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HomeMy WebLinkAboutBuilding Permit #578-12 - 1160 GREAT POND ROAD 1/31/2012 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: �2` Date Received Date Issued: IMPORTANT:A plicant must com lete all items on this age LOCATION (ab 6�.1 4 Print PROPERTY OWNER FJIM SSG I�lx L Unit# Print MAP NO: l 3 PARCEL: 0.& Print DISTRICT: Historic District yes no Machine Shop Village yes no 100 year-old structure yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential 1XNew Building ❑One family ❑Addition ❑Two or more family ❑Industrial ❑Alteration No. of units: ❑ Commercial ❑Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑Other s Oa Septic welly y r D;Fldplain ®a� a Ian «� } r :� r. or- ,❑�WatershedD strict F 0 Water/Sewer• x ray� >�x+;r..q t* �'� �`,; �`� .�� '� � DESCRIPTION OF WORK TO BE PERFORMED: (Identification Please Type or Print Clearly) OWNER: Name: Ph �7� 72S'-63o0 one Address- CONTRACTOR Name: I�J-�{Q�i/� f{I NgP_(L phone: Address: d7PIPP S , M Supervisor's Construction License: —,Zoe, I , Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER -F Phone: Address: Reg. No. FEE SCHEDULE:BULDING ERMIT.'$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: -- o A FEE. $ /S , Check No.: Cis/O Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Si natureMgent/O.wner -- -- — Stgnature-of contracto -- 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 o 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 o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition or Decks o Building Permit Application o Certified Surveyed Plot Plan o Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) o 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) o Building Permit Application 1 ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses o 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 a 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: Doc.Building Permit Revised 2008mi 1. 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 eodrop requires approval of Electrical Inspector Yes 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 2011 June/mi Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer 11' Tanning/Massage/Body Art ❑ Swunmmg 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 Sionature 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 Location //6 () C` -, /--A^4 I/A Q'r y No. �—7 �� Z Date 2 MORTot TOWN OF NORTH ANDOVER 3 O H R A �a ,;; Certificate of Occupancy $ l ss�CHusE< Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ r Check # y Cyd O 249 , 1 Buifding Inspector Fold,Then Detach Along All Perforations COMMONWEALTH OF MASSACHUSETTS ,D SHEET-ME I AL WOHKLKb AS A MASTER-UN RESTRICTED ISSUES THE ABOVE LICENSE TO: PHILLIP E HOROWITZ ENERGY ENGINEERING INC 60 TRIPP ST Cn FRAMINGHAM MA 01702-8751 2061 07/28/13 39245 Fold.Then Detach Along All Perforations NMI Fold,Then Detach Along All Perforations ' COMMONWEALTH OF MASSACHUSETTS JE 'D SHEET METAL WORKERS AS A BUSINESS ISSUES THE ABOVE LICENSE TO: PHILLIP E HOROWITZ ENERGY ENGINEERING INC 60 TRIPP ST i FRAMINGHAM MA 01702-0000 ►7 159 12/15/11 959037 Fold,Then Detach Along All Perforations - NORTH To'" of 0 No o , '� dover, Mass.,0 LAKE COCHICHEWICK ORA TED p'P�`�,�5 v BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR n 1. THIS CERTIFIES THAT................91-7.a�....�........`. ... .......`....:........................... .... .................... ............ ... . ...... ..... .......... Foundation 40 has permission to erect...........:............................ buildings on.........^..............,�................./���c,.:..�.......G�.....;���.. Rough tobe occupied as............................................... ................�f�1`........ '.......... ......... ...................`�_....�,.:... ...... 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 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION ST TS 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 BeDone FIRE-DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner - Street No. SEE REVERSE SIDE Smoke Det. �--�� OP ID: MF CERTIFICATE OF LIABILITY INSURANCE DAT04/04111 YY) 04/04!11 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 781-642-9000 CONTACT NAME: Eastern States Insurance 781.647.3670 PHONE FAX A/C No Ext: A/C No Agency,Inc. E-MAIL ADDRESS: 50 Prospect Street PRODUCER HERME-1 Waltham, MA 02453 CUSTOMER ID#: INSURERS AFFORDING COVERAGE NAIC# INSURED Energy Engineering, Inc. INSURERA:Ohio Casualty Group 60 Tripp Street INSURER B:American Fire&Casualty Ins. Framingham, MA 01702 INSURERC:Guard Insurance Company 31470 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 ADDL S B POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM/DD/YYYY MM/DD/YYYY GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY 53611986 03/21/11 03/21/12 PREMISES Ea occurrence $ 100,00 CLAIMS-MADE OCCUR MED EXP(Any one person) $ 10,00 PERSONAL&ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,00 POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,00 B ANY AUTO 53611986 03/21/11 03/21/12 (Ea accident) BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ X SCHEDULED AUTOS PROPERTY DAMAGE $ X HIRED AUTOS (Per accident) X NON-OWNED AUTOS $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ 5,000,00 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,00 A 53611986 03/21/11 03/21/12 DEDUCTIBLE $ X RETENTION $ 10,000 $ WORKERS COMPENSATION X WC STATU- OTH- AND EMPLOYERS'LIABILITY T RY LIMI E YIN C ANY PROPRIETOR/PARTNER/EXECUTIVEENWC215323 04/01/11 04/01/12 E.L.EACH ACCIDENT $ 1,000,00 OFFICER/MEMBER EXCLUDED? ❑N N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) "For Informational Purposes Only" CERTIFICATE HOLDER CANCELLATION EVIDENC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Evidence of Insurance THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2008 ACORD CORPORATION. All rights reserved. ACORD 25(2009109) The ACORD name and logo are registered marks 0f ACORD Sheet Metal Commercial Guidelines/Life Safety/Critical Systems Inspection Checklist Y'es/ No N/A, V Set of stamped engineering documents and detailed description of mechanical system to be installed has been provided All workers performing sheet metal work onsite has valid Massachusetts sheet metal license V All sheet metal work being performed with proper journeyperson-to-apprentice ratios Fire dampers with access door properly installed and checked for operation Smoke and combination fire/smoke dampers with access doors properly installed- actuator checked for proper operation(May also be verified by fire department during fire alarm testing) _Duct smoke detectors with access doors properly located (May also be verified by fire department during fire alarm testing) Smoke/atrium exhaust systems installed and operation verified (May also be verified by fire department during fire alarm testing) Stair pressurization systems installed(where required) and operation verified(May also be verified by fire department during fire alarm testing) Grease/kitchen hood exhaust system installed with all seams and connections welded airtight with properly located cleanouts. Proper cles;`ances, fire rated enclosures and pressure testing required: res' aint3 installed vfii�:ze required on egpipment and du,.t:..;rK ✓uct penetrations in fire'ratol 4vall:,and f166rs sealed Metal roofing systems installed watertight using proper materials and fasteners Flexible duct nins installed 6'-0"maximum length Ductwork installed using proper hanger spacing, hanger stock,threaded rod and angle iron Ductwork/plenum connections sealed substantially airtight V Ductwork insulated by means of external covering or internal lining Volume dampers installed for each supply air branch duct New/clean-properly sized filters installed(final inspection) Testing and Balancing report complete(final sign-off)