HomeMy WebLinkAboutBuilding Permit # 9/8/2016 t%ORTH
BUILDING PERMIT 0*
TOWN OF NORTH ANDOVER 0
APPLICATION FOR PLAN EXAMINATION
Date Received_ ATED
Permit C140
Date lssued3cis,1 (7—v
IMPORTN
AT:_ApLlp�rlt must complete all items on this page
LOCATION 9 3 __A a L�,u sot,
Print
PROPERTY OWNER— 4
Print 100 Year Structure yesno
MAP PARCEL: ZONING DISTRICT:, _---Historic District yes no
Machine Shop Village yes no
TYPE 6_FTM_FR0VtMENtPROPOSED USE
Residential Non--Residential
[i New Building E.-I One family 0 Industrial
0 Addition o Two or more family o Commercial
D Alteration No. of units: —-------
El Others:
R7emoEl R pair, replacement [.1 Assessory Bldg
el
lition Ei Other
' t"t"`
E,-] S60C 0,well 0 Flbbdl3lbin n bq�d Distract
qq
El Wat rJS,'
DESCRIPTION OF WORK TO BE PERFORMED:
Identification- Please Type or Print Clearly C,
Phone: 1'7V a�S_—
OWNER: Name.
6A13
Address:--
Contractor Name: AiCl S,.vll �Id- , Phone: I"7r
Email: 42— z /I I Q-+
Address: /Y) 14e K_ /
Su ervi or's Construction License: Exp, Date:
>
V
Exp. Date:
Ho e Improvement License-
rr
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.: Receipt No.:
NOTE: Persons contracting with unregistered contractors elo not have access to the guarantyfund
------------
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Town of 2 _ ., b ndover
No. .as _
Z01,P__ La�o R )x ta
h ver, Mass, 5. bov N-wr (two-9w�r-
-16
C0C"1C"E W.0 4
V
S U
BOARD OF HEALTH
Food/Kitchen
P E R LD Septic System
THIS CERTIFIES THAT ,,,,,, BUILDING INSPECTOR
................MJT .
T�,
.. ........... ... ........ .......
has permission to erect .......................... buildin s on . ��..„ 4� ! ..( .�.,,,, �i ..... Foundation
0
.rto Rough
to be occupied as .... `.. ... � .� ...{��, . ... ....... Chimney
provided that the person accepting this permit shall in every respec confor�the terms of the applica ion Final
a
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
1
Rough
VIOLATION of the Zoning or Building Regulations Voids this Permit.
Final
PERMIT EXPIRES 16 MONTHS ELECTRICAL INSPECTOR
LESS CONST TIO 10
Rough
Service
...�. ....... ........ ....... ....
Final
BUILDINGINSPCT
RW
GAS INSPECTOR
Occupancy Permit Required t® 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.
Plans Submitted ❑ Pians Waived ❑ Certified Plot Plan ❑ Plans Stamped A. ❑
TYPE OF SEWERAGE T
Public Sewer TFood
Tanning/Massage/BodyArtlsTobacco Sales g/Sales ❑Private(septic tank, etc. Penuanent Duu�pster on Site
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF e U FORM
PLANNING & DEVELOPMENT Reviewed On
Signature
COMMENTS 1V #-
------------
,/ CONSERVATION Reviewedr
on Si nature" `
COMMENTS
HEALTH Reviewed on 7f f Si nature
COMMENTS 0' (C
Zoning Board of Appeals: Variance, Petition No:
Zoning Decisionlreceipt submitted yes
Planning Board Decision: Comments
Conservation Decision:
Comments
Water& Sewer Connection// naturo& bate
. l7rivewa Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street
FIRE,DEPAI TIMI=NT TetriP-;QUr7.. =7f
e
Located a# 124 Main Street ;
� Fire De a I COMMLNTS :;
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.$1oo-si000 fine
NOTES and DATA — (For department: use)
I � Le 1
1 i
Q Notified for pickup Gall Email
Date Time Contact Name
0
Doc-Buildiug Ponuit Revised 2014
B.
j .
I
0
S
BATE,SON ENTERPRISES,,ry INC
11. 1 rgil I aRoad A ndover, X 01814
Phone: (978)475-1474 Fax: (978)475-5451
July 28, 2016
Mr. Steve Mouzakis
693 Johnson Street
North Andover, MA 01845
Quote RE: Pool Fill In
Fill Pool Including:
Permit
Remove Walls, Liner, Shed and Haul to Disposal Site
Remove Patio Block and Small Shrubs
Fill and Grade Pool Area, Compact
Prep Area with Stone Dust for Patio Stones
Loam and Seed Areas of Excavation
Total Quote: 4,500.00
Thank You for the Opportunity to Quote.
T.,��
odd Bateson
Approved By
Commonwealth of Massachusetts
Title 5 official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
693 Johnson St.
Property Address
Gaffn
Owner Owner's Name
information is North Andover MA 01845 May 26, 2014
required for
every page. Cityrrown State Zip Code Date-of Inspection
D. System Information (cont)
Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to
at least two permaent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate
where public water supply enters the 6bilding. Check one of the boxes below:
® hand-sketch in the area below
❑ drawing attached separately
k--���
mar: a 9
porgy lam.
�E
u
1�t De"
d
? t5ins•3113 L Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 o€17
0 Ci,n 1�Yr4Oi.
08-31 16 11 :59 F ROM— 07855721 K T-267 P0001_/_0041 F-25-5
4�1 -, ' CER`TIFICATE OF LIABILITY INSU ANCE o 0883 )201 vvl
TEAS CEltTIRtCATE I&ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICJATL? DOES NOT A1eFIRMATIVFaLY OR NROATIVEL.Y A€WFeNI3, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE 0CIL"s9 NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE W)LDEFR._
IMPORTANT: If the eortlficat*holdgr is an ADDITIONAL INSURED,the pollcypas)trltJst be endorsed. IF SUBRO43ATION Is WAIVED,subject to
the terms and condition:,of the PONOY.OlftUln poliales may require an wdomenlent. A slratament on this certiHtWo does not confer rights to the
certificate holder in lieu-vf su oh enOQMjerr+04rik
PNoouceR "_ilAiclLaud l�iP/e&Ru&oak _ -- -
Michaud,Rows And Ruscak Ins. }<978 488 8828 W -_r+er.97 5572130
P.O.Box 10$
North Andover,!IRA 01046 ��� --
MiehaUd,Rowe&RuwAk INSURE acove€4c _ 14AIC0
€ SU€ERA:HarieyvilieInI#VranceCompMnY _ 26182
INSURnsBateson Enterprises,Ino _ r INsuRFJZa:a�'7S I �If13nGC Ct III�an 92808
Todd Bateson Iris PGwNorGuard�_
11 i Argilla Rd
Andover,MA 01010
COVKRAGES CERTIFICATE NUMBER: REVISION NUMBER, _
THIS 18 TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE 13EEN ISSUED TO T"HE INSURED NAINEO ABOVE FOR THE POLICY PER144
INDICATED. NOTWITHSTANDING ANY REOUIREMENrT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT'TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE WSURANC E AFFORDED BY THE POLICIES DESCRIBED HEREIN iS SU€3JF'CT TO ALL THE TERM$,
EXCLUSIONS AND CI:IND(TTONS OF SUCH POLICIES.LlM"$HQWN MAY KAYE BEEN REDUC60 BY'PAJO.0 LAIMS.
iLR
TYPE OF INSIR/WCE o`er PUBIC _err FlU€iEia472 �y .� LIMITS
A X OOerMaRcIAI cENertAL Luisturr FACT+OtAU�tscE aF t 1000,00
CLAIMS-MADE X OCCUR I 6IIPAY4 42E 0610,1201$ 0510112017 5 Pr r�r •B eso urepnceL 100,06
�—nn a+s ) 16 5�0
j P6R O"I 8 A111 INJURY S 1,400,40
WRLA01REGATELIMIT APPLIES PER; I GENERALAOGRGOATE 0 tow0B
POLICY 0 PR- LOC I PRODUVrt,j OMPlpP AMG S
AUTOM OWLE L11Ui UTY G LE LIFA
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ANY — � �24339T'f 071UFI2016 07f021Y017 BC�OILYINJURY MorpsPwl s
ALL QVUTOS ED CIIEDULED s06€LY INJUIdY(PBf 9CeidacQ) x
N WNED
NIREQ AQTvs AUTbs
us€ascu A una X occur — i - sAGI ocourt>Q�Nce s —_ 11000,00
A t3S UAS CLAlMC•MAAE
jCM8627000 0f�l0112016 0$101120171 AGGFIEGATE $ _1,000,00
RET TION 0 I 6
WORKUWCo€MPENSATION X Y
ANDEMPLOYERS'LABNTTYBAVYC777632 Oi1Qt1aIa1S 01/QiF2I347
C �PRIZINER
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ANYACCIDENT S .�
[O[FFIG�12A&Ms r.XCLUMM � � E.LINSEAM-9AEMPLOYEE
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71p �cJOW _ � ! EL,DI8EA8£-P LIGYL€MIT 3
OE$CI0.IPT�ON OF OpERA110k$!LOCATION&1 VEtIICLES !ACM 101.Aa1;l1 M&I Re+BAN 9 444,IMY 14 QUID "If MW 6WO it iaryufred}
CERTIFICATE H!RLDER
-- w CANCELLATION
NORT1413
SHOULD ANY ayf'E'Hla ABOVE L7l:6CR►BSI3 F'[1L9C1E&9E CIaWCELLlfiI}IB£FBRfi
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DIELiVF.I ED IN
Town of North Andover ACWRDANC6WITH TJIE POLICY PROVISIONS.
8844 Osgood Street
North Andover,MA 01846 AU•TI10IUM REMSENTATPIB
--_� 0198&2014 ACORD CORPORATION, All rights reserved.
ACORD 25(2014109) Tho ACORD nanw and logo Are registered marks of ACORD
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The Commonwealth of Massae husettg
Department ofIndustrialAceldents
I congres$stpeet, ,Smite 100
.° gostoR,HA.0211W 2017 ,
a www.mass:govldia
" �'�t�;l�exs'Coxa-pezlsa�za�.�s�.u'a�zce.A..£�davi�t:B�dexs/Cox�fxac�orslEXecixze .sl.�'X�bexs.
TO JOE'MED WffR TJ32]?ER TT'NG AUTROMTY-
A Rican#T axxrxation )? easaPxiut Legibly
Nam(-, (B €esslOrganizaiiar�l�di�zdaal): �•�€l e sc,.v �iv - -���
Address: l� zlu- f114 �
CitylStatevzip: - '
Areyou an employer? Checl�t7ioap�iropxiatehoX; Type of project
S. aamployezv�itb€ . ! employees(fullaudlorpartthne).* Nowcozi5tx ofion,
2.�I am a sole propzWo:�ar partnership and have no employees vgorlring forme in 8. ❑Rernodeliiig
auy capacity.[lda-workers'comp.i-O=anoe required g_ Demolition
I fJ jam ahomeownerdoingall workmyseI£[NO vwarkers'comp.iusurauee regtured.]� 10 $txil#g ad[ISf7on
hElTa-mahom.eownerandvrillbahidngcont£actorstoconduatalIwozkonmypzoperLy. r3xs
ill �Fjeotrzcalxopaor.a-ddiiaus
ensuze£oat an contractors either haus workers'compensation insurance or are sole r .
pro'p'rietors wzthn-o employees. 32:Q Plumbing repairs or additionB
5.�X am a general co?�trac#arandT lca�e hired the sub-cantracforslisted ontlae affaclted s1 eet. 13:p Roo rep3iTs
xhese stib-coniractorshaYe eii�ployees andlrave worl�ers'comp.insruanoe�
14.El O'Ebez'
6.❑We area cozporatagM pad ifs ofcers have exezoisedthdr rigbt of exempti0aperMCrL r;.
152,§I(4),a ndwehavepq, rp-w rkers'comp.iusmawaraquked.] t.
��y applicant-that eheclosh axs#1 must also'fdl.outfhe session belowshoevingtheirvrozlcers'compensaiion polioyin,-azzu?iinr3.
iHomeovrtterswlrosiztiuiif' is zdavitzrrdica#ingtheyoradoingall orksndtbenhireoutsideaontractorsmsrstSil�nutanewa davr cats snob
xContractors Yhatrhecletlzisbogmols a�Eache[I an additional sheet shov7ingthw name oi"the sub-mntzactors and state wahethu or�ot those entities have
employees. f the sub cniacEors 1isYe employees, eymust pravidethaiz rrorkeis'comp.policy number. :
I cin an errzployer�iTz at zsp�ovidifzg orkeYs'compensation insurancefo:r my employees:'Belov is thepomey and jab s=zte
inforanatiorz.
Insurance Company aTaan-e:
.��-w L,. l �1�
TOHV,y#ax Bele.Zic.#: 4��. I
CitylStatel71p:0 60
Job Site Address:
Attachacopy ofthan lZexscompez satiorzwbzgfizeipoiicynumbexandexpatioa eerie).
Failure to secure co�esage as zec�ed-t�dex MGL c. 3.52, §25A.zs a criro��.l�ala�.an puz�s�.able dry a dna�p to$1,5fl0.QQ
and/or a �year ianprisonment,as weld as eiv)1.penalties in ibe form of a S' P WORK ORDF�k�.and a.f ne of up to$250.0 0 a
day against the violator.A,copy oft7azs statement may be forwarded to the Of ca of lnvestigatioxts Of'thODI&fOrfi]:i112aZ100
coverage vexff<catiort.
Z '---'-e�y cextify u er ze pazrzs and � pe�7��'gjai�the irzformaizonpr�oWded above€s due and cor'�ed.
�.�--- - Date: �� l
Si ature:
P
ficlaZ use only. Do not tt�rite in this area,to�s cornpletedTiy city Or ior.�rz offidal
City or Tow.: 1'erix�it/License
Issuing AirthorRy(circle One): i
1.BOarcTof$ealth2.Buildi gDepaetment 3.CitylTo Cle)A 4.Electrical Inspector 5.?lumbing7nspector
6.Other
Contact Persoxa: Phoxxe#:
a:
Co
mmonwealth
Of MASS
.� ' eAartr:,eat of public S Setts
License:' "P"1eel Safety
HE-033250 .
TODD `L ti E:r'r:5
94 8 3 BATS n>�
AND R =01 .
�.
ms's• �`�`
C°mmissioner
,6XPiration:
03/09/2017