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HomeMy WebLinkAboutBuilding Permit #562-2011 - 1719 OSGOOD STREET 2/15/2011 TOWN OF NORTH ANDOVER NpRTH APPLICATION FOR PLAN EXAMINATION apt"OED 16. - 3? b6 p 0 n 0 t vC �6'11 Date Received Permit NO: J` Date Issued: / !� �9SSACHUS���y IMPORTANT: Applicant must complete all items on this page LOCATION/4� Qt r S -� ,/Print MM PROPERTY OWNER C4 r� Print MAP NO.: Co` PARCEL: ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non-Residential ❑New Building ❑One family ❑ Addition ❑Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ pair, replacement ❑ Assessory Bldg ❑ Commercial emolition ❑Moving(relocation) ❑Other ❑ Others: ❑Foundation only DESCRIPTION OF WORK TO BE PREFORMED Identification Please Type or Print Clearly) OWNER: Name: Pco c4 m , rN L, Phone: 97 r-(x (3(366 3 Address: /7,;?-/ 699!R no rl SP< A)y- CONTRACTOR Name: �- /�/�G�41c11cd� ,� Phone: 60 3:1 �9 Address: �(� X / Supervisor's Construction License: C S _7F9 _Exp. Date: 3� /�U% ;7- Home Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Name: Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost C)00 x12.00=FEE:$ ,,o o Check No.: �o�s Receipt No.: Page I of 4 TYPE OF SEWERAGE DISPOSAL Swimming Pools ❑ F1Taming/Massage/Body Art E]Public Sewer Well F1Tobacco Sales ❑ Food Packaging/Sales El � Permanent Dumpster on Site ❑ Private(septic tank,etc. El Permanent Meter location to project NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund Signature of Agent/Owner Signature of contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ j THE FOLLOWING SECTIONS FOR OFFICE USE ONLY f INTERDEPARTMENTAL SIGN OFF-U FORM DATE REJECTED DATE APPROVED PLANNING& DEVELOPMENT ❑ ❑ ❑Water Shed Special Permit ❑ Site Plan Special Permit ❑ Other COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ i COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS Zoning Board of Appeals:Variance,Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments I Conservation Decision: Comments Water&Sewer connection/SiQnature&Date Drivewav Permit Temp Dumpster on site yes_no Fire Department signature/date i Building Setback Front Yard Side Yard Rear Yard Required Provided Required Provides Required Provided Dimension Number of Stories: Total square feet of floor area,based on Exterior dimensions. Total land area,sq. ft.: NOTES and DATA— For department use Page 3 of 4 Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 Created JMC.Jan.2006 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 Addition Or Decks ❑ Building Permit Application ❑ 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) o Mass check Energy Compliance Report (If Applicable) New Construction (Single and Two Family) i ❑ 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 i 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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 Pane.4 of 4 Location /7 No. Date &ORTil TOWN OF NORTH ANDOVER O0 41 4L Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ � Other Permit Fee >M $ yy'Do TOTAL Check # Building Inspector xAORTH TO."11%M Of 6over o dower, Mass. COCMICMEWICK V ADRATE D P""�' 7 S BOARD OF HEALTH Food/Kitchen -PERMIT Septic System BUILDING INSPECTOR THIS CERTIFIES THAT . .. c l ............................................ Foundation.A7 .. / .. .. � C . ........................................... has permission to erect............ ...................... buildings on 9 s�..✓.. ................. �pS .................................. Rough to be occupied as..:.. ..,. ,-�©......,...S, �1'�. /6 �/� i"� Chimney . . ;provided;that the personsacceptigwthis{permit shall in every respect conform tot a terms of the application on file in Final this office, and to the provisions`ofthe 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 I Final . PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR _ Rough i .............. ":...... ..'`. .. .................................... Service BUILDING INSPECTOR ' Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. BurneFIRE DEPARTMENT r Street No. SEE REVERSE SIDE Smoke Det. = Massachusetts- Department of Public Safet% Board of Building Regulations and Standards Construction Supervisor License License: CS 57893 Restricted to: 00 LEE M DANLEY 92 SCRIBNER RD - FREMONT, NH 03044 -^�- —y-- Expiration: 3/4/2012 < muni..inu r Tr#: 19391 Restricted to: 00 00- UnrestrIcted IG-1 2 Family Homes 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 Town of North Andover of tiO oTk Building Department q .� f./,�i v •aVb 0 0Osgood street 0 r 16 a•r o .�' - t North Andover MA 01845 0 p Tel: 978-688-9545 Fax: 978-688-9542 0by r 04A cOCNKNtw..`M�' DEMOLITION OF BUILDING AFFID"IT ' sSaCHUs�� DATE OWNER'S NAME & ADDRESS d LOCATION OF PROPERTY TO DEMOLISH 1 -719 V ,s 2 c�_S� DESCRIPTION - CONTRACTOR'S NAME &ADDRESS D EPA E T SIGN-OFFS/ DEPT. OF PUBLIC WORKS -WATER: SEWER: DEPT OF CONSERVATIOPt HEALTH DE : Sept" Well kol n�,)klI HISTORIC COMMiSSIO GAS 14 Cv ELECTRIC cx-- � TELEPHONE CABLE TAXES POLICE r d UGC' r ` v�✓Q FIRE EXTERMINATOR J Zc G hL DUMPSTER—ON/OFF STREET DIG SAFE NUMBER &LO t t 0 3 0 / •7'y DATE REC'D BLDG. INSPECTOR Doc.form demolition of building affidavit The Commonwealth of Massachusetts 1 r Department of Industrial Accidents Office of Investigations 600 Washington Street tll d Boston, MA 02111 fwww.mass.gov/dia . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly l Name(Business/Organization/individuai):__ c, cr -7 fe ci De/7t)� Address: Po d6-V /a City/State/Zip: e�zvnq' Af k1 0 3CS�i4/ Phone #: Ari an employer?Check the appropriate box: Type of project(required): 1. m a employer with-- 4. ❑ 1 am a general contractor and 1 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 211 I am a sole proprietor or partner- listed on the attached sheet.t 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. [Demolition. working for me in any capacity. workers' comp. insurance. g, ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL .11. Plumbing repairs or additions myself, [No workers'comp. c. 152, §1(4),and we have no 12.0 Roof repairs insurance required.]t .employees. [No workers' 13.❑Other comp.insurance required_] *Any applicant that checks boz#t must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit.indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this 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 my employees. Below is the policy and job site information. Insurance Company Name: 0--u/'e-51/1) 1 ,1 S jl 0,r•,0,e Policy#or Self-ins. Lie.#: [ S6 0 S4. 9 /_z�a /y Expiration Date: /U a� Job Site Address: / -71 �'t �S T ell Sl/, i : _ ' '- '-City/State/Zip: /YD d vo4, j'/ Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date)U Failure to secure coverage as required.under Section 25A of MGL c. 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 fine 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 hereby ce nder the pains n enaliks of perjury that the information provided above is true and correct Signature: Date >l Phone Offlcial 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 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: Jan 11 11 05: 12p Ins Offices 6036353815 p. 1 .466R,1:70CERTIFICATE 4F LIABILITY INSURANCE - 1%11 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: If the certificate holder is an ADDITIONAL INSURED,the poBcy(ies)must be endorsed. it 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 ACORN INSURANCE NAME: — 25 Old Lawrence Rd �c"�Extl_ 5c.No:(603)635-3815 Pelham, NE 03076 Ainsoffices@aol.com ST R #: r9AIRERISI AKORDWO COVERAGE NI11CIt INSURED Danley Demolition, Inc INSURER A: r xng on assurance P O Box 154 INSURER 13:Pro gr saive 92 Scribner Road RISURERC:A—dW-Cral Ins Fremont, NE 03044 INSURER D:Hartford ns 603-895-4900 INSURER E:Great American 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 DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. fY EXP it TYPE OF INSURANCE NSR VYVD POLICY NUMBER MMI O"UL SUM Y Yv MIDD LIMITS GENERAL LIABILITY EACH OCCURRENCE 5 ! UUU COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ f 1000 CLAIMS-MADE M OCCUR 000 A EGL0023906 MED EXP(Anvoneperson) $ , ; X y /29 /2010 9/29/2011 PERSONAL B ADV INJURY S 0010 GENERAL AGGREGATE $ r GENT-AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG S POLICY JPE OT LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANYAUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS B 034498875 /30/2010 9/30/2011 BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE $ HIRED AUTOS Per accident) NON-OWNED AUTOS $ $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ C X EXCESS LIAR CLAIMS-MADE EXOOOO1130001 /29/2010 9/29/2011 AGGREGATE $ VVV J, r DEDUCTIBLE $ RETENTION S $ WORKERS COMPENSATION WC ATU- 0TH- AND EMPLOYERS'UABILITY YIN 0/17/2010 10/17/2011 TORY LIMITS ER D AW PROPRIETORIPARTNERIEXECUrIVE 6S60UB4396P72210 E.LEACH ACCIDENT $ OFFlCERtMEMBER EXCLUDED? N!A00 prrndswyinMf E.LDISEASE-EAEMPLOYE;$ r I�f yes,describe under DESCRIPTION OF OPERATIONS betaw EL DISEASE-POLICY LIMIT $ an arine E IMP2003302 /29/2010 9/29/2011 $460,500 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101.Additional Remarks Schedule.if more space is required) Additional insured Roy McK3-nney CERTIFICATE HOLDER CANCELLATION Roy McKinney 1721 Osgood St SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE g THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN NO Andover MA 01845 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPREA t l (l a 1988-2009 ACORD CORPORATION. All rights reserved. ACORD25(2009l09) The ACORD name and logo are registered marks of ACORD 041 P.O. Box 154, Fremont, NH 03044-0154 Tel. 603.895.4900 Fax 603.895.4922 Demolition & Environmental ***Inspections & Consulting ***Licensed & Insured January 20, 2011 Roy McKinney PO Box 8373 Ward Hill MA 01835 Re: Abutters Notification To Whom It May Concern: III Please be advised that we will be demolishing the home located at the following address: 1. 1719 Osgood Street, No. Andover MA Respectfully, Rita M. Danley President, Danley Demolition Inc. i AV P.O. Box 154, Fremont, NH 03044-0154 Tel. 603.895.4900 Fax 603.895.4922 Demolition & Environmental ***Inspections & Consulting ***Licensed & Insured . January 20, 2011 Yvette & Roy McKinney 1721 Osgood St. No. Andover MA 01845 Re: Abutters Notification To Whom It May Concern: Please be advised that we will be demolishing the home located at the following address: 1. 1719 Osgood Street, No. Andover MA 7Ceu lly, ,Q,.,, Rita M. Danley President, Danley Demolition Inc. i . A P.O. Box 154, Fremont NH 03044-0154 54 Tel. 603.895.4900 Fax 503.895.4922 Demolition & Environmental ***Inspections & Consulting ***Licensed.& Insured January 20, 2011 Ozzy Properties Orit Goldstein Osgood Landing 1600 Osgood Street No. Andover MA 01845 Re: Abutters Notification To Whom It May Concern: Please be advised that we will be demolishing the home located at the following address: 1. 1719 Osgood Street, No. Andover MA Respectfully, Rita M. Danley President, Danley Demolition Inc. I� ANTE.. .. X Pest Control Co. LLC 4 SUNRISE TERRACE • PLAISTOW, NH 03865 (603) 382-1776 • (978) 372-9929 PEST CONTROL SERVICE AGREEMENT DATE OF AGREEMENT1 / Io NAME IDE AME] .r /g i(.) ADDRESS DD E§S .C„ I !7 STTZIPCITYSTATE ZIP � Y�HONE 2ND PHONE PHONE 2ND PHONE SCRIPTION OF S RUCTURE(S)COVERED 1. THE COMPANY AGREES TO PROVIDE PEST CONTROL SERVICES AT THE SERVICE ADDRESS INDICATED ABOVE. 2. THE COMPANY WILL PROVIDE PEST CONTROL SERVICE TO CONTROL THE PEST(S) CHECKED BELOW. EXTRA SERVICE FOR THE PEST(S) CHECKED BELOW WILL BE PROVIDED AT NO ADDITIONAL COST TO THE CUSTOMER. 3. CUSTOMER AGREES TO MAKE THE PLACE OF SERVICE AVAILABLE FOR TREATMENT AND/OR INSPECTION AS OFTEN AS NECESSARY TO CONTROL PEST(S) CHECKED BELOW. 4. THIS AGREEMENT WILL BE FOR AN INITIAL PERIOD OF�_MONTHS. 5. AFTER THE INITIAL MONTHS,THIS AGREEMENT MAY BE CANCELLED BY EITHER PARTY BY GIVING THIIRTY(30) DAYS WRITTEN NOTICE TO THE OTHER PARTY. 6. THIS AGREEMENT DOES NOT PROVIDE FOR THE REPAIR OF PRESENT OR FUTURE DAMAGES TO THE SERVICE ADDRESS, NOR DOES IT PROVIDE REIMBURSEMENT FOR REPAIR EXPENSES ALLEGEDLY ARISING FROM PEST INFESTATIONS. 7. IN ENTERING INTO THIS AGREEMENT CUSTOMER WAIVES ALLCLAIMS FOR DAMAGES TO PROPERTY OR PERSONS WHICH MAY RESULT INDIRECTLY FROM WORK PERFORMED BY THE COMPANY, WITH THE EXCEPTION OF GROSS NEGLIGENCE ON THE PART OF THE COMPANY. 8. THIS AGREEMENT DOES NOT INCLUDE SERVICE FOR TERMITES OR OTHER WOOD INSECTS, NOR DOES IT PROVIDE FOR DAMAGES ARISING FROM INFESTATION OF SAME. TO BE CONTROLLED ❑ CARPENTER ANTS ❑ SILVERFISH ❑ WASPS ❑ HOUSE ANTS RATS ❑ HOUSE CRICKETS ❑ FLEAS -MICE ❑ CLOTHES MOTHS ❑ INDOOR SPIDER CONTROL ❑ GERMAN COCKROACHES ❑ PANTRY PESTS (SPECIFY) ❑ CARPET BEETLES ❑ BEES ❑ MATERIALS USED • �® METHOD OF e MAX FORCE FC MAGNUM 432-1460 CONTRACT BLOX 12455-79 p G � �' `F' J , TERMIDOR SC 7969-210 DELTA DUST 432-772 DEMON MAX 100-1218 SUSPEND SC 432-763 DITRAC TRACKING POWDER 12455-56 / � 1 APPLICATO 'S NO.. EC NICIAN SIGNATURE 7 CUSTOMER SIGNATURE i TOTAL FEE FEE IS FOR AMOUNT OF PAYMENT PAYMENTS TO BE MADE AMOUNT PAID TODAY ❑ONETIME ❑QUARTERLY MONTHS a a - ❑MONTHLY ❑ANNUALLY Ic-;,, - • YOU,THE CUSTOMER, MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE,OF TI-lI TRANSACTION. AUTHORIZED COMPANY SIGNATURE DATE CUSTOMER SIG�NA•.URE I } DATE 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: 1 7/ 1 CQ-scavc- �Yis 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 10A. The debris will be disposed of in: (Location of Fac' ' ) Signature of Permit pplicant Fire Department Sign off: - Dumpster Permit Date