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HomeMy WebLinkAboutBuilding Permit #150-2016 - 21 HEWITT AVENUE 8/3/2015 i BUILDING PERMIT NoRTy O��tten TOWN OF NORTH ANDOVER J. hF;i • �_ '•;6 APPLICATION FOR PLAN EXAMINATION '- ' A. i �O eh Permit No#: V\Y Date Received ACUS Date Issued: r 17 IMPORTANT:Applica must complete all items on this page LOCATION ;2, PROPERTY OWNERVQ 'F 11 `b Print 100 Year Structure yes MAP _PARCEL:- ZONING DISTRICT: Historic District yes o Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family [I Addition ❑Two or more family ❑ Industrial Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other _ 0 Septic 01Nell'' ❑ Floodplain ❑Wetlands [j Watershed.Distnct;Y fl -- WaterlSeyveP - -- -- -- l DESCRIPTION OF WOr TO BE PERFORMED: r C i M 'y J' G P ra r►cam` .. Identification- Please Type or Print Clearly OWNER: Name: V� n n e-4-- "'ou{-I (�&-ern Phone: 23 Address: 2W ` �- ° �'�� �� Im 3 Contractor Name: Phone' Email: co4AW5 efO Ln U/1 Address: I Ve J 7F Supervisor's Construction License: C5, L Exp. Date: Home Improvement License: Exp. Date: <2 S It 6 ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.•$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. -30 Total Project Cost: $ ��%I FEE: $ . -7 `' Check No.: Receipt No.: 11 I NOTE: Persons contracting with unregistered contractors do not have access to the ar ty f nd to 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 PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature "COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Plarning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Signature& Date Driveway Permit r DPW Town Engineer: Signature: Located 384 Osgood Street FIRED RTMEN - ��. 9 �EI'� T� TernpDumpster on4siteaA. est JjLo ted'at`124�IVI"� ,_�N Y.���. �, _ Yw. �_ ain Street F Depm g 'inn-Yr.K,. �4.1G..c. u: r(i. � J n..�. Otl kr 1 i5. '• � ,x .. - , _ Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Rueter 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.$1oo-$1000 fine NOTES and DATA— (For department use) ❑ Notified for pickup Call Email Date Time Contact Name Doc.Suilding Pennit 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 4. Building Permit Application 4, 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 OTE: 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/Cross Section/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 OTE: 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 2012 IECC Energy code Engineering Affidavits for Engineered products OTE: 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 Locations No. U �� Date • - TOWN OF NORTH ANDOVER,, • LED 746` . • Certificate of Occupancy $ Building/Frame Permit Fee $30� ` Foundation Permit Fee $� Z Other Permit Fee $ v TOTAL $ Check lle�5� ►- Building Inspector F NORTH_ Town of 11 T.." ndover o �^ It JI. h h ver, Mass, st3. zalS �o«Nic" WICK �'►• �.9 0 A I°R�rEo S U - BOARD OF HEALTH Food/Kitchen PER IT T D(��, Septic System THIS CERTIFIES THAT ......... & BUILDING INSPECTOR .. . ... . . .. AI �. Foundation has permission to erect ................:......... buildings on ... ...................V`!.......................................... Rough to be occu led as p� ....alm. ....af ......................�. Chimney provided that the person accepting this permit shall in eve spect c rm to the terms of thea application 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 ARARTS Rough ....... Service ............ ..... . . ............. ........ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required 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. GEMINITM DIRECT VENT GAS FIREPLACES 4 Y� +k yy V f� . r mw ku a#;^ff �� t...�.._...._- n� AIL 77777-7 �� k Traditional cFireplace J I a. Design Collection F I R E P L A C E S APPLIANCE SPECIFICATIONS SPECIFICATIONS F _ 101/2 P SV (267) G 4-1/2-1/2"x7-t/z" direct vent pipe Vent Framing—Top Vent with One 90e Elbow J - 51/8 7(178) (1� 121/8 Blower I (308) Access Gas 0 Entry L M I E � i G N K �\ C A D B Junction GEMINI 33 G 35 GEMINI 40 GEMINI 45 Gas Access K 33-3/4" 35 3/8" 40 3/8" 45-3/8" Entry L 34-1/4„* 36_1/4„* 41.114„# 41_1/411* ft -0, . M 36-9/8” 38-3/4” 43-3/4, 43.314, o. I � N ]4-1/2" IS" 18" IS° H o 19-5/8" 23-3/8" 28-1/4" 28-1/4" Includes 4"for fold-up standoffs GEMINI 33 GEMINI 35 GEMIN140 GEMINI45 A 30-1/8" 32-1/8" 37-1/8" 37-118" B 26-1/4" 28-3/4" 33-1/4" 33-1/4' MODEL FUEL BTU/HR AFUE** P4/ENERGUIDE* 0 18-5116" 22-1/4" 27-1/4." 27-1/4." GEMINI 33 NO 14,000 65% 6o.o%/63.o% D 30-1/2" 32-3/8" 37-3/8" 42-3/8" GEMINI 33 LP 13,000 65% 6o.o%/63.o% GEMINI 35 NG 16,000 66% 61.o%163.o% E 33 5/8" 35-1/4" 40-1/4" 45-1/4" GEMINI 35 LP 15,000 66% 61.o%163.o% F 21-7/8" 25" 3o" 35" GEMINI 40 NG 20,000 66% 61.o%/63.o% G 10-15/16" 12-1/2" 15" 17_1/2" "GEMINI 40 LP 19,000 66% 61.o%/63.o% H 31" I. 32-7/8" 37-7/8" 4z-7/8., GEMINI45 No 21,500 67% 61.o%163.o% GEMINI 45 LP 21,500 Ery% 61.0%/63.o% 1 14" 17., 17,. 17" `Intermittent ignition systems.Millivolt/Electronic. J 5-3/4' 6-7/8" 6-7/8" 6-7/8" "Annual Fuel Utilization Efficiency(AFUE)is the recognized U.S.rating system for the total efficiency of heating products. On the cover:Gemini showfi with Black Painted Interior G IMPORTANT NOTES: q I'�eplaCe� #` As with any fireplace,this a 1:- /��`ojois S coueet a. instructions before usir' 1"� 2`'t p ��[eA 01 830 '�t Local conditions,such a,� Vylexbllh l'— 1G e / i.canu+oio� File and heating performai ga $11 e EUROPEAN COPPER — CHIMNEY CIA�SI S r�$312- ee_eo� type .r��cc�aao,n of fuel used,appliance Iota 9 1 Cage.ATO ..�perated. Diagrams,illustrations and I aavan _.eons.Product designs, Approved for use with European Copper and Chimney Classics chimney tops,which improve performance and materials,dimensions,specii wW•" ..,,cnange or discontinuance without notice. add an elegant touch. aC M I a Visit us online J ❑ ❑ Canada F I R E P L A C E S ENERQUIDE =EI. R". erGuide ©2015 Innovative Hearth Products PFS Energy ®785580M 04/15 Astrla.us.com C US P.4.1-02 The Commonwealth of Massachusetts , - Depariment oflndustrialAccidents Office ofInvestigations 600 Washington Sheet Boston,MA.02111 UqF www.mass gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/El.ectricians/Plumbers Applicant Information Please Print Legibly Name(Business/Orgmization/Individual): Kt)•0—Vl Address: E' - City/State/Zip: Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1. I am a employer with �— 4. ❑ I am a general contractor and I 6. E]Now construction employees(full and/or part-time).* have hired the sub-contractors 2.El am a sole proprietor orpartner- listed on the attached sheet. 7• Remodeling ship and'have no employees These sub-contractors have S. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. ❑Building addition LN comp o workers' .insurance 5. ElWe are a corporation and its aired. officers have exercised their10.❑Electrical repairs or additions required.] 3.El 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.❑Roofrepairs insurance required.]i employees.[No workers' 13.❑Other comp.insurance xequired.] !Any applicant that checks box#1 must also fill outthe 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 checkthis box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. lam an employer that is providing workers'compensation insurance for my employees. Bellow is the policy and job site information. Insurance Company Name:. V E ('S , U+'—C',i',G Policy#or Self-ins.Lie.�#: (� v `� � j '2'� xphationAate: 1 Job Site Address: 2.1 City/State/Zip: r .D/0-C�5 Attach a copy of the workers'compensation-policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL o.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 maybe forwarded to the Office-of Investigations of the AIA.for insurance coverage verification. I do hereby certify er A airs d penalties of perjury that the information provided above is true and correct. Simature: Date: Phone#• 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#: RightFax C3-1 3/24/2015 9:51 :03 AM PAGE 2/002 Fax Server CERTIFICATE OF LIABILITY INSURANCE DATE(MMrODnYYY) T.494MIFICATE 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 ORPRODUCER.AND THE CERTIFICATE HOLDER. IMPORTANT:if the certificate holder Is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require and endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: GILBERT INS AGCY INC PHONE FAX 137 MAIN STREET (AIC,No,Ext): (AIC,No): E-MAIL READING,MA 01867 ADDRESS: 246WY INSURER(S)AFFORDING COVERAGE MAIC# INSURED INSURER A: TRAVELERS INDEMNITY COMPANY OF AMERICA KEEN CONSTRUCTION CO INSURER B: INSURER C: INSURER D: 1175 TURNPIKE STREET INSURER E: NORTH ANDOVER,MA 01845 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TEAM 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 I ADD SUB POLICY EFF DATE POLICY EXP DATE LTR TYPE OF INSURANCE L R POLICY NUMBER (MWDD1YYYY) (MMQDIYYYY) LIMITS GENERAL LIABILITY ACH OCCURRENCE COMMERCIAL GENERAL LIABILITY --"" CLAIMS MADE DAMAGE TO RENTED $ OCCUR. REMISES(Ea occurrence) ED EXP(Any one person) $ GEN'L AGGREGATE LIMIT APPLIES PER: ERSONAL 8 ADV INJURY $ ENERAL AGGREGATE $ POLICYID I PROJECT LOC RODUCTS-COMP/OP AGG $ AUTOMOBILE LIABILITY COMBINEDSINGLE $ ANY AUTO LIMIT(Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULE AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ I DEDUCTIBLE $ RETENTION $ $ A WORKER'S COMPENSATION AND X WC STATUTORY OTHER EMPLOYER'S LIABILITY YM UB-999IM582-14 10/08/2014 10108/2015 I LIMITS ANY PROPERITORIPARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? WA E.L.EACH ACCIDENT $ 100,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 uyes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRIC nONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. CERTIFICATE HOLDER CANCELLATION TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 1600 OSGOOD STREET BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENT ,VE NORTH ANDOVER,MA 01845 :> ;;: +:c ..: ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 1988-2010 ACORD CORPORATION. All rights reserved. Massachusetts -Department of Public Safety Board of Building Regulations and Standards -'-- - _ License: CS-076691 ROBERT A KEE11j:`' 12 E WATER ST North Andover N1fA 0 i I Expiration Commissioner 08/16/2017 i ,y� CJ�ie�oaninzamtiuea,�o�C�aac�uaelta _\ Office of Consumer Affairs&Business Regulation ME IMPROVEMENT CONTRACTOR V,J. istration: <,.�08383 Type: .iration ZPfN-(16- DBA KEEN CONSTRUCTf;ONCQ,. =_== I Kenneth Keen <i 1175 TURNPIKE ST NO.ANDOVER, MA 01845' Undersecretary