Loading...
HomeMy WebLinkAboutBuilding Permit #197-13 - 19 HALIFAX STREET 9/11/2012 BUILDING PERMIT of NORTH q �St{•t0 X67�O ° TOWN OF NORTH ANDOVER � L APPLICATION FOR PLAN EXAMINATION Permit NO: I / Date Received �" ,_ 4 o7. a �gSSACHUs���y ED Date Issued: I v IMPORTANT:Applicant must complete all items on this page 'L-OCATION Prin PROPERTY OWNERt �v�C ^�N A � C n Pnnt.. . _ `MAP NO'6 PARC.EL04/6 ZONING DISTRICT: Historic}Districtyes no MachineShop 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 L Watershed District Wa' ter/Sewer DESCRIPTION OF WORK TO BE PREFORMED: $I6dVe GncyaYJ POLI Identification Please Type or Print Clearly) f OWNER: Name: Tji nc) Zt3J•o61L(,:)co Phone: 979-A73-1P (a Address: ` Hn);Y CONTRACTOR Name: cv, Phone. S - �. . . _ . Address:. jy -� . y i Jl,o� -Z, -I- 'Supervisor's Construction License. -T Exp. Date:: 4 d / Home Improvement.�License . Exp: Date: . —1 -- ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COSTBASED ON$125.00 PER S.F. Total Project Cost: $ g. 000,00 FEE: $ I •6-0 Check No.: Receipt No.: �� 07 NOTE: Persons contracting with unregi Bred contractors do not have access to the guaranty fund r---- _.- .._.�.. - �_ __.._. ��.- Tom_•---^_---.-=z.-. �._-. �.z.�.-._a- „-..-:____ __.-�.-._ >_._�._._ Signature of Agent/Ovvner 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 CONSERVATION Reviewed on _ — �— Si nature 41141t, COMMENTS LIL Awj� P 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 Main`St�eet Fire Departirnent;signatureldate 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) I I ❑ Notified for pickup - Date Doc.Building Permit Revised 2008 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: All dumpster permits require sign off from Fire Department ent 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 I. Location h No. r ` Date • TOWN OF NORTH ANDOVER • M Certificate of Occupancy $_ ° � Building/Frame Permit Fee $ •oo Foundation Permit Fee $ � � Other Permit Fee _ TOTAL Check# V 25697 Building Inspector omee i�L�o���m�r�i'rai�s` �i�U �i/��(teg` °a ° HOME IMPROVEMENT CONTRACTOR Registration: 118519 Type: =" Expiration: 3/29/2013 Private Corporatior _ _- SWffMING POOL CENTER INC ROY CHARLAND 670 S UNION ST LAWRENCE, MA 01843 Undersecretary +- Massachusetts - Delru-tment of Public Safco Bom-d (it' Buil(linl, Regulations and Stan hwds Construction Supervisor License License: CS 2837 ROY J CHARLAND 670 S UNION ST LAWRENCE, MA 01843 I Expiration: 11/30/2013 ('nnmis�iuni r Tr#: 7494 i NORTH own o 2 ndover o - .:� No. -_W-W_ w- - 0 h ver, Mass oil 2012.. COC NIC41WICK A' 7�A�'VATIE r4P�,`�5 _ S V BOARD OF HEALTH Food/Kitchen PER IT T LD Septic System THIS CERTIFIES THAT ... „ .. ,,,,,,,,,,,,, BUILDING INSPECTOR . Foundation has permission to erect ................. buildings on ...... ............ . . ......................... • Rough to be occupied as ..................A.I�i.....:.... �►.... ... .. .........................:............. Chimney Finalprovided that the person accepting this permit shall` very respect coniCrmto the terms of the application 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 I ONTHS ELECTRICAL INSPECTOR UNLESS CONSTRU S RTS Rough Service 1 ........... ................................................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Ruildin 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. SEE REVERSE SIDE ,a►co O® CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDI 1 09/12/201212 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(ies) 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 endorsement(s). PRODUCER CONTACT NAME: NORTH ANDOVER INSURANCE AGENCY, INC. (ICNEIo, Ext): (978) 686-2266 FAX (978) 686-6410 (A1C, No): M.J. FOSTER INSURANCE SERVICES ADDARESS: Psullivan@nafins.com 163 MAIN STREET PRODUCER SW I in Pool Center Inc. CUSTOMER ID #. .g —__ NORTH ANDOVER MA 0l845-2508_________ INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A ACADIA INSURANCE COMPANY Swimming Pool Center Inc. INSURER B 603 South Union Street INSURER c INSURER D INSURER E Lawrence MA 01843- INSURER F COVERAGES CERTIFICATE NUMBER: 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. INSR - ADDL SUBR --- POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MMIDDIYYYY) (MMIDD/YYYY) LIMITS A GENERAL LIABILITY Y Y CPA0290628 05/01/2012 05/01/2013 EACH OCCURRENCE $ 1,000,00 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISESAEaoccurrence $ 250,00 CLAIMS-MADE �OCCUR / / / / MED EXP(Any one person) $ 5,00 PERSONAL&ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: / / / / PRODUCTS-COMP/OP AGG $ 2,000,00 X POLICY PRO- F C LOC / / / / $ A AUTOMOBILE LIABILITY Y Y 0290632 05/01/2012 05/01/2013 COMBINED SINGLE LIMIT $ 1,000,00 ANY AUTO (Ea accident) / ALL OWNED AUTOS BODILY INJURY(Per person) $ —---- BODILY INJURY(Per accident) $ X SCHEDULED AUTOS PROPERTY DAMAGE X HIRED AUTOS / / / / (Per accident) $ X NON-OWNED AUTOS / / / / $ $ A X UMBRELLA LIAB X OCCUR Y CUA0290633 05/01/2012 05/01/2013 EACH OCCURRENCE $ 1,000,00 EXCESS LIAR CLAIMS-MADE / / / / AGGREGATE $ 1,000,00 DEDUCTIBLE / / / / $ RETENTION $ / / / / $ A WORKERS COMPENSATION CA0290634 05/01/2012 05/01/2013WC IMITSTATU- YIN OTH- AND EMPLOYERS' LIABILITY X TORY LS _ ER ANY PROPRIETOR/PARTNER/EXECUTIVE L.EACH ACCIDENT $ 500 OFFICER/MEMBER EXCLUDED? ❑ N 1 A E.- _— rQQ (Mandatory in NH) / / / / E.L.DISEASE-EA,EMPLOYEE $ 500,00 If yes,describe under - DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. SWIMMING POOL CENTER, INC. 603 SOUTH UNION STREET AUTHORIZED REPRESENTATIVE LAWRENCE MA 01843- ACORD 25(2009/09) _ ____ ©1988-2009 ACORD CORPORATION. All rights reserved. i The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 ,• www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leizibly Name (Business/Organization/Individual): SW l >m /m�+ z � L Address:. y N t, j!' City/State/Zip: ZaL�� Phone #: q�1 - C Ed Are y an employer?Check the appropriate box: Type of oject(required): 1. I am a employer with 1 4. El am a general contractor and I 6. New construction employees(full and/or part-time).* have hired the sub-contractors 2.E] I am a sole proprietor or partner- listed on the attached sheet. F]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 requifficers have exercised their 10.❑Electrical repairs or additions red.] o 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.❑Roof repairs insurance required.]t employees. [No workers' comp.insurance required.] 13.n Other *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. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: fob Site Address: f 14?a61 �/j'�C f' City/State/Zip: 1716 A, 7J�ayt \, 1-Yxh 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 irre 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 I'I )f 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. do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. signature: Date: 'hone#: 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#: Town of North Andover Page 1 of 1 • e AND&VER • 2ley PJ miln%Comn'llssion 012 Base Map I Zoning2008 Aerials Watershed Zone Utilities 0 SizeDE]E:] SelectionLegend Location Markup Help Scale V= 41 ft Select Parcels (show all) OwnerProp ID Address ZAHORUIKO,JAMES DI 026.0-0010-0000.0119 HALIFAX STRE r 1 selected To Mailing Labels To Spreadsheet QProperty I Building Permits Planning Septic Pala e _ Print ` I Ownerl ZAHORUIKO,JAMES D Owner2 ANNE M ZAHORUIKO , Address 19 HALIFAX STREET j PropertyID 026.0-0010-0000.0 t, Lot Size 10018.8S Fiscal Year 2010 Land Use 101 Code I .J 1 —a-t.. ,stn, Get Pictometry Imag.l Go vs.z.o AppGeo Save Map as Image 4`'I •.. uwvnack valley Dlantfng em nisslon does not make any Vimamy.0.pftssed oT Impned,mf aeataSE any lept tiahahy orrespomEtty to the accurecy.ewoeleness, _1� a+settttness ct the Geog',Wk Wotmation%-4a n IG#}Dau a any oew data pm,4ded herein.The data does not tare the place or a potesswal aw."and has m l �y+.. legf ocadng m the tn�e shape,sae.txat>an,o.exhtelge of a 9ea¢aFnk teot,Fe,property tne;.orpclltkal repte9erttzgaat.f.6:rtNrs d&ltztiAy t8arxang Cmmlmm request. \ W any use d tms Infametim be acmr pwied oya mt&wce to its source aro the Memmam vaaey Ptnnhtg cmmisalm scaveal mm h notices no wemamiesoi MPESM t-JaM as ld the a=Yacy dt S94 W n ultiM Any traa M MIs hHaTrtanon[a at Me PeclpieM a C%n MW V �0 Ie Q L http://mimap.mvpc.org/NorthAndovermimapNiewer.aspx 7/2/2012 Town of North Andover Page 1 of 1 i F • ! i ❑F Base Map I I Zoning 2008 Aerials Watershed Zone Utilities ❑ Size OQE] SelectionLegend Location Markup Help Scale 1"= 41 ftF Select j Parcels (show all) ! j, 026.07M 022b-0071 Owner Prop ID Address CONDO. ZAHORUIKO,JAMES D 1 026-0-0010-0000.0119 HALIFAX STRE `. 1 selected To Mailing Labels To Spreadsheet R4 02�o oto 02240119 Gb..VU ❑ Property Building Permits Planning Septic Pufij vl`vl "' Print i�Jai i 'c:F•ulOwnerl ZAHORUIKO,JAMES D 109, Owner2 ANNE M ZAHORUIKO -- Address 19 HALIFAX STREET `:. PropertyID 026.0-0010-0000.0 Lot Size 10018.8S Fiscal Year 2010 Land Use 101 026.04013. Code OT. 12 t��r.e•.t...+�mtn000 _� Get Pictometry.Imag, Go v3.2.0 AppGeo Save Map as Image 9 Merrhteck Valley nwvdng Commission aces tat make amywamamy eWerzed w ImP'ied.nor asswe any Iegs1 Kat ufty W mapoftbity Wax accuracy.camplete WM er tatetutnew a the GeogrspNc wvmaum%sw-n(DIS}Data W any otnerttsfa pmridad he:e+n.me data aces not Me the pnce of a potessional and nas m c tagg tasrmng at the MRShape,sx•locattan W"Wexe of a geoVpnlc faahm vq*ey ane,orpouWal repmmtmon.ssetdmwk vmey Pw"C a isgdn requests VO any use of ma ndnm irlar w acoompwied by a reference a its salt•.ce and the Meronactc vamy PLmnlrg ccmniss scaaw mat a makes no wwannesot reptesesat2lla>5 as to the tcctrracy oe said hramacoa any use of itis hfamsimn is at"tectpent sown msk http://mimap.mvpc.or /NorthAndovermima Niewer.as x g p p 7/2/2012 Town of North Andover Page 1 of 1 ORT HANDo\fr=R . .. ❑ Base Map Zoning 2008 Aerials Watershed Zone Utilities ❑ Sizep[]� Selection Legend Location Markup Help Scale 1"= 41 ft Select Parcels (show all) 026,04003 022AN71 Owner Prop_ID Address OD3W ZAHORUIKO,JAMES D026.0-0010 0000 0+19 HALIFAX STRE 626.0-0021 026.0-0010 022.-0119 1 selected To Mailing Labels To Spreadsheet WNW#19 ❑ Property Building Permitsjr�Planning Septic Pub Print y # -ii'pl Ownerl ZAHORUIKO,JAMES D ` 109 Owner2 ANNE M ZAHORUIKO t : t Address 19 HALIFAX STREET PropertyID 026.0-0010-0000.0 Lot Size 10018.8S — Fiscal Year 2010 Land Use 101 026.-0013Code OT. 12 Get Pictometry ImagGo v3.2.0 AppGeo Save Map 9 as Image, ` memirnack valley K"ring Comrrisdon Coes rot make a ,y warm my.exp'es:ea of implied,nor emare my laps Itahllay a'reapaerbmy for the accuracy.eottSlkteneys. or U%Kilnew d the Geograptic wetntavan System(GCSI Osla ce any other daa provided hefeln.Ina data does not tm 4 t?*puce of a p tress5owi sun--y any has no �./ tegaf bat earing m the tae stupe,si--,loca%n,arexistence of a geographio%Were.pFopeny fine or poln"I MpreaentE lot Me tmack VN"P>7mnr g CatmMsion reques�thany use c1 bA lnr&madon be acoompmed try a mrer nee b Ito soiree aW the Menlinack.Valley P1anMrg m Com im 'a caveat mat n makes Ito watram ea m mpre*enmWvn as to tte-amiracy W saN Information Arty use of mis imottnstYm Ls at the recipient sown risk. http://mimap.mvpc.org/NorthAndovermimapNiewer.aspx 7/2/2012 �10RT/� (!f St�.tO 161'y Y �9SSACHus t� CONSERVATION DEPARTMENT Community Development Division July 26, 2012 James &Anne Zahoruiko 19 Halifax Street North Andover,MA 01845 25 Margate Street, North Andover Installation of Above-ground Pool and Minor Grading Conservation Conditions of Approval,NACC #97 Pursuant to section 4.4.2 a) of the North Andover Wetlands Protection Regulations,James and Anne Zahoruiko (owners) filed for a small project for work proposed at 19 Halifax Street,North Andover.The proposed work includes installation of an above ground pool and minor grading located more than 90-feet from Bordering Vegetated Wetland (BVW) as shown on the herein referenced plan. An existing deck and driveway are between the proposed pool and the resource area. All disturbed areas will be loamed and seeded upon completion. During the July 25,2012 public meeting, the North Andover Conservation Commission (NACC) voted unanimously to approve this project.The following conditions are hereby mandated: RECORD DOCUMENTS: Small Project Filing Including: Project Checklist and Aerial Plan Prepared by: James and Anne Zahoruiko Date: Materials received 7/12/2012 CONDITIONS: 1. Prior to the start of construction the applicant shall ensure that the site contractor has reviewed the small project permit and is aware of the wetland resource area and the limits of the proposed work and shall contact the conservation department for a pre-construction site visit. 2. Prior to the start of construction, the applicant shall have 8 haybales on site or other form of erosion control to be used for emergency purposes. 3. Prior to the start of construction,the applicant shall install three (3) wetland markers (available at the Conservation Department—2 round 1 square) at the existing tree line. 1600 Osgood Street,Building 20,Suite 2-36,North.Andover,Massachusetts 01845 Phone 978.688.9.530 Fax 978.688.9542 Web www,htq)://wwca.townofnortbAndovercom/consenel.htei 4. Excess material shall be properly disposed of offsite. 5. Upon completion of the approved project and site stabilization,please contact the Conservation Department for a final inspection. 6. This permit shall expire six months from the date of issue Should you have any question or comments regarding the contents of this letter,please do not hesitate to contact the undersigned at 978.688.9530 at your earliest convenience. Thanking you in advance for your anticipated cooperation with this matter. Respectfully, ORTH ANDOVER CONSERVATION DEPARTMENT en fer A. HuAI es " o servation dministrator 1600 Os, Stree Buddin 2 - T Osgood t, � 0,Suite 2 36,Forth Andover Massachusetts 01845 Phone 978.688.9530 Fax 978.688.9542 Web www.htq):/Jwww.townofnorthandover.com/conse wl.htm