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HomeMy WebLinkAboutBuilding Permit #495-11 - 170 GREAT POND ROAD 12/10/2011TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Z_/ /� Date Received 'ANT: Applicant must complete all items on this LOCATION 110 A-JLE l P M ,D PbAD .^� • , —print r .� Print - --- MAP NO: !il 6 PARCEL:—J-7 ZONING DISTRICT: Historic District yes Machine Shop Village yes 100 year-old structure yes o TYPE OF IMPROVEMENT PROP SED USE Resi ential Non- Residential ❑ New Building One family ❑ $ddition ❑ Two or more family ❑ Industrial Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other e tic PFiloodplain Water/Sewers ' ®We laii s - Watershedistriet� J7. t %-B-,r r lviv yr, w Uf<,& 1 v ,tit; PhEYOKMED: (Identification Please Type or Print Clearly) OWNER: Name: P pr`I c2 UiL _ 4 S U I A � tJ 6 1/101 �l P k I/A Address: I10 WA -f— Po P b aD. CONTRACTOR Name +phone: F Address: Supervisor's Construction License: C,5 d (o a Exp. Date: Home Improvement License:155 c ARCHITECT/ENGINEE FEE SCHEDULE. BODING PERMIT. $92.00 PER Exp. Date: j /S--- / one:_78�7��19� . No. /v 7*,q 00 OF THE TOTAL ESTIMATED COST BASED ON $925.00 PER S.F. Total Project Cost: $ 11 1146,00 FEE: $ y%.?- 60 No.: x0=30 Receipt No.: 9 ,5,02 iPersons tracting with unregistered contractors do not have access to the guaranty fund a I F_ 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 COMME DATE REJECTED RI DATE APPROVED CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS %Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: - Comments Conservation Decision: Comm Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: FIRE DEPARTMENT - Temp Dumpster on site Located at 124 Main Street Fire Department signature/date COMMENTS Located 384 Osgood Street yes no 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 Doc:.Building Permit Revised 2011 June/mi 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 ❑ 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 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 2008mi Location 1-20 No. ` �� a Date oZ NORT1y TOWN OF NORTH ANDOVER OL w I o Certificate of Occupancy $ sCHus Building/Frame Permit Fee $ aav Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 2 2 4 9 0 213 %ling Inspector Edi r\ z W 0 V x ■ y 0 x d L w W a a 04 w o z � 00 0 <L_A .a�44 z Q O v w cn O O G w a: U w" O G w w" O w cn w O G a: w" 0 cq cn cn x ■ y 0 x d L 0 <L_A fr tNGOA. C� AZ74-Vip- 0 • 1� 0 Z uiCO) W F- cc CLW C.3 CA c �►- C2 as c `o ` C h O C C0.1 C-2 ac ev ea =c o , p CD L co) = EQ O m c _ is C:, O. N CD C C2 C.3 O ZL3 Cm mc ®m 3: C* N � m C m 9 _m C43 C O ES aC.3 co N m Z 0 O! O C Cmgo 'Z CD C42 r. QO Q m C m 0.= 30 "" Na = O e-0rr o Z 0:5 *-, c ... .y 'd= O'C_ E33 *a"m N CD C3 ® c CL O .9 O O ..� CD CD 211 N •_ t $ CL.*- m A! N Z N N C O C m am C 'O m O cm C �C N m Z O Z O O F. CO z 0 W Oil U Z 0 u C/) ��i a) O E C L � O 'S s Z v. O co O cm I O C � Q -0 .� M cD. 'E m m L i .�..r CD O � CL; CD O L e_cv o a M cmQ c Co .0-0 c d O ,a; CD CL U CO) � C cc CL C . C CO) 0 -' ^Office of C l ne R A nes�nu HOME IMPROVEMENT CONTRACTOR Registration: ,155879 Type: Expiration: 5/jb12013 DBA J ONOVAN COhlSTRi ai6Nil4 , JOSEPH DONOVAN 43 ACROPOLIS RD:;' g ,tea LOWELL, MA 01854 zs if; Undersecretary License or registration valid for individul use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza -Suite 5170 Boston, MA 02116 1116 k-ltvt/ R-�' c Not valid without signature --- Nlassachusetts - Department of Public Sutet} ,' Board of Suiitlin�- Ri!_ufati«n1 and Standards Construction Supervisor License License: CS 2604 Restricted to: 00 JOSEPH E DONOVAN 43 ACROPOLIS RD LOWELL, MA 01854 t'uinetti�siutter Restricted to: 00 00 - Unrestricted 1G -1 2 Family Homes Expiration: 5123/2012 Tr#: 25180 Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. Refer to: WWW.Mass.Gov/DPS DATE JOE DONOVAN CONSTRUCTION COMPANY 43 Acropolis Road, Lowen, MA 01854 (978) 453-6209 o (978) 804-8415 Quality Custom Carpentry Roofs- Additions - Remodeling DESCRIPTION This is a contract between Joe Donovan Construction and Patrick Wolfgang to be done at. 170 Great Pond Rd., No. Andover, MA 01845. All work to be done according to plan provided by Space Craft Architecture. "Renovation Wolfgang Residence", September 3, 2011. AMOUNT o Remove existing cabinets, file and subfloor - Demo kitchen walls and entire bath as per plan o Cut cased opening from dining into hallway o Remove and block off small window Repair Siding e Hang smaller double hung window to replace existing window o Flush frame beam into ceiling of new kitchen * Provide proper header for large cased opening in hallway e Build new walls as per pian e New plaster ceilings throughout, plaster on new walls o Existing walls to be patched or skim -coated • Hang and trim new cabinets supplied by owner e Trim out interior window, cased openings, baseboard, crown molding, etc. • Sub -floor ready for oak floor by owner e Walls and trim ready for paint by owner o Electrical, heat and plumbing, by Owner Permit provided as well as all debris removed from jobsite. Payment Schedule Deposit $5,000 Frame Complete $5,000 After finish work $5,000 Upon completion $7,800 Total $23,800 ,r3 l� Completion of job, 4 Nweeks, provided subcontra maintain their timely schedule.. TAX 17� sl TOTAL RightFax C2-2 12/16/2011 7:57:17 AM PAGE 2/002 Fax Server ACORD. CERTIFICATE OF LIABILITY INSURANCE 12/16/2011 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: H 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 and endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such erdorsement(s). PRODUCER DANIEL OROURKE INS AGCY 429 HIGH ST MEDFORD, MA 02155 7857W INSURED DONOVAN JOSEPH DBA JOSEPH DONOVAN CONSTRUCTION CONTACT NAME: PHONE FAX (A/C, No, Ext): FAX (A/C, No): E-MAIL ADDRESS: PRODUCER CUSTOMER ID #-. INSURER(S) AFFORDING COVERAGE INSURER A: TRAVELERS INDEMNYCY CONIPANY INSURER B: INSURER C: INSURER D: 43 ACROPOLIS RD INSURER E: LOWELL, MA 01854 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THATTHE 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 ALLTHE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDLSUBR POLICY EFF DATE POLICY EXP DATE TYPE OF INSURANCE POLICY NUMBER (MWDD\YYYY) (MPADD\YYYY) LIMITS LTR INSR WVD GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY It yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/RESTRICTIONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS CONIP COVERAGE. THE WORKERS' COMPENSATION POLICY DOES NOT PROVIDE COVERAGE FOR DONOVAN JOSEPH. CERTIFICATE HOLDER TOWN OF NORTH ANDOVER 170 GREAT POND RD NORTH ANDOVER, MA 01845 ACO RD 25 (2009/09) NAIC # 100,000 100,000 500,000 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Charles J Clark 1988-2009 ACORD CORPORATION. All rights reserved. DAMAGE TO RENTED $ CLAIMS MADE OCCUR. PREMISES (Ea occurrence) MED EXP (Any one person) $ PERSONAL && ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PROJECT LOC PRODUCTS - COMP/OP AGG $ AUTOMOBILE LIABILITY COMBINED SINGLE $ ANY AUTO LIMIT (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULE AUTOS . (Per person) HIRED AUTOS BODILY INJURY $ (Per accident) NON -OWNED AUTOS PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WC STATUTORY LIMITS OTHER WORKER'S COMPENSATION AND EMPLOYERS LIABILITY Y/N UB-4890P83A-11 10/21/2011 10/21/2012 E. L. EACH ACCIDENT $ ANY PROPERITOR/PARTNER/EXECUTIVE Y E.L. DISEASE - EA EMPLOYEE $ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L. DISEASE - POLICY LIMIT $ It yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/RESTRICTIONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS CONIP COVERAGE. THE WORKERS' COMPENSATION POLICY DOES NOT PROVIDE COVERAGE FOR DONOVAN JOSEPH. CERTIFICATE HOLDER TOWN OF NORTH ANDOVER 170 GREAT POND RD NORTH ANDOVER, MA 01845 ACO RD 25 (2009/09) NAIC # 100,000 100,000 500,000 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Charles J Clark 1988-2009 ACORD CORPORATION. All rights reserved. /Z .�" �7- A� hI® CERTIFICATE OF LIABILITY INSURANCE 3ATE(MMIDDVYYYY)10/3/11 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 Daniel N. O'Rourke Insurance 429 High Street Medford, MA 02155 CONTACT NAME: Mart PHONE (781) 396-8244 FAX No; (781) 391-2975 ADDaRESS: sales@ORourkeInsurance.net _ PRODUCER 1008 ST0MERIDit, — _-- - INSURE R(S) AFFORDING COVERAGE_______ _ _ NAIC # INSURED JOE DONOVAN CONSTRUCTION 43 ACROPOLIS RD LOWELL, MA 01854-1301 INSURER A: Commerce IISURERB_Commerce_-- INSURER(: INSURER p_ INSURER E: INSURER F : COVERAGES CERTIFICATE NUMBER: 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 DESCF,IBED HEREIN IS SUB!ECT: TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE AML 111 SUBR WvDPOLICY NUMBER POLICY EFF (MMIDD/YYYY POLICY EXP MM/DD/YYYY LIMITS A GENERALLIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Fx-1 OCCUR 13CDZZ Q 8/9/11 8/9/12 EACH OCCURRENCE $ 1 ALO -0,0 0 Q DAMAGE TO RENTED M I Ea occuEence $ 100,000 MED EXP (Anyone person) $ 5,000 PERSONAL& ADV INJURY $ 11000,000 GENERAL AGGREGATE $____ 000 000 GEN'L AGGREGATE LIMIT APPLIES PER POLICY PRO- LOC PRODUCTS - COMP/OPAGG $ 1000000 — ---- — $JECT B AUTOMOBILE LIABILITY ANYAUTO ALL OWNED AUTOS SCHEDULEDAUTOS HIRED AUTOS NON -OWNED AUTOS BBXWItJ 11/28/1011/28/11 COMBINEDSINGLE LIMIT $ (Ea accident) BODILY INJURY (Per person) $ 100,000 -- --— BODILY INJURY (Per accident) $ 300,000 X -- -- PROPERTY DAMAGE $ 100' 000 (Per accident) $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ D ED UCTI B LE RETENTION $ $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N PROPRIETOR/PARTNER/EXECUTIVE —� OFRCER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A WC STATU- I OTH- TORY T., F RANY E.L. EACH ACCIDENT $ —_-- — — E.L. DISEASE_ -EA EMPLOYEE $ E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Rernarks Schedule, if more space is reqs red) CERTIFICATE HOLDER CANCELLATION o © 1988-1009 A -CORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The AC ORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN TOWN OF NORTH ANDOVER ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE o © 1988-1009 A -CORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The AC ORD name and logo are registered marks of ACORD