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Home My WebLink AboutBuilding Permit # 7/29/2015 t%ORTH BUILDING PERMIT of =LED ,.1 -4, C, TOWN OF NORTH ANDOVER 16 0 APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received Date Issued: RiyuKTANT: Applicant must complete all items on this page 041 LOCATION 1017 61Print PROPERTY OWNER. 461k�) �0,�L Print 100 Year Structure yes(Jno MAP PARCEL: 2,65' ZONING DISTRICT: Historic District ye no Machine Shop Village ye no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential [I New Building )9One family El Addition El Two or more family 11 Industrial ,I4.Alteration No. of units: El Commercial El Repair, replacement El Assessory Bldg El Others: El Demolition El Other WEP/?P`X`N�,�.,-,� ("�/0,111q PA 1pfli ,FJ,011 DESCRIPTION OF WORK TO BE PERFORMED, Ale 2 ,�e/V.Identification- Please Type or Print Clearly OWNER: Name: e X., 6 74� e Phone: Address: Contracto(Name: ell,") 61)&&f I) Phone: zS- 2 Email: A > 5')E Wri Address* Supervisor's Construction License: ",(L-5 71� Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT.,$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 0 FEE: Check No.: r Receipt No.: NOTE: Persons contractinZg * i un egiister ad contractors do not have ace to the g�ttara fund 7 f6ie78f M Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swunming Pools ❑ Well Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank, etc. ❑ Permanent Dempster on Site i THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OPE - U FORM { V ANNING DEVELOPMENT Reviewed On Signature' COMMENT � CONSERVATION Reviewed on Si nature "I'l llrztl,.� yu COMMENTS ALTH Reviewed on Signature J �. ..., 4. ... .... (.. .( COMMENTS e��:� ' � Ct° , wt.`s � �ti�❑.. �� (`�"� � "�> Y . J 4. ,,.. Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Con nectlonisignature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPAO—MENT',- Temp;Dumpster on site . yes Located at 124 Main Street FieD �artMpg,t-sigraatuire/date COMMENTS SORT H Town ^� ? _ 1,ofAndover 1�'� ®No1 6 6 ,T- _ T -/'.�/1 ,^^ T rO LANE h y Very d.SS.,TI•t V l az' I COC NIC NE W.CN A. A°RATED S if BOARD OF HEALTH oil R T Food/Kitchen 17 E M I T LD (� Septic System THIS CERTIFIES THAT ............. " .`66 e'.) . `�""�5......r..Ne: ..... .... BUILDING INSPECTOR ( 1S41�0-1 .,. has permission to erect .......................... buildings on .. I..... ... ..................... Foundation Rough tobe occupied as ........... 1 1. ........ .................................................................................... chimney provided that the person accepting this permit shall in every respect conform to the terms of the application 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 MONTHS PERMITI 6 MONTHS ELECTRICAL INSPECTOR -UNLESS CONSTRUCTIT)ARTS Rough Service ................ ............................................................. Final BUILDING INSPECTOR GAS INSPECTOR ccupancV Permit Required t® Occupy Building Rough Islay in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry (Nall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. - Burner Street No. Smoke Det. North Andover Board of Assessors Public Access Page I of I pORTH North Andover Board of Assessors roperty Record Card Click Seal To Return Parcel ID :210/106.A-0025-0000.0 FY:2015 Community : North Andover SKETCH PHOTO Click on Sketch to Enlarge Click on Photo to Enlarge "','Xk Search for Parcels WE Search for Sales Summary Residence 'r 8k 4' Detached Structure Condo 1447 SALEM STREET „' ` Commercial Location: 1447 SALEM STREET Owner Name: BURNS,MARY B C/O IRENE DEFREITAS Owner Address: 35 HERITAGE DRIVE City: LOWELL State: MA Zip: 01852 eighborhood:6-6 Land Area: 1.00 acres Use Code: 101-SNGL-FAM-RES Total Finished Area: 1792 sqft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 340,900 326,700 Building Value: 132,300 128,300 Land Value: 208,600 198,400 Market Land Value: 208,600 Chapter Land Value: LATEST SALE Sale Price: 16,000 Sale Date:02/22/1982 Arms Length Sale H-NO-COURT-ORD Grantor: BURNS RICHARD D Code: Cert Doc: Book: 01562 Page: 0141 http://csc-ma.us/PROPAPP/display.do?linl<-Id=2622678&town=NandoverPubAcc 7/28/2015 The Commonwealth of Massachusetts Department of Industrial Accidents It Office of Investigations ..600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: General Businesses Applicant Information Please Print LeeiblY. Business/Organization Name: D .2/vx/ y_" �✓�. Address: /k s 5 It 5°c' City/State/Zip: Phone#: %�' 26 Are y a an employer?Check th appropriate box: Business Type(required): ,Yani am a employer with employees.(full and/ 5''[ ]Retail or part-time).' 6. [�Restauran0ar/Eating Establishment 2.❑ 1 am a sole proprietor or partnership and have no 7. Office and/or Sales(incl.real estate,auto,etc.) emplayms working for me in any capacity. [No workers'comp,insurance required] 8. ❑Non-profit 3.❑ We are a corporation and its officers have exercised 9. ❑Entertainment their right of exemption per c. 152,§1(4),.and we have 10.❑Manufacturing no employees.[No workers'comp.insurance required] 4.r-1Weare a non-profit organization,staffed by volunteers, 11.0 Health Care with no employees. [No workers' comp.insukance req.] .12.❑Other *Any applicant that checks box#1 must also fill out'the section below showing their workers'compensation policy information. **tf the corporate officers have exempted themselves,but the corporation has other employees,a workers'compensation policy,is required and suchan organization should check box#1. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy information. Insurance Company Name: / �� Insurer's Address: /.2�5�" S� City/State/Zip: Policy#or Self-ins.Lie.# OV C, 6, dMl � �G/y :� Expiration Date: 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 tip to$250.00 a day gainst the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of t for insurance coverage verification. I do hereby cy, Inde the p in nd penalties of perjury that the information provided above is true and correct Signa _1,, / Date: 5 Phone it: Official use only. Do not write in this area,to be completed by city or town official T City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Licensing Board S.Selectmen's Office 6.Other Contact Person: Phone M www:mass.gov/dia OBRIE4 OP ID:ST AeC1t�► L7P" CERTIFICATE OF LIA ILI` Y IN U ANC bATE( YYYYI 0711x811281115 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(les)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 Phone:781-665-2990 HAW T F Ward Insurance Agency,IncFax'781-665-8703 Pg"�A°N o Fall: Arc No): 403 Franklin Street Melrose,MA 02170 b Ss; Pantano Vonkahle Ins Agency INSURE S AFFORDING COVERAGE NAIL fF INSURER A:Essex Insurance Company INSURED O'Brien Homes,Inc.&O'Brien INSURER a Construction Enterprises,LLC INSURERCI 18 Cass(mere St Andover,MA 01810 INSORERD: 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 TYPE OF INSURANCEPOLICYNUMBER MMIUDCD EFF M Y EXP LTR MIuODAWY LIMITS GENERALUABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY 3DW3366 11101114 11101/16 pREMISEs Eeocaarenm s --100,00 X CLAIMISWADED OCCUR MEDEXP(An onapmon) S 5,00 PERSONAL S ADV INJURY $ 1,000,00 '.. GENERAL AGGREGATE $ 2,000,00 '.. GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGO S 2,000,00 ''..... X POLICYEl PRO• LOC S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT , Ea auveentL,,,_, ANY AUTO BODILY INJURY(Por pe(son) S '.. ALL OWNED r7 SCHEDULED BODILY INJURY(ParaccWcnt) 5 AUTOS NON-OWNED PROPERTY BXWMF S HIRED AUTOS AUTOS (Per aaSdent S UMBRELLALIA13 OCCUR EACH-OCCURRENCE $ EXCESS LIAO CLAIMS-MADE AGGREGATE $ DED I I RE7gNTJON$ S '',... WORKERS COMPENSATION VJC S7ATU- I I OTHI- AND EMPLOYERS'UABILITY Yt ANY PROPRIETORMARTNERIEXECUTIVIE❑N N f A E.L.EACH ACCIDENT $ '.... OFFICERIMFMBER EXCLUDED? (Mandatory In NH) EL DISEASE-EA EMPLOYE $ Rppe3CS,RIPTION desaOON undo ''..... OEOF GPERA71DN3 6elocr E.L.DISEASE•POLICY UMn 4 '..... DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101.Additional Remarks Schedule,If more apace is required) General Contractor - construction of residential property CERTIFICATE HOLDER CANCELLATION TOWNNOI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood Street North Andover,MA 0104.57 AUTHORIZED REPRESENTATIVE SQA\ 0 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD - neo' �,N`L-nent lz,� Pu�o!ic S*i'e-'y ard, o� 3 Rc ons -C 0...Pto...I Z, C So, jldi; n S.I. ..d H..Ith AdmlNndnUon Con Clio n superN k0r, Ucanse: CS-028379 This card acknowledges that the recipient has successfully completed a 10-hour Occupational Safety and Health Training Course in KEVIN T OBRIEN-' Construction Safety and Health 18 CASSIMYERE ST KEVIN O'BRIEN ANDOVER MA 01810 Rick t Knight 3/29/2010 09/23/2015 (Trainer ....... ainer name—print or type) (Course end date) NOW%I A; H' USETTS, I i T o� DRIVER&LICENSE }l i tin, Fn inccr NUMBER _7 43 HE-139559 LY7, EXP DOSKEVIN T OBRIENfi 18 CASSIMERE ST 2`-20-2014 09-�3-195 LAS s REST HGT SEX ANDOVER NIA-01810 D 8 6-00 M 2a v,ai KEVIN T. 18 CAWMERE STREET ANDOVER,MA, D1810-2980 09/23/2014