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HomeMy WebLinkAboutBuilding Permit #125-14 - 2009 SALEM STREET 8/7/2013 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION 1 �i Permit NO: Date Received Date Issued: I (ORTANT: A licant must complete all items on this page s _ LOCAT,IO.N _ - I - _ Pr4nt PROPERTY, OW ER_ Y�1G�1x - 'LI Print 100 Year Old Structure yes nq PARCEL:MvLONING DISTRICT _ Historic District yes no I, k MAP-NO _ -- - -- , Machine)S,hop Village_ _yes o TYPE OF IMPROVEMENT PROPOSED USE Reside al Non- Residential ❑ New Building ne family ❑Addit' n ❑Two or more family El Industrial 4 ❑AI ration No. of units: ❑ Commercial t epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑Septic. 01Nell f�❑ Flg.odplam ❑Wetlands ❑ WatershedEpistrict_ _rg Water(Sewer DESCRIP� Th OF O OBE �ERFO�RPA : I Identificatio lease T pe r Print Clearly) ` i9 Phone r ll OWNER: Name: Address: _ AJW Rh C-Nf °RAPTOR Name_ one - _ _ �. Add ss: - } - , Ek Date: ." SUpervisor sConstructon License: �f� - = p - Exb. Date: Home Improvemerift cense p ARCHITECT/ENGINEER Phone: 4 Address: Reg. No. I FEE SCHEDULE.BULDING PERMIT.-$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ r-1 r�n FEE: $ Check No.: C � Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to a uar my fund )h Signature,of contractor _ ;Signature�,of Agent/Qwnerf 4 , - Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ St ped Plans ❑ Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE--OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/MassageBodyArt ❑ .. 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 Siqnature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments QI ater & Sewer Connection/Signature & Date Driveway Permit DPW Tow;; Engineer: Signature: Located 384 Osgood Street FIRE DEPARTf!lENT =Temp Dumpster onsite eyes. no Located at 124iMair, Street .i„» .J. ,s ..f . F I s M Fire ®epartmerit signature/dat COMMENTS - u 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 ® Notified for pickup - Date E Doc.Building Permit Revised 2010 Building Department The fol owing 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 L, 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 L3 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 L, 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 a 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 apn>al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submAted with the building application Doc: Doc.Building Permit Revised 2012 Location ��� C1vtPw� No. CJ �!tD�� Date t . - TOWN OF NORTH ANDOVER Certificate of Occupancy $� Building/Frame Permit Fee $ ---' 3 Foundation Permit Fee $ Other Permit Fee $ *� TOTAL $ i Check# t /� 26706 Building Inspector � NORTI� Town of EAndover 0 - to I �` h ver, MaSS, AqA11&!k 4 O0 Z A1 i, 1". . COCNIC"'WICK �d A2R-4TE0 S U BOARD OF HEALTH Food/Kitchen PERIVII LD Septic System (7)T THIS CERTIFIES THAT0 .......... BUILDING INSPECTOR Foundation has permission to erect .. ...................... buildings on ....�0�:�.... ..tk............. Rough to be occupied as .......... ............ .. .�� �,�j... �� Q1�41�......................... Chimney provided that the person acceptingthis mit shall in eve respect conform to the terms of the application p p p every p pp Final 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 IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCT TARSRough Service ............... ... ....... .......................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Reguired to Occupy Building 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 Jul 29 2013 7: 01AM MIKE SIDMAN 6039345514 p. l ROME D&ROVOW-rZONTRACT &EM READ tM gold,•Ygmisbed m4,1p04lted•by 13 h N1rme: Boatrm note; THD At-Ham Scmlces,.Inc. . d/b/a The Roan Dopat At-3me-Scry m 908Bostan Turnpike,Unit.l,Shrewsbtuy,MA 01,545 Toll Free(800)657.5182;Fax(SOB)843.WI7 > nuick Naraber:31 Fedmi ID 44 75-UO&W;W Lk p C 02439:Ili Conk Ue#1.6421 (` ) Cr Lia 0 Hh".030522;MA-Hoath lmprer�emdni CSlntrwtor)tey.#J UOS InataAatlonAddretre; aZDZI� ..la•(G.�!'l_-�_2' City Ste a 2*, Ptee>¢aaar(a): Work P90110: Kwu Phone: C0111phane: alga t [ [ a [Abe I9 dome AddreMs: (ifdiftmnt fromhtatalistion Addfem) City State Zip Email Addtgss(to mesive project communications and Hume Depot updetesj:—.—.... .. ._...__.... ..._-- ... ... _... I•00 NOrl!wish to receive any nwkeOtig emoils favor The Harne Depot PrWeat Undersigned•("Customer'),the ownep of the propeacy located at the abtwe�iftus]lation address,ageeaa to buy; an A� r-Hpme Srry cee.Inc.C'The Home Depnt")agrees to•htrnisfi,detiverand arraaga.fw the installation("ltwtalfatlan'•'169 all rt7atrtriala riFat ribed an Wo below and on the rtsforenced Spec S,heat(5},all of which sue ixworporatea into tins Contrua by this .rofcmuc,alfa with any applicable'Stste Supplement had Pityrimat 9whMory attacbed hereto and any Change o]rd"A tcoltectively; l Vokraet° •T�! t"�"'soa"°s Preduetsk auShee 'M: Pftled Amount Rang siding Wiatlnw6 ltquistWn .1_70 Cl6rea, Lorrywors❑� / y©Y $ • nQ siding Wirakrvrr: ir®trieaon . ©tn.lt:overa ❑6etryDaonr . Rmf%ag LISWrig Owindpwr 011witadtin ©Galax*/Cavcm OE'iatryDomafl � AMA-9 ushuns wiO&ZQ799anr Qauttera�caves psauy noon, C3-- Mei25%Dgwku(PrractAt*taWdue rtpontxerutieaoftfift T901 Contraid Amount $ 7(f�r. Mahn Putah AN nay Ant dwwt mane fhm az4wrd of the lbtttnWo Cltatotrar agrees that,immediatrly upon completion of the work for ah Prc+dttct,Cr,ttomer*W execute a Completion Ceatffuate (one for"ch-Product as defined by an individual Spec Sheet)and pa any t:altutGn'dua, Aa:applicable,each-Customer tul&x this Conuaa ttgree+t 96be 901rtHy and tevetaUy trb]tgnaeA VWliaKk The Home Dtpot Nerves tate right W inuit a Change Order-or vwrmi this CAtt4004rr Any individtral Product(s)iIIcluded hetttia,at ita distaetion,if'Tha Home Depot or it%authorized N—ce provider 114-h aaaAet perform its obikWoru due ao a s rtwitil problem,vitt the h=A environmental hazards such as mold,asbestos x Iced p shm.other safety concerns,!*icing cnwa ce hec:utse work rw4uiredio complete the job was not included in ythe I°ettnent Buttamarv: The Payment Sun mum M Poor Included as part of this Contract,sets forth the tolii C intrad aw. unt end payments tequimd fvr the deposits and deal 0aymc qu by Prodtact(as applicable). NOME TO CU MBtt you are endtlled to aidely SNeof-*v,Cm1ftd tit the- tttt you tea, Do not-align a•Comm*t v Cerditcate Jzukr 011 to ams Campiificnte�ttor cosh IWW P.odv4•ae ddEfted liylmNvWW,@pet Sheets?before work on tial prod Is complete la the event of terodnadon of a&Coatraey Cusmaw agrees to pa The Boma D t the costa of math iale,labor,expenses -W services provided try * Dope wr Authorised Service raAder�ft date of termination,plus any other m aaemtaset forth In ttda ew allowed ander itppitemble law. TEM HO DEPOT MAY WITHHOLD AMOUNTS OWED TO THE HOME ORPOT FROM THE D$POSIT PAYMENT OR OTHER PAYMENTS MADE, WITHOUT LIMITING TME HOME DEPOT'S OTHER REMEDIES FOR RECOVItRY OF SUCH AMOUNTS. A=tago and Atrrl rr Customer 0916:8 and tmcierstanda that this Afiresttttetrt is the enl1ty aSteerrrcm between Cuso)mer &at The Ham Aepnt wit reglad w the Products KW I,tstsllation services and Bupers-rAcs all prior discussions and agreements,diow ural or"'am rdl ing w snid ProdUCtF and lnat4lfutltur,ThiA Agreemera gannet be maigned oe amended except by a writing signed by Customer aril The Home Dgxn.Customer acknowiedgeA and agrees that Cuatnr=htts read,qMderA&nCI&volnntwily accepts the awrts of and has nnceived a copy of this Agrretaent. Acctp / sub f: 43 x cenwrl"Swature Date Sales Cumuitant's Sigaaturr Daae T depboae No. Customeer,Siartattuc nate saim Consultant License No. — mCELLATION: cueroMER MAY C414L-EL THIS (��ppri..ixley AGREEMENT WrMOUT PENALTY OR OBLIGATION BY DELIVEMG WRITTEN NOTICE TO THE ROME DEPOT BY MIDNIGHT ON Tft THIRD BUSII SS DAY ArMR SIGM0 Tws AGREEMENT. THE STATE SUPPLEMENT ATTACHED HERCM CONTAl1+i8 A FORM TO USE IF ONE 1S SPECIFICALLY PII"CRIBED BY "W IN CUSTOMER`S STATE. MnCF:A=TtONAL T'E05 AND CONbMOM ARE RTATED ON THz i0gVZEtgS g1DC ANb Asr:eAw op 1'At8 CMnAcr 10-11.12 White—Bramh Pdp Yvtbw—Cwftmer The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations 600 Washington Street Boston,MA 02111 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lezibly Name(Business/Organization/Individual): 44ri Tlemt Address: III City/State/Zip: Phone#: LIDI Are you an employer? Uk a appropna a Type of project(required): 1.❑ 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 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' 9 ❑Building addition [No workers'comp.insurance comp.insurance? required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself.[No workers'comp. right of exemption per MGL 12.❑R�airs insurance required.]t c. 15Z§1(4),and we have no 13 Lr�,/�� employees.[No workers' comp.insurance required.] 'Any applicant that checks box#1 must also fillout the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hue 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 and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and jab site information. .-�- Insurance Company Name: Policy#or Self-ins.Lic.#: � ��� Expiration Date: �L-F— City/State/Zip:Job Site Address: 54�� 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 Investigations of the P4for insurance coverage verification. Ido hereby cert un er t pa' s an p alfies of pedury that the information providedabo is ue and correct Si atur . Date: Phone#: 200 71 7 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#: CERTIFICATE OF LIABILITY INSURANCE 1 DATE(MM106ffYYY) 022712013 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 MARSH USA,INC. NAME: TWO ALLIANCE CENTER PHONE FAX A N x AlC No): 3550 LENOX ROAD,SUITE 2400 E-MAIL ATLANTA,GA 30326 ADDRESS: INSURERS AFFORDING COVERAGE. NAIC B 1OD492-HomeD-GAW-13-14 INSURER A:Steadf '?- dffice of CansumerAffhirs�&b�ustness Regulation Licensz•cr registtiation valid for individu}cis.vi-dp , OME It47PR0ilEME�IT CONTRACTBR befor.'e the exgir3tion date. If found return to. Office of Consumei Affairs acid Business 1�eguNt.ion Registratiionj893 TYPe 1Q. 'ar*l;'Plaza=Suite 517Q Expira n^mgtg- Su lament.ard + i� PP, �os.on.,.M.A-02116 The Home Depor. 1= a : RICHARD FALL h!- '_��r�� , • : 269D.CUIVIBERLARY.'t° t ate— tl`�LTNr GA'3033§�� ? 'E'. Uode'rsccretary tot valid ithouk'sigratui e ` r Massachusetts - Department of Public Safety Board of Building Regufations and Standards .0m.4truction Supervisor Speciale License: CSSL-100696 ALAN S PA ANTED-` r% 11 16TH.AVENUK HAVERHM .111,E 01$ Expiration Commissioner 08/21/2014