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HomeMy WebLinkAboutBuilding Permit #571-12 - 24 LANCASTER ROAD 1/27/2012 TOWN OF NORTH ANDOVER (' APPLICATION FOR PLAN EXAMINATION Permit NO: J 7�—/2 Date Received Date Issued: ` '2 7/ " Z IMPORTANT:Applicant must complete all items on this page LOCATION , L Atgc 4keJe�L.. ��. N r�n� c s✓� Print PROPERTY OWNER A N€ �0 RAN J A Unit# / Print MAP NO:/e /O PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no 100 year-old structure yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building YOne family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial Ind Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other � S�"tic D Well ._ ®Food lain ®Wetlands D Watershed tract E��Water/Sewers � DESCRIPTION OF WORK TO BE PERFORMED: '�,��✓ �S�© . ;;a 1. �, v (���� cop + R,d Ve-,4 ANJ i Identification Please Type or Print Clearly) OWNER: Name: i r^H .'? Phone: 5?�. :v7'y G''Vyd . Address: W�s�9 ,. �,v _ ���✓ v;��-� IM CONTRACTOR Name: Phone: Address: Supervisor's Construction License: ig 6 5`� Exp. Date: /:2 Home Improvement License: Exp. Date: <? X01 ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT:$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $_ ,7�(o " S' FEE: $ O. D a Check No.: 6_3 ,2 / Receipt No.: oC y�FR�` NOTE: Persons contracting with unregistered contractors do not have ac ess to guaranty fund 5R gnatnt/Owner'j' a. �;, -,j?i- - -` - - +,.w_Sgnature.ofcont[acto 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 CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS 4 , I 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 i 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 ❑ Notified for pickup - Date Doc:.Building Permit Revised 20117une/mi J 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 I Doc: Doc.Building Permit Revised 2008mi I Location ')y �GM�f/F� ��I tr' No. 5-71-12- Date / ,9 711,— NORTH TOWN OF NORTH ANDOVER f � ti0 9 Certificate of Occupancy $ cMusEt� Building/Frame Permit Fee $ �go Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 63,;27 2 4 9 b 4 Building Inspector Eli" i s �� Phone 800-999-7847 508-699-0440 i11 ��, ,, ....-------- Fax 508-699-6075 MFF—S OHAITICNd EXPERTS www.jbrianday.coni 13rsat:ter a'olivii. Guaranteed. i YYatc.r • Fire - Soot - fviold - 1417 �,tc 1da4 /� a Customer Name; t ,l c.----- �_R.R+�- ^�� ___. �__ Approximate Start Date of Work. Address 7 (�� . Effective Date of Contract. Il MASS 01 PYS Date of Loss: Construction Contract 1. Description of Services. For the sum specified below,J. Brian Day. Inc ("J Brian Day. Inc'")agrees to furnish the material and labor necessary to complete the following services at the premises located at: Location StreettA<.idress. . ' L4_. C—A"C4 S 778 J(,- SOD. Town N. / AI1)o l C State'/r A Zip: �- Any drawings or plans describing said work shall be incorporated into and attached to this contract, J Brian Day's obligation shall be Itinited to the work described above. No changes in work shall be a part of this contract unless approved and signed by both parties in writing This contract supersedes all other written and oral agreements entered into prior to the effective date of this agreement 2. Access. Customer shall provide continuous access to the location for the period when work is scheduled Custon•ier's electric, rest room and water are to be made available for J. Brian Day's use during work time at no cost to J Brian Day. Customer agrees to be ; present as needed for scheduled on site work, pick ups and deliveries, and to sign for items when delivered. At the time J. Brian Day picks up items from the location,an inventory of items being removed by J_ Brian Day shall be submitted to the Customer for signature j' No responsibility will be accepted for any item unless it is listed on the inventory signed by the Custorner. Ii 3. Cost of Services. Customer shall pay J Brian Day a deposit ofv.on signing this contract, The total fee payable to } J Brian Day for services hereunder shall br 1-7 IVO. SS The balance owed for services rendered under this contract is due upon completion of work J.Brian Day may increase the contract price and estimate hereunder if there is any change in the work scope which was not requested or expected at the time of signing of this contract, in such a case,a new contract will be signed by the parties. 4. Payment Obligation. Customer agrees to be personally responsible to J Brian Day for any fees or charges not covered by Customer's insurance including but not limited to deductibles,depreciation,policy coverage limitations and exclusions. Customer agrees to pay J Brian Day for any fees or charges within 30 days of the date of the invoice whether or not Customer's insurer has pard or resolved the insurance claim. Custorner authorizes insurer to pay J. Brian Day for services provided herein. Customer shall pay J. Brian Day ininiediately upon receiving a check from insurer payable to Customer. Any payments received by Customer from insurer shall be immediately endorsed over to J Brian Day to the extent of any unpaid balance. 5. Interest. if invoices are not pard within 30 days,after the invoice date. Customer will be assessed interest at the legally allowed rale J Brian Day may commence collection efforts after the 30th day in which case Customer shall pay all court costs,attorney fees and other rolaled costs, 6. Representation. Customer acknowledges that it is the owner of the location where services are performed and/or has legal ability to enter into this contract. Customer acknowledges that its insurance policy was effective as of the date of loss and that no assignment of insurance proceeds have been made to anyone. 7. J.Brian Day Liability, J Brian Day's liability under this contract is limited to the amount paid for services under this contract_ This contract does not cover asbestos abatement,and/or remediation of hazardous wastes t 8. Disputes, Any dispute under this contract,including interpretation of the contract,payment of sums due and owing,and work performed under the contract,shall be resolved by arbitration in accordance with the rules of the American Arbitration Association and the results reached shall be binding. VhcrevailIng party in any dispute concerning this contract shall be entitled, in addition to any other award, to reasonable ttorney tnd costs incurred in such proceeding. J. Bria Day, InDate i2� /a !� i� �' !� Date: // /�i /c3 YI, CCustomer Sg Signature and Title dJl(j�G' �'�I /'�G � /hom.o t; �jA'►CCS 4 Jx r Pnnt Name Print Name ronH iii �r n.+s=Y+ �ILfitlltlll' �i -vc.rr�rr 1 I NORTH o ® Andover 0 No. / r y 0 _ o , dover, Mass.,- 0 7�p ORATED S BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System �Qd� uW� BUILDING INSPECTOR . THIS CERTIFIES THAT..... ........................................................................................................................................................ n!E Foundation 07 y has permission to erect......................................... buildings on .............................................d�.. .....................:.:................ Rough nnll to be occupied as .?1iP©tIF ��/GCEdO.......C' ..,r.. ! Xication Chimney .................. .... ........................................ ....................provided that the person accepting this permit shall in every respect conform to the terms of thea 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 PERMrF EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR SUCTION ST �SUNLESS CON Rough - ............................... Service ................................... . ....... ......... BUILDING 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 FIR_ E_DEPARTMENT. Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. �1,\ "./�adscrcfu� Y � lOffice of Consumer Afi'airs andsiness ReLl � tIC n 10 Park Plaza - Suite 5170 Boston, MLISSaI use.tts 021 1 o Home lmhrovement Contractor Registration Req is Itation: 135029 Type: Private Corpotalion Expiration: 2/22/2012 Tr# 2.94251 J. BRIAN DAY , INC. JOHN DAY 54 WASHINGTON ST. PLAINVILLE, MA 02762 Update Address and return card. Mark reason fm-ctlaug I_.. AddressReucwatl ! N:mploymeot 1 Lust f Or'G•CA1 d yi)ai.0.vua-G 1012tH ....e;.wwr•w��.+.w,�...,.r.....«..er„ ...mw...,..<...-..awn......,... ,. - - Vt t�xarhu.ctt.- DCfoil rtInco I t,r I'L!I>lit. /++ (nrrrrvnco�eu�acrc &+trd tr( 13ttiliiin� RcuutatiolIN alld tifau<1ar11% Office ofConsumer Affairs&Business14gulation Construction supervisor _14�r,sEy ROME IMPROVEMENT CONTRACTOR V License: Cs 83657 K2#,91'St1Ati0r#,'136029 rs`, EXjSiY�ti�iSt! 2j2�212}12 Tr# 2942:51 '! TypeV f;fjwe Co 6ftlion JOHN W DAY ., J.BRIAN DAY,ftd� ��{_} . 54 WASHINGTON ST DOWN DAY .% PLAINVILLE, MA 02766 i 54 WASiMTON ST ' i PLAINVILLE,MA 02rs2Atlrrt�l etiretsry o— �J� Expiration: 8/4/2012 < <�ruzcri�cirnor ,-rte. 688 CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD YVYl) Rte® DAYJB01 07[06/11 PRODUUCCERR� THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION R.A. Re.Lnbold Ins. Agency Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 850 Landry Ave HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR P.O. Box 68 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. N. Attleboro MA 02761- INSURERS AFFORDING COVERAGE :NAIC# INSURED INSURER Utica National INSURER B Safety Insurance Co. j. BRIAN DAY INC INSURER L Utica National 1 54 WASHINGTON STREET tINSIJRER0 A—rr—,, xnc� iarxonl! Gro p PLAINVILLE MA 02762 _.. INSURER Chartis COVERAGES --E 1=O1.�C1E5 OF INSUPANCE LISTED BEL(;,V -AW-SEEN ISSUED TO'HF INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING A:Ii REQUIREMENT TERM OR CONDITION Or Ai:f CONTRACT OR OTHER OOCUTAENT WITH RE--PECT TO WHICH THIS CERTI-ICATF MAY BE ISSUFD Or, ;r.Y PERTAI'!,;i IE INSURANCE AFFORDED By THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS CIF SUCII FOL I,IES 4GGREGATE LIMITS SHOW,',MAY HAVE BEEN REDUCED BY PAID CLAIMS — -- -----'1SOLIC\TE'FEC7@E VYb1'fLYE7TPiRn—TtOA POLICY NUMBER -DATE MWDD/YYYY (DATE MM/DD!YYY LIMITS LTR INSRD TYPE OF INSURANCS 07 GENERAL LIA131LITYC-hGH CiG£TrrR�ruCI:URRELICE S1,000,000, . ,Nr)c A X X ';oMh1ERCIALGENEPALLLABILI"r CPP 4093093 O1/O1/11 01/01/12 LLcMisE51Eno xrmtai $100,000 ' ['AEU E±Cp_IAny one person) $5,000 ' Ci AIMS MADF i X OCCUR __—. _. i PERSONAL&ADV INJUPIT $ 1,000,000 GENERALAGGREGATE s2,000,000 rEtl't AG REr r.TE LIMIT pPFUE.7 PER 'RPRODUCT'S•COMWOP AGG t2,000,000 X POLICY JECT LOC _ --- - AUTOMOBILE LIABILITY COMRtNED SINGLE LIMIT $1,000,000 X X NA ca acvdentt }( �.1.L O•tlarp gVTOS NA BODILY INJURY 5203306 05/17/11 I j B �X srHE�uLeoAuTns 05/17/12 (PerPersonl--- -- .---- -- II }{ BODILY INJURY y (P^I A,.adentl B X !N<Iha-OWNED AUIG�S I. .. .- - PRGPERTr DANtI`GE .Wer 8=1wil) AUTU ONLYE.A ACCIDENI 5 GARAGE LIABILITY - - 'OTHER THAN EA ACC S ANY AUTO _ AUTO Gi1LYt AGG I S FEXCESS I UMBRELLA LIABILITY EACH OCCURRENCE I$ 1,000,000 D'=C:U" CLAJrssI.IADE CULP4282500 01/01/11 ! 01/01/12 AGGRE„TE IS1,000,000 i DEDUI'TIBLE RE`EF+rION ! t 5 WORKERS COMPENSATION AND EMPLOYERS'LIABILITY /L o I t- I C.i t t TORY t.IMITS Y*f ER. rN 04/23/11 04/23/12 'F.L EACH ACCIDENT s 1,000,000 D ANr PROPRIETOR/Pr RTfdERR:itEC4JT`IVS--- WC051751221 .. - OFFII-ERIb1Fk;L3FR EXC.I-UDED% N I � � i �E L DISEASE�EA EMPLOYEE)$ 1,000,000 (Mandatory In NH} I 9 09 dPSC-'IUa UM:- I E L DISEASE•POLICY LIMIT $1,000,000 SPEC{AL PROVISIONS oPIVN OTHER D Pollution CPL6602610 07/03/11 07/03/12 ! EACH LOSS 1,000,000 AGGREGATE 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DAYJ13RI DATE THEREOF.THE ISSUING INSURER WILL ENDEAVOR TO MAIL 20 - DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO 00 SO SHALL. IMPOSE No OBUGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR J Brian Day Inc. REPRESENTATIVES. 54 Washington St. AUTHORIZED REPRESENTATIVE Plainville MA 02762 Thomas Reinbold ACORD 25(2009/01) (D1888.2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD OP ID:JL CERTIFICATE OF LIABILITY INSURANCE F DAT01/06//YYYY) olrosrl2 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). CONTACT PRODUCER 781-455-0700 NAME: Roblin Insurance Agency, Inc. PHONE FAX 144 Gould Street,Suite 100 781-449-8976 A/C No ExtI: 'C'No): Needham,MA 024942321 E-MAIL ADDRESS: Roblin Insurance Agency,Inc PRODUCER CUSTOMER ID#:JBRIA-1 INSURERIS)AFFORDING COVERAGE NAIC# INSURED J Brian Day Inc INSURERA:Acadla Insurance Company 31325 Jonathan Foley INSURER 8: 54 Washington Street INSURER C: Plainville, MA 02762 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 UBR POLICY NUMBER MM/DDY/YYYY MM/DDfYYYY LIMITS EFF POLICY EXP LTR GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 AMAGE ToRENTED A X COMMERCIAL GENERAL LIABILITY CPA 5017172 01101/12 01/01/13 PREMISES Ea occurrence $ _ 100,000 CLAIMS-MADE FKOCCUR MED EXP(Any one person) $ 500 PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY7-1 PRO-JFCT LOC Emp Ben. $ 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE HIRED AUTOS (Per accident) $ NON-OWNED AUTOS $ X UMBRELLA LIABX OCCUR EACH OCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,000 A CUA 5017175 01!01!12 01101/13 DEDUCTIBLE $ X RETENTION $ WC STATU- OTH- WORKERS COMPENSATION AND EMPLOYERS'LIABILITY TORY LIMIT ER YIN ANY PROPRIETORIPARTNERIEXECUTIVE F—] E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Issued as evidence of Insurance. CERTIFICATE HOLDER CANCELLATION ISSUEDF SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ISSUED AS EVIDENCE OF ACCORDANCE WITH THE POLICY PROVISIONS. INSURANCE AUTHORIZED RREPRESENTATIVE ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 26(2009/09) The ACORD name and logo are registered marks of ACORD