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HomeMy WebLinkAboutBuilding Permit #546-2017 - 140 BRADFORD STREET 11/21/2006 ON NORT1� BUILDING PERMIT 3? 4�`.-,•. _•_.'6 °� TOWN OF NORTH ANDOVER y o APPLICATION FOR PLAN EXAMINATION Permit NO:J LAO ' !l Date Received a IZ16. p�RATlO 4�,1+ Date Issued: /I �t ' � 9SS�CHUSEt IMPORTANT: Applicant must complete all items on thisa e s _ LOCATION / Print PROPERTY OWNER , .rint MAP NO: U _PARCEL: ZONING DISTRICT: Historic District yes Machine Shop Village :yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ne family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial j5•Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑Septic 0 Well ,.tj Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer. G e-e U100 ee1/ —74�eO_1_ e:�4"/1 '1!1 E. Identification Please Type or Print Clearly) Id/ OWNER: Name: 4Dtn ��/1 gar_e14, Phone: Address: CONTRACTOR Name: Phone: a ' - Address* 1Ea i ✓ C Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. :Date: z ARCHITECT/ENGINEER Phone: Address: Reg. No. j FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ a Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund ignature of Agent/Owner ure.of contractor,? "� s ter,". 4t- . Plans Submitted ❑ Plans Waived Certified Plot Plan ❑ Stamped Plans ❑ -rTVF1F-3rbF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ j Tobacco Sales I Well 11 Tobacco Food Packaging/Sales ❑ Private(septic tank, etc. ❑ Pennanent Dumpster on Site ❑ . I THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF v U FORM j ti PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature r COMMENTS i HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes e Planning Board Decision: Comments Conservation Decision: Comments Wafer & 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 signatureldate COMMENTS I i dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. i 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) i t I I ❑ Notified for pickup Call Email ate Time Contact Name Doc.Building Permit Revised 2014 -- . I Building Department The following is a list of the required forms to be filled out for the appr€ipriate permit to be obtained. I Roofing, Siding, Interior Rehabilitation Permits ❑ 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 ❑ 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 Pian ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (if Applicable) o 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 o Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit j ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of CO' ntract o Mass check Energy Compliance Report o Engineering Affidavits for Engineered products 40TE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit i 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 2014 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 4/Building Permit Application j ❑ orkers 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 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 � NORTy Town of 2 ndover No. yr * z h ver, Mass 0 COCHICH1.1c, �. Ii9S�R-1TE0 hPP`��5 U BOARD OF HEALTH PERMIT T Food/Kitchen Septic System THIS CERTIFIES THAT ........ ...rpq.&v.k................ ,V �..L v BUILDING INSPECTOR ......................................... .. ................ has permission to erect ....................................... buildin s on Foundation . Rough - to be occupied as ..........Ap opt*- we.....,•,rro% /` Chimney y provided that the person accepting this permit shall in every respect conform to the terms of the application on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Final 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 CONSTRUCTIO TS Rough Service .. .. BUILDING.INSPECTOR. Final GAS INSPECTOR Occupancy Permit Required to Occupy Building 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. Smoke Det. Adams3 PART Carbonless PROPOSAL 4 � ✓ ,, W� � � DATE ' ILI PROPOSAL SUBMITTED TO: WORK TO BE PERFORMED AT: ��"�a a%n v��`: ,�. � ;�w��� .tiv. ,ir .Aid-,`K �� g s'.'s�t;' F�� ,f` ~: �" -;:; Yt��r.'�`.`�-'� ,. ,�,f«s��:.�,, r. '�;`•Sk �+ s-�"i'� 'a,�?,, .,,� P'kyy i^ a,t( >+- X:* s%"^ .d'✓�5�. v k��k� �;� ��.,� � x�' '�4� 1 ,.. � �• a1.'. 'i=;.,1z�" n� �. �f, y •" �} Ogg ,t#'A'$ :�F�¢r ��r:fig f .v . _ !�� AQBF3ESS 1 N 4 7P 3 r.1 ". k ..{ F d S{ + H y R " r frf' z,i. 7 y '' `,' �,?,.a, r �Cna � "€':'�? �C��� ��"-.�� 4t r a :.� Wj ARCHITECT'` t"'".`F a ana -' 1'*gs s. ,,,:�i''�,.5�' -,. ��, V1rehereby F � �ait � i t �ls awlef4rttie la or nice ��;� oft . t1t. t�4� of � ua , „.R' 3^p: ��� Na� _� 4 , - ', �rM-;; Y, !#+" " •;�% '�..,,r"�`^a.�c�x�:' "E4�'..;.:� <L. ,�'�'°.�;;rw � :;�„:� � � .- �~ fs�, �'� r:°,r �*'. ,��, "� "a�� '�.v`�d?�'>'� ��t? �+` ,t. 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AA,�a'y✓•+:�"r�ratfi s��`# R�z�a,:� �,� c� i 's : t"s ' sw AI! maten�l Isyquarant�ed to, be ;- specified, andythewabo�e work to bre performed to accordance wfth the drawings and specrfi- cations submitted for above work.and completed in a substantial workmanlik manner for;the sum of 7`?�io ✓rte v `�v� ,,,; Dollars ($ �S71G�t ot;G' '�,. withpayments to be made as follows f t r , ,• S Respectftjtly subnitted Any alteration or deviation from above`specifications involving extra costs will be executed only upon written order and will become an,extra.charge Per over and above tie'estimate.All agreements;;eontmgent,upon strikes ac cidents,or delays beyond our control: Note".This prop al rn withdrawn by us if not epte ithin-days. "p, The above gnces, peciffcatigs and conditions are s jt►sfactory and;;ale h eb � aceefed� tt are authonzetl to dothe"work. as spe�ifleci Paymeri�s will be rrr�cie"as otatkrned�aboue �` �"�' �` � ��� �.� s �'� Slgnatur Date Signature The Commonwealtli.of MassacTiusetts• - ri-,a.;:a iatf Form; Depailinent of 1iadustrial Accidents 6 w�•� rr � Office of Investigations b r• µw .•e ±t 41n _ � :f L'.4 it LLufLEiL��fify ULf-GCS Boston,MA 02111 t `:1 ivurft.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Tame(Business/Organization/Individual): Address: savj7J 0 0�is y City/State/Zip: -5a 6V, IV AI e)307f Phone#: CD3 P9_ Q � 7 7- [2. re yo employer? Check the appropriate box: TyE fproject(required):Iam a employer with - 4• ❑ I am a.general contractor and'Iemployees (full and/or part-time).* have hired the sub-contractors 6, New construction ❑ I am a sole proprietor or partner- listed on the attached.sheet. 7. ❑Remodeling ship and have uo employees These sub-contractors have g• ❑Demolition working for me in any capacity. employees and have workers' [No workers'comp.insurance comp.insurance$ 9• ❑Building addition required,] 5. ❑ We are a corporation and its '• 10.❑Electrical repairs or additions 3.❑ I am-a homeowner doingall work officers have exercised their . I1.❑Plumbing repairs or additions ' myself. [No workers' comp, right of exemption per MGL . 110 Roof repairs insurance required.],t c,152,§1(4),andwe have no employees.[No workers' , -13.❑Other•, comp,insurance required.] *Any applicant that checks box#I must also fill out trio section below showing their workers'compensatioe policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew,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: If the sub-contractors have employees,they must provide their workers'comp,policy number. I am an-enTloyer that&Tn'rt 4dhig w"kets"'compensation Insurance for my employees..Beloni is thepolicy and job site infotmatioit, Insurance Company Name: Policy#or Self-ins.Lic.#:__ `3 QlL Expiration Date; Zv / —7 Job Site Address:_ �%O �{g� �� Aa City/State/Zip: r Aieo 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 Of ce of Investigations of the DIA for insurance coverage verification. I d..o/tet'P•by retll, utt.dal•Mena--i'ns and altiay o p Ii 'f/:at ilia;afnp Hatlolt ,prvov.:7 , - ide above,to trine an.,' Si nature: e� Date: Phone#: F e only. Ido not write fit this area,to be completed by city or town official wn: Permit/License# hority(circle one): Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5•Plumbing Inspector. son: Phone#: �5.. - - :�r.a o, �Rx-- - :r..:ca=w•;, - ;^��t�a: :ea7b -- - ;r.'M>;...,..=.- _ _ �s,,�.v.i'••L-'.ae�'�� -_ _t ':.5'�Y ^.'q!•..- r.;�. 3 til`- '``7"'r' -'. '''�.• .?`.�'''.isa�iF�`�"is.�\iwti�.�Y�.-�''_m';„y '=�- .�y.'�!�i�R�S;isr �'.:�..y.�-S" ::!G;o-:r•�:S'�.y.,` _ R. „'i• -vrt,"n•=='_=._s�. .�'yk r-cr.r'.'75r_' c: Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as".,.every person in the service of another under any contract.ofhire", express or implied, " p P , ora]o r written. An employer is defined as"an individual,partnership,association,corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. -However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair wort:on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced ai ceptable evidence of compliance with the insurance.coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the cormnonwealth'nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority," Applicants Plcase fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to cant'workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit maybe submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should �--�' be'retumed to the city or town that the application for-the permit or license is being requested,not the Department of Industrial.Accidents. Should you have any questions.regarding the'law.or if you.are required to obtain a workers' compensation policy,please call the Department at the number listed below,.Self-insured companies sbould.emter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly, The Department has provided a space at the bottom of the affidavit for you to fill out in.the event the Office of Ynvestigations has to contact you regarding the applicant, Please be sure to fill in the permiUlicense dumber which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that Lias been officially stamped or marked by the city of town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a-home owner or citizen is obtaining a license or permit not related to any business or coniniercial venture a doQ license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number; The.Commonwealth of Massachusetts .Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. #617-727-494.0 ext 406 or 1-877-MASSAFE Revised 4-24=47 Fax#617-727-7749 nrci min+»nncrn.s/ratio , - .-:A�"�, '=.a..F��:Y�:���.��s",_��._..-..�3�3^ f;�'�.�.<.-"rte-`.--� �"���"_.;��z.�: vim=�'�.:��;' "-`��.w._s...�.��nuc-�s,. .�.�'y.�• �+%�z:�`� ':�:, i DATE(MM/DD/YYYY) ACo CERTIFICATE OF LIABILITY INSURANCE 1 11/18/2016 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 have ADDITIONAL INSURED provisions or 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 CONTACT Jim Lafond R.C. Lafond Insurance Agency, Inc. PHONE Fax 396 Andover Street 978 686 3826 AIC.No):978-682-0713 North Andover,MA 01845 ADDRESS: jim@rclafond.com INSURERS AFFORDING COVERAGE NAIC N INSURERA: The Main Street America Group/NGM INSURED NH Sunrooms&Conservatories, Inc. INSURERB: Liberty Mutual Insurance Co. Frank J. Rullo 40 South Policy Street INSURERC: Salem,NH 03079 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 ADDLTYPE OF INSURANCE IVSD SUER POLICY NUMBER MM DDPOLICY POLICY EXP LTR IYYYY EFF MMIDDIIYYYY LIMITS A COMMERCIAL GENERAL LIABILITY MPT1284R 02/11/2016 02/11/2017 EACH OCCURRENCE $ 1,000,000 DAMAGE ToRENTED CLAIMS-MADE V OCCUR PREMISES(E.occurrence) $ 500,000 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY EI PRO- JECT RO F-1LOCPRODUCTS-COMP/OP AGG $ 2,000,000 PRO- OTHER: $ B AUTOMOBILE LIABILITY B1T1276R 02/11/2016 02/11/2017 COMBINED SINGLE LIMIT $ 500,000 Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident $ UMBRELLA LIAS OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ C WORKERS COMPENSATION WC-31S-605215-016 06/01/2016 06/01/2017STATUTE TH- ORH AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YY N/A E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 It yes,descr be under 500,000 IDESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Operations usual to the installation of sunrooms and conservatories. Corporate officers excluded from workers compensation coverage. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Building inspector ACCORDANCE WITH THE POLICY PROVISIONS. Town Hall Main Street AUTHORIZED REPRESENTATIVE North Andover,MA 01845 o4e we ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD I Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration X00290 Type: Expiration: 811512018 Private Corporation RULLO CONSTRUClt�ION t7NC ', Frank Rullo t4`fir 14 Stonepost Rd Salem,NH 03079 Undersecretary r t 01 ublicids Safety S Dep3rtm oaS and eta 3SS3chuse inc �egulat� o- Hoard Q= ;��4i°'� "►, .`:i Ca�str CS-041156 op cense i.. �X , lq S'f���p'19` too gra p17... J COMMIS C