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HomeMy WebLinkAboutBuilding Permit #173-2011 - 1518 Cochichewick Drive 8/27/2010 NORTH BUILDING PERMIT o� q TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION 3 ' o , Permit NO: // o . Date Received RA 0441-00 Fv �� •�-� �' ACHU5���� Date Issued: ZI171,e2 I IMPORTANT:Applicant must complete all items on this page J_,PERTYOWNERPrint- MRARCEHistoricrict yes-h TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addi " n Two or more family' Industrial teration No. of units: Commercial Repair, replacement Assessory Blcttj Others: Demolition ic Other p Se t1Nell h - R Floodplpine tlands Wates b s Water/Sewer ' _ sh trict, DESCRIPTION OF WORK TO BE P FORMED: �• CvJri' � k Identification Please Typeor Print Clearly) OWNER: Name: GS j�G Phone:G� 6�"1� 1l V Address: KA Q� J .. n CONTRACTOR N = y io .amen Phone Address: Sr _ v r �? Su:peniisor's Consfructioh:,License Expb6� Moine Im r=' of ernent Lr cense - , ARCHITECT/ENGINEER W . oe , Phone:_ Address: S. /ya►Z.. S. T� A A4A Reg. No. FEE SCHEDULE:BULDING PERMIT:$12,00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ `ZO 0 p©, — FEE: $ yp Check No.: loe9 P5�' Receipt No.: NOTE: Persons contracting with unregistere contractors do not have access to the guaranty fund S_ignat eru of Agee Owner - -_ �– -�- - - I nature of confraetor � "` Location ��` VG No. ? O// Date 7 NORTIy TOWN OF NORTH ANDOVER Certificate of Occupancy $ NU ;<� Building/Frame Permit Fee $ ,?C�n -- ACS i Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # .2.33 7..� r 233 / 6 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 Private(septic tank,etc. Permanent Dumpster on Site i I 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 r Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted- yes . i Planning Board Decision: Comments i Conservation Decision: Comments I Water & Sewer Connection/Signature&Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT Temp Dumpser onsite :yes no Lricatedat 124 Main Street; Fire De:partmenf signata�e/date w_ _ �CO.MMENTS ` - i Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: i ELECTRICAL: Movement of Meter location, mast or servicedroprequires approval of I Electrical Inspector Yes DANGER ZONE LITERATURE: Yes No -MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use) i i i i I El Notified for pickup - Date II, � Doc.Building Permit Revised 2010 C 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 neerin g g IAff' davlts for�Englneered 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 co and must be submitted with the building application PY proof of recording Doc:Building Permit Revised 2008 NORTH T099*1M . o _ 6Andover . No T 10 LAK dover, Mass.,_-z i 0 COCHICMEWICK ATED �J BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT .. C��� <. .... .s�.............................. ........................:......... ' Foundation has permission to erect........................................ buildings on . ,�—.�.�.. ��.4. ....t. .C�.!.,r.� .. .. Rough r �,/- Chimney to be occupied as .., ....c:�: -.....................rte.�..........✓' ........................c` ..... .................... .... .................................... 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 PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR Rough ........... Service UILDINC 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. C I�tt � I � CO DCO CSD Cl CD m N ' N C VAAjWkCa VA)trr- m IM 0. r --� rn jUAW' X M ZLI 41 Tmi other items to consider in the Pavilion include: • Provide complete insulation per building code in all walls,floor, and ceiling(including the existing tale faced wall, excluding the timber cathedral ceiling). • The HVAC system should be a 1%ton air heating/cooling unit,.ducted downdraft,with insulated duct 7�0`7114:7 1 distribution in the crawl space. Gas is preferable,but could be electric. ■ Provide 60-100 AMP electrical service. ■ o--i,4n ein to:k rahIP outlets in selected locations. ...._.._..... �......_..r,...._.�_ ..._.: ..........._ ';` _ ...._� .., -�..�. ... .._.�,_.,�...__ IU.10 C it tairy CW m m CM a EL VAe T? N CD N IL da N Q Lr' N X t CL TDN Other items to consider in the Pavilion include: w Provide complete insulation per building code in all walls,floor, and ceiling(including the existing file faced VMI-T IV 914P wall,excluding the timber cathedral ceiling). 7/ r • The HVAC system should be a 1%:ton air heating/cooling unit,ducted downdraft,with insulated duct distribution in the crawl space. Gas is preferable,but could be electric. ■ Provide 60-100 AMP electrical service. in rr%R rahip mitlets in selected locations. The Commonwealth of Massachusetts Deprartment of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plurnl bers Applicant Information �j Please Print Legibly NaII16(Business/Organization/Individual): � 1n(�v�/8✓ ��t/��� (�y� G_��`1 CTAS 1yt Address: 11 O W 1,1.x. 4—!k W O(-Jivt . "A 01;30t � I City/State/Zip: Phone.#: Z Q)k 1q51 Q2-0,r Are you an employer? Check the appropriate bog: Type of project(required):. 1. I am a employer with Q 4. ❑ I am a general contractor and I i employees(full and/or part-time).* have hired the sub-contractors 6. New construction 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' g Building addition [No workers'comp. insurance comp.insurance.$ 10.❑Electrical repairs or additions required.] 5. E] We are a corporation and its 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or�dditions j myself.[No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.❑Other. I 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. tContraetors that check this box must attached an additional sheet showing the name of the sub-contractors and slate whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp,policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: o o��-,C ,i Policy#or Self-ins.Lic:#: 6Ll0Q g"14 6 D12nD�-a Expiration Date:I 1 12A 10 Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expirationldate). Failure.to secure coverage as requited under Section 25A of MGI,c. 152 can lead to the imposition of crnuinai penaltils 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 ins ce covera e verification. I do hereby certify under the pai s a penalties of perjury that the information provided above is true and correct Signature: Date: . 10 Phone#: 718 1 �aj'1 1?2-0Y Official use only. Do not write in this area,to be completed by city or town official 1 City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.PIumbing Inspectot• 6. Other I Contact Person: Phone#: I --- — y - - --- -r ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID MS DATE(MWDD/YYYY) PRODUCER AMOV-1 02/04/10 Scotti & Company, Inc. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 19 Mount Vernon Street ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 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 INSURED NAIL# INSURER A: Essex Insurance Co. 39020 Andover Renovation INSURERS: Associated Employers Solutions Inc. INSURER C: 110 Winn 6treet, Ste. 207 Woburn MA 01801 INSURER D: INSURER E: i 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TAUTOMOBILE E OF INSURANCE POLICY NUMBER DATE MM/DD V PDATE MM%D LIMITS BILITY RCIAL GENERAL LIABILITY 3DC6444 EACH OCCURRENCE $1,000,000 10/01/09 10/01/10 PREMISES(Eaoccurence) $50,000 AIMS MADE XI OCCUR MED EXP(Any one person) $ 1,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE s2,000,000 EGATE LIMIT APPLIES PER: PRO- LOC PRODUCTS-COMP/OPAGG $ 1,000,000 JECT LIABILITY ANY AUTO COMBINED SINGLE LIMIT $ (Ea accident) ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY $ (Per person) HIRED AUTOS NON-OWNED AUTOS BODILY INJURY $ (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY LANYAUTO AUTO ONLY-EA ACCIDENT $ OTHER THAN ACC $ AUTO ONLY: qGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE RETENTION $ $ WORKERS COMPENSATION AND _ S B EMPLOYERS'LIABILITY X ITORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE WCC 5008746012009 11/23/09 11/23/10 E.L.EACH ACCIDENT OFFICER/MEMBER EXCLUDED? $ 500,000 If yes,describe under E.L.DISEASE-EA EMPLOYEE S 500,000 SPECIAL PROVISIONS below OTHER E.L.DISEASE-POLICY LIMIT S 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS 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. AUTHORIZU RE HESEWATIVE ACORD 25(2001/08) ' ©ACORD CORPORATION 1988