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HomeMy WebLinkAboutBuilding Permit #548 - 1160 GREAT POND ROAD 3/27/2008 BUILDING PERMIT NORTH OfSttac ibgti� TOWN OF NORTH ANDOVER �� '�" - •_4. APPLICATION FOR PLAN EXAMINATIONL Zi , Permit N0: DI ^O 1,et ate ReceivedSys RAr[O SACHUS� Date Issued: r .OV— IMPORTANT:Applicant must complete all items on this page . � 'A .' P 2 'PERT�1(01IV lER lla Al IAP NO.- A'RCEff Qv = } MGIC _ #�ncasct yds © tea { { 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 peptic_ 1%ell �logd�l �r etl �ds ' Yerstaed x7rsct _ Vya#e_/Sewer DESCRIPTI N OF W K TO BE PREFORMED: 60-".q 04"e44oe-dy-4 L f Mel Iva 'efm An'q Identification Please Type or Print Clearly) N a f"'-0'V/X4 , OWNER: Name: Phone: Address: COR \CTOt dame k , tPon - , m Address3' � _. T perviSIDT, -onstru ionlAcense a date .._ o g iotxae l�raproerrient. acense Fl � 4c„p, a � - ' 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. .2. �i�l- Total Project Cost: FEE: $ Check No.: 3`f S! Receipt No.: °� (,b Z7 NOTE: Persons contracting with unregistered contractors do not have access to the an 9netu9enkSt�nature of mon#tactor yz n a 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 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 y o s ( 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 2.2007 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 COMMENTS D HEALTH COMMENTS I 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 F RE� 3EP ►RTMTrste sitees � � o Located= t �# Iairr Stre � 12 °V 10- �,. f ire De nU111V toA . � ti hrs- ;,� 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 2007 Location &ootslct�vuL /�G��a►�+/L:c.. �o�►—�—No. Date NORT1y TOWN OF NORTH ANDOVER ?O• ` O . ,'tip i 3 • O� F A dr Certificate of Occupancy $ �'�a•,n°•'<�' Building/Frame/Frame Permit Fee $ s�CHust 9 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 33 2 : 023 Building Inspector w;a ` ""7'V'CdBuI.Q. Boand of Building Regulations sand Standar s t HO.ME IMPROVEMENT CONTRXICTO:R 3 ��' Registratipn 143928 fxpir� bta �67�1V2.0 { 08 Yr# 1301:73 ° ; i 3 �f? DBA I S.G.M.CONSTRUCTjo tr:: SERGE i1'MICHAUD" 4� DON NH 03051 Administrator { PROPOSAL SGM CONSTRUCTION 2 TATE ST HUDSON,NH 03051 1-603-595-6923 3/21/08 .BROOKS SCHOOL Holcombe House 1160 GREAT POND RD Interior Renovation NO.ANDOVER MA 01845 Kitchen:Remove and dispose of all cabinets,countertops,demo partition,install new drywall on ceiling,tape to finish coat,prep for paint Bathrooms:Demo bathrooms,insulate where needed,drywall prep for paint Windows:Move windows to new location where requested Drywall:Kitchen ceiling,bathrooms,living room ceiling,back foyer ceiling,fire code walls Flooring:Install Luan in bathrooms,kitchen $23,875.00 Signed by Serge Michaud Owner Date Certificate of Liability Insurance Date of Issue 03/24/2008 Producer This Certificate is issued as a matter of information Appletree Insurance only and confers no rights upon the certificate holder. This certificate does not amend, extend or alter the 1 Campbell Ave coverage afforded by the policies below. j Hudson,NH 03051 _Companies Affording Coverage_ _ 6038819900 Company CONCORD GROUP Insured SGM CONSTRUCT Company CONCORD GROUP SGM CONSTRUCTION Company ------- --"" C 2 TATE ST Company HUDSON, NH 03051 Company ST.PAULS•TRAVELERS i Company - — - ------ ----- ---- -- F ;Coverages -- ------- -- (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 decribed herein is subject to all the terms,exclusions and conditions of such policies,limits show may Ihave been reduced by-paid.claims. i Co Type of Insurance —Policy Number Policy Effective Policy Expiration Limits L-t-r -- _� Date Date General Liability General Aggregate — $2,000,000' A Commercial General Liability E8879259 03/21/2008 03/21/2009 Products-Comp/Op Agg _$2,000,0001 ❑ Claims Mad E-/].Occurrence Personal&Adv Injury _$1,000,000( f� Owners&Contractors Prot Each Occurrence _ - $_1_,000,0001 Fre Damage(any one fir $50,000 !_-- -------_—.--- - ---- Med Exp(Any one perso —1 --- ------—S1 000' Automobile Liability ___..-- C392245-9 03/21/2008 03/21/2009 Combined Single Limit - B SIJ Any Auto g $300,000 j❑ All owned Autos Bodily.lnjury $ I-- Scheduled Autos (Per Person) - i I ❑ Hired Autos Bodily Injury $! 71Non-OwnedAutos (Per Accident) ❑ Properly Damage �— $i I C I Garage Liability Auto Only-Ea Accident ❑ Any Auto Other Than Auto Only: Each — --- _ -_(Aggregate Ji D Excess Liability Each Occurrence i �❑ Umbrella Form Aggregate ❑ Other Than Umbrella Form - --- Workers Compensation0764L20707 08/11/2007 08!11!2008 L EJWC Statu- [:1I Other - E and tory Limits - EL Each Accident —$100,000' j The Proprietor/Partners/ ❑ Ino/ EL Disease-Policy Limit _ 500 0 Executive Officers are: ❑) Excl _ 00 EL Disease-Ea Employee __ 100 000 _ Other - ------ ----_ IDescription of Operations/LocationsNehicles/Special Items INSURED TO BRING TO THE TOWN OF ANDOVER ITS NEEDED FOR HIM TO OBTAIN A PERMIT ---- ---��_�-- - -- Cancellation --- ----------- Certificate Holder Should any of the above described policies be cancelled before the i BROOKS SCHOOL expiration thereof,the issuing company will endeavor to mail 10 11160 GREAT POND RD. days written notice to the certificate holder named to the left,but failure to mail such notice shall impose no obligation or liability of any kind upon the company,its agents or representatives. NORTH ANDOVER, MA 01845-1298 Authorized Represent the-, The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street .Boston, Meq 02111 www•mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): S�a_ti'I 1V1_A17,f7- Address: . City/State/Zip: Phone.#: Are yo an employer? Chetik the appropriate box: Type ofproject 1. I am a employer with � � 4• Q I am a general contractorF7andl � (required);`employees(full and/or part-time).* have hired the sub-contra6 ❑Ne onstruction 2.❑ I am a sole proprietor or partner- listed on the attached she7 SEP and have no employees These stmt-contractors have workingforme in as ac employees and have workers' 8. �molition y capacity. [No workers' comp.insurance comp.insirrance.: 9• Muilding-addition 3.❑ required] 5. 7We are a corporation and its 10.❑Electrical repairs or additions I am a homeowner doing all work officers have exercised their Myself mp right 11.(]Plumbing repairs or additions ys [No workers' co ri t of exemption per MGL insurance required]t c. 152, §1(4), and we have no 12.[�Roof repairs employees. [No workers' 13.❑ Other_Q*ce *1'1 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 aro doii:g all work and thein hire outside contactors must submit a new affidavit indicating such. +Contractors that check this box must attached an additional sheet showing the narne of the sub-contactors and state whether or not those entities have employees. If the sub-contractorshave employees,they must provide their won k=T'coni Policy number. I am,an employer that is providing workers'compensation information. insurance for my employees Below is the policy.and job site Insurance Company Name: Policy#or Self-ins.Lic. ---.Expiration.Date — c0 9 Job Site Address: % o G'cc';r . ,0l] City/State/Zip: t/ Attach a copy of the workers' compensation policy declaration on 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 the 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 violator. Be advised that a copy of this statement may be forwarded to the Ofnce of Investigations of the DIA for insurance coves verification. �dc hereby certify er the realties of perjury that the information provided above is true and correct Phone#: 7Con�ta&Person: e only. Do not write in this area, to be completed by city or town officio[ n: City Permit/I,icense# M11* thority(circle one): Healtab. 2.Building Department 3.City/TownClerk 4.Electrical Inspector 5.Plumbing Inspector son• Phone#: C NORTH '9 0downover 0*0_ A­ NoS # o �Y�` dover, Mass., 040 0 12 T 0 - LAKE T I� COCHICHEWICK V %S RATED P, iCC 4 BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.....9-ro-alCos......4..G1k.O&I..............gatc.... .( .........f4oc. Foundation has permission to er t........................................ b ildings on ......���0..... �.. .. .�............... Rough to be occupied as.... ! ........ ...... ... .. .......1.........M`r`...... ........�IiAl��rtlt� 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 OV% PERMIT EXPMES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS V LESS CONS 1 R V T RTS 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.