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HomeMy WebLinkAboutBuilding Permit #331-2017 - 16,18,20,22 Compass Pt 9/28/2016 L NH V_ ORTq fI� 'h� BUILDING PERMIT of SCowwa (� f0 N OF NORTH ANDOVER114 TWAfPLI ° : I TION FOR PLAN EXAMINATION * _ Permit No#•-^,7n-71-2017— Date Received �1�°0�+wrEo �,Q �SSgCHUS� Date Issued: �G IMPORTANT: Applicant must com Tete all itWns on this page (� / LOCATION � (. LOA) �✓( �r� ' IQ Pri.t � PROPERTY OWNER T Print_ 100 Year Structure yes r MAP PARCEL: ZONING DISTRICT: Historic District yes Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building ❑ One family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration P4 [1Commercial [IRepair, replacement ( 1/�S 'Bldg ❑ Others: [I Demolition A-0�,(s� ❑ Septic ❑Well Hs ❑Wetlands ❑ Watershed District ❑Water/Sewer [ DRK TO BE PERFORMED: i t li Identific tion- Please Type or Print Clearly OWNER: Name: C64 co L LC Phone: q S Address: Contractor Name: TS V- 10L Phone: 50 ' = q3� Address: CO 6b I ) Mt, 01 S k Q 2 1 Supervisor's Construction License: L,�`� ��� 75� Exp. Date: Home Improvement License: '15S Exp. Date: `l a ARCHITECT/ENGINEER Phone: 3�40 Ct3 AddressLou U k6f) mc". Reg. No. 33110 FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE:°$ 6100.6)0 Check No.: 9Receipt No.: �c� �26�� NOTE: Persons contracting wa h istered contractors do not have access o t Juty fund Signature of Agent/Owner Signature of contractor 1 tAORTH �1 'N BUILDING PERMIT • o� SC�w/VC °tet<�E° ;b;�ti0 NORTH ANDOVER� '�S 32 y,,..,. � b4WPLI O NOF I� TION FOR PLAN EXAMINATION 7° e� Permit No#: + 2017— Date Received �q,TE° US Date Issued: og 2P VS CIMPORTANT: Applicant must cornIllete all it s on this page LOCATION � ' l�� YYICt( t� t� f✓ r" G 7 �t� 1 �r, Tint PROPERTY OWNER ti q L I (f--, not100 Year Structure yes r� MAP i D ( PARCEL: ZONING DISTRICT: P)L4—Historic District yes Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building ❑ One family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: TI LLl L Identifi tion- Please Type or Print Clearly OWNER: Name: ffL4 Phone: S � 3451 Address: e LJS =� YY1 ® 1 "7 Contractor Name: K- Phone: q33 I Address: eb a S �rti-fin t�1� 0 S k�0 Supervisor's Construction License: hS C, Exp. Date: 1 3y 1 Home Improvement License: S _ Exp. Date: ARCHITECT/ENGINEER V 1aoc,..Q tl L/,Lc c Phone: 11 SSC? CM Address: �,ioef- Q11 AGS C,. Reg. No. '33110 A C, FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE:`$ 6100.690 Check No.: 9 7/ Receipt No.: 7—a !26Z � NOTE: Persons contracting wi hJ istered contractors do not have access o t gu ty fund Signature of Agent/Owner Signature of contractor Location /.' C �. i' r �' ,7 No. % i ' , . Date A. • - TOWN OF NORTH ANDOVER ' Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee Other Permit Fee $ TOTAL $ Check# / !' 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 ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on 0 ( �o Signature I COMMENTS (a \\ g j,al Ke HEALTH Reviewed on Signature �J> 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 FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft..- ELECTRICAL: .: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 i I NOTES and DATA— (For department use) ❑ Notified for pickup Call Email Date Time Contact Name Doc.Buildirig Permit Revised 2014 L - t 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 a 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 ❑ Building Permit Application ❑ Certified Surveyed Plot Plan o Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses Li Copy Of Contract o Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) a 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 ❑ 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 Doe: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 o Building.Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract o Floor Plan Or Proposed Interior Work ❑ 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 o Photo Copy of H.I.C. And C.S.L. Licenses o 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) o 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 Doe:Building Permit Revised 2014 ����s NORTil Town ofAndover _ a O 0 No. h ver, Mass, o 1 �Q COt NIC CHI NlWKw �•9 A°RwrEC) S U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System ............. THIS CERTIFIES THAT Co C BUILDING INSPECTOR ......................` ......... ........................ ............................................ Foundation has permission to erect .......................... buildings / Rough I to be occupied as .........�..'. C/�1�G.(k.. `.� 1 .... ........................................ .... Chimney provided that the person accepting this permit shall in eve 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 CONS I Rough Service .. ..... . . ...... ""' "' Final i (WING IN CT R 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. ACIORO CERTIFICATE OF LIABILITY( INSURANCEDATE-) _. _ F 3/10/16 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(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 onthiscertificate does not confer rights to the certificate holder in lieu of such endorsemen s. PRODUCER CONTACT NAME: CoonanInsurance Agency, Inc. PHONE --fAIC,N,9,41508 97-122 --- -- -i FAN N (508) 987-7152 267 Main Street ADDRESS: Cin @coonaninsurance.com Oxford, MA 01540 _ INSURE S AFFORDiNGCOVERAGE NAICa -- _-- ---------------•--_-_-- INSURER A;Liberty_Mutual INSURED INSURER BTravelers TJK, Inc. PO Sax 12INSURER C:Safety, Insurance Company -f--------•- South Grafton, MA 01560 --'---------- --_.--- --------�--_-— 1NSli12ER E; 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 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.LUIT_S SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. _ (NSR--- `— - AOOLISUBR- - - POLICY EFF POLICY EXP I ---------__--�-.- LTR TYPE OF INSURANCE f R POLICY NUMBER MIDOfY MM/DDIYYYY { UMTS B , cENERALUABfuTv # X680-335M2703-25 �GHOGGURREwGE 000- _00 11/3/15' 11/3/16'c, 1-1 _- A_110 T _ -1 -.- IX1CT,WERCIALGENERALLIASILITY ? # GVh_&GCT(f2ENTE0 - i— s 300,000 -4 i GUAtMS MADE L—I OCCUR MED EXP(Aryans persm} $ j i PERSONAL&ADVINJORY i 1 .000.000 _ i ? ffGENEPAL AGGREGATE__ S 2,000,000 GENT AGGREGATE L WIT APPLIES PER PPODUCFS-GOM�JOPAGG ?$ 2 OOO OOO PRO- -- --- X POLICY LOC # f ---- ---_ �..___.' C AUTOMOBILE LIABILITY 3952949 4/1/15E 4/1/16 a �SINGLELIMIT - w ANYAUTO BODILY INJURYtFerperscn)�s 100_000-- 1 ALLOWNEDSCHEDULED t - - - -- AUTOS X AUTOS { BODILY INJURY(Per arcidem s X HIREDAUTOS X NON-OWNED 300,000 ( pROFERty DAMAC Q - AUTOS000 UMBRELLA UAB OCCUR i ; ± EACH OCCURRENCE $ EXCESSLIAS CLAJMS_MA% 1 j �----------- - ----- --- �'� , !AGGREGATE $ DED RETENTIONSf---_---. B MARKERS COMPENSATION 1/26/16 1/26/`7 YYCSTATU OTH i AND EMPLOYERS'LtABIL11 Y rN `IE-UB-9914N01-3-16 X: th57S E ANYPROPRIETORIPARTNER/EXECUTNE i _E,L_EACtiACp( PiT� OFFICE RIMEMBER EXCLUDED? N/A; 00�OOO i (Mandatory to NH) E.L.DISEASE-EA EWA YEE�_. --_ZOO 000 If yyes.describe under t DESCRIPTION OF OPERATIONS below i EL.DISEASE-POLICY LIMIT I 500,000 A (Contractors Equipment - !IM 8988315 5/8/15; 5/8/16€Property Limit 79,000 I � r j Deductible 1,000 DESCRIPTION OF OPERATIONS/LOCATIONS f VEHICLES (Attach ACORD 101,Additional Remarks Schedule,Hmom spare 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 Cindy Davis ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The AC ORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: iburns@blackbrookrealty.com - - A. - -- Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-059359 Construction Supervisor 4 r l TIMOTHY MICHAEL BARS OW P.O.BOX#12 SOUTH GRAFTON MA 01560 CA- Commissioner 01/24/2018 � r�1JC �('Y+IJ//JY6lJ/IM[7(�/Y R�(�i��Y1JCJCdJ(lJPll1 Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration: 143758 Type: Expiration: ;7/2912018 DBA BARLOW BUILDINGr TIM BARLOW 13 DEPOT ST S.GRAFTON,MA 01560 Undersecretary