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HomeMy WebLinkAboutBuilding Permit #1248-2016 - 15 HOLBROOK ROAD 6/1/2016 �1oRTP� BUILDING PERMIT TOWN OF NORTH ANDOVER ®� APPLICATION FOR PLAN EXAMINATION °- �Permit iso#: Date ReceivedR "'""`""' ACFiu`�4�� Date Issued: I PORTANT: Applicant must complete all items on this page YL®C TI®N `r EP�R©PRR#TY ®WNER' t1©©fear 5tructu e es no � � V I'AFiCELr � '®KING ®ISTFifICT: : Historic ©i"stict . ;k x es no '' , Machine Shop Vil ageyes _ �no ;y TYPE OF IMPROVEMENT PROPOSED USE Resi ntial Non- Residential ❑ New Building One family ❑Addition ❑ Two or more family ❑ Industrial ❑AI ration No. of units: ❑ Commercial O'Ri epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other .Septic , N Well , ® FI©odplaiin ® W� e,Ytlamds ® V1/ateguied str�i.ct` � i All —.4 -.,r 4 !�L� J DESCRIPTION OF�WOR BEP RFORME fA) Jhjn,� r— Identif ca ion- Please Type or Print Clearly OWNER: Name: Phone: Address: IAin -!�c Y� , ''•.. � .-Ci +� �:� �+ F1.� Yd'°.'4s{ 'tI evi � , sayi3. � At i"°t Contract©r � PhoneNyJ'° ' ._ .,4 "Ya T �a� a • E-mail.; . ` �- Lliii 's ®a nsprovement Lillie :.�., _ .q ,. ` Epp. atm_ - , '�..• 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: $ Check No.: in— � �° Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaran Si nature�gf�A�`'erit/O er•`�:��` *� � ��r `� 'x:�}�Signature�of�contract _ ; `"�`"b' ��- ; �" �� Plans Submitted ❑ flans Waived-0 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 ❑ THEFOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF m U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Siqnature COMMENTS HEALTH Reviewed on Signature COMMENTS I i Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes 9 �ianning Board Decision: Comments Conservation Decision: Comments i Water& Sower Connection/Signature& Date Driveway Permit l DPW Town Engineer: Signature: Located 384 Osgood Street FIRE ®EP�RTMENT Temp ®umpster onsiteyes Located'at 124 Main Street, ` Y v Fire Departm n signature/"d C,�O I V I.I�Vawvr4. � .+.ss�:L1:.,C .��y, '. 1 �CL:.wn.� s.• .`��J«��#�+�F=i��d""` `�`�� k„ '°��`.',.'."x A � �£n Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, wast 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 1 ti ti I f ® Notified for pickup Call Email Date Time Contact Name Doe.Building Permit Revised 2014 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 DOTE: 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 o• 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) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products 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 a of Contract t ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products i IOTE: 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 Clerics 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 Location No. J ca 4 2 o� Date • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ 3G Foundation Permit Fee $ s Other Permit Fee $ �'" TOTAL $ Check# 30440 Building Inspector NORT#i F own oAndover Zh ver, Mass A° 2wbi O1,� � tr.nt COC NIC H!WICK � �•9 OATIE o �Pp,��(y S t1 00 BOARD OF HEALTH Food/Kitchen PER NLD Septic System %A ...... ;........ BUILDING INSPECTOR THIS CERTIFIES THAT ................ ............................... ........ ......... .. .. ..............:.......... Foundation has permission to erect ........ uildings on ... .... ... ........... ... . .♦..... - � Rough to be occupied as ....... ..... ... .. ........ 1 .. Wk&.......................... Chimney provided that the person accepting this rmit shall in every respect conform to the terms of the application Final on file in 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 CONSTRUCT10 ARTS Rough Service ............... ... ... .... . ..�i.................................. Final BUILDING INSPECTOR 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. twm my*I 400ow CT Reg#0606216 row �. Federal ID#20-2626129 RI Reg#26463idiiietiiipiotjrr5diiitlbi►s Corporate Head/quarters,26 Cedar St,Woburn,MA,(P)800.342-2211(F)m-933-8626,www.newpro corn THIS CO CT(M/ADE THE l� day of 20_Z6 _between 1 Of is rsJ 14c)lob bio k tNomaPhorta) (eur,�eNanavraJ Alt ov�P. R 4-10vs– (AoV— the"Owner"and NEWPRO Operating,LLC,"NEWPRO". (E-901#forp OprietaryUss an/y NEWPRO hereby agrees that itwln for the consideration hereinafter mentioned,furnish all labor and material necessary to Install the following described worjtet�located at n The job address is a condominium. (✓06 AddressNO 111 Grids:Ij YESMJ NO U CONTOUR USDL L.IEURO. U DIAMOND Window for OTY Window color QTY OSSlTMP:(toceetmij TOP QBOTTOM Int: Int: Screens:(Fxteft color Full Screen Standard) 1AFIALF ❑FULL Ext: Ext UYES ONO Lappin Color• I E/a satnitls� PVClaSmoothLjNoMar No Cappin MOM aim Co I- ' Out; Double Hung Active: Left Center R rundestendsdrotfEEwPROop 2Lits Slider NDWR: SN 86 BGE WH naeormyPandingorsm;mng 3Lite Srtder Ili im v4) la:who rernwingmrepleft Werlar 3 Uts Slider (Ira,1 A I&) Color hr: " Oul: stops or trim).NEWPROVa Trot respo. Casement(Hinged Right) Floe 804 nsibiafor oondHt woranamsowsbay. Casement Hinged Left) DWR: .SN AGB AS ORB ondits control indim!"condermtkin ni Twin Casement Itingfromorduetoprae*ftconti Stationary Casement Cour In:Triple Casement pi in.va) CASH Triple Casement va tri,tla)• Color tn: Out, aalonce paid to rrrslaller et compieHon Picture Window KDwR: SN AS AG9 AS Sash Only Left VW RI ht FINANCE Hopper eardc comp! Instatlerlon Awning Color out Garden Window 4Fitneri Steef Say Window(MOM I Saint) :4 SN 88 Are AB OR J Bow window(Poi sofeg Other In: Out Other yre. DESCRIBE WORKSFRO�LfOT/p/ySAPPL/ED.' (�J f1U9 r rn s Est.Start Data. 0K* FS,C Data n� o�Rw Customer understands this is an"estimated date° Owner has read and agrees to the terms and conditions on the front and the reverse of this Agreement. Owner. specifically agrees to the(1)Total Cash price;(2)work being performed;and(3)work not being performed. Owner understands that this Agreement and any attachments contain all of the promises made by NEWPRO. Owner has been orally advised of his right to cancel this transaction at any time prior to midnight of the third business day after the date of this transaction and Owner was provided with two(2)copies of a cancellation form explaining this right. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. (Rhode Island Sales Only): Notice to buyer: (1)Do not sign this Agreement if any of the spaces Intended for the agreed terms to the extant of then available Information are left blank. (2)You are entitled to a copy of this Agreement at the time you sign it. (3)You may at any time pay off the full unpaid balance due under this-Agreement, and In so doing you may be entitled to receive a P"i rebate of the finance and Insurance charges, (4)The seller r hes no right to unlawfully anter your premises or cdmm Vany breach of the peace to repossess goods purchased under this r ement. (S)Xou may,-cancel th s ilfia If It has not been signed at the main office or branch office of the>#eiler�iOed you notifytfe'sler aflls or branches a shown In the Agreement by registered o certified ma11,which Shall be posted na la er than midnight o S t titer calendar day after the day on which the buyer signs the Agreement,excluding Sunday and any holiday on which regular mall deliveries are not mads. See the accompanying notice of cancellation form for an explanation of buyer's rights. C (Rhode island Sales Only): Owner acknowledges receipt of required Contractor's Registratlon and Licensing ; Board consumer educatlon:materhnht. (Owner's initials) t ar Pq � r i c) eltwrPt apeelallailpff, pd mqJ e The CommonweoM Of'Mass�;liasseft Department ofladustilW1.4eddients 1 Congress Sta°eO4 Suite 100 Boston,MU 02114-1017 wwwmamgovIdia W'Driers'Compensation Insurance Affidavit:Builders/(aatractors/Elecbiciam/riumbers. yo BE FUM W179 THE PERbffrMG Al(THORM A licant Information - Please l'viltt Name(Business/Opgamzation/lndiW 441): r pr Address: City1State/Zip: done#: Areyou pioyer?f�ec?c t e pPPropr[rstr box: pe Of pro) Cre olre�: l. i am a employee with empk►yees(fix and/or part-time).° 7. ❑New ConSbiwOon civ . ..�. -�. 2.®Ism a,sole .orpartne ship Lave no etaployaes worinng forme in �; D R=odo*g any cegacrty:Il'To aince l 9. 0Dbm- ] - Miog` 3.®I mm a homeowner doing 20 walk myaelC[No workers'Comp.iaMMM MgUh9 t 10 p But7ding aaditio�n. d.01 ana homeowner and wi0 be hiring o�ractars to condlxt a0 work an my property. I wHl 11.0 Electrical rgirs or additions etmae that'all contractms dffiahave weakens'compeasafion insurance or ate sole propri-- with no emplgye-es. $Z.t3Plim>bing yrs of additions 5.0 jam a generaf c affd Mare hued%c sins lilted ori the ofte hed.AoeY j f1C 8Tts. These yuo.q i*tarsbave mployees and have wow'-camp.in�8 r 14. er 6.❑FJe are a earpoiarioa�its officers have euertised theaiiglit of e�cetpphonp�MC�I.c. - o worloeis msv�ce iequmed) 152.§1(4),and we Dena employees IN .... 3Ary appliraof ilei checlm bos�I.moa�also 50 Deet the sewn below sltowmg tbgr wcrrfcea' P?�' �- t Homeowners who submit t>os sffidav tihdi *eY are all auk and 9r¢t tart oiagide s apse ser�it anew affidavivmdirsimg such tContractors that check t di lion niu+t 2ttae_hed affi'addrhonal shxtsli►WMZ the namafQee sub-a swd swe w istt c ai nm them odder have musttLeir-pvorla rs',00mp.polity mbq=.:-: employees._ff the syb c9mtiaQnta.haye-empltryer� }'_ ..-Proms I am a."employer thatasproviding workms'compeaWadon insurmrrefor my eilrpiPyces elordis the j7#R an jab-s4e - iirfvrmation. r----� Insurance Company Name: Policy#or Self-ins.Lic:#: EVkation Date:- Job Site Address: VIA wap �noAttach acopy of the*Orkeis'compensation policy declaration page(showingtliepolicy RU*er Failure to secure wverage as regtrued tinder MGL c.152,§25A Ica ter urinal violation piutisLabte by a Sae erg to$1,500.00 and/or nine-year imprisonaoent,as weD as civil penalties:in the form of a STOP WORK ORDER toed a fine of up.to$250.00 a day against violator.A copy of this ststtgnt may bt:foiW.' t0 9u Office of bivestigatiams:of lite DIA f&ins uancx st th coverage veriacation. I do hereby certify undo of information provided above' true acrd correct 4 SNFM PAW— 011e OjJ`ieial use only. Do not write in this area,to be completed by city or town offreiaE City or Town: Permit/d icense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.Cltyffown Clerk 4.Electrical Inspector S.Phunbing Inspector 6.Other Phone#: Contact Person: ACo® CERTIFICATE OF LIABILITY INSURANCE DATE(MM)DDIYYYY) �..�` 1 4%29/2016 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(les) must be:endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain polities may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements. PRODUCER CONTACT Melissa Pflug NAME: Mg Mackintire Insurance Agency Inc PHCnN E : (508)366-6161 AAX IC No:(508)366-5202 11 West Main Street AD� SS:melissap@mackintire:com INSURER(S)AFFORDING COVERAGE NAtC# Westborough MA 01581-1931 INSURERA Netherlands 24171 INSURED INsuRERB:hibert Mutual/Peerless . 24198 Newpro Operating LLC INsuRERc Acadia Insurance Co. 26 Cedar St. 1NSURERD: INSURER E:. Woburn MA 01801 INSURER F COVERAGES CERTIFICATE NUMBER-Master 15-16 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 VM16H 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. INSIR ADDL SUBIR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MMIDD MMIDDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE L-J OCCUR. PREMISES Es occurrence $IJAMAI�t IV HUN 1 100,000 CBP8589577 12/31/2015 12/31/2016 -MED EXP(Anyone person) $ 5,000 -PERSONAL&ADV INJURY. $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES P.ER: GENERAL AGGREGATE $ 2,000,000 X POLICY❑JECT.PRO- ❑ 2,000,000 LOC PRODUCTS COMP/OP AGG. $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Eaaccidenf $ 1,000;000 A, ANY AUTO BODILY INJURY(Per person) $ ALL OWNEDX. SCHEDULED SA 8564174 12/31/2015 12/31/2016 BODILY INJURY(Per.accident) $ AUTOS AUTOS X HIRED.AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident Uninsured motorist B1 split limit $ 250,000 X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 5,000,000 B EXCESS LAB CLAIMS-MADE AGGREGATE $ 5,000j000 DED I X.I RETENTION$ 10,000 CU 9582578 12/31/2015 12/31/2016 $ WORKERS COMPENSATIONPER 0TH-. AND EMPLOYERS'LIABILITY -Y/N x STATUTE ER ANY PROPRIETORIPARTNERIE).ECUTIVE E. EACH ACCIDENT $ 506,000 C OFFiCER1MEMBER EXCLUDED? Fy N I A (Mandatory in NH) Fdd-20-20-003506-02 5/1/2016 SJ1/2017 .E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if morespace is required) Excluded Officer: Nicholas Cogliani CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TO Whom it May COAcem THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE. T Moynagh/DORRTE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401) 10 frt7 C.%iUL 7 j 4,;1`nLf�{L,i - ?G:`tufMG `:!:l °J fanHi ' i0i flee 01 k-, _- � w/ R89�3�f6doe: S PPIe estt��rd r; R ;,f�tal�p 4 OPERATNC: ';( pct 1. f- 25 G-DA , 4e- rressoa fnr chi- �.,•'`Jf) ��j�, 1�]� G�8G , �,`���C �tg address and return -:ola cnan* ❑"a¢ , d AddtO SCnI J =uiir�-fitW r duLUse an Qt'St1011 vaU r d TDIISbIt[o: - �C9n69 OT 53g� �i:Uit41 be,orethe ePi*joa d,,w. {tion if[c-aiC�neumer s irs d:B}siae3sii a n Office e15.bIISU e; i u%I Business its�u _ t42E1�1?o�}u`=��ii:i�iTCO GT04� 1 la'a-Suite7l?4 rCt3(iicri; -4 ..Lr ..ref'-�r ii f / atur- 2,s :DAR i• -..� `W/' L.�l_�=c�:'-='-' `