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HomeMy WebLinkAboutBuilding Permit #792-14 - 1665 GREAT POND ROAD 5/5/2014Permit NO: ✓, TOWN OF NORTH ANDOVER s APPLICATION FOR PLAN EXAMINATION Date Received Date Issued:-.!2 IM ORTANT: Applicant -must complete all items on this page NYe+� a a ,` a LOCATIONS � 4� ' �a , t 77, x` .77- - _ 1-_ -7 l t� t ' IPROPERyTI(r®WNER�= Y Year 01dr8tructurex Yesrio ��L ZONIIV¢G DI�TtRIGT ��. sH.istonc District Eyes nog MAP ANO: RCE { = i } #IVlachine�ShopVil e,; y �' _..ate .�_ �� �,.3 � - - lag �f � � Ye TYPE OF IMPROVEMENT. PROPOSED USE Residential Non- Residential ❑ New Building 9One family ❑ Addition ❑ Two or more family ❑ Industrial 0 Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ` _` s❑ Septics ❑WPI= otFlood Iain ®Wetland%s �4 r p �€ ��I��Natershed ®i t ict £ , �1NaterlSewerm g �ry,. DESCRIPTIUN UI- VVUMM i v or- rrmrur<mrzu. R�rvwuE tr�-rrra.�of� 02Yw�auTE�'f�Rao2. �o�nl'c ANO P.oaF�nt� , won�o�Tlor1 P(.�nrr+N6s, Pa" Fol S?tt.0 CTUR-Rt- i(I(JE S?F 9 Ar_R 011 A-4 fit0hge NaW Lpnm0gCAPINC PLAO. Identification Please Type or Print Clearly) OWNER: Name:-rI✓C1+tAtUi— fr(LA I M IMC, F6900 t00 'Phone: 9�8-(Dg7•,IoS 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: $ ©00d FEE: $ ��� Check No.: Receipt No.: NOTE: .Persons contracting withrZre iced contractors do not have access to the guaranty fund Plans Submitted LJ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ I Plans Submitted > ❑ Plans UUaived ❑ .-Certified Plot Plan ❑ Stamped Plans ❑ '`I YPE OF:-SEWERAGEDiSP.OSAL Public Sewer ❑ Tanning/Massage/BodyArt ❑ .. .Swimming Pools ❑ Well ❑ Tobacco -Sales ❑ ' 'Food Packaging/Sales ❑ -Private`:(septic tank, etc:: . =Permanent Dunpster on Site THE. FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM - -_..-'DATE REJECTED PLANNING & DEVELOPMENT ❑ COMMEN ..CONSERVATION COMMENTS Uj Reviewed on__q OU 14 Sianat 1. DATE :APPR.OVED El HEALTH Reviewed on Signature COMMENTS P% Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments !Water & Sewer Connectionisignature & Date Driveway Permit DPW TowA2 Engineer: Signature: Located 384 Os ood Street FIRE DEPART' N1` Temp Dumpster on site .yes Located at;,124�Mair Street a {� t=� x , no FlreDepartmeNtip ignatW(dffllte, ��r, , : R t° t t �, c �, r ,• s. » t,�ta �y COM ; MM t -Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. _Total- land area, sq. ft.: ELECTRICAL: Movernent 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 imu i t5 and UA I A — Igor department use El Notified for pickup - Date Doc.Building Permit Revised 2010 Building Department The fold?wing 1"84 list of the required-forms to be filled outfor the. appropriate. permit to .be obtained. Roofing, Siding, Interior Rehabilitation Permits - Building Permit Application 0 Workers Comp Affidavit 4 ❑ Photo Copy Of H.I.C. And/O C.S.L censes ❑ 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 ❑ 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 casts if a variance or special permit was required the Town Clerks office must stamp tlie,decision from the Board of Appeals that the apw• al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submAted with the building application Doc: Doc.Building Permit Revised 2012 oca ion No. �` Date !4,-R,W-M TOWN OF NORTH ANDOVER Certificate of Occupancy Building/Frame Permit Fee Foundation Permit Fee Other Permit Fee TOTAL i Check # r Building Inspector E9_ _* J Q _ LA -Z p Q m C al t- u Y \O O O LL ai ? Ln '� Q a) V) p W (A z m = O C 7 O LL mo O O W v E dE U — = LL O {A z Z J C W 7 O cr — C LL 0 V1 Z Q U W LU U.a 7 O or cu U a1 V) m LL OC a z Q 7 O d' m LL Z L►J LU Lu L1. O i 3 m z N v N 14 O V) cu � O S i ja O W g N N Q t � G O E- E w � L � E CD L = P►_ 0� cn Ham`, a. O O N O.a N 0-0 O O > .O O � 'w C 6 c8 o t Q=z N O J c o CL W cl- m 0 0 F— v O = = O Q L L LC .O 2 d r.L N ~ O V m d co cc W C 'a O OU) uj O �O W O $ U �. 0.0 CL F: m N (n - '®w Z- 0- O 0 F e t Z W W a. ui F_ w a U cn O U U) LUJ O N� I.L � Z Q N ^� O O O �0s Cc O N Q. O tm CL ca m v .v —J 'O 0- az O G� OCL v V U) Cl yThe Commonwealth o f Massachusetts Department o,f'Indusstrigl Accidiks Office o, f lnvestigations 600 Washington. Sheet Boston, .MA 02111 www.mass govIdia Workers' Compensation lnsuran.ceAffidavit: Builders/Cont°actors/Electricians/flumbexs Applicant �nformatlon . Please Prim Le4b' Name (Business/Oxgani'zaiionwividual): '�i� ��'iC A (A)B 0) E60494,717 0 J .Address: I � PAT NJ0 V City'/State/Zip: N 0 A-siod U' 9& Phone # A,r.,e_,yo an employer? Check the appropriate box: �_ 4. ❑ I am a general contractor and I Type of project (required): 1. L`�" I am a employer with 6, (l New construction employees (full and/or part-time).* 2. El am a sole proprietor or partner- have hired the sub -contractors listed on the attached sheet. 7• E] Remodeling ship and'have no employees These sub -contractors have 8. %Demolition working forme in any capacity. workers' comp. insurance, g. [] Building addition [No workers' comp. insurance 5. ❑ We area corporation and its 10.❑ Electrical repairs or additions required.] 3. ❑ X am a homeowner doing all work officers have exercised.theix right of exemption per MGL ILE] Plumbingrepairs or additions myself. [No workers' comp. c. 152, §I(4), and we have no 12. ❑ Roof repairs insurancere ed. ] employees. [Nb workers' 1311Other comp, insurance required.] xAny applicantthat checks box#I must also fill out the section below showing their workers' compensation policy information. I -Homeowners who submitihis affidavit indicatingthey go doing allwork and then hire outside contractors must submit a new affidavit indicating such. tContractors that cheAthis box must attached an additional sheet showing the name of the sub -contractors and their workers' comp, policy information. I am an employer that is providing workers' compensation insurance for fry employees Below is the policy m4joh site information. Insurance Company Name:. �� ii '� N S QLA-U Policy # or Self -ills. Lic. #: WC CC t+1 q (1 Expiration. Date: o I I l/ Job Site Address: V- ro 0-,Oq- City%State/Zip: bo , &.0g/t, , /K Attach, a copy of the workers' compensation -policy declaration page (showing the policy number and expiration elate). Failure to secure coverage.as requiredunder Section 25A of MGL o. 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 time 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 X2ere cert iflder tli ain cl penalties of perjury that the information provided above/is true and correct. Qionafima• Date: -A•%� Oficial 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 6. Other - - 4. EIectrical Inspector S. Plumbing Inspector Contact Person: Phone #:, ACORUr CERTIFICATE OF LIABILITY INSURANCEDATE(MMIDD/YYYY) 4/25/2014 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(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 on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER MTM Insurance Associates 1320 Osgood Street North Andover MA 01845 CONTACT Victoria LowesCISR NAME: r PHONE (978 681-5700 FAX AIC No:(978)681-5777 EMAIL ADDRESS: vickiel@mtminsure.com INSURERS AFFORDING COVERAGE NAIC # INSURER A:COvin ton Spec alt INSURED Technical Training Foundation 1429 Osgood St N Andover MA 01845 INSURER B:Safety Insurance INSURERC:Hartford Fire & Casualty Group INSURER D:HartfOrd Insurance INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:13-14 REVISION Nt1MRFR- 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. INSR LTR TYPE OF INSURANCE ADDL INR SUBR ffVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR 386280 0/1/2013 0/1/2014 DAMAGE TO RENTED 100 000 PREMISES Ea occurrence $ r MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ incl X POLICY PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident 1,000,000 BODILY INJURY (Per person) $ B ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS 5057738 /11/2014 /11/2015 BODILY INJURY (Per accident) $ X HIRED AUTOS X NON -OWNED AUTOS PROPERTY DAMAGE $ Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DED RETENTION $ $ C WORKERS COMPENSATIONWC AND EMPLOYERS' LIABILITY Y/ N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? a (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A OBWECCN9146 10/1/2013 0/1/2014 STATU- OTH- X TCRYLIMITS E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE- EA EMPLOYEE $ 100,000 E.L. DISEASE - POLICY LIMIT $ 500,000 D Directors and Officers[L oA1318737 0/1/2013 10/1/2014 Limit $5,000,000 Deductible $5,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) This certificate of insurance represents coverage currently in effect and may or may not be in compliance with any written contract. Town of North 384 Osgood St. No Andover, MA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Andover Mass ACCORDANCE WITH THE POLICY PROVISIONS. 01845 1 AUTHORIZED REPRESENTATIVE n r� O N Q 1b CL N o �Y� o LA C A ^ '�. ;o CD m� H CL Lo c- n' ' X w mti Q N ®. m N .. y A � Respectfully Submitted By: A. . Glenn T. Saba Treasurer (978)815-7073 ACCEPTANCE OF PROPOSAL The above prices, specifications and conditions are satisfactory and are hereby accepted. You are autho ' dZdoe work specified. Signator : Date: �112 Signatur . Date: THE REMAINDER OF THIS PAGE IS INTENTIONALLY LEFT BLANK CENTURY BUILDERS, INC PO Box 907 Methuen, MA 01844 PROPOSAL Date: April 23, 2014 Proposal Submitted To: Technical Training Foundation 1429 Osgood Street Telephone: (978)687-7105 North Andover, MA Email: joseph.leone@verizon.net Work Address: 1665 Great Pond Road, North Andover Estimate to remove interior sheetrock, exterior siding and plantings against foundation. We propose to remove the sheetrock walls in the dwelling, strip the siding off the exterior of the structure and pull up the plantings along the foundation. We will dispose of all debris through the hiring of a waste disposal company and will provide slips upon request. Excavated plantings will be hauled to a landfill and material will be hauled in to fill voids. Owner is responsible for all necessary permits. We propose to perform the work as specified for the Total Sum of Ten Thousand ($10,000.00). We anticipate it will take 10 business days from start to finish to complete stated work. If accepted please return a deposit of $3,500.00 with signed agreement. The balance will be due upon completion. This Proposal is good for 14 days. NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit at: (o` -pd,ep f� o is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150 A. Also, note Permits are required under Fire Prevention laws Chapter 148 Section I OA. The debris will be disposed of in L L_IS C C. $"1 C.owC-C.L RA 5Ac 4 o30-79 (Location of Facility) XSignature rnut Applicant Date D) e /"1 hS 77/v- 7, ---fAey 0149y A f-,ee