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HomeMy WebLinkAboutBuilding Permit #259 - 1155 SALEM STREET 5/1/2018 r►ORT#1 . BUILDING PERMIT O�st�ec �bgti TOWN OF NORTH ANDOVER to APPLICATION FOR PLAN EXAMINATION 4Ps Permit NO: r Date Received ,T.o �SSACHU`+�� Date Issued: IMPORTANT:Applicant must complete all items on this page 3 6I �he }-", ^""'�'2' Yr t '�" '-. _ _Y Go- r t °�. + -v r ""'y"' p� (-nit .a,.- 3.".' s� �s. ,.dk'�'''',.., +�tY'rus re °" ?�€--�•` y,''�,,"'E"`` k y� v"` '�: v'w,��x r�'�xir� a+�v �:''�� e 5``r' i� �''',� ^� �'"'.,,.F �. K'b'- �. y 3c"s' r-� J4„s�o.*� L° �:��- s+'� -C�'`d,��;��w ..7s• ,'�' �'�-', �y 5,.« � ,;.�,3%s +. -a z; ,�nnt,�.�, - ...max -�..�'� y < �."���, � _cc`�' •�"� x �: w.�,�" '�y�x-�"- f�:��A � s k���� �s�g E'; ,�"-dY�' � knLa r ih`�n g�'a.� �' ,,p��*•�`K�_'`'".,��. �-. -'�'� � ''rte *�4 �ev �. ,�.� ��a�t;a w?�n +� TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more.family industrial Alteratio No. of units: Commercial Repair, laceme Assessory Bldg Others: Demolition Other c Well ' Ft�o�'ocpla�n �IVetlarads �4Y 1Natershed Dastr{ct ' ., WaterS.ewer _ -, DESCRIPTION 0F.WORK TO BE PREFORMED: ntification Please Type or Print Clearly) OWNER: Name: A-An 7-6Nao Phone: Address: 100-1714 Bks s fit. g brei ' �a'- 7 ^a a ,� s +-,r- �,bra ��7. � CONTRATOR Name � 'hone � -- 2' " v'r�''"a�^ "4^ z ; ...; a .�+�,- r ..�^ m�,,6* $; da r, {'Fea wr F �-aa "�'"" rm�=kr �r x^ _ ^z• i r .. r 41" .; 'e-i,`ir r y a a § zs4 i 'ate a t k F Supervisor's°Construct�onicense it E'�*ii 14.asn [g x k 6 d ,.f' lfw Horne�Improvmerit�L�censeWo ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.$112.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ S® 6) FEE: $ o���. 0 Check No.:_Z S� Receipt No.:_ a o i��� NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund S� nature of A"ent/Owner= 'F Signature of contractor g 3__....wm.. _ ...a...9 s._. -- H 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 DATE REJECTED DATE APPROVED CONSERVATION COMMENTS DATE REJECTED DATE APPROVED HEALTH COMMENTS s 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 Located at 384 Osgood Street FIRE©EPAt MERIT TemPDumpster ori site yes , ` no Located at 124�Mam Street E f` : Fire Department-sigh s"ture/date M fi z *jn. u s Dimension Number of Stories: Totals square feet of floor area, based on Exterior dimensions. q Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No f DANGER ZONE LITERATURE: Yes No I MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use E I E I ' E ❑ Notified for pickup - Date , --._......_._...............--......_....._........_._..-- _ _--------_..._..__..__._......_..........._._._........ _.. Doc.Building Permit Revised 2007 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 o 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 j 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 i Revised 2.2007 h Location . No. Date Mo"T:,ti TOWN OF NORTH ANDOVER 3? •• 0 ` Certificate of Occupancy $ • o�CCC �; ��. ��ssw MUSEI Building/Frame Permit Fee $ p^tf Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # ! l 20663 �" Building Inspector The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual):�� &-W :7=nc,fJXAk &&ems to_ „v-•121L-1 Address: d102 City/State/Zip: Phone you an employer? Check the appropriate box: Type of project(required): l 1 am a employer with 4. ❑ I am a general contractor and I 6. ❑ New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole ro rietor or partner- listed on the attached sheet. $ 7 Remodeling P P ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ,❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its officers have exercised their ME] Electrical repairs or additions required.] 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.] t employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box#1 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 their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lie.#: r . Expiration Date: d�/ Job Site Address: �JSK� SAL04-4ll City/State/Zip: _Q1-7,q 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains andpenalties ofperjury that the information provided above true and correct. Signature: - Date: Phone#: Official use only. Do not write in this area, to be completed by city or town officiaL City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: DATE(MMIDDNYYY) ACORL , CERTIFICATE OF LIABILITY INSURANCE 05/02/2007 PRODUCER (781)449-6786 FAX (781)449-4269 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION BOYNTON INSURANCE AGENCY ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 72 RIVER PARK STREET HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. NEEDHAM, MA 02494 INSURERS AFFORDING COVERAGE NAIC# INSURED Kyron Inc INSURERA Harleysville-Worcester Ins. Co 26182 DBA Preserve Painting INSURER B: Hartford Insurance 203 W$shington Street INSURER C: Salem,MA 01970 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 REDUCEDBY PAID CLAIMS. NSRIN0S0Rr 0 — - - "_* POLICY El P C"WE -POLICY EXPIRA-noN TYPE OF INSURANCE POLICY NUMBERLIMITS GENERAL LIABILITY CB7n478 05/16/2006 05/16/2007 EACH OCCURRENCE $ 1,000,000 X COMMERC[AL GENERAL LIABILITY 05/16/2007 05/16/2008 DAMAGE TO RENTED $ 100,000 CLAIMS MADE FX OCCUR MED EXP(Any one person) $ _ 5,000 A PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEITL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP-OP AGG $ 2,000,000 -XI POLICY PRO- LOC JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS BODILY INJURY. $ SCHEDULED AUTOS (perp—) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per acadent) PROPERTY DAMAGE $ (Per aocdent) GARAGE LIABILITY AUTO ONLY-FA ACCIDENT $ ...-.:,.. .�. ANYAUTO . EA ACC $ OTHEP.-THAN AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR FICLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND 6S60UB5213C18306 05/20/2006 05/20/2007 X I WCsraru- I OTH- EMPLOYEwLIABILITY 0$/20/2007 05/20/2008 B ANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT $. .. .. 100,000 OFFICERIMEMBER EXCLUDED? NO E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERASIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS 500 Prope4rt�-, Damage Deductible Sean O'Connor is covered by the.-Workers Compensation policy. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. Laurie Kuhlmann mann BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 29 Belair Ave OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. Lynn, MA 01902 AUTHORIZED REPRESENTATIVE Michael Merrill/DEB ACORD 26(2001108) FAX: (978)745-3476 ©ACORD CORPORATION 1988 NORTiy 0 0Andover No. Jam? o dover, Mass., lb 4 p O K1• COCHICHEWICK V ORATED `s BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THISCERTIFIES THAT fop.1! ,...... ...........V..................................................................... ..................................... Foundation has permission to or t........................................ t�uildings on ....1.1 .r1r....... ...!'1411011.1.000 ...................... Rough ... ... . 31-16ANI * �^�/h Chimneyto be occupied as 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 ry� PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRU N STAINS Rough Service BUILDING INSPECTOR 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 FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. PRESERVE P -b .,.CARPENTRY 203 Washington St.#256 Salem,MA 01970 \ Registration# 123553 Phone 1.800.346.6742 Sam Dantonio - - - 1155 Salem St _- North Andover, MA 01845 _- MA t '� s� �mom+ � •` '� z a � - �� s �;� =a=te ��¢• �{ a �' r "' Scope: Replace all old siding on the house excluding the back wall but including the back walldormer. Prune and paint the entire house Clarification: For carpentry purses the garage and addition are excluded accept'for specified trim. I Carpenty: Pull building permit. The permit is typically a non-inspectional permit meaning the inspector will not inspect the work. Remove the siding;dispose of the siding;install tyvek install pre-primed cedar siding smooth side out using stainless steel nails. The following items will be changed as well;on the front night window we will install a new window sill,facia(pvc),molding(pvc)and rubber membrane around window, 1 comer board on the front right(pvc);2 vents; 1 board on rear dormer adjacent to the roof(pvc);both comer facia boards on the rear addition(pvc); facia board adjacent to the roof above storage (pvc);2 boards on storage roof(pvc-) Painting: Power wash areas not being replace,scrape all remaining old wood as necessary, caulk as necessary,prime all wood surfaces with an oil based primer even the new pre-primed i siding(new siding is.prone for cedar bleed,i.e.the sap coming to the surface. Oil primer is necessary to inhibit this natural process.) Paint all new surfaces 2 full coats and the old i full coat with a latex acrylic. Price: $17,500* Labor paint and materials I Payment Terms: 20%deposit(day of start); 30%progress; 50%end of job McNisa/Aniex P Customer Signature * Carpentry bid includes all promotional discounts. Ouul-ujLufz pceY -uedto"`Rill-glazing"Preserve Paint&Carpentry does not take any responsibility should this occur. It is a manufacturing defect. ** Bid is good for 120 days. i ;'' BQARfl QF Bt71LpiNG;REGUL1TiONS License CONSTRUCTION'.SUPERv'lSOR Number.GS 093403 t Birthdate 12131/1959 Exptrbs -1213412009 Tr na; 93403:: Restricted 00 SEAN OCONNOR 26 CHESTNUT ST r SALEM: tVEA 01970 ��--i S y G®mm�ss�oner �'��aole.ysmieup�+ 01660 WU W3lb'S �°" - 99Z# 1S NO1JNlHSttM E0Z �; 10000 � UB2$ ' - "6unuiea aniasa�d £60 600Z/91£ dol- dx3 {{ $5S£Z6 uogeri6ab i 2101 VNLLNOJ iN3W3/,10)+dm 3WOH sae ue;g pus suogelnaa3u1P11ng;o pAeog 'pj��r �a��amzamrc�iur���