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HomeMy WebLinkAboutBuilding Permit #042-16 - 110 RUSSETT LANE 7/9/2015 •7�'1 APPLICATION FOR PLAN EXAMINATION Permit NO: oo` V Date Received CHU`�tt Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION Print � PROPERTY OWNER M 1N,k `o rrg aG'Y e � 1` '� Print MAP NO.: I PARCEL:V U`L ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF HAPROVEMENT PROPOSED USE Residential Non-Residential ❑New Building ❑One family ❑Addition ❑Two or more family ❑Industrial ❑Alteration No.of units: ❑Repair,replacement ❑Assessory Bldg ❑Commercial ❑Demolition ❑Moving relocation ther ❑ Others: ❑Foundation only DESCRIPTION OF WORK TO BE PREFORMED ,. ��L� lc� ��� �r� �n--GrL✓IL[� `f l�' ���r Su,�M�r13 V&,7\ vP. ma--e ;ner cyi� U ftceo . avxA - t I w4K CCyx Identification Please Type or Print Clearly) OWNER: Name: iet�r am"Aye. Phone: 41) -Q4L-`AF7 Address: `U Q-JS(t4 1-0 CONTRACTOR Name: a 101,'`1 v Gtr Ewott jaL n Phone: -71 -102L. ?e 3l f Address: 0 Da i, Supervisor's Construction License: �2�l1 Z'� Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Name: Phone: Address: Reg.No. FEE SCHEDULE.BULDING PERMIT.-$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST�� �DO�N$125.00 PER S.F. Total Project Cost(:$ Cru S' /G S. (90 x12.00=FEE:$ Check No.: ��l a 2. Receipt No.: Page Iof4 • pans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ - TYPE OF SEWERAGE DISPOSA JLh Public Sewer Tanning/MassageBody Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ ElPermanent Dempster on Site THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF m U FORIlBII PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on a- � Signature COMMENTS 15os HEALTH Reviewed on 5 Si nature 10 COMMENTS jO> Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Wafter& Server Connection/Signature& Date Driveway Permit ]DPW Town Engineer: Signature: Located 384 Osgood Street FIRE bEPA �TMENT TernD - ' _ _ i, umpster on sit ,_ �� o , . e Locatedlat�'�12,41MaintSt�eet ,yes,,:.: n _ F ;_'FiraeDepartmentsiglid ture/date COMMENTS. - _ _ i Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: f 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 I NOTES and DATA— (For department use) Lj ® Notified for pickup Call Email Date Time Contact Name 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 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 OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks 4. Building Permit Application Certified Surveyed Plot Plan Workers Comp Affidavit Photo Copy of H.I.C. And C.S.L. Licenses 4. Copy Of Contract 4. 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 i Doc:Building Permit Revised 2014 I Location No. �/ o�— o�f1/(� Date / . - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $--� � Foundation Permit Fee $ t Other Permit Fee $ c TOTAL $ Check# ,, Building Inspector NORTH Town of . � E �FAndover O o h , ver, Mass, LAKI A_ c0c»1c"1W1CK �1• 7�AORA'rfv I'PP�,�S S V BOARD OF HEALTH Food/Kitchen PERM ,IT T I LD Septic System ; THIS CERTIFIES THAT ..�I :..1............ r�.t . ...... �V c , BUILDING INSPECTOR .............. Foundation has permission to erect .......................... buildings on .1 fQ....... ....... -4� ..........�.................. !.'.�,. .�.1....� .. ..�.1.!.�L�LJ.�{ .. y�0 Rough to be occupied as / JJJ ..�....................................... Chimney provided that the person accepting this perm 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 CONSTRU I TARTS 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. North Andover MIMAP 110 Russett Lane July 1, 2015 �i. µ 103.0-0058 Boxford i 1� + • ' 110 RUSSETT�N p s RUSSETT~LN._ 104.A-0053 > .Q 104.A-0052 104.A-0051 Interstates —I —SR Horizontal Datum:MA Stateplane Coordinate System,Datum NAD83, Roads Meters Data Sources:The data for this map was produced by Merrimack f NORT"q Valley Planning Commission(MVPC)using data provided by the Town of t Easements O ,So r6'�,O North Andover.Additional data provided by the Executive Office of Q MVPC Boundary ? s� s O Environmental Affairs/MassGIS.The information depicted on this map is Parcels 3' L for planning purposes only.It may not be adequate for legal boundary f -- 'J V. definition or regulatory interpretation.THE TOWN OF NORTH ANDOVER MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING {t THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY -F i ^ * OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT #o+ _ r ♦ ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF •�1 0�,�.0^�.�� THIS INFORMATION SSACHUSB 1"=42 ft ~�° tomn i iri%oA i G ur LIACiILi I T 1N*UnAIVt.rC 05202015 THIS CE ff*VATE 6 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERIIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY ANEW, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERft AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE FOLDER. IMPORTANT: B the certlflcate holder Is an ADDITIONAL INSURED,the poOCypes)must be endorsed. B SUBROGATION IS WAIVED,subject to the temps and conditions of the policy,certain popes may require an endorsenumL A statement on this certificate does not comer rights to the CwMcate holder In lieu of such endo s PRODS Phom:781 729-9200 NCONTACT AME- Scottl&Company Inc. FAX 19 Mount Vernon street Fax:781- PHONE P.O.Box 1000 Winchester MA 018904OW ADDREM- Vincent A GtalLsePRODUCER MAYOT-1 INSURED NLT PO Boit O C ration Specieft Nano s IN�A:MESA Underwriters Wobum,MA 01888 INSURERS: INSURER C. 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 iMTH 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. LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF EXP LIMITS GEXIERAL LIABILITY EACH OCCURRENCE S 1,000,0001 A X COMMERCIAL GENERAL LIABILITY SCO0600250001503 11/17/2014 11/17/2015 PREMISES Ea octi+www $ 50, CLAIMSMADE X❑OCCUR MED EXP(AM am Pin) $ 5.004 PERSONAL&ADV INJURY $ 1'000'wd GENERAL AGGREGATE $ 2,000, GENT.AGGREGATE LIMIT APPLES PER-- PRODUCTS-COMPIOP AGG S 2,000, X POLICY PRO-J_CT LOC j AUIOMOBRE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO ALLOWNED AUTOS BODILY INJURY(Per Pelson) S BODILY MJURY(Peraoodem) $ SCHEDULED AUTOS PROPERTY DAMAGE HIRED AUTOS (Per aunt) S NOM-OWNED AUTOS s $ VIBRE 1 A Lab OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMSMADE AGGREGATE $_ DEDUCTIBLE $ RETENTION $ $ rYORKERS IXNPENSAMON WC STATU TH AND EMPLOYERS'LIABILITY ANY PROPRIETORIP,�YIN BE ISSUED DIRECTLY EL EACH ACCDENT i OFFICEFUMEMBER EXCLUDED?No ElN/w Ryes de Tin FROM CARRIER EL DISEASE-EAEMPLO S DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ DESCMPTCHOFOPERATKMILOrATIMIVBNCLES(AIacA ACOROD 101,AddRi0na1 pdnarkg Sdwxkft I mote space b requked) CERTIFICATE HOLDER CANCELLATION CIT'YWOB SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, AUnoRIUM REPRESBITATiVE ®1988.2009 ACORD CORPORATION. All rights reserved. FrarcUc�derwnYn"g Dapt �ax6 488 650p1 �. To 781729fif6RT� ean•Fax• 17817286670 Pa ,2 .I-OBi052015107 ��� THS CERi1RG1TE IS iSSl�p AS AMAT7ER OF NFORMATION ONLY AND CONFERSNO RIG'FiTS UPON THE�RTGiCATE HOLDHL THS CERTOaCATE DOES NOT AfFINMATIYELY�NEGATRR'1YAINBfD, E)tTEND OR ALTER THE OOVERAGE AFPORDW 8Y THE POl.IQES�l7Mlf.THIS CERTtfiCATE Of RisllRANCE DOES NOTCONSTIME A CONTRACT BETYIEBN THE ISStAIG NSIAtEtt(S),AtJTF1pR1�REPRESENTATIVE OR PRODUCER,AND THE t:Eit7iRtATE fIOLDETI NYIPORTANT_MtM owtifieMte holder is wt AD01TiONALtNSUREQ the poficy(wt Rralt 6e erLdwsed IF SUBROGA710N IS VIWIVED,wBjaLt to the terms and TxrsdiHaLs dthe patwy, may require wt errlDrserrLerlf A statwrLera an st chat aoifer d to the ow"Cate holdMriM lieu d audL wderswrlMrtfs(s) PRDOAxtrt CONTACT Scot6&Company,Inc. (PHON.aoE.Eer (781)729-9200 FA, No.:) 19 Mount Vernon Street E-MAIL ADDRESS' Winchester,MA 01890 PRnru Irm r_r ICTnIJFR m S KWRERSAFFORDING COVERAGE UNCS RutinED INSURER A Atlantic Charter Irmunnee Company V DAC 44326 MT Mayo Corp INSURER e INSURER C: PO Box 3054 INSURER 0 Wobtun,MA 01888 INSURER E: INSURER F COVERAGES: CERTIFICATE NUMBER REVISION NUMBER- TM ISTD CEKrWY TIMTTM POLICES OF RORWANGE L07M OMOW WAVE B EM13V ED TO THE OBtNtED NAMED ABOVE FDR 7W POLICY PeNM sommm.NO7MrrNSTAMDawA YREQlUB*3 Nr,TERM ORCOMOMON OFANYCONTRACTOROTHEIt OOCUMEWrNf}HREUWTTOVMRCHTM GATE WY BE WRED OR WAY P@tTAMN,THE RlSURANLE AFFORDED BY THE POLICES DES04MED NERBM IS MB,ECT TO ALL THETERYS, EXCLUSUM AND CONDMONS OF SUCH POLICES.LOM SFIDIN MAY HAVE BEEN REDUCED BY PAD CLAIMS. wN TYPE OF INSURANCE ADOL saes POLICYNUMBER POLICYEFFECTVE POUCTE7PUMTIDN LAM LTR WSR TMPD GATE puuDorm DATE PONDOrn) F TheuwM 11 GENERAL UUABLRT EACH DccuRIRB/cE s GE ® ETORBtTPR9ASE5 CLACKS MADE El El F-1 = DEXPI"ane PamP) s 'ERSOMALAACIVINJURV S 3ENBPALAGGRGGA'IE s GE LASOZECATE UNIT APPLN3PE7 S ' POLICY❑PROTECT ElLOC TS-CONP90PAGG AUIOMOBLELnIKm OOYBWEOSIGEUMIT _ ANY AUTO (Ea AMid.M ALLOANEDAUTOS ❑ FwPers UURY = SCNIA EDEOAUTOS IP�P BODILY MNJURY _ NIREDAUTOS MAPROPeRTYA O NON-oxtIDEDAUTos DAMAGE _ (EA Attietrp ANAMR44 OCCUR UAMIm E] EACH OCCURRGNcE f EXCESS LUIS 1:1 CLAM MADE AGGREGATE S DEDUCTIBLE _ S RETEMDON S P—, COMLPBISATIONAND STAMArEiS tLA9uTv WCV00938804 11/2012014 11/20/2015 XSUTAAARTNEft"ECUDYE Y'NPoMEMBEREXC UDED? N nOl � PolicyCovNxage State:MA EACHACCIOEHi s 50(k000 DISEASE-POLICY UMIT t 500,000 DISEASE-FACHEMKOYEE $ 500,WO OTHER ❑ DEBCrErIDI OF OFERATgNSILOC1nip6frBaCLF.S pfaNAtOID 101.AAAWnM RSNLs 6KIN�1e•aMllfpiCtlsPlQA1MI __ } . _ SHOULD AW OF THE ABOVE DESCF48m Pouces BE CANCELLED BEFORE 7FE E XPIRATIOM DATE THEREOF,THE ISSLM4G C0kWMNY VdLLENDEAVOR TO MAIL 12 DAYS TMaT%N NoTiCE To THE cERTtRcATE HOLDER NAMED To THE LET. WN FAlt1JRETO DO SO SHALL WK)SE NOOBLIGATION OR LM8ILITY OFANYtW4DtM MTHEONS ER.rMAGHNTSORREPRESENTATIVES. Rr-D�LTATIVE ACORD 26 PEAS) Uftq� Page r of T CERTIFICATE ROLDERCOPY o iSMaZDOS ACORD CORPORATION.AD rto►d osewsd I he uommonweanh of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Please Print Name: (y) -A . („1�r`r'o toCQo& lLn Location: \1 U �A5ee- ---n `µ` I // /� City c)�`�h ,l�� r _ PA Phone am a homeowner performing all work myself. F-1I am a sole proprietor and have no one working in any capacity 1ZI am an employer providing workers'compensation for my employees working on this job. Company name: ml a Co�� < Address Q�� \��'{�:�D.5-y City: WA L)c rt QV 0 0 v Phone#: Insurance Co. AA tAA i t Policv# Company name: Address City: Phone#: Insurance Co. Policy# Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of($100.00)a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do herby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature Date Print name Phone# Official use only do not write in this area to be completed by city or town official' ❑ Building Dept []Check if immediate response is required Building Dept ❑ Licensing Board ❑ Selectman's Office Contact person: Phone#: ❑ Health Department ❑ Other FORM WORKMAN'S COMPENSATION — Office of Consumer Affairs and Business Regulation r' 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 173259 Type: Corporation Expiration: 9/20/2016 Tr/i 260577 MT. MAYO CORP MATTHEW MAYO 96 CAMBRIDGE RD WOBURN, MA 01801 -= Update Address and return card.Mark reason for change. SCA 1 Cr 20M-05/11 [—I Address Renewal F-] Employment f-] Lost Card e erA ffaairruecuusi o�ss Regulation efla License or registration valid for individul use only _ Office of Consumer Affairs&Business Regulation ' g� Y ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: gistration: 173259 Type: Office of Consumer Affairs and Business Regulation xpiration: :-9/20/2016 . Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 MT.MAYO CORP MATTHEW MAYO 96 CAMBRIDGE RD WOBURN,MA 01801 Undersecretary Not valid without signature i �vta�sachrxs `ts-0 # # .. min$of P blip afrt canard o .Suild;n9 Rcgcjati(5As.arrd.Standkds = -* Cnrr4trtrc�airn�rrft�hisut- License. CS-102925 96 CTTIiEW T MAY(D AMBRIDGE 12oAD WO BURN MA ©lsol °'xpi �t�csrti 07/11120 s TYPE OF SEWERAGE DISPOSAL Swimming Pools ❑ Tanning/Massage/Body Art ❑ Public Sewer v Well F1Tobacco Sales ❑ Food Packaging/Sales ❑ Permanent Dumpster on Site ❑ Private(septic tank,etc. F1 Electric Meter location to project NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner 6EXAM;Ck Signature of contractor Plans Submitted Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF-U FORM DATE REJECTED DATE APPROVED PLANNING &DEVELOPMENT ❑ ❑ ❑Water Shed Special Permit ❑ Site Plan Special Permit ❑ Other COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS Zoning Board of Appeals:Variance,Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water&Sewer connection/Sipature&Date Driveway Permit Temp Dumpster on site yes no_ Fire Department signature/date