The URL can be used to link to this page

Home My WebLink AboutBuilding Permit #090-14 - 115 MAIN STREET 7/30/2013 NORTH q ,,-F.20 " ti- BUILDING PERMIT TOWN OF NORTH ANDOVER ° APPLICATION FOR PLAN EXAMINAT ON , " - b Permit NO: Date Received ,. �9SSACH Date Issued: i US��y IMPORTANT:Applicant must complete all items on this page x n, �:' k AT, - s x 2t^ a x OC1 T10l - . ��. , 41 I �� - � � � s 77 1='RC ?l?RTYtWIR t?rrrgt Print r V Al ?ARC ZONE DISTRICT�� Hts � 417strix =y �no s m " �Nladh� le Shop`Va g y e TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑One family []addition ❑Two or more family dustrial Alteration No. of units: Commercial ❑ Repair, replacement ❑Assessory Bldg Others: ❑ Demolition ❑ Other Septic o�Weli � d"", cttns,a Floodpl6a it Wale Sewe ., �- SL Identification Please Type or Print Clearly) OWNER: Name: LO-0 e- E:1 Phone: OF1 X- y J�- 13Uv Address: m�-�R�m�-k ��`z/� C�ow��l rn� C�►�52 All X CON" R,�TOR Prn 3- n 3. .. ,,j -C.. � Addre55 + N � x�� 4001 k 9 low Supelrlsol sG�n `ructlon .leense Et 'aten Er .., sr�„ W _ �11 Aax Hom4 ed -rOtdv6ment License y F < ARCHITECT/ENGINEER C my,y j Su I II vim,, Phone: Address: 1 �-$ W Nggc-w si' Reg. No. 5I-1 FEE SCHEDULE:BOLDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ O 3��000 O FEE: $ �yoz Check No.: Z Receipt No.: 9�� ` NOTE: Pers ns contracting with unregistered contractors do not have access to the g�nty fund S� n ur _ure,of Agent: , I u fr., nate of:contract� ft't � ;r�► ,, eta.: �. _ M� TOWN OF NORTH ANDOVER , APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION Print PROPERTY OWNER Print 100 Year Old Structure yes no 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, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: CONTRACTOR Name: Phone: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: 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: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund :Signature of Agent/Owner ri Signature of contractor- r Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan 0 Stamped Plans ❑ Plans Submitted D 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 j COMMENTS i HEALTH Reviewed on Signature � f 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 Toivo Engineer: Signature: Located 384 Osgood Street [FIRE DIEPARTMENT Temp Dumpster on site yesno ocated at 124 Mair, Street Fire Departinerit signature/date COMMENTS -7— — I 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 I DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A-F and G min.$100-$1000 fine NOTES and DATA— (For department use i i I I ® Notified for pickup - Date I Doc.Building Permit Revised 2010 r— Building Department The fohowing 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 apt)%al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm.tted with the building application Doc: Doc.Building permit Revised 2012 Location No. b cl U- `� Date 7AU r . - TOWN OF NORTH ANDOVER LED I . Certificate of Occupancy $ Building/Frame Permit Fee $ qzy o0 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# J u ., Building Inspector I Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost 37,000.00 m $ - $ 444.00 Plumbing Fee $ 55.50 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 55.50 Total fees collected $ 655.00 115 Main Street 090-14 on 8/1/13 ATM Kiosk for Lowell Five I� t. i Massachusetts - Department of Public Safety �f Board of Building Regulations and Standards Construction Supervisor License: CS-071970 MICHAEL E ALL)MI) 104 FOURTH AVE LOWELL MA Of854 Expiration Commissioner 06/18/2015 i NORTH own of EAndover O to No. - . ,*h ver, Mass, 7 d COC NICNlWKK AD4AT E D ►P�,`�(� S tl BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System r THIS CERTIFIES THAT .............. m. '.F.��... ....°1�6......../.................................................................... BUILDING INSPECTOR .... (�� ................................. Foundation has permission to erect .......................... buildings on ................. ..�........... �� Rough to be occupied as ................ � �/ :.!5c!.�.../ !..�:�.:�................................. Chimney p' ............. ........ ........................... 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 ......... .... ��•••.�y•airtl,��... ............ ........ Final BUILDING.. INSPECTO.. R 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. SEE REVERSE SIDE ` RT'j� OFFICE OF BUILDING INSPECTOR t?4' TOWN OF NORTH ANDOVER a. CONSTRUCTION CONTROL PROJECT NUMBER: PROJECT TITLE: LQWOJ. FAIr, G PROJECT LOCATION: II K I"A'�A'l0 JI�1k 'r NAME OF BUILDING: �/W,E�. bmN� NATURE OF PROJECT: AIN\ 622! 4IN ACCORDA CE WITH AFATI•CLE 116 OF THE MASSACHUSETTS STATE BUILDING CODE, d:L) E. iwyk) d-�., 1 REGISTRATION N0. BEING A REGISTERED PROFESSIONAL ENGINEER/ARCHITECH HEREBY CERTIFY THAT I HAVE PREPARED OR DIRECTLY SUPERVISED THE PREPARATION OF ALL DESIGN PLANS, COMPUTATIONS AND SPECIFICATIONS CONCERNING: ENTIRE PROJECT • RCHITECTURAL • RUCTURAL • MECHANICAL • FIRE PROTECTION • ELECTRICAL • OTHER(SPECIFY) FOR THE ABOVE NAMED PROJECT AND THAT,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 rials. 3. Be present at intervals appropriate to the stage of construction to become, ge with6the progress and quality of the work and to determine, in general, if the 'r being .. performed in a manner consistent with the construction documents. PURSUANT TO SECTION 116.2 .2 1 SHALL SUBMIT WEEKLY , A PROGRE • EP ` TOGETHER WITH PERTINENT COMMENTS TO THE NORTH ANDOVER BUIL I��TO . UPON COMPLETION OF THE WORK, I SHALL SUBMIT A FINAL REPORT AS TO `. SATISFACTORY COMPLETION AND READINESS OF THE PROJECT F CUPAN IGNA E SUBSCRI E AND RM TO BEFORE ME THIS_L7_2:;>_DAY OFc. 20 AhL DANIEL J.DONAHUE NOTARY PUBLIC MY COMMISSIO S NdaPdit CommonwNadVANWA db My Coxnnft"EWm t August 10,2018 �+"°"T:� OFFICE OF BUILDING INSPECTOR r,, TOWN OF NORTH ANDOVER a '•°' CONSTRUCTION CONTROL aSM1W+*i PROJECT NUMBER: PROJECT TITLE: Lywaj_, PROJECT LOCATION: 1K•� r"►AW. NAME OF BUILDING: Loujo- w' E/ : �Tf�VL NATURE OF PROJECT: AnA 620 7� I IN ACCORDAV�E WITH,ARATICLE'1i� REGISTRATION NO OF THE MASSACUILDING CODE, I, t 40L BEING A REGISTERED PROFESSIONAL ENGINEER/ARCHITECH HEREBY CERTIFY THAT I HAVE PREPARED OR DIRECTLY SUPERVISED THE PREPARATION OF ALL DESIGN PLANS, COMPUTATIONS AND SPECIFICATIONS CONCERNING: ENTIRE PROJECT • RCHITECTURAL • RUCTURAL • MECHANICAL • FIRE PROTECTION • ELECTRICAL • OTHER(SPECIFY) FOR THE ABOVE NAMED PROJECT AND THAT,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 rials. 3. Be present at intervals appropriate to the stage of construction to become, ge D with6the progress and quality of the work and to determine, in general, if the, rlr dieing � . performed in a manner consistent with the construction documents. 1 ' KI PURSUANT TO SECTION 116.2 .2 1 SHALL SUBMIT WEEKLY , A PROGRE . . EP ` TOGETHER WITH PERTINENT COMMENTS TO THE NORTH ANDOVER BUIL II TO UPON COMPLETION OF THE WORK, I SHALL SUBMIT A FINAL REPORT AS SATISFACTORY COMPLETION AND READINESS OF THE PROJECT F CUPAN 1GNATJdRE SUBSCRI E 1 AND RMTO BEFORE ME THIS 7--'> DAY OF c, 20 i DANIEL J.DONAHUE NOTARY PUBLIC MY COMMISSIO SNowp+ift CommonwwM�MtiaoMmlls My Comn*Wm EWm t August 10,2018 AeC) CERTIFICATE OF LIABILITY INSURANCE 0712D5/2013MM/DDIYYYY) 16. - 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(les)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 Jennifer Norton Fred C.Church,Inc. NAME: 41 Wellman Street PHONE 978-322-7255 FAX (978)454.1865 Lowell,MA 01851 AIC No Ext): AIC No): (800)225-1865 E-MAIL jnorton@fredcchurch.00m ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Federal Insurance Company 20281 INSURED INSURER B: Lowell Five Cent Savings Bank INSURER C: One Merrimack Plaza Lowell,MA 01852 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:26570 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 ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MMIDDNYYY MMIDD/YYYY GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence) ccurrence $ CLAIMS-MADE F]OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY F7 PRO- LOC $ AUTOMOBILE LIABILITY (Ea D1SINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per acc dent UMBRELLA LAB OCCUR EACH OCCURRENCE $ _ EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION WC STA OTH- AND EMPLOYERS'LIABILITY YIN CRY T E A ANY PROPRIETOR/PARTNER/EXECUTIVEF—] E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? NIA 71707974 2/1/2013 2/1/2014 (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 500,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION The Lowell Five Cent Savings Bank One Merrimack Plaza Lowell,MA 01852 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Client Met# 26570CertHolder# @ 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts Print Form Department of Industrial Accidents Office of Investigations 1 Congress Street, Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Lowe—I/ Ry6' Address: I r Y)tz- IZIM#�r_k ?10-L& City/State/Zip: Lowe U MA OI pS3 Phone #: 61_1Y yY/- 6 q6 9 Ar e employer?Check the appropriate box: Type of project(required): 1. a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. E]New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.+ required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.F] Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.]t c. 152, §l(4),and we have no employees. [No workers' 13.2/Other T2N-�p►-+� S2�'-�I comp. insurance required.] *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. t 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: FeJUZA t LI.ISU IZ N\4C.i `-) C,6 Policy#or Self-ins. Lic.#: ;?oad ] / ulq I Expiration Date: Z 20! `1 Job Site Address: City/State/Zip: I AZ� ZA �N bcr/�,'� rA Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and eenalties o er'ury that the in ormation provided above is true and correct. Signature: - ___.. Datef1/ Phone#: —1��✓ S��"�('�2 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#: