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HomeMy WebLinkAboutBuilding Permit #046 - 109 MAIN STREET 7/18/2008 BUILDING PERMIT ot p10RTly�t,.6o 06�ti TOWN OF NORTH ANDOVER 3? '`'''- `-�' '6 ° 0 V APPLICATION FOR PLAN EXAMINATION R n en Permit NO: (� Date Received �SSACHus�� Date Issued: y la(IMPORTANT:Applicant must complete all items on this page LOCATION 1 t ox � ��x, T 0l } nt PROPERTY OWNER Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family AdditiQn Two or more family Industrial Alteration No. of units: ommercia epair, ,replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: Y1' tPraucc !k vim-- -to c5- Identification Please Type or Print Clearly) OWNER: Name: 15A-xi Z-AU ZE--� Phone: Address: CONTRACTOR Name: J �r��/` Phone: ©- Address: � 1 q7o Supervisor's Construction License: �� � Exp. Date: Home Improvement License: Exp. Date: ARCH ITECT/ENGINEER /��T �eiC� Phone: S l 744 Address: ZZ/ WW//,)67D/J Ste' AAA 01170Reg. No4�2(? FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ d019,? FEE: $ . Check No.: 0 Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access t e �a'ra ur Signature of Agent/Owner Signature of contract- 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 i PLANNING & DEVELOPMENT COMMENTS I CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on _ Signature COMMENTS y 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 FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS 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 Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 Location 10 No. Date 7 �� 'TOWN OF NORTH ANDOVER °c F p Certificate of Occupancy $ l0 6 ' E<� Building/Frame Permit Fee $ "us Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # ��G 4. i 3 3 Wilding Inspector OFFICE OF BUILDING INSPECTOR TOWN OF NORTH ANDOVER CONSTRUCTION CONTROL PROJECT NUMBER: G C/ DGr✓- PROJECT TITLE: �� PROJECT LOCATION: , MA T— NAME OF BUILDING: NATURE OF PROJECT:_1/A41 IN AC RD CE WITH ART CLE 116 OF THE MASSACHUSETTS STATE BUILDING CODE, I, W REGISTRATION NO. Z�l BEING A REGISTERED PROFESSIONALXaNG JEEBIARCHITECH HEREBY CERTIFY THAT I r HAVE PREPARED OR DIRECTLY SUPERVISED THE PREPARATION OF ALL DESIGN PLANS, COMPUTATIONS AND SPECIFICATIONS CONCERNING: ENTIRE PROJECT ARCHITECTURAL 0 STRUCTURAL 0 MECHANICAL 0 FIRE PROTECTION 0 ELECTRICAL 0 OTHER(SPECIFY) FOR THE ABOVE NAMED PROJECT AND THAT,HAT,TO THE BEST OF MY KNOWLEGE, SUCH PLANS, COMPUTATIONS AND SPECIFICATIONS MEET THE APPLICABLE PROVISION OF THE MASSACHUSETTS STATE BUILDING CODE,ALL ACCEPTABLE ENGINEERING PRATICES. AND APPLICABLE LAWS AND ORDINANCES FOR THE PROPOSED USE AND OCCUPANCY. I FURTHER CERTIFY THAT I SHALL PERFORM THE NECESSARY PROFESSIONAL SERVICES AND B EPRESENT ON THE CONSTRUCTION SITE ON A REGULAR AND PERIODIC BASIS TO DETERMINE THAT THE WORK IS PROCEEEDING IN ACCORDANCE WITH THE DOCUMENTS APPROVED FOR THE BUILDING PERMIT AND SHALL BE RESPONSIBLE FOR THE FOLLOWING AS SPECIFIED IN SECTION 116.0 1. Review,for conformance to the design concept, shop drawings, samples and other submittals which are submitted by the contractor in accordance with the requirements of the construction documents. 2. Review and approval of the quality control procedures for all code-required controlled materials. 3. Be present at intervals appropriate to the stage of construction to become, generally familiar with6the progress and quality of the work and to determine, in general, if the work is being performed in a manner consistent with the construction documents. PURSUANT TO SECTION 116.2 .2 1 SHALL SUBMIT WEEKLY, A PROGRESS REPORT TOGETHER WITH PERTINENT COMMENTS TO THE NORTH ANDOVER BUILDING INSPECTOR. UPON COMPLETION OF THE WORK, I SHALL SUBMIT A FINAL REPORT AS TO THE SATISFACTORY COMPLETION AND READINESS OF THE PROJECT FOR OCCUP Y. S TUr SUBSCRIBED AND SWORN TO BEFORE ME THIS DAY OF _�pU c1 ri.4 n D x NOTARY PUBLIC MY COMMISSION EXPIRES 1C�`� L+ ACORD„r, CERTIFICATE OF LIABILITY INSURANCE 0DATE( NYYY) 7/1 MIDD 07/14/2008008 PRODUCER (978) 745-6464 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Rose Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 66 Loring Avenue ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 958 Salem MA 01970- INSURERS AFFORDING COVERAGE MAIC# INSURED INSURERA:CO10ny Insurance Rumpf Design Group INSURER B:Granite State 74 Wharf Street INSURER C: INSURER D: Salem MA 01970- INSURER E: COVERAGES 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L POLICY EFFECTIVE POLICY'EXPIRATION LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE(MM/DD/YY) DATE(MM/DD/YY) LIMITS A GENERAL LIABILITY / / / / EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $O 000 PREMISES Ea occurrence $ r CLAIMS MADE Fx_1 OCCUR GL3546724 04/10/2008 04/10/2009 MED EXP(Any oneperson) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S 2,000,000 POLICY JECOT� LOC AUTOMOBILE LIABILITY / / / / COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS / / / / BODILY INJURY SCHEDULED AUTOS (Per person) S HIRED AUTOS / / / / BODILY INJURY NON-OWNED AUTOS (Per accident) S PROPERTY DAMAGE (Per accident) S GAR AGELJABILITY AUTO ONLY-EA ACCIDENT S ANY AUTO / / / / OTHER THAN EA ACC $ AUTO ONLY: AGG S EXCESSIUMBRELLA LIABILITY / / / / EACH OCCURRENCE $ OCCUR ❑CLAIMS MADE AGGREGATE $ S DEDUCTIBLE / / / / $ RETENTION $ S B WORKERS COMPENSATION AND WC4393610 07/26/2007 07/26/2008 X TORY LIMITS ER _ EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT S 100,000 OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEEI S 100,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONSILOCA'nONSIVEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT Town of North Andover FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. — AUTHORIZE EP�TATiVE I u' ng"oan Construction =16 ds Supervisor License L"! e. CS 38856 r -- Tr# 52esTrtion pprr 20683 a •�. ERI.CR MP i}4r '1 RU F w : Pb BOX 4483 SALEM, MA 01970 Commissioner w K rn1I ��►����� �� a a a a a � 1 H II 1 ' II I � 1 IMEN MOW LWMIN L1 1 II I 1 1 , 111 II r � MIN�1,1111�1� 164LL Project - Center 0I e ' • " - •. • North Andover, c _ - NORTI, ovm of No. 44a a 4/ 4 ° :, i10 over, Mass. 0T O LAKE �. COCHICHEWICK 7,p ADRATED P5 `s BOARD OF HEALTH i PERMIT T D Food/Kitchen Septic System THIS CERTIFIES THAT % ~� -'�I y ,�C �/ i'�� / S" BUILDING INSPECTOR BUI ................................................ ...... Foundation has permission to erect........................................ buildings on .....�... Rough r to be occupied as.....................�' / t�..C, �'•...............f.....�c:, :i .. {%... ....... ..,.:,........,...................... Chimney provided that the person accepting this permit shall in every respect conform to the termiof the application on file in Final 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 CONSTRUCTION TARTS Rough ....... Service ..................................................................... .... . , BUILDING OR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. Burner FlRE DEPARTMENT Street No. SEE REVERSE SIDE Smoke Det.