Loading...
HomeMy WebLinkAboutBuilding Permit #459 - 1 HIGH STREET 12/21/2009 BUILDING PERMIT of NORTFt ,S1.tD I° tiO TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION F°- Permit NO; Date Received �9•o,, T°o^ "� c►+uss� Date Issued: PORTANT:Applicant must complete all items on this page LOCATION �-�rl� ��..'E _ p K L MA OAS IN PROPERTY OWNER 6G4-atalD � [i /�/ /t/.S'UGZ /yCi�;rd,•k Print MAP NO: PARCEL: 01 ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteratio No. of units: ommercia_ Repair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: Homy oWa (f OA/ //cr r _5-,0_r=, Identification Please Type or Print Clearly) OWNER: Name:= (iT� 11 Phone: 1122, Address: 21/ VL (c4t?vd CONTRACTOR Name Phone. Address: 0LIA0 S{' St, 30_2� 4 V a Supervisor's Construction License: 5�Mr7 Exp. Date: 315-111 % Home Improvement License: ------- Exp. Date: ce"Ot yh r� ARCHITECT/ENGINEEk A ehd ��Y ` Ir' Yln h -� Ir'IQi � �fione. � 35D O�kSb Address Soo A STY'yk. Bo HA MA O Reg. No. ¢�2� FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ �t� f��,n0 FEE: $ (12jZ.0 0 Check No.: Receipt No.: -90-7713 NOTE: Persons contracting with unregistered contractors do not have access un Signature of Agent/Owne �N IL Signature of contractor i 'J TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION Print PROPERTY OWNER Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: CONTRACTOR Name: Phone: Address: t Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: S 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 do not have access to the guaranty fund Signature of Agent/Owner Signature of contractor Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc: Doc.Building Permit Revised 2008 � I q Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art Swimming Pools 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 COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS ,iZoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments ti Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS 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.$100-$1000 fine NOTES and DATA— For department use ❑ Notified for pickup - Date Doc:.Building Permit Revised 2008 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) Li Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc: Doc.Building Permit Revised 2008 Location ' J No. Date NORTH TOWN OF NORTH ANDOVER F 9 ♦ 4 Certificate of Occupancy $ i , s�cMus t� Building/Frame Permit Fee $ i 7�Z ad Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 2 2- + ,, Building Inspector AORTH OANM Of - L Andover No. -�zpw o _= A K E dover, Mass., COC MIC ME � AERATED PQa\ � S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System 1 THIS CERTIFIES THAT........ ...�...............f/ ....! .f.. . /s"r ..... .........��C'/�S. l .. .` �s(T` ' s d BUILDING INSPECTOR BUI NS Foundation has permission to erect........................................rbuildings on .. .... /. ....... ?' ................................................... Rough to be occupied as...... '� '�Ct�. ...�`� `5?... / d/" � f_`� j ........................... Chimney . . . .. ................................................................................. provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final 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 CONSTRUCTION,STARTS Rough ................ Y..:l ................. ... Service ' BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR 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. SEE REVERSE SIDE Smoke Det. -IX The Commonwealth of Massachusetts Department of Industrial Accidents ( � ' Office 011HY8 t 92HOHS 600 Washington Street, 7 h Floor Boston,Mass. 02111 Workers'Compensation Insurance Affidavit:Buil in mbinpJElectrical Contractors A Ircaatt'informatio»: w I'Iease.MLN.'TIc ib� name: J. Calnan & Associates, Inc. address: 1250 Hancock Street Suite 302N city Quincy state: MA zip: 02169 phone# 617-801-0200 work site location full address): t0 h W 0 104" ❑ I am a homeowner performing all work myself. Project Type: ❑New Construction r7Remodel ❑ I am a sole proprietor and have no one working in any capacity. ❑Building Addition . © i am an employer providing workers' compensation for my employees working on this job. 'company name _J Calnar &"ASESOGlaeS; Inc ' Addressc:: 12.5 Q, an .St.reet, Suite:: 302N _ city._,Q1�ncy;, "MA !0216'9 phone#. 617:-801-020'b' irisuratfceco Ohs ;Casug'lt Grou otic # XWO; (06) 53119614.: p I Y - ❑ I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices .._ _.._ _. rcumm pan�nae. �� kaddre s: phone# r, insurance co.. 'otic .#' ., . r, cltY phone#: . m 01 c •# y Failure to secure coy r e as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'impr'so me t as well as c' it penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a copy of this state ent ay be for r ed to the Office of Investigations of the DIA for coverage verification. I do her y ee t' oder a ai nd pe alties ofperjury that the information provided above is true and correct. Signature Date 1'i 12'd el Print name �� �`ti� Phone#T�!�IbS� b3b6l official use only do not write in this area to be completed by city or town official city or town: permit/license# ❑Building Department ❑Licensing Board ❑check if immediate response is required ❑Selectmen's Office ❑Health Department contact person: phone#; ❑Other (revised Sept.2003) - ACORD„ CERTIFICATE QF LIABILITY INSURANCE ioizi2ooe PRODUCER (781)681-6656 FAR: (781)681-6686 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION The Driscoll Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 93 Longwater Circle ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 9120 Norwell MA 02061 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A:Nat'1 Fire Ins Co of J. Calnan & Associates, Inc. INSURER B:Everest National President's Place, No.Tower 3 INSURERc:Ohio Casualty Insurance 1250 Hancock Street INSURER D: Qui.niy MA 02169 INSURER E: OVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION BATE fMMIDDIM GATE MMIDD LIMITS GENERAL LIABILITY 1,000,000 EA HOCCURRENCE $ i K COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED 3OO OOO PREMIS S IF, occurrence $ , A CLAIMS MADE FXJ OCCUR INS2095325239 10/1/2008 10/1/2009 MED EXP(Any onePerson) $ 5,000 X Inc. Contractual Includes PERSONAL 4 ADV INJURY $ 1,000,000 A.Oweners Protective GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: B. R, C, II PRO PRODUCTS-COMP/ PAGG $ 2,000,000 POLICY x JECT LOC AUTOMOBILE LIABILITY COMBINE R ANY AUTO (Ea aco dent)ANGLE LIMIT t) 1,000,000 A ALL OWNED AUTOS SAP2095325225 10/1/2008 10/1/2009 BODILY INJURY SCHEDULED AUTOS (Per Person) $ HIREDAUTOS BODILY INJURY NON-OWNEDAUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN A $ AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY FACH CURRENCE $ 10,000,000 OCCUR CLAIMS MADE AGGREGATE $ 10,000,000 B DEDUCTIBLE 71CB000071-81 10/1/2008 10/1/2009 $ X RETEI,ITION $10,000 C WORKERS COMPENSATION ME) X WC STATU• DTH_ EMPLOYERS'LIABILITY ER ANY PROPRIETOR/PARTNERIEXECUTIVE E.L.EACH ACCIDENT Is 500,000 OFFfCER/MEMBEREXCLUDED? XW053119614 10/1/2008 10/1/2009 F-LDISEASE-EA EMPLOYE $ 500,000 It yes,describe under SPECIAL PROVISIONS klow MA CT E.L.DISEASE.POLICY LIMIT IS 500,000 A OTHER INS2095325239 10/1/2008 10/1/2009 Leased/rented Contractors Per item $100,000 Equipment DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS ***Please refer to attached addendum*** Evidence of insurance for work performed within the Insureds scope of normal business operations. Notice of cancellation provision is 30 days, except 10 days applies for non-payment of premium. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE SAMPLE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE -� Dennis Driscoll/GJM ACORD 25(2001108) ©ACORD CORPORATION 1988 i Massachusetts - Department of Public Safety Board of Building; Regulations and Standards Construction Supervisor License License: CS 56087 Restricted to: -00 STEPHEN M TERRENZI 12 ENDICOTT STREET NORWOOD, MA 02062 Expiration: 3/5/2011 ('u►rani isinncr Tr#: 12500 TOWN OF NORTH ANDOVER a` •a,o,°off OFFICE OF M' BUILDING DEPARTMENT ,h 400 Osgood Street North Andover,Massachusetts 01845 C HU D.Robert Nicetta, Telephone(978)688-95454 Building Commissioner Fax (978)688-9542 CONTROL CONSTRUCTION- SECTION 116.0 M.S.B.C. CERTIFICATE OF ENGINEERING/ARCHITECTURE BULDING INSPECTOR TOWN OF NORTH ANDOVER 400 OSGOOD STREET NORTH ANDOVER MA 01845 I, Carolyn Hendrie ,HEREBY CERTIFY THAT THE BUILDING CONSTRUCTED AT 1 High Street DOES CONFORM IN ALL RESPECTS TO THE MASSACHUSETTS STATE BUILDING CODE AND APPLICABLE FEDERAL REGULATIONS FOR THE FOLLOWING: Building 14 , 5th Floor Renovation for Converse, Inc . 1 i AUTHORIZED SIGNATURE: DATE: December 18, 2009 REGISTRATION: 4 8 2 3 Ntk�ED Aij NOTE: ENGINEER"WET STAMP" MUST BE AFFIXED TO THIS FORM ON 99 0 N. A. Control Construction Form revised 11.15.2004 �9tIN OF 10A''9�' BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535