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HomeMy WebLinkAboutBuilding Permit #67-15 - 164 SUTTON STREET 7/21/2014 BUILDING PERMIT �� e`::� .• ^•s °oma TOWN OF NORTH ANDOVER ° �o 4/ APPLICATION FOR PLAN EXAMINATION Permit NO: 1 Date Received °.o„ Date Issued: V 4SSt Teo � I RTANT:Applicant must complete all items on this page -LOCATION Pnn a PROPEFtTY:OWNEF2 QnS' Pri, t MAP NO: PARCEL: ZONING DISTRICT Historic District yes a, , no Machine Shop Village , yes no TYPE OF IMPROVEiANT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑ Two or more family ❑ Industrial VIteration No. of units: KCommercial ❑ Repair, replacement Assessory Bldg G w A c ❑ Others: ❑ Demolition ❑ Other ��-- El Septic ❑Well ❑ Floodplain Q Wetlands ❑'Watershed Disthct ❑Water/Sewer;.: 1 s C _awl Identification Please Type or Print Clearly) OWNER: Name: '-siA'I Phone: Address: CONTRACTOR Name: Phone: 1 U G Address: KA Supervisor's Construction License: Exp., ate: s -01Z3 LC3 J24/ Home.improvernent License: Exp: Date z ARCHITECT/ENGINEER 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: $ s��,(is _ FEE: $ Check No.: Receipt No.: NOTE: Persons on ra ng ww unregist contractors do not have access to he guar my fund Sigr.dture of Agent/Owne `' ature of contractor s .rte Plans Submitted ❑ Plans WaivedE] 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 I PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS s HEALTH Reviewed on Signature COMMENTS U Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments i ,Conservation Decision: Comments Water & Sewer Con nection/Siclnature& Date Driveway Permit Q. DPW Town Engineer: Signature: � Located 384 Osgood Street aFIRE .EPARTMENT = Temp�Dumpster on site yes: -_ Ino, 'Loc ated,at 124Wain,Street Yy Fire'Departmentaignature/date.___ _ - 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 ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses o 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 ❑ 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/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 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 i 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 copy and proof of recording must be submitted with the building application Doc:Building Permit Revised 2014 Locatio. No. Date 411f 0 . ; _ TOWN OF NORTH ANDOVER Certificate of Occupancy �$ Building/Frame Permit Fee $Woo, - Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# 2779 .5 Building Inspector Location N ! - Date o TOWN OF NORTH ANDOVER Certificate of Occupancy $0-0 Building/Frame Permit Fee $' Foundation Permit Fee $ Other Permit Fee $ a , TOTAL $ Check# . 27935 t Building Inspector :1 fN�DTH1 ti A •"� ry �73"C"Us'49 CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 067-15 on 7/21/2014 Date: August 21, 2014 THIS CERTIFIES THAT THE BUILDING LOCATED ON 164 Sutton Street,- Unit 1 MAY BE OCCUPIED AS a real estate office — Century 21 IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. j+ye 1 Certificate Issued to: Sutton Street Realty Trust 164 Sutton Street North Andover, MA 01845 F 1 t Building Inspector Fee: $100.00 t Receipt: R 7Z63 q'61 OS 913 i Check : w oN�oM 1 # - r •4 r o r ,SSA'CHUSE CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 067-15 on 7/21/2014 Date: August 21, 2014 THIS CERTIFIES THAT THE BUILDING LOCATED ON 164 Sutton Street - Unit 1 MAY BE OCCUPIED AS a real estate office — Century 21 IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Sutton Street Realty Trust 164 Sutton Street North Andover, MA 01845 4 l� f � , Building Inspector Fee: $100.00 Receipt: Check NORTH own of E : 1, ndover F. O ��" 0 No. ito w- — h ver, Mass, A A- LAKI COC NIc"t—CM 7,9 ATE D #kVP y S U BOARD OF HEALTH PERMI-T T D Food/Kitchen Septic System CA THIS CERTIFIES THAT ..... .. �.�. .V .� ��.. . . ....................... BUILDING INSPECTOR has permission to erect .......................... buildings on .j.uY..... ,� ... Foundation . ..✓.1,..s..� .......�<!/e.��..... ,. ., Rough ` f� 1 to be occupied as ........Faj.lLj..J6.VT... ....e.�....... •.Lei.! :5.:...........11!!W � ..� Chi ney provided that the person accepting this permit shall in every respect conform to the terms of the application Final Z/�41 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 S A S ou 't Service ............................ .... ....',..... ........... ................... inal 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. NORTH own of . t E ndover 0 . - No. ; soh ver, Mass, COC LAK HICH[WICK �'►- �,�A�R'STED PPa,�'�y S V BOARD OF HEALTH PERMI-T T. D Food/Kitchen Septic System CTHIS CERTIFIES THAT ..... .. . . a.�. .WL Z&.". .. C) BUILDING INSPECTOR has permission to erect .......................... buildings on ..l.9lt.Y � Foundation .................. ...... . . ...a.. .......... ,�A°r �. Rough to be occupied as ........tS. .1�..,6.YT.... ....' .- -....... .L�i.!'�5.:........... �... ccr!®..' cni ney in this permit shall in eve respect conform to the terms of the application Z t Z/ provided that the person accepting p every p pp 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 I PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STAS �u � Service ............................ .... .... '...... ............ .................. BUILDING INSPECTOR final 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 FIRED EPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. zl � 1 Massachus efts _. #soof Builds Department o f public J Construction Su 9utations and Staafety - 9 R, License: CS-067 Pervicor r arils ROV D S 1343 137 _ TE KSBURY 0187' _ CO �l'IFI \J ►nissioner '-! -Expiration OS12412016 Roy Demmons 137 McLaren Road Tewksbury,MA 01876 July 16, 2014 Project site: 162 Sutton Street North,Andover MA 01845 Scope of work to be performed as per floor plan: • Wall to be constructed using steel studs and Y2"drywall • Install 6 panel solid core doors with hardware • Install baseboard Total cost as described above..........$9,600.00 (Nine thousand Six hundred dollars) Payment terms as follows: 50% deposit to start work Balance upon satisfactory completion Roy Demmons ' date Ji mrco date a� CERTIFICATE OF LIABILITY INSURANCE 7/1DATE(MMIDDIYYYY) 8/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), 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 CANTACT Rebecca Berube Tarpey Insurance Group PHONE (']81)246-2677 FAXFLU VC (781)224-0973 442 Water St E-MAIL .rebecca@tarpeyinsurance.com PO BOX 567 INSURERS AFFORDING COVERAGE NAIC# Wakefield MA 01880-4667 INSURERA:Travelers Insurance Co 36161 INSURED INSURER B: Roy Demmons INSURER C: 137 McLaren Rd INSURER D: INSURER E: Tewksbury MA 01876 INSURER F: COVERAGES CERTIFICATE NUMBER:14-15 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. LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF MMIDD/YY Y LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $ 300,000 A CLAIMS-MADE ❑X OCCUR 680-OD115172-13-42 /8/2013 /8/2014 MED EXP(Any one person) $ 5,000 PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY JFrT PRO LOC COMNSINE $ AUTOMOBILE LIABILITY Ea accident,D I LIMIT ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOSAUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ REXCESS UAB CLAIMS-MADE AGGREGATE $ E _ DED RETENTION $ WORKERS COMPENSATION WC STATU- OTH- ER AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE� N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If yyesdescribe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required) Evidence of Insurance CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town Of N. Andover ACCORDANCE WITH THE POLICY PROVISIONS. N. Andover, MA AUTHORIZED REPRESENTATIVE Rebecca Berube/REBECC ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. IN8025 r7ninnni m Tho Ai npn nama anr4 Inn^oro raniefarorl mark*of ar`npn Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools D 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 DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMENTS CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ 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 Located at 384 Osgood Street FIRE DEPARTMENT Temp Dumps on`site ,yes: no Located at 124 Main:Street Fire Department signature/date COMMENTS I The Commonwealth of Massachusetts Print Form Department of Industrial Accidents Office of Investigations I Congress Street,Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Zk.� be m Cn a� S Address: Q-7 City/State/Zip: Phone "( Are you an employer?Check the appropriate box: Type of project(required): 1.❑ 1 am a employer with 4. ❑ I am a general contractor and I ployees(full.and/or part-time).* have hired the sub-contractors 6. EJ New construction 2.INrAlam a sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These sub-contractors have g. ❑Demolition workingfor me in an capacity. employees and have workers' y p �'• 9. E]Building addition [No workers'comp. insurance comp.insurance. required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am 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 c. 152,§1(4),and we have no employees. [No workers' 13.❑ 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 state 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: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: 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 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 W for insurance coverage verification. I do hereby cern der th ains and enalties o er'u that the information provided above is true and correct. w - �- - Simature: -- -- - ---- - ---—--- ------ -— - - Date -21— Phone#: ` 3 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#: i �. . . . entrance --" DA u. i 4- _ NGore ceiling drop 2 pen ant lfghts L . oY trLi1Ct 4i`VVX 4"' _ far pavwer to t -- dsk'&1pu Er bar e _. ... - n II - I� e)dstina restroom x ;,.' wf?rtnter_;Gopjer..;Fax. errter. I t 1•@w--ex IT" wnie was ' i NORTH Town of � t E : �t ndover 0 .l y. 90 No. ;. h8 ver, Mass, e c0C"1C"ewjc« �1 pDRATED S V BOARD OF HEALTH PERMIT 'T LD Food/Kitchen Septic.System THIS CERTIFIES THAT �.. �.�. .� ��.... . ....................... BUILDING INSPECTOR has permission to erect .......................... buildings on .j . Foundation ................ .tX ......S:t a!l...s..r...........VNe�' Rough � / I 1 to be occupied as ........ �Il.(.j...1 .... ...:P' -....... .1,G1.!�S.:.......... �/... '4..' Chimney provided that the person accepting 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 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION SS 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. NORTH Town of : ,, Andover ONo. S ' NAh ver, Mass, A- COCNICNEWI[K 7d p�R^TED NPP,`,�5 BOARD OF HEALTH PERMIT T LD Food/Kitchen Septic System THIS CERTIFIES THAT .....�.. p�..1. �C.Sr.... ......... . ....................... BUILDING INSPECTOR has permission to erect ..... buildings on .. ... Foundation I 1 Rough to be occupied as ......F .!\1 .., .1t..r..... .. :....... .Lti!�s.............. .�... .� ..� Chimney p •• ' provided that the person accepting 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 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION SS 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.