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HomeMy WebLinkAboutBuilding Permit #435 - 142 MAIN STREET 2/2/2009 BUILDING PERMITpORTH ,6'97. TOWN OF NORTH ANDOVER 02 4 �' -� .6 APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received ��p°RArg° SSACHU`-+� Date Issued: '� IMPORTANT: Applicant must complete all items on this page LOCATION P-12. cry S-1-. Print PROPERTY OWNER Richard L.Gwfi;rnr' Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration No. of units: Commercial X Repair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District WaterlSewer DESCRIPTION OF WORK TO BE PREFORMED: T,nS�J�c;�e waits V1ang, S11- . foc e- rm -.)CAks IAS474.0 df-OA Ce.1 ��wQ i n sj-d rtes -�IoQ��',�►G iris(�!/' �l���,S �' r,rrr , Identification Please Type or Print Clearly) OWNER: Name: Rl' i ry Lend-,;►1` Phone:%79'3?Z- 4115- Address: 56 Ne.&k- 12-*l 6,)dW o193-r CONTRACTOR Name: avid T 6v-qn,1,q4JVm Phone: (03-231/- ►tab IJ Address: 7f( Old SohnJ00 , , mps d '41. 03k Supervisor's Construction License: Gr( INO Exp. Date: /r olL Home Improvement License: 33 - Exp. Date: S. 2-3. 0 ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 21x,3006 c' FEE: $ Check No.: & Receipt No.: I�� NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Own 1_ `. Signature of contractor ra/614ARi) 4k-)/7`lni/ 1 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 38 ,sgood Street FIRE DEPARTMENT - Temp Dumpsler on s'(te yesIq o Located at 924 Main Street Fire Department signature/date V'd&�w COMMENTS "T 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 2008 - - 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 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 2.2008 Location !� ,G1//� No. Jr Date 4 = d �ORTM TOWN OF NORTH ANDOVER 3? �• •SOL ~ 9 a Certificate of Occupancy $ CMUS<� Building/Frame Permit Fee $ 3t (11,V ^ Foundation Permit Fee $ �— Other Permit Fee $ TOTAL $ Check # 2 . 8 "+ 2 v Building Inspector C NQRTH Town of : Andover . 0 No. __ o dower, Mass., • • o �. COC HIC HEWICK V RATED PPG �C� ri BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING.INSPECTOR THIS CERTIFIES THAT....... . `..&44......... ....................................................................... Foundation has permission to erect buildings on ....IY4;......... ............. .....�........................ Rough Chimney to be occupied as..... � I.I. ........�/� .�.�r..rt.............. .. �.� .....I.. � .. 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 314 PERMIT EXPIRES IN 6 MO THS ELECTRICAL INSPECTOR UNLESS CONSTRU Rough Service j 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 Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. i k_ H-AL:_ is 4 j FXV /NG i.1�ftLsZS I Z-1 _pVGT.GJo/EK c' �L,EG?/21C�L O S'Fpek)+r/aN %'am IL c!J3E I - AND HVNG -,�Xrs7�ntG rXT�IZia2 (.dALI_ IY2- MAIM s-f 16 t � _�iIL.E f�'lock� .1NSt�LrtTE' - GocE GYP.��,� a3a+Ar�D I /z� GYPsV�r Bo�at� I Ij 11 , i i r i ✓lie�w�sz.na�zuieal��ej��Ztcssacftuaed� Board of Building Regulations and Standards E HOME IMPROVEMENT CONTRACTOR Registration. 433211 ExIsIration: 5/23/2009. Tr# 131864 Type: =lndiyidual DAVJD-J.CUNNINHAM DAVID CUNNINHAM . i8 01.0 JOHNSON RD. E.HAtMPSTEAD,MA 03826 Administrator ' 4a+�a�llnstatt,-Department of Pi7hliC�afet% Boal-d of 13uildin<'. Ked-Mations anti Stantlaa tl Construction Supervisor Ucense License: CS 66462 Restricted to:. .00 DAVID J CUNNINGHAM 78 OLO JOHNSON RDAh E HAMPSTEAD, NH 03826 Expiration: 1/5/2010 ("e.€1€n!i+moi elle r Tr»`: 354 The Commorzwealth of Massachusetts Department o P f Industrial Accidents D,c O p` • r Office f Investigations 600 Wash inalon Street Boston, MA 02111 H'WKI-"z=S.gov/dia Workers' Compensation Insurance-Affidavit: Builders/Contractors/Electricians/,',D rs AD Iicant Information Please, Prinf Le6ibly Name (Business/Organization/Individual): G,N`d T Address: ( o City/State/Zip: e4s f• /- r,,�s�c , N. 0A 2-(-Phone#: Are you an employer?Check the appropriate box: 1 ,® I an a employer with _ . 4. ❑ [am a general contractor and I . 752-R Typeoject(required); emp}oyees(full and/or part-time).* have hired the sub-contractors construction2.❑ 1 am a so}e proprietor or partner- }fisted art the attached sheet x odelingship and have no employees These subcontractors haveworking for me in any capacity. workers' comp insurance . ❑ Demolition [No workers' comp. insurance 5. ❑ We are.a corporation and its 9. ❑ Building addition 3.❑ required] officers have exercised.their 10.0 Electrical repairs or additions I am a homeowner doing all work right of exemption per MGL 1 l.❑ Plumbing repairs or additions myself. [No workers' comp. c. 1$2, 1(4) and We.have no insurance required.] t employees. 124[] Roofrepairs P Yees. [No workers comp. insurance required.] 13•17 Other *An}/applicant,that checks box#1.must also fill out the section below showing their workers'compensation policy information. t tioma tors th t ch cu this bo mus!attached ched ting tile)-etc u'utEi'cit:t+;: ;&ftd ihcn hire cutaide conitat;turs must submit a new•amdavic indicating such. tConttat tors That chc^1 this box must attached an additional sheet showing the retro o.the sub-cotmmctai3 and their worker's comp,policy info manor.. I am urs.employer that is providing workers'compensadori iasarance or information f mj employees. Below is the policy and fob site Insurance Company Name: &eA CSS G e. - Policy#or Self-.ins. Lic.#:_ fW C $Z3 O sq Expiration Date: Z8- Z.0%0 .lobSite Address:—.1L4 I n (' f- Attach a copy of the workers' compensation otic decia City/State/Lip: p P y ration page(showing the policy number and expiration date). .Failure to secure coverage as required under Section 25A of MGL c. 152 can }gad 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 5250.00 a day against the violator. Be advised that a copy of this statement may n Investigations of the DIA for insurance coverage verification. } be forwarded to the Office of 1 do herebj)certify under the paint and panaltdes oer u rP l r I that the information provided above is true and correct Signature: � Dates: � Z g •p Phon--#: U 3 Of fccial use onip. Do not write in this area, to be completed by city or town offCciaL City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Tovvn Clerk Q. E(ectriral inspector S. Piumbirtg Inspector 6.Other p Contact Person: Phone Information and Instructions 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 of hire, express or implied, oral or 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 includi-n-the legal representatives of a deceased employer,orthe 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 maint-nance,construction or repair work 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 o r 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 acceptable evidence mf compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states"Neither the commonwealth 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 Please fill out the workers' compensation affidavit compi-etely,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 carry workers'compensation insurance. If an LLC or LLP does have _ employees, a policy is required. Be advised.that this afiica.vit 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 returned to the city or town that the application for the peenit or license is being requested,not the Department of Industrial Accidents. Should you have.any questions regarding the-lava, or if you are required to obtain a wor kers' compensation policy,please call the Department at the ntx ribber-listed below. Self insty ed companies should enter their self-insurance license number on the appropriate lire. 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 Investigations has to contact you regarding the applicant. Please be sure to fill in the permit5icense number which will be used as a reference number. In addition,an applicant that must submit multiple permit/hcense applications in arty given year.need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should writs"all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or 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. Va/here a home owner or citizen is obtaining a licenste or permit not related to any business or commercial venture (i.e. a dog license or permit to burnleaves 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)Eavestibatious 600 Washington Street Boston; MA 62111 Tel. 4 617-727-4900= 406 or 1-877-MASSA.FE Revised 5-26=05 Fax 4 617-72.7-7749 VMMMass.bov/dia JAN/29/2009/THU 01 :26 AM P, 001%001 ACORD. CERTIFICATE OF LIABILITY INSURANCE ii28 2009"' PRODUCER (603)432-6414 FAX: (603)432-3852 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Financial Services HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR PO Box 950 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Derry NH 03038 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A,Peerless Insurance Cc DAVID J CUNNINGHAM BUILDERS LLC INSURER B: 78 QLD JOHNSON RD INSURER C: INSURER D: E HAMPSTEAD NH 03826 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. " kTELIMITSSH WN MAY HAVE BEE 4 REDUCED BY PAIDCMMS, rA mDD-L TYPE OF INSURANCE POLICY NUMBER DALTE MICY FM/DDIYY FECTIVE SATE MMIDDIYY EXPIRATIONLICY LIMITS GENERAL LIABL17Y EACH OCCURRENCE 1,000,000 DAMAGE TO RENTED 50,000 X COMMERCIAL GENERAL LIABILITY PR MISES Ea occurrence) $ r CLAIMSMADE OCCUR CCP9735458 6/13/2008 6/13/2009 MED EXP one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN-L AGGREGATE LIMIT APPLIES PER: $ 2,000,000 X POLICY PECT 17 RO LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 500,000 ANY AUTO (Ea accident) A ALL OWNED AUTOS BA9739558 6/13/2008 6/13/2009 BODILY INJURY (Per person) $ X SCHEDULED AUTOS X HIREOAUTOS BODILY INJURY $ X NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EAACCIDENT $,._. ANY AUTO OTHER THAN CA ACC AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY OCCUR r-1 CLAWSMADE AGGREGATE $ DEDUCTIBLE $ RETENTION A WORKERS COMPENSATION AND WC STATU- OTH- EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT 100,O00 OFFICERNEMBEREXCLUDED? WC8230359 1/28/2009 1/28/2010 E.L.DISEASE-EA EMPLOYEE$ 100,000 If yes,describe under SPECIAL PROVISION$below E.L.DISEASE-POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONSILOCATtONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE FOR OFFICE USE ONLY EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO 00$0 SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER RS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Sam Fragala/BROCHU ACORD 25(2001/08) ©ACORD CORPORATION 1988 David J Cunningham Builders LLC PROPOSAL 78 Old Johnson Rd. - E Hampstead NH 03826 DATE PROPSAL NO. 603-378-0898 1/29/2009 104 NAME/ADDRESS Richard Lentini 142 Main St. North Andover, MA 01845 DESCRIPTION We here by propose to furnish the material and preform the labor necessary for the completion of a commercial space remodel. This will include the scope of work detailed in estimate#101. All work is to be as specified and the above work done in accordance with the drawings and specifications submitted for work and completed in a substantial workmanlike manner for the sum of: Twenty eight thousand, one hundred and fifty dollars($28,150.00). With payments to be made as follows: $9,383.00 with acceptance of proposal $9,383.00 walls are hung and sanded $7,000.00 flooring is installed $2,384.00 when job is complete SIGNATURE t