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HomeMy WebLinkAboutBuilding Permit #140 - 1785 GREAT POND ROAD 8/21/2007 BUILDIN NORTH G PERMIT OF t,eo ,6 Ati TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION10 Permit NO: V Date Received � 04 41 0 1• TED Date Issued: ��SSACHUS IMPORTANT:Applicant must complete all items on this page '� LOCATION_fu !� A, P,fint . ,PROPERTY OWNER_ �..OU .Pnnt MAP NO: ;PARCEL: ZONING IJISTRICTs s �' Historic District yes a �o y _ Machine Shop`Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition . Two or-more family Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic Well floodplain Wetlands W tershedwd strict WaterlSewbr, e DESCRIPTION OF WORK TO BE PREFORMED: g®0 ().�,-T- Identificat!gp Please Type or Print Clearly) OWNER: Name: Phone: 06 762,00 Address: CONTRACTOR Name: ` Phone `` ,S Address: Supervisor's,,Construe#ion License: 0 Exp. .Da#e: t� . . Home Improvement ticense: Exp. Qate 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: $ 500 FEE: $ Check No.: oO`(�- Receipt No.: 0 57 I_'J— NOTE: Persons contracting-w' u jis red contractors do not have access t the guaranty fu Signature'of Agen#/Owner Signature of contractor` 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 DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS DATE REJECTED DATE APPROVED CONSERVATION COMMENTS DATE REJECTED DATE APPROVED HEALTH', COMMENTS l I 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 Located at 384 Osgood Street l FIRE DEPARTMENT -Tem- Dumi ster on rsite p p yes - , no , Located,at 124 Allain_ Street-, � °+ Fire Department signature/dateA�t a . r COMMENT' = , 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 j 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 pickup - Date ..........._......._._........_................................._.............._................---............................_..........._........_._......_.._...._..........................................--- Doc.Building Permit Revised 2007 f t, 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 o - 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 PP 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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 i Revised 2.2007 Location No. l d Date AORTol TOWN OF NORTH ANDOVER AL F 9 L Certificate of Occupancy $ ;�ssACMUSE<�' Building/Frame Permit Fee Foundation Permit Fee $ i Other Permit Fee $ TOTAL $ Check # 205,17 Building Inspector 7768 �OA Date.�. .� .1. � .}. ... .. .. ,aOAT1,. o� TOWN OF NORTH ANDOVER F p • PERMIT FOR GAS INSTALLATION '� X0,,..0•'a Sh �. ,SS^CHU5ES =, This certifies that . ✓�. • • •�� �`! . � has permission for gas installation . . , . .L 11-Pt=. . . . . . . . . . . . . . in the buildings of . . . ,<y—j. . . . . tj .�,.A. L w k(S. . • . at .1- . 6--*P"j.. . t?�Y�!. . . ., North Andover, Mass. � 4 SaO. . . Lic. No..?) T. . . . . . . . GASINSPECTOR !t Check# l 1 Z 3 ��`�4 as CS_ MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) F — NORTH ANDOVER ,Mass. Date JULY 5, 2011 permit# 1785 GREAT POND RD. CLEON DASKALAKIS Building Location Owner's Name Owner Tel# 978-337-1555 Type of Occupancy RESIDENTIAL New W1 Renovation❑ Replacement Plan Submitted: Yet NoEl FIXTURES a w � •. H w a 9 ; 1 Lu w w N o x �' � t, z x F ¢ �" z z 0 �" w V 1 m F W w o w x w ¢ m w ¢ x F g a w W U) J z ¢ x rx W w � A v x a s f 0 z H z H O > w a w a z a w z O z = O u=l w A C¢7 a a > A a H w 3 SUB-BSMT BASEMENT 1ST FLOOR i 2ND FLOOR 3RD FLOOR 4T"FLOOR 5T"FLOOR 6TH FLOOR 7T"FLOOR 8T"FLOOR l Installing Company Name Eastern Propane & Oil, Inc Check one: Certificate j Address 131 Water Street ZCorporation Danvers, MA 01923 Partnership Business Telephone# 800-322-6628 Firm/Co. Name of Licensed Plumber or Gas Fitter JOHN MARSHALL INSURANCE COVERAGE: I have a curO liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YesNo ❑f you have cked yes,please indicate the type coverage by checking the appropriate box. A liability insurance policy ✓❑ Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass.General Laws,and that my signature on this permit application waives this requirement. Check one: Owner ❑ Agent ElSignature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit IssLied for this application will be in c pliance with all ertinent provisions of the Massachusetts State Gas Code and Chapter 142 of t er I Laws By Type of License: ••P•Idmber g ature of icensed Plumber or Ga Fitter Title •Gas fitter •-Master cense Number 778 City/Town •-Journeyman APPROVED(OFFICE USE ONLY) NORTH 0 0 over _. _ �. ;. No. f 4 -_ o dover, Mass., 0 LAK* �. COCMICHEWICK V %ds RATED 7 BOARD OF HEALTH Food/Kitchen - PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.... ..OAA.,0......... ........................................... ..................................... Foundation has permission to erect........................................ buildings on ...I. .g'S....... !' " !x..........64...... Rough to be occupied as:....S.l........ .....'f....... ........�. .......... ...... !!� ....5.� ..... ...... himney ............................. provided that the person acce ing this_permit shall in ery respect conform to the t ms of the application on file in Final 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 PERMIT EXPIRES IN 6 MONTHS Final ELECTRICAL INSPECTOR UNLESS CONSTR ON TS Rough .............................................................. Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR 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. SEE REVERSE SIDE Smoke Det. J�ie �om uUea�/ 0 I N E' r B"OAR�OF BI�ILC},6MG�FEGI� Kv 5 `��,(^S�� LicenseONSTR1CTIDN,S PEOR NU be`r a C`S 09484,8 B� dat X9/03/19,65 IaCpies.:�9/03/ f0 Tn r o 94`848 66 GEORGE S WA . J a 'fEYNIZSBURY', - JpS� 1 6 1 00-35,000•cf enclosed:space ;r (MGL C-112 S 60L),. s `` ry on tisNf x 1MA Mason lya �e i lik,G 1 2 & 'Fah tly Homes Failure toSpossess a-current edition of the !Massachusetts State Building Code -.Jis cause forrevocation of this license. 'l , b!'04AFE-CAL CENTER m344 7233 l i i i I I G. W. SIDING INC. 54 Delwood Road Tewksbury, Ma 01876 TEL: (978) 658-3065 CELL: (978)804-4445 TG ' job: date: % Aov, c C/ cc, i i lir -e i jo The Commonwealth of Massachusetts Department of Industrial Accidents g t. :. Office of Investigations 600 Washington Street Boston, MA 02111 c�w www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): - Address: JL�J C3a City/State/Zip: l� � ' 0� _ Phone #: Q Are y1pirrfin employer?Check the appropriate box: Type of project(required): 1.Cqrl am a employer with�_ 4. ❑ I am a general contractor and 1 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ 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. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ I 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.,L-RRoof repairs/ insurance required.]t employees. [No workers' 13.[] Other comp. insurance required.] *Any applicant that checks boz#I 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. Q Insurance Company Name: T(,/ , ' 6tvv" Policy#or Self-ins. Lic.#: W C.. -70 F q "Z 3 9?0 I 'L®c�Ls Expiration Date: Z ,10 - Job Site Address: ®/'tQA, City/State/Zip:/"F ��� byt- 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 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 1 do hereby ce ify u der the pain,paypenallies of perjury that the information provided above is true and correct. Si nature: 11 2-5-h Date: Phone#: •� Official 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#: ACORD CERTIFICATE OF LIABILITY INSURANCE DA E(MMMD 7rn PRODUCER THIS CERTIFICATE IS ISSUED ASA MATTEROF INFORMATION Judith Pinney Insurance Agency ONLYAND CONFERS NO RIGHTS UPON T HECERTIFICATE 325 Main Street HOLDER.THIS CERTIFICATEDOES NOT AMEND,EXTEND OR North Reading, MA 01864 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC# INSURED D Siding Inc INSURERA Penn-America Insurance Co G. INSURER B: ASSOC. Industries of Mass 54 elwood Road INSURER C: Tewksbury, MA 01876 INSURER D: INSURER E: COVERAGES 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. INSR D' p UCYEFFECLIMITS11YE FODUC IXD PIRATN LTR N F C POLICYNUMBER GENERALLIABILITY EACH OCCURRENCE $ 1,000,000 A XCOMMERCIAL GENERAL LIABILITY PAC6603579 9/20/06 9/20/07 PREMISES Eam=ence $ 50 000 CLAMS MADE 1XI OCCUR MED EXP(Arty one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERALAGGREGATE $ 200,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $ 2,000,000 17 POLICY PROJECT DLOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS I SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EAACCIDENT $ ANYAUTO EAACC $ OTHER THAN it AUTO ONLY: AGG $ EXCESSIUMBRELLALIABILITY EACH OCCURRENCE $ OCCUR CLAIMSMADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION ANDSTATUWrTH $ EMFLOYERS'LIABILITY AWC7019738012006 9/24/06 9/24/07 TORY LIMITS ER ANY PROPRIETOR/PARTNER/D(ECUTK E.L EACH ACCIDENT $ 100,000 OFFICER/NEMBEREXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 500,000 ffCdescnbei PEIAL PROVISI9C El DISEASE-POLICY LIMIT $ 100,000 S �1 S below OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEH CLES I EXCLUSIONS ADDED BY END CRSEM ENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS W RITTEN Lewis P. Minicucci NOTIC ETD THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DOSO SHALL 1785 Great Pond Road IMPOSENO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR North Andover, MA 01845 REPRESENTATIVES. AU ORIZEXEPRESENTATIVE_J�� ACORD 25(2001/08) © CORD CORPORATION 1988 6 Q f} B"OARD'OF BUILbING REGULATIONS License CONSTRUCTION SUPERW 6k ;y`I Number CS 094848 ' B►rthdafe 09/03/1965 Expires 09/03/2:0 10 Tr.no: 94848 Rest it ct€ed 00�' r GEORGE S WARD`III 54 DELWOOD TEWKSBURY, Y: T. 07k ri2orr Board of Building Reg 4nonac�d WOMEIMPROVEMENT CONTRACTOR i RegistraQRT\156832 lEi pn 8 /2009 Tr# 256382 T ! eF vate Corporation G.W.SIDING ING E t `+ 't f GEORGE WARD r Ir ' 54 DEL WOOD RD i TEWKSBURY .MA 01878- -- - Administrator - - F r i e ro