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HomeMy WebLinkAboutBuilding Permit #695-2017 - 20 JOHNSON STREET 1/5/2017NORTH ANdtl BUILDING PERMIT o tt�E� :6 ti TOWN OF NORTH ANDOVER 3 APPLICATION FOR PLAN EXAMINATION , Y Permit No#. 11 Date Received 1 �ysSgcHus���u Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION !40 ao& )b,,rJ:CeJ" Print PROPERTY OWNER�,,.���p� �e(�� �/ TRt>s:f Print 100 Year Structure MAP PARCEL:gcZ ZONING DISTRICT: Historic District Machine Shop Vill e yes no no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family [I Addition El Two or more family ❑Industrial ❑ Alration No. of units: ❑ Commercial epair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑ Well ❑ Floodplain ❑ Wetlands ❑ Watershed District ❑ Water/Sewer RIPTIUN UF- VVL)KK 1 V mr- r rumiviw. *c & C � ads. 4wd Identification - Please Type or Print Clearly OWNER: Name: CeK;rL leeA LW —l'2m� & F N2 ( K�ove e- Phone: 9?8- 6 J Address: I • ©, oX 8?q, �V o hcb0ye�, WI V� o /8�1 s --f-S e k1 64-0 fl Contractor Name: Phone: Address: Lecr 01,A Y,1646 -v L*N r,, 00 A-111otle,,2 l / Supervisor's Construction License: G' S"4`1�.3��-- Exp. Date: Home Improvement License: 18(o IR o Exp. Date: !� 17 Aa Address: Phone: 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. $ // U� FEE: $ Check No.: 20 Receipt No.: 3 4o 1 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund —... I na u -e of contract G Signature of Agent/Own i.7! f gV V 4 L— r-- J 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 JLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS � A CONSERVATION COMMENTS HEALTH COMMENTS Reviewed on Signature Reviewed'on Signature - 4. Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes t 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 I_ 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 NU I E5 and DATA — (For department use) ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 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 u Building Permit Application a Workers Comp Affidavit Li Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract o Floor Plan Or Proposed Interior Work o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks u Building Permit Application Li Certified Surveyed Plot Plan a Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract o Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) u 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) o Building Permit Application o Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) Li Copy of Contract Li Mass check Energy Compliance Report o 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: Building Permit Revised 2014 Location No. 0 6 - 7N7 Date `� i Check # CI TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ !;�. Foundation Permit Fee $ :� Other Permit Fee $ TOTAL �' Building Inspector = J Q LL DZ a m C L av .+ O LL E= aa+ In j. Ln 4J (n O z z o m_ C O J O LL O CC C L U C LL O ~oC w z J d L O cr C LL 0 a z Q U W W L O d' U >_ N C LL O a z L -to LL i- z W o~C CLW LL v m O z N N _N O (n z LU _ _0 m �' 0 O n o E AC" O w O _ 40 E O is N L L LU � _ _ as 43 N O = O > O 'a > a �) a = �• t O E c Qo �z cm �,=o a) o = 'v_, 3 CD a> > o = ltcxL �=O •cn a1cI kvi 4i '� CL 4) H' O yV m d - O O W = -a LL'ya? % (n = O N •� M O z LV 'E 0 -a = v O i 0 CD V Qi OCL 'a m. FE M L- H i - CL 0 U > a w ti S It v c� r -i L N N r_ H � cc 00 O CL CL ca O � J � o z CLA O U W a z C) 0 CD Cl) O O v+ Lu� Z x W Cl) cnW az a w ti S It v c� r -i L N N r_ H � cc 00 O CL CL ca O � J � o z CLA NORTH ANDOVER OLDE CENTER HISTORIC DISTRICT COMMISSION Certificate of Appropriateness This certificate of Appropriateness is issued this Third day of January 2017 to Center Realty and Trust for 20 and 20A Johnson Street in accordance with Chapter 40C of the General Laws of the Commonwealth of Massachusetts as amended and the by-laws of the North Andover Olde Center Historic District Commission. i7f�<�v�L ot- t�1� wo�c.� watt �V)c(uC��. 2Mov�� bF i11 -9X_Wf-10 1/L k LUd0t> Ikri AND he plAC.Qm-a&-t W11-7`1 +/L XH21Ji PLANK S1©WG ADblvto /►qll keimovAt, or— SKg11TP vv14&"J REsP/A"/'n� 0(= ROOF. Ui 2 S F-rcX e uLq R QVC d kCMOUAL -AA)b AA Azl41Ne, or- y2_AK� w"ru ✓i�S�T�`� cells(L P vc- 1-3-1ot? CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYW) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THS16 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 M.P. Roberts Insurance Agency NAME:PHONE p' ROBERTS 1060 Osgood Street (978) 683-8073 A/x N - (978) 683-3147 North Andover, MA 01845 aDDRRESS* AMY@ mprobertsinsurance. com INS._ URERA: INSURED --- KEY LIME INC 10 HEPACTICA DRIVE INsuRERc: NORTH ANDOVER, MA 01845 INSURERD: COVERAGES cGorrrrr+ArC .11a■sem" KEVISION 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 CONTRACTOR 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" _ VSR� —" �MODE SUBR POLICY EFF POfJCY IXP .TR TYPE OF INSURANCE I t POLICY NUMBER M/DD/Y (MM/DDIYYYY) LIMITS A GENERALLIABILITY 3EE0820 6/15/16 6/15/17 EACH OCCURRENCE $ 11000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED _MLGE e I$ 50 000 CLAIMS -MADE � OCCUR ME GENT AGGREGATE LIMIT APP LIES PER AUTOMOBILE LIABILITY ANY A UTO ALLOWNED SCHEDULED AUTOS AUTOS HIREDAUTOS — _ NON -OWNED AUTOS UMBRELLA UAB �_ OCCUR EXCESS LIAB CLAIMS -MADE B WORKERS COMPENSATION WCC50050075812016A 9/15/16 9/15/17 AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTNE OFFICER/MEMBER EXCLUDED? N I A (Mandatory in NH) DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Rema Schedule, if more space is required) TE CELLATION D EXP (Anyone person) $ EXCLUDED PERSONAL& ADV INJURY $ 11000,000 GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ EXCLUDED BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per accident EACH OCCURRENCE $ AGGREGATE a Cl DE NT $ 1,000,00 -EA EMPLOYEE $ 1,000,00 -POLICY LIMBI $ 1,000,00 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN SAMPLE CERTIFICATE ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE MICHAEL P ROBERTS ©1988 2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD Phone: Fax: E -Mail: - _—_--- Office of Consumer Affairs & Business Regulation =' HOME IMPROVEMENT CONTRACTOR Type: Corporation Registration Expiration 166186 10/07/2018 Key -Lime, Inc benjamin Osgood 10 Hepatica Drive North Andover, MA 01845 Registration valid for individual use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, MA 02116 �C U Undersecretary Not valid without Ognature Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS -075302 Construction Supervisor BENJAMIN C OSGOOD 69 OLD VILLAGE LANE NORTH ANDOVER MA 01845 '1VIt"� v`— Expiration: Commissioner 12/04/2o1s