HomeMy WebLinkAboutBuilding Permit # 11/17/2016 04 g3QRFf���
BUILDING PERMIT ar 6=s o f
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION °
Permit NO: � -` r` Date Received '_
o> 4a
Date Issued:'
IMPORTANT:applicant must complete all items on this page
r _
LOCATION
Print
j
PROPERTY
TY
MAP NO: ' PAAOEt yes tS � r
Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE j
Residential I Non-Residential
New Building One family j
Additioni Two or more family Industrial
Alteration No,of units: Li Commercial
Repair,replacement Assesso y Bldg { u Others:
Demolition Other
€ptic `_ ll 0 Floodplain `wetlands _ _ ,�atst d DisMd
Luer ' tis
k ac::\x _ ` Com,
Identification Please Type or Print Clearly)
OWNER: Name: `�I N
Address:
CONTRACTOR Name: a Phone-
Address:
hone Address,
perAsQes Construction Limnse: Exp. DaW, t
Home Improvement nt License: � . Date:
ARCHITECT/ENGINEER tT" Phone € ��
Address: S � , � c �� Reg.No
FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ES77MATED COST BASED ON$125.00 PER S.F.
Total Project Cost: `'i, i F FEE:$
Check No.: - Receipt No 7 1"Z_'f
NOTE; Persons contracting with unregistered contractors do not have access to the 05cardnti fund
Signature of AgelltiO ner Signature of contrador-
Plans Submitted❑ Plans Waived❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer TanningtMassage/Body Art ❑ Swimming Pools ❑
Well Tobacco Sales ❑ Food Packaging/Sales ❑
Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑
i
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF-U FORM
DATE REJECTED DATEAPPROVED
PLANNING&DEVELOPMENT Elt 2U) I-
COMENTS 1 � U F m mo . UG
CONSERVATION :j ❑ ❑
COMMENTS
DATE REJECTED DATE APPROVED
HEALTH ❑ ❑
COMMENTS
f� jf�g '?e, ,J M
Zoning Board of Appeals:Variance,Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Water&Sewer Connection/sfctnature&Date Driveway Permit
Located at 384 Osgood Street
FIRE,DEPARTMENT'-Temp Dumpster on site ';yes no
Located at 124 MainStreet
' ;
Fire Deparfinertt-sinatuce/date
COMMENTS _
`Mmension
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
Total land area,sq.ft.:
ELECTRICAL:Movement of Motor location,roast or service drop_requires approval of
Electrical Inspector Yes No
DANGER ZONE LITERATURE: Yes No
MGL Chapter 166 Section 21A—F and G min.$10041000 fine
NOTES and DATA—n(Eor department use)
I
f
❑ Notified for pickup Call Email
ate Time Contact Name
Doc.Building Permit Revised 2014
Town of "°RT" L Andover
o
No. 17r h * ver, Mass, (/1/+
* 0
ATED'11?
`r U BOARD OF HEALTH
PERMIT To I Food/Kitchen
%4.001W
,'��,,..�� r� y Septic System
THIS CERTIFIES THAT "�1.0 ...�....MC7�J.. ... BUILDING INSPECTOR
`MA Foundation
has permission to erect..........................buildings on. !I ..... .... ..
t Rough
to be occupied asArs6n1?ceptinAis
... �R �... f......• ........... chimney
provided that the permit shall in every resect 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
Final
PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
UNLESS CONST TIO Rough
Service
Final
BUILDING INS TO —
GAS INSPECTOR
Occupancy Permit Required to Occupy Suildin 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.
Albert Wyman Construction LLC
AW£LLC Phone.(603)765-2060
P O box 516 Fax:(603)974.2034
RE L JJJ)JJJ Plaistow NH
03865 Email;
t` "1 AWCLLC2006Qyahoo.com
2nd Floor Bolcony project I_-
To: Sutton Management C/O: Colonnade Condo.Association
200 Sutton St 1401 Great pond Rd.
N.Andover MA N.Andover MA
We propose to furnish the materials and provide the labor necessary to finish removing existing
cantilevered 2nd floor balcony systems,and replace with new 5'x 6'cantilevered balconies,with com-
posite decking and railings.
Scope:
Remove remaining balcony components and dispose
Install new 2xg pressure treated framing for new 5'x 6'balconies
Re install existing sliding door/repair and replace any damaged,or missing vinyl siding.
Install composite decking and white composite railing systems.
All waist and removed materials to be removed by contractor.
Cost per unit $6100
Total cost for above proposed on all units $24400
Cost does include permit fee
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as lay as you own your home.
Detotbeany—Rona perWft to these pars and any addWWRIterms pfrheWamunant You may want to Indude mnihsendesthat wiadteathe
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The Commonwealth of Massach'setts
Deparnnent oflndustriallAccidents
1 Congress street,Suite 100
Boston,JIfA 02114-20-11
"wtv.nuass govldia
VPovkers'ComgensationLusuraned Affidavit:Bvitder5lC n ba 0 ectiicians/pinmbers.
TO BE FILED W--ffTEE RM'MTIN A ..Tease PrintLe'bl
A'Iicant Informallon (�
Name(Rusines„0igaai ation/Individuat):
Address:
, nlL1 03€bs Phone 4'.
City/State/Zip: c — —
• rafebar. Type o£project(recluired);
A,yon an empIoyerY C4?clI tiro appropr 7 NeWd6na"611031
L®Iam aemployer with �`. employees(--A-dlorparttW-*
8. Remodeling
2.❑Is;nasole proprietor or partnership andhaveno employees Working£crmeir't 9Demolition
any capaa!ty.[Nnvrodmrs'camp.ins,ssaece required.]
3.01amahomeowncrlongallworkmyse$[lowoxkos' omp.nu ncerequ ed.]t
16❑Building addition
4.❑Tam ahomeowner andwillbe liking coatradoxsto wndact all work onmY ProportY-Twill
1I.D Electrical repairs or addiflops
onsuretlsst aL omtmetors eitherbavew kers'camnensation insurance er sz sole P undrin re airs or additions
proprietors withno"eaiployous-
12>[� B P
13.[jRoofrepahs
5❑Iama general cantractorandlhavohbmathesub-contractors listed enfho aHacfied sheet. 14 Other
These sub-cenhaetorshave omployees sndhaveworkexs'camp.insurance f
b.�vda are aeoxporafiogand ifaoffirshava exeraisedthcirright ofexemgfiaa peiIvlC-L c.
152,§1(4),andit'o have no omploYaSs-[Nowoxkers'comp.insyuuance required]
*AnYaPPucantthatrlxeaks�bx affdav tindioatmgthey are doing aA t nxkandthonbire outside contractors out eotmbraiit ncwafiidavitiadicatinS such
fi HomeoKueis who submiftLis,,, ..
tConaecfors that checkthis'•iwz.'."�-r'ust attacflod e^s the mustbr videOirfv ork 'ocomP�Palicy nnmbe�dstate whether eFnatfhoseentities have
employees.I£the sub-conhaatn.�have employ r, Y P ,
X am an employer that is providing workers'compensation insurance.for my employees. Below is t tepoTdcy and job site
information.
Insurauoe CampanyNan:e:
k�oyo ExpirationDate-
Poi cy#or Self-ins.Lic.9” S,v` l
City/State/Zip:
7obSiteAddress' I p shoFvngthepolieynumberandexpnationdata).
Attach a copy oftbewoxkers'compensa ionpoticy declaration age
Pa lure to secure coverage as required under VWL c.152,§25A is a criminal violet on pun shable hp a fnle ng to 1,250.00
mdlorone�imp oo�eot,aswouascivilpfm ie fo�rwardedtothe0M aooffrvestigationsoftheDIAforhssurancB
day againstp
coverage verification.
X do Zeereby certify under tlse ins and penalties ofperjary that M-information provided Eav is true an correc.
.r Date: t) I
Si attire:
Phare#: �j3_ �
of,ficial use only.Do not write in tllis area,to be completed Ey city or Town official
Permit/License#
City or Tovvn:
Issuing Authority(circle one): p ector
I.Board of Health 2.Build ng pepartment 3.CRYiTow t Clerk 4.Electrical Ins ector 5.Plumbing Iusg
6.Otber
Phone#.
Contact Person:
From Allio GoUld F-10:G4ark ln;<.,rannc Oatc:10l10ROiG 2:0254 PM Paoc:2 of 2
ALBEWYM-01 AGOULD
ACQRI?" CERTIFICATE OF LIABILITY INSURANCE nn10/191 016
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THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFIGATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THI5 CERTIFICATE OF IN5URANGE DOE5 NOT GON51ITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER,
IMPORTANT- If the certificate holder is An AnnITiONAI INSt.iwn,the policy(ies)mR5J have AnniTIONAi INSURFn Provisions or he endorsed
If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain Policies may require 3n endorsement.A statement on
Ihlx GertlNcate doer oat Gonter r htti to the Oertllicate homer in Fleo or xdch endorsement s).
PRODUCER U.Imsef)AGR01SO rdR�T,or
Clark Insurance fAlf Nn.Pd't6p3)622'2$66 i�rc,.NRr(603}622-2$64
Duc 11—di.1 A—S.,i6,302N P-Man
Manchester,NH 03102 �;ngouid(delArk ri8uren0e eam
INSURERjSJ,AFFOROINC COVERAGE_ ,__ ., NAICII _,_
_ INSURERA:Ohfo Security Insurance Go 24082 __-
INSURED _INsuRER e„Ohio Casualjyansurance Company _.'24074
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P n,Rov 516 �R o
Plaistow,NH 03865
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oC1CRICTION Or OPCRAIiONDt LOCAT4oNot VCtIICICe{AC6Ror ..vet n.v.a,#eO.fiarlNs,mre.4e enec14cfl 41 vt:na eyaca to reyulraJ)
flifitnrs ftIrdariod Imm workers rnmpensAtinn'AlhnTf WYen In
Workers Compensation 3A Include.MA and NII
I
rCERTiFiC�LT£HOLDER CANCELLATION
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.
120 Mal.St,
North Andover,MA 04845 ..._......._.. .......... ...__..._ ......._._......
......_.._
AUTHORRRED REPRESENTATIVE I
�....._................... _.....;
ACORD 25(2016103) d 1988.2015 ACORD CORPORATION All rights reserved.
The ACORD name and logo are registered marks of ACORD
y �ea� ra�avaa��a�C? lel a r�aCLaal�i
Office of Consumer Affairs and Business Regulation
10 Park Plaza-Suite 5170
Boston,Massachusetts 02116
Home Improvement Contractor Registration
Registration: 180635
Type: Individual
Expiration: 12/11/2016 Trk 261034
JOHN WYMAN III __._.. -��.....__.�_.,�...-...—.—.. ---
JOHN WYMAN
P.O.BOX 561
PLAISTOW, NH 03865 _--------
Update Address and return card.Mark reason for change.
Address D Renewal O Employment (]Lost Card
SCA 1 ci 20M-05111
Board of Building Regulations and Standards
License:C"42330
Construction Supervisor
JOHN A WYMAN,JR
P.O.BOX 838
HAMPSTEAD NH 03841
Expiration:
Commissioner 04/182018