Loading...
HomeMy WebLinkAboutBuilding Permit #297 - 14 BEECH STREET 10/17/2007 ,AORT,4 BUILDING PERMIT qti TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit 14001'­7 Date Received �q °0„4Tp SSACHuse Date Issued: '” - 0 IMPORTANT:Applicant must complete all items on this page PrIT3#� PR )p O ER �; r x t , Nt r 4x Prlflt a f d sL TYPE OF IMPROVEMENT PROPOSED USE I.-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 pepticdell x �'F�oodpla�n 1Jiletlands Watershed�Distrwt z DESCRIPTION OF WORK TO BE PREFORMED: (�— r Identification Please Type or Print Clearly) OWNER: Name: D in 4coczIf Phone: Address: !t/ ,EGfi' � v,�/�I` rod2 TCON,-RL.. J of„xn'Ya 78,4 . 1 L t S per�rrsox's gCronstrac#ray rcense, ✓Le + Y; ' n t + �; t• :. n.;� y s ,; � x li. Y 5 Hol ae ra pro�ement� cense 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. Total Project Cost: $ /�li1O C� FEE: $ zj� Check No.: Receipt No.: 0 NOTE: Per ns contracting with unregistered contractors do not have access to th gu ty fund Signature ofi Igen; wner ' Signature of:contractor � 2 ORSM ANO (1 p 164, 0 O o * 1C oaauMaP " 4 pgnpRwT40 y¢, MASSAGNJ E ox!o��R 6 F r10 P�PN e\�ed owl N F0� pa'�e Reds 4a�e � , PPP p�ete all � =ro est c � F fi �e5 yes so VVI- 0 V,s �a11ag _ ,'�/r.t� `,� ,Render + S b Ml Y.� Nor Number o rNG�� TOtal f Stories, \r �a �met� x 1 ien vsE G ecs 1 area 89 FSEy.,_ "• -,-k 01 I E/eCtTRCqt'ry10 � qNG /nspe°to��eht Of MEQ '� chaR 20 Meter ter / - 1 16s NF L/T °Cati n, Secfio„ and yes Mast or se �S a nd in.$1 yes ry ce aro 1 ha�q rq 0$ 000 fie NO p re C"'kes or aa eh't No pprOVal o f ent use f oa�e +�+ � Prore• N u PER S.P• I NO OX125 U Re0• s�BPsEv E5�lop, �cc ty fnnd �FtNE ���.�' �o ,o ce�ptiNe a access t FLe not ha t�'acto'�s d0 co�Lwa �ste�ed con an��eg -S�9 I e i I 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 o Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract o 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 o 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) Li 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 o 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 Location /No. Date Date NORTH TOWN OF NORTH ANDOVER AL 3? C � 9 Certificate of Occupancy $ — Building/Frame/Frame Permit Fee $ r s�cMusE 9 Foundation Permit Fee $.•- —�`` Other Permit Fee $ TOTAL $ Check # f� 20703 Building Inspector A/ass Svb F0 I�°blcSeueS�WERgCED plot? p elI ISPOSAL 14/a/Ild nate (septic CGrf%f. to etc T T a�lhg�as /°d A%t A Pe obacco Sales sage�odyArt %ah s 7)7ane4tD�''nAs Swi taped A% F A %V FFO� �cr°n Site oPools ans CANNING: rFRO14 1v/NG' odAackagi CoM OFV'`o ARrMFNrcr IN �g'Sales I MFNTs pM�i yr -44SiGNFoR OF ; p�r�RF✓ OFF,vF F ASF FcrFp SRM °N4 Y r C CopNs�RV-4 Oq TF A r/O 'SAA MM�Nrs N RoVFo d Oq r�RE✓ M! yFA FCrFp � COUCry oMMFNTs gAARo�F 0 Oq TFR R✓�CrFO ng�Qar�f Oq rFgA p/ann'�9 g Appeals' far AR��F °ard 'ace O C°nse�at pec/s;On Petitio, ,Oh °: iwatte��$ oeCiN017. F eaat 384 o et.Co COmn7e 2On"'9 Oe t� D�p�4 s9°pa St�ect�Oh/S C nts c/s,Oh/recejpt Fire hep��4aF1', ' nature& °��e�ts svb�ittea 8/ �'S'tr T fat Ae M s MINTS f date on s/te. �. I .y,•@S, pri�e�a I Aer�,t - O NOt/f r �o /ed�OrAi°k c Ball] Oil 2007 P`\ tea°ee or s4eeTbe app�'ucA_ sitava oaisove'r— a4p 1 ha tibe a�be� ed with the b �Y must be s 'Cto�AL S�R�CES D �SpEC Dp0' Re`"Sea Z Zpp'i i 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 0 Zoning Coardjof 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"DEPARTMENT Temp. Dumpster on site yes no Located at 124:�11am Street Fire EDepart'. t s�gna'turetdate =COMMENTS - i' 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 2 1 A—F and G min.$100-$1000 fine NOTES and DATA— For department use ❑ Notified for pickup - Date i Doc.Building Permit Revised 2007 � - t I NORTH. i. Town of North Andover F q p Building Department 4� 1600 Osgood Street c North Andover MA 01845 #- t Tel: 978-688-9545 Fax: 978-688-9542 * -- - A a DEMOLITION OF BUILDING AFFIDAVIT sgcHus DATE C1, 29 - ©' l ---- --- OWNER'S NAME &ADDRESS DA ID tiU A"H L+ qw ec N STS I;ET ► rt(D . ..4 n 00� LOCATION OF PROPERTY TO DEMOLISH e,i,-� 'T-P— 1 DESCRIPTION S l u�+LE r-' VUt L'4 D t_1._tnf Cr i � CONTRACTOR'S NAME &ADDRESS C qk&E" UT yyA�j �Dn�S"T'/ZtX.TIO�c( C.4 0/64"111- DEPARTMENT f6DEPARTMENT FFS DEPT. OF PUBLIC WORKS -WATER: S W DEPT OF CONSERV ION EALTH DEPT: Se tic❑ Well 0 – N GAS a � ✓ELECTRIC " ,/TELEPHONE ,/CABLE owc " _ l�.i� TAXES D R POLICE L FIRE EXTERMINATOR DUMPST ER 0 FF TREET i DIG SAFE NUMBER 2oD'7 yl 0 9/ d 1 N DATE RECD BLDG. I SPECT R Doc.form demolition of building affidavit 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): Cm6Jf—XU/' IN �/ t�GZyi' �lnGl� Address: /Z ChJT�ClU� k�f•¢� City/State/Zip: ,MA- MW Y Phone #: 97,9- 3 7039' Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I 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 proprietor or partner- listed on the attached sheet. # 7. [] Remodeling ship and have no employees These sub-contractors have 8. f Demolition workingfor mein an capacity. workers' comp. insurance. Y9. E] Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.F1 Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL 1 1.❑ 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.❑ 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. lContractors 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. Lic. qj /ZSZ Expiration Date: Job Site Address: City/State/Zip: 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 d r t ains and penalties of perjury that the information provided above is true and correct. S44nature: Date: 62 /> 0 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#: NORT►y Town of No. C;97 �, do . '� dover, Mass., /TJ • /�• D �- T 0 LAKE COCHIC HE WICK y 7�S RATED BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT...... ...... ....1�.�..!f.�.� w.�...�................................................................................................. Foundation has permission to erect buildings on je �� �`� �............................. Rough . ........... ................... .............. to be occupied as....... .... h! . ........rS. ���'V.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 CONSTRU N S Rough ............... .................................. .. ................. Service BUILDING INSP - 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 Approve by the Building Inspector. Burner - - - Street No. Smoke Det: SEE REVERSE SIDE OenL Dy: n a R insurance Agency, inc.; 011-`leo-UtJ12; Aug-1 -U/ 1b:U2; Page 1 /1 ACO RD CERTIFICATE OF LIABILITY INSURANCE °ATEIMMIDDIYYYY) s/1/o7 PRODUCER THIS CB:MFCATE IS ISSUED ASA MATTER OF INFORMATION H 6 K Ins. Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THECERTFICATE P.O. Box 344 HOLDER THIS CERTIFICATEDOESNOTAM90,EXTENDOR 182 Main Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BROW. Watertown, MA 02472 INSURERS AFFORDING COVERAGE MAIC# INsuR® INSURERA Harleysville Group/Worcester Chestnut Way Construction LLC INSURER B: Hartford Insurance 12 Chestnut Way ---- ------- -- ------ F. INSURER C: Methuen, MA 01844 -.._--._..__.. ...-.. _.. . ... .... INSURER D: f INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REOUIREMENT.TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT 7O 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. -- --- - -- --- .----- - - -- --------- --.._.. T Q_..—.---.__........__.—.. POUCYNUMBER POUCYEFIEC.0 UCYEKRRMDN LIMITS TYPE OF INSURANCE ATEIMWDOYin ITS ILIABLITY EACHOCCURRENCE iS 1 Q()Q QQQ L—_1.. A COMMERCIAL GENERALLUBIIfrf GLBJ1252 9/25/06 9/25/07 PREM�S°� m,�) !a 10010 .... _ -- CLAMS MODE i X OCCUR MED EXP(ayarwn) I a 5,000 PERSONALBADV INJURY a 1 a0o GENERAL AGGREGATE a 2,000,9%.. GGERLAGGREGATE LIMIT APPLIES PER: i PRODUCTS-COMPIOPAGGG 2,000,000 POLICYJPERCT :LOC --__....-•---------- i :AUTOMOBK.ELIABILIIY COMBINED SINGLE LIMIT S —ANY AUTO (EeacdderY) �- ALL OYWEDAUTOS BODILYINJURY I S I SCHEDULED AUTOS (Per pefs^) I f HIRED AUTOS i B�ILY IN.0.IRY a NON-OWNED AUTOS I i (Pereaider0 PROPERTYDAMAGE i(Pa aaian) I S !GARAGE LW LITY AUTO ONLY-EAACCIDENT 5 ANY AUTO I OTHER THAN EAACC S AUTO ONLY: AGG S EXCESSIUMBRELLAILABLLlTY EACH OCCURRENCE S -------........... - OCCUR CLAIMSMADE AGGREGATE S DEDUCTIBLE $ RETENTION S I S 1 WORKEtSCOMPENSATIONmn I VC - B EMRAYEiL4'umuTY 6S60UB5626C35806 9/12/061 9/12/07! YUMIT$......IDTHI _ ANY PROPRIETORPARTNERIDCECUThE I :E._LEACH ACCK)ENT S 100,000 OFFlCERAEMBER OLCLUDED? i ELDMEASE-EAEMPLOYEE S 100.000 Ify�deSUbeurafer _ i - - SPECIAL PROVISiONSbebw 1 E.L.DISEASE-POLICYIJMIT S 500,000 OTHE R I � I I D ESCRIPTIO N OF OPERATIONS/LOCATLONS!VEHICLES I EXCL UEIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELATION SHOULD ANY OF THE ABOVE OESCRI BED POLICIESIBE CANCELLED BEFORE THE EXPIRATION DATE THEREOF.THE ISSUING INSURER W ILL ENDEAVOR TO MAIL 10 DAYS W RITTEN 'town of North Andover NOTICETC THE CERMMATEHOLDER NAMEDTOTHE LEFT.BUT FAILURE TODOSOSHALL I MPOSE NO OBLIGATION OR LUMILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR rREPRPSENTAnVM A THORtZED RWRESMTATIVE Sohn R. Herlihy ACORD 25(2009106) ®ACORD CORPORATION 1988 Ioagd of Building Regulations and Standards C9tisi:ructign Supervisor Llcense Licefls�e:s CS 85446 ihd 2/?1/1972 - plr;�En 2/ 1 009 Tr# 10773 Res I ft19n 00 F -Ij STEVEN E POULI?T 12 CHESTNUT WAY METHUEN,MA 01844 Commissioner \ J