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HomeMy WebLinkAboutBuilding Permit #397-2017 - 103 SUTTON HILL ROAD 10/13/2016 � rc / `Q AW s�A Nt ORTH .q 6 ��Q BUILDING PERMI� �IIO��tLE� yb +O TOWN OF NORTH ANDOVER oA APPLICATION FOR PLAN EXAMINATION b y'� Date Received �4"�R,TE, c� Permit No#: 0",� � gssgcHus�� Date Issued: 119 � IMPORTANT: Applicant must complete all items on this page LOCATION 10 3 5 Ath Print PROPERTY OWNER T K Z L L C Print 100 Year Structureyes PnMAP b0__ PARCEL: ZONING DISTRICT: R3Historic District yes Machine Shop Village yes <5o_ TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential XNew Building *X One family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other 11 Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Ide tification- Please Type or Print Clearly OWNER: Name: T KZLL Phone:C17 '`gR-�461, Address: 4 �Evk 9 56irt ZO 1 ) A4J 4A d � S Contractor N me S 1 .• D Phone: Email: 7Ze. 'e Address: &1I JVG� h �S�1 Supervisor s Construction License.: r � Exp. Date: rag Home Improvement License: Exp. Date: ARCHITECT/ENGINEER 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: $ I'L S SIU (Svu�Anw a�U) FEE: $ I SCS . 60 Check No.: 2 Receipt No.:� NOTE: Persons contracting with unregistered co Tactors do not have access;to guaranty u d inature of Agent/Owner _ Signature of contractor 1 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 o Building Permit Application _ o Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract o Floor Plan Or Proposed Interior Work Li Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks o Building Permit Application o Certified Surveyed Plot Plan o Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract o Floor/Cross Section/Elevation Plan Of Proposed.Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) o 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 o Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract a Mass check Energy Compliance Report a 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:Building Permit Revised 2014 Plans Submitted Plans Waived LI 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 PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTSTI l� IZA �u � � 601h� )b� S L L CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed onV ' Sin ,, 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�A��� /Driveway Permit DPW Town Engineer: Signatur <4��� /d�-!_Z- (, Located�384Osgood Street ___FIRE DEPARTMENT - Ternppumpster on;site yes__ �_ ., ., . Locefed at 12..4 Main Street Fire Department signature/date 9�zft�, / COMMENTS—,&-,; Dimension Number of Stories: 2 Total square feet of floor area, based on Exterior dimen si ons.2,$�D— Total land area, sq. ft.: Z 5 ,32 5 F 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) roUlo dee6kD D�y cd� �,� Z l D 1066 x 12 ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 Location 10.? r � No. 3O . �' Date • • TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $���� Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# } ,i Building In pector�� •••••Verizon LTE 9:21 AM 6. 80%®, docs.google.com sat ?LAO A #156—#372 CKSTWUT STc r #132 CHCSrWW SIRCET TAX WAP 60 LOT 71 N 7 1 4 �"'�, 34a6 '-� �V -r 3 3,y�LOT � 2 aP�A: C's. OM 4 Nam IItA � �' 'R •. M TAkoi FROM Tii OF tMTH AKDD%fR CIS :7 2.k T BE RAZFM po TAX MAP 60A LOT PAVENT AREA i Plans Submitted Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer 9 Tanning/MassageBody 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 PLANNING & DEVELOPMENT Reviewed On 16 Signature_ COMMENTS OAK 64ait&( )4 ELI CONSERVATION Reviewed on D \10 Signature r—,4- COMMENTS- �i� �, �,.�, V� HEALTH Reviewed on-10j ( Sin COMMENTS Zoning Board of Appeals:Variance, Petition No: oma. Zoning Decision/receipt submitted yes Planning Board Decision: ^ Comments -- Conservation Decision: Comments Water & Sewer Connection/Si nature& Date Driveway Permit DPW Town Engineer: Signatur � rf ��--13 )4:7 _ Located 384 Osgood Street �FIREEDEPA Mai NT Tem on site_.Y _ _ �.� - RTM street r p Dumpster _ Loeatetl,at�iC 4t Fire Dep�o ftff ent signature/date COMMENTS;_ i Dimension I Number of Stories: Z fee Totals square q t of floor area, based on Exterior dimensions.�,$2� Total land area, sq. ft.: Z S Y 22 5 F 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) "O1J,1�1 l 0 u►.� � cv s t ) Z s� dee, �61 00 _ 1066 X 1Z -Fe-p- Die.. 1 so , (JO ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Pennit Revised 2014 NORTH own of ? _� ,t sAndover O No. d * - ,� o Ph ver, Mass, COCHICNlwICK y1' ---�'- T �d ADRATED S U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT NEON .. ....,�T .. BUILDING INSPECTOR ...... �• ..... .. •*".................. .......... ..... has permission to erect buildings on �. �� Foundation ... . . . . . . . . . . Rough to be occupied as ... .... ... . 77&*J...a*&0................. .. ................ Chimney provided that the person accepting this 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 CONST TION Rough Service ..... ........ ... Final BUILDING I CT 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. 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(a ,4` yr ' RPppppANa a11N YNt NJtda J\ M Ir4a.flas a me LOT'1 re i 30i=ep.2 11++ NORTH ANDUVER q car.-1au �i� 0 PLANNiNC BOARD @@ or tm APP-0 UNaCn NIC 91J9WNsan 9 4. jw 9.r COSITn0.l`A` C9`P10137aNs --- d �y pAm ORN n.+'n,R'G'sif.aw+nNcoou,.w .PYAMAA`Jey1,G1.�'�A ----- ------ ra \ LOT a \ { I \ ;m"o OFA ro, ej C.P A.-IOPr \ r 1 9 I'yp. _ A w1 ercraec "a re I alOR9 I I Alae wd' A resp ti 9sa vppp 1RAu5 ► MAI' �. '41 wrnNe olwr2 amCTYYa cARAq' � t �.. ..YrN 1lNn guar P.rw"rr {�j, \ R1MM P`IIIIICI.N (RGA ewl Or Ore.11 aI A� rx rq.,RN1.ANr n rrrr rR1p!ea �` N+e p NpR« or rrrr i+l cN°°0r.uCnra' n.�2i4tlC>C rrr-T).jr �• � ..land _ c-nOge I I � CAPSTONE" SUBDMMON 2ft0030P.a 0 CPA.1Par PROOJP MAN �� 4 N. ANDOVER, MASSACHUSETTS TfC PROOF PLAN IN INTENDED TO SHOW CONFORMANCE COUNTY WITH ZONING AND IS NOT INTENDED FOR CONSTRUCTION. � � = rR11=r" SCAJX. r'—20' NMSdD. AN 2a1 8016 DAM DrC. 17, F015 RE✓15SD'FED 5. 2016 GRAPHIC SCALE i1:B. 23 Y016 aaadPf!a t SULLIVAN F,NCI'VEERINC CROUP. LLC �N 961) a /s wxa aa16AA.MA Ossa (10)M1-4NA SHawr 3 OF 4 i NOTICE NOTICE Z m y O TO b T EMPLOYEES ) $k¢ EMPLOYEES The Commonwealth of Massachusetts DEPARTMENT OF INDUSTRIAL ACCIDENTS 1 Congress Street, Suite 100, Boston, Massachusetts 02114-2017 617-727-4900 As required by Massachusetts General Law, Chapter 152, Sections 21, 22, & 30, this will give you notice that I(we) have provided payment to our injured employees under the above mentioned chapter by insuring with: Associated Employers Insurance Company P Y NAME OF INSURANCE COMPANY P.O. Bax 4070 Burlington, MA 01803-0970 ADDRESS OF INSURANCE COMPANY WCC-500-5006517-2016A 10/01/2016- 10/01/2017 POLICY NUMBER EFFECTIVE DATES 1060 Osgood Street M P Roberts Insurance Agency North Andover MA 0184597 { 8)683-8073 NAME OF INSURANCE AGENT ADDRESS PHONE TKZ LLC 4 High Street#201 North Andover, MA 01845 EMPLOYER ADDRESS 08/04/2016 DATE MEDICAL TREATMENT The above named insurer is required in cases of personal injuries arising out of and in the course of employment to furnish adequate and reasonable hospital and medical services in accordance with the provisions of the Workers Compensation Act. A copy of the First Report of Injury must be given to the injured employee. The employee may select his or her own physician. The reasonable cost of the services provided by the treating physician will be paid by the insurer, if the treatment is necessary and reasonably connected to the work related injury. In cases requiring hospital attention, employees are hereby notified that the insurer has arranged for such attention at the NEAREST AND BEST MEDICAL FACILITY HOSPITAL ADDRESS TO BE POSTED BY EMPLOYER e•eeo verizon LI t tv.v.,r1LVl All lnboxes (2) s'e fl ll� Ga Sent from my Pad Ate_ V CERTIFICATE OF LIABILITY INSURANCE � 6/21/1.6_: 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 INSURERIS),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER_ IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(es)must be endorsed. if SUBROGATION IS WAIVED,subject to i the terms and conditions of the polity,certain policies may require an endorsement A statement onthis certificate does not confer rights to the certificate holder in lieu of such endorsement(*). PRODUCER NAFR- Sandi Munroe M.P. Roberts Insurance Agency PHONE 978) 683-8073 FAX Na: (975) 6e3-3147 1060 Osgood Street ADDRESS: sandi@mprobertsinsurance.com North Andover, MA 01845 INSURERAFFORDING COVERAGE MAIC 5�—IIID----IIID`----- ---`---_. INSURERA:Essex Insurance CO __. INSURED INSURER 9:Associated Empl_o_Vers-Insurance TKZ, LLC OSURER C: c/o TOM ZAHORUIKO INSURERD., 78 GREAT POND ROAD -" - INSURER E: NORTH ANDOVER, MA 01845 USURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW RAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY RFOUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTALN,THE INSURANCE AFFORDED BY TFT`POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL TI IE TERMS. EXCLUSIONS ANDCONDiTIONS OFSUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR� :AfZ11JSUBR: POLICY EFF POUL'Y EXP LTR! TYPE OFINSUHA)ICE %IN RIIWVDI POLICY NUMBER s IAIA)DOIYYri rximrwym tm9T5 i pLGENERAL LIABILITY I (3DX4936 7/23/15; 7/13/16;EACH OCCURRENCE,___s 1,.000,000 j RENTED � I X i CONTAF11CIALGFNERALLtARILITY i Et IBES«ocurt: c_9 S 50,000 onI CWLMShiAUE `}({OIL UH i SFO EXP tArnon Pasut% 5.... 5_000 L.-...? - _.r._.._._-__—_: I PERSOM\LEADVINIURY .5 GENERAL AGGREGa7E 's 2,000,000 _.._... .......... -- — I I .. GEN'LACGRFGA7E;LWITAPPLIFSPER -PRODII(:f,^,`rAk:�NPAGG XI POL)GY i PRO ;LOG XCi AUTOMOBILE UABIOTY i I COVUINIA)SINGLE LIMIT �Ea n[cld:•r1) i - i UODIL.Y IN.RIRY(rr.r P,.r..nn) `F ANYAU70 - ( - ALLONW:O SCHEDULED 890 AUTOS AUTOS 1LY IN,IU _. .:. !a....- ...._ . RY!Pcl.-n rsl s:t [ I PROPERrY rwiikui ' NON-OV4TLFp } i g ! _HIREDAUTOS _AUIOS UMBRELLA LIAR —OMUR - : _LAC)I Mr tllt_RE NIX - �r.-__.__. ..._. - EXCESSLIAR CLAVAS LADE_' i ;AG.^,til?Gn7E It Ohn REI EN110143 : - .n U• I WORKEASCO`APEt1SAT14N I C5005006517-2014A, 1U/L/15' 10/1/16:X' $ , :WC _ .lOf YLIh11Ju: .:_EN AND EMPLOYERS'LiABiLiTY YIN ANY PROPRIETORPA RTNEREXECUTIVEE, F.CH ACCir£-Nr 5 1,000,000 : OFFICZ-WAVAKA EXCI.LrJED� N)A F1 E IMandatory In NN) �( EL DI5t_ASF4ArUPI0NFE:S 1,000,000 11 gl,d('Saft:l Idr-r 1 UES(:RIP DON(V OPL RA TIONS EeM.t i I E.L-DISEASE-POLICY L16UT s 1,000,000 1 OESCRIPTIONOFOPERATIONSILOCAIIONSIVOaCLES(Aft-h ACORD101,Addition,dRn,rerks Saedlt.,ifmmrspami%,eglircd) j ( ' s CERTIFICATE HOLDER CANCELLATION I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL SE DELIVERED IN i TOWN OF NORTH ANDOVERI ACCORDANCE WITH THE POLICY PROVISIONS. i BUILDING DEPT FA 1600 OSGOOD STREET au7l0 D EPAESENTA NORTH ANDOVER, MA 01845 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The AC ORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-055417 - d Construction Supervisor THOMAS 0 ZAHORUIKO 4 HIGH STREET SUITE 201 NORTH ANDOVER MA 01845 i �, ;:KCA, - Expiration: Commissioner 04/05/2018