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HomeMy WebLinkAboutBuilding Permit #976-16 - 24 GREAT OAK STREET 3/16/2016 BUILDING PERMIT NORTH OFtt�en 6�ti0 TOWN OF NORTH ANDOVER 0 - ��1,yIA/ APPLICATION FOR PLAN EXAMINATION 1 - b Permit No#: 7 Date Received �9q�RAreC,ea��5 SSACHUSE Date Issued: 24 I ORTANT: Applicant must complete all items on this page I iLOCATI';N uPnnt RROPERTY OWNERc� -s Print �^ 100 Year„�tructu a yes: no MOP" ._T_ PARCEL ZONINGiDISTRf(p __ Historic District yes - - --_ — Machine Shop Village _yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family 11 Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic °.WWII: ❑ I`oodplai"n� Wetlands i` ❑ Watershed}Disfnct ,_ ❑•UVater//Sewer :._. . - - DESCRIPTION OF WORK TO BE PERFORMED: qui? fih—rouq� a_ w4ll Identification- Please Type or Print Clearly s OWNER: Name: r; IPftp Phone: 6/7- Y&o-U696 I' Address: 3L-16 Gre.4T 0 a,k 57— Cont actor Name ' 5c,z- - Ph 23 - -- - IM, �cNy a Eone Address-,] 9 f I C Ex f Date "Supervasor''s Corr structionE License _ _ S`? �- -. _ .p - . z Homey Improvement Lice ��` lr _.- _ .Exp Date: f__I x 1 t ! 9 1 - { Ya ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125XOO 'ER S.F. Total Project Cost: $ Uo:a� FEE: $ Check No.: Receipt No.: . f NOTE: Persons contracting with unregistered contractors do not have access to the guar my f nd i nature of A er t . Signature of contractor_ ent/Own Y g 9 Location - ,.%!r',4 No. ,f 4 ffn Date • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ j TOTAL $ Check# " Building Inspector t0 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 I Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes r f Planning Board Decision: Comments I F .,Conservation Decision: Comments i r, Water& Sewer Connection/signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street 4FIRE DE �RTI�I9—gfiff `��emp ®ump te.��on�,tsi y s . ELocateci�a#F�1�24�kMa�n,�Slreeth , � A � � kF,reDeparnen �rsi1onze aturel"datej_ a C®MMEN S � . 1 i Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: i 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 Call Email Date Time Contact Name _ Doc.Building Permit Revised 2014 1 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 Li Building Permit Application ❑ Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses o 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 Li Certified Surveyed Plot Plan o Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses Li Copy Of Contract o Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) i Li Mass check Energy Compliance Report (If Applicable) o Engineering Affidavits for Engineered products i NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit 3 New Construction (Single and Two Family) ❑ Building Permit Application o Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If,Applicable) o Copy of Contract o Mass check Energy Compliance Report L, 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:Building Permit Revised 2014 04,�� RT1i ®w of ®ver No. : z h ver, Mass, o 1Cme 1. A- COC MIC M!WICK 79 A�R�TED APP`,��(y S U BOARD OF HEALTH PERMIT T _LD i Food/Kitchen rr�� Septic System THIS CERTIFIES THAT.....3 ... . . ...................................................................................... BUILDING INSPECTOR has permission to erect ............ buildings on a� �� Foundation . Rough to be occupied as ����l —S ��� s�G%� .............. .....: . . .......... ................................................................................... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application -,_ 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 CONSTRUCTION TANTS Rough Service .......... ... EOccupy .................................. Final. BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Require toBuilding 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. proposal 474 Main,Street Wilmington,MA 01887 Phone- 979447-5192 Far. 978-447-5478 Bill To: Ship To Proposal Date; 1/412016 Bridgette DeV'eau 13ridgette DeVeau Proposal#: 631 26 Oak Street 26 aak Street Project: North Andover.MA 01,845 North Andover,NIA 01845 Terms 50150 !tart! Description Est.HourstOty► Rate Total Labor Installation Labor for a Pleasant Hearth Pellet 1 500;00 500:00 Stove.and venting. I I i (6.25°!e) $0.00 This proposal is good for 30 days from proposal dale.Colonial Fireplace has-a return policy of 30 days after purchase.Unit and or parts MUST be in new condition to get full refund Total JdQ.©Q within 30days on materials only.Used parts and-or unit customer will recieve refund:minus a' 25%restocking fee on materials only.Labor is non refundable. E-mailWeb Site SIGNATURE sales@colonialfp.com Colonialfp.com Date of Accepiarace 6 Dimensions and Clearances MODEL: PH50CAB B. Clearances to Combustibles (UL and ULC) A. Appliance Dimensions 23-314(6031 —4-112 A C � I O .. O ` C 23-3116 [5 0] straight Back*ir st&Wall Inches Mllllmeters ". A Back Wall to Appliance 10 254 B Side Wall to Appliance 13 330 C;`orner Installation Inches .„M1111meters`°: C I Walls to Appliance 3 76 ti J CAUTION 35-v2 DO NOT CONNECT THIS UNIT TO A CHIMNEY FLUE [9�] SERVICING ANOTHER APPLIANCE. DO NOT CONNECT TO ANY AIR DISTRIBUTION DUCT OR SYSTEM. A WARNING x" � r�o HOT SURFACES! 4.1)16 ,',c� 11031 Glass and other surfaces are hot during operation AND 1' cool down. Apr.■. , Hot glass will cause burns. • Do not touch glass until it is cooled • NEVER allow children to touch glass • Keep children away 32-5116 [8 11 CAREFULLY SUPERVISE children in same room as 1 fireplace. _ _ Alert children and adults to hazards of high temperatures. High temperatures may ignite clothing or other flammable materials. • Keep clothing,furniture,draperies and otherflammable 1 22-1111615761 materials away. 22 7077-171 •July 10, 2012 6 Dimensions and Clearances C. Hearth Pad Requirements (UL and ULC) Use a non-combustible floor protector, extending beneath appliance and to the front, sides and rear as indicated. Measure front distance "M° from the surface of the glass door. V 0 K K Must extend 2 inches (51mm) beyond each E=1 side of pipe (shaded area) M USA Hearth Pad Requirements *L Exception for Horizontal Installations: CANADA INSTALLATIONS: A non combustible floor pro- 1444h Pad Requirements lractti"e`s" tections extending beneath the flue pipe is required with K Sides 2 horizontal venting or under the top vent adapter with verti- L* Back 2 cal installation. M Front g USA INSTALLATIONS:A non-combustible floor protection extending beneath the flue pipe is recommended with hori- zontal venting or under the top vent adapter with vertical installation. Canada Hearth Pad Requirements Hearth,Pad Requirements Milhme#ers K Sides 203 WARNING L* Back 51 If the information in these instruc- M Front 152 tions is not followed exactly, a fire may result causing property damage, personal injury, or death. • Do not store or use gasoline or other flam- mable vapors and liquids in the vicinity of this or any other appliance. • Do not over fire - If heater or chimney connector glows, you are over firing. Over firing will void your warranty. • Comply with all minimum clearances to combustibles as specified. Failure to comply may cause house fire. 7077-171 •July 10, 2012 23 The Commonwealth of Massa chusetts Department oflndustrialAccidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 www massgov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information //' / � Please Print Le¢ibly Name(Business/Organization/Individual): Co 4n i� � 1 r (&Q Address: W 7 y /)]a,n S t City/State/Zip: Lv; ,r,;,, h MA W19 Phone#: Are you an employer?Checkt6c appropriate box: Type of project(required): i 1.�I am aemployer with _employees(full and/orpart-time).* 7. 0 New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 3.0 I am a homeowner doing all work myself[No workers'comp.,insurance required.]t 9. 0 Demolition []4.0I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.[],Plumbing repairs or additions 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. These siib-contractors have employees and have workers'comp.insurance.$ 13.0 Roof repairs 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.(Other Pe Rel 51b�e 152,§1(4),and we have na.employees.[No workers'comp.insurance required.] *Any applicant that checks Box 41 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 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 state whether or not.those entities have employees. If the sub-coriiractors have employees,`they must provide their workers'comp.policy number. f am an employer tfiai is providing workers'compensation insurance for my employees.'Beloiv is the policy and job site information. n�] Insurance Company Name:_/QCQ ,/`trae,-ir_4n �nSara.+�t Policy#or Self-ins.Lic. l 2 U F Expiration Date: 6 Job Site Address: & Gr&.t Ua k 57 City/State/Zip: /10'N 4.,droll M4 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. X do hereby certi under the ain dpenalties ofperjury that the information provided above is true and correct Signature: 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#• 11' 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 lure, 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=contractors)name(s),address(es)and 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 cityor 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' compensatioil'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 bum leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel.#617-727-4900 ext.7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia COLON-1 OP ID:JD '4`c,oRo CERTIFICATE OF LIABILITY INSURANCE DATE 08/05iD20011 YY) 08/05/ 5 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 NAME CT Wilmington Insurance Agency Wilmington Insurance Agencyy Arc No):978-657-5724 Five Middlesex Avenue Unit 14 McoNN .978-658-3805 FAX P.0.Box 1010 ADDRESS: Wilmington,MA 01887-0580 John F.Doherty INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Ace American Insurance CO INSURED Colonial Fireplace LLC INSURER B:Arbella Protection 41360 474 Main Street INSURER C:Ohio Security Insurance 24082 Wilmington,MA 01887 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 MAY HAVE BEEN REDUCED BY PAID CLAIMS. /NSR TYPE OF INSURANCE AD S POLICY NUMBER MM/DDIYYYY MM/DD//YYXYPY LIMITS LTR C X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000100 CLAIMS-MADE T OCCUR SKS56005897 03/14/2015 03/14/2016 PREMISES Ea occurrence $ 10,00 MED EXP(Any oneperson) $ 1100 PERSONAL&ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 X POLICY E JECT 71 LOC PRODUCTS-COMP/OPAGG $ 2,000,00 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,00 B ANY AUTO 1020028151 04/01/2015 04/01/2016 BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTOS Peraccident $ UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY X STATUTE X ER H A ANY PROPRIETORIPARTNER/EXECUTIVE Y r N 6S62UB2E12396214 03/1412015 03/14/2016 E.L.EACH ACCIDENT $ 1,000,00 OFFICERIMEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,00 Wsdescribe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space,Is required) i r i i - CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE.POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD a a Massachusetts -Department of Public Safety �//rti rarwazaratoeu•���t�� CuJJac �Jed Office ofConsnmerAtfairs&Business Regulation Board of Building Regulatic s and Standards ROME IMPROVEMENT CONTRACTOR Construction Supervisor x egistration 181414 Type, License:CS-105920 r r. , -xpiration: 411/2017 Corporation SCOTT MHAYES-` COLONIAL FIREPLACE 6 CANTERBIIRY:AWR f 40 Haverhill MA 01930 _ SCOTT HAYES e 474'MAIN ST WILMINGTON,MA 01887 �- Und'ersecretary� Expiration i Commissioner 08/1912016