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HomeMy WebLinkAboutBuilding Permit #781 - 1160 GREAT POND ROAD 6/3/2010 BUILDING PERMIT of"O RT bgti TOWN OF NORTH ANDOVER 0 r APPLICATION FOR PLAN EXAMINATION x Permit NO: Date Received �SSACHUS�� Date Issued: NWO IMPORTANT:Applicant must complete all items on this page LOCATION % :I oat Print - � PROPERTY OW tea ' cC . U�.S Print , MAP 210 PARCEL: ZONING DISTRICT: Historic District yes Machine Shap Village yes o TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration No. of units: Commercial Repair re lacement Assessory Bldg Others: Demolition Other sc kri L.- Septic Well Floodplain Wetlands Watershed District Water/Sewer. ,DESCRIPTION OF WORK TO BE PREFORMED: &;q 6 F, 6KzS7,z-;u9R006- G Identification Please Type or Print Clearly) OWNER: Name: L( 6Ks7 Sc Rcob L Phone: �r 7$/ 3 750 Address: C C6. :T 1ae)tJt CONTRACTOR Name: CU 1 hone: 7 ' 9n Z(a74 Address: Y5 00 ke t3�c Supervisor's Construction License: . 3 Exp. Date: !1 ,tel Home Improvement License: c 7 ,3 Ex Date: Ithi 6 P p. ARCHITECT/ENGINEER IVIA 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: $ � t�0 FEE: $ Check No.: Receipt No.: �� � /JA, NOTE: Persons contracting with unregistered contractors do not have access to the a n Signature of Agent/Owner Si nature of contractor Building Department i 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 ,t. Building Permit Application 2,"' Workers Comp Affidavit z( Photo Copy Of H.I.C. And/Or C.S.L. Licenses u// 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 9 9 9 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:Building Permit Revised 2008 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 Reviewed on Signature COMMENTS HEALTH Reviewed on Signature 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 Durnpster'on site-= yes no Located at 124 Main Street t - Fire Department signatureldate COMMENTS 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 2010 A 4 Location � No. Y Date /W63 � N0RT1y TOWN OF NORTH ANDOVER C? • Ow � 9 Certificate of Occupancy $ �'�J'•ry E<� Building/Frame Permit Fee $ +cMus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 97 23257 �, Building Inspector The. Commonwealth of Massachusetts Department of Fire Services Office of the State Fire Marshal P.0.Box 1025 State Road,Stow,MA 01775 PERMIT Date: 'Oor 3-Zo ),g Norah Andover Permit No Dig Safe Num er (City of Town) (If.Applicable) In accordance with the provisions of M GJ,.l 4 8 Chagmr__L(L as provided in section 5 7 7 (MR 34 Start Date This Permit is granted to... Full name of person,Firm or Corporation Permissionto locate dumpster for construction/renovation/demolition of building. Continents: dumpster must be . 25 ' from structure if unable to place with required Restrictions:clearance dumps-ter must be covered with 1 wood or tar end of work -dap at (Give location by street and no.,or describe insuchmanner as�to_provied adequate identiHcadon of location) Fee Paid$ 50.00 ��� (lo�� \ 1�1I�� %►� ArFire Chief This Permit will expire. Signature of offical granting permit) OFfical granting pemut (Title) NORTIy 0 0Andover 0 .1 0 No. C% _: _ 0 dover, Mass., r� O LAKE COC MIC KE WICK S041 E I p P�,`�5 BOARD OF HEALTH PERMIT T/ D Food/Kitchen Septic System THIS CERTIFIES THAT....................... BUILDING INSPECTOR ' 1 .C� 7 CD c' Foundation has permission to erect.............. ......................... buildings on ..//.6.0.... Po.,,-,V .�� Rough to be occupied as................................... �.... .......!/1.F......V �r.�'�.,1 ................................ �.J..L7�1!1��r.C�/''� ..Ue �r hi ney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in F' al 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_ T TS Rough ................... ....... ....... ' . y. ......... :.......................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal 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. f rr7,-- Board of Building Regulations and Standard, i I HOME IMPROVEMENT CONTRACTOR Registration; 137434 Expiration: 11/12/2010 Tr# 277580 a Type: Private Corporation f RONDEAU CONSTRUCTION INC. i DONALD RONDEAU 25 CHUCK DR.#4 11 DRACUT,MA 01826 .e.=..,� Administrator Massachusetts- Depat-tment sot'Public Sara} Board tit'Building Ren lations and Standards Construction Supervisor License License: CS 35313 Restricted to: 00 DONALD G RONDEAU PO BOX 522 DRACUT, MA 01826 c- J"�- Expiration: 5/2/2012 ('4muni.Kiuuer Tr#: 25775 T� _ The Commonwealtl,ofMassaalusetts f 1-)epar17nent offiidush al Accidents ~S Office oflnvestigations .�' 600 Washingtolr Street Boston,MA 02.7.7.7 ' wwwanass gov/dia Workers-' C'mpensaition Insurance Affidavit:Builders/Contractors/E lectricians/Plumbers: A Iicant Information Please Print Le 'bI Name(Business/organintion/lndividual : ►`O"P E ,i � Address: O r �pbL c� 2,2- -1)CZ.A G U l City/State/Zip: -r,> t,e-�V 1: AAA , t Phone#: 78 Z Are Yo an employer? Check the appropriate box: 1.671 am a employer with 4. 0_I am a general contractor and I Type of project(required): employees(full and/orpart-time).* have hired the sub-contractors 6. ❑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 working for me in any capacity employees and have workers' 8. ❑Demolition [No workers'comp,insurance comp:insurancet 9- ❑Building addition 3.❑ required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions I am a homeowner doing all work officers have exercised their myself. [No workers' comp. right of exemption per MGL 11-E1 Plumbing repairs or additions insurance required.]tc. ISZ, §I(4),and we have no 22'�oofrepairs . employees.[No workers' 13.Q Other comp.insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their workers'ca mpensation t Homeowners who submit this affidavit indicating they arc doing all work and'hen hire Outside contractors moulstt cy submiinformation.new affidavit indicating such tContractors 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. Irthe sub-contractors have employees,they must provide their,workers,comp,policy number. I ant an employer that is providing Orlters-1 compensation insurance for my employees. Below is the policy and job site information. , Insurance Company Name:S�-�Gj/4'1 t�j pL) t 6t s Ito./t! Policy#or Self-ins.Lic.#: W CoC c'C)C)10 8 ,60l 20[ - Expiration Date�� [1 Job Site Address: l 1 (oa G V_6X—L ':jlJ'� City/State/Zip:_�!V��)P, -j�kN 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 ofMGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-y ar imprisonment,as well as civil penalties in the form of a STOP WORD ORDER and a fine of up to$250.00 a day again iolator. Be advised that a copy of this statement may be forwarded to Investigations of the D f ce coverage verific 'on. the Office of Ido Hereby certify nd r r ain a p nalt es of etj ry that the information provided above is try and correct Si ature: Date: 8 3 16 Phone M Official use only. Do not write in this area,to be completed by city or town offtciaL City or Town: Permit/License# Issuing Authority(circle one): I.Board of Health 2.Building Department 3.City/Town Cie ti:Other rk_„ . Plumbinglectrical Inspector S.Plumbing Inspector Contact Person- Phone#: ACORD� CERTIFICATE OF LIABILITY INSURANCE ATE( MIDDNYYY) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Cowan Insurance Agency,Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 359 Main Street HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Haverhill MA 01830 INSURERS AFFORDING COVERAGE NAIC# INSURED Rondeau Construction Inc. INSURER A: Nautilus Insurance Company PO Box 522 INSURER B: Associated Employers Insurance Company INSURER C: Dracut MA 01826 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 REDUCED BY PAID CLAIMS. INSR ADD'L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS -LIL It= GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 -COMMERCIAL GENERAL LIABILITY NCM713 06109109 06109110 DAMAGE TO RENTED $ 50,000 PREMISES(Fa occurence)CLAIMS MADE 7)bCCUR MED EXP(Any oneperson) $ 5,000 PERSONAL&ADV INJURY $ 1,000+000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1,000+000 "POLICY PRO- 7LOC IFrT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANYAUTO (Eaaccident) $ ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ TH- WORKERS COMPENSATION AND )( CSI IMI IR EMPLOYERS'LIABILITY WCC5006885012010 03/0312010 03103/2011 'LOaY- 100,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L,EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? NO E.L.DISEASE-EA EMPLOYE $ 100+Wo If yes,describe under c�0 000 SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS t LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT!SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION Brooks School SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 1160 Great Pond Road DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN N.Andover,MA 01845 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2001108) ©ACORD CORPORATION 1988 a 0 c�M��n��c�M Phone(978)459-2684 Fax(978)459-2614 Rondeaulnc@aol.com Rondeau Construction, Inc. AO. Box 522 Dracu4 MA 01826 Johnson's Bldg. Brooks School 1160 Great Pond Road N. Andover, MA 01845 Quote Number: 712 Quote Date: Mar 2, 2010 Page: 1 Brooks 4/1/10 C.0.D. SHINGLE ROOF QUOTE AS FOLLOWS: -Existing shingles will be removed to decking. -Roof decking will be re-secured as needed. -Aluminum drip edge will be installed on all perimeter edges. -6'of ice and water barrier shield will be installed at eaves. -3' barrier shield will be installed in all valleys. -18"of barrier shield will be installed against all walls and around penetrations. -A self-sealing asphalt architectural shingle with a 30 year warranty will be applied over under-layments. -All walls and chimney will be re-flashed as required. -All pipes will receive new collar flashings. -Valleys will be shingle woven. -Cap-over vents will be installed at all ridges. -All roof related debris will be removed daily. -Roof will carry a 30 year material and 5 year labor warranty. TOTAL LABOR, MATERIALS AND PERMITS* - Roof over existing 11,050.00 *Cost to remove existing roof and install new shingles would be$14,450.00 *Additional fee for a man lift to access certain roof areas would be an additional fee of$2,070.00 *If roof decking is needed, the charge per sq. ft. would be$4.00 dha Ajgou M allow to doe W&A tAL6 quoto e� �D Subtotal 11,050.00 A11Sales Tax If you would like us to proceed with this quote, please sign and fax back to o 978-459-2614 7 3 b 3 Date... f/�...... MORTN pf a` TOWN OF NORTH ANDOVER A PERMIT FOR GAS INSTALLATION • S.AC HUSEt l t �.'This certifies that . . . t.s.t.�./I. . . .<� has permission for gas installation . . . !<�. ff. . . . . . . . . . . . . . . . . . . in the buildings of . . . .T A!U° . . . . . . . . . . . . . . . . . at . .jllz ) . . . X-� f. t.a.�. � . . . . . . .. North Andover, Mass. Fee. U . . . . Lic. No.. �?�C�'. . �. .-1 . . . . . . . . GAS INSPECTOR Check# 2 G c t' RASSAaWSETTS LNII+DEVIAPPUCATONFOR PERTNIrrTO DO GAS FITT PING (Type or print) Date NORTH ANDOVER,MASSACHUSETTS D Building Locations hf ermit# Amo t$ Owner's Name New❑ Renovation ® Repl ment Plans Submitted 1 U U F C4 t4 C40 Cn xl F O z z p F W q r�7 F O 00 O H tw7 H ZH � � t1 W C�.7 p0�� • w �'.a, J O A U a U x y 00 H F In SUB -BASEMENT • B A S E M ENT 1ST. FLOOR 2ND . FLOOR 3RD . FLOOR . 4TH . FLOOR 5TH . FLOOR 6TH . FLOOR 7TH. FLOOR 4 8TH . FLOOR (Print or type) ~ .� Check one: Certificate Installing Company :tame V i Corp. 9 Address Partner.. Business Te ephone ❑ Firm/Co.- Name irm/Co:Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes [:] No If you have checked M,pleijsfndicate the type coverage by checking the appropriate.box. Liability insurance policy Other type of indemnity Bond Owner's Insurance Waiver: Tam aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass.General Laws,and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the, best of*m} knowledge and that all Plumbing work and installations perforniod nluaer Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. By: Signature of Licens Plumb• Or a. ittc- Title Plumber Gas Fitter CityrTown ' Master .WPROVED(OFFICE USE ONLY) Journeyman