HomeMy WebLinkAboutBuilding Permit # 8/29/2016 TOWN OF NORTH ANDOVEk
APPLICATION FOR PLAN EXAMINATION
Permit NO:ryJ ;7.� �-- ,� Date Received
w
Date Issued: '
IMPORTANT: Applicant must complete all items on this page
LOCATION
Print,.,
`PROPERTY OWNER 41yV
Pant 100 Fear7Cd StrGcture y no
MAP NO: PARCEL: ZONING ![STRICT ..,-.....___Historic District e no
Machine Shop Village e no l
"4
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
----- ----------
❑ New Building One family
❑Addition ❑Two or more family ❑ Industrial
❑Alteration No. of units: u:::l Commercial
Repair, replacement ❑ Assessory Bldg ❑ Others:
❑ Demolition ElOther
11Septic ❑Well u Floodplain ❑Wetlands ❑ Watershed District
❑Water/Sewer
DESCRIPTION OF WORK TO BE PERFORMED:
`'"A i P Rzo 5-)/) /. /V Z 4/. gip„ " "5 -Iz
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/ 4--,6.Z` '" 61. "I ° -1, 4" c >�
_. ,_
Identification Please Type or Print Clearly')
OWNER: Name: 1-9 -" "F iq Phone: 9, ,,p , � -/ gc"j
Address: 1 / O' i " , ° , 'cw-1/7,14-
CONTRACTOR Name: -'4_ 7%57PW Phone: 7
Address: a 1. . 4 .tw
Supervisor's Construction License: I-A�Z,4, Exp. Date:
Home Improvement License: 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 cls)not have access to the guaranty fund
Signature of A enflOwne &, ,_,�Signatureg'9 g of contractor
Plans Submitted p fans
FJ Waived ❑ Certified Plat Plan �� Stamped F�' ������
tAoRTF
Town of z q _ A,... 6 ndover
0
No. p _
�� ILAKRh ver, Mass,
'Q COCWC"EwK■Ab
�•9 °'urea ,.ea��,�5
S U
BOARD OF HEALTH
PER I T
Food/Kitchen
Septic System
THIS CERTIFIES THAT ..... .v ,...,. . BUILDING INSPECTOR
...... ......
has permission to erect .......................... buildings on ..ats...a......
Foundation
Rough
to be occupied as .... ........ � ,. .. ., �. + Chimney
provided that the person accep ing this permit shall in every respect conform 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
Final
PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR.
UNLESS C 5TP!OUBUiLDINGIN
Rough
Service
Final
EC R
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 pet.
I
Plans Submitted ❑
PlansWaived-11 Certified Plot Plan ❑ Stamped Plans ❑
.T-YPE_OF.SEWERAGEDTSPOSAL'- ..
Public Sewer ❑ Tannin Swimmin fools ❑
g/Massage/Body Art ❑ g
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'- ] 0
COMMENTS
.CONSERVATION Reviewed on
Signature
COMMENTS
HEALTH Reviewed on
Signature
COMMENTS
Zoning Board of Appeals: Variance, Petition No:
Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
!Dilater Sewer Connection/Si nature 8� Date
- Driveway Permit
DPW Tbiv;, Engineer: Signature: E
PFF'ire
E-D'EPARTML�I7' Temp Diampster on site es Located 384 Osgood street
ted"at 124 Mair StreetY - no
Departrnerit-signa#urb/date
COMMENTS
NEW ENG.LAND CUSTOM DESIGN, INC.
226 LOWELL STREET
WILMINGTON,MA 01887
#978-658-0881
florne Improvement Contract Registration No. 102.467
ROOTING AND SWING AGREEMENT
This is a legally binding contract.Make sure you read this Agreemoit and understand it before signing it.Oo not sign this contract if there are any blank spaces.
NOTICE:All home improvement contractors and subcontracrols,injess specifically exempted by Massachusetts law,niust be
registered with the Commonwealth of Massachusetts.All inquiries abour registration should be directed to:
DIRECTOR 1-10tIL-IMPROVEMEN'I'C:()rJ'I'KA(,'r(.)It RRGISTRA,riON
One Ashburton Place,Roctin 1301
Boston,Massachusetts 02108
"telephone:tt617 727-8598
his Agreement is nade on.___
by and between New England Custorn Design,Inc.Otewinafter,"Contractoi
id owner f) -einafter,"Owner"),of
19 (her
ity Towl I State Zip6q-t/�(H)Phcln,2��Cef6 /7S_0
'•57 (W)Phone �i)r-
Custom Design,Inc.Salesperson T7,:]=F ZL_z 76,,r_ .................................
Roofing will be applied only oil slope roof surfaces below,over Present roofing shingles Unless specified under REMARKS.
MATERIAL Color
go Main Roof liar windows ................ Extensions
porches:Front Side
Real Other Roofs
NOTE:Roof board replacement cost V per foot OR
per.T x 8'shect of
inch(.DX plywood.
EMA RKS EXTRAS:Missing or defective fit in ber is not included in any category of work u it less specified here.
4
6
?b P,:c !:Pv
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al d?.
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(c, In, J -jx�,zgz,,�,,
Die Contrartar jKnes to perfonij in a good and workmanlike matmer all%vork detailed allove. B(/ -rIV
CASH PRICE $ Zr Note:All Roqfing Customers:
DOWN PAYMENTS New England Custom Design,Inc.will not be
PAYABLE ON S I'ART OF WORKS
PAYARLP S held responsible for dLlStand debris falling in
attic areas during roofing installation.Please
PAYABLE TI(.NS C)
remove or cover valuables.
DATE: 20 IL
RIGI ITTO CANCEL
ia own-may cancel this agreement if it has been sq;ncd by ch,Owner aca place other than the.a(dress of the contractor.which may be his main office or branch thereof,provided that the Owner
aifivs the Contractor in writing it his main officco,blanch by ordinary nail posted.by t'leg—n sent or by'lelively,not later than midnight of the third business day following tire signiiigof this Agree-
e.lit.See attached Notice of Cancellation.A c-ceflatron fee representing 3014,fthe crsntrict price will be in effect ifcancellation is requested alter the legally allotted trint,has elapsed.
ic owner hereby certifies that he has read this Aglcenicnt.that the teens and conditions and the meaning thereof have barn e_xplainvd in him,and that he fully
y Iniderstands thein and that there,is no t
idea standing betweer,the.pities,verbal or othcmrjSC,tljao that which is contained in this Apernuml,and agrees that the said contractor is lot re4xonitA,nor bound by any rcprecennations not C.011n
inedio this Agreement,made fry any ofits agentsunless the same be reduced to writing and signed by the Co itr>tor.
Tl'rr,N i ler K NN7NrR NOT SIGNTHIS CONTRAfX IFTI-11-3,YR ARE ANY BLANKSPAC:
• /_Z�2
e,
aoire
s S a e Net lngi.,� Date,
tjrc
-wrier s Signal re Date A
1PMassachusetts Department of Public Safety
Board of Building Regulations and Standards
License: CS-008828
Construction Supervisor ; ,
VAL J LANZA
34 BIXBY ST
REVERE MA 02151 ..:
Expiration:
Commissioner 04/2012018
C~���1��?'JJ-
Office
:Offce of Consumer Affairs and Business Regulation
10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Registration: 102467
Type: Private Corporation
Expiration: 7/2/2098 Tr# 419291
NEW ENGLAND CUSTOM DESIGN, INC.
Val Lanza.
226 LOWELL ST.
WILMINGTON, MA 01887
Update Address and return card.Mark reason for change.
iCA 1 r,;, 20M-05/11 ❑ Address [] Renewal ❑ Employment ❑ Lost Card
'q CER_T_IF_I_CA_TE_ O�_L_IA_BILIT_Y_ fNSURA_NC_ E °""'jmmfoo fyy'
a�Iaix6
THIS TE 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 COVE;RAOF AFFORDED BY THE POLICIES
BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE 18611ING INSURERIS), AUTHORIZED
REPRESENTATIVE OR PRODUCER,ANP THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an AA"nONAL. 114UREq, the policy 06) must bs Widarsad. If SUBROGATION 13 WAIVED, subject to
the terms and conditions of the policy,certain policies may require an endorsement. A stat tent on this certificate does not confer rights to the
certificate holder in lieu of such endorsementls),
Kilgore Tnsliranas Aganay PHONE — Rax
--'•—•— -.—
55 -
5 CentOrxnial Drive .�,1ry 97ti 531^60 x" ry9701 531-0442
_
Peabody, MA 01960 Aft6s: µ
INSURS 6 AFFORl7ENG GVEA
ggGE
..�._......_ .-. _....._ NAIL 0
......... .. ........ .... IN511RERA:WeatI!rn WOrl.d Tnatirance
iNSUAW
INauiiEvzo:Trave:lera Insurance Company
New England Custom Design InsuRER c. •��—
Ron Weinberg -- -- .._............. ...
:
226 Lowell Street / Unit; B4-A IhPPRFltn W ---- _-._... ........._____....._-
Wilmington, MA D1887 1%Sl6.€ -- -- -_-....
INSURER F_:
COVERAGES I IER_Tl FICATF NUMRER: REVISION NUMBER:
T141S I$TO CERTIFY THAT THE POUCIF$OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMW AUOVIE FOR THE POLICY PMOD
INDICATED, NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THrS
CERTIFICATE MAY W ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBE-() HEREIN IS SUBJECT TO ALL THE TERM$,
EXCLUSIONS ANDCONOITION$OF SUO-i POLICIES,LIMITS SHOWN MAY HAVF WEN RFDXED BY PAID CLMMS.
INSR -..._..__.,......_—._._... ..........
AW 1.StlI1R -.... . ... ...---.... .. _._..._..----. -.. . . _..
LTR TYPE Of INSUAM Pol.iL7'EFF PODG'(�E]CP
_ PpIJCY NUMRF:Ft IAK><1!V MMID[YYVYY LN,�TS
GENERALLIABILIYV y NPP1403151 3/14/16 3/14/17 BACHOCCURRENCE 3 1 000 000
J_J-__......
X_ coaniERcwI.cENeaALLrrslurY cAMAGEroRENTED
� s 5Q 000
cLAxhS+nanC C�OC(uR NISOW(Any OMpenon) 5 _ 5.000
'— PERSONAL6ADV INJURY �....1 DQD DOQ
GENERAL Aa GREGATE 3 2--ry ,( 0 i()Q0
GEN'L AGGREGATE LSrS T APPLIES PE R PRODUCTS.00?*4P AGG 1 S 2 (}0(L).'()'0()
POLICY PRg: LOG g —
AUTOMOaILBI.IABIrrTY — C ED.IN L LIMrr
F 5 ncdearw --
ANYAUTO BaaILYINJURY(Parpaaon) S
ALLOWNFO SCHEDULED
AUTO$ AUTOS BODILY INJURY(Por Toidanll 3
HIRED AUYOG AVTQSWNE()
PBr&oCltlOrtl
UASdREU1�LIAe OCCUR ♦asGH OCCURRENCE ! w
_ T
IJ(CE&6LIAB CLAIM:�MAOe AGGRPGATE — ; �-
OED RETENTION f _.__.
B AIDE MPLcERS'LIAILI'T ?PJIM-0239N23--2-15 3/14/16 3/aa/17/i7 X wcsrATu- OTH. s
AND r�APLaYERs•uA61LITY YIN
CFRNE&*4REXUWED?"�� � NIA E L.EACH ACG DE NT 1�p 0 000 —
IM;Indabry in NM) EA F_L.OESEASE. ETu1Pr1lYE DO,DOO
Ir as aeatrlCOundQr
DESG`RIPTIoNa1-OPaRATIDN5p0raw f.L.DIS EASE•POLICYLIMR S— 5001U00
fXSCRIP TION OFOPERAMINSIU>ATIONSIVWraa IA WI1ACn#W1M.AdStiondRarnarlas gcheaule,iffraxeepttceArogrinedl
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE AWVF DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERER IN
ACCORDANCE WITH THE POLICY PROVISIONS,
ALITifORI2CD REPRESENTATIVE
CV"!j A. Kilpare
_._. ---i—i_ _--------- --—
i._...'..`._.......- �18613 1110 ACORD CORPORATION. All rights resorv+ed.
ACORD 25 2010105) The ACQRD name and logo are registered marks of ACORA
Phalle: Fax: E-Mail:
North Andover MIMAP August 29, 2016
2.12.5 TURNPIKE ST � 108.0-0142
108.0-0053 108.0-0010
/ >* 108.0-0009 13
✓ 2135 TURNPIKE ST
/// 108.0-0054
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2147 TURNPIKES, \ 10$.0-0008
108.0-0055
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108.0-0032 .G-0056 f 108.0-000
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2177 TURNPIKE ST
108.C-0066
108.0-0044 e
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2189 TURNPIKE ST
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'109.C-0067 / 108.c-0060
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'e, 2163 TURNPIKE ST
108.0-0059
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108.,0-005
108.C-0038 \
i.^r�af"W'rlr.
108.0-0042
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(108 C=0043 " 108.0-0039
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role;
[]MVPG as Zoning Overlay Zoning
C7 Municipal Boundary Adult Entertainment Dishic Busing s 1 District
ISA Machine Shap Village Ove Busine.s 2 District Horizontal Datum:MA Stateplane Coordinate Sysiarn,Datum NAD83,
Rail Line rel Watershed Protection Dist M Busine s 3 District Meters Data Sources:The data for[his map was produced by Merrimack
intershies El Historic Mill Area M Busina.s 4 District AORTH Valley Planning Commisslon(MVPC)using data provided by the Town of
k!" Medical Marijuana R.Genera Business DistdetOf 4rp "q�, North Andover.Additional data provided by the Executive Office of
.....,SR Dowreown Overlay District FA Planum Commercial Dev <<* r s ry 4 Environmental AffairslMassGIS.The infomration depicted on this map Is
E)Historic District Corrado Development Dist ,�} r' OL for planning purposes only.It may not be adequate for regal boundary
Roads Osgood Smart GrovAh(40 1. Comido Development Olst 0 .., fi definitionor regulatory Interpretation.THE TOWN OF NORTH ANDOVER
0.a Easements Hydrographic Features N Corrado Development Dist (" p MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING
Industri I 1 District At y THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY
❑Parcels Streams Industri it2 District 'A i � * OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT
WetlandsIndustri 13 District y, c < w n� ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF
0 Iridas(ri I S District 4p< ""`" THIS INFORMATION
Exempt Lands Reside ce t District
Reside ce 2 District SSAHLig�
Re., ce 3 Distdet
de r:e 4 Distinct
1"= 144 ft Y de ca 5 Drs cl
trio ca 6 DtsWet
,�a esidentlal District
Tile Commonwealth of Massachusetts
Gu IR
Department o f Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 021.11
www.mass.gov1dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Ledbly
Name (Business/Organization/Individual): r,:!-A'KJA "d CUT6,4,
Address:-,2-1,� 1.6" 97'
Ci�y/State/Zip: Wi e/' ?,'2 Phone 0:
Are you an employer? Check the appropriate box:
I Type of project(required):
I.[ff,[-am a employer with 6' 4. ® I am a general contractor and I 6. R New construction
employees(full and/or part-time), have hired the sub-contractors
2.0 1 am a sole proprietor or partner- listed on the attached sheet. 7. E] Remodeling
ship and have no employees These sub-contractors have 8. Demolition
working for me in any capacity. employees and have workers' 9. Building addition
[No workers' comp. insurance comp, insuranceJ
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' compright of exemption per MGL 12.E] Roof repairs
insurance required.] t c, 152, §1(4), and we have no
employees. [No workers' 13.El other
comp. insurance required.]
*Arty applicant that checks box#1 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,
lContractors 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.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:_ J A VI T L rz,tZ S
Poiicy#or Self-ins.Lic. M 7 P iv 9 10"7 Expiration Date,
Job Site Address:
's"T City/State/Zip:
Attach a copy of the workers' compensation policy declaration page(showing the policy numb6r 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 and penalties ofperjury that the information provided above is true and correct
St nature, Dat,
Phone
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 S. Plumbing Inspector
G.Other
Contact Person: Phone#: