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Home My WebLink AboutBuilding Permit #457-2017 - 174 JOHNSON STREET 5/1/2018 v I � ' NORTH BUILDING PERMIT o ""6 TOWN OF NORTH ANDOVER . APPLICATION FOR PLAN EXAMINATION ^\ T y K 1 Permit No#: Date Received �y°°R�TEo�Pa icy ' Ss CHUSS Date Issued: - IMPORTANT: Applicant must complete all items on this page LOCATION --Y- - ...Print PROPERTY OWNER � Print 1o0 Ya r§trU7 dtu re yes no MAP PARCEL.ZONING DISTRICT:_ Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Two or more family ❑ Industrial 11 Addition y ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other 1. ❑ Septic 0 Well ❑ Floodplain ❑Wetlands. ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: Contractor Name: Phone: I Address: ' Supervisor's Construction License: _ 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. i - ,Total Project Cost: $ FEE: $ Check No.: Receipt No,; NOTE: Persons contracting with unregistered contractors do not have:access to the guaranty fund Signature of Agent/Owner L Signature of contractor. _ r Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TypE�OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swumning Pools El I Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank, etc. ❑ Pennanent Dumpster on Site ❑ 4 r' THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM i PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS 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: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on.site :yes no. _ - Located,at 124 MainStreet J - - Fire ,Department signature%date COMMENT limension 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're'y vires approval of q pp Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA — (For department use) ❑ Notified for pickupCall Email ate Time Contact Name Doe.Building Pen-nit Revised 2014 r Building Department 'n i I' o he required forms to be filled out for theappropriate ermit to be obtained. The following s a list f t q edp ,.-..� 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/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 NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit I 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 VOTE: 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 I Doc:Building Permit Revised 2014 Il Location 17Y N No. 4(S-7_ go I ? Date M 3/- � • - TOWN OF NORTH ANDOVER e Certificate of Occupancy $ ' Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ F Check# 4 f/ V Building Inspector r - NORTil - . : ve ' 'o O - �+► No. 461vop� q - - � 1b % ver, Mass, O • 31 40 4P 01 (b COC KICKE WICK �1• A�RATEiD s u BOARD OF HEALTH Food/Kitchen PERIT T D Septic System THIS CERTIFIES THAT ........ ....� .. ............... ,,,,,, , ,�, r �, BUILDING INSPECTOR ............ A ............. has permission to erect .......................... buildings on ...../... .. ..... .......ZOOMSAV........... Foundation Rough to be occupied as ... .0............W,l.N....' $.�............. .......j ! .lb............ 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 CONSTRUCT STARTS Rough Service ...... ...... .... ....c . ........................................ Final BUILDING INSPECTOR 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. Rmwal Agreement Docu ment and Payment Terme lwsdnrr sed-Gary DWS x.o .- tiY Frwval b'k4fsm LIC 174 Jcdhitson at 3U WUS FbiaJ I Wghkt(rough,MAC 153 C t�76 a94 SA I r, ?h`+o W 593-,1-22G31Fac I'M!SZZ-7'J3211 E Sian rttat�rn "+rer5eis QrF�.€are li t'xmonsclji) Nair,& Oairra aaVIS an.d'Gary [ lWaS �011tract Mut i 116 CvAtooati+.) Street Add,*m:1,74 Johison St, Worth Ando er. W.O''9 845 �tiln3t}'".I:tJ�plitia�t=''.umber 'wouois> Tt9cF5Fixitie i'utitbet (978)$90_5010 Piisnary byk ad: Som ratuY 6itai.l: Baytin sl hereby patnr_ly and s�erally 29rces to Pur a dtt plod ucrs aiEcEi a .sem- es 4 Rmc caval by Andersen U..0�9.tPa.Renewal by a�9r1�Cll-o B4*.Ati.Sii��CC]+I�U=t*t7), uY AC'ti'Whl�MC�Wi&rbt tcrAU:Illi lrrfutdi{7Gri'�r d6cn'btd iii [IlLs}��i 775ent avid '[thew Tem"Te Kcidce of 4�anaelllatimn.tr�iml FdCF.l}-cam.Sjb*.Co5r Vine_NtA t?4 dmdtarm,Terns nn4 CiratdMPnic-of$nlrr,XYEaiTcr,owaff c4 Builder,EJecrndnic Commn; MR(nntrrc:tOF Arbirradca,ti d.any Aer docun::nt armched co This ApomK t DOCU nerit,Elx rerun of-which arse al]agreed m h,;the pzniu and.i.rtccrtparsted bem6m by r6enenco(rnll'ztiiis�l}�this"Agvwmtmt').S.,�r(s}hereby.avers''ta s n a, cosnlrlesietm asrri6wfs alisunrraaar has rrtmPEeterla0 srorl;under thi9 fSgreerzat�, "I mal Job AUtit3u11E: S6,843 ,`r 'i cfi95 a rxrrnffl ,)TIJ nL tltar the 1.3ae riX ..an4 6c.Amc m1 Filo"mull tV IvA& •r#11c6cl�bna thy,cvdlz aid,gar�Cvh� l:�tp.nit I�c�cS+nc:d: � (3rdancr.Oew: 56,843 EftibsartJ Ss,art_ EReiii'_i11 A Ccj MP!tjrikhit: Aiuowii F]MIsteid: 561843 weeks 1. da i lnh tl d R:i*',isi,eiSC: �itlii,g 'Sit s cl dide•irtsaallarions bed im die Jtzt of rhe jj_WA conuaor and sec rily 013 tlae•"C in Which,va oaraI:lrte thr srebniml metasureammntsv The installatean date r1"sa1 LSat� 3 pl �i#31 1�'3 f Weare Pmviding ar Ellis time is onbr,an csomax.Ve wiH communicase an official cute 113at start S2294. Mid drjr=a bEcr LIUM Mn tel elUt-trt,+Ti lufr ate dit nwa Co.rntiro►i,2u ('O.r 113sub.00mplotlo;62284 &�I Bayti(s)agrees and uridefsran&iliac Ellis+i,gmment consurutes rhe•enTirt uirdenundinz between Elie panics wd duE'Entre are txo+t to Esrtdiot;5 c_1kjmgi at ts:at9iC ltt ais�+of Elk ottitas a:cti,!€h ixci5tctle:. Cd,�ailE ic,ia [a rir deuiatiotsa ern dlis h irxi�tcna vrill L+c rtiilitl _Agrcca�t�a s"t_,an alert ov nt of hvr.h rhl flu s)and Conwacrnr, F�E:y=W bsi*- 'AC rKnvW ctzxr Rvmrf:5;i 0 las rend 9has - ign. undc cL dw rerr> E.Of Ehis,ri me®r,nd has received:a 4ornp,"ocA s�ncd, acid dated CM of 16,4rieemeor,Indoft thr twv atrachad Xoticxs ofCanrOation-on talus dart first sYT'M-n abW!20dL Zf Was anally informed of BETt v right to caned this �rc+crrtcnr. NOM C ` O OWN LR [Jta rruE sial dik c0t1=1 if bhnL 3'i+u ate 0116161 W 2.COP) of d1e.�r,itEraef aE d�liwe,�rxi. YOU,THE EL IL M"CANCEL,THIS TRANA. 'TT0N AT ANY TDIE NOT LATER THAN MIDNIGHT OF 081 1 16 0 R THE TF IRI 13VS1 IM DAY�%T E R:TH E LSAT Fi Ill"- 1T11;1' �"AC TIV , W I CHISVIER DATE LS LATER.S IEE THE TIAC1-IE NOTE O ff;CANCELLATION FORM FOR AN EXPLANATION OFTTHS WGHT. LquANcmti Bracts!ttyrAn&rsm LWC d31=Ricc•a]'�.findarscn aft .� _ r SvizumofSalc-i'lk-ilure gieftnust 4l ivaEsul Clierald Perron Lorraine Davis G_ary Davis Fi.rrtE artaersf al G'r uwt Fiiittis a Rim.N'atrtt 4rs173116 page 2 1 1? I �IeWa I Itemized Order Receipt tyArdersen l�rxl[rgr snd GaRyr res t.eoil 1f2-,g.FLrwNal by arduwn itC 174 JohrrsDn St Hl[.A170910 ,4WD W.Mao 4134� 3-11 Ftytt2s FALA I Mw0bmugh,.MA f-1532 {g S44-5414 Frcge:Xr,1-22001 Faa:1 015f-7a72 i Ft�E�rlan�3peraf�un��u-,+ nr��yam 141 Laitarary V11n'dow: Gliding-Tn;!e,Gliding, 1:1:1, E)Frame, 8rxkmould I TraditLonA. EX:'ERIOR White, I11TIEl30ft White, Glass: Sash All: Kqh Pelormance SmartSun Gams, No Pattern, Hardware: white, !Screen! a-ibe rglass, Grille She:Grilles Between Glass{GBG). Grille Pattern. Sash Alk Colonial 3w x tab. fAllics Mari 102 I i F$r + Wi'ritiraw:Gliding -Tf a'e,Glicling, 1:1:1, E1 Frame, or.ckmo,41d t Trad,tiOste, EK- RIOR whalo, I ITEMt3R White, 614159 Sash All: Kgil Per{urrlance Smarl5un Was% I'to Pattffn, Tempered Glass, Ha rdwaTe, White, Screen: Rb:erglassr Grille Stlrla; Grilles Between Glass iGBG1, Drilla Pawn;Sash Al Caftmial 3w x 6h, Misc -:an VdiNDOWS:2 PATIO MRS'0 SPE 'U!"t 0 MISC.,0 Tow 56,843 UPDATED 001 016 - - la=tnr,�'a#bjr�:�'triiia Kr ra�rrr�r�irrr��o fxuFgr�rr�`r�a��r E� ramolying trAb rkv ruler and from=ioft cap+prac.r&r;,rpfrjfiedby jw EIK I73t76 Pane 4 r V 1!v • -y�-g►{¢dap• mws*nNvtyle�o�wwn'+�i+�l .,_ ««. « DLVH RMOnqp tiy>.grllpiallwr.asr+�suwe 1 '.Yi�a�l.GrlrYrr�i.:a�a�wr�ryaolr�l4pllrulauwr �al..d Mn>•WI�LLMI�urK�prW�Jl.s��Adll.��r.i�w.+��1 « 6V •• MMM EMW80iJ d-"=lady , Woo w o Uwe WH ADS mw$3il pssollkm InUVSBDM"ACV= Ilk -M-AKLPnP-d ung :6g, =A1w m _ I sfMrs-WUM AWMe Y PLIVAq •hn++wrer�rrrY•drl �- �• ��. � CERTIFICATE"' ANDBCOR-01 SALWAUN iv OF LIABILITY INSURANCE DATEtMWMY" THIS CERTIFICATE IS ISSUED AS T 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. the ter ANT: H the carion of the holder Man ADDITIONAL INSURED,the polky(Rea)must be endorsed. If SUBROGATION IS WANED w the terms and conditions of the polity,certain Policies may require an endorsement. A atetement on tFlle Meet to certificate holder in Riau of such endorseme s certtiicate does not confer rights to the PRODUCER Wulls of Minnesota,Inc. NAME: Willis Towers Watson Cerifficate Center do 26 COMM Byrd P E 877 943.7378 P.O.Box 305181 No 888 467-2378 Nashville.TN 37230-5181 A williallicom AFFORDING COVERAGE MAIC e INSURER A:Old Republic Insurance Com an 24147 INsuREIe a Reneml by Andersen INSURER C: 30 Forbes Road Northborough,MA 01532 INSURER n. INSURER E: COVERAGESIINURER F CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED To ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT THE INURED NAMED OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIB EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.ED HEREIN IS SUBJECT TO ALL THE TERMS, OUCY LTR TYPE OF INSURANCE �` A X COMMERCIAL GENERAL UASIM ►AAMa T LINTS i;La EACH OCCURRENCE $ 1,000,00 OCCUR WZY 308234 1010112016 10101/2017 PR j $ 500,00 MED EXP me $ 10,00 GENL AGGREGATE LIMIT APPLIES PER: ! PERSONAL 6 ADV IN iURY $ 1,000,00 X � ❑dECT ❑LOC + ! GENERALAGGREGATE S 4,000,00 DIRER: I PRODUCT'COMP00P AGG s 4,000,000 AUTOMosLE LIABILITY $ COMBMEp SINGLE LIMB $A X WIVE MWTB308232 11010112016 10/01/2017 swiLYIWURYPer 5,000,000 OWNED � I i Pe�ea:) S HIREDAUTOS BDDILYIri1URY(Peracddg1we,N) S AVTOS I For a _ S uN6RELLA LU18 OCCUR $ EXCESS UAB CLAIMS-MADE EACH OCCURRENCE s I DED RETENTION + AGGREGATE $ WORKERS COMPENSATION AND EMPLOYERS-LIABLrry d A ANY PROPRIETORMARTNEREXECUTNE YIN ❑ X OWCERWMBEREXCLUDED? NIAWC3O823100 10/011201610/01/2017 STATUTE ER 0Aandal in NN) ACCDN S 1,000,00rION OF oR bepw I I E.L.DISEASE•EA EMFq s 1,000,00( I E DISEASE,POLICY LIMIT S 11000,00 fl I DESCIePTiON OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101-Addtd0i ROmuq Sol el li11ey be tlbahed If mote spools iequbrd) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WrrN THE POLICY PROVISIONS. AUTHDRnD REPRESENTATIVE roof of InsuranceA. K� ACORD 25(2014/01) The ACORD name and logo are registered marks of A ORD D CORPORATION. All rights reserved. rn i The Co nntonwealth of Mawaehun& Deparhuent of Industrial AceM=& Offlce 0f1xvcstiSations 600 Washington Sher Boston,HA 02.111 IF www.anas&gov/dia Workers' Compensation Insurance Affidavit;Baflders/ContractorgMeeWd�s/pl�� A Heart arm d n Name ). RENEWAL BY ANDERSEN Address: 30 FORBES ROAD Ci /State i : NORTHBORO.MA 01532 Phone#: 508-351-2214 Are you an employer?Cheek the app roprfste box. 1. I am a employer with 30 4. []I am a general contractor and I Type of filed(require ): employees(full and/or part-time).* have hired the atb-contractors 6. ❑New oonal action 2.❑ I am a Bole proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These sub-mutrgGbis have woddag for me in any capacity. employees and have workers' 8• Demolition [No workmI comp.insurance comp.insurance! 9- ❑Building addition required.] 5. ❑ We am a corporation and its 10.[]Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑pig repam or additions Myst!£[No workers'comp. right of exemption per MGL ios� -]t a 152,61(4).and we have no 12.❑Roof mpaim emPlOYm-[No workers' 13.[]Odw COM.insurance required.] *Any M&AW fat dmb boor Ill must alto Sapt the amda,below showiq their worloera'oompensetiop pally i,6tmobbn. H,meowa=who submit dais affidavit ip *win doing all wmk rad than hire aatsids pct==,t sprit a raw =Caahaebsrs that check this baa mast attached m addi�al sheet�8�y�� este mer�WSdnieiasdash,g such. employees. 1f the nbl-c�harm empiaym.they must povide their workaas'caorp poIiay,amber. enlidss have ll dn efirloyer AN is pranid6eg wo?*em 0 cosnpeWatbn faramaw for my ems, Rdew Is dFe P&Vq mdjob ache Insurance Company Name: OLD REPUBLIC INSURANCE COMPANY Policy#or Self--ins.Lk.#; MWC30823100 10/01 Expiration Date. 12017 Job SiteAddr+eas: 174 Johnson Street aty/state/zip: North Andover, MA 01845 Attach a copy of the workers'eompensatlen policy decLnfiafl paw( the pWky Faihue to secure(overage as requited under Section 25A of MGL e.152 can lead to t>m number � ��te� fico trp to Z 1,500.00and/or one-year imprieo m�as p� of miw!W penalties of a Of up to USO-00 a day against the violator. Be advised that a penalties in the form of a STOP WORK ORDER ad a rine j' m IA for iastuance coverage vatiticafn caP3+of this statenuat may be ffi ,arded.to the Office of r6-0ther car* dlre pairs axd pettddea ofp8dany o w diva ¢J O1e pro►a'dsd arb� w is pare mwd c�onuft Com—+ 10/24/2016 8-351-2214 true oxb& Do rwt writs In dlda dvea,b be carr pJ�by�'or tmm of'icid Town: Andmulty(drele one): Perms# sal HealW 2.Bntlding Department 3.Clty/Tmm Clerk 4.Eleettical Inapectar S.PlurmbhtgPerson. Phone P y ' Massachusetts Department of Public Safety ; Board of Building Regulations and Standards ! License:.CS.090125 Construction Supervisor JAIME L MORIN 8$GARBIWA ST LYNN MA Q1905 <U A, CA, . Commissioner Expiration: — — .- 'ItN0618618 J I Construction Supervisor Restricted to.- Unrestricted o:Unrestricted-Buildings of any use group which contain less than 35,000 cubic feet(991 cubic meters)of enclosed space. s i r s Failure Es psSeas a current edition of the Massachusetts State Buiik*V Code is cause for retreaadisn al eft k"se. DPS Lining information visk VWW AABSJ;iWWS r fie r�ammeonu�ea�/a o�C��aaaac�/ivae� #ReghhW, Type: e of Consumer Affairs&Business Regulation ME IMPROVEMENT CONTRACTOR , r ; Supplement Card RENEWAL BY AND r ;} JAIME MORIN 30 FORBES Rb NORTHBOROUGH,MA 01532 + Undersecretary