HomeMy WebLinkAboutBuilding Permit #032-2017 - 1665 GREAT POND ROAD 7/8/2016 k
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I� BUILDING PERMIT o��tLEo '6t9�'o
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit No#: � �7 Date Received
9SSACHUS��
Date Issued:16116
IMPORTANT:Applicant must complete all items on this page
LOCATION O (0 (oS t P �dd
Pnnf
' PROPERTY OWNER'
q ' ,PrintStr'a0ure yes no
MAP �OZ PARCEL: ( ZONING'DISTRICT Historic District' ` yes no
Machine Shop Village yes
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
)'New Building t(One family
❑Addition ❑Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other _
ick
S,�eptia '�Welly a JIoodpla ®W�tland's dW e, he Distr ct
F ate1 ewe
DESCRIPTION OF WORK TO BE PERFORMED:
ly
,Identifcation- Please Type or Print Clearly
`�0WNER: Name: TKZ u-6- Phone:Q7g 85Z-!/az
Address: SLS zoI. NO 4414�r
II -,
Contractor Nar S �/VtA Phone:
Email:.`�'Z��te.
Address.
Su ervisor srConstruction License: ' 7, ' .. , . Ex . Date t.:.�`.
p , . l p
Home Imrovemp
ent License: ' Exp. Dater
p . . .
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: $ N FEE: $ 100 -00
Check No.: ZO SZ Receipt No.: :to
NOTE: Persons contracting with unregistered cont actors do not have accee guaranty fun
Plans Subrnitt4< Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ �
TYPE OF SEWERAGE DISPOSAL
Public Sewer
Tanning/Massage/Body.Art ❑ Sysimn
well ❑ Tobacco Sales ❑ Foo'!" akaa �l
❑ ;
Private(septic tank,etc. Permanent Dumpster on Site ❑
i
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
i
PLANNING & DEVELOPMENT Reviewed On Signature_,
COMMENTS �Pf( jl
CONSERVATION Reviewed on 1 �o Signature
d _
COMMENTS o t✓ S
ton
HEALTH Reviewed on Si
COMMENTS '1`(ll'lX
- j
Zoning Board of Appeals: variance, Petition No: 201(o- 001 Zoning Decision/receipt submitted yes —
94
wcRM t3k 14636 P6 �� Pl,h�►
Planning Board Decision: �lSll b Comments
�f Conservation Decision:_ N IA Comments
x
1*ater& Sewer Connection/Si nature& Date
Drivewa Permit
'DPW Town Engineer: Signature:
Located 384 Osgood Street
FIRE DEPgRtTMENT - Temp ®umpster on site
Located at 1%24 Main Street ".,� °" � � y,
A*
°`• ', iy a« .M r- �'ii. ] %` , 41. ,. 2+ ar + ,� 'itr. %,
P dy:j
ill _ .- o - ♦ ... .
Dimension
1
Number of Stories: Total square feet of floor area, based on Exterior dimensions.2S?_pSF
Total land area, sq. ft.: Zq 315
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
Ik
NOTES and DATA-- (For department use)
1b� vNL
® Notified for pickup Call Email
Date Time Contact Name
----------- i
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 j
4. Building Permit Application
I
4. Workers Comp Affidavit
4. Photo Copy Of H.I.C. And/Or C.S.L. Licenses
4� Copy of Contract
4� Floor Plan Or Proposed Interior Work
4. Engineering Affidavits for Engineered products t
OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
i
Addition Or Decks
4, Building Permit Application f
4. Certified Surveyed Plot Plan
4 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 j
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)
4; Building Permit Application
Certified Proposed Plot Plan
Photo of H.I.C. And C.S.L. Licenses
Workers Comp Affidavit
4, 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
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
Doc:Building Permit Revised 2014
Location
No.037 -Zal-7- Date
• - TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee
Foundation Permit Fee
Other Permit Fee $
TOTAL $
` Check#�W3-Z -
I I
f
30 0-502 *ct
�' .Building Inspector �
�10RTId
BUILDING PERMIT oF�t�eo 06;°tio
Z y� rr, •^'n, b
TOWN OF NORTH ANDOVER 3
F0- t p
APPLICATION FOR PLAN EXAMINATION
Permit No#: IZOP /7 Date Received
SSRCHUS�
Date Issued:
IMPORTANT: Applicant must complete all items on this page
LOCATION V b (OS re0iflJ�trX �.cd�C
Print
PROPERTY OWNER T K Z L LC
MAP (OZ- PARCEL: ZONING DI
Print 100 Year structure yes no
�_ STRICT: � Histone Distncf eyes no
Machine Shop Village yes
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
''New Building 0One family
❑Addition ❑Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
e -
DESCRIPTION OF WORK TO BE PERFORMED:
Identification- Please Type or Print Clearly
OWNER: Name: Z LLC Phone: -95Z W
Address: S SUS ZO l. N04 4u��Vr )L�A d ,�
Contractor Name: 6W Phone: 17F- SZ-- �
Email: tZ (1c 4y
Address: S.� ►`�. r Q INT
Supervisor's Construction License: —Exp. Date:.,
p p -
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: $ o FEE: $ 100 -OCO
Check No.: Z-0 SZ Receipt No.: � .
NOTE: Persons contracting with unregistered cont actors do not have access to the guaranty fun
Plans Submitted'X Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ .
TYPE OF SEWERAGE DISPOSALr
Public Sewer Tanning/Massage/Body Art Sw�
❑ ; „
Well ❑ Tobacco Sales ❑ Foodla $ -
.
❑ .
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 Vii( 'i 5 ZOl
CONSERVATION Reviewed on 1 to Signature
COMMENTS C' c_c-t s
HEALTH Reviewed on Si
COMMENTS +0A)Y, J�J8Uf 4 �;hk g
Zoning Board of Appeals: Variance, Petition No: Zoll(,-° 001 Zoning Decision/receipt submitted yes `®
�cFM t&k 1gb36 P6 LA.V
Planning Board Decision:_4/sit(0 Comments c t c
Conservation Decision: ly LA Comments
Water& Sewer Connection/s; nature& Date �Driveway Permit
]DPW Town Engineer: Signature: -u' _
Located 384 Osgood Street
AFIRE DEPART TM NT - Tern Du`m sfe� onsit ¢
Located at 124 a n Street
Fire Departmen si,g : afore/date
Alis
ME�� l L :.' ''. / � f �u-.Y S 3 14 lR + SW;.�/ a.� •„
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No.
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coc..icMeMcK y1•
RATED
U BOARD OF HEALTH
Food/Kitchen
PERMIT T LD Septic System
THIS CERTIFIES THAT ......... BUILDING INSPECTOR
Foundation
has permission to erect .......................... buildings on ..�. ..4i .&0r .... .. . .
Rough
to be occupied as ... .�I�". ..6191/r.......100. ...... 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 CONST TION Rough
Service
.. . . .. .... . . ..... .......
Final
BUILDING PE TOR
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.
f
j Co(c S GRE:A ' PomD ROAD
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NDN-dSUTARDE BtIFFEA ZWF�_ .— —.— �• Nd1-DISLNARGE BURTR Z.f_ _.�•. —.—.—, _
(S25'4H011 EDGE OF WAIpT) (11S MDM D]EE
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SD.(MoJ � DRE1i q
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DN-ORNPBNT2 811iTLR 2012
I HEREBY CERTIFY THAT THE PROPERTY UNES //----!!��pT-DISIURBWCE BUF]tF ZDNEDD'MCu EDf£6 WATDT)
SHOWN ON THIS PLAN ARE THE LINES OF E%ISTNG L PROM ma a'
OWNERSHIPS,AND THE UNES OF THE STREETS AND LOCUS PLAN
WAYS SHOWtT ARE THOSE OF PUBLIC OR PRIVATE LOT A 121.6SCALE:1"-800'
STREETS OR WAYS ALREADY ESTABLISHED,AND N
THAT NO NEW UNES FOR DUSTING OWNERSHIP OR Y 28,345 S.F.
FOR NEW WAYS ARE SHOWN.AND TI,AT THIS PLAN /.� 29,345 S.F, R (asfSSaAs YAP 62 LOT 1e)
CONFORMS TO THE RULES AND REGULATIONS OF $ (A5561ags uAP a2 LOT 18)
THE REGISTERS OF,DEEDS OF MASSACHUSETTS. _
gdgT REG.PROF.LAND SURVEYOR
fl, RLE.WAIL b, FaA xows
T I I INE 9lE 5 L�GATEO WIHN 1NE TOWN K NORM ANODVEF'S
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NORTH AOOARAPPAnO- F I=HX
BORD POT(AIAY OIS7faOT AND lONE A OF
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PRDPOSEp x nns FLAN Is FOR 159lANCE OF A vIAIA PWI-7 TO
S I O WNG sFcna,.t]R(m<xR)(a)aF TNF NDRTN A—D4-0"'
DATE OF APPUCATION ' ___ BWAw,
I WALL T
DATE NEARING \ /
PRP+WALK PN(MD.) _
RR-1 ZONING DISTRICT '
DATE OF APPROVAL \ / y§{ �} R T �ZONING A i LYSIS
CHAIRMAN p I / q PROP qEi.wAu LOT udA B>.ito Sf. 18.115 SF. 2P.Da5 sF.
N / PAOP NEW DPW MONT SEIAAIX b R. ta{.8 FT. Bt,PT.
/ I _ S�SEIBALW b R. 241 Fi. 83110 R.
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PM(MDJ I ,�F�Q PAVEMENT
PIPE(M0.) I of PANMENT -—— ———•'—————J
GREAT POND ROAD
GREAT POND ROAD —
--------------T— --- ----
--------------T— -- ---- `mcE aPAVEMu1T
`4DCE OF PAVEMENT
'- awATm n/]/1a1s)
LAKE COCHICHEWICK 0 MTM(]/7nD15' LAKE COCHICHEWIC�_
ZBA VARIANCE PIAN
EX/ST/NG CONDITIONS PROPOSED CONSTRUCTION 1665 GREAT POND ROAD
NORTH ANDOVER, MASS.
OWNER/PREPARED FOR.-TECHNICAL
TRAINING 5
FOUNDATION TRUST
DATE: January,13.2018 nN
SCALE: 1'e 20'
acc r
nsult
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p/ Inc.
/ 'Patar D.Cood� 1 Eo<t Rl—Plea Dooms A.Griecci
Reg.Prof.Land Surveyor MaU,uan.M.:01944 Reg.Prof.Engineer
020 40
0 60 80 Ft.
10 20 Mater
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�(C"Ra 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
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,0)e policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to
the terns and conditions of the policy,certain policies may require an endorsement. A Statement on this certificate does not Confer rights to the i
certificate holder in lieu of such endorsernent(s). I
PRODUCER CONTACT
NAME: Sandi Munroe
M.P. Roberts Insurance Agency PHONE ------ — ----- --`FAX. _--_-_.-......_.._ _.
4 Y �.NQExn (9783 683-8073 ___{Lc- ,L(97II7 603-3114'14'1
1060 Osgood Street Ein/uL
Anor:Fss:-._-sandi@mprobertsinsurance.com
North Andover, MA 01845 -- -___-.-.-
INSUfTR(SI AFFORDING COVER_A_G[ _ ,. - YAIC/r
INSURERA:EsseX Insurance Cc
INSURED 7NSURERB:Associated Emplovers Insurance
TKL, LLC INSURER C:
c/o TOM ZAHORUIKO INSURER 0:
78 GREAT POND ROAD
INSURER L':
NORTH ANDOVER, MA 01845 INSURER r:
COVERAGES _ CERTIFICATE NUMBER: _ REVISION NUMBER:
TRIS IS Tp CFRTII=Y THAT Tf iE 1'OLI0.TS OF INSURANCE I ISTED BELOW HAVE BEEN ISSUED T'0 T ITC INSURED NAM W- r\BOVE FOR THE POLICY PERIOD
INDICATED. NOTVWTHSTANDING ANY R1 OUIRENI FNI-,TERM OR CONDITION OF ANY CONTRACT 012 OTI-IFR DOCUMENT WITH RESIN-iCT TO WHICH THIS
CERTIFICATE MAY BE 1SuUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY-11.17 1101-ICIES DE$C121BED HEREIN IS SUBJECT TO ALI_THE T E-RMIS.
EXGI_USIDNS AND CONDITIONS OF SUO'I POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSRi :ADD L SUSHI I POLICY EFF 1 POLICY EXP
LTR( TYPE OFINSURANCEI VJVO;--_POU6Y MIMBER �IMtdID01Y YYV)i{Pl'A.rOnYYWI`. LIWTS -__-_-
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A i GENENALLIABILITY j _ 13DX4936 '7/13/15 '7/13/161 I A(,tlOt;CU1tRl Nc,t -5 J,000,000
unrvk r io;Er n u s 50,000
X!1.Oh)MPHC1n111 f19a)rIIAHn LIv I , i It+LItISLS rI.r vr. _ �. i
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IX:SCRIPTIONOFOPERATIOIISILOGAIIONSIVEHICLES(Attach ACORD I01,AAtitimrnl Ranwrks Schedule,it more ep'�ca 7sregri,erl)
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CERTIFICATE T HOLDER CANCELLATION
CE
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN i
TOWN OF NORTH ANDOVER i ACCORDANCE WITH THE POLICY PROVISIONS.
BUILDING DEPT ----- --
. 1600 OSGOOD STREET AUTHORV. D F.PRF.SEId7AF
NORTH ANDOVER, MA 01845
n 19118-2010 ACORD CORPORATION. All rights reserved.
ACORD 25(2010105) The AC ORD name and logo are registered marks of ACORD
PhOne: Fax: F-Mail:
I
±' Massachusetts Department of Public Safety
X11/° Board of Building Regulations and Standards
License: CS-055417
Construction Supervisor ,
THOMAS D ZAHORUIKO
4 HIGH STREET SUITE 201
NORTH ANDOVER MA `01845
Expiration:
Commissioner P
04/05/201$
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