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HomeMy WebLinkAboutBuilding Permit #027-15 - 15 WOODCHUCK LANE 7/9/2014 BUILDING PERMIT of TOWN OF NORTH ANDOVER o? y�<t�10RTyo PPLICATION FOR PLAN EXAMINATION Permit No#: Date Received �QQ04ATEG gSSACHUs�� Date Issued: 4 NMPORTANT: Applicant must complete all items on this page LOCATIONS y 'Print - - - r PROPERTY OWNER -- — Pnnt 100 Year Structure ) -yes no ,. MAP _PARCEL: _VZONING DISTRICT _ -z_Historic1Distnct yes no �. -v - Machine Shop Village. __yes _ ono TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building XOne family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial I(Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic E Well: ❑iFloodplain E Wetlands FWatershed District: - El Water/Sewer - —_--- - DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: �s� Z-1A1 Phone�47 ;2,0 Address: 1,1tV6 Q� Contractor Name Phone: Address: 'Super visor's Construction License:.. __—__ Exp. Date:; Horne,"Improveq eggLLicense . __ r _:Exp: Date:. 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: $ S FEE: $ Check No.: 7-� Receipt No.: �7 NOTE: Persons contracting with unregistered contractors do not have access to the zuaMtyfiund Signature of Agent%Owner Signature of contr-_acto _____ Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ —T—Y_P_E OESE_W�ERAGE_D-ISPO.SAL_ 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 PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS e a 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 I DPW Town Engineer: Signature: Located 384 Osgood Street `FIRE DEPARTMENT - TemptQumpster-onsite. yes no s Located.at-424 Mair!.Street Fire Department signature/date..:_ tCOMMENTS. -, _ 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 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use) ❑ Notified for pickup Call Email Date Time Contact Name ------..._.__.._...------------- 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 ❑ Building Permit Application o Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract o Floor Plan Or Proposed Interior Work 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 o Building Permit Application E3 Certified Surveyed Plot Plan o Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract o Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) a 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) o Building Permit Application o Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract o Mass check Energy Compliance Report o 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:Building Permit Revised 2014 Location WG)r)CQ �'tL- L' No.C2�7^( y Date ! i o - TOWN OF NORTH ANDOVER+ Certificate of Occupancy $ t.= Building/Frame Permit Fee $ 3`ry x Foundation Permit Fee $ .` Other Permit Fee $ ' kr•,, SSR TOTAL $ Check#2 / 755 ' , ^ Building Inspector NORTH Town o.f 2 S E ndover 0 y M-_ '-, ' 0 �h ver, Mass, 2oiq , o 1. COG N1I1CCA HI WICK � S U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT .................. A0110011100 ~� BUILDING INSPECTOR ................... ...................................................... ............................ has-permission to erecg ,,T Lv.b � „`, ...... Foundation ........................ buildin son .... ....... Rough to be occupied as ..... ...... .. ... .� ........ T.......! .......... +� .......�r !... Chimney provided that the person acce ting this permit 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 MOVAS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION T Rough Service 3 X.w ' ....................... ....... .........: ....................... Final - B DING INSPECTOR GAS INSPECTOR Occupancy Permit Reguired to Occupy Buildin,:; 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. Massachusetts Board of Building Regulations and Standards Construction Supers isur License: CS-043550 E. LEONARD F SAL - r. 5 B ILLCREST RD Andover MA 01810 Expiration Commissioner 08/19/2015 V/ie�um�mcaruuea�C�a��cr�dcc�ctaeGt� Of.kce of Consumer Affairs&1lusin.ess Regulation ME IMPROVEMENT CONT 1A0Tt fk— egitratl�q::' =,1123602": . , '; _., Type: �. _- xpiration: '.3%1+3/20'15. Private C'6rporaiia All Pro Design Builders;Inc,': ; L'e,onard Saltzman P;"13OX4111:475 Hillcrest Rd Andover;-MA 431;80.- 7Jiia'r'sei're ary License or registration valid for individul use only. b6on tfi'e:`bxpirption date. Iffound return to: Office`of Consumer Affairs and B"usitess Regulations 10 Park Plaaa-Suite 5.170 Boston,MA 02116 '.tV.pt.val:id witho t nature " 2'he Co�nraonr�eul�ri of li2'a�s�saghuseft bepartmen oflndusfrlglAccidde is 0, ee oflnvestigations 600 Washington Street Roston,MA 02111 -www.mass.gov/dza WQrkexs'Compensaf..onbsuranceAffidavit:Suifders/Cont°actor$Xlectricia is luinberg ,App7noranat�on Please Print Le0b Name(Businessiorgadzationftdividual): Address: City/StateMP: Are yo exnployer?check the appropriate box: Type of project(required): 1. i am a employer with 4. ❑ 1 am a general contractor and 1 6. New contraction f employees(fall and/or part:time) haveliixedthesub-contractors .[] listed on the attached sheet; 7. ❑Remodeling 21 am a sole proprietor orpartn.er- - ship and`havena.employees 'Ihesesub-contractors have 8. [[Demolition working for me in any capacity. workers'comp.insurance. 9. Building addition [No workers'comp.insurance 5. ❑We are a corporation and its 10.p Electrical repairs or additions required.] officers have exercised their 3.[] I am a homeowner doing all work right of exemption perMOL 11..[]Plumbingrepairs or additions myself EEO workers'comp. c.152,§1(4),and we,have no 12.!]Roofrepairs insuraucerequired.]i employees.[No workers' 13.0 Other comp.insurance required.] K Any applicantthat checks box#1 must also£dt outihesection beldw showingtheirworkere compensation.policy Information. Homeowners who submitihis affidavit indicatingthey 2're doing allwork and then hire outside contractors must submit anew affidavit indicating such. xContractors that checkthis box must attached an additional sheet showingthe name ofthe sub-contractors andtheir workers'comp,policy information. 1 am an employer that isproviding worrAer�s'compensation insurance formy einproyees Serol as the policy arzc rob it fafarmadon. Insurance Company Name' Policy##or Self ins,clic.##: Expiration Date: Tob Site Address: City/State/Zip: Attach,a copy of tfie workers'comp enation-policy tleelaration page(showing-the p olicy nu ber and q*atioxz date). Failure to secure coverage as required.under Section 25A of MGL o.152 can lead to the imposition,of criminal penalties of a fine up to$1,500.00 and/or one-pear imprisonment,as well as civil penalties in the form of a STOP WORTS ORDER and a fine of-up to$250.00 a day against the violator: lie advised that a copy of this statement may be forwarded to the Office of investigations of the AIA for insurance coverage verification. -Idolierebycert under' 1i in n •penaltiesofperfuryMattlieinfar�nationprov' above ueandcorrect. - Si afore• Date• Phone I#: Official use only. Do not write in Mis area,to be completed by city or toren ofcial. City or Town: Permit/License# Issuing Authority(circle(ne): 1.Board of Health 2.Building Department 3.city/Town Clerk 4.Electrical Inspector 5.,Plumbing Inspector 6.Other - - - tax,,,, A Aco CERTIFICATE OF LIABILITY INSURANCE °/6/w2'/°° 9/6/2013 3 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 IOVTF7E�P t1I1-;E- 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 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 CON AE:ACT House FAX Pinney-Linnane Insurance Agency IPA HONE (978) 664-1250 A/C NO:(978)664 0180 280 Main St. #101 A DREss: PRODUCERCUSTOMER ID400004434 North Reading MA 01864 INSURERS AFFORDING COVERAGE NAICit INSURED INSURERA:Travelers Ind. CO of IL-ARWC 13579 INSURER B SALTZMAN, LEONARD, DBA: ALL PRO DESIGN. INSURERc: PO Box 4223 INSURERD: INSURER E: Andover MA 01810 INSURER F: COVERAGES CERTIFICATE NUMBER:CL115900651 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 DDL s BR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE NSR POLICY NUMBER MWDD/YYYY MWDD/YYYY GENERAL LIABILITY EACH OCCURRENCE $ G RENTED $ COMMERCIAL GENERAL LIABILITY u CLAIMS-MADE 7 OCCUR MED EXP(Any one person $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PRO JECT El LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ee accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS 'i BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE $ HIRED AUTOS (Per accident) NON-OWNED AUTOS $ $ UMBRELLA LIAR HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ A WORKERS COMPENSATION VVC STATU- OTH-FIR — AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXC�UPED� ❑ N/A 6/10/2016 6/10/2011 (Mandatory In NH) 6XUB0609N493 E.L.DISEASE-EA EMPLOYEt $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE M Linnane/LINMSI ACORD 25(2009/09) @ 1988-2009 ACORD CORPORATION. All rights reserved. INS025(200909) The ACORD name and logo are registered marks of ACORD At 40R" CERTIFICATE OF LIABILITY INSURANCEDATE(MM7/10/13 %O)13 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 THPOLLQE- 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 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 NAME: Cloutier. Insurance Agency PHONE FAX (978) 957-4881 A/ No: (978) 957-7230 1996 Lakeview Avenue E-MAIL Dracut, MA 01826 ADDRESS: cloutier@insurer.com INSURE S AFFORDING COVERAGE NAIC ft .._...........------ - --- - ---- ---- ---- - -------- INSURER A:ATLANTIC CASUALTY _ INSURED INSURER B Leonard F Saltzman INSURERC: DBA Pro-Design Builders INSURER D: _ 5 Hillcrest Road INSURER E: Andover, MA 01810 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 i INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS i 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. ADDL SUBRI T POLICY EFF POLICY EXP -— -- -- - -" LTR; TYPE OF INSURANCE INSR WVD POUCYNUMBER IMM/DD/Y MMIDLYYYYY LIMITS A GEN.ERALLIABILITY L117001163. 7/13/13 7/13/14EACH OCCURRENCE $ 1,000,000 i --- X COMMERC IAL GENERA,LLIAB ILITY DAMAGE TO RENTED � I PRE I(N SES(Ea occurrence] i S _100,000_ CLAIMS-MADE OCCUR �— I I MED EXP(Arty one person) $" - 5 ,000 -1 i PERSO NA L&ADV I NJU RY_ $ 1,000,000 I L— _ i I GENERAL AGGREGATE 2,000`--000 j GE_N'LAGGREGATELIMITAPPLIESPER PRODUCTS-C ~ -- i2,000 ,000"- OMP/OPAGG i $ —_ — . --- X 1 POLICY 17 PRco� !!�j LOC I I $ AUTOMOBILE LIABILITYCOMBINED SINGLELIMfT i $ Ea accida" ANY AUTO BODILY INJURY(Per person) I $ ALL 0 WNE D. SCHEDULED id Per accent) $ AUTOS AUTOS BODILY INJURY( I ( NON-OWNED PROPERTY DAMAGE I FIIREDAUTOS — AUTOS Per accident $ I —i UMBRELLA� CESOCCUR EACH OCCURRENCE I $ ---_ I f, EXCESSLIAB CLAIMS-MADE. AGGREGATE $ DED RETENTION$ I I $ WORKERS COMPENSATION - WC Sl"ATO- OTH- AND EMPLOYERS'LIABILITY Y/N I - - --- ANYPROPRIETOR/PARTNER/EXECUTNE E.L.EACH $ OFFICER/MEMBER EXCLUDED? N/A� I---- - - (Mandatory in NH) E.L.DISEASE-EA EMPLOYEEI $ Ifyes,describeunder i ---------""--j ! 0 SCRIPTIONOFOPERATIONS below E.L.DISEASE-POLICY LIMIT; $ __ I I DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION I SHOULDANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. i AUTHORIZED REP N TIVE i ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The AC ORD name and logo are registered marks of ACORD ?hone: Fax: E-Mail: Pro Design Builders PLAN SHEET ;7"'St Cffil.,@ BCY t222 Andw.'C;f N7— D1 8 16 "'97`8 477 5-2999 F eaer .......... GARAGE SPECS � 1p C, P4 r N�?tE-s�es S RL ft; U't wce Cov j-npw6 Ce4 ADDITIONS K p 6y C- -:fj"z1 ao L VINYL TILT WINDOWS Y°z DOORS AND WINDOWS Oil ol' ...... C.sw Spfice P, 0*01or .41 7, SOLAR S�nw zozr. 7, eey VINYL TM WINDOWS 4c -INIPROVVEME-NT CONTRACTOR LIC.# 123602 PRO DESIGN BUILDERS, P.O. BOX 4223 ANDOVER, MA 01890 TEL: (978) 475 -2999 FAX: (978) 749 -9402 THIS AGREEMENT, made this day of , 200#by and between r rof hereinafter called the "Owner" and PR DESIGN BUILDERS, hereinafter called the "Contractor." WITNESSETH: The Owner represents that he is t Owner of the premises located at: Gu��c( 6"_.e I ". and the ontractor relying on such representation agrees to furnish and the Owner agrees to pay for the following: DESCRIPTION OF WORK PERFORMED: FRAMED ONLY, NO INSIDE FINISH, NO INSULATION t'=j�Clru WEATHER TIGHT ONLY Total Job Price$ - Sales Tax$ Down Payment$ Balance$ 40 0 Terms of Payment$ �/�0 This agreement is subject to terms,conditions and obligations set forth in the attached page. BUYERS RIGHT TO CANCEL Pursuant to Massachusetts General Laws you may cancel thic agreement if it has been signed at a place other than the offices of PRO DESIGN BUILDERS, provided that you notify the Contractor in writing at its offices no later than midnight of the third(3`d)business day following the ' execution of this agreement. Agreed to and acknowledged: Owner ) , P O DESIGN BUILDE Owner