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HomeMy WebLinkAboutADD 6X12 DECK TO EXISTING 18X12 AND 4X4 LANDING t%4RTM BUILDING PERMIT �'LED 169 T NORTH ANDOVER , '6 APPLICATION FOR PLAN EXAMINATION .47 ® z Q Date Received Pei'1111t NO#: AYED r `J SSACHUS� Date Issued: " IMPORTANT: Applicant must complete all items on this page LOCATION L &Atoq. 14'1) �* � Print PROPERTY OWNER p( �CtJ� Y"���3 Print 100 Year Structure yesno ' ZONING DISTRICT: Historic District yes no MAP PARCEL:` w Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building o 'One family ❑Addition ❑Two or more family ❑ Industrial Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other v„ @wq IAy pl✓3Mt>Y(rly /i/✓ �Y 17/.. // 1 f/% yl / /%/lrf(l. 0�%( td�%///:.oil t%//I !, l ,/I )//l/f1 .IKU///4Va /#f/ 1/ �101111ff 0�((dJ�'P 1,1115,.,,.9 �rr Jf%/ �IJr / ,/ f/ �/ , /i�u,��w.,�/�ra� 1111 ui�,�'�r�e�f�0. 11,Septic ��wE ,e I �; ,/, e i,�„�F ood�IaN ` eds �l Gfit it 1 �DESCRIP�TION'OF WORK TO BE PERFORMED: AdJ � r Identification- Please Type or Print Clearly OWNER: Name: �y Vic, v,6IJ; Phone: (,� / w S 5'L( Address: ° j3 1u,c J. ro, l4, I I /4vc Contractor Name: 6,' rtid Li 0►r1,1 SL4 Phone: C 7 , 'l T q� Email: (-(QA)T C )4 ,t,o,71 Address: C14 llr5)-' NJA ,,, 0 r9 G� Supervisor's Construction License: L LIc1�I Exp. Date: l I l Home Improvement License: 1 ulq Exp. Date: , ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.•$92.00 PER 9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ I TYPE OF SEWERAGE DISPOSAL Public Sewer 4❑ Tanning/Massage/Body Art ❑ Swimming Pools El 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 Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Si nature U COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes .Tanning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Signature& Date Driveway Permit ]DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPART ME'NT - Temp Dumpster on site , yes na, t Located at 124 MainStreet ,% Fire D®�p�r�m�nt�ign�aitire/date ,. COMMENTS t%°.ary Andover Town of 0- No. _ h ver, Mass ' 20 16 L^K1 oNIc"tWICK �®A�RATEU MQp��y S u BOARD OF HEALTH Food/Kitchen rERFAIT ' LD Septic System 1 THIS CERTIFIES THAT #. .. .` BUILDING INSPECTOR .............. ..� ®....._............ ............ ..... ..................... ...... .. ......... .... .......I has permission to erect ........... g .a . . ............. �1i. Foundation ............... buildings ... ....... ............ Rough to be occupied as ......... . ... .tv... tG ...... ... Xf'.'...� .. �.� &JV Q Chimney 1 provided that the person accepting this permit shall in every respect conform to th�terms of the applicatfbn Final on file in 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 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR LESS CONSTRUCTION STARTS Rough Service ..............r.....,t.-��'� . ..`:�......:,-.......................... / BUILDING INSPECTOR Final GAS INSPECTOR Occupancy Permit Required to Occupy Building 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. Smoke Det. Tobias And Andrea Krause 124 Blueberry Hills North Andover, Ma 617-852-9954 Estimate # 000096 Date 06/06/2015 B.L. Contracting 92 Pringle Street Tewksbury, Ma 01876 Phone: 978-815-9884 Email: blcontract@yahoo.com Web: blcontract.com Description 2412 deck with 44 landing Slate grey azek decking with hidden fasteners White azek trim 12 stairs Titan vinyl rail system Demoted disposal, permits Subtotal $15,000.00 Total $15,000.00 Notes: Back deck Pagel of 2 Signed on: 07/16/2015 Signed on: 07/16/2015 Bradley Lawrenson ' Tobias And Andrea Krause r Page 2 of 2 North Andover MIMAP July 16, 2015 / �i✓r, /E 1. ��' I / r� a I I D I i I NIVn 1i to�Uu iI � I � I 3 ry /ll d� Interstates —.I Horizontal Datum:MA Slateplane Coordinate System,Datum NAD83, —SR Meters Dala Sources:The data for This map was produced by Merrimac --Roads HOR7M� Valley Planning Commission(MVPC)using data provided by the Town of gcei Easements Ot t V Fp , 'Q� North Andover.Additional data provided by the Executive Office of (' MVPC Boundary } bbt 6'a OQ Environmental Affaim/MassGIS.The information depicted on this map is for planning purposes only.It may not be adequate for legal boundary ParcelsO M definition or regulatory Interpretation.THE TOWN OF NORTH ANDOVER MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING * -1 M THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY yt ± * OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF THIS INFORMATION �pSSACHUs�t�g 1"=81 ft North Andover MIMAP July 14, 2015 98.0-0097 098.0-0013 '` 43 r CHESTNUT ST 098.C-0084 r 99 BLUEBERRY HILL Ltd 098.0-0096 098.0=0092 Cq 104 BLUEBERRY HILL Ltd ry 098.C-0085445 CHESTNUT ST t5� .t 'x, w i 01 098.0-0095 N 109 BLUEBERRY HILL LW098.0-0093 x;,,114 BLUE ERRY'HIL:L LN '" 098.0-0029 098.0-0094 IMP, DILL Lidb, 098.0-0026 R1 a" , 4t 124 BLUEBERRY HILL,LN � 1'�3' 098.0-0108 u� WESLEY ST 098.0-0025 61 tr `' .��, �A ee ��A 465 CHESTNUT ST e5` r* 098.0-4030 2A1" AD rs 42MESLEY ST 098.D-00Q1 �y 098.,-0036 00 098.0-0035 098.E-0041 2,ADRI AN SIT 34 WESLEY ST IV 098.0-0042 8 BAPRIIaP�!"ST'' ' OJB.0-11112 1 098.0-0031 r 68.61 -- Rail Line +�Wetlands Zoning Interstates Exempt Lands Busine s i District Busine 2Disrict P Y Horizontal Datum:MA Stale lane Coordinate S slam,Datum NAD83, I _ ld st — IS Busine s 3 District Meters Data Sources:The data for this map was produced by Merrimack M Busine s 4 District %tORTM Valley Planning Commission(MVPC)using data provided by the Town of Roads N Genera Business District Of `+p North Andover.Additional data provided by the Executive Office of Sri Planne Commercial Dev �� r�+ O Environmental Affairs/MassGIS.The information depicted on this map is q»'y Easements ? g� s O Garrido Development Dist „�! for planning purposes only.It may not be adequate for legal boundary 0 MVPC Boundary Kr Corddo Development Dist O »— (+ definition or regulatory interpretation.THE TOWN OF NORTH ANDOVER 0 Municipal Boundary W)R Corrido Development Dist it. MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING Zoning Overlay Industn I 1 District #t * THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY Industn it 2 District M _ w^ y OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT 0 Adult Entertainment 'N, Industn I3 District y,oo'q 4 s.+ p ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF 0 Downtown Overlay District N Industd I S District `" Historic District `""C� THIS INFORMATION 0 0 Water Protection Reside ce 2 District Reside ce 2 District ACHUS� D Parcels Reside ce 3 District Hydrographic Features de—4 District de ce5 District --Streams $� ft rFde ce 6 District ...age esidential District The Commonwealth of Massa chusetts F Department oflndustr"ialAccidents X Congress Street, Suite 100 Boston,MA 02114-2017 W`t www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMIT UM AUTHORITY. A,o plicant Information / Please Print Le0bly Nalne (Business/Organization/Individual): (, �t� I Address: W p1 rW& s T wil) L' &1 G City/State/Zip: e ) Phone#: �l 7�'Y1 Are you an employer?Check the appropriate box: Type of project(required): QA I am a employer with 1.. : employees(full and/or part-time).* 7. E]New Construction 2.Q I am a sole proprietor or partnership and have no employees working for me in 8. W`Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.Q I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 E]Building addition 4.F1I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.[]Electrical repairs or additions proprietors with no employees. 12.[]Plumbing repairs or additions 5.❑lam a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.Q Roof repairs These sub-contractors have employees and have workers'comp.insurance.t 6.Q We are a corporation and its officers have exercised their right of exemption per MGL c. 14.El Other 152,§1(4),and we have no.employees.[No workers'comp.insurance required.] `Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must s4bmit a new affidavit indicating such. tContractors 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. X am an employer that is providing workers'compensation insurance for•my employees.'Beloit,is the policy and job site information. Insurance Company Name: TCCt VZ b rA '1'S 1-1✓_I417 Q — Policy#or Self-ins,Lia#: lit G chi V L] tP 6 6 �S 0 �� Expiration Date: 6- fob Site Address: ( `ULvro k►I City/State/Zip: ( �U` Y 11 Attach a copy of t e workers' compel ,ation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORD ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA.for insurance coverage verification. 1-do Hereby certify un er thepamp andpenalties ofperjuiy that the information provided above is true and correct. Si nature: �� ... .. Date: - Phone 4: YY,)l 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.PIumbing Inspector 6.Other Contact Person: Phone#: 1 ® DATE(MMIDDIYYYY) A�" CERTIFICATE ®F LIABILITY INSURANCE 7/16/15 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 INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms 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 endorsement(s). PRODUCER CONTACT NAME: American Insurance Agency PHONE (978) 657-0209 FAX No: (978) 657-5551 404 MAIN STREET E-MAIL ADDRESS: Wilmington, MA 01$$7 INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:SAFETY INSURANCE INSURED INSURERS:SAFETY INSURANCE Bradley Lawrenson INSURERC:Ace Group 92 PRINGLE STREET INSURER D: TEWKSBURY, MA 01$76 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION 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 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 IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUER POLICY EFF POLICY EXP LINTS LTR TYPEOFINSURANCE INSR WVD POLICY NUMBER MMIDD/Y MM/DDIYYYY GENERAL LIABILITY CP0001782 9/10/14 9/10/15 EACHOCCURRENCE $ 1,000,000 DA NTED X COMMERCIAL GENERAL LIABILITY PREF SGE E TOE Eoccurr $ CLAIMS-MADE [i]OCCUR MED E\F(Anyone person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGA TELIMITAPPLIES PER PRODUCTS-00MP/OPAGG $ 1,000,000 POLICY PRO- LOC $ AUTOMOBILE LIABILITY 620$114 11/16/14 11/16/15 COMccicbrr#NED SINGLE.. $ ANYAUTO BODILY INJURY(Per parson) $ 100,000 ALLOWNED X SCHEDULED BODILY INJURY(Per accident) $ 300,000 AUTOS AUTOS NON-OWNED PROPERTYDAMAGE $ 100,000 HIREDAUTOS _AUTOS eracadent UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MALL AGGREGATE $ '.. DED RETENTION$ $ '.. WORKERS COMPENSATION 6S62UB-5B66665-0-12 10/19/14 10/19/15 WCSTATU- 1 FR OTH- AND EMPLOYERS'LIABILITY Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE EL.EACH ACCIDENT $ 100,000 OFFICER/MEMBER D(CLLDED? NIA '.., (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under E.L.DISEASE-POLICYLIMIT $ 500,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Rerarks Schedule,if more space is required) WORKERS COMP CERTIFICATE TO FOLLOW DIRECT FROM COMPANY CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN North Andover ACCORDANCE WITH THE POLICY PROVISIONS. 124 Blueberry Hill ave North Andover MA AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The AC ORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: _ Office of Consumer Affairs and Business Regulation s. 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 182440 Type: DBA Expiration: 6/19/2017 Tr# 267600 B.C. CONTRACTING - BRADLEY LAWRENSON 92 PRINGLE ST TEWKSBURY, MA 01876 Update Address and return card.Mark reason for change. 3CA 1 ES 20M-05/11 Address 0 Renewal D Employment Lost Card ��e�Q-7JT 977 @71[62[[�l�0����ClJJ4C�UJB��J _ Office of Consumer Affairs&Business Regulation License or registration valid for individul use only ( OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration 182440 Type: Office of Consumer Affairs and Business Regulation Expiration, -6/19%2017 DBA 10 Park Plaza-Suite 5170 B.C.CONTRACTING Boston,MA 02116 BRADLEY LAWRENSON 92 PRINGLE ST TEWKSBURY;MA 01876 Undersecretary Not valid without signature 1 � (Y1assacitusetts - De --- -- - -- .Board of B P 1�`trnent of Pubi�e Saf4fr� uiiciing Regulations and Stanctare9s: Contih'uction Supervisor. License: CS-106494 BRADLEY LAWRENSOTr 17-LAW IZENCE COURT ; r f.. Wilmington MA 01887 Ex Cooln issioner pi;at9On •; 11/13i2p45y .