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HomeMy WebLinkAboutBuilding Permit #201 - 23 MERRIMACK STREET 9/19/2008 BUILDING PERMIT pORTFi O��t�eo TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION C Permit NO: Date Received CIC 1— 9SSAc►+us���y Date Issued: - c7 IMPORTANT: Applicant must complete all items on this page �- 'tX s tom' �, , .d• t�, 'Y`�. <s : WRIP u x$ xiir rm" ' .•r�,; < ,t;'�, "' amaze ,�5 �dx, XK rRJ L M s "14" I .a42 j.- MCA � tvx �r �4q� � �' +�,r,�•<� ����.,� ," y. <n ' .fix a a; �� - ��� � ��., � � ���� �� �,.��^,. �� w,;,s- �.x,<,• - s'is .e. .b ,' '�� rsc,,•,=��>w«,�....'vz�b ..�.�.,r a�..-. a � a,,, i �,a-i, F,.�r;. TYPE OF IMPROVEMENT PROPOSED USE Residential . Non- Residential ❑ New Building ❑ One family ❑ Addition e wo or more family ❑ Industrial ❑ Alteration No. of units: 0 Commercial 0-Repair, replacement [�-Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Ego 4sJ°E�l .�"`� ��.,�4�'�.��. �.,„, �i��:�°... ,. .e,`�..�•. * �.:.,s'" :z.,.�Wc�'�.� ��,"� e' ,-+yw,.s�r�.,. -�i. �✓" �.v�4., t"y �a '+; >. .."�..� .,;.: ,7-V�T SV j7 dif d 1lRK TO PR 10RI�A��D: d o Q 1? 1 A51CYII 11/0 i/ .517 � Identification Please Type or Print Clearly) ��73d3 OWNER: Name: 7Y)I1 h L/'<rd) 0 Phone: Address: g �7 rly r r vvw I h id A 4- 12 31 as >" b u u 47 n r �" �:� .; h. � v Y ' ``et r ,a � '.cz` -�"•Si `"� �g� k k< '' 'a`i s"L ,,,'" � YnA f `� Y •^ .,.� I s .. . ., u. a �v �z�; ARCHITECT/ENGINEER 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: $ L(�-7�'d FEE: $ Check No.: ��e Receipt No.: Ca NOTE: Persons contracting with u registered contractors do not have access to th gralranty fund SiatcarIgnOvn ,. ,rf , S�turec�cd- rate. , . �.. 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 ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ I CbMMENTS 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 Located at 384 Osgood Street gF�RE DEP' t 'W "t� Tep R i' seoti suers`e: f w K Loctcl atz2 "�lltt e{ ' 'y nt ~•�'�rs�Qe art e �"` ��F�� � " `t'.,�z-�'#�`�" `` ,��h ��i�� �„�. ' .�"��s",,�q r.''e r �, :. �rwz 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 I NOTES and DATA— For department use ❑ Notified for pickup - Date Doc.Building Permit Revised 2007 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: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 Location Q-'�-t vvkct C— No. Q Date O MORTh TOWN OF NORTH ANDOVER Maj • • O9 Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # �S I 2 . 5 - 0, Building Inspector ,SQiF d of 110og�e l�ti. �►�d ap NQME IAAPROyEMENTZONTRACTO9 d {tegistrpt ion,e 120199 xR -'-41/l/2009 Tr#.260618 Up i- 'hype I ciyadual w DAVIIID)GUL�Z1A�Vi ,r : DAVIQ C�ULEZIAN � r .'m �q "! 428 PT Nt3ftThftANIYER, / Q1#'+5;, Adu�& Co n ce#sp � 'vl C�ice Birt date` 1$21 7 ; t DA VII)Pi ►: tIQ T tA� 5X68 12g PL . GV E2IAN r r Z AAt©0 SANT d �NORT►y 0" 0 T f Andover 0 No. 20 _,. ..W., Wiz^ _ - - - •� �' • O� o o dover, Mass., A COCMICME WICK � ��ADRATED PPp` �C`7 BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT........ � . ....... ..r. ..h......................................................................................... Foundation has permission to erect........................................ uildings on .....Q3......Y. .�r.t, .. ,it.4........V1110 . Rough • to be occupied as.......... Aelk�i.itChimney provided that the person accep g this permit shall in every conform 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 Final PERMIT EXPIRES IN 6 MONTHS UNLESS � T A D ELECTRICAL INSPECTOR �J1 V LESS CONSTR�J N STARTS Rough Service B SPECTOR 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. 1�1 .QLu 00 L, O �G J D.G. Contracting Inc. Kitchens, Baths , Decks , Home repairs ,Excavation work Commercial fit ups* finished basements* Dumpsters David cjul,ezi12VL esidevLt 428 Pleasant st. N Andover Ma. Office 978 689 4797 Home 978 683 0397 Fax 978 686 6337 Cell 978 815 7745 Ma. License # 001821 * Insured * Home improvement # 120199 Dgbuilding@aol. com John Cronin 23 Merrimac st N Andover Garage sept 14 , 08 Remove and dispose of 2 layers of roofing materials, repair the soffit on the house side of the garage. This price does not inc. painting , plywood on the roof if needed or repairs to hidden damage. Price for the above $1, 970. 00 Side the garage with vinyl siding Siding price $2, 300. 00 i i i i NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL FORM Inhaccordance wit therovision of MGL c 40 S 54 a condition of Building Permit P � g at: is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150 A. Also, note Permits are required under Fire Prevention laws Chapter 148 Section 10A. The debris will be disposed of in: wdq le wX41,m P14 (Location of Facility) Signature of Permit Applicant Date 4/7/2008 10:26 AH FROM: MACDONALD PANGIONE MacDonald _Pangione Insurance Agency, Inc. PAGE: 002 OF 002 ACORD. CERTIFICATE OF LIABILITY INSURANCE °04107 8 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION MacDonald&Pangione Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P.O. Box 42$ ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 104 Main Street North Andover, MA 01845 INSURERS AFFORDING COVERAGE NAIL it INSURED D G Contracting,Inc NSTRERn Patrons Mutual Insurance Company 428 Pleasant St NsL B: S@MV Indemnity Insuranoe Com N Andover,MA 01845 NsuRER c Insurance Co of the State of Pel3n5ytvania NSkRFR D. NSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR D1 N POLICY EFFECTWTYPPOFINSURANCE POLICY E)IPIHA7ION LMIrfS EACH OCCURRENCE S 1,000,000. A GENERALL"LnY COMMERCIAL GENERAL UABOY CTR0006803 07/12/07 07/12/08 PREMSES a ocaffenmis —50,01W. CLAMS MADE ©OCCUR MED EXP Ift one person) $ 55,000. PERSONAL 8 ADV NJLRY $ 1,000,000, GENERAL AGGREGATE $ 000 GEML AGGREGATE LMT APPLES PER PRODUCTS-COA1P10P AGG $ OOO 000. MX POLJCY SECT LOC B AUTOMOBLE UMUTY COWSWED SNGLE UMT g 1,000,000. ANY AUTO 3116538 07112/07 07/12/08 (EescadeM ALL OVA4ED AUTOS BODILY NAw SCHEDULED AUTOS X HRED AUTOS BODILYHWIAit s (Per acdder0 NONV NVED AUTOS PROPERTY DAMAGE _ (Per ecdderq . GARAGE LIIIBLLlrY AUTO ONLY-EAACCDENT $ ANYAUiO OTHERTHAN EAACC S AUTO ONLY. AGG $ E)(CESSANiiBRELLA LMLLRY EACH OCCURRENCE $ OCCUR CLAMSMADE AGGREGATE S s DEDUCTIBLE s RETENTION $ S C WORKERS COMPENSATWN AND VVM51477 03/31/08 03/31109 X wcsTATu EMPLOYERS'LIABLLITY E.L.EACH ACCIDENT Y 100.000 ANY PROPRIETOR/PARTW.ROSCUTME OFFICERIMEMBER 0(CIUDED'1 El.DISEASE-EA EMPLOYEE Y 100,000 (yes.desalbs mder E1.DISEASE-POUCYLMT f 500000 SPECIAL PROVISIONS Delon OTHER DESCRFT1DN OF OPERATK)NS ILOCAMNS I VEHICLES!EXCLUSIONS ADDED BY ENDORSB*NT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DEQ POLIOS BE CANCELLED BEFORE THE EXPIRATHON D G Contracting DATE THEREOF'THE WLMG 04SURER WLLL ENDEAVOR TO MAIL 10 DAYS WR1TTM NQTiCE TO THE C8VTTCA7E HOLDER NAMED TO THE LEFT,BUr FALLURE TO OO SO SHALL 428 Pleasant Street NPOSE NO OBU6aTION OR LJASR Y OF ANY KURD UPON THE INSURER,rrS AGENTS OR N Andover, MA 01845 REPREsENrATTVEs AU7HOR12ED REPRE3BdTATHVE ACORD 25(2001108) OACORD CORPORATION 1988 The Commonwealth of Massachusetts Department of Industrial Accidents 4(4 Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): .A/ G v(toy 1 m Address: 04 Numr 0 City/State/Zip: 0 1l Phone #: ';"E G S Cl PV 7 Are you an employer?Check the appropriate box: Type of project(required): 1.EV am a employer with L4 4. ❑ I am a general contractor and 1 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. t 7• ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised.their 10.❑ Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.7 Plumbing repairs or additions myself.[No workers' comp. c. 152, §1(4),and we have no 12.E] Roof repairs insurance required.] t employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. t Homeowners who submitthis a„idavit indicating they are doing all work and hien hire 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 their workers'comp.policy information. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic.#: C `l 7 / Expiration Date: 7) 77� )/ Job Site Address: tM�L `1'� City/State/Zip:XtA�"y 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 DIA for insurance coverage verification. 1 do hereby certify un he pains and penalties of perjury that the information provided above/is true and correct Sicnature: Date ,�'� gds Phone#: q;77 r�6 F O C/7 r O/frcia/use only. Do not write inn 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#: 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." 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 of 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-contractor(s)name(s),address(es)and hone numbers along with their certificate(s)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 required 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 the 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 burn 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 1-877-MASSAFE Revised 5-26-05 Fax 4 617-727-7749 www.mass.gov/dia