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HomeMy WebLinkAboutBuilding Permit #194-13 - 166 SALEM STREET 9/10/2012 TOWN OF NORTH ANDOVER v APPLICATION FOR PLAN EXAMINATION Permit N0: Date Received Date Issue • IMPORTANT:Applicant must complete all items on this page 6 �Printr ) _ (/_1.� �( -- - - --- -_ Pnnt� 1005Year 0 d Structure,9 T T yes no; F�NO ; -r v=FARCE ZONINGS®ISTIRICT: �Hist`onc!'Distnct yes; no, e�S age) Y - of e . 'Machin_, h I 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 ❑,Septics- ,pkWell.t U,Flood_' lain ❑V1(etlantls � VC/atershedDistfict? . - - =1/1%ater/S_QW err_ a DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: C®NTRACTOR' Address - - F Su ervlsorsCon'structiom License.: p ' , _ Exp, Date 1� HomeImprovemenLlcense 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: $_���, y6� FEE: $ Check No.: r 6p Receipt No.: ID'S NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund SignatureofAgent/Owner4 Si.gnafure�ofcontractor,- r Plans Submitted ❑ Plans Waived 0 Certified Plot Plan ElAl" mpe al ns 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 DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature i I COMMENTS HEALTH Reviewed on Signature I COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes 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•Dumpster on site yes no Located at;124;Main,Street. Fire Department signature/date S COMMENTf ' ` , a � I Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ii ` ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No t DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine 1 MOTES and DATA— (For department use ® Notified for pickup - Date Doe.Building Permit Revised 2010 L 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 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 a 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 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: Doc.Building Permit Revised 2012 I Location e No �. Dat e TOWN OF NORTH ANDOVER r eflL� s4G'7 Certificate of Occupancy $ _ .�x.. Building/Frame Permit Fee $� r— Foundation Permit Fee $ Other Permit Fee $ TOTAL $ ;t Check#L�)--K 25691 Building Inspector i NORTH Town o.f �_� � 6Andover No. o LAK, h1• ver, Mass, < Coc"Ic"IWICK � pDRATED I.P���S s V BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT C&. BUILDING INSPECTOR ................. .. ........ ;. .............. •.... ......................................... Foundation has permission to erect .... buildings on . . ....A_............... ...... ..... ...... ..........L ....................... �_ Rough to be occupied as � ! ............. 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 MONT S ELECTRICAL INSPECTOR UNLESS CONS TRUr 10 T 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. SEE REVERSE SIDE I roposal AM & AM MASONRY 203 Granville Lane North Andover,MA 01845 .� (VA)686-2034 PROPOSAL SUBMITTED TO I PHONE I DATE jAGK 9/32 STREET ( JOB NAME 1 366 SAT-pm STERET CITY, STATE AND ZIP CODE I JOB LOCATION ANDOVER,NORTH MA 1845 166 SALEM STREET, N_ ANDOVER ARCHITECT ( JOB PHONE We hereby submit specifications and estimates for: SCOPE OF WORK C nNSTRTICTMON nF FIREPTACE AND CHIMNEY WITH BRIDGE BRICK 7ft WIDE CUT DOWN TO 44in. , two 12X12 TNSIDE FACING, FIELD STONE WITH A FtUSH HEARTH A 5'X4 ' OPENINe. TOTAL: DE OSIT: BALANCE: p j1rV:pj18p hereby to furnish material and labor — complete ir, accordance with above specifications,for the sum of: dollars ($ ). Payment to be as follows: UPON COMRIXTION Authorized All material is guaranteed to be as specified. All work to be completed in a Signature workmanlike manner according to standard practices. Any alteration or devia- '4�'414 tion from above specifications involving extra costs will be executed only upon written orders, and will become an extra charge over and above the estimate. Title All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire, tornado and other necessary insurance. NOTE: This proposal may be withdrawn by us if not accepted within days. Arr,Q tanr.G of praposal— The above prices, specifi- cations and conditions are satisfactory and are hereby accepted. You are auth- Signature \\\ orized to do the work as specified. Payment will be made as outlined above. Buyer Signature Signature Date of Acceptance OP ID: SS '4 op CERTIFICATE OF LIABILITY INSURANCE F DAT09/101YYYY) 09/10/12 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). PRODUCER978-688-7000 CONTACT Durso&Jankowski Ins Agcy LLC NAME: FAX 198 Massachusetts Avenue 978- 688-7001 p//CNN% Ext: A/C No): North Andover,MA 01845 E-MAIL Durso&Jankowski Ins.Agcy. ADDRESS: PRODUCER CUSTOMER ID#:AM&AM-1 INSURER(S)AFFORDING COVERAGE NAIC# INSURED AM&AM Masonry, INSURER A:Safe Insurance Company 33618 Anthony M. Manchini DBA INSURER B:The Hartford 203 Granville Lane INSURER C:National Grange Mutual 14788 North Andover, MA 01845 INSURER D: INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BEL01W 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. INSR I DDL SUBR LTR TYPE OF INSURANCEPOLICY POLICY NUMBER MMIDD YYYY MMIL DIICYYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 C X COMMERCIAL GENERAL LIABILITY MPK27389 03123/12 03/23/13 DAMAGE TO RENTED PREMISES Ea occurrence $ 500,000 CLAIMS-MADE �OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY PRO- JECT RO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT A ANY AUTO 2430636 09111/12 09/11/13 (Ea accident) $ ALL OWNED AUTOS BODILY INJURY(Per person) $ 250,000 X SCHEDULED AUTOS BODILY INJURY(Per accident) $ 500,000 X HIRED AUTOS PROPERTY DAMAGE $ 100,000 (Per accident) X NON-OWNED AUTOS $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION C STATU- OTH- AND EMPLOYERS'LIABILITY X TOWRY LIMITS ER B ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N 08WECRJ5941 03/23/12 03/23113 E.L.EACH ACCIDENT $ 1 OFFICER/MEMBER EXCLUDED? ❑ N/A ,000,000 (Mandatory in yes,describe under E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Masonry CERTIFICATE HOLDER CANCELLATION JACKCAH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Jack Cahill THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 166 Salem Street ACCORDANCE WITH THE POLICY PROVISIONS. North Andover, MA 01845 AUTHORIZED REPRESENTATIVE ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD :. . r;trtmrnt��riPulr6tc} :if t �; �. �,..-Z„ 3trty arf BeiilclrnWtc¢u1�►fiari s`Liciase CS Restrjctedto k00,,, . 6 ANTHQNY'M',.MANCHINI T203 GRAtVILLE-LN NOANOOVE,�R MA 01.845 t Exp+raton � J i i j; f• { r r