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HomeMy WebLinkAboutBuilding Permit #106 - 12 MASSACHUSETTS AVENUE 11/22/2010 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION I Permit NO:! Date Received Date Issued:A a IMPORTANT:A licant must com Tete all items on this age LOCATION G U O N M y 6111 4- Print PROPERTY OWNER a:U04- - Print MAP NO � ' �'2'0 PARCEL: 64 iJ ZONING DISTRICT: - Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition El Two or more family El Industrial ❑Alteration No. of units: .KCommercial Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other eptic ®Well Floodplain,` D We ands Wa`ter`shed,Di ct #p ; .r s e...t: _ <emmmm�i4v. - - !�- .�?M4?i• ��.'.51..�i� �.-.ti!'w.e-Mh.. j� ..ES�� yf.. DESCRIPTION OF WORK TO BE PERFORMED:r Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: CONTRACTOR Name: LfonQx A S Phone: i 3 S 'S 7z S.- Address: Address: 7 Lc,�L` Z . �/� _ ,; l l►�,',,c !�,, I`1 - = '� Supervisor's Construction License: 8(- 0//"/5 7 Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT,-$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ �� �� FEE: $ 4 Check No. Receipt No.: NOTE: Persons contracting with unregistered contractors of have access to the guaranty fund Sig"nature°ofAgent/Owner«r��,._ �,j : : �. aSt r ', ont'ractor�� �x I 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 Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products 40TE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit n all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals hat the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording lust be submitted with the building application Doc: Doc.Building Permit Revised 2008mi Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ E WERAGE DISPOSAL ❑ Tanning/MassageBody Art ❑ SwimmingPools ❑ Tobacco Sales ❑ Food Packaging/Sales ❑tank,etc. ❑ permanent Dumpster on Site ❑ FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature COMMENTS I HEALTH Reviewed on Signature COMMENTS I f' 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 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.$10041000 fine NOTES and DATA— For department use ® Notified for pickup - Date Doc:.Building Permit Revised 2008 ff /. 106 Date! . ,.pr+TH TOWN OF NORTH ANDOVER 0 �� � `p PERMIT FOR MECHANICAL INSTALLATION �9SSACMUSESS This certifies that . . . . . . . . . . . . . . . . . . . . . . . . . . . . . has permission for mechanical installation in the buildings of . .4 Xyxy ?. !6 _... . . . . . . . . . . . . . . . . at . . . .fr.. �r5 �''.. . , North Andover, Mass. ks% Fee/��• • • . Lic. No.. . .1 ; .. . . . . . . . . . . . . . . . . . . .6. . . . GAS INSPECTOR WHITE:Applicant CANARY:Building Dept. PINK:Treasurer North Andover Building Dept 1600 Osgood Street Bldg 20 Ste 2-36 North Andover MA 01845 HVAC PERMIT FOR THE INSTALLATION OF AIR CONDITIONERS, BOILERS, EMERGENCY GENERATORS, FURNACES OR ROOF TOP UNITS. The undersigned applies for a permit to install the following at: LOCATION DATE OWNER OF PREMISES ADDRESS CONTRACTOR NAME ADDRESS PREMISES NAME MATERIAL OF BUILDING TYPE OF FUEL CHIMNEY NO.OF FLUES SIZE CHIMNEY THICKNESS LINING' IF STEEL STACK LOCATION DIAMETER HEIGHT DESCRIPTION OF HEATING APPARATUS TYPE OF HEATERNUEL HOW MANY MAKE BTU INPUT LOCATION IN BUILDING PROTECTION AGAINST FIRE AS REQUIRED HOW PROTECTED ROOF TOP UNITS OR EMERGENCY GENERATORS (See the State Code pertaining to chimneys,smokestacks and heating apparatus.) MAKE WEIGHT DIMENSIONS:LENGTH WIDTH HIEGHT LOCATION ON BUILDING HOW SUPPORTED SIZE OF ROOF RAFTERS MATERIAL SPAN OF ROOF TIMBERS DISTANCE ON CENTER PROTECTION AGAINST FIRE AS REQUIRED HOW PROTECTED BTU INPUT/OUTPUT FUEL TYPE APPLICANTS SIGNATURE DATE 11/19/2010 15:49 FAX 978+739+4235 BABB_REFRIG.@ HVAC 001/001 ........./__.../......,. /.. 1 �f� JIxC Vu�rw9ltn�earnrxtl� n�...-1U7a1ac� DEPARTMENT OF'PU13UC$0 Retriwarion ContaoW-UCmnso Nuribor: RC 011457 Exp!c"!04/1212012. Tr.no: 2 Roslrlctad: TRADE WINDS MECMAN DAVID W BA58 . QA VILLAGE POST RD. DANVERS, MA 01923 comm►wlor na I i I ACORD" DATE(MM/DDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 7/1/2011 11/19/2010 PRODUCER LOCKTON COMPANIES,LLC-N DALLAS THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 717 N.HARWOOD,LB#27 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE DALLAS TX 75201 HOLDER.THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 214-969-6700 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC# INSURED Lennox National Accounts Services,LLC INSURER A: ACE American Insurance Company 22667 1321049 Trade Winds Mechanical Services LLC INSURER B: Indemnity insurance Co of North America 43575 Enterprise 3A Enterprise Rd INSURER C: Everest National Insurance Company 10120 Billerica MA 01821 INSURER D INSURER E: COVERAGES LEN IN06 L 1 THIS CERTIFICATE OF INSURANCE DOES NOT REPRESENTATIVECONSTITUTE A CONTRACT BE THCERTIFICATEE ISSUING INS" OL DF 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 ADUL POLICY EFFECTIVE POLICY EXPIRATION LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE(MM/DD/YY) DATE(MM/DD/YY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1.000.000 A X COMMERCIAL GENERAL LIABILITY HDOG24942892 7/I/2010 7/1/2011 DAMAGE TO RENTEDPREMISES(Ea c re $ 1,000,000 CLAIMS MADE FRI OCCUR MED EXP(Any oneperson) $ Excluded PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ Excluded PRO- X POLICY JECT LOC A AUTOMOBILE LIABILITY ISAH08590916 7/1/2010 7/l/2011 COMBINED SINGLE LIMIT $ 2,000,000 X ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ XXXXXXX SCHEDULED AUTOS (Per person) X HIREDAUTOS BODILY INJURY $ XXXXXXX X NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ XXXXXXX (Per accident) GARAGE LIABILITY NOT APPLICABLE AUTO ONLY-EA ACCIDENT $ XXXXXXX ANY AUTO OTHER THAN EA ACC $ XXXXXXX AUTO ONLY: AGG $ XXXXXXX EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE 5,000,000 X C OCCUR CLAIMS MADE 7107000121-101 7/1/2010 7/1/2011 AGGREGATE s 51,000.000 UMBRELLA $ XXXXXXX DEDUCTIBLE FORM $ XXXXXXX RETENTION $ $ XXXXXXX - B WORKERS COMPENSATION AND WLRC46135908(AOS) 7/1/2010 7/1/2011 X WC STI.,T O R EMPLOYERS'LIABILITY A ANY PROPRIETOR/PARTNER/EXECUTIVE Y� WLRC4613591A(AZ,CA&MA) 7/1/201 7/1/2011 OFFICER/MEMBER EXCLUDED? E.L.EACH ACCIDENT $ 1,000,000 A (Mandatory in NH) SCFC46135921(WI) 7/1/2010 7/l/2011 If yes,describe under E.L.DISEASE-EA EMPLOYEE $ 1,000,000 SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 A OTHER HDOG24942909 7/1/2010 7/l/2011 Each Occurence Limit$3,000,000 General Liability Aggregate Limit$10,000,000 (Products/Comp.Oper.) DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS 11 068798 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Town of North Andover DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL -30 DAYS WRITTEN 1600 ASgoud St. NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL North Andover MA 01845 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2009/01) ©1988-2009 ACORD CORPORATION.All rights reserved The ACORD name and logo are reIstered marks of ACORD For questions regarding this certificate,contact the number listed in the'Progucer'section above and specify the client code'LENIN06'.