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Architects 11 Engineers ❑ Surveyors ❑ Land Planners
200
Sutton St., North Andover, MA 01845, (617) 687-1483
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Richard F. IGaminski & Associates, Inc.
Architects 11 Engineers ❑ Surveyors ❑ Land Planners
200
Sutton St., North Andover, MA 01845, (617) 687-1483
prepared for L Me)ec;PSe FLp.TL EY
'
location MC)a-ri-1 AwpovEl2 MASS.
revisions
title
stamp
Itr. description
date appd
I
LEC LI E
-i - i WJ F
Lam- 120.0.0
scale I"=40' 40' date OCTOI5El2 10 I°?8r
drn. G. p F. disk no. job no.
chk. I.W.P appd. I W P.
sheet no.
job folder no.
plan file no.
Location/Aj tit[ 2�7 - C
No. 6�U47 Date a �v
14ORTM TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $ Vis-
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check # 6)
2270
Building Inspector
Permit NO: Z¢j O
v
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN
EXAMINATION
Date Received
D
DESCRIPTION OF WORK TO BE PERFORMED:
110,- T'; (16
EVA
OWNER: Name: Identification Please Type or Print Clearly)
Phone:
Address:
hKl-r1l i LU I /ENGINEER_ l_ R9,R, J p4c�� 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: $ '66 . '60 FEE: $
Check No.: C_ Receipt No.: d'J
NOTE: Persons contracting with unregistered contractors do not have access to the guaran 7 fund
_...
Signature of Agent/Owner
signature of contractor
.r
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
u 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: Doc.Building Permit Revised 2008
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
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH
COMMENTS
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
0.
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 21 A —F and G min.$100-$1000 fine
Doc:.Building Permit Revised 2008
?E $ � Df. iV CC _
Lawrence H. Ogden P.E.
!l �
198 East Main St
`J Georgetown, MA 01833
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NOTES:
I) SCREWS TO BE 4Z4S-M" tA4STF_i —
'tRuss GO1G
SEE DRAWINGS FOR LENGTH OF SCREW AND .. _
ON CENTER SPACING. -
2) ALL:2MEMBERLVL BEAMS TOHAVE SCREWS
FROM ONE SIDE,
3) ALL 3 OR 4 MEKBER LVL BEAMS TO RA YE
SCREWS FROM SIDES UNLESS
OTHERWISE NOTED ON DRAWINGS.
4) USE TYPE OF SCREW SPECIFIED DO NOT
SUBSTITUTE AS CAPACITY MAY NOT BE -- - - - -
ADEQUATE.
DETAIL OF CONNECTING -
LVL MEMBERS TOGETIIER
NOTE:CAREFULLY
THE NORTH ANDOVER BUILDING DEPARTMENT
WILL REQUIRE A FRAME INSPECTION AND CERTIFICATION
FROM THE ENGINEER
BRING ALL DISCREPANCIES, PROPOSED DEVIATIONS AND
ACTUAL FIELD CONDITIONS THAT ARE DIFFERENT THAN
DEPICTED TO THE AT'T'ENTION OF THE ENGINEER PRIOR TO
PROCEEDING WITH CONSTRUCTION.
DO NOT DEVIATE FROM THESE DRAWINGS
WITHOUT APPROVAL
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2k"
LAWRENCE H. OGDEN, P.E.
198 EAST MAIN STREET
GEORGETOWN, I%IA 01833
978-352-8318 fax 978 —352-2858
cell: 978-502-5921
February 24, 2010
Mr. Mike MacKay
181 Berkley Road
North Andover, Ma., 18145
RE: MacKay Residence, 181 Berkley Rd. North Andover, Ma.
Dear Mr. MacKay
As you requested I visited the site to review the installation of the Engineered
Materials consisting of LVL Beams utilized in the framing of the attic space over the
garage at above project. These are shown on SK -1 and SK -2 prepared and certified by
me, dated 241 2021.
Based on the above site visit and based on what I could visibly see I can certify
that to the best of my knowledge the LVL members utilized in the framing as shown on
the drawings are installed properly and meet the loading conditions of the Massachusetts
,tate Buildina Code for 1&2 Family Re-sidences. This certif_i.ation.assum-?s that -all ether
framing requirements of the code, including but not limited to materials and nailing
schedules, were properly complied with by the licensed construction supervisor
responsible for the project.
Shniild ynrn have any nuestinns please dn. not hesitate to call.
Yours truly,
La ence H. Ogden P.E. Structural 27765
�ZN OF MA
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02/08/2010 13:49 FAX 978 957 6612 COUGHLIN INSURANCE 001/001
R CERTIFICATE OF LIABILITY INSURANCE OP c c
t�CON01 02101
eER TH15 CERTIFICATE 15ISSUED AS A MATTER OF INFORMATION
CHARLES , COUGHLIN ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
INSURANCE COUG9Y MOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
IN URANCEDINI.Ey 5T . P . O .SOX 10 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW
aRACUT M 01826-0010 NAIc
Phone- 978-957-3588 rax:978-957-6612 MSURERSAFFOROINGCOVERAGE
'INSURED INSURER A:
INSURER B: 0". to ataaa inaurance
!al Builders LLC wsURERc:
1+>:Ltthew Palmer
Jewell,429Bumo Road INSVRERD.
INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTwITHSTaNDMG
ANY REOUIREMIENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE My 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. AOGF EGATE LIMITS SH" MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LIYITB
EACH OCCI>RRENGE 3
PREMISE91Eaoaclrrellee E
MEO EXP (Ary one PM40n) E
PERSONAL&AOVINJURY E
GENERAL AGGREGATE
BENE tAL LIABILITY
C OMMERCIAL GENERAL- LIABILITY
CLAVAS MADE [] OCCUR
CENT AGGREGATE LIMIT APPLIES PER.
�'OLICY n JaC I � LOC
AyTCM:OVILE LIABILRY
%NY AUTO
,kLL OWNED AUTOS
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EDAUTOS
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DEDUCTIBLE
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WORKERS COWENSAT"
ANDEMPLOYERS' LIABILITY YIN
g ANY PROPRETORMARTNER(EXECUTNWC004284990
OFFICEMIEMBEREXCLUDECD? LJ
(M ndlftr• M NM
e c aeecrdw vadat
LOCAL PROVISIONS De1vM
DESCRIPTION OF C
Carpentry
ut
North Andover Town Hall
1600 Osgood St.
North Andover 181 01845
I PRODUCTS - COMPIOP AGO I E
COMBINED SINGLE LIMIT Is
(Es "*on])
BODILY INJURY
E
(Par permn)
BODILY INJURY
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(Per aa(den)
PROPERTY DAMAGE
E
(PeI ec"rAI
AUTO ONLY - EA ACCIOENT
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AUTO ONLY: AGG E
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08/03/091 08/03/10 ELEACHACCIDENT E100�000^
jI fl, OISFJSE • EA EMPLOYEE B l DO r CO0
E L. DISEASE -POLICY LIMIT $500,000
.
CANCELLATION
SHOULD ANY OF THS ABOVE OROCRIBED POLICICS BE CANCELLED REPORE THE EXPIRATI01
ANDOVNd DATE THEREOF, THE ISBWNO INSURER WILL ENOSAVOR TO MAIL 10 —9 WRITTEN
NOTICE TO THE CERTIPICATTE MOLDER NAMED TO THE LEFT, BUT FAILURE TO DO 80 SHALL
IMPOSE NO OBLIGATION OR LIMLITV OF ANY KIND UPON THE INBUREk ITB AOENTB 0"
REPRESENTATIVE&
2 3 120 09101] - --- The ACORD name and 1090 are molstsred marks of ACORD
M B Builders LLC�`�+�,o,���
Residential & Commercial LD W-C't iv to '
978455-5707 O)M4-
Patios / Decks / Additions
Retaining Walls Windows /Siding
Fully Insured Fully Licensed
HIC reg. no 144284 Contractor Lic no. 048363
We hereby submit specifications and estimates for:
Renovation of existing Garage attic.
Specifications and Plans provided by Lawrence H Ogden P.E.
See Attached
We propose hereby to .furnish material and labor - complete in accordance with the above
specifications for the sum of: $6500 Dollars $ Six Thousand Five Hundred and 00/ 100
With payments to be made as follows: 30% down 60% as needed 10% upon completion
Any alterations from the above specifications
involving extra costs will be executed only upon
written order, and will become an extra charge over
and above the estimate. All agreements contingent
upon strikes, accidents, or delays beyond our control.
Respectfully
Su/bmitted M Palmer Owner Manager
`�
Note — this proposal may be withdrawn by us if
not accepted within 30 days.
Acceptance of Proposal
The above prices, specifications are satisfactory
and are hereby accepted. You are authorized to Signature
do the work as specified. Payments will be
made as outlined above. Signature
Date of Acceptance
Pasie 1 of 1
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The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, 21,L4-02111
www.massgov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/individual):
Address: 'I r -f�;)-� Yn)W
City/State/Zip: L o u,,xel � ry) a4 'I Phone #:
Are you an employer? Check the appropriate b
L ❑ I am a employer with
4. 91 am a general contractor and I
employees (full and/or part-time).*
have hired the sub -contractors
2. ❑ I am a sole proprietor or partner-
listed on the attached sheet. t
ship and have no employees
These sub -contractors have
working for in any capacity.
workers' comp. insurance.
[No workers' comp. insurance
5. ❑ We are a corporation and its
required.)
officers have exercised their
3. ❑ I am a homeowner doing all work
right of exemption per MGL
myself. [No workers' comp.
c. 152, §1(4), and we have no
insurance required.] t
employees. [No workers'
comp. insurance required.].
Type of project (required):
6. ❑ Ne onstruction
7. Remodeling
8. ❑ Demolition
9. ❑ Building addition
10. [1 Electrical repairs or additions
11.0 Plumbing repairs or additions
12.❑ Roof repairs
13.❑ Other
U1 aryuca :� irat ca=.nox V ; Must also ul) out the section below showing their workers' compensation policy information.
f 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 mine 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 Name: C Q - y
Policy # or Self4ris. Lic. #: Expiration Date: 9, �? 10
Job Site Address:_ �le City/State/Zip: No, 4)% -Id er
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 pa' enalties of perjury that the information provided above is true and correct
Signature: a,
Date: / � � V
Phone #: ! 7 d S 707
Official use only. Do not write in this area, to be completed by city or town offwiaL
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 employers 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 Iicensing 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-contractor(s) 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 pennit/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 Iicense or permit to bum leaves etc.) said person is NOT required to complete this affidavit.
The Office of Investigations would Iike 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. 4 617-7274900 ext 406 or 1-877-MASSAFE
Revised 5-26-05 Fax 4 617-72.7-7749
vA ,.mass.gov/dia
MAS � 'RESLDF.tV.c�f _.. _I.g_1.__.
Ri" rc �(- .t
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Lawrence H. Ogden P.E. .
198 East Main St
Georgetown, MA 01833
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NOTES:
1) SCREWS TO RE 45"MA.# N4S-rf-
?Ru55 L.01c
- SEE DRAWINGS FOR LENGTH OF SCREW AND -
ON. CENTER SPACING.
2) ALL2-MEMBER LVL REAMS TO HAVE SCREWS
FROM ONE SIDE. - -
3) A•LL 3 OR 4 MEMBER LVL BEAMS TO HA VE
SCREWS FROM SIDES UNLESS-- -
OTHERWISE NOTED ON DRAWINGS.
_ 4) USE TYPE OF SCREW SPECIFIED DO NO I'
SUBSTITUTE AS CAPACITY MAY NOT 13F, - -
ADEQUATE, -
DETAIL OF CONNECTING
LVL MEMBERS TOGETHER
NOTE: CAREFULLY
THE NORTH ANDOVER BUILDING DEPARTNIENT
WILL REQUIRE A FRAME INSPECTION AND CERTIFICATION
FROM THE ENGINEER
BRING ALL DISCREPANCIES, PROPOSED DEVIATIONS AND
ACTUAL FIELD CONDITIONS THAT ARE DIFFERENT THAN
DEPICTED TO THE ATTENTION OF THE ENGINEER PRIOR TO
PROCEEDING WITH CONSTRUCTION.
DO NOT DEVIATE FROM THESE DRAWINGS
WITHOUT APPROVAL
TN OF bjgS
`r9
WREN Py
0 HAROLD N
v cN
—I
27 5 O
On
SS YAL ENG `0
Date
N'2375
HoaTN TOWN OF NORTH ANDOVER
A PERMIT FOR PLUMBING
'1 •D••IND •�``
,SS^CMUS�
This certifies that................. .
1�.0=!�
has permission to perform ... .......... .............. .
plumbing in the buildings of .. /!1� ...A / /.................
at .. /�-/ .. is 4. -J h /. �.'! ................ North Andover, Mass.
Fee.. !.J t . -. Lic. No..,,i,�. 6 .. ..............................
PLUMBING INSPECTOR
08/11/48 08:48
WHITE: Applicant
15.00 PAID
CANARY: Building Dept. PINK: Treasurer
MASSACHUSETTS UNIFORM APPLICATION FOR PE
'ype or print) Ll /
NORTH ANDOVER, MASSACHUSETTS t!
„uilding Locations I � �
i �/L �( _0 —,f,
`
IT TO DO PLUMBING
Date `,
/-�r
Permit #
Amount /J ;
Owner's Name
144C /<"h I
New 13-- Renovation ❑ Replacement E] Plans Submitted n
FIXT11RES
•
'
G
G
•
Mr., �1171
MON
MMMMMMMMMMMMMMMMMMMM
M.iVD17ADMMMMMMMMMMMMMMMMMMMmmmmmm
11'
...................m....
m 1 11'
m..m.-.mmm-mmm-.®.-.m...
..,1 11'
........................
W-11:119 /1'
W..--0WWWMMM.M-MM-....MM
(Print or type) i Check one: Certificate
Installing Company Namer, eZ e / D Corp.
Address �� / D d � S /— 1:1 Partner.
0—Firm/Co. Telephone �p c (o
Name of Licensed Plumber: Po
Insurance Coverage: Indicate fhe type of insurance coverage by checking the appropriate box: F]Liability insurance policy 13—Other type of indemnity Bond
Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above
three insurance
Signature Owner Agent ri
I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the
best of my knowledge and that all plumbing work and ins tions erformed er PermV1,,sed for thiapplication will be in
compliance with all pertinent provisions of the Mas us Ol bing de and C142 e General Laws.
By: Wgriall.117C Of kens ue
Type of Plumbing Li se
Title lr�
City/Town Licepje Mumoer Master 11- Journeyman El
APPROVED (OFFICE USE ONLY