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HomeMy WebLinkAboutBuilding Permit #879-15 - 1140 OSGOOD STREET 5/6/2015 y� LT— t%oRT►1 Aa BUILDING PERMIT O�St LED by �O TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION i _ 1 41 Permit No#: y N Date ReceivedAna 01 �gSSACHUS���� Date Issued: 6U14_ MPORTANT:Applicant must complete all items on this page LOCATION i/U GS fLel4e - rint PROPERTY OWNER Print 100 Year Structure yes no MAP , PARCEL:L5_ ZON G DISTRICT: Historic District yes no Machine Shop Village yes .o 6;::2 f� TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other T _ ❑ Septic-, ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District, El WaterSewer - ----------- --- �/ _ DESCRIPTION OFrORI�TO BE PERFORMED: � ulhf( W G5-& Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: Contractor Name: CP i c11Q Phone: zy Email CG CQn/ ,_gLc e C 9^3 Address: L91-y A_C//.0 ;/ C16-vd Supervisor's Construction License: (' o C7 Exp. Date: G" Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING P .MIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ Z d r-- FEE: $ 4v Check No.: 1 Receipt No.: 2-�� 2-So NOTE: Persons contracting Wit r uregi d contractors do not have access to the guaranty fund i r 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 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 A Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street iFIRE bEP�RATiMENT Tempi®umpsteronsite � `. #;Located[at'�1�2�4�MaintSt�eet �r r 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 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 4. 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 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/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) Mass check Energy Compliance Report (If Applicable) ;as 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. Date . - TOWN OF NORTH ANDOVER • ��ED 7646 • Certificate of Occupancy $ Building/Frame Permit Fee $ Qa Foundation-Permit Fee $ Other Permit Fee $ TOTAL $ . Check 1 _ Building Inspector NORTH Town of 2 1 E I�' Andover z oh ver, Mass, _ COC LAKI "IC"I WICK �1' S it - BOARD OF HEALTH Food/Kitchen PERMIT TLD Septic System THIS CERTIFIES THAT .......................................................... BUILDING INSPECTOR has permission to erect . buildings on Foundation ......... . ............. ..���..........��..�...��... . .............................. Rough to be occupied as ...........C.,..../�?:S...�....�f��.'.�.:!`�':.�...............:.................................................... �! 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 CONSTRUCTION STARTS Rough ............ .... ................................... Service """' Fina 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. SCOTT-3 OP ID: KAG CERTIFICATE OF LIABILITY INSURANCE DA 0E IM 511 DDIYYY1� 05/05/2015 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 INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT John J Doyle Insurance Aggency PHONE Kim Giambrone Fax 85 Constitution Lane Ste 2H A/c No Ext:978-777-6344 ac No:978-777-9804 Danvers,MA 01923 E-MAIL Sean P Doyle ADDRESS:kim@doyleinsurance.com INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:A.I.M.Mutual Insurance INSURED Scott Cogliano INSURER B: SC Contracting Inc 4 Milan Ave INSURER C: Saugus,MA 01906 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 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE POLICY EFF POLICY EXP LTR POLICY NUMBER MMID MM/DD LIMITS GENERAL LIABILITY EACH OCCURRENCE $ DA AG_ETORENTEU_ COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ CLAIMS-MADE OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PRMT O LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS AUTOS ( ) NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS PER ACCIDENT $ UMBRELLA LIAB HOCCUR EACH OCCURRENCE _ $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION WC STATU- 0T"_ AND EMPLOYERS'LIABILITY Y/N T RY LIM TS ANY PROPRIETOR/PARTNER/EXECUTIVEAIM 07/17/2014 07/17/2015 E.L.EACH ACCIDENT $ 100,00 OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory In NH) CC-5005013640-2014A E.L.DISEASE-EA EMPLOYEd$ 100,00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ 500,00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE The Loft THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1140 Osgood St ACCORDANCE WITH THE POLICY PROVISIONS. North Andover,MA 01845 AUTHORIZED REPRESENTATIVE Sean P Doyle ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD Massachusetts -Department of Public Safety ' 363rd of Building Regulations and Standards Construction Supen-isor License: CS-061507 SCOTT A COGLL4NU.�:� r. 4 MII.AN AVE Saugus MA 0190 Expiratior Commissioner .10/20/201;