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HomeMy WebLinkAboutBuilding Permit #525 - 178 WATER STREET 2/8/2005,10RTN of �.�•° Y. 1N0 p TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION �SS4cNuset r Permit NO: J a%13 Date Received: G Date Issued: 'O - IMPORTANT: Applicant must complete all items on this page LOCATION — / R _ Print PROPERTY OWNER � 0 � S C(/` 4-) <- Print C� MAP NO.: PARCEL: qO ZONING DISTRICT: TVDV A%Tn rTes nc UITIi niN!_ U1Q.TnUIC nlgTRIC'T VFS n TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential E New Building D Addition X'Alteration 011 One family grwo or more family No. of units: C Industrial C Repair, replacement Demolition C Assessory Bldg ❑ Commercial ! Moving (relocation) Other ❑ Others: Foundation only DESCRIPTION OF WOKK 1 O Bh FREPURMLll G�/l V ✓� � i�� Identification Please Type or Print Clearly) tn n 9 7P OWNER: Name: nn s Address: /9-0 IAJc04vC CONTRACTOR Name: Ili Cha Address: /() 6 Supervisor's Construction Licen 6 Exn. -g37 3 o �3ss3 Date: Home Improvement License: lI G 324- Exp. Date: ARCHI"TECTiFNGINEFR -'IDA Co �nc, ��er��-yName: Phone: C%7 �— G 6 y Address: r f— I U -ems4-�_ Reg. No. FEE SCHEDULE: BULDING PERMIT. $10.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $12.5.00 PER S.F. Total Project Cost :$ d x10.00-=17EE:$ Check No.:! �� Receipt No.:9�, TYPE OF SEWARGE DISPOSAL Tanning/Massage/Body Art Swimming Pools 10 Public Sewer Well , Tobacco Sales Food Packaging/Sales — _ Permanent Dempster on Site Private (septic tank, etc. ! _j NOTE: Persons contracting with unregistered contractors do not have access to the guara&,/,,Signature of Agent/Owner 4�';zSignature of Contracto Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ 1 Stamped Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM I DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION COMMENTS ❑Water Shed Special Permit ❑ Site Plan Special Permit ❑ Other DATE REJECTED 11 C DATE APPROVED DATE REJECTED DATE APPROVED HEALTH ❑ ❑ 'COMMENTS Zoning Board of Appeals: Variance, Petition No Zoning- Decision receipt submitted yes Planning-, Board Decision: Conservation Decision: Com Com Water & Sewer connection signa/turree&& date Temp Dumpster on site yes_n� o_ Fire Department signature,'date_� �%_ Building Permit Approved and Issued by: Building Setback Front Yard Side Yard Rear Yard Required Provided Required Provides Required Provided L11vi l ii,4 01"1 1 Number of Stories:_ Total land area, sq. ft.: Total square feet of floor area, based on Exterior dimensions. N(.) I bJ and UA I A — ( For department use) i I( � l J Uuc: INSPEC 1 ZONAL. SERVICES UEPAR I MLNT:I>I'1:GRM05 Irl 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 ❑ Debris Removal Form ❑ 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 ❑ Form U ❑ Surveyed Plot Plan ❑ Debris Removal Form ❑ 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) 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 Hydraulil Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report j 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 Location 2 ,rl - No. BSc Date f NaRT►► TOWN OF NORTH ANDOVER Oft.o �'�ti F 9 Certificate of Occupancy $ �'�s'••° t��' s�cwus Building/Frame Permit Fee $ Y Foundation Permit Fee $ Other Permit Fee $ # TOTAL $ s Check #� C 18967 - //1—Building Inspecto1v ACORo CERTIFICATE OF LIABILITY INSURANCE OP ID B DATE(MM/DD/YYYY) r . WILLI-3 02/06/06 PRODUCER Samuel J. Durso I,nsurance Agcy THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Charles S. Randone HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 198 Massachusetts Avenue ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. North Andover MA 01845 A ORI REP SENTATIVE Phone: 978-682-5175 Fax: 978-794-0313 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Preferred Mutual Insurance Co. 15024 INSURER B: Williams Construction INSURER C: Richard Williams DBA 106 Beverly Street North Andover MA 01845 INSURER D: INSURER E: UUVERAGES 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, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR INSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MM/DD/YY POLICY EXPIRATION DATE MM/DD/YY LIMITS A ORI REP SENTATIVE GENERAL LIABILITY EACH OCCURRENCE $ 500000 A COMMERCIAL GENERAL LIABILITY CLAIMS MADE 50 OCCUR CPP0110573904 PREMISES (Ea occurence) $ 50000 MED EXP (Any one person) $ X Business Owners 05/18/05 05/18/06 PERSONAL BADV INJURY $ 500000 GENERAL AGGREGATE $ 1000000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OPAGG $ 1000000 POLICY PE& RO LOC J AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT $ (Ea accident) ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per person) $ HIRED AUTOS NON -OWNED AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR F—I CLAIMSMADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OIH- TORY LIMITS ER E.L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? If yes, describe under E. L. DISEASE - EA EMPLOYEE $ E. L. DISEASE -POLICY LIMIT $ SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS GERT IFIL:A I E HULUER CANCELLATION LOI SCUT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN Lois Curtis NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL 178-180 Water St. IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR N. Andover MA 01845 REPRESENTATIVES. A ORI REP SENTATIVE AL.VKU 20 (2UUl/US) © ACORD CORPORATION 1988 The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Annlicant Information Please Print Letsibl, Name Il�usincss/(lrganiratian/Individual): Address: City/State/Zip: Are you an employer? Check the appropriate box: I. ❑ I am a employer with 4. ❑ 1 am a general contractor and employees ( full and/or part-time).* 2. 1 am a sole proprietor or partner- ship and have no employees working for me in any capacity. [No workers' comp. insurance required.] ;. ❑ l am a homeowner doing all work myself. [No workers' comp. insurance required.] t have hired the sub -contractors listed on the attached sheet. 'These sub -contractors have workers' comp. insurance. 5. ❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] 3 kz) Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions I I .❑ Plumbing repairs or additions 12.❑ Roof repairs 13.XOther �41 'Any applicant that checks box it I must also till out the section below showing their workers' compensation policy information. + Homeowners who submit this affiduvit 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 intimmation. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy 4 or Self -ins. Lic. It: _ Expiration Date: Job Site Address: City/State/Zip:__ :attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). 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 tine 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 certi1j:4inder.1/y paiy and Rq nal4igof perjury that the information provided above is trite and correct. 4 a Ullicial use only. Do not write in this area, it) he completed by city or town ollicial. City or Town: Permit/License # —6 lv Issuing ,authority (circle one): I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: v O z 6 fA W C=.` O N C vV :0 : D O O � Ea CD _o ' •r Q on . E c • oma'. com w a ' N R m O �CA N N m 3 cm 45.3 C_ C� m Cc N C A t N CD a� N m .J -CO3 t c"ya O 1 v .N O cc Z ti o o a O N m C = m O= C F- �01-- O W C-00fl LL m �... C F. ,N .E 67 V v m ,a V� a m 'r 1- $ cpm E Ir CION zip0 CDN C m CD c CIO 0 ca c 'c N m O Z O g 0 F. co O CD L CD Z p. O y D C O Cm CO) O O .� O O .CO2g m m CD CD CD 3� CD L. Cc 0 oMa �Cc cm O C Z �..� Na O C — C •= C _c J. H Til Yi W to 19W i W d" W W co w w w Q� R7 u cn ► a C v t'+ V A; W v Q w e a a-� o w w w cn cn C=.` O N C vV :0 : D O O � Ea CD _o ' •r Q on . E c • oma'. com w a ' N R m O �CA N N m 3 cm 45.3 C_ C� m Cc N C A t N CD a� N m .J -CO3 t c"ya O 1 v .N O cc Z ti o o a O N m C = m O= C F- �01-- O W C-00fl LL m �... C F. ,N .E 67 V v m ,a V� a m 'r 1- $ cpm E Ir CION zip0 CDN C m CD c CIO 0 ca c 'c N m O Z O g 0 F. co O CD L CD Z p. O y D C O Cm CO) O O .� O O .CO2g m m CD CD CD 3� CD L. Cc 0 oMa �Cc cm O C Z �..� Na O C — C •= C _c J. H Til Yi W to 19W i W d" W W co C .20 .Jm-f CV) -0 00 E co (D 0 cc Ir— crp--u C%4 C: 0- C_ cc 0 .5 C: 0 (1) Cl) o< 0 (D 00 MO 0 OD LO CY) OD 00 C) a; ca —.A 9 to t- oo V C,3 00 0 co (0 (0 �u CL E 4) 4) FL- co co O (A x w V C,3 00 0 co (0 (0 �u Lois Curtis 180 Water Street North Andover, MA 01845 We treat your home like, ours Gorst : Uct- �y; :::. .. C° •� d General Contractors C/S # 051796 .......................::.:.. HIC # 116328 Jrii ii'r ((� Q 1 O 1 No. A0d01 Apartment Building Within the existing foot print, we will build a 3'd separate unit. Frame the 16' x 10' area of flooring. Frame in the entire ceiling using 2 x 8 ceiling joists. Add two door entrances per plans. List as follows: Frame floors Frame walls Frame ceilings Electrical outlets, switches, lights, & heating Plumbing for kitchen & bath Piping for sprinkler system — per approved plans Sheet rock & tape walls & ceiling Install door, window, & baseboard molding Place installation inside walls, ceilings, & floors wherever possible. Owner is to supply kitchen cabinets & appliances. Owner is to supply bathroom cabinet, shower, & toilet sink 0441J C Total Cost: $75,000.00 Customer: z ` n „c„ Date: -_ IS Contractor: x Date: Rick Williams Bus: 978-688-3033 Cell: 978-335-5380 builderrickwcc@aol.com I r t ds�cNusa� Town of North Andover Community Development and Services Division Office of the Zoning Board of Appeals 400 Osgood Street North Andover, Massachusetts 01845 D. Robert Nicetta Building Commissioner •d 'J , 1 I1. Telephone (978) 688-9541 Fax (978) 688-9542 Town Clerk Time Stamp RECEIVED 1005 APR 22 A10.3q This Is to certify that twenty (20) days have elapsed from date of decision, filed 1 without filing of an appeal. aGU� Date T/i y Joyce A. Bradshaw 'Down CUM o U) � e o H S N r N N N co D 3 t C,J0 H v d voted to GRANT a V3 C per Certified Plot Plan, C Curtis, Date: August 3, CL les Surveying, 50 ''n N by H. A. Curtis Jr. o O ° M. Vaillancou 4 Mrt � 0. (14 a & b) of the y o trimental than the co ATTEST: 3 1 A True Copy ' a N P4 0 Town Clerk Time Stamp RECEIVED 1005 APR 22 A10.3q This Is to certify that twenty (20) days have elapsed from date of decision, filed 1 without filing of an appeal. aGU� Date T/i y Joyce A. Bradshaw 'Down CUM o U) � e o H S N r N N N co D 3 t p v d voted to GRANT a 2 )rder to allow a third C per Certified Plot Plan, C Curtis, Date: August 3, Is Board of App� 1� 1;1i���`111111�'�11111 �s,� v+�'• 0 0 .N o� R LL a"r Street u April 12, 2005 2005-006 G April 15, 2005 � 1 itmg in the Town Hall top floor LL 105 at 7:30 PM upon the !• ng a Special Permit from Section 'ater Street in order to add a a;Water Street within the R-4 > 21 & 28, 2005, and all abutters C omas D. Ippolito, and Richard Planning 978-688-9535 v d voted to GRANT a 2 )rder to allow a third C per Certified Plot Plan, C Curtis, Date: August 3, CL les Surveying, 50 ''n by H. A. Curtis Jr. fly manner. so at his own risk. M. Vaillancou 4 Mrt \ 0. (14 a & b) of the trimental than the ATTEST: w 1 A True Copy ' a N Town Clerk Planning 978-688-9535 :4 Town of North Andover Office of the Zoning Board of Appeals Community Development and Services Division 400 Osgood Street North Andover, Massachusetts 01845 D. Robert Nicetta Building Commissioner Telephone (978) 688-9541 Fax (978)688-9542 Furthermore, if the rights authorized by the Variance are not exercised within one (1) year of the date of the grant, it shall lapse, and may be re-established only after notice, and a new hearing. Furthermore, if a Special Permit granted under the provisions contained herein shall be deemed to have lapsed after a two (2) year period from the date on which the Special Permit was granted unless substantial use or construction has commenced, it shall lapse and may be re-established only after notice, and a new hearing. Town of North Andover Board of Appeals, Del Ellen P. McIntyre, Chair Decision 2005-006. M69P40. Page 2 of 2 Board of Appeals 978- 688-9541 Building 978-688-9545 Conservation 978-688-9530 Health 978-688-9540 Planning 978-688-9535 of MOR7N 1y asACIW�t, D. Robert Nicetta Building Commissioner Town of North Andover Town Clerk Time Stamp Community Development and Services Division Office of the Zoning Board of Appeals „�'` l dEE r. BRUSH 400 Osgood Streetr � �?q' C North Andover, Massachusetts 01845 : ; ; Telephone (978) 688-941 Fax (978) 688-9542 Legal Notice North Andover, Board of Appeals Z65 APR 20 P 3. 15 Notice is hereby given that the North Andover Zoning Board of Appeals will hold a public hearing at the top floor of Town Hall, 120 Main Street, North Andover, MA on Thursday the 12th of May, 2005 at 7:30 PM to all parties interested in the appeal of Hollis A. Curtis, Jr., 180 Water Street, North Andover requesting a dimensional Variance from Section 7, & Table 2 of the Zoning Bylaw for relief of lot area, street frontage, the front setback on the existing dwelling and the left & rear setbacks on the detached garage. Said premises affected is property with frontage on the North side of Water Street within the R-4 zoning district. Plans are available for review at the office of the Building Department, 400 Osgood Street, North Andover, MA Monday through Friday from the hours of 8:30 to 4:30PM. By order of the Board of Appeals Ellen P. McIntyre, Chair Published in the Eagle Tribune on April 27 & May 4, 2005. Legalnotice 2005-009. MONO. Board of Appeals 978- 688-9541 Building 978-688-9545 conservation 978-688-9530 Health 978-688-9540 Planning 978-688-9535