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HomeMy WebLinkAboutBuilding Permit #017-2017 - 1665 GREAT POND ROAD 7/6/2016 III r `` ORTy �IIe� AAW `t'c BUILDING PERMIT oF�N��eo bq�o TOWN OF NORTH ANDOVER 32 y . APPLICATION FOR PLAN EXAMINATION '" A -2s�t� Permit No#• � Date Received IDate Issued: (I SgACHUSB IMPORTANT: Applicant must complete all items on this page LOCATION �.C9�S Gr JAI : 1�Otd', Print . PROPERTY OWNER T Q, LC cl M1• `Pant -100 Year Structure .Yesr i 1/ ._. . MAPZ PARCEL. ZONING DISTRICT`' _ Historic Distract. yesno Machine. Shop Village yes no 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 Sept 01 Floodpl�ainr �Wet- .lands.., ' c T7`1ersh"etl D� trict Y DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: �k �,(,�- Phone: `'l �4b7i Address: Contractor NameT1 hone: Email. Address: tit 1 V Supervisor's;.Construction License,. )._7 ;. . . : .Exp :`Date, , Home.Improvement License: Exp. Date: . I �- ARCH ITECT/ENGINEE R Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 71 T. F�lo1 . FEE: $�(� . Gb Check No.: Receipt No.: NOTE: Persons contracting with unregistered co actors do not have access to the guaran un�d 8: ©.7n� _ri,�g_ii 6 a a c�_ ,� <'�, _ erg. � �: Ei.���'�s`o`E'tf .�,:� ►_ Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL E Public Sewer ❑ Taming/Massage/Body Art ❑ Swimming Pools El 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 i mat COMMENTS "A HEALTH Reviewe o U . nature COMMENTS i I Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes :Planning Board Decision: Comments Conservation Decision: Comments Wafter& Sewer Connection/signature& Date Driveway Permit DPW Town Engineer: Signature: FIRE DEP�1RtT Located 384 Osgood Street umps - MENT - Ternp ® ter on sit �yes no A � �� Fire Department�si.g atureldate �! « - r � y, :`'�•r i 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 Yeses No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use) i ® Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 1 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 4, 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 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 OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) � Building pp Permit Application 4 Certified Proposed Plot Plan 1 Photo of H.I.C. And C.S.L. Licenses 1 Workers Comp Affidavit 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 IS 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 Doe:Building Permit Revised 2014 I 7 I Location e:-,f cLi No. P-1 S1— G—V 11 Date j • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ � Foundation Permit Fee $ i Other Permit Fee $ TOTAL $ f - Check#• " Building Inspector BUILDING PERMIT of NoRrN gSt-ED I6 1r TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION '' O bH Permit No#: I1-2 0 Date Received �RADRA7ED .Pp`y't5 �) + �SSACHUS��` Date Issued: ( ` I ORTANT:Applicant must complete all items on this page LOCATION I C9 dos C7i 14 S. 9Q J'` Print PROPERTY OWNER ' T KZ, U& / Fant. 100 Year Structure ' yes MAP X22 PARCEL: I�ZONING DISTRICT: Historic District yes*no 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 Se 1/llell ® F1©®tlpl 'n$ g �' V�letland "® 1%11atershed`®ist, .._ �fic; .: 4lNafe lcSe.-.er DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: j k?, t�,( �. Phone: Address: �/ �I. S z� Z�) �J, ✓ Jul Q 1 � Cohtractor Name: Phone: Email. J ► , 71- Address;.:. : r t. 1 V. Su ervisor's:Construction License: . p ��( �� Exp; Date:.-.. Home Improvement License: -- Exp. Date: 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: $ '70 S-UI> . FEE: $ Gb Check No.: Receipt No.: NOTE: Persons contracting with unregistered co actors do not have access to the guaranty nd "` e,t . d:6_ e e u _ a :ads ,4 .�,�„ �•o ;i "`-a rm•+=p. ---. 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 42 CONSERVATION Reviewed on ► nat COMMENTS HEALTH Reviewe o U Sf/cinature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Violater& Sewer Connection/signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPRT ENS Temp DFu`pater on sit yes no Located et 1►24 Main Street '`' ' 9 `��. . Fire Departmen si. ature/date �C®IVIIVIENT"S �' .--i.�,r,�"���.�' .? � � �, � ;�#;•��'�.ar� �,'. X10 R TH veWn of � No. l - 1- _ * � h ver, Mass,JTji (P . 2.61 �v T 0 COCKICKEWICK �qS RATED APp� *S U Mal& BOARD OF HEALTH PERMI T T L U Food/Kitchen Septic System THIS CERTIFIES THAT L. ........... BUILDING INSPECTOR Foundation has permission to er ......................... buildings on .. ... .. ....... .. �......... -% Rough to be occupied as ....4A .0.........RIS . ... . . ....... ... .. Chimney provided that the person accepting this permit sha n every respec onform 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 CONST TIO Rough Service .. ............ .. .......41BU61i!z:: rliN�i�PIE� i&R... 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 FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. i Town of North Andover RT q Building Department O ��yED 16 ao 1600 Osgood Street Bldg 20, Suite 2035 �a' ,� - .. :., Z. North Andover MA 01645 Tel: 978-666-9545 Fax: 976-666-9542 DEMOLITION OF BUILDING AFFIDAVIT �A ccc.ih'."1.ItK 1 °RAreD #kQP DATE S 5�� S�iB�b gCHU OWNER'S NAME &ADDRESS ''KZ LLC n LOCATION OF PROPERTY TO DEMOLISH aeo* PA 0q� DESCRIPTION CONTRACTOR'S NAME &ADDRESS DEPARTMENT SIGN-OFFS G DEPT. OF PUBLIC WORKS -WATER: a SEWER:f4�21 TREE WARDEN TOWN ENGINEER -DEPT.OF C'ON ER�ATIO HEALTH DEPT. .A SEPTIC WELL 't l A, HISTORIC COMMISSION `v lA ( ►`165 PLANNING 0 cry � GAS No c r, •ee G ELECTRIC r{r.r n�a�.�D , disconne� ��23h(0 ® 10 30 01� TELEPHONE h/A TAXES POLICE ' FIRE EXTERMINATOR DUMPSTER- ON/OFF ST ET o F•,F-S-tkCc DIG SAFE NUMBER O 162 Q l3SSy ,r BLDG. INSPECTOR Building Demolition Affidav- � '' •••••Verizon LTE 10:06 AM 75%W All Inboxes nationalgrid 40 Sylvan Rd Waltham MA 02451 June 23, 2016 Via email—tzeke@comcast.net Tom Zahoruiko 4 High Street, Suite 201 North Andover, MA RE: Service Removal for Building Demolition Work Request number - 22078949 Dear Tom, This letter is to confirm that,per your request,National Grid has removed the electrical service and meter number 12807852 fi-om 1665 Great Pond Rd,North Andover, MA. if you have any questions or need further assistance, please feel free to contact me at (508)357-4515. Sincerely, Andy Schwartzberg Customer Order Fulfillment nationalgrid Unfortunately the elosest.gas mains 2437.feet away.and 1 don't believe this will be cost effective to bring natural gas to 1665 Great Pond Road. Let me know if you have more questions. r Sincerely Lilian Kagoma New Business Representative Columbia Gas of Massachusetts 55 Foundation Ave Suite 200, Haverhill MA 01835 Phone:978-556-89091 "roll Free:888-639-4270 1 Fax: 978-556-8928 ,Safety is like a lock-But you are the key." From: Thomas Zahoruiko<tzeke@ me.com> To: ikagoma@nisource.com, Date: 05/19/2016 11:43 AM Subject: Pre-demolition Inquiry, 1665 Great Pond Road, North Andover Hello Again, I have another residential demolition planned at 1665 Great Pond Road, North Andover, and am y just checking to see if you have an record of a gas service at that location? If so, we will need to get the process going to get that service terminated. Please let me know and thanks. Sincerely, Tom Zahoruiko, 978-852-4002 Sent from my ipad ooeoo Verizon LTE 10:00 AM Ali Ynboxes (2) Sent from my Pad DATE(MMMIY'YYW i CERTIFICATE OF LIABILITY INSURANCE 6/21/,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 j REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the Policy(1Ls)must h8 e?Tdorsed. If SUBROGA ION IS WAIVED,suhject 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). CONTACT PRODUCER _NAALE:---Sandi Munroe -- ____—.___..----.__..._-- M.P. Roberts Insurance Agency PHONE- L(9-18) 6183-314')-- 9 Y C-Raw); (978) 683-8073 FacNo:_^._� 1060 Osgood Street E55AIL g AoczEss__Sandi@mprobertsinsurance.com North Andover, MA 01845 _INSurr {.-R 5)�FFOROItY COVERAGE JAICfi INSURERA:Essex Insurance CO INSURED INWRERB:Associated Employers Insurance TKZ, LLC INSURER C: _._ .....-.. - c/o TOM ZAHORUIKO IMURERD:_ ---- 78 GREAT POND ROAD INSURER,E:_.__._._--------__-.-- NORTH ANDOVER, MA 01845 INSURER F: COVERAGES CERTIFICATE PLUMBER: - REVISION NUMBER_ _ THIS IS TO CFRTIFY THAT THE POi ICES OF INSURANCE LISTED BELL.':IIA -BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE PJ'ICY PERIOD INDICATED. NOTWITHSTANDING ANY RFQUIRENIENT,TERM OR CONDITION O=ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH TFIIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED By•F 1-E POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TEM-4s- EXCLUSIONS ANDCONDITIONS OF SUCH POLICIES.LIMITS SHOV%I SAY HAVE SEEN REDUCED BY PAID CLAMS. INSR' -ADDL'SUBR'. i POLICY ErF ` PODGY IXP Ut JT5 I LTR! TYPE UFINSURANCE IINSRWVO� P0UCY -,.-BER '{!ar«rDDrvi rrl'Ih44lDLYYYYYI A GENERAL LIABILITY i I j3D:Y4936 i 7/1s/1Si 7J13l1611At.IG LUFftI rLL - 1,000,000 ;_.-, 3 UANIA u3RrNTto s 50 ]Z COr F.rF;RrICI Cr i'PAI.t.IABILITY I i FR_r.iISE` Lu c r^r _000 -� Err FYJ z- �,orc p< , $,000 CLAIMS MAUL X IUUSUH -LRS•ONNI t ADV INJURY 1,000,000 i I I pant i+Ar Tc c uc,nit ,000 GCN1.,3GRECAICIIainAPP I.IES Pr,.R }{�POLICY PRO " - I'M I •Ai } I L NIMNI-(3 ti NCI.1:LIf rl AUTOMOBILE LIABILITY DOLLY INTURt(P:r rm) :i rJJ'Y AU10 1 AS.L OWAE;D SCRLOULLI? ! I dODR.Y1J1I1R�lP••:: AUTOS AUTOS r'RC1rEI?TV UPId4G NON.OVINPA HIREDALITOS ADIOS - - umEIREU-ALIAS _OrS:UR j Giatal OCr.IJRRI:NCI: _ EXCESS LIAB -. .�CLAIraS VID•_I DED N1 I'N I10i•I VJ< Sl�lll OTII', I3 - WORKERS CO PE NSATION 1DJ 1J1� lOJlj: - .MJDEfi1PL0YERSLIABILITY kWCC5OO5O06517-201418; .r Tl<Y t1rS Y11,i a I t.I ACI Ar CII( iz „ 11000,000 ,. AFY �IN,M 01,r rt 01 RA11FIX1Excl.tr L L DI5I.Aq. I A rlrt l nyr,r.s 1,000,000 iMandatorf in NH) I I °7ez. i „hder { I EL.DISF_4SE-POLICY Limrr 1 000,000_ UuLt?IPdtsuIIUnttr.(2 OPL Fbt I IONS tr`law LIE SCRIPT ION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,At44rlonat Ref.rkh Schedule,if rnnre H[>ACt is 1""-d) I 1 I CERTIFICATE HOLDERCANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED REFORE j THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN i T047N OF NORTH ANDOVER ( ACCORDANCEWInt THE POLICY PROVISIONS. i BUILDING DEPT 1600 OSGOOD STREET Aun?nRSE NTA. D F.Pn'erJ7Ar NORTH ANDOVER, MA 01845 _.- - 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: Massachusetts - Department of Public Safety Board of Building Regulations and Standards 'Coils triCrio it isor License: CS-055417 ; " Thomas D Zahoruiko 78 Great Pond Roid �' North Andover MA 01845 r , �•�..��1.6tc. " '``� Expiration Commissioner 04/05/2016