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HomeMy WebLinkAboutBuilding Permit #600 - 114 COACHMANS LANE 5/11/2009 ORT N H ,9 O �eD BUILDING PERMIT .. C? 4` t '6 O� TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received �4"6g4TED gSSACHUs�� Date Issued: � l'O IMPORTANT:Applicant must complete all items on this page LOCATIO ,40 A' _. t - _ Print PROPERTY OWNER f r c.(c a CA+ A- cct 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 Addition Two or more family Industrial Alteration No. of units: Commercial Repair, placeme Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF (F WORK TO BE PREFORMED: Identification Please Type or Print Clearly) OWNER: Name: C'�/q IIJ cr t > Phone: Address: //9 CaCAU �-'rY��'� �: ►;-1 CONTfiACTOR Name: KOK J- Phone: Address: `lfi / rrd Supervisor's Construction',License: - Exp, Date: l y1 t d Home Improvement License: JY Exp:. Dater eo 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. 412f J.. cv Total Project Cost: $ 3 , FEE: $ 3� Check No.: 2 2 $'� Receipt No.: 2 Za ISS NOTE: Persons contracting with unregistered contractors do not have acc- s to the guar ty f ad of Agent/Owner Signature of contracto i Location No. _ Q U Date �� U__► NGRTq TOWN OF NORTH ANDOVER F p Certificate of Occupancy $ ��a",•° titer Building/Frame Permit Fee $ sCHUS Foundation Permit Fee $ �. Other Permit Fee $ TOTAL $ Check # 2 2 0 -" �1-----' Building Inspector Location l /` a No. lm - 5Fb Date , r NORTH TOWN OF NORTH ANDOVER O:�t.a° 0 � p Certificate of Occupancy $ # . Building/Frame Permit Fee $ 00 3, �''�� Fou f ation Permit Fee $ A sACHUgb --T ermit Fee $ ZS Sewer Connection Fee $ Water Connection Fee $ _ TOTAL $ 5 t _M Building Inspector 4' 1 Div. Public Works o 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 PLANNING & DEVELOPMENT 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: 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 i i 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 dr Copy of Contract x 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 CABICO FRAMED ,FULL OVERLAY MAPLE PAINTED VS MDF PAINTED DOORS 212''=" CH = 89" WALL CABINETS HUNG 84"ABOVE FINISHE 131-21" 15" f 30" f 12"-7r-24" 124" 83-21" 3.. – �24"— v – 15" 30" 36" t� 1530 W3012 1230 UVAS2430R:' o N Cn r u 0 w cn (D U, w J vEP01 E CA) - - 77- W361,224 A .NA W4230 r W2130R ` ... . ............................................ L......................-—------------- ..... ....... ................................... 468„ 42" —4018" 36"- 9" 36" a' a' 43" 49" 35;" 83;" 46;" 42" � 40 e" 36" 21" 24" 211" All dimensions _size designations given are Chris Ann Sullivan This is an original design and must not be Designed: 4/4/2009 subject to verification on job site and JACKSON released or copied unless applicable fee has Printed: 4/22/2009 adjustment to fit job conditions. KITCHEN been paid or job order placed. DESIGNS HIGGINS--PARKHURST.kit All Drawing #: 1 NORTH ToVM of 4 over 0 No.,; co - _ _ _ _ Y �, "F -- dover, Mass., So COCMICMEWICK 7� ORATED Cl �Gl `r BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT y 1.!!�.. ..........P..'�...�.{�..�w�..........`.......... ..4. �............................................................... Foundation has permission to erect........................................ buildings on .................... ......6.A.661&V.% ........................ Rough to be occupied as........ . . .P0.6w".O.A.MAMW.......................................................................................... Chimney .. provided that the person accepting this permit shall in every respect conform to the terms of 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 3i(ouv PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRU STARTS Rough .. ............................................................................ Service BUILDING INSPECTOR Final Occupancy Permit Required to Ocatpy Building GAS INSPECTOR 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. SEE REVERSE SIDE Smoke Det. ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 214109 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Cowan Insurance Agency,Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 359 Main Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Haverhill MAAqP INSURERS AFFORDING COVERAGE NAIC# INSURED Ray Parkhurst INSURER A: Providence Mutual Insurance Company 44 Bateman Street INSURER B: Associated Employers Insurance Company INSURER C: Haverhill MA 01832 INSURER D: 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 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRDD' POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS URANCF TYPE OF INS EACH OCCURRENCE $1,000,000 GENERAL LIABILITY I DAMAGE TO RENTED A X COMMERCIAL GENERAL LIABILITY CP0064260 0911112008 0911112009 $50,000 CLAIMS MADE rx-1 OCCUR 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 $2,000,000 X POLICY PRO LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO ALL OWNED AUTOS BODILY INJURY $ (Per person) SCHEDULED AUTOS HIRED AUTOS BODILY INJURY $ (Per accident) NON-OWNED AUTOS PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR EICLAIMSMADE AGGREGATE $ DEDUCTIBLE RETENTION $ X WC STATU- OTH- WORKERS COMPENSATION AND B EMPLOYERS'LIABILITY WCC5006506012007 0912812008 0912812009 E.L.EACH ACCIDENT $500,000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? Yes E.L.DISEASE-EA EMPLOYEE $500,000 If yes,describe under E.L.DISEASE-POLICY LIMIT $500,000 SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS I, Carpentry contractor. Sole proprietor is not included on the worker's compensation coverage. CERTIFICATE HOLDER CANCELLATION SHOULDANYOFTHE7- E ESCRIBEDPOLICIESBECANCELLEDBEFORETHEEXPIRATION DATE THEREOF,THE INS WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERHOLDER NA D TO THE LEFT,BUT FAILURE TO DO SO SHALL IM OBLIGATION OR LIABILITY OF AN KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2001108) ©AcoRb CORPORATION 1988 License or registration valid for individul use only j - found return to: Board of.Building Regulations and Standards r ;before.the expiration date. If Board of Building Regulations and Standards p I ; HOME IMP$OVEMENT CONTRACTOR One Ashburton Place Rm 1301 I Registr�ior�0 142387 Boston,lVla:02108 ExBl atrr�x� #71/2o10 Tr# 265525 ry RAY PARKHURST REAAODI=t1PCr':' RA YMOND PARWIt1R ' ?t . 2 tJvalid without signature `; 1 44 BATSMAN ST " 1L A 01 Administrator HAVERN L M 832 `J 00'=35,000 cf enclosed space -j lA-Masonry' only Lee. �anvYiiarwieall� o�% aaoac�u�aeka 7 - 1G 11 Family Homes- � K: Board of Buildiug Regulations andStandards -. Failure to possess a current edition of the Construction:Supervisor License :. Lis CS MassachusettsstawBuilding Code ` 87229 is cause forreVocation of this,license. r 14UU10 Tr# 164:21 ; zo OND G PA �� l 44�1A'TTEMAWST f .a HAVERHILI,MA 01'832'' Comfglssloner. J J The Commonwealth of Massachusetts Ul j! Department of Industrial Accidents Dee of Investigations 600 hT Washing ton Street Boston, MA 02111 www.mass gov/dia . Workers, Compensation Insitrance Affidavit: Builders/Contractors/Eleatricians/Piambers Applicant Information Please Print Leembl Name (Business/organizafion/Individual): o G u Address: eA4,A_— T_— City/,State/Zig: ���BVe�'/�. , A-IL Phone #: j'7 (� )l" ? Are you an employer?Check the appropriate box: 1.❑ 1: am a employer with-Part-time).* 4. 111 am a general contractor and I Type of Project(required): employees(foil and/or part-tint )e .* have hired the sub-contractors b ❑New construction 2. 'I am.a:sofe proprietor,or partner- , listed on the attached sheet t 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me.in any capacity, workers' comp.insurance. [No workers comp,insurazi'a 5. 9• ❑Building addition ' p ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I airs a homeowner doing all work right of exemption per MGL I I.❑ Plumbing repairs or additions myself.[No-workers'comp, c, 152, §1(4),and we have no insurance required.]t 12.E] Roof repairs re<N ] .employees. [No workers' comp. insurance required_] 13.7 Other "Any applicant that checks bcrz#t must also rill out the section below Showingtheir workets'nom pensation t Homeowners who submit this affidavit indicating they are doing all work enthen hire outside contractors must submta new affidevit indicating such. xContn3ctors that check this box must e�clted sn additional sheet shatvitt�the Warne ofthe soh-contractors and Eheir workers'cen;p•clic;ir,{Qrmation. I am an employer that is Providutg:workers'co►npensation uzsuranorfce infornwtion. mY employees Below is the policy and job site Insurance Company Name: C ,Ir" NI.. Policy 4 or Self-ins.Lic.#: L L,f`6 0 6 J-0 k a 1co 0 d Expiration Date: ' .L Job Site Address:1J y ea 4y–� City/state/Z Attach a copy of the workers' compensa ' o tion policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required.under Section 25A of MGL e. 152 can lead to the imposition fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form p n Wof crrrrtrnal penalties afa . p rm of a of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forward d to he O Office of d a fine Investigations of the DIA for insurance coverage verification. I do hereby certify under the airs a1qdPena&i4s of perjrcry that the information provided abo is true ared correct Si tore: Date: u �/ Phone#: 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): 1. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,assaoiation,corporation or other legal entity,or any two or more of the'foregoing engaged in a joint enterprise,and includir ag the legal representatives of a deceased employer,or the receiver or tnrstee of an individual,partnership,associatiori or other legal entity,employing employees. 'However the owner of a dwelling house having not more than three apas-tments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or- local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or 1to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence.of compliance with the insumnce'coverage required" Additionally, MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation.affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es),mind phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to cant'workers'cornpensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of industrial Accidents for confirmation of insurance coverage.. Also'be sure to sign and date the affidavit The affidavit should be returned to the city,or town that the.application for-the permit or license is being requested,nottthe Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' oompensation policy,please call the Department at the number listed below. Self-thsured companies should enter their self-insurance"Iicense number on the'appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which Nvill be used as a reference number. in addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(.if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of'the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Lnvestibations 600 Washington Street Boston, MA 02111 TeL # 617-7274900 ext 406 or 1-8.77-MASSAFE Revised 5-26-05 Fax#617-727-7744 www.mass.gov/dia 4 r �'doal Pep RAY PARKHURST REMODELING HAVERHILL MA No Job Too Small MA Lic. #CS087229 Tel.978-521-7512 MA Lic. #142387 Cell.978-609-5473 PROPOSAL SUBMITTED TO PHONE DATE !- G� '� y/.p ac! STREET . JOB NAME 173 L/ Co Vic I clike CITY,STATE AND ZIP CODEtt JOB LOCATION No itr� Oyuvo- i�_1A 01 �Y f- ARCHITECT DATE OF PLANS JOB PHONE We hereby submit specifications and estimates for: ' ......................... ............................................... eN .. ...M u .......... .X:�...t.T'.. .... .........1 .. ..c: . . :... ....:1��..�.. c .......:.w.. . - .............................................. c'sq c �. C............... ... t r- .5..1...`....... .. .r-�.: ................... .. QAj 1.. ` �ccen< L .............................1.................................................. �.:N.. .......1C.w►. y e ........ off:......F�u�+ r -..... < t f......` ............ ........kL c......;R...................................... �V�. .:.... ... .. ....:.. ............... . �`` ..... j.. CL,I2ri-,t- Tv Y ...U r .k. 1.... .. c4orr ................................................... .................................. ...........................,.......� �" !�L'.........�...::!... '. . ' .Gc ......:.....��:.... . `..C..'.:........La....... .......:....... z' ..... . ... ........................... . . . ......... . . t- ..................... .....�.r....-.;�...1 s�. �............� . . � �` ... :. .... 1. ' . , C✓.s. U.. ..e ......W .�.(.�...... Nom.(<. .... C�/u...K .... ............................... ............................................................................................................................................................................................................................ ........................................:...................................................... ....... ........................................................................................................................................................................................................................................................:................................................................................ ...............................................................................................................................:........................................................................................................................:............:...:.............................................. T............................... .. ................ ........................ ........................ .................... . .. ..... ........ .. ....... .........:...............................:. ...... G.T.m.... �J.. .............................. .............................................. ..................................:................................................................:.........:......:....:... ... . . ........................ ................:.......................................................................... .......1....... .......J.... 5........................................................................ ....................................................................................................................................................................................................................................................................................................................:...................... lVC PrOP00 hereby to furnish material and labor—complete in accordance with above specifications,for the sum of, 3 Iwy„ �'p -�" 'vvvr �s etc. dollars ��� �� � ��-- ($ / ), Paym dnt to be md� o4vs: 3.3 All material is guaranteed to be as specified.All work to be completed in a workmanlike manner Authorized - according to standard practices.Any alteration or deviation from above specifications involving Signature extra costs will be executed only upon written orders,and will become an extra charge over and I above the estimate.All agreements contingent upon strikes,accidents or delays beyondour control.Owner to carry fire,tomado,and other necessary insurance.Our workers are fully cov- Note: ered by Workmen's Compensation Insurance. This proposal may be withdrawn by us If not accepted within days. Z(IUept0nre Of j)r0plool —The above prices,specifications and conditions are satisfactory and are hereby accepted.You are authorized to do the Signature work as specified.Payment will be made as outlined above. C Date of Acceptance: Signature