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HomeMy WebLinkAboutBuilding Permit #292-11 - 18 STEVENS STREET 10/12/2010 NORTH BUILDING PERMIT of A, 1w• 2 t�S'-ED 16y -YQ 3.. TOWN OF NORTH ANDOVER ` APPLICATION FOR PLAN EXAMINATION Permit NO: _ Date ReceivedC ITED Date Issued: A SSACHUs���y IMPORTANT:Applicant must complete all items on this page LIE G-1in iM'APN003�J�VPARCE �� NI.fVG DIS RICT� i 2 - Hi to i}c®istrictA tno� dyes. c1%inefShopiUillage, :�yes�,•Y ..� TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building XOne family ❑Addition ❑Two or more family ❑ Industrial ' ❑Alteration No. of units: ❑ Commercial Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other o 'PQn f®�Wetlands� �f��® � + �'�� � ,p 4 Pte. - = ict r , , Watershed Dstr i ��1Water/Sewers - t DESCRIPTION OF WORK TO BE PREFORMED: _5:AMZ-:: 6(1: + S /2_47 Identifi on Pleased pe or Print Clearly) OWNER: Name: AC.t-I /WCC Phone Address: Ig i E i /V0, A ER MA f ' CONTIAC�T�®�R AT 0 UlUKgM f5 �g E �Su ervisor�s Construction Licenses � iHo mr:ovement ARCHITECT/ENGINEER N o N E- 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: $ FEE: $ Check No.:_�p ��S� Receipt No.:��.5 � NOTE: Persons contracting with unregistered con Tactors do not have access to the guaranty fund SgnatureoftAgent/®wn rfgatureofcontractor�:rA : Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swunm'ng 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 Signature COMMENTS rHEALTH 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�DEPARTMENTg �>T�em� m:sfen sitef yes _ � �� _ _ jLocatedaat.�124(MamtStreetf: �` ` x ���F` 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.$10041000 fine NOTES and DATA— For department use i i ® Notified for pickup - Date Doc.Building Permit Revised 2008 Building Department I The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Biding, 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 Plann Of Proposed Work With Sprinklerrinkler 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 p p 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 Revised 2.2008 11 Location /t( 57L -/&0 No. Date �v - +/U NaRTM TOWN OF NORTH ANDOVER O:i•No 9 a y �� • , Certificate of Occupancy $ CNUs<�a Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # &S—c �r^ 2359 Building Inspector ORTIy An T0VM of dover _ -a dover, Mass., Z l O COCHICHEWICK 1• V 7�p ADRATED `�� `s BOARD OF HEALTH Food/Kitchen Septic System , iMIT T ­ A , BUILDING INSPECTOR THIS CERTIFIES THAT......l.... ... � . �................ ... ............................................................... ................................. Foundation �40has permission to erect buildings on ... '....s' •....... I........................ Rough to be occupied as �1i�. IN1....,..,.. t Chimney p� ...... G� 't......... .................... provided that the person accepting this permit shall in every res ect conform to the ter 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 CONSTRU ON T S Rough Service BUILDING INSPECTOR Final Occupancy Permit Required to Ocmpy 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. ` | � | � ! / � � | C&,.�mCouo From: 10/12/2010 09:21 #566 P. 001/001 CERTIFICATE OF LIABILITY INSURANCE DIDD to0/la/12/so0lo10 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 policy(les)must be endorsed. If 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 endorsements). PRODUCER CONTACT NAME: Shannon Sperraaaa Risk Strategies Company PHONE (781)986-4400C.No:(761)963-4420 15 Patella Park Drive E-MAILADPRESS,ssperrazzeRzisle-strategies.com Suits 240A0019083 Rand01 h MA 02368 PRODUCER INSURE S AFFORDING COVERAGE NAIC# INSURED INSURERA:National Union Fire Ina Co 19445 INSURER B: Richard Irons, DBA: Restoration Masons INSURERC: 12 Burnham Rd INSURER D INSURER E: Limerick M39 0404$ INSUR RF: COVERAGES CERTIFICATE NUMBER:CL10101232161 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. ILTR TYPE OF INSURANCE ADDL USR POLICY EFF POLICY EXP GENERAL LIABILITY WV POLICYNUAIIBER MM D M LIMITS � EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY PREMI ES Ea ENT-el) T-e soca $ CLAIMS MADE OCCUR MED EXP Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'LAGGREGATE LIMIT APPLIES PER:PRO- PRODUCTS-COMP/OP AGO $ POLICY LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANYAUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY(Per person) $ SCHEDULED AUTOS BODILY INJURY(Per accident) $ PROPERTY DAMAGE HIRED AUTOS $ (Par accident) NON-OWNED AUTOS $ UMBRELLA LU►B OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ A WORKERS COMPENSATION Richard Irons is WC STATU- OTH- AND EMPLOYERS'LIABILITY YIN X ANY PROPRIETORMARTNERIECECUTIVE included in coverage E.LEACHACCIDENT $ 500 000 OFFICERIMEMBERE(CLUDED? �. NIA (MandatorylnNH) 003787934 6/4/2010 6/4/2011 EL.DISEASE-EAEMPLOYE $ tF yysess describe under 5 0 0 0 0 0 DESGIRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500;000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) Issued as evidence of insurance CERTIFICATE HOLDER CANCELLATION (978)688-9542 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF NOTICE WILL BE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. Building Department 1.600 Osgood Street AUTHORIZED REPRESENTATIVE North Andover, XA 01845 9 Michael Christian/SMS ACORD 25(2009109) ©1988-2009 ACORD CORPORATION. All rights reserved. INS025(2owoe) The ACORD name and logo are registered marks of ACORD 4N; The Commonwealth of Massachusetts Department of Industrial Accidents At Il �A Office of Investigations ! i 1':v 600 Was Street tae 1.' ;�f Boston,MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LelZibly Name (Business/Organization/Individual): Address: I a (3 U R N td R ;n City/State/Zip: L/M�R i C k_M E, 0'10q - employer? `10 q Phone#: l�'1"�D 3 a` ® ' iate box: Type of Are you an employer. Check the appropriate yp project(required): p J 1.LR 1 am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction . employees(full and/or part-time).* have hired the sub-contractors 7. F1Remodeling 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 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 10.0 Electrical repairs or additions required.] officers have exercised their right of exemption per MGL 11.r] Plumbing repairs or additions 3.❑ I am a homeowner doing all work g p myself. o workers'comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.]fi p employees. [No workers' 13. "Other C ill h&"' " OVF"'o-r comp.insurance required.] - *Any applicant that checks box#1 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 add their workers'comp.policy information. I am an employer that is ptovicling workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: CC 14 R 1/S NA" U t 0 F'I 5 U I U- l < < PoltY c #or Self-ins.Lic.#: 37M34/ Expiration Date: Job Site Address: 17 STEL/—S ST, 1f City/State/Zip: N0, AND OVEP, MA.®1 V/6- 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 fonn 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 certify under the pains and penalties of perjury that the information provided above is true and correct SlPnature � -P-� � �/ �'� Date: /Oba/lo Phone#: &07— Co 3 a ;8 0 6D - / 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#: r = 0 lJ on�Aairsndu atiousiness e n��fice ofg 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement'Contractor Registration Registration: 114122 Type: DBA Expiration: 8/6/2011 Tr# 287445 RICHARD IRONS - MASON RICHARD IRONS - 12 BURNHAM ROAD LIMERICK, ME 04048 Update Address and return card.Mark reason for change. ❑ Address Renewal ❑ Employment F] Lost Card ! DPS-CA1 0 50M-04/04-G101216 �. t Y. •.x rat+ tt�-tTcpartm+Mnt of Public Safri . Beard af' uildirt-Re,--,atior+s and Standt,zs , '�*! Con tructicrt.S�rper iss�r Licenses j License: GS 19238 Re!"Itctr1 to; 00 .. I RICHARD H IRONS _ I 12 BURNHAM RD LIMERICK, ME 04048 A Expiration: 11/2/2011 . Tr#: 9653