HomeMy WebLinkAboutBuilding Permit #595 - 2225 TURNPIKE STREET 5/7/2009 BUILDING PERMIT r►ORTFr
of
TOWN OF NORTH ANDOVER c -
APPLICATION FOR PLAN EXAMINATION
X09 �
Permit NO: � � Date Received
p�gA7ED
,� gSSACHU`���
Date Issued: J
IMPORTANT: Applicant must complete all items on this page
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LOCATION 2.7- TORN-P1 1 # a t*i M 9
Print
PROPERTY OWNER-,`:RP r)`/ M f--(A 0 WS
Print
MAP NO: + `PARCEL:15--A" ZONING DISTRICT: Historic' "District- yes no
Machine Shop Village ye no
TYPE OF IMPROVEMENT PROPOSED USE
Residerati. Non- Residential
New BuildingOne fa
Addition Two or more family Industrial
eratio No. of units: Commercial
Repair, replacement Assessory Bldg Others:
Demolition Other
Septic Well . y Floodplain ��� VVeflands � Watershed ict _
Water/Sewer an '
w.
DESCRIPTION OF WORK TO BE PREFORMED:
Fz�f c)im RoGF C)FI' TrsiSTe)LL NL-t,J O Jr, Roc)F
Identification Please Type or Print Clearly)
OWNER: Name: r->'Y Mf--(-�CJO L-j S Phone:• R716 .500 215
Address: '.2-2*2-5 lugl:
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
i
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on Signature
p
COMMENTS
b
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
�Flre Department signature/date
COMMENTS ee
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
it
❑ Notified for pickup - Date
Doc.Building Permit Revised 2008
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
o 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
o 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
i ❑ Mass check Energy Compliance Report
❑ Engineering Affidavits for Engineered products
i NOTE:, All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
i
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 2.2008
Location
No. Date 4v
NORTH TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $ �,
swcNus
Foundation Permit Fee $ P— '
Other Permit Fee $
TOTAL $ J a !
Check #
22UfU
Building Inspector
05/07/2009 14:32 19786859460 HASBANY INSURANCY PAGE 01
DATE(MNUDDIYWY)
ACQR - CERTIFICATE OF LIABILITY INSURANCE 5/7/091
Tns PRODUCER ONLY AND�CAONFTE IS 'No r AGHTS S A U��THE CISIMFIC TE
Haobany Insurance Agency JJOLDW THIS CERTIFICATE DOES NOT AMEND, FIND OR
236 Pleasant street ALTER THE COVERAGE AFFORDED BY THE POLIOS BELOW.
Methuen, MA 01844
INSURF22S AFFORDING COVERAGE - NAIC 0 -
INSURED INSILIFRA: Penn America Insurance C9
Craig Cohen INsuRGR5!A2G_- Granite.Atate Insurance 4 .
4055 Waltham Street INSURER C: _.. - ..
Mehtuen, MA 01844 INSURER D,- -
INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE 05EN 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 WMICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBEO HEREIN IS SUBJECT TO ALL THE TERMS.EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES,AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
1bDD` POLICY NUMBER IIOUCY EFFECTrvE pIPIRATION LIMIT$
066IM LIABILMY DAM
—
O—TO
!...1'A00 0.00
DAMAGE TO PtTITED � ]O.O OOO
A X X COMMMIALCIENERALLMBILrTY 987668 6/28/08 6/28/09 pREm.R8.eL(Ea..q=wwW
�CLAIMS MADE X�OCCUR M®EXP;trywwpC-01 S 10.,000
PFFISONAL&ADVINJURY S ,1,000,000_
GEI!RAI.AGGRB3ATE S. Z10-9.19-0
GEN'LAOOpEGATE LIMRAPPI.iFCPER: ntODUCTB-CCMPOPAM R 2,000 000
Y PRO- LOC
X7 POLIOJCCT
AUTOMOBILE LIABILITY COMONEDSNGLEUMIT S
tr
ANY AUTO _
.-
ALL 0V*0AUTOS BDOILYN.NRY 6
Ilbr ver?mi
SCMEDULED AUTOS
HIRED AUTOS BODILY N.A1RY
(Ru aw Ove)
NON-OWNED AUTOS
PROPERTYDNMAM S
—_ •. (RM x6drt)
GARAOEUABILm _!ui00NLY-EAACCDENT
ANVAUTO OTHER TN AN EA ACC, E
wTOONLY! AGO, S
EKCESSAIMBRELLAUABILITY C�OCCURRENCE % , ...
OCCUR CLAIMS MADE AGDREGATE.. S
DEDUCTIRI.S
RETENTION 5 >
WORKERS COMPENSATION AND
roRv_LIM).
8 OMPLOVEWLIABILITV WGT9A87-31@-09 6/2@/OS 6/28/09 EL.BAC"ACCIDENT S 1,000,00_0
ANY PROPRIETORMARTNERIEMCUTNE
OFFICERMIEMBER EXCLUDED?X Exclude owner -EL DISEASE-EA EWLOI6E s 1,OD0,000
e LPROVISIONSbelow
01--bounAer Crai Cohen EL DISEASE-POLICY LIMITS 0
S IA
OT►IER
OESCRIPTION OF OPERATONS/LOCATIONS I VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPEOAL PROVISION$
Opporations: General Contractor
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICRS BE CANCELLED BEFORE TME®IPIRATON
North Andover Town Hall DATE THEREOF.THE rAUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
Ref: NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAIWRE TO 00$0 SIAL
2225 Turnpike St. IMPOSE NO OBLIWITION OR LIABILITY OF ANY KIND UPON THE INSURER.ITS AGENTS OR
)Horth Andover, Ma 01845 REPIESENTATWES.
FAX 4 978.688.9542, AUTHORIZED REPRESENTATIVE
Eric Jansen
ACORD 25(2001MB) W ACORD CORPORATION I OU
Ak
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
`t11R 600 Washington Street
i Boston, MA 02111
��i www_nzass.gov/dia .
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print LeQtbly
Nanie (Business/orgenizadon/tndividual): t�t�l� �1 (°, t�7'P. ►C i 0�/
Address: 2v\
City/State/Zip:_ AL Phone la 17 33tii 3�he
AYloam
u an employer?Check.the appropriate box:
I. a employer with 4, g Type of project(required):
❑ t am a general cont;s�heet.
and I • 6. �-New construction
employees(full and/or part-time).* have hired the sub- ctors
.2.❑ I am.a:sole proprietor or partner- listed on the attache1 ?• ❑Remodeling
ship and have no employees These suit-contractors have 8. Q Demolition
working for me m any capacity, workers' comp.insurance.
[No workers.'comp.insurance 5. El We are a corporation and its 9' Building addition
required.) 10.red-] officers have exercised their ❑Electrical repairs or additions
3.❑ I am a homeowner doing all work right of exemption per MGL t I.Q Plumbing repairs or additions
myself. [No•workers'comp, c. 152, §1(4),and we have no 12. Roof
insurance required.]t 'employees. ❑ repairs
[No workers' 13.[3 Other
comp. insurance required.]
•Any applicant that checks bore#t must also fill out the section below showing their workers'compensation policy information
t Homeowners who submit this affidavit indicating they are doing all work and then hke outside contractors must submit a new affidavit indicating uch.s
tContmctors that check this box must attached an additional shat showing the name of the suis-contractors and their wortcers'cernp_patio;irsfornration.
I am an employer that is providing workerscompensation i nsurance}or iM employees
information. Below is the policy andjob arta
Insurance Company Name:_ I� SP�P1 n{�� 1J.f5 t)>�'•A�1G� ASI t Y
Policy#or Self-ins. Lie.#: Expiration Date:
Job Site Address: 2212.5- I f1(2.NIFAE 5-11 - City/statezip:_& �1�Lr G16 LQ)
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration da>t4
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 $t,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 DIA for insurance coverage verification.
I do hereby certify the pains and enaltieserj at the information provided above is true and eorred
Signature: Date: �07 D
Phone 7 3_3
ficial use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/License#
Essuing Authority(circle one):
I. Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person• Phone#:
r
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire,
express or implied,oral or written." 4'
An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more
of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the
receiver or trustee of an individual,partnership,association or other legal entity,employing employees. 'However the
owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the
dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence wt compliance with the insurance'coverage required."
Additionally, MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers'compensation,affidavit completely,by checking the boxes that apply to your situation and,if
necessary; supply sub-contractors)name(s),address(es).acid phone number(s)along with their certificate(s)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit may be submitted to the Department of industrial
Accidents for confirmation of insurance coverage.. Also be sure to sign and-date the affidavit. The affidavit should
be returned to the city or town that the.application for the permit or license is being requested,not'the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are requited to obtain a workers'
compensation policy,please call the Department at the number listed below. Self-insured companies should enter their �
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant
that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating-current
policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or
town)."A copy of tare affidavit that has been officially,stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit.
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address,telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
Tel. #617-7274900 ext 406 or 1-8.77-MASSAFE
Fax#617-727-7749
Revised 5-26-45 www.mem.gov/dia
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Licensed&Insured
Member of Boston Better Business Bureaupropos a 1 Page No of Pages
C 0 H
BROOKLINE . _ v MALDEN
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i .`fin,- �'F L'LY�LICEHSEb ROOFING�SPEC1.4L1ST5x u�vtNsui�ED
yr f. '��,� F.•;t u: s -,,.'a ri LS d;- iv�.�� ` r+c:v kty3r i 'c".'i'„+�'`{i r' ,.�, •.,ei } i- .� i' '♦try r y i. };yS+z d'--,+ aa•
:�.Hr.,., 3 „<,yk.♦-.Fk.'A,t r'f r i ` /`F.'�; 405'WAI THAM ST#356,�.LEXtNG'foN;MA 02421
t *, PROPOSALSUgfNITTEDTO ,r s"� '•` �' sy:�v Y � a'i'r` .t =rPHONE '' r, +"'rv < ,'<;? + th d' ��
" r l a ti` '`„ i' i' ^.,<< ,.*, t e - DATE ..•'" v t
/y
r a• r r j'". � • ��V 1--� f 11� �1
7 STREET, - �JOB.NAME
22:7 `r ..NPII S'1� a
CITY,STATE AND ZIP CODE JOB LOCATION
N• �N ��1�
PIA
ARCHITECTDATE OF PLANS JOB PHONE
We hereby submit specifications and estimates
IL
Strip roof down to the boards, replace normal amount of boards. Maximum amount of boards to be
replaced 75 feet at no charge.
Put three feet of Winter.Guard on all bottom edges.of roof, and existing valleys. Refer to Exhibit A.
Cover entire roof with roofing paper.
Install,8” aluminum;dnp edge on all edges of roof(color tkW counter flash chimney; newvent ;
.. .d i
Install a � Yr'tb -� year roof All roofs hand nailed r1Ne DQ NOT use nail guns r
All.debris'will be removed by Cohen Construction
12 year guarantee on Workmanship License
'v year guarantee on Materials #148746
wn -FrjS i n r,L. T( S c gni Et2 sr�rFr__t w
I( .-!.W 61 L-U r
M1�Gi AL-L- V`i/VYZ TU I�<,12tiK_t U1(\ --L _ '�t`�S,uc� �_LxI A)
>1 ri Lx —_' i t 7< 1,...� fi' T)�'R..l"� "l r- t'.'1r 'tC'"Q.l
Ne propUSP hereby to furnish material and labor—complete in accordance with above specifications,for the sum of:
SL��N i Mouso(vr) hvF 1Aur\inRaW)c> Fi177 `/ N1,10 o/��� dollars ($7550<c<)
Taymennt tobr ma e�ows'
,Z�, s� �'o51TT 'Hi 60 nt)F OrJ Sir1P1 A?y+> i�AU J,, (; 0r,0 �I,t
All material'is guaranteed to be as specified.AIl.work to be,completed;in a workmanlike
}. ner_according:to.standard`practices:Any alteration or d6viatio6 frpm,above specifications Via?
involving_extra costs will be executed only upon watt@n orders,`artd`wdf'become an:extra Sgnafure
charge over.'and.above the estimate.All agreements epntingent upon.stnkes„accrifents of {; f
- delays 6eyorid'our.control.Owner,io�carry,fire`tornado and other necessary,insurance O.ur: `" , Note.This proposal may be
. workers are fully covered by Workman s Compensation insurance.. wil6awn by usG acTFcepted,wlthinr �1` days:;
r. I
�ltC�#itM1�CPrL1�1D18Ft1 The above prices,specifications
and conditions are satisfactory and are hereby accepted.You are authorized to do the worki
-
as specified.Payment will be made as outline//d above. Signature�... �� — -
Date of Acceptance: '" /��' I[ �� Signature
V4pRT1y
Town of t 4Andover
sus
i
o
dover, Mass.,
COCMICMEWICK V
�d ADRATED O'Qa\
`S BOARD OF HEALTH
PERMIT T D Food/Kitchen
Septic System
BUILDING INSPECTOR
THIS CERTIFIES THAT �
............ ... ..... �........................................................................................................................ Foundation
do low
has permission to erect........................................ bui ings on...Z,i ,..V ....... r..N.... ..k•. ....... Rough
to be occupied as ,,,t�r0� Chimney
. . . . ...........................................................................
provided that the person accepting is permit shall in every respec nform to the terms of the 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
t SOW PERMIT EXPIRES IN 6 MONTHS Final
le
ELECTRICAL INSPECTOR.
UNLESS CONSTRU STARTS Rough
........... ..... ...... ... ...... .................................. Service
BUIL 'ACTOR
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 SIDEji Smoke Det.
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