Loading...
HomeMy WebLinkAboutBuilding Permit #518-2017 - 157 BERKELEY ROAD 11/15/2016 QJ -� L p BUILDING PERMIT %A°RT"6_�tio TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION / 2 Permit No#: >�(�' a-� f 7 Date Received t_ j '�Oj,b oR ��SSACHuSE��y Date Issued: l - f - 0 f IMPORTANT: Applicant must complete all items on this page LOCATION 1 � �L V jb0- J� �.e Print PROPERTY OWNER �W(Lr& r3YU#J r) Print 100 Year Structure yes no MA-_PARCEL: lb_W ZONING DISTRICT: Historic District yes no Machine Shop Village yes o TYPE OF IMPROVEMENT PROPOSED USE ResiOential Non- Residential ❑ New Building One family ❑Addition ❑Two or more family ❑ Industrial Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Sceptic DlWelh Fl©od I'ai +Wetlantl's; I ❑°Wat`erslied�®�stnctp T ..� T � �. Z �-__ _ ®,Water/Sewer•' - -_- _ _�__�___�_� ___ � ��._ ._r_a�__�_z_�__���.��._.., �. DESCRIPTION OF WORK TO BE PERFORMED: (flit' s-ea�►►2 •. aMm� r� •. c�lt��o�r>, ir�� �-N�'. ych�-►la-flan Identification- Please Type or Print Clearly OWNER: Name: �-}1WOLvA 13000n Phone: fi� �S� • b Z Address: S 13-trk,t l 'ItiDa�-ex Contractor Name: Wvi Phone: CCM 7 slfl• 3 4 5 3 Email: i r• vk '� \, Lom Address. 3 �4-\ B Supervisor's Construction License: bZ- �- Exp. Date: 2 �� Home Improvement License: I t 3\4 la Exp. Date: l0 1 ARCH ITECTIENGINEER Phone: Address: 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: $ -3 -3,ili •a to FEE: $ 7Q �- Check No.: 3 63 -7 Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaran fund -.: Location ' F L = No. 3l ` fi lms .. � Date OJ • �+ TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# 2 0 7 XX 3 1 1 8 9 Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ - TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Taming/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 WEALTH � Reviewed on Signature COMMENTS 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 DPW Town Engineer: Signature: Located 384 Osgood Street i- I.��RE DEPr/1RdTMEfVT `"Temp 'Dumpster on4s1t`An')"s Ljcated at 124 Main Street �� a '4 y+ riaA 4 S 7 Firetwepartment signature /date � � , {,�.s� �a° �t , ,:. �' '` a�i�. ,' �_t 't ' F' ^� P." "t tYia ,� m �`s��.,`°y'7*, e'. , . COMI..,kt♦ 1 ur 'I}, V. VIENTS� '�- *zt� ., '� 'jm y �, e� k ,: t �.ie�f ,3 },Mi, r{ �,.gg ; �>�; .,` , ri 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 case) ® Notified for pickup Call Email Date Time Contact Name Doc.Buildinb 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 4� Building Permit Application 4. 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 OTE: 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 4. Workers Comp Affidavit 4. 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 OTE: 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 4. Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) Copy of Contract 2012 IECC Energy code Engineering Affidavits for Engineered products OTE: 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 NORTH Town o � Andover 0 so44LINal. h ver, Mass, • COC MICNEWICM 1 A�R4 TE D S V BOARD OF HEALTH Food/Kitchen PER T T LD Septic System 0jTHIS CERTIFIES THAT ���o...����� I�. �. ...... BUILDING INSPECTOR .... ......................... .... ..... r . . .. ... ... .. .. buildings on Foundation has permission to erect ........................ g ..�.�.�......�.............. ............. ......�..� � ������ Rough bill to be occupied as ... ..... �. ......... �... ........� t. :t .. Chimney provided that the person accepting this permitII 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 CONSTRUCTION RTS Rough Service ............... .. ... ... ......................................... 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. I RISESo Blurt Road.unit 21 Canton.MA 02021 l 33940244 ENGINEERING www OWNER AUTHORIZATION FORM(Ownefs Name) owner of the property located at: (Properly Adicirilpf ( i► ) hereby authorize � Uw 4 `�t r ( cW) an authorized subfactor for RISE Erg.to act on my behalf to obtain a building permit and to perform work on my property.This form is only valid with a signed COWI80L s tate i In coff 10 9 a No em RISE F.egltteerft �"ea RwwmFtoll 110 12M arcoffusewr ftg �itGIM20 CTCaiArador Rao RISE68 showmat Road.Csotoe.MA 8202{ CONTRACT ENGINEERING 339.502.6335 FAX339-5024345 POP 1 PROGRAM ° ommwa4As _. CMA'HES MIN oar ataara Noma aatorea (y7 1N24I2016 441887 230Howard Brown asurrs attxa► 157;Nwh P=d 157 Ht41te� !toad Bum an.sar.: slt r.o► North Andover,MA 01845 over.MA:01845 JOB DESCRIPTION AIR SIFALINQ PMVWC iabor_mtd mataie►b to seat arms of your homy df vr3geftd,excess air tmkW This vank will be 'af0tmW in waoert vah the use of special tools and diegtuwie tags to esae that yotr home wilt be left sxfttr a lrealthfid keel of ah exd mp and Qubor air quality.Mmerials to be used to sell your 11029 can indude veldts foams 9W other pr0du L PrtmM areas for surfing irlolede sk ta&w to attics.b;semeats,artach0dg nqp and other unheated areas 061*0 are not gvlereNy addressed)This wall 0010m(9)sswking Dace'{A M"ioa in cft fed Per mine(cfm)of air infiltration wd0 onac,tut the $flail nmabw of efm is not Omranued At the completion of the meatheriaett on work.and at no satiemel ern tin the homeowner,a final blower door andlor eOmUsti" safety analysis will be eonduded by the sttboontnm0r to estteae the sntdy of the indoor air gWky. 5680.00 DAMMING:Provide labor and materials to installs 12 layer of 1,39 atfeoed tiba3lass!tetra to(146)t fat for damming prPosm s299.ao ATTIC FLAT:Plmv*labor and mataiets to instal!a 4'layer of It•14 Class I CCOdwe added to(1006)sttmre fact of open actio i1.t36.78 ATTIC FLAT:Prov'de!abet ettd taataials to irtsttdi an r layer of R-30 CI=I Cdfidose added to(176)square feet of open attic spite 5241.12 ATT1C ACCESS`Provider laborand materials to wmtllcrstlp the perimeter of(I)attic hatch with Q6100- 525.OD ATTICACCProvide labor and materiels to ins Bte the bedr of the an is door wdh Y rigid initdetiaa hoard and seal tha door's edge with vs0hergrtpingto uegrict air leafage. $73.9! VENi'ILATION:Provider labor and materiels to install(3 ywtda ed exhamt hose with ow wail moaned flapper vent to achmi t %xisiingbathtoom ftal(s). 535625 VENTILATION- abor and mtderiels to instNl var11 t011 etion dtutes a(60)rafter bays to maimaht air flout WOO to 36 square fad of common wail Theo install Cow&M Wtabor and matedafsto instal!It 19 tnfsad febagluastsof hlst�ngood< Sed all seamswkh FSK two. 2•rigid boardat matsthe seetions R316.5.4 aced 316.6 row 5147.40 Fedasd Know tZISB gogl=tdq arlb UM eoweder MUM R SE M RDAMows CONTRACT pap 2 ffLm IWM= 4atea� zi9o� Casae aseatr soma= t 7DWa ay bW aszttMmiq F=d s�eawas�a► ,eases wMaase.sa WoMAndowMASM WoA Attu&MA OIM ottw,vise�eaadwr F��eeaeaoi*�dt��ts��a°etot msoa � ��� isae�iratotbb<waoaet.YaswIDantpbols'�dteelsaae+oaa.dseestb. Poreli�ame�► tiseel�,cT3�iiao�saciea.aettoaoaeeasTAMoal�.s'd��0°Aeiveaotla0l6�r thaAtr vm'�tbeBnt>MOasdsa aaitoad f910�tsvbs@tase j�todby tmeaoA6tor FordsasaPory au�dhaatl6 otyossloomdle indoor eirtlostHy.aevdllbeas8a tlaaerdoor tieotthaaseddisatr Boa is yotr homoteRh buses the woslc is buss.aad star the aodt isoo�a.Wo std abp aomdott a Adt essmsaest ottheoambtelbotttt q►�? °RSA'" t ThbIwa'dwats"Miism man toym Told a�o+edie weiort iao�e is f 3.1 to Tha F+assi< ba eeesaodby*A bne g*a aaww.at■o saw Ott.h 190whomol"%lopowaft todm out ab vel► germs yd ft aftibmdL sWoo Tdo.. "A" ftepw mnfd te. Skma homer Tobi SM74 asa�esosttm+noe a000ra�sraa+ss+rsears +'auaeuew -'ft Hw*ed Fa pThMe 8 74MOD Dofto SM74 sxw 9rettatetx crtr, �neutW .cies • eawnarewarm+rassom�aa aaaa+aamererea 30_oase. a� The Commonwealth of Massachusetts Depuroment of IndusWd Accidents x Office of Investigations I Congress Street,Suite 100 t Boston,MA 02114-2017 www.massgovldia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Aaplicant Information Please Print Leg v Name (Business/Organization/Individual): q won Address: C� Gv X '3�N City/State/Zi SVj%` � N 613�3 Phone#: I Are yyou an employer. Check the appropriate box: Type of project(required): 1.E 1 am a employer with _ 4• ® 1 am a general contractor6 ®New construction have hired the sub-contraemployees (full and/or part-time).* 7. Remodeling listed on the attached she2.® I am a sole proprietor or partner- These sub-contractors hag, ®Demolition ship and have no employees employees and have wor9. [3 Building addition working for me in any capacity. comp. insurance.: [No workers' comp. insurance 10,®Electrical repairs or additions required.] 5. ® We are a corporation and its 3.® I a homeowner doing all work officers have exercised their 1 l.®Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.®Roof repairs insurance required.] t e1(4),and have no 13.®Other employees. yeees. [No workers' kers' comp.insurance required.] *Any applicant that checks box 91 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 state whether or not those entities have employees. 1f 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: � Ct_��� ��SV�tA. C� " -Lo #or Self-ins.Lia#: Expiration Date: I� R - City/State/Zip: Job Site Address: I S 1�- 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 WORD 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 pains and penalties of perjury that the information provided above is true and correct. Date: Si ature: Phone 4: 3S�0' `��3 EEanDonly. Do not write in this area,to be completed by city or town official. n: PermitlLicensehority(circle one):Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspectorson: Phone#: ® DATE(MWDD/y M AC40R 0 CERTIFICATE OF LIABILITY INSURANCE 10118/2016 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 policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). uONrE PRODUCER unroe MARTIN J. CLAYTON INSURANCE AGENCY INC )536-0604 aC No: roe m cla ton.com C i Y 1649 NORTHAMPTON ST.,RTE 5 NSURERS AFFORDING COVERAGE NAIC# HOLYOKE MA 01041 DIA INS CO 31325 INSURED INSURER B: GAUTHIER INSULATION INC INSURERC: INSURER D; PO BOX 344 INSURER E: IPSWICH MA 01938 1 INSURER F COVERAGES CERTIFICATE NUMBER: 94521 REVISION NUMBER: O THE INSURED NAMED ABOVE FOR THE POLICY PERIOD THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED T 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. INSRADDL UBR POLICY EFF POLICY EXP LIMITS LTR TYPEOFINSURANCE POLICY NUMBER MIDD(YY MMIDD EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY MAGE TOR NTED $ CLAIMS-MADE 1:1 OCCUR PREMISES Ea occurrence MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOPAGG $ POLICY❑JECT PRO- F LOC $ OTHER: COMBINED SINGLE LIMIT $ AUTOMOBILE LIABILITY Ea accident BODILY INJURY(Per person) $ ANY AUTO ALL OWNED SCHEDULED N/A BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ Per accident HIREDAUTOS AUTOS $ UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED RETENTION$ WORKERS COMPENSATION X PH TATUTE ER AND EMPLOYERS'LIABILITY Y/N E,L.EACH ACCIDENT $ 500,000 ANYPROPRIETORIPARTNER/EXECUTI VE A OFFICE RIMEMBEREXCLUDEO? WA WA WA MAARP300327 10/30/2016 10/30/2017 E.L.DISEASE-EA EMPLOYEE $ 500,000 (Mandatory in NH) If yes,describe under E.L.DISEASE-POLICY LIMIT I $ 500,000 DESCRIPTION OF OPERATIONS below N/A DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached If more space Is required) Workers' lf to sel irnirOauthorization ttto pay aims fobe benefits to employees in states other thanMassachusettsf the insured hes,or has hired hose employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/lwd/workers-compensation/investigations/. 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. TOWN OF NORTH ANDOVER 1200 OSGOOD STREET AUTHORIZED REPRESENTATIVE j LvS . NORTH ANDOVER MA 01845 Daniel M.Cr y.CPCU,Vice President—Residual Market—WCRIBMA ®1918-2014 ACORD CORPORATION. All rights reserved. ACORD 26(2014101) The ACORD name and logo are registered marks of ACORD wommla 1 � Office of Consumer Affairs and Business Regulation 10 park plaza- Suite 5170 Boston, NjassQ�; 02116 Home Improvementr Registration - `" Registration: 173410 Type: individual Tr# 291320 M Expiration: 10/112018 Z a KURT GAUTHIER 1 KURT GAUTHIER w" 119 COUNTY ROAD �4 IPSWICH, MA 01938 p Update Address and return card.Mark reason for change. ❑ Address Renewal F] Employment [] Lost Card SCA 1 ib 20M•08H1 i C-.' is�i�e�+co9uvoal�c�C °�o�� Registration valid for individual use only before the Office of consumer Affairs&Business Regu1 expiration date. If found return to: HOME IMPROVEMENT CONTRACTOR pffice of Consumer A�sirs and Business Regulation RegistratiON', 3410 Type: 10 Park Plaza-Suite 3170 Expiration, 18 Individual Boston,MA 02116 ?rc . ti KURT GAUfNIER '� KURT GAUTHIER mall tachusetls Department of Wu he safety 802rd Of Budding Rogulatiorts and Standtard$ �4A��a Avc it E CSSL-1??58 P.Q Rot 334 �~ Ips ith MA 01039 [ j Cu+aroAxa �r ed. 0512502017 Y'