYE 11LR'HAN Ss UMahrla.A rf" ��yyrr •/CSI�cTU WC*Kra'E CQMFNt4A'n0N AND Jl 'I;MmslYrii,4'L1AD1Li'rY 6005346012006 US119r7006 OSAM007 s A114,,I�1rAP&M'rOw X INCL ELn[s9&N:m_ Y rJMIT s SOD 000 PARY OLVEXEC'U RVR P!419tJns&. 9MPI Y i Y s CIO 000 10"IMA AILI pun gJIraoxo>= alma RE.lypp.-90 AMBFRVTLt E RD.; NORTH ANAOVE&MA 01845. CP.RTIFICATE HOLDIM GANCEUAnON S1 CUM ANY OF THE ABOVE bESCMMpPdL1=89 CAAIICELLSD SORE nm Z'YET� PxpmAT= jwm Tl nciz. meISSWG COMP 9-L ERDEAvOlt TO CFO MAM 10 DAYS WRnTENNOTICE TO T11E INH =,BUr FAILURE TO MAIL SUCK NO=SRUL 200.SR NO OBx ATION OR 99 AMBERVII,LE RD LtABnZrY OF ANY XWP UPON 7M COMANY, rr5 AOffi+D,fS OR AtrlIoaa as�ITATcP$ NORM Arroovst;MA a1$a�s � The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' 600 Washington Street Boston,MA 02111 wwte.rnassgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leeibly Name(Business/Organization/Individual): Address: City/State/Zip: Phone.#: Are you an employer?Check the appropriate box: Type of project(required):. 1. I am a employer with_.2 4. [1I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' insumnce.t 9. ❑Building addition [No workers'comp,insurance comp. required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself.[No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t C. 152,§1(4),and we have no employees.[No workers' 13.❑Other comp.insurance required.] *My 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 subcontractors and state whether or not those entities have employees. If the subcontractors 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. r� Insurance Company Name: Policy#or Self-ins.Lic.#: 6 005 JY 00 i apo,_' Expiration Date: Job Site Address: 22 g-Ai "-Vi tle— Pd, City/State/Zip: A,Jrnyl jj1�,W )Il 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 d penalties ofperjury that the information provided above is true and correct Si afore: Date: Phone#: Official use only. Do not write in this area,to be completed by city or town offlclaL 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#: Information and Instructions Massachusetts General Laws chapter 152 requires all employdrs 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." 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 including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the 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 work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for,the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)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 or partners,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' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department 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 will 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 policy information(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 applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where 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 to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel.#617-727-4900 ext.406 or 1-877-MASSAFE _ Fwc#617=727-7749--._._ --- Revised 11-22-06 www.mass.gov/dia