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HomeMy WebLinkAboutBuilding Permit #123-2011 - 1518 Cochichewick Drive 8/11/2010 ORT BUILDING PERMIT M. t&L.9 D ,,+N 6 TOWN OF NORTH ANDOVER °32. a- APPLICATION FOR PLAN EXAMINATION Permit NO:41—aoll Date Receivede7 044rao,,Pa C S ' HUS Date Issued: IMPORTANT:Applicant must complete all items on this page I m 0711 -i -Lot PROPERTY OWNER ' -77777�' . X. MAPS "PAR `0%---__-,Z0.'_N1NGD R tot DISTRICT ' Hig Distract -96 M.­_hihtf tthdb Villa ac TYPE OF IMPROVEMENT PROPOSED USE oe=:� Residential Non- Residential CNew Building One family Ad i g ion Two or more family Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic Well' Floodplain W tlii6s" Watershed :District. DESCRIPTION OF WORK TO BE PREFORMED: Identification Please Type or Print Clearly) I . OWNER: Name: Cetwv%l? qy% Sss�4wyveS LLG Phone: q Address: _7 Phdni�Cl -A 11.0- NT N' 6. Ao- CONTRACTOR Ad Av U, f` `PgE 2 b"ing;it u'6-11 b n- License on e,., Pat I- J Av jp Al License: JZ$-pljo 6 ARCHITECT/ENGINEER 1&3A\N4tw 45 r-41'CUQ Phone: Address: 10 576. AA e2}', 12. Veg. No. F CHEDULE:BULDII&P M MOO PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. EE s f 1 S= Total Project Cost: 16° FEE: $_ Check No.: Receipt No.. A NOTE: , Persons contracting with unregistere ntractors do not have ac 7 to the gr tyfund —ft 1 Location 6G1� G`I<L��G Or - No. " 2 0// Date zo �oRTN TOWN OF NORTH ANDOVER 3?O�tt`•o •,hO0 AL 00 a y Certificate of Occupancy $ ^�•, cMUsEtA Building/Frame Permit Fee $ ? Foundation Permit Fee $ © U Other Permit Fee $ TOTAL $ '3 Check # 233 ; Building Inspector 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 � i Private(septic tank,etc. Permanent Dumpster on Site I THE FOLLOWING SECTIONS FOR OFFICE USE .ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT bd COMMENTS 0 ,2 - v Ad CONSERVATION Reviewed on It 10 Si nature • COMMENTS f HEALTH Reviewed on Signature COMMENTS I Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted. yes C Planning Board Decision: Comments i Conservation Decision: Comments Water & Sewer Connection/Signature&Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT -Temp Dumps�er ori site yes _ no Locatedat`124 Mam*Street Hire Department.sgnature/date 1 - COMMENTS_ 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 department use — For de NOTES and DATA p i i i i I . I I I ❑ Notified for pickup - Date Doc.Building Permit Revised 2010 i 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 o Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or.C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work o 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 o Certified Surveyed Plot Plan o Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑' Copy Of Contract o Floor/Crossection/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 ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ 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 ❑ 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 2008 5N The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' 'its I; 600 Washington Street Boston MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/ wow �o�a't1 w� S a l�Jt}1.I►�S lac Address: ��p 4J�„•�,. �-, City/State/Zip: Phone#: OT Are you an employer?Check the appropriate box: Type of project(required): 1.)6 I am a employer with 4 4. ❑ I am a general contractor and I 6. ❑Newconstruction employees(full and/or part-time).* have hired the sub-contractors 7. 2.❑ I am a sole proprietor or partner- listed on the attached sheet. t ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition i working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 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.El Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. .*Contractors 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 is providing workers'compensation insurance for my employees. Below is the policy and job site I information. Insurance Company Name: a��c�Gt da-)-G O>u GvS Policy#or Self-ins. Lic.#:-LJ GG 15 00!C-74(o O%n O&J Expiration Date: tl I's 1 e Job Site Address: 1 1$ Go`14 G 1 Gw%A-Itot . City/State/Zip: N D, AN /t1►r" r1d► L Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration dati?l8, 'r 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 under the pain d penalties ofperjury that the information provided above is true and correct. Signature: Date: Phone#: 1�l 931 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 INSURANCEOPID Ms DATE(MMIDD/YYYY) ANDOV-1 02/04/10 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Scotti & Company, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 19 Mount Vernon Street HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR P.O. Box 1000 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Winchester MA 01890-8300 Phone: 781-729-9200 Fax:781-729-9500 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Essex Insurance Co. 39020 INSURER B: Associated Employers Andover Renovation Solutions Inc. INSURER C: 110 Winn 6treet, Ste. 207 INSURER D: Woburn MA 01801 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 PERTAINJHE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. lNbK AWL _P0_L_1CY_ffFFMIVE POLICY RATIO LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MMIDDIYY DATE MM/DDIYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X X COMMERCIALGENERAL LIABILITY 3DC6444 10/01/09 10/01/10 PREMISES(Eaoccurence) $50,000 CLAIMS MADE FX]OCCUR MED EXP(Any one person) $ 1,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $1,000,000 X7 POLICY 7 PRO LOC JECT AUTOMOBILE LIABILITY I COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) i ALL OWNED AUTOS BODILY INJURY $ I SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO EA ACC $ OTHER THAN AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR 1-1 CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND X TORY LIMITS ER B EMPLOYERS'LIABILITY WCC 5008746012009 11/23/09 11/23/10 E.L.EACH ACCIDENT $ 500 000 ANY PROPRIETOR/PARTNER/EXECUTIVE i OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 OTHER I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS i CERTIFICATE HOLDER CANCELLATION KEOGHJA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE 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 DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORI�eESE ATI ACORD 25(2001/08) ©ACORD CORPORATION 1988 i ORTM Townof �, Andover No. = - -o �` dover Mass. Q LAKE 1' 1 Iwy co_.,C.. ICK RATED `S BOARD OF HEALTH PER \M IT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THATC-� .....................'��..°��r.`�..�.�....v... . .5..................................................................... Foundation l / has permission to erect........................................ buildings on ..../. .co/c,': �.,r.c: .....�G�r��!(.....41.... Rough to be occupied as .... Q/`te E �� X.. .................... G�G. ®.�.. ..... Chimney ... provided that the person acceptf'ng this permit shall in everyrespec nform 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 A ver. PLUMBING INSPECTOR a12 -Gf e VIOLATION of the Zoning or Build(ng Regulations'Voids t ' Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough 01 . . . . . ......................... Service ... . . .............. 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._--.— - S E E REVERSE SIDE Smoke Det. l Date.../....".7.1n..... 1' f NORTH 1 TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ...........................:`... ............................. has permission to perform... ` t 1% � ............... ................................................ wiring in the building of...'.. .. .................� /z"-clo - ..................................................... at.........`.. `t'.y:t. .. ....G'......... .f% ,North Andov ,Mass. I Fee'-- . ... Lic.No�� /a ............... '1 ELECTRICALINSP Check # 9222 yds s Office ly he Commonwealth of Massachusetts I t Department of Fire Services Permit No. BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 CK# — �'` M/ Occupancy&Fee Checked (Rev.11/99) (leave blank) 111+ APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK! All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12:00 1 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) DATE January 26,201Q City or Town of North Andover To the Inspector of Wires: By this applicationthe undersignedives notice of his or her intention to perform the electrical work described below. Location(Street&Number) 1/ `Y COchichewick Drive Owner or Tenant BUILDING CONTRACTOR Andover Rennovations Owner's Address CONTRACTORS ADDRESS 110 Winn St. I Woburn,Ma 01801 I Is this permit in conjunction with a building permit Yes No Building Permit no. 1 Purpose of Building Residential Condo Building Utility Authorization no. Existing Service Am Volts PHASE Overhead e Undgrd 8 No.of Meters Mast Service Syphone New Service _�� 7Amps Volts PHASE Overhead Undgrd No.of Meters Mast Service 8 Syphone B Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work Install underground conduits to building for power and communications. �i�R.U(,c,c:-:;7 1 Completion of the f lowing table maybe waived by the inspector of wires No.of Recessed Fixtures No.of Ceil.-Susp.(Paddle)Fans No.of Transformers Total KVA No.of Lighting Outlets No.of Hot Tubs Generators Total i KVA No.of Lighting Fixtures Swimming Pool Abgrnd In-griNo.of Emergency Lighting Battery Units t No.of Receptacle Outlets No.of Oil Burners FHW FHA FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners FHW FHA No.of Detection and Initiating Devices. � No.of Ranges No.of Air Conditioners Total Tons No.of Alerting Devices. 'No.of Waste Disposers Heat Pump Number Tons KW No.of Self Contained Detection/Alerting Totals: Devices. No.of Dishwashers Space/Area Heating KW Local Municipal Other Connection Connection Security Systems: No.of Dryers KW Heating Appliances KW No.of Devices or Equivalent No.of Water KW No.of Signs No.of Data Wiring: Heaters Ballast's No.of Devices or Equivalent No.Hydro Massage Tubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equvalent OTHER: Attach additional detail if desired,or as required by the Inspector of wires. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is w in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE �x BOND [] OTHER ❑ (Specify:) I (Expiration Date) Estimated Value of Electrical Work $ (When required by municipal policy.) Work to Start: Inspection to be requested in accordance with MEC Rule 10, and upon completion. I I certify,under the pains and penalties of perjury,that the information on this application is true and complete. J FIRM NAME Leonard Electric,Inc. LI .NO. A10638 Licensee Signature LIC.NO. I I Address 154 Fletcher Street, Lowell, Ma.01854 Bus.Tel.No. (978)937-8620 Alt.Tel.No. OWNER'S INSURANCE WAIVER: I am aware that the licensee DOES NOT HAVE the insurance coverage or its substantial equivalent as required by Massachusetts General Laws,and that my signature on this permit application waives this requirement. Owner E] Agent E] 1 (please check one) Telephone No. PERMIT FEE$ (Signature of Owner or Agent) CUSTOMER# W 0 #