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HomeMy WebLinkAboutBuilding Permit #907-11 - 191 MASSACHUSETTS AVENUE 6/28/2011TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: jE; _ Date Issued: IMPORTANT: Date Received must complete all items on this LOCATION/ Fl AA 5 5, A U f Print PROPERTY OWNER 64 US '��� C y _Sl�eA Print MAP NO: O/0 0 PARCEL: 00S:570NING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential - Non- Residential ❑ New Building eOne family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units-'- ❑ Commercial ,Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other .�® Septic D Well _ odlamp;' " ®Wetlands` ❑ Fl_00,I) ®I Waterslied.Distr ctt - = , DESCRIPTION OF WORK TO BE PEItFORNIED: ovc 4-- a�GP(HCe, f?0C i .�uAe pllcreca.,� r ati� /0 - Identification Please Type or Print Clearly) OWNER: Name: G b f IS 1�, f)ei4CY Phone: 6 `7 .3,*,�a 3 S_ Address: 144 $6'• AV(, /i/ AVA CONTRACTOR Name: ]�, �• �O f Jq)el - 6 w5 l Phone: Address: S e w a eQyc, Supervisor's Construction License: Exp. Date:_ Home Improvement License: / Exp. Date: 106 16 l ARCHITECT/ENGINEER Phone: Address: Reg. No. , .ham FEE SCHEDULE: BULDING PERMIT: $92.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Coat: $ 7 ©e FEE: $ 5-6, Check No.: �y 7 Receipt No.. NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Plans Submitted ❑ Plaris Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Well ❑ Private (septic tank, etc. ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Permanent Dumpster on Site ❑ - THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION COMMENTS HEALTH COMMENTS Reviewed on Signature Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Co Conservation Decision: Comments Wader & 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 ® 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 NOTE: ❑ Building Permit Application ❑ Workers Comp Affidavit p ❑ 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 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 i ❑ Photo�Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ,.E.. ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) X ❑ 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 ConstructionSin le ( g 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 P40TE: 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 tlhat 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: Doc.Building permit Revised 2008mi Location .No. Date 'rot TOWN OF NORTH ANDOVER M Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL Check # 2 4 62 8 V building Inspector �Ci z cz 0 r U 0 cn 71.0 U =.0 W V .rA O c i O O v Z CLo O h D � I O Cm C C ca H O �O E cc m 0 co Z O.0 O � � as o 0 y C *C C cc C.3 C Z CD �..± ca O C _cc 0. E 19 LLI U) 19 W cz W to c y- o m c xAG 0 O 0 O t .CL0NZ O ev H W : •., m oc �'1 o a � ;Ec m C2 0 j .: s rm Qom: m c E c.;... N O .mm L : �N Mot m 3 �. _m .10 213 CCU E m w cm CLU �� m c 'E mor m 603 Z c C o o. c Q � y m c •p = m m 3o a w ~ e0.. N m.2~ CD W c to= fl m a O •tNA c r.+ CD 0 O °c E CL=O C v cn o V a p ®`.� c co x CO m O 'O .a y .= cn F- ` d'c... m aT, U ° Q cd WF �, O w v cry O w O w U w" O c� w O C rw v� w O c� C u. w �. cn o U) 0 r U 0 cn 71.0 U =.0 W V .rA O c i O O v Z CLo O h D � I O Cm C C ca H O �O E cc m 0 co Z O.0 O � � as o 0 y C *C C cc C.3 C Z CD �..± ca O C _cc 0. E 19 LLI U) 19 W cz W to c y- o m c O O t .CL0NZ ev : •., m oc �'1 o a � ;Ec m C2 0 j .: s rm Qom: m c E c.;... N O .mm L : �N Mot m 3 �. _m .10 213 CCU E m mo cm CLU �� m c 'E mor m 603 Z c C o o. c Q � y m c •p = m m 3o a N ~ e0.. N m.2~ CD W c to= fl m L O •tNA c r.+ CD 0 O °c E CL=O C v cn o V ® p ®`.� c co x d m O 'O .a y .= O F- ` d'c... m 0 r U 0 cn 71.0 U =.0 W V .rA O c i O O v Z CLo O h D � I O Cm C C ca H O �O E cc m 0 co Z O.0 O � � as o 0 y C *C C cc C.3 C Z CD �..± ca O C _cc 0. E 19 LLI U) 19 W cz W to A CORD TM. CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 06/28/2011 PRODUCER Phone: (978) 475-0400 Fax: (978) 475-2171 THE HOWE INSURANCE AGENCY 4 PUNCHARD AVE ANDOVER MA 01810 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. POLICY EXPIRATION DATE MMIDDIYY LIMITS Attention: wn�rrr� n INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: National Grange Mutual EACH OCCURRENCE Is KEITH J CORMIER DBA K J C CONSTRUCTION 35 MAPLEWOOD AVENUE (INSURER B: ACE Group X COMMERCIAL GENERAL LIABILITY --' CLAIMS MADEX] OCCUR INSURER C: INSURER D: DAMAGE TO RENTED PREMISES (Ea occurence) Is METHUEN MA 01844 INSURER E: 10,000 g A %+v v r_rcr►ur_a 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 ADD'LI LTR INSRD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MMIDD/YY POLICY EXPIRATION DATE MMIDDIYY LIMITS Attention: wn�rrr� n GENERAL LIABILITY MPK46220 I 07/31/11 07/31/12 EACH OCCURRENCE Is 500,000 X COMMERCIAL GENERAL LIABILITY --' CLAIMS MADEX] OCCUR I I DAMAGE TO RENTED PREMISES (Ea occurence) Is 500 QQQ , MED. EXP (Any one person) 10,000 g A - PERSONAL & ADV INJURY Is 500,000 — GENERAL AGGREGATE Is 1,000,000 j i GEN'L AGGREGATE LIMIT APPLIES PER: 1 PRO- �i POLICY JECT LOC PRODUCTS-COMP/OP AGG. $ 1,000,000 AUTOMOBILE LIABILITY i I --- I ANY AUTO COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY ALL OWNED AUTOS I SCHEDULED AUTOS i I (Per person) $ � BODILY INJURY (Per accident) $ HIRED AUTOS -� NON -OWNED AUTOS — PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO L I I OTHER THAN EA ACC AUTO ONLY: AGG 1$ _ $ EXCESS / UMBRELLA LIABILITY i EACH OCCURRENCE i$ ATE $ OCCUR _ I $ J DEDUCTIBLE I RETENTION $ is WORKERS COMPENSATION AND EMPLOYERS' LIABILITY UB4549P50-9 04130/11 04/30/12 WC STATU- OTHER �TORYLIMITS E.L. EACH ACCIDENT is 100,000 B ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? I If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE -EA EMPLOYEE $ 10Q�QQ0 E.L. DISEASE -POLICY LIMIT $ 500,000 OTHER: � I DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS VLr\IIrIVm i C nlV UCR !'Amfr­l l AT1"kl Chris & Tracy Shea SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE 191 Mass Avenue North Andover, MA 01845 EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, IT'S AGENTS OR REPRESENTATIVES. Attention: wn�rrr� n AUTHORIZED REPRESENTATIVE vl0 OuiS -�- -� ti rnnlcate * /ats © ACORD CORPORATION 1988 ACORD TM. CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 06128/2011 PRODUCER Phone: (978) 475-0400 Fax: (978) 475-2171 THE HOWE INSURANCE AGENCY 4 PUNCHARD AVE ANDOVER MA 01810 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MM/DD INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: National Grange Mutual MPK46220 KEITH J CORMIER INSURER B: ACE Group EACH OCCURRENCE DBA K J C CONSTRUCTION 35 MAPLEWOOD AVENUE INSURER C: X I COMMERCIAL GENERAL LIABILITY CLAIMS MADE i X OCCUR I INSURER D: METHUEN MA 01844 INSURER E: $ 500 000 r MED. EXP (Any one person) l.V V tKAUtb 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. INSRiINSR LTR INSRD, TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MM/DD POLICY EXPIRATION DATE MMIDD LIMITS GENERAL LIABILITY MPK46220 07/31/11 07/31/12 EACH OCCURRENCE $ 500,000 X I COMMERCIAL GENERAL LIABILITY CLAIMS MADE i X OCCUR I DAMAGE TO RENTED PREMISES (Ea oocurence) $ 500 000 r MED. EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 500,000 A I� _ [GENT GENERAL AGGREGATE $ 11000,000 AGGREGATE LIMIT APPLIES PER: POLICY i J CT I I LOC PRODUCTS-COMP/OP AGG. $ 1,000,000 AUTOMOBILE LIABILITY ANY AUTO �i COMBINED SINGLE LIMIT (Ea accident) $ ALL OWNED AUTOS L— I SCHEDULED AUTOS BODILY INJURY (Per person) $ HIRED AUTOS NON -OWNED AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE. (Per accident) $ E—�-----'– j GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO AUTO ONLY: AGG $ EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR L� �_ l CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ I $ ' WORKERS COMPENSATION AND EMPLOYERS' LIABILITY I UB4549PSO-9 04/30/11 04/30/12 IC CTATUT -S OTHER .L. E.L.ACH ACCIDENT $ 100,000 B ANY PROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below I E.L. DISEASE -EA EMPLOYEE $ 100,000 E.L. DISEASE -POLICY LIMIT $ 500,000 OTHER: DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS \+ FN I irl%,M I C I-IVLUr_M (—ONCFI I GTInFJ Chris & Tracy Shea SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE 191 Mass Avenue North Andover, MA 01845 EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. Attention: AUTHORIZED REPRESENTATIVE V A�Ouis zV <<VV uVo) ueruncate ;F tdzs ©ACORD CORPORATION 1988 ? Office of Consume" r'AffaP� s&✓�/laeaac�iaaP HOME IMPROVEMENT CONTRACTOR Regulation Registration-—, 125049 Expiration: 1011/2011 Type DBA Tr# 287967 K.J. Cormier C n�truction <l ! i' Keith Cormier35 Maplewood Ave l mss' Methuen, MA 01844> :1 Undersecretary Massachusetts - Department of Public Safety Boar(I of Building Re"uiafions an ' Construction Supervisor License�intl.t►d5 License: CS 81948 Restricted to: 00 KEITH J CORMIER I 35 MAPLEWOODAVE�; METHUEN, MA 01844 Expiration: 8/18/2011 -- - ---- --- - Tr#. 1-691 J a 1 MORTGAGE INSPECTION PLAN PROPOSAL P. CORMIER CONSTRICTION 978.852.9461 LICENSED CONSTRUCTION SUPERVISOR 081998 r..� � .1 1777", D.B.A. Keith J. Cormier HOME IMPROVEMENT CONTRACTOR /,,� .5"0 Yq PROPOSAL SUBMITTED TO: f MA s.s. AVE, All 4,vd, WE HEREBY SUBMIT SPECIFICATIONS AND ESTIMATES FOR: J Page No. of Pages DESCRIPTION OF JOB ARCHITECT DATE OF PLANS JOB ADDRESS CITY STATE ZIP PHONE DATE Dec t4;'7'a r Jl L'A/011c (/rk• i �,Po6 f &ee-g ccs 4'0jP'C r?fy o"CAXZ4!54A1)C1 J 61-F,41(1 CMe6A., 7- XPi Of fw o2x2 P7- Ale-, es f 11J)C,4tO k, /0 sow a ,b,P ,?x '-r. X3-11 UZell S QG Make Checks Payable To: Keith Cormier 35 Maplewood Ave. Meth, MA 01844 4-rez eXI S We hereby propose to furnish material and labor, complete in accordance with above specifications, for the sum of dollars ($ !� with payment to be made as follows: /W/ 0o, 0e.QoS if- r All material is guaranteed to be as specified. All work is to be completed in a workmanlike manner according to standard practices. Any alteration or deviation from specifications Authorized involving extra costs wiff be executed upon written orders, and will become an extra Signature charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire, tornado and other necessary Note: This proposal may be withdrawn by us if not accepted insurance. Our workers are fully covered by Worker's Compensation Insurance. within days. Acceptance of Proposal - The above prices, specifications and condi- tions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above. Date of Acceptance: Signature .1�0 Signature