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HomeMy WebLinkAboutBuilding Permit #1299-2016 - 100 ELM STREET 6/10/2016 BUILDING PERMIT �<tLE° ,,�o TOWN OF NORTH ANDOVER o ; A APPLICATION FOR PLAN EXAMINATION * _ Permit No#: Date Received gSsgcHus�`��h Date Issued: I PORTANT: Applicant must complete all items on this page LOCATION Prin PROPERTY O NERZAIJ VQ Z 15�YA � L ° Print 100 Year Structure yes no MAP _ ARCEL: ONING DISTRICT: Historic District i no Machine Shop Village no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition [I Two or more family ❑ Industrial ❑Alteration No. of units: El Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: demolition ❑ Other [] Septic D 1I:00; E�#❑tFlood"pi am. Wetlantls � e❑ Watersheda`Distnct 0`Wate /Sewer ., -- DESCRIPTION OF WO K TO BEgPERFORMED: L5 Jl ✓' 6— Identification- Please Type or Print Clearly OWNER: Name, Phone: Address. •� �1S k0 ' J,�y`oo �o l S t`twwL Contractor Name: Phone: Email: Address: s Supervisor's Construction License: E' G 33 Lt' Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$92.00 PER$1000.00 OF THEE TOTAL ESTIMATED COST BASED ON$1�0 PER .F. Total Project Cost: $ r dV J FEE: $ Check No.: Z Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund _ T t Location I�'i `C; ✓� j J P-t No. �2 61 r!- 2— Date(o�t 0 - TOWN OF NORTH ANDOVER ,,.., Certificate of Occupancy $ Building/Frame Permit Fee $ f� r Foundation Permit Fee $ �� Other Permit Fee $ TOTAL $ �_ Check# �! l �� G'` Building fnspector 1 i Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer X 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 m U FORM PLANNING & DEVELOPMENT ReviewedOnSignature_ U COMMENTS �U CONSERVATION Reviewed on (C (o Signature x U/n,/I---- 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 Water& Sewer Connection/ ay Permit DPW Town Engineer: Signature: Located 384 PIRE�`D PyAQ4 'N1ENT � ernp �Dum ster onsite� ,es �Osgood " :¢ ` w � , ffli , p y>.. � ono :..� Street Lo�redai1 Mam 90 ``FireartmentJ4' '. ,,F°s<a nt 5tur«e4/'l`AatP.�'�. ' t 71 ""'4,. r ,. .,r t�•ry.. r� +z s 4 r'F ,, +�n�i•' 5 `"t �' ,.} ` ��,'�s-r : 't +, a COMMENT4S . . w , , L ti *�+ I99•, q t, f r{ }i �, :'. ;, i Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: i 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 Call Email Date Time Contact Name Doc.Building Permit Revised 2014 Building Department i 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 4 Building Permit Application 4. 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 OTE: 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 46 Photo Copy of H.I.C. And C.S.L. Licenses Copy Of Contract Floor/Cross Section/Elevati^- 01-- of Drnnncimrl Werk Ifflith_Sprinkler Plan And Hydraulic Calculations (If A 4 Mass check Energy Compli lid '4 Engineering Affidavits for E OTE: All dumpster permits require sign lance of Bldg Permit NewConstruction (Single and `�� li /-e,/ els./ Permit Application Bullding Per Certified Proposed Plot Pla �a 46 Photo of H.I.C. And C.S.L. �7 4 Workers Comp Affidavit Two Sets of Building Plans' Sprinkler Plan And Hydraulic Calculations (If A. Copy of Contract 2012 IECC Energy code Engineering Affidavits for Engineered products OTE: 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:Building Permit Revised 2014 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 4. Building Permit Application Workers Comp Affidavit Photo Copy Of H.I.C. And/Or C.S.L. Licenses Copy of Contract Floor Pa p Plan Or Proposed Interior Work Engineering Affidavits for Engineered products g 9 OTE: 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/Cross Section/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 OTE: 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 2012 IECC Energy code Engineering Affidavits for Engineered products OTE: 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:Building Permit Revised 2014 t%ORTH Town of � ndover No. rMl,e t hyr, Ma - Its z ` WX 42-611 � e ss, � O A- COC HICHIWICK 7,95 RATED P.PP,`�(y U BOARD OF HEALTH Food/Kitchen PERN T D Septic System THIS CERTIFIES THAT ........ BUILDING INSPECTOR ..... .. .. ...... ......Via........ ......... ......... ................... ..... . .......... .... 5. k" has permission to erect .. .......... buildings on ...1.0.0 Foundation .. Rough to beoccupied as ...... � �i ....... . Thalillinlevery .. ...I...lm c...S .. ....L14...O&UL. Chimney provided that the person accepting this nit respect 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTR_ CTIO Rough Service *OF .... .. . .... .............. Final BUILD G I PECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz 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. JK Contracting LLC Proposal 31 Richmond Street Weymouth, MA 02188 617-592-6775 (Kieran) 781-254-2862 (Judy) Proposal Date: 6/10/2016 Proposal#: 203-19 Project: Bill To: David Streinbergh 100 Elm St, N.Andover, Mass 01845 m_. Description _. °'w,_ ��, Est.'Hoursl+ tyTotal, Demolish garage[provide dumpster set on site for 3,600.00 3,600.00 removal of debris] . .Supervision,,, 36©00 360.00 Insurance 40.00 40.00 Total $4,000.00 NoRTH 300<< ao e Q�00 p Town of North Andover Machine Shop Village Neighborhood Conservation District Commission i cols 4a� 1600 Osgood Street i��ort}i Andover, M A 0 11315 SSACHUsk Certificate to Alter Date: March 24,2016 Contact Name&Address: Seth Zeren RCG LLC. 17 Ivaloo St Suite 100 Somerville.MA. 02143 Project Address: 100 Elm Street Project Description(attach additional pages,if needed): Demolition of the shed structure on the property y (?'a a I et ' Commission Vote: Voted a' to D to grant/deny Certificate to Alter on, Comments (attach additional pages;if`needed)- S, e eeded)-Sine !/.l� Gj� �l2Yf� 4Ma' re Shap illage Neighholhond Coservirtvn District Commission MSV NCDC Page 1 _ - The Commonwealth of Massachusetts .- Department ofindushulAccuints Office of Inva*ations 600 Washwgton Street Boston,MA 02111 www.massgovh a Workers' Compensation Insurance Affidavit:Builders/Contractors/Elecb icians/Plumbers Applicant Information Please Print Le:=ibly Name(Business/Organirationb&viduat): ,i CL. Lr I N 1r- Address: 9,.s f K 10 K 91 C-H 2- �' - ND dy i►'Y`- 1 18�!'1 City/State/Zip: N - A0 � V 4 fav� N9 �� I dlPhone#: b ti�-'S� Are you an employer?Check the appropriate box: Type of project(required): 1.® I am a employer with A— 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors attached sheet :' 7. Remodeling a sole proprietor or partner- listed on thea 2.❑ I am Pr Pn ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions required.] officers have exercised their 3.[] l am a homeowner-doing all work right of exemption per MGL 1 L❑Plumbing repairs or additions myself.[No workers'comp. c.152,§1(4),and wehave no 12.❑Roofrepairs insurance required.]t employees.[No workers' 131i Other coniP.insurance required.] `Anyap'licantthatchecksbox#Imust also01out IhesecEionbelow showing theirwod=ecomp ons stionpolicyinfom�flon. t Homeowners who submit this affidavit indicating they&e doing all work and tuen hire outside contractors must submit a new affidavit indicating such $Contractors that checkt16 box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy infommtion. lam an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information Q Insurance Company Name:.Z C5 �.1 N crn A rl.(0 Kow L,6, c►-P'i ` M C— Policy#or self ins.Lic.#: W e, 0 `� Expiration Date: i Z ! 7 Job Site Address y� q"i'S 1't- 0 3 J S1!- City/State/Zip 4' Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL o.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 ofup to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of P . Investigations of the DTA for insurance coverage verification. I do hereby calift under the pains andpenalties ofperjury that the information provided above h true and ppcorrec4 - Si 0- Date: phone# L l -7 - T`t -L— 6 -7--+-(�— Official use only. Do not write in this area,to he completed by city or town offccial City or Town: PermwLicense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other - - Contact Person Phone#: JKCON-1 OSP ID�c HS ACORO' CERTIFICATE OF LIABILITY INSURANCE 02/1712016 THIS CERTIFICATE 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 COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER- IMPORTANT. OLDERIMPORTANT. B the GOO cob holder Is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,vu-bled to the terms and conditions of the Polley,OwWn Policies may require an endorsenelt. A statement on this certificate does not confer rights to the osrtlficate holder M lieu of such end s PRODUCER MAME Dellandis Insurance Agcy,Inc. PHONEKIM No 100 Unicom Park Drive Woburn,MA 01801 -ADDIIIIM' 0151,118M) e COVERAGE NAIL• B UMMA;Star Insurance Com 012245 else JK Contracting,LLC. BauRER B:Selective Insurance Com 19259 4 High Street SUN@ 108 Rau=C: North Andover,MA 01845 INSUMR D: INUORE: INGURBR F COVERAGES CERTIFICATE NUMBER. REVISION NUMBER. THIS IS TO CERTIFY THAT 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 EXCLUSIONS CNS AND CONDITIONS OR OF MAYUCH POLICIES.THWsuRANCE E SHOWN MAY HAVE BEEN THE POLICIES L BY PAID CLAIMS. HEREIN IS SUBJECT TO ALL THE TERMS, LTR TYPE OF INWRANCE POLE►NUMBER B X co .600IN UA�nY EACH ODCURRENCE 5 1, CLAWAIADE 0 OCCUR 115 0211012016 02J101�17 Ea $ 100, MED EIP WW era -non 16 10 p—mwNAL a ADv INJURY i 1,000,00 GENERALAG3REOATE S 8,000,00 OEhTI AGGREGATE UMR APPLIES PER PROp�g-�fpP AGG s 5,000,00 X PoucY❑� ❑Loc s OTHER: NGLEUMff s AWONOBILE UASLnY BODILY INJURY(Ps►P-,-o 0 s ANY AUTO ALL�® SCHEDULED BODILY INJURY(Per-oddenU 5 AUTOS NNED o�N o $ HIRED AUTOS p AUTOS s rsraexiJ►ie-L-1 occuR EACH DCCURR9= Is EXCESSUA8 CWMBWE AGGREGATE s Is p RETENT om s X A jjW�0-18 COMPENSATION AND EMPLOYERS'UABLLITY Y f N WCOSM42 0211712016 021`1712017 E.L.EACH ACGDENT AOFFICERNEMSER ANY 000 N f AJ MA E.L DISEASE-EA EMPLOY S 1�� N ys�PknddWy in*Q 6-0ib--dW E.L.DISEASE•POLICY UM7T i SW, DESCRIPTION OF OPEftATI DEaCPPTION OF OPERATIONS!LOCATIONS 1 vEFeCLEe(ACORD 1eI,Addltlo�ai R-nlflb ed�nqy U--10-elyd K nla--e-a Y nOW�di Evidence of oovenge. CE ATE HOLDER CANCELLATION - TO WHOM SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN TO WHOM IT MAY CONCERN AccsOR0ANCE wmt THE POLJCY PROVIS1ONa. AUfN MO REPRESENTATM 01988 2014 ACORD CORPORATION. All rights reserved. ACORD 26(2014101) The ACORD name and logo aro registered"mft of ACORD �= Massachusetts Department of Public Safety k �:i Board of Building Regulations and Standards License: CS-066334 Construction Supervisor f. KIERAN T WHELAN 31 RICHMOND STR WEYMOUTH MA:02 ;r� '. .rim f: Expiration: Commissioner 09/2612017 �' r Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Cor Registration ` T Registration: 171393 } Type: Corporation �� Expiration: 3/15/2018 Tr# 288589 X CONTRACTING LLC. 1Y KIERAN WHELAN 31 RICHMOND ST y 4 _ r / WEYMOUTH, MA 02188 Update Address and return card.Mark reason for change. SCA 1 Co 20M-05/11 Address E] Renewal Employment Lost Card