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HomeMy WebLinkAboutBuilding Permit #922 - 10 WOODRIDGE DRIVE 6/22/2012 BUILDING PERMIT cF"O RT b'�� I 'l 96 0 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION _ Permit NO: Date Received �.y A°Rwreo SSACHU`�E Date Issued: 2— IMPORTANT:Applicant must complete all items on this page �, .-�4'!" �a t.., = x.t•-€2 a - x. �'t# -w ., ��-..� �.-r,.> as. ,���t.c:;z.� :�.�.y� b��`»Y;,p.�,r�.,yS• ^...rf�y,'�*se a.�, ��'a�.�tia:r .�v-w,.t;t�'Sn ;.r1� x i�r��7,�'.L�'tr�.c .7.�Es '3",.. ^. y� ..: T� ,�� .k,s..�^�, rLQCATI OWN:N, .s•�"S a'.gs°bs TJa"-Vii` `Pi'x3°` ,y �+{�,ew-;,,.s-.,� r++q�� 'r,-+�., ff »'� � ...'fy'yy'"` sr.�vu �.�ti a*.c.,y�t'X,#<.�t��'r��.s'#°�'A��"'i}�1O 1rr� e'��s. 4 4161 'fit Pg JPROPERTMYOVI/NER . »� C7dfrC4�1�P ��.� > � � �� �_• t� ..fr �''- .,j - .->�.t.+�•i�.-�r �, �tx;.r, ,l�Pn � :`F... q t:.. '�.'t �. _'c �° ®_� `.�����-q�'f.t',+.._•� �p°i�.wt. �Pr' ,MAPNO`. ' r �PAFZCEL ', hZONINGDISTRICT. ," 4.Hstoric;Districtx dyes inok `'.Y 4 ;"'sr ?. . 'BFs'r,�t.,,.;syr-.$ rt € '7",r�p .� fi''�€ =L ', + ,.,,,: a 'Y l�•,L,'. •w:' t t— .. -^4¢ 'S-:.t� a_.,'t�$ �Nlachirie ShopVillage� �yes� �nog�.� 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 -x � � ' �Septic�Y ;UVell �. Floodplai�nrWetlands �� . , y:WatershedDistnct� , ' c. rf ';•.t-iWate,�/SeWE,�t*„ .',. �::- k. _.i ..«.. f '4v'.+.�.. ` f� s `4 DESCRIPTION OF WORK TO BE PREFORMED: I a Y(O �eekd-d (�f Idenlficat*on Please Type or Print Clearly) 17,r73 Y/2-3 7 OWNER: Name: `AJod 24ge Phone: "I Address: Iy Cuov����� ���� „�•e•a .1 �f 7- y '� � CONTCTORName `u�(. � � 4, r, �� P.hone- � 0. 4Y �F #,<-A .�y�,w .. rfi-gr-, �.a aats4F�st�r'•;r•t...-r .•�-+[. ,p'.'..•f�a+.+r� g�'n'ppz�,4��"y'�a.�„a.v - P-t. ,� a -3$'�'� s s#- i �w.�'Vim, .eL s1, r-a' 40 mss-, a -t✓ _ z .�+ fjQdressst �.�' k on , -.,.. A�,s'�,'�YS i� .� ))J lir: �4 ��� � ` �•y�"�� SFerviso up , 9tr0cti6MBicense n`+cy.`.�p., asi.a .sib-#�z " t • lF -_ '.^. _G ses� .""»` i rF'f°'±t erg- „Y;' '�3t' � . . � `f� Home Im rovementLicense � � ..;�_- ,.A. '. _ � Expo<3Date , xz ;,; ARCHITECT/ENGINEER �rn Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT:Q $12PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.Total Project Cost: $ da FEE: $ � Check No.: ��( � Receipt No.: NOTE: Persons conn actingwit reregistered contractors do not have access toIth uarantyfund ;rcontract I 9 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 yy Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature &Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street «� *r h.•�,`fi+' '"t.:: vo Laii,'°fi�L.. ;. r,'Fw=' "4'4' Y'^ ,�'f"'s'°"�". , �§!sT <FIREMDEPARTMENT; -Temp DumpsteFbn bite,,:,�3yes a , j w no+ � � LocatedSt atx124jMam,Street � 7,4 �F�re .++ '�Department�"signature/date, = Y� r � '�' Ai � 9.`7.r...; k�i ...$-..�....�...�..$vi. ,..w .._.�.r�.+3•..��i c,.o..�}.a+.+ w-�.2'�.._....,..�-.kx... - *..t?-- ��`t -� Ay +�4• '�*`,`�'Ffi` 5 f •..s+"t>'f"q'":�" c .rt r es*'+F r :. Y-��.ieS "5-°�: .r-4-" f`->r'q Q,r-:.J" "`i' -^^rm ."lYu,«�«��,,,, Y 5!k,'t- �„✓� s�tr,�1 � ^Y �'� �rtA' `1V9 z�`'P.� i;J��t e�,;,'Y,�j..�§�" ki_t�•.'�.'i�'`+C h�i... :d..,�. S. -.at ��"Ci'. y�.+o€c 3,•r�v°4.] 5'� Y 4 i€ Y r }. �z, ,N 2 a +f -•,` rf °�r.e ,� � 'f' CA M :'S .`<.e.`�i _��._�. �� ..�� ,�.. -l .s. ...,.��� .".t...�s, ....a,=...-._�..c.-l"sa�.'��c: .�-_ice*_.. z,_•.••�-.. �.�„�3 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) ❑ 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 i Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 I 4- r Locatioo "A No. • TOWN OF NORTH ANDOVER o.a Certificate of Occupancy Building/Frame Permit Fee Foundation Permit Fee $ � Other Permit Fee f,$ TOTAL $ Check# i' 3� 25445 Building Inspector �pR�11 7own Of 'Indov'er i No. - h ver, Mass, cocmictew.c« p�4Arao S U BOARD OF HEALTH Food/Kitchen PERMIT LD Septic System THIS CERTIFIES THAT ....... .. BUILDING INSPECTOR ... .�.,� ................................ Foundation has permission to erect .......................... buildings on 1.0..... ..Ply Rough to be occupied as .. .c.. .......ori. .. .... ...x....... — — Chimney provided that the person accepting this permit shVin ery respec 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 CONSTRUCTI TA Rough Service .. ........... .................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Reguired 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 Det. SEE REVERSE SIDE 1 Office of Consumer Affairs&Business Regulation 1 27. HOME IMPROVEMENT CONTRACTOR _ Registration: 120189 Expiration: Type: , " 11L112013 Individual f; DA fD GULEZIAN DAVID GULEZIANi 428 PLEASANT ST... 3 �— NORTH ANDOVER,,MA 01845 Undersecretary L I"�--. ill t+s ic�te►.ctt��1}��t�:tr=trtrr�t fit t'tsiif'"> , Bte ttt3'nt'Btr�lt€in; t�Ttal��tian: ConstructionSuper,., an ►�In(l.trcjJ1fi }4' cf St. s y" isor Lnse' „ tense: CS1821 DAVID P GULEZIAN " 428 PLEASANT ST N ANDOVER; MA,01845 t,;a Expiation: 10/2/2013 \ nfi&.yirxtic ._ Tr#- 4472`{ a.F, The Commonwealth of Massachusetts Deparbnent of Industrial Accidents Office ofIsnvestigations 600 Washington,Street Boston, MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information f Please Print Legibly Name(Business/Organization/Individual): - - Address: I �c�E� - City/State/Zip:__ ��l /�"�C6 wr V\4 G 0 f$� Phone#: 9 �7 Are y an employer?Check th appropriate box; [2. T am a em to er with 4. D�dd project(required):- P Y ❑ I am a general contractor and I employees(full and/or part-time).*' have hired the sub-contractorsew construction ❑ I am a sole proprietor or partner- listed on the attached sheet.t modeling ship and have no employees These sub--contractors have emolitionworking for me in any capacity. workers' comp,insurance. [No workers com .insurance 5. ilding additionp ❑ We are a corporation and its required.] officers have exercised their ectrical repairs or additions3.❑ I am a homeownerdoing all work right of exemption per MGL mbing repairs or additionsmyself. [No workers'comp. c. 152,§1(4),and we have noinsurance required.]t em to ees. of repairsP Y [No workers'comp.insurance required.] her *Any applicant that chec:W bo 4l Lmst also ill out the section below sho:=.in. ��� information.licy T Homeowners who submit this affidavit indicating they are doing all work and then hir outside ontrCoIuPeRactors madon ust submit a ew affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp,policy information. lam an employer that isproviding workers'compensafion in information. surance for my employees Below is the policy and job site /�'� qI Insurance Company Name: C/' W �t Policy#or Self-ins.Lie.#:_ { 0-0-11"i (/ Expiration Date: Job Site Address: /L11dwlilwa City/State/Zip: 6YO I/ 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 ofM.GL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-y=' 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 pa' and penalties of perjurer that the information provided above is true and correct- Sitmature: p� Date: l Phone#: 6 �f U2-9"I Offzcial use only. Do not write in this area, to be completed by city or town of City or Town: Permit/License# - Issuing Authority(circle one): L Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical=5-.Plmb 6. Other Contact Person: Phone#. Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house.of another-who-employs persons lotlo.maintenance,.construction or-repair-work on-such dwelling-house-- ---- -_--- - or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,'§25C(6)also states that"every state or local licensing'agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub=contractor(s)name(s),address(es) and phone number(s)along with their certificat'e(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,.are not required to carry workers'compensation insurance. If an LL'C or LLP does have employees,a policy is required. Be advised that this affidavit maybe submitted.to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date'the affidavit. The affidavit should zse.returned to the city or town that the app li¢ation for the pe-manit or License is being reqaesfcd3 not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. 'The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be-used as a reference cumber. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business.or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would'like to thank you in advance for your cooperation and should you have any questions, please do not-hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents office of Investigations 600 Washington.Street Boston,M-A 02111 Tel. #617-727-4900 ext 406 or 1-8.77-M.ASSAFE Revised 5-26-05 Fax#617-727-7749 ZDSH�HE CERTIFICATE OF LIABILWY INSURANCEDAT06113DIYYYYI 06/13/12 THIS CERTIFICATE IS ISSUED AS A.MATTER OF INFOPJAA770M ONLY AND CONFERS NCI RIGHTS UPON THE CERTIFICATE.HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AINEND; EXTM OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE.OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE.HOLDER. IMPORTANT: if the-certificate holder is an ADDITIONAL INSURED;the PotiCAl0s)must he 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 endorserne s). PRODUCER 7H8SS2} SACT - Macdonaid&Pangione insurance P.O.BOX 428 978-688-5350 OHM FAX 104.Main Street a MaILEft No: North Andover,MA 01845 ADDRESS: Donald Schemack a D e:013COi+t-1 INSUREri D G Contracting,Inc ID 64664$ ]-. AFFOR�rIG COVERAGE NAI:A 428 Pleasant St ulsuRER A:Travelers Pro '8 Casua CL North.Andover,MA 01845 INSURER 8:Sa Insurance Com 39454 insuR6R c.Chartis INSURER D: INSURER E INSURER F:.. COTHIS IS VERAGES CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSUREDREVISION NUMBER: CERTIFICATE NUMBER: THIS'S INDICATED_ NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TOED ABOVE FOR THE LWHICH RHIS 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 LTR TYPE OF INSURANCE POLICY NUMBER y plYY F EXP GENERAL LIABILITY LIMITS A X I COMMERCIAL GENERAL LIABILITY I EACH OCCURRENCE $ 1,000,00 I I-680-1553818-1-ACJ-12 0sr17112 06f17113 I° o-- CLAIMS-MADE X�OCCUR i PREMISES Eaocuarence s 300,00 MED EXP(Any ane person) $ 5,(I0 PERSONAL&ADV INJURY $ 11000,00 GENERAL AGGREGATE $ 2000, GEN'L AGGREGATE LIMIT APPLIES PER. POLICY X PROrey LOC PRODUCTS-COMPIOP AGO $ 2,000,00 AUTOMOBRJS LIABILITY $ COMBINED SINGLE LIMIT ANY AUTO (Eaa=deM) $ 11000,0 ALL OWNED AUTOS BODILY INJURY(Per person) $ B gAX 1 wISCHEOULED AUTOS 3116538 07/12/11 07112M2 BODILY INJURY(Per aa°dert) $ BHIREDALTOS 1 PROPERTY DAMAGE (Peraocident)BNON-OWNED AUTOS UMBRELLA I IAB OCCUR $ I EXCESS LIAe EACH OCCURRENCE $ CLAIMS-MADE j f I DEDUCTIBLE AGGREGATE I RETENTION ; $ WORIMIS CoMPENSATION $ AND EMPLOYERS'LIABILITY X WC STATU- pTH_ �.' OyypROpRIETpR/PgR7HERIEXECUnvE YIN 0009874107 03/31!12 03/31/13 OFFICERIMEMBER EXCLUDED? NIR EL EACH ACCIDENT $ 1,000,0 fMattdatory'In NN) if yes de�ibe urr�r E.L.DISEASE-EA EMPLOYE S 1,000,00 DESCRIPTION OF OPERATIONS bahnv E.L.DISEASE-POLICY LIMIT $ 1,0000,00 DESCRIPTION OF OPERATIONS!LOCATIONS fAtEHICLEs(Attach ACO RD 701,Additional Remarks Schedule,H more space is requiradl f- t CERTIFICATE HOLDER - CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Princeton Properties Mgmt,Inc THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN. as Managing Agent for: ACCORDANCE WITH THE POLICY PROVISIONS. t CLPF Katandin woods L.P. One Katandin Drive AUTHORIZED REPR TATIVE Lexington,IIIA 02421 Donald Sc�m k r € ACORD 25(2009/09) The ACORD name and logo are reg ©1988-2009.ACORD CORPORATION. All rights reserved. istered marks of ACORD ) ) Site Plan 1144 �� R" ►K,,r} y atr v ......... . �•" "'+.•y��r .amu` \.;$._. -. ^ �/J�., T AW ei, SNF t a �`c -:�y; 1 Community t: b'+ Facilities � w j4X Wood Ridge Site Plan A . r.. Wood Ridge is a community that Ain ' consists of 230 townhouses in seven clusters.The centrally located community f # c facilities include a swimming pool, _ 3 tennis courts and a large clubhouse/ meeting hall. } 4 ., w r: a`�`, i� 1!SYW .., ',A`• fir,\. v'- •`�_.. L:J Equal Housing Opportunity � ,- i �!"'T� .:r� - :r' .t' S.. .��. ♦� .v,: f" �`•t.• RY�k�iB��:; \ ,j all. i x� 1 a.. a t, raf "� r , wt Waverly Road � Q