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HomeMy WebLinkAboutBuilding Permit #325 - 147 JOHNNY CAKE STREET 10/21/2009 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: 3 2<' Date Received Date Issued:4 2-1 IMPORTANT Applicant must complete all items on this page CATION PROPERTY OWNER` t� . y { rClt a MAP N PARC�� � ZO�tL�G�1STRIC T � � �-Histor"rc s�� � ��.o. Machine Scp pillage ye o TYPE OF IMPROVEMENT PROPOSED USE Residen ' Non- Residential New Building ne famil __ Addition wo or more family Industrial Alteration No. of units: Commercial Repair eplacement Assessory Bldg Others: Demolition Other Septc llllgll g Flo6plr `ltetladstershed Distni ' ata +ewer � DESCRIPTION OF WORK TO BE PERFORMED: L)&,, uv-0chAnS LA.-, KPO--1 L/ P-) t � Identification Please Type or Print Clearly) OWNER: Name: 9-1 jSVUAJ Phone: gt 7 Ga '13-7�- Address: l �-i 7 D lN�( C -lG� lug /� A*4, t � - C©NTRACTflR Name 't �1 '? phone. Addii r Supervc Coobw icesexp.. 3at� - k Home�lm*r—e' eht, io Exp. Dafe E 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. CV Total Project Cost: FEE: N3 , Check No.: Co �3 Receipt No.: 2�5 NOTE: Persons contracting with unregistered contractors do not have access to the guar nd Signatur� of.Agent/Owner �� °� � _ -�5ignaure�ifFcontrac �� .-.- ��' `�' 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 f THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT i COMMENTS CONSERVATION Reviewed on Signature COMMENTS I, 'HEALTH ' Reviewed on Signature . i COMMENTS r Z I oning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Conn ection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT -Tern Dum ster,on site p p. yes . no . Located at 424 Main 5treef; e : Fire'Department signatureltlate _. 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 i E i ❑ Notified for pickup - Date C .. 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 o Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract o Floor Plan Or Proposed Interior Work F Li 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 Li Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit Li 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: Doc.Building Permit Revised 2008 Location 7325' TO 1,n C,g�,L No. _ S Date �oRT� TOWN OF NORTH ANDOVER o� ~ s a 9 Certificate of Occupancy $ - T'Area �' Building/Frame/Frame Permit Fee $ s�cHusa 9 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 22557 Building Inspector xAORTjj TONIM of : Andover 0 No. � .�". dower, Mass., LAKEd O� COCHICEWICK V�• ORATED BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT....... .. ..............................CA-44--e..-Wis.. .. ................................... .............. Foundation has permission to erect.......... :. buildings on ...... . ...... �� .. . . ......... Rough Chimney to be occupied as.W .. ..- e.... � himney provided that the person accepting tis permit shall in every respect con m to*46fms ofFe 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 ' PERMIT EXPIRES IN 6 MONTHS Final ELECTRICAL INSPECTOR UNLESS CONSTRU S ARTS Rough 11119..... ............................................ Service BUILDING INSPECTOR Final Occupancy Permit Required to Ocmpy 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. Nj;t,�'s tC h 80`�ttlr�}'���tt5 Q Cons gUi}Utnu�Al��tt•tn�tt tic trttc . 4 Pe„ Restricted ose CS ��'�SUper�s}ports'�t ��Silzt� &/CHq O r Ci�en et�tttc/ar t��., METHFtkPp Hr N MA Qv 01844 "I�71111 Xpiratio p. 4/zz I� �. Tom. 3 Opt 130g -71w __-- Board ofBw,a� ` g Regulations end Sta 1 HOME IMPROVEMENT CONTRAC Registrato TOR 106620 ExplrattoA ` 124/2010 rr# 270996 RICHARD FLU Corporation ET COlat Richard F2,gQTJWp aNC. FI t 102 Bridle Path Lane,.-� If Methueh,MA 01844 " Administrator i I I FLUET RICHARD PATHLANE CONTRACTING,INC 02 BRIDLE PROPOSAL METHUEN,MA 01844 Date Estimate# 9/11/2009 66 Name/Address STEVEN CAVAZZA 147 JOHNNY)✓ST. C,4,KE N.ANDOVER MA.01845 Description INSTALL 28 HARVEY WHITE CLASSIC DOUBLE HUNG VINYL REPLACEMENT WINDOWS WITH LOW E/ARGON GAS GLASS WITH FEDERAL PACKAGE FOR TAX REBATE,1/2 SCREENS,AND GRIDS IN GLASS.$325.00 EACH TOTAL$9100INSTALL ONE PICTURE WINDOW WITH 48 LITE INGLASS GRIDS AND SAME GLASS AS ABOVE.$740.00 INSTALL ONE TWO LITE MAJESTY CASEMENT WINDOW ABOVE SINK WITH INGLASS GRIDS PINE SNAP IN GRIDS AND SCREENS.SAME GLASS AS ABOVE.REPLACE INTERIOR AND EXTERIOR TRIM AS NEEDED.$1200.00 INSTALL ONE THERMATRU#S262 DOOR UNIT WITH INGLASS GRIDS.REUSE LOCKSET.REPLACE TRIM AS NEEDED.$850.00 PROPOSAL IS VALID FOR 30 DAYS. Finance Charges on Overdue Balance 1 1/2%/MONTH 1/2 WITH ACCEPTANCE BALANCE UPON COMPLETION. WORK TO INCLUDE,INSTALLING,INSULATING,CAULKING,PERMIT AND TRASH REMOVAL.OWNER WILL DO PAINTING/STAINING. REPLACE ROTTED SILLS AS NEEDED.$100.00/SILL AZ gljt 6/-9 6, - -,y/ass uJl�, N��6��i oF pc� shv4 �t ht�y u� i411)V 411evo.+? PIFs YOe sl "X-,5-8 3�¢�� oZD /aZ OV&K ova-4, wex 4P �orJbl� Total $11,890.00 Signature Phone# Fax# E-mail 978-685-7010 978-685-7010 RFC102@COMCAST.NET 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 Lezibly C Name (Business/Organization/Individual): �/C%J� 'I/ j �'y/ "V..,c Address: Lo ? City/State/Zip: y. Phone#: 7V f f-?d/a Are you an employer? Check the appropriate bog: Type of project(required): 1.V-011'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.t 7• ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me 'many capacity. workers' comp. insurance. 9. ❑Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its 10. Electrical repairs or additions required.] officers have exercised their ❑ 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ 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.] •,A.;..applicant, u .. v icant,th8i checks box 41 must alSo fill out the section below showing their workers'compensa inn POE iWfn Wat'312. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such IC ontractors 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 isproviding workers'compensation insurance for my employees. Below is the policy and job site information. . 2� Insurance Company Name: tJ(jZ- �}- Policy#_or Self=ins. Lic.#: Cl /0 —r 0,� Expiration Date: 3 % , , Job Site Address: - l LI -7 *)t/AJ t1 C4+t-( " City/State/Zip:_ Y-A A4.4, 0 R Lj d! 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 pains pe. 'es of perjury that the information provided above is true and correct Signafore: Date: © do Phone#: 7� 0 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#: ACORD. CERTIFICATE OF LIABILITY INSURANCE OP ID I DATE(MMIDDIYYYY) FLUET-1 DI 07/07/09 PRODUCER THIS CERTIFICATE IS,ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Segreve 6 Hall Insur.Assoc.Inc HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 305 North Main St. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Andover MA 01810 Phone: 978-975-1300 Fax:978-975-7596 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Arbella Protection Ins. Co. 41360 INSURER B: Cammerce Insurance Co. 34754 Richard Fluet Contracting Inc. INSURER C: 102 Bridle Path Lane INSURER D: Methuen MA 01844 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 OFANY 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 TOALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. AWL POLI EFFFC POLICY EXPIRATION LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MMIDD DATE MMID LIMITS GENERAL LIABILITY EACH OCCURRENCE $1000000 A X COMMERCIALGENERALLIABILITY 8500034727 06/12/09 06/12/10 PREMISES Eaoccurence) $10_0000 CLAIMS MADE ®OCCUR MED EXP(Any one person) $5000 PERSONAL BADVINJURY $1000000 GENERAL AGGREGATE $2000000 GEN'LAGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $2000000 POLICY JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY B X SCHEDULEDAUTOS XV1460 12/01/08 12/01/09 (Per person) $100000 X HIRED AUTOS BODILY INJURY $300000 X NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $100000 (Par accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANYAUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESMMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR FICLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND TORY LTATU- IMITS ER A EMPLOYERS'LIABILITY 910434 03/31/09 _ ANY PROPRIETOR/PARTNER/EXECUTIVE 03/31/10 E.L.EACH ACCIDENT $500000 OFFICERIMEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $500000 It yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $500000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION PROPMAN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN PROPERTY MANAGEMENT OF NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL ANDOVER, INC. P.O. BOX 488 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR ANDOVER MA 01810 REPRESENTATIVES. ACORD 26(2001/08) 0 ACORD CORPORATION 1988