HomeMy WebLinkAboutBuilding Permit #121 - 18 MOLLY TOWNE ROAD 8/12/2009 BNORTH UILDING PERMIT o�t�.o„6 q1'o TOWN OF-W-RT,H.ANDOVER s - APPLICATION FOR PLAN EXAMINATION Date Received Permit N0: � Date Issued:LA6i �Ssacr+us�� I ORTANT: Applicant must complete all items on this page LOCATION1/2 M a 1 l i OUl✓IC. l 0�'T� �✓J ,�'e/ ',/ oT�7 P 'nt` / PROPERTY OWNER_ -3 Co`dam -f- �T .7n L-�vi C�eW:5 Print MAP NO:0 . 0 PARCEL: OPP ZONING DISTRICT: Historic District yes qjP Machine Shop Village yes o 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 Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: ,S Identification Please Type or Print Clearly) OWNER: Name: 5cq-rT A- ,�;t�� L� 1z rs Phone Address: MON. vJvi, YJJ �J �-Y1 Ab1fCe , r CONTRACTOR Name: mtLt, Po-Js Phone: Address: n) ojc j«t r-�-0- (--C Ak,:z�, Supervisor's Construction License: Jq_.ZS0 Exp. Date: {,I - 2. Home Improvement License: I( fL 2.o 4 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. Total Project Cost: $ 12 2.rb FEE: Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to a guars fund Signature of Agent/Owner � Signature of contrac 6 / 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 CONSERVATION Reviewed on Si nature \AL/(---' COMMENTS ` t, ,,/BEALTH Reviewed on Signature COMMENTS �R�oning 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 Main Street Fire Department signature/date COMMENTS 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 NOTES and DATA— For department use) e ❑ Notified for pickup - Date i...._.__._._....................._...._...................._._._._......_......................._............._......._.._................................................__....._.......-.-.-................_......._ -._..._......................_..._._... __.._.__..................._...._._ Doc.Building Permit Revised 2009 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: 11 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:Building Permit Revised 2008 L iAVLocation No. Date NORTH TOWN OF NORTH ANDOVER 16. 41 9 " Certificate of Occupancy $ s'•'�°''<� Building/Frame Permit Fee $ s�CHU Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 2 2 5 + 6 436fllding Inspector V40RT T►y Town of _: 4Andover O •, µ•4• ,I, ` ' No. / - z. * - -- _A K Edover, Mass., COCHICHEWICK y� ORATED BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System SG �/N��n� BUILDING INSPECTOR THIS CERTIFIES THAT................. ................................ ............. `................................................................................... ."" . - ' Foundation has permission to erect........................................ buildings on ......�/WaA.../...t7 L1 ..... ............... Rough o� © / �o l /•1•• �- ,1,+r Chimney to be occupied as.............................................................? ..................... .....�C�./................ ....Q....... provided that the person accepting this permit shall in every respectconform to the terrhs 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 Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS 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. valid for individul use Only �istration return to: o d Standwa� License or reb date if found ex iration and Standards J ��? Mations and Standards before the P emulations oReg Building 'Regulations Board of Budden CONTRACTOR Board of B I TOME IMPROVEMENT One Ashbu,t02108'place RM r ti3 Bost 118204 r V,, Registration: 118204 Tr# 280313 ;� 1 ! Expiration 2l13I201' oration Private Corp - INC � _ PATIOS Ila FAMILY POOLS& - °t valid wi ° WILLIAM GIANOPOULUS 70 S.BROADWAY Administrator L.AWRENCE,MA 01843 —d:s lations and Stands Board of B"'ld'ng Rem i5or License n P _... :. e; Constr'uctio License: CS 10330 111911960 fir# '16112 Birthdate. 711912011 �,xpiration: 00 striction: C POULOS j.l r0 S BROAOWM C;osuuaiss�°ncr LA 1�1RE`ICF,MA 01843 The Commonwealth of Massachusetts j Department of Industrial Accidents t9, _. Office of Investigations a 1 600 Arrrshin;tin Street Boston, MA 02111 ��'t=B2�£�gOV�dla Workers' Compensation Insilrance Affidavit: Builders/Contractors/Electridans/Plumbers A licant Information {} Please Print Leaibl Nanle (Business/Organization/Individual): Ntttti t clog ¢ Address: City/5taxe/Zip: alS-I' di'V .7. 7 8" Nl �' Phone#: . Are you as employer?Cheek.the appropriate box: 1• am a empiaycr with 4. ❑ 1 am a general contractor and I Type Protom(requires): employees(full and/or part-time).* have hired the sub-contractors d• ONew cotistruction 2.❑ I am.a.sole proprietor or partner- listed on the attached sheet 7. ❑Remodeling ship and have no employees These sui}.eontractors have working for me in any opacity, workers' comp.insurance, g' Q Demolition [No workers'comp.insurance 5. ❑ We are a corporation and its 9. Q Building addition 3.❑ required] officers have exercised their 1 Q•Q Electrical repairs(r additions I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions Myself [No workers'comp. r 152, §1(4),and we have no insurance required.]t .employees. [No workers, 12.❑ Roof repairs 13.❑.Other S,�• �- dw� wmp. insurance acquired..] want applir rs that checks bot#I must also fill out the section below ahowiag their workers'compenution policy infonnation. t Homeowners who submit this affidavit indicating they are doing an work,nd then hue otaside contractors must submtt a new affidavit indicating such 4Cvntn�ctors that cheek this box rezust ettached an additioast showing.tate name of the sub-coraracim and their workers'c, i:_. I ar><e€n errr,pioyer fitaf ispr? r pc•w infomistion. P vi&ng:workers compensation insuranceform!'eVjoyem: Below is the infornratiod, police and job site . Insurance Company Name: f M_X . Policy#or Self ins Lie, Z Expiration Date: (%'�` (,—a Job Site Addrms Attach a copy of the workeCitylstato/Zip: p_._ M E � 7C rn. ;s, �'rs' compensation policy declaration page(showing the policy number and expiration date}.0 Failure;to ricin a covers a asrequired g 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 imprimen sont;as well 8s civil penalties in the farm of a SMP 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 certify under the pains and penalties o e ' rP rlwy shat the i►tfnrmalion provided above is One and correct 5i tta e: Lj� �, Date• d' ' Phone [6.0ther ial use nnfy. Do not write in this area,to be�raPleted b or town o y 'Ci4l or Town: Permit/License# g Aathority(circle one}: ard of Health 2 Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing inspector 'ct Person• Phone#: Information a lad I11structions Massachusetts General Laws chapter 152 requires all emp I oyan to provide workers'.compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, - express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the'fomping engaged in a joint entezprise,and includirig the legal representatives of a deceased employer,or the recoiver ortrustee-of an individual,partnership,association or other legal entity,employing employees.'However the owner of a dwelling house having not more than three apartments and who resides thercK or the occupant of the dwelling house of another who employs persons to do mairztenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment bo deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local Ficensing agency shall withhold the issuance or renewal of a license or permit to operate a business or *o construct buildings in the commonwealth for any applicant who has not produced acceptable evidence oft'compliance with the insurance coverage required" Additionally, MGL chapter 152, §25C(7)states"Neither tlic commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicant Please fill out the workers'compensation•affidavit completely,by checking the boxes that apply to your situation and,if necessary, supply sub-contractors)name(s),addmss(es):aired phone numbers)along with their certificates)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no empioyees other than the members or partners,are not requiredito carry workers'ca rnpensation insurance. lfan LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage.. Also'be sure to sign and-date the affidavit. The affidavit should be returned to the city or town that the.application for the permit or license is being requested,not thDepartment of Industrial Accidents. Should you have any.questions rcpr-ding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number.fisted below. Self-insured companies should eni-ffm r self-insuran=e license number on the'appropfiate line. City or Town officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sum to fill in the permit/license number which%vilI be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating-current policy information(if necessary)and under"Job Site Address"the applicant:should write"all ioca6ons in (city or town)."A copy of,the affidavit that has been.officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said parson is NOT.required to complete this affidavit The Office of Investigations would Ike to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The CommonweELith of Massachusetts Depattinent of lndustrial Accidents Office of Investigations 600 Washington Street Boston, 1v2A 02111 TeL#617-727-4900 i=406 or 1-977-MASSAFE Revised 5-26-45 Fax#617-727-7744 wrww.mass.govldia 70,3.24' A 6 CESS & DRAINAGE CASEWNT 20 0 20 40 FT SCALE: 1 " 40' 9.3' LOT 7 AREA = 25,021 S.F. 71� 20' tiv � - i2' LOT 8 PROPOSED SWIMMING POOL 40' E-X5 TING HOUSE IPG ?R�95 6f3.77 U J4.74 ! - 'OLLY To WNL- RO,40 A PLOT PLAN FOR PROPOSED SWI MMI N POOL�'--."./ A1" 18 MOLLY TOWNE ROAD IN NORTH ANDOVER, MASS. PREPARE© FOR SCOTT LANDERS DATF: JULY 27, 2009 CHRISTIANSEN SERGI 760 SUMMER ST. IMVEAWILL, A4- 01530 TE- 978 373 0310 (C)2009 By CHRISTIANSEN SERGI, INC. owG. No. 911066012 ..a, •_••.w.r. wa,Client#: 53642 rrn..... II.09 VJ�,V I J VU',;I'll l^UV{rg UO-UO FA4�ILYPCOLI PRODUCER I �� CERTIFICATE OF LIABILITY INSURANCE /Q72Q� fYYYY, HUB international New England THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORNtATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 299 Ballardvale St HOLDER,THIS CERTIFICATE DOES NOT AMEMD,EXTEND OR Wilmington, MPA 018811, ALTER,THE COVERAGE AFFORDED BY THE POLICIES BELOW, 9T8 657-5100 iNSUREJ INSURERS AFFORDING COVERAGE NAIL# Family Poois$Patios Inc. iNEURERA: Nautilus Ins CO C/o Bill Gianopou!os; 70 S.Broadway m:uREREI APG Lawrence, MIA 01843 NEURERC. Safety Insurance CG INSURER D i COVERAGES IN. WERE: THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE=0R THE POLICY PEPI_)D INDICATED.NOTWITHSTANDING ANY RECUIREMENT,TERM,OR CC,NDITION OF ANY CONTRACT O:R OTHER DOCUMENT 4b7TH RESPECT TO`AJHICri THIS GERTIFICATE MAY BE ISSUED OR P,A'!FERTA.IN.THE INSURANCE AFFJRD _Y PAID CLAIMS.BY THE POLIc ;ES pE;,RIE+ED HEREIN IS SUR:IECT TC ALL THE TERM! F,AGGREGATE LIMITS SHO}J/N MAY HAVE BEEN REDUCED� n,� EKCLUS ONS AND C:�NDI T iCN1 OF SUCH . LTR RSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIYE POLICY EXPIRATION DAT: ,DD!','Y+. DATE MMIDD+Y'! LINTS A GENERAL LIABILITY NC818633 i 0911i 9168 09/15109 i DICH OCCURR_VCE 1$1,000,00D X CAh4MFRCIAL GENERAL LIABILITY DAMAGE TO RENTED I PREFAISES Ea erre CLAIh19 MADE I $1Qa QaQ OCCUR MED EXP(Ary one p�rsorjX Bl Ded;2,500 °S 000 PERSONAL G ADV INJURY I$1,000,000 I ^— GE:JERALAGGRE:A,TE .g Q-- f -ENL AGGREGHTE LIMIT PER: s2 0Q0 400 f PRO- PROD UCTS•;Osa!^F GG POLICY I.00 11 C AUTOMOB:LELIABILITY 2947232 12131/08 �12/31109 `'r"ABAECSING�ELIMIT $1,000,0Q0 AUY A.LITO (Ea acoidmn) ALL OOVNED AUTCS X SCHEDULED AU-CS BODILY INJURY' $ Per person! X HIREDAUTOS X NON-GUNNED AUTOS i BODILY INJL FY Per aced-nil (OROPERTV DAMAGE $ Per ax�.]snI GARAGE LIABILITY ANYA.TO ;AUTO ONLY-EA ACCIDENT $ OTHER THAN Ed AOC AU-,0 ONLY: AGG $ EXCESSIUMBRELLA LIABIL;TY EACH OCCURREN'E $ OCCUR CLAIhfSMAGE AGGREGATE $ DEDUCTIBLE I ! RETENTION S WORKEMPLERSCOR(PEILTF,Y NAND WC005216$73 +2131iaQ 12131/09 X vK=•STATJ- OTH- EM PtOYER9';.LgB4Li"i Y �r�- ANY PROPRz OR,'PARTNERIEXEC:JTIVE OFFICERE.L.EACH ACCIDENT I$144,01}4 AIEDEBERE.XCLUDED? No If YfG.describe U^,der E'.Di^EASE-EA EMPLOYEE$00,000 SPECIAL PROVISIONS bele. OTHER E.L.DISEASE-POLICY LIMIT I S500,000 S I I DESCRIP T ION OF OPERATIONS'LOCATIONS'VEHICLES!EXCLUSIONS ADDED BY ENDORSEMENT J SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,TRE ISSUING!NSUPER WILL ENDFA'VOR TO MAIL 10_ DAYS WR'TTEN NOTICE TOTHE CERTIFICATE HOLDER NAMED TO Th E LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND JDON THE INSURER.ITS AGENTS OR REPRESENTATAm-S. ��- AJT,40RIZED RE"EM'ATIVE QQFFJJ//yyGGCC � .a��0 i/�Jfi/w/-`"w' ACORO 25 12001103;1 of 2 4%S249074/rM219653 E14002 0 ACORD CORPORATION 1989 I I a[� 11-9Pkda?oss 0811.009 - - 4•d'Pf°in Pone6 0811-016 L �4'Radts{uoars 0811-111 f 14 4' G80111*i 6 a N�OeaDW l YaO P�emi ! 2'RAD, i•Sim krdwwe& t801.yg 2-17Sragluiap* (Vl 1001fi1J A 9 4 n e F 4 H 1.7 WN t Cv x 4' 1Ytayiluerp! +w 1001.158 is:iD b' �o tK' rr rs,s, rYd- Y i 6'l6re 1.8'gma gyp,low l-6' 1.5 pamb rara -- I 441_9 ` g+ 3'S[ Rise 4-8'pan91 lasdr 1.8 +ep t 4'piney ti. 41 , gree°P?a 10 WPM4' 2 RAD. x 0 o I Z. 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