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Home My WebLink AboutBuilding Permit #956-15 - 108 MOODY STREET 5/22/2015 �� BUILDING PERMIT of No°T b:�tio TOWN OF NORTH ANDOVER � APPLICATION FOR PLAN EXAMINATION Permit No#: � ®� Date Received °SSgCHus�`�� Date Issued: IMPORTANT• Applicant must complete all items on this page LOCATION JOS ynwo`/ 1V01t1'1-A 41110CV67Z Print PROPERTY OWNER AFF lwcLL �•°, Print 100 Year Structure yes tn MAP PARCEL:ZONING DISTRICT: Historic District yes Machine Shop Village yes. TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building 9.One family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ARepair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Septt_c -OWell ❑ Floodplai.n Wetland's 0 Watershed'District. 0_Wafer/Sewer DESCRIPTION OF WOR.1 TO BE PERFORMED: Aelyv✓/47c- 01 6,67014eeMS Ale6e �l�"�errr�t�5 �inm�Cr P%�C /z�P/li2 ,e4✓ILasNir fA��, i�Z Identification- Please Type or Print Clearly OWNER: Name: aPhone: Isl- -7& Address: 7 1<1tng q_ t,,we yn,4eId ou Contractor N me: Phone: Email: t - Address: 2 L Supervisor's Construction License: /6V .5 _Exp. Date:��;� Home Improvement License: �'S 3 Exp. Date: 2 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: $`71, 2.06% 00 FEE: $ �1' 41 Check No.: / 7 )"r Receipt No.: NOTE: Persons contractin with unregistered contractors do not have access to the guaranty fund Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ T g/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ j Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF o U FORM i 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 P,',anning Board Decision: Comments 6onservation Decision: Comments Water& Sewer Connection/signature& Date Driveway Permit DPW Town Engineer: Signature: Located Osgood Street c ed 384 g eet � jFl_tDEPARaT11�lENT s }ernDum sfe�•onsite ns o ` - KA ,Fi e�ep�artment�,signure%date._,._ . Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Deter 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) I LJ Notified for pickup Call Email Date Time Contact Name Doc.Bnilding Permit Revised 2014 Building Department The followingis a list of the required forms to be filled out for the appropriate permit to be obtained. q Roofing, Siding, Interior Rehabilitation Permits Building Permit Application 4. Workers Comp Affidavit � Photo Copy Of H.I.C. And/Or C.S.L. Licenses 4� 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 Photo Copy of H.I.C. And C.S.L. Licenses ;re 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 Location No. S6 �� Date . - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $�' °D Foundation Permit Fee $ Other Permit Fee $ ? TOTAL $ Check# /2 2 ]p 3 13 ding Inspector I Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 745200.00 m $ - $ 890.40 Plumbing Fee $ 111.30 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 111.30 Total fees collected $ 1,213.00 108 Moody Street 956-15 on 5/22/2015 Gut Remodel NORTH • Town o �.. t E ndover o - �+ No. o$5 h ," ver, Mass, T O LANE [O[NI[Mt WICK �1' A04ATED S � . U BOARD OF HEALTH Food/Kitchen PERM- IT T D Septic System _ L ............................ BUILDING INSPECTOR THIS CERTIFIES THAT ..........................:...............:... . ..................................................... • �• -, Foundation has permission to erect buildings on ... Rough to be occupied as .......... : ...... <. -- . .. .... = Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application rFnal ,� &)Z-, wUi w 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. LUMBIN� II/NSgPE l °- / Rough .VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rou ` T Service ....................................... ................................ BUILDING INSPECTOR Fina _'J�.. GAS INSPECT 2 / Occupancy Permit Required to Occupy Building RoughLi , '� � Display in a Conspicuous Place on the Premises — Do Not Remove Final p// /, No Lathing or Dry Wall To Be Done FIRE DEPARTME Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. NORTH Town of . � ,� ndover No. 9%r ,05 h ver, Mass, CO[.NIC"2W1CK A04ATED r,Pa�,�S S U BOARD OF HEALTH PER T T LD Food/Kitchen pSeptic System MTHIS CERTIFIES THAT '.. � a ... .��C�. .:C 'C ..................................• BUILDING INSPECTOR ............................ ........ . . .. .. /�� has permission to erect ............,.............. buildings on /............... .. �................... ....................... Foundation .. Rough f y to be occupied as .....X61.9.lAke.....��,.!'.'fE�,rfr.�Y..... .... .. .......:-.......................... ...... 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION RTS Rough ..�............................... Service ............... ........ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required 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. Contract between ALRO,LLC and Munson Property Management,LLC. 108 MOODY ST NORTH ANDOVER, MA 1. DEMO MATERIALS AS DISCUSSED 2. REMOVE ALL DEBRIS FROM SITE 3. REPLACE 12 WINDOWS 4. REPLACE 3 EXTERIOR DOORS 5. REPLACE 13 INTERIOR DOORS 6. REPAIR STAIRS TO BASEMENT 7. ADD CLOSETS AS DISCUSSED 8. INSTALL NEW CABINETS IN KITCHEN 9. REPAIR, PATCH AND PAINT WALLS 10. REPAIR/ REPLACE SLIDER 11. SUPPLY AND INSTALL NEW HEATING SYSTEM WITH A/C 12. REPAIR SAND AND POLY HARDWOOD FLOORS 13. REPAIR ROOF AND SIDING AS NEEDED 14. RENOVATE TWO BATHROOMS WITH NEW FIXTURES 15. UPGRADE ELECTRICAL 16. REPLACE RUGS AND TILE 17. RELACE FENCING 18. NOT INCLUDED: LANDSCAPING, FIXTURES,GRANITE OR POOL AREA 19. NOTE: PLUMBING, ELECTRICAL AND HVAC BY LICENSED CONTRACTORS JOB WILL START WITH ISSUANCE OF PERMIT BY TOWN AND BE COMPLETED IN TEN WEEKS TOTAL JOB COST$86,120.00 5/20/2015 JEFF MOLL/ALRO,LLC. MUNSON PROPERTY MANAGEMENT, LLC 746 9`0 (p 17 ~ 712.- agjq The Commonwealth of Massachusetts f Department of Industrial Accidents i d I Congress Street, Suite 100 Boston,MA 02114-2017 www.mass.gov/dia 5�•V` Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Le ibl Y. Name(Business/Organization/Individual): d �� Address: a C, rL City/State/Zip: Lo Phone#: �l7 F3�' 7G 9 Are you an ployer?Check the appropriate box: Type of project(required): 1. am a employer with employees(Rill and/or part-time).* 7. ❑New construction 21D.L—a sole proprietor or partnership and have no employees working for me in 8. C&Remodeling any capacity.[No workers'comp.insurance required.] 9, ❑Demolition 3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10❑Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.t 14.Q Other 6.Q We are a corporation and its officers have exercised their right of'exemption per MGL c. 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: � — Policy#or Self-ins.Lie.#: 06 a CZ 7 X1 9 �^ S r Expiration Date: 3 o C Job Site Address: 16� r h2,!voy City/State/Zip: N v�TN d Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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 of up to$250.0 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby certify unde the ' sand enalties of perjury that the information provided above is true and correct. • Date: Signature: Phone#: 7 94' TC Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# — Issuing Authority(circle one): LContact'Person: oarof Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector Other Phone#: CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYn TN IFICATE 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 HOLDERL IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require and endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: JOSEPH PINTO INS AGCY PHONE FAX 142 PLEASANT ST (A(C,No,Ext): (AIC,No): E-MAIL MALDEN,MA 02148 ADDRESS: 27BSY INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA ACTION SIDING AND REMODELING INC INSURER B: INSURER C: INSURER D: 3 PINEWOOD RD INSURER E: PEABODY,MA 01960 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THts Is To CERTIFY THAT THE POLICES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD NOICATED.NOTWITHSTANDING THSTANDNG 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 5 SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.Lunn SHOWN MAY HAVE REDUCED BY PAID CLAIMS- MSR ADD B POLICY EFF DATE POLICY EXP DATE LTR TYPE OF INSURANCE L R POLICY NUMBER (MMXMYVYY) (MMiDDXYYVY) LIMITS GENERAL LIABILITY ACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY YCLAIMS MADE Q OCCUR. AMAGE TO RENTED $ REMISES(Ea occurrence) rRODUCTS P(Any one person) $ GEN'L AGGREGATE LIMIT APPLIES PER: AL 8 ADV INJURY $ ENERAL AGGREGATE $ POLICY PROJ ECT a LOC -COMP/OP AGG $ AUTOMOBILE LIABILITY ED SINGLE $ ANY AUTO LIMIT(Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULE AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) UMBRELLA LOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ A WORKER'S COMPENSATION AND X WC STATUTORY OTHER EMPLOYER'S LIABILITY Y/N UB-2E072226-15 03/10/2015 03/10/2016 OMITS ANY PROPERITORIPARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? N/A E.L EACH ACCIDENT $ 100,000 (Mandatory In It yes,describe under er E.L.DISEASE-EA EMPLOYEE $ 100,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OP£RATIONSfLOCATIONS/VEHICLESMESTRICTIONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. CERTIFICATE HOLDER CANCELLATION t SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED i IN ACCORDANCE WITH THE POLICY PROVISIONS. _ AUTHORIZED REPRESENT VE +:;..... ACORD 25(201D/DS) The ACORD name and logo are registered marks of ACORD 1988.21)110 ACORD CORPORATION. All rights reserved. C?��ce�orrrrwr�anetsear'�.�i C%' aau�lut�ells ° OI[��COI�CTCfIt �, �. 1'tfi7 Types. 4tS_ DBA ACTIOUSIDEU ORTHLfiR CA >artE 3 M PIISiEkN'CK�I3T�D. j: C :POI)1(, U11 a _ Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supen-isor License: CS404381 ARTHUR R CARD 3 PINEWOOD ROADM r Imp s PEABODY MA 615 ` �t Expiration Commissioner 12/11/2015