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HomeMy WebLinkAboutBuilding Permit #179 - 196 MAIN STREET 9/4/2007 BUILDING PERMIT oq r►ORTf� t,�D TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION * _ 1• w Permit NO: Date ReceivedADAATED �•y �SSACH�1`��� Date Issued. `G IMPORTANT:Applicant must complete all items on this page LOCATION �b � 11 k i'Pr✓�E' 4,0V ArA- 80VfWl Prin�j PROPERTY OWNER Satf)f Mt � 1'C ,+1' t Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes Pno3 Machine Shop Village yes 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: USe fib` IbO T'rNT int 5��1, 9"-Y-ir-J6 �T dN f�+N Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: CONTRACTOR Name: � _ ��A -"D Phone: Jj Address: Supervisor's Construction License: Exp. Date: ti Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ / �G� °= FEE: $ Check No.: �3Z Receipt No.: 02 S �O NOTE: Persons contracting with unre ' tered contractors do not have access to the guaranty fund signature:of Agent/OwneJ I 1,4,XA i Pf f S' nature 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 (� }� r 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 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 2007 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) o 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 Revised 2.2007 Location ("Ib M(U No. 1 '"r 1 Date NORTH TOWN OF NORTH ANDOVER • ; . Certificate of Occupancy $ ssAcMusEt�' Building/Frame Permit Fee $ -�� Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # ! t S� 2 20563' Building Inspector rha 21 August,2007 Gerald A. Brown Building Department Town of North Andover 1600 Osgood Street North Andover, MA 01845 Re: Proposed Alterations to Lunch Room—St.Michael's School,North Andover,MA Mr. Brown, I have been monitoring the renovation work on a regular basis and understand that the contractor is interested in closing the walls and ceiling to continue with the finishes. Please be advised that the above referenced architectural project is proceeding according to plan and to the Mass State Code requirements. Feel free to call with any questions. Sincerely RERED �lF, . ...... 6,, r o I o.4627 ' N HAVE RHILL, ~- Ronald Henri Albe H'. �W Architect )F n�►S�! ronald henri albert,aia-architect 262 mill street, haverhill,ma 01830 978-374-0547 978-374-4092 fax 08/16/2007 14:33 FAX 19786865408T_- ST MICHAELS __ _ ___ 07).002 _ !V .'. 196Maun Street, North Andover, N�A`0,1:$45-259$: - 4;8 - 8 686- 50 Ph: 978-686.4050 Fax: 97 www.saint-michaef,org August 16, 2007 :Building:Department. Tow6bf-Notth Andover 1600.Osgood Street North-Andover,.MA 01845 ... Dear Sir: Saint Michael. Parish is planning our -parish picnic ort_Sunday September 9, 2007 fro.., -'Fpi�to 5pm.We.would;like to have a 40 foot.by 1.00 foot' tent on.the Main . `S.treet parking.lot in front of the schoolentrance.,The tent will be staked on the-40. foot.sides into.tlie.islands and..at the center of the 100 foot sides. We will use rain. barrels for the .rest of the IGO foot.sides: I .have attached.the.flame resistance certificate for the to 1 will.eiso call Dig,,Safe: Tl a tent wil( go up on Friday September 7, 2007.. When does'the tent need to be completed far art inspection from;the.building department?.When. can (:.come into co implete..the.permit applicabon and what will-the.cost.be? Is there anything else:the parish will need to do to have he tent for the picnic? Thank you for your help and time) . Sincerely, - Earline Tweedie Saint Michael Parish Picnic Coordinator 078 68.6 4050 ext. 15 7,o i•1-.. :::i' :• I:♦ .�Ii .., ♦Ii x.11 '♦�11:•. ��1♦ !1!' ♦f+ : 11i I.11 }4!'.:. ♦.I ..: f.1 'f I1 r •.i' 1}♦ .' 1�1, �I M• !f1 '. ...-1fi '„ _'111 ,. 11 ,. 1l1�-: '11l 1:..:;:.!l1... ii ii.r. 'I II i:, _, ff 1♦- 'lif 1:., i1i1': t/.1. : /./e'-. ifli 1111 -.l iifi:. Illi '., �ii��e. 11 :. :./f. '//i1..,. 1/Ii•.;,1.11; ...1 1}/Yl.-•-;ipiit ;1H•1,.: 111 f+1i.=. ,It1 Ui1+';:- �0►I1,/i'ii 'I iilte+l`'.111/1 rr.:t1+1117.".�'ltYiYi/i'..:� 1i/1�' '11 1.',;:': q ••. 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F '�iii�' �iii�'�` ii1i. �iie` ♦/ ♦♦ i♦ i •1� --:. •f 1 ',.Ii; ' ♦1'i , illi :._�/�.• .<pl}' 1•, -I 1 :_♦• 1♦i,. ie• cif ♦ • } ♦ • i .NORTH 0downover O �1 a�•• 1 .�,rt No. 179 X _ Ao over, Mass., COCHICHEWICK ADRATED S ` BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System `vBUILDING INSPECTOR THIS CERTIFIES THAT..... .. ...... ....................................... .�l.......l. ........................... �M ........................ Foundation . buildings t I(/ has permission to erect....................................... gs on....... . ............ ...... ... t.�............r�......... ........ Rough .. to be occupied as / �� Chimney , '� 4 . that the person accept this erTnit shall in eve respect conform to the ter of the application on a in provided a p p g p every p PP Final this office, and to the provisions of the Codes and.-By-Laws relating to the Inspection, A tion and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final SO .� PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTR O ST 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. Aug 27 07 04:15p Paul 978-443-0072 p.2 98/24/2007 16:14 FAT 19786865408 S'1' RICKAELS 44Juuo The donimonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 kvi www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/ElectricianslPlumbers Applicant Information Please Print Leeilbly Name(Business/Organization/lndividual): Address: City/State/Zip: Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.0 1 am a employer with 4. ❑ 1 am a general contractor and 1 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.El am a sole proprietor or partner- listed on the attached sheet. « ❑ Remodeling ship and have no employees These sub-contiactors 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.❑ Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL I I.❑ Plumbing repairs or additions myself.f No workers' comp. c. 152,§1(4),and we have no 12.[3 Roof repairs insurance required.]t employees.(No workers' 13.❑ Other comp, insurance required.] .Any applicant that checks bar#t must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this sflidavit indicating they are doing all work and then hire outside contractors must submit a new afridavit 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. lam an employer thal is providing workers'compensation insurant a for my emplayeec Below is the policy and jab site information. Insurance Company Name: MA Rif*11, Policy#or Self-ins.Lic.#: G(y0c2� IO(p Expiration Date: 1�a�o8 i .fob Site Address: 14(P Afl I'vN S? A% ft-lf..r City/StateJZip: /`It+ 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 lnvestigations of the DIA for insurance coverage verification. I Ido hereby fers#yander the pains and penalties of perjirry that Ilse information provided above is tree and correct Signature Date: Phonet�- O)TIcial use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License tt Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing inspector 6.Other Contact Person: Phone 9: Aug 27 07 04:15p Paul 978-443-0072 p.3 CERTIFICATE 4F LIABILIW INSURANCE °�' ar°"127 07 Protlucer IS CE TIFICATE IS ISSUED AS A MATTER OF Association Benefds Ins Air Inc INFORMATION ONLY AND CpNFERg NO RIGHTS UPON TliE 529 Main A Ste BD6 CERTIFICATE HOLDER. TFi16 C);RTIa=1GATE 0(E5 NOT Boston,MA D212s-112 T AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Insured INSURERS AFFORDING COVERAGE NAIC# Ma ial Rentals,Inc. INSURER A; MA rWtaQ M5[0hant3 WC G?0UP Ino. d/Wa Sudbury Taylor%ntals INSURER B: 712 Boston Post Road,Fde•20 Sudbury,Mgot776 INSURER C; INSURER D, COVERAGES JNSURER r- -THE PaLIGES OF INSURANCE LISTED 8YE eEFJV rSSLIED ANY RECUrfZEytENT lERm OR CQNDITION OF ANY THE INSURED T VWTM ABOVE FDR THE POLICY PERIOD CA D.NO7W A0131RUp THE INSURIINCEAFFl7RDED BYTHE POUl:1E 9011 DMERE IIS SUBEJECT O 1. SOTTO IAMICH 7NIS eERTIFTCATE MAY 9E J85t)ED OROR DING MAY AOGREOA LInAiT38HOWNNAYHAvEBEZN1REDUCeDeYFA1Dq.A1MS, ACL 714 TERMS-EKCLUSIONSANDCO=TlONSOFSUCHPOLIVES, Root PoULY *611 LTA MSRG OF INSEI:TEcrIVEGATE POLICYEXPIRATION ®!NiA @L UAALMY PO1tCY MM6EH DATE uMrTs COfAM9tCll4L 3E146tAL LIABnJTY EACN OCa;LRtRJ3JGE S CLAINSMA06 =OOCUR F1REpANAfSgIftyone De) f, MED EXP(My aro pe S PERt30ly1L s ADV INJURY E GB"I AGGRMATEymr APPLIES PER GEkfiiWl_A83REGAIX : FOIJCY PRO--isCTLOC PRODUCTS-COMP/DPAGG AUTOMoslle LrAelLrry I ANV ALITb - d t4LE utas _ I( ALLOWNEDAUTDs SC}MuFM AUTOS BODILY INJURY H RED AUTDS (F—Pom" S rJDN-0V WED AUTOS BODILY I'm 0 oJL1tY raeddard i GARAGE Li0B1 PROvEaTY OANAOE LRT (Par emldmd) S ANY AUTO AV11D ONLY-EA ACCIDMr OTWR THAN EA AI S 'm LABILITY AUTO OmY FiIGT1000LR�i S OCCUR LZAtMs'MADE AGOREGATE BICE ` S uscumELE RETtJ'1nOP1 i s WO SATTO BaPLOYERS LL4BIL(TY ANY PROPRiET'ER MSC 6rATU• rT. A OP- r «mvE 1 TDR rwTS ER �1MEMBER EXCLUOEDT NO 0ELEACC% B S 500,000ZPWALPROVISIONS eeia. 10005010169071PotA7 1107/08 EL as�eE-EA B�aPLovff OT PJL EL ,. LI urr ib 500,000 s 501),000 DE I (ON OFOPERATIONSf LOCATtON9l VFJIIC,FSJ uslcNs 0 Br1 OupOR,�Fc,I,,IE T/ � PROVL90Ng CERTIFIGAiE IidLDER AoanoNAL INS1JRH2 INbZRe1 CANCELLATION 1 29 Of i S Rh ATId01/Br SFIOULDANYpF T?TE gBOyE OEBCRI ED P OLID s pc� 120 Main over, THE EXPIRA710NDATE 11fEREOF,THE ISSUIN4UINSURERVJILL ENDEAVOR TO Noeth Andover,N!A 01845 MAIL __DAYS WRITTEN N40MCE TiD T1{E CE"FIr-ATEHOLDER k*AeD TO THE LEFT,I3M FAILURE TO DO SO SMALL III NO OBL IGA7tON OR L1A91L11YOF ANY MND UPON THE INSURER,ITS AGENTS OR REPRESENTA71VES. AUTHORIZED RFDRESENTATIVE ziz d 9« •AIN }wd6ti:z =L0oz iz .9na