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Home My WebLink AboutBuilding Permit #365 - 22 MIFFLIN DRIVE 10/25/2011 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: Date Received Date Issued: 0 �� L IMPORTANT: Applicant must complete all items on this page LOCATION 3(d M Fel 10 Lr' J /� Pri t PROPERTY OWNER M r Lh e 11 e.- I-"oy o s� - Toe— Unit# �� U CJoo2� Print MAP N0. PARCEL: ZONING DISTRICT: Historic District yes Machine Shop Village yes no 100 year-old structure yes no TYPE OF IMPROVEMENT PROPOSED USE Resid ial Non- Residential ❑ New Building Ane family ❑Addition ❑Two or more family ❑ Industrial ❑ eration No. of units: ❑ Commercial Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other _ ®Septic ®,W ll� -�� 0 F ood ant 0 Ian s �� ®WaterShdDlstrict« DESCRIPTION OF WORK TO BE PERFORMED: i ��✓ �. av � �`�o�� rax. �3 s �a°�-� identification Please Type or Print Clearly) OWNER: Name: VM t,6�� 1 of ov osJ - -T(,,,e Phone: Address: 0,ok 1q? CONTRACTOR Name: 1"ocve &WPe Wode_lr k ((a/ePhone: I Address: �� fie. o<��. C�"Jev /qU�d Supervisor's Construction License: 9�o Exp. Date: P, Home Improvement License: 16106 Exp. Date: ARCHITECT/EN GINEER Phone: Address: 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: $ /� 1d 7 FEE: $ Check No.: I I y Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Slgriature of Agent/Owner., .. ,-. ... A Signature of,contractor _ -Z-4 . p . - 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-) !, ❑ 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: Doc.Building Permit Revised 2008mi Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Pians ❑ 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 CONSERVATION Reviewed on Signature COMMENTS f HEALTH Reviewed on Signature COMMENTS 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 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 i i I i ❑ Notified for pickup - Date Doc:.Building Permit Revised 20117une/mi Location'DIW.. No. Date NaoTH , TOWN OF NORTH ANDOVER 1 s 9 :'a Certificate of Occupancy $ JACMUSE�� Building/Frame Permit Fee $ �� t Foundation Permit Fee $ Other Permit Fee $ . TOTAL $ Check # r 55 wilding Inspector 24 ! ; ! t?owar i.Gine Rdpxv lel rig Crestt�i` bttp://niao;powerltrgCbrt�prgiCd dOCLUMnt5/3Sdri43?pagi:s=5 h1n7JDN,Iit,ttkAttiTtJARTERs _ _.. . ,._25tS1 Srapor}Ortvk Ct�rsreGtl't(4013...., tvUrhsila.Pisr�:t TvfA. I!as ncim 3G 1L ► s 4R.ti,Y3 .. CUSTOM F EMODWNG AND lMPRbVEMENT AGREEME st( tai►ttiraioa:a 7tuyee's'tntotaalio{�' '3W3t179 .Fticttolsn�ravostTine.. �dl�hrumtrec �oasoaerot�2d'ti i2'MUun.[ir.. ta?a)7ieC4a6 00 j aw.cal Nosih:An�a�.MA::oraie `. cai iy;Ai _ Btty'erla)ftalnd ebpVettetai6y jolgtly and sovwally ergre9S io ptrrchasa the goody e►}ttfor siirxtees of PoWetr Homo 1lgrriod .169:0toup'(!oatractol 7 tt1 accordenco Wlth the.0000S ettd tortrts dascr)bod on Sha arpnt arid ttrfl tof(vwing iour paQOs•ottlifaagrcetnontan ony.spoctffattlon`slwc�ts.(cotlrpiivoly;thla"Agr6etrientj.-fifsAg;oont4tttpcptnsat(1a:acaztt sato of goods►+nd seivkea B ryer(mj agraos to',poy thci.cost.bt ttra.gooda arta sid vices purrtimsbd:bs;eeaerlhalhoro7a,,.. t9$8(41O8Y'O(:tt1111Y4Q'Ot'!tp}YreVtil'ot�(1y.11t}811 ng BUyQr(9}�Ji q iook tQ'J.iho r piirchaso. � � .. Frypchase Ptke;; Pre 510,924.80 Irt:atal)atfon ns ,r atiori Dat s .. 04Wt1,t'8yt11t3RC. _ .. $0.00 Eitfmatcd.Pro)e+ctSts ,' .. S to?tinolrc Salance_Due.att'' 510,924.00: Es{lrnated Pro�aci Cotirplellon &obstantial: t:� ; ;.. CampSoNon: t?fltirii c toirptatlon t'.ti�e b nat:dt tfiu ebeltq p bcyptui.Ctyrtrectofa QNUd 1Wt trir"uaes4tri gsik�aU1�0:Emo Ira�tmf<:Sr+e'Dr9ayth�k�cwnCormrtke�oh 7aYotsb ' ' htath'od"of.ptiynteiti Other B--wit" ore by adcntiidiedgos re6W'Pf Gl.a capy at iha pamphl at,'?fio teadS�rte CattNlod.Csuldo is i�vnovrifa Rfght';a. ini'' ag Bciyer(s)of iho poterRtlnl risk of.load:hazetct exposure tramranamtion acltatty is tm porforrr�d tn't3uysr's horrse;.at the 'a wrhtert above guycrts)recolUed thit pamphtot on iho dnite.otitils 1lgreomenI. b.otoro eemtr'�etico►npnt of vrork (etiyers�atiiots}. ;., . it,s agroed.aiid tm bedoratooit fiy raid *Qen It'pariles hist:thls,Agreetnestuconxtliuies ittit onttra.Uhifct".tepili. tiotvween tttepnrtfesJand Itx3re aro no vorbol undc(standings chaRglcip or snodthylttg any bfsfie fertns of this Agreoment 8dge(lsj. ` hereby eckiwvrteclQas that f3vyor{s}xj has:read tit®entire A_grooment And hes received e.comQl6w,slgtted,and dated coj y of thisAprtie nent,Mptudtng ihe.two ttecornpemjtap Notlee OCCencaltstton forms,on-the data first,�tiritten ebpve and 4was oclalty7nfoiistied o{htsltier right to canCe11t1f9.trensriciiori:D.t2 3 f07 S1Ci31 TtitS AtiREEt4Eti r'.1F`ttiL•AEARE'ANY:BLANK SQACf.S., Futures. M.—donx itol a ticatilo: Dom... " . ' :.� ;i�avo`road and rocolv4i!'onch"Pu9a:;o1'hls:S,ptig eg`itae • p tiif4ie ..... hg• .. P. r 4j Buyer(s):w. ..... Slgnature nf-_.o.' Stgtiakt(e.- (WId:Sttehx MfcFia{to:P..rovo4t:.{lne YOtI„THE'SUYERis),OAY:t:AtiCEI.-mitTRAtimdt4do ATA'NVTthtE PItIORTt3 tACii iGtiT OFTtfETHlRD SUSWF1 SS RAY. IiPTER7FiE:bATE OFTNi3Tftt41J511G7tMs THE Nonni OI CANCELLAT10N FARM R.i1Pt tFt liMAIIAN DFTHIS fltCytiT.' tJciotit r O.T;24t 1`_I2:4 f [[ ii page oris .. `tr!3.';X13"f`liJ*2`_rt✓.fiYx�aS>_:I1Uci'.�ISy .. .. . AA N®RTiy ® ® ndover 0 No. - _ `= To , lover, 1VIaSS., �� t T O LAKE COCHICHEWICK V O,ps FATED 7 BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System 0 BUILDING INSPECTOR THIS CERTIFIES THAT.................... .................................. .....0 v: .�.. ......... ....1060oft.0........................ Foundation has permission to erect........................................ buildings on . ....... !......... ..... ... ...... Rough to be occupied as......... �. !'..... ............................... 0 ............... ........�.................... Chimney provided that the person accep g this permit shall in every respe onform to the terms a application on file in Final- 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 NTHS ELECTRICAL INSPECTOR UNLESS CONSTRUC N S Rough .:.::......... ........: :....i.:............................. Service VILDING 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. NATIONAL HEADQUARTERS Michelle Provost-Tine 2501 Seaport Drive,Chester..PA 19013POWER': 30-31478 "°"`""""°""9G October 01,2011 888-REMODEL -- �� v.. MA 14IC9 16Mt 6 Project Specifications Rooting: Whole House i z3ooA"x1.0" 4 Roofing:Whole House 1 2300.0"x1.01 ROOFING:Models GAF Styles Architechtural Shingles Types None Contigs None OPTIONS:Color Barkwood f Removal Standard Shingle J Installation Derails None ; GAF MATERIALS CORPORATION Roofing: Whole House 1 75.0'x1.0" �1 Roofing:Whole House 1 75.0"x1.0" ROOFING:Models GAF Styles Cobra Ridge Vent Types None Conrrgs None OPTIONS:Color Barkwood f installation Details None GAF MATERIALS CORPORATION �I October Oi,20i1 12:41 Itl1W11INil1110ltWiltll----.............-• -------....... Page2of2 lWllltlllll POWER-1 OP ID: EL ,a►corro- CERTIFICATE OF LIABILITY INSURANCE DAT0112D,YYYY, 1 1 0„2,,, 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). CONTAPRODUCER 215-723-4378 NAME,cr Lacher&Associateslns Agency NAME, Chad Chad Lacher F LacherinsuranceGroup 215-723-8604 ciao Ext: AJC No: 632 E Broad St P O Box 64398 E-MAiL Souderton,PA 18964 ADDRESS: Chad Lacher INSURER(S)AFFORDING COVERAGE NAlcs INSURERA:Pennsylvania Manufacturers 41424 INSURED Power Home Remodeling INSURERS:Pennsylvania Manufacturers 12262 Group, Inc. INSURER C:Ironshore Specialty Ins.Co. 25445 2501 Seaport Drive Ste B110 Chester,PA 19013 INSURER D: INSURER E INSURER F. COVERAGES CERTIFICATE NUMBER: REVISION 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 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 MAYHAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE IN POLICY NUMBER MMIDDIYYYY MMIDDA^?YF POLICY Y LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DPMAI' 04T E17- A X COMMERCIAL GE14ERAL LIABILITY 821100-66-20-96-7 09122,11 09122112 PREMISEES Ee amurrence $ 300,000 CLAIMS-MADE I A I OCCUR MED EXP(Anyone person) $ 10,000 Fv PERSONAL&ADV iNJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOPAGG $ 2,000,00 X1 POLICY PRrof LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident) $ 1,000,000 A X ANY AUTO 151100-66-20-96-7A 09,22111 09122112 BODILY INAIRY(Perperson) $ ALLOWNED SCHEDULED BODILY INJJRY(Per acddent) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTYDAMAGE $ AUTOS Per accidenl $ UMBRELLA LIAR X OCCUR EACHOCCURRE14CE $ 5,000,000 X X EXCESS LIAR CLAIMStv1PDE 001158200 09,22,11 09,22112 AGGREGATE $ 5,000,000 DEO I X I RETENTION$ 10000 $ WORKERS COMPC14SATION X WC STATU- I OTH- AND EMPLOYERS'LIABILITY I TORY LIMITS ER A ANY PROPRIETORrPARTNERIF�CUTIVE YIN N NIA 201100-66-20 6-7A 09122111 09/22/12 E.L.EACH ACCIDENT $ 1,000,000 (Mandatory In ER EXCLUDED? ❑Y 01107-66-20-96-7 MASS 09/22/11 09/22/12 B (MandatorylnNHJ � ) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes.describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 A MASS AUTO 151107-66-20-96-7B 09122111 09122/12 LIABILITY 1,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEFCCLES (Attach ACORD 101,Additional Remaeks Schedute,If more space Is required) CERTIFICATE HOLDER CANCELLATION NANDOVE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood St North Andover, MA 01645 AUTHORIZED REPRESENTATIVE