Loading...
HomeMy WebLinkAboutBuilding Permit #1171-2016 - 103 JOHNNY CAKE STREET 5/10/2016 �2 Oh*�N•,'ORT'!h{ BUILDING PERMIT 'A�'y . AAA UP ti O TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: 1 I Date Received 'll A°Frwreo �SSACHU5�4 Date Issued: 'J 1 0 IM RTANT:Applicant must complete all items on this page LOCATIO :L61nV1 PA VF N � Pr t PROPERTY OWNER ��1Qq '�i tmx Print 100 Year Structure yesno MAP PARCEL: ZONING DISTRICT: Historic District yes. no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ne family ❑Addition ❑Two or more family ❑ Industrial ❑ Iteration No. of units: ❑ Commercial Repair, replacement ❑Assessory Bldg ❑ Others: emolition ❑ Other —71 ' pti *w- I W, ❑ Floodplain ' Y Wetlan°tls . : 0 V late gTe k strict : DESCRIPTION OF WORK TO BE PERFORMED: emoK nt (acp �5 �A4tV1 WkhABWJ r Ident fication- Please Type or Print Clearly OWNER: Name: Phone: q, b Address: n iContractor Name: S C ' Phone: Email: 17 Address: bl Supervisor's Construction License:—y i 4:z, Exp. Date: G 4 Home Improvement License: 1 -775(17 Exp. Date: 6 ARCHITECT/ENGINEER /440 Phone: 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: $�D,3! ��— FEE: $ � ,�qy — M.O.*P361 � Check No.: K -)D 619 �-7-7 t 66 0 Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access guaranty fund .r _ __ Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Taming/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 e U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ 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 Water& Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: AFIRE DEA°Ra M N TSM—EP)D pster, es� Located 38 Osgood Street urn. onl�si Located at8�1�2�49iMaip Sf eet� `"`�' W ,Fire De 4g "date _ �_` [_ partmensi nature/ r�C`OMMEN1T.pSF 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 DANCER 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 b 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 4. 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 aBuilding Permit Application Certified Surveyed Plot Plan Workers Comp Affidavit Photo Copy of H.I.C. And C.S.L. Licenses 4, 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 4. Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (if Applicable) 4 Copy of Contract 4 2012 IECC Energy code 4. 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 ■ Location No. R-" 2a t Date 4 ) I l O i • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ r Other Permit Fee $ TOTAL $ Check r • Building Inspector NORTH . / A c : ve: 0 h ver, Mass, 10261� cocMic„!WI[.l 1. q^TED U BOARD OF HEALTH Food/Kitchen , PERMIT, T D Septic System THIS CERTIFIES THAT .........%70�W. ...._, .'�i►1�.11 .... BUILDING INSPECTOR . ............................:....................... Abs... 6” ... ... ... Foundation has permission to erect .......................... buildings on ..... �...�. ! ........... Rough to be occupied as .....It... ...!pting -u..... .... .....W� � .......................................... Chimney provided that the person accehis permit shall in every 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO ARTS Rough Service ............ ...... ... ... ............................... BUILDING INSPECTOR Final 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. x CONTRACT# 0003357 ► s�►c� y� s 41C001fist' LOWE'S AUT�RED REPRESENTATIVE NUMBER �: CUSTOMER 6.: .lien. ALL I ia7 oLC1l Jvhti ,ate iGr}w STOR O. STREET ADDRESS .. ..::. ..:' � STREET ADDRESS 1. NN` rfu syr ��vw� OITYSTATE ZIP CITY STATE ZIP A4 [yS' TELEPHONE / TELEPHONE - - DATE ( - LOWE'S HOME CENTERS LLC'S MA HIC NO.148688 _ CASH BANK '-� LCCREG r+,rt FEIN:56-0748358 _ CHARGE + s f � r q 4 This a only aquota for.fire metthandlse aM bail as Plitded.beiow:This becomes an a�eenrent upon raymer�t.UDon PaNnant the etdYa agreemehf<�tidud>lq lhespeclf ally co mpiefed�ages ofdNs .doasnent;the 7emLs aria Wait n =laded wgtt_.&s docaFneM aiul anyro$ser addenda entl aitachmegis hereto shall be referred.to beretR�s ths:°CoMradt w -, .i PLEASE#2EAD AL1_TERMS ANO C6ND'mONS Dt3'�r(ii= R'sE'SIDE OFT 1tS PAGEANpfOt2NGPAGES BEFORESIaNPf6 OWI e INSTALLATION STREET ADDRESS WT CIN t r. N /l�dv erg STATE /9 L- /19 (_t,�} Y U itv Uti 14 L FOcuo NOTICE TO CUSTOMER—PRICE CALCULATIONS:In order to properly perform the installation of certain Goods,the Contract Price may include more Goods than actually will be installed based on the measured square footage of the Project Area.As a result,the parties agree that the lump-sum Price stated in this Contract is calculated upon both the value of estimated Goods required to fulfill the Contract(including waste),which may exceed the actual square footage of the Project Area,and the labor which may be estimated based on the amount of Goods required to fulfill the Contract(including waste). By signing this Contract below,Customer acknowledges receipt of this notice and agrees and understands that the Price includes these costs which may not be refunded once the Installation Services are performed. i Contract Total Are 01 permits required for this installation?:[Vf [ ]No *applicable tax included bw �S1' gy NOTICE TO CUSTOMER: Federal law requires Lowe's to provide you with the pamplet Renovate Right By signing this Contract,Customer acknowledges having received a copy of this pamphlet before work began informing Customer of the potential risk of the lead hazard exposure from renovation activity to be performed in Customer's dwelling unit. Pte,,, NOTE:If rotted wood is discovered during installation additional charges will�eP1Y.You will be given a quote and a change order must be completed and signed by the customer for any additional charges. - Customer must initial. *Any work or material not specified is not included in this contract.Any changes or additions will be at an additional charge for the material and labor. PHOTO RELEASE:Customer grants to Lowe's and Lowe's employees and independent Contractors the right to take photographs of the Premises where Installation Services will be performed and all work performed at the Premises related to this Contract,and irrevocably grants to Lowe's all right,title and interest in and to the photographs for use in all markets and media,worldwide,in perpetuity.Customer authorizes Lowe's to copyright,use and publish the photographs in print and/or electronically,and agrees that Lowe's may use such photographs for any lawful purpose,incl ing,but not limited to,marketing, advertising,publicity,illustration,training and Web content.By initialing here,Customer agrees to the foregoing. [Customer to initial to the left]. Work is to comyence upon reasonable availability of Contractor and/or any special ord or customs ade Good(s)which is anticipated to be /f.. L. N L— [fill in date].Estimated completion date is V✓F / 11 [fill in date]. Said estimated substantial completion date is not of the essence.A statement of any contingencies that wouldmaterially change said estimated substantial completion date is as follows: (if applicable,insert a statement of such contingencies). IF THE CONTRACT TOTAL IS$1,000.00 OR LESS Customer must pay in full. COPPLETE THIS SECTION ONLY WHEN THE CONTRACT TOTAL EXCEEDS1 0 . $ , 00 00: Customer to Pay in.Full; OR [ j Customer to use the following payment schedule: (1)Deposit $ to be paid upon signing contract.Deposit should be 1/3 the total contract price;and (2)Payment of$ to be paid anytime after this Contract is signed and before commencement of installation,I/We authorize Lowe's to do one of the following(check appropriate box below): [ ]Charge my/our credit card for the amount of the payment indicated above anytime after the date this Contract is signed; or [ j Deposit my/our check for the amount of the payment indicated above anytime after the date this Contract is signed;and (3)Final payment of$100.00 to be paid upon completion of th installation and both parties'satisfaction. NOTICE REGARDING ARBITRATION AGREEMENT FOR CLAIMS COVERED BY M.G.L.c 142A LOWE'S AND OWNER HEREBY MUTUALLY AGREE IN ADVANCE THAT IN THE EVENT LOWE'S HAS A DISPUTE CONCERNING THIS CONTRACT,THAT LOWE'S MAY SUBMIT SUCH DISPUTE TO A PRIVATE ARBITRATION SERVICE WHICH HAS BEEN APPROVED BY THE SECRETARY OF THE EXECUT- IVE OFFICE OF CONSUMER AF IRS AND BUSINESS REGULATIONS AND THE OWNER ALL BE REQUIRED TO SUBMIT TO SUCH ARBITRATION AS PROVIDED IN M.G.L.c.142A. By: Date: 4f 11.6 By.Lowe' Home Centers,LL � Date.,<' 16 Owner Signature THE SIGNATURES OF THE PARTIES ABOVE APPLY ONLY TO THE AGREEMENT OF THE PARTIES TO ALTERNATIVE DISPUTE RESOLUTION INITIATED BY LOWE'S PURSUANT TO M.G.L.c.142A.THE OWNER MAY BE PERMITTED TO INITIATE ALTERNATIVE DISPUTE RESOLUTION EVEN WHERE THE SECTION ABOVE IS NOT SEPARATELY SIGNED BY THE PARTIES. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES AND UNTIL YOU HAVE READ THE TERMS AND CONDITIONS CONTAINED ON THE REVERSE SIDE OF THIS PAGE AND THE FOLLOWING PAGES OF THIS CONTRACT. BY SIGNING BELOW,YOU ARE ACKNOWLEDGING THAT YOU HAVE READ,UNDERSTAND AND AGREE TO THE TERMS AND CONDITIONS SET FORTH ON THE REVERSE SIDE OF THIS PAGE AND THE FOLLOWING PAGES OF THIS CONTRACT.YOU ARE ENTITLED TO A COPY OF THIS CONTRACT AT THE TIME OF SIGNATURE. WITNESS OUR HAND(S)AND SEAL(S)BELOW THIS--,F--DAY OF ADIL L Lowe's H Cent4J- L�L.0 Lowe's Auth ed Representative Owner Co-owner or Witness Customer aclknowledges receipt of a true copy of this contract which was completely filled in prior to Customer's execution hereof.You,the buyer,ma, cancel this transaction at any time prior to midnight of the third business day after the date of this transaction.See the attached notice of cancellation form for an explanation of this right. s AX r_t The Commonwealth of Massachusetts Deparinrent of hidustrial Accidents Office of Investigations x ' _ 600 Washington Street Boston, MA 02111 www.mass.gov/iia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Pl umbers Applicant Information l_ Please Print Le�tbl� Name iCiu.ins,;!(7r ,Ill ii;ttion!Cndi�idtt,tl): Address: �T �tJoum City/State/Zip: t 1 h ✓h 01 M Phone#:` �-7 d`7a 9- V 3 Are you an employer? Check thepropriate box: 1. 1 ,1111 a employer with 4. ❑ I am a general contractor and I Type of project(required}; cmployces(firll andlor parr-tiruc)," have hired the sub-contractors 6. ❑ New constnlction Ill 2.❑ [ a 'a sole proprietor or partner- listed on the attached sheet. 7. ❑ Renlodclirlg ship and have no cnlplov.ecs These sub-contractors have g, ❑ Demolition working for me in any capacity. employees and have workers' 1No workers' corny. insurance comp. insurance.' q• ❑ Buildirlg addition required. 5. ❑ We arca corporation and its 10.El Electrical repairs or additions 3.❑ I all'a hon'cowner doing all work officers have exercised their I I- Plumbing repairs or additions myself. f No workcrs' comp. right of exemption per MGL insurance required.] ' c. 152. 1(4),and we have no I=' ❑ Roof repairs employees. (No workers' 13M Othell,41"A to romp.insurance required. _:1m applicant that cited.,hox#1 mast tdso fill out the section below showing their workers'compensation policy inR,raruion, hvncowtters who submit this aftidacit indicatinL they are doing all work and lhcn hire outside contractors nuut sulnuit a new affidavit indicating such. :('<I"' ,r<that check this NIX MUM attachcd an additional sheet showing the name of the suh•comractors and;talc whether or iwt those entities ha\c cmplmces• If the sub-contracu,rs have emPlovecs.they must provide their workers'comp.policy nutnlx•r. lain air employer that is providing workers'compensation insurance for rity eiirphycec. Below is(lie policy and job site iii wination. Insurance Con'panyNan'c: .T M. u4vk �nS, �1N�D4n1LPS Polic\ #or Self-ins. Lic. t{: �) Cr_'50Dr5OI y o01 ;?olExpiration Date: tt Y 1$ .lob Site Address: . City/State/Zip: Attach a copy of the workers' compensation policy deqfaration page(showing the policy number 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 line UPlo Sl-500.00 and/or one-year imprisonn'ent,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to 5250.00 a day against the violator. Be advised that a copy of this statement may he forwarded to the Office of lnve�li!-'anon;of the DIA for insurance coverage verification. 1 du hereby c•erti f in thepains and penalties of perjury that lire information provided above is trite and(correct. siollature: DZile: Plume Official rise only. Do not write in this area,to he completed by city or town offrtial. City or Town: Permit/License# 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#: 4 t .3 - .. "d a ;a k ARG $ Rs I � ` -5,s c= y � { a.' $ kNg ¢ t t g� ,t r 9MCNA01 OP ID: DP CERTIFICATE OF LIABILITY INSURANCE DATE 6/2 0 1 6Y) 03/16/2016 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: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be 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 endorsement(s). PRODUCER CONTACT John J Walsh Ins Agency,Inc NAME: David C Bruett P O Box 4407 ac°Nr o Ext):978-745-3300 ac Nol:978-745-9557 Salem,MA 01970-6407 E-MAIL David C Bruett ADDRESS:dbruett@walshinsurance.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Travelers INSURED McNary Construction -INSURER BALM.Mutual Ins.Companies Joseph McNary 767 Woburn Street INSURER C: Wilmington,MA 01887 INSURER D: INSURER E: INSURER 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 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 I TYPE OF INSURANCEDDLSUBR POLICY EFF POLICY EXP LTR POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY X 680-6621 P22A-15-42 02/08/2016 02/08/2017 DAMAGE TO RENTED__ PREMISES Ea occurrence $ 300,00 CLAIMS-MADE ❑X OCCUR MED EXP(Any one person) $ 5,00 PERSONAL&ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,00 X I POLICY 7 PRO LOC $ AUTOMOBILE LIABILITY EOMaBINdED SINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Peraccdent AUTOS AUTOS ) $ NON-OWNED PROPERTY DAMAGE HIRED AUTOSAUTOS PER ACCIDENT $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB 1. CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION WC STATU- TH- AND EMPLOYERS'LIABILITY TORY LIMITS PER B ANY PROPRIETOR/PARTNER/EXECUTIVE Y I N CC6005014081-2015A 11/14/2015 11/14/2016 E.L.EACH ACCIDENT $ 500,00 OFFICERIMEMBER EXCLUDED? ❑ N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,ff more space is required) Lowe's Companies, Inc and any and all subsidiaries are named as additional insured as respects General Liability. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Lowe's Companies,Inc THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN and any and all subsidiaries ACCORDANCE WITH THE POLICY PROVISIONS. Mail code:A3ESS 1000 Lowe's Blvd AUTHORIZED REPRESENTATIVE Mooresville,NC 28117 David C Bruett ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD