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HomeMy WebLinkAboutBuilding Permit #553-2017 - 24 SALEM STREET 11/22/2006 RT ` BUILDING PERMIT TOWN OF NORTH ANDOVER 0? APPLICATION FOR PLAN EXAMINATION T Z h T Permit No#: S a-0/ -7 Date Received ATED �5 gSSACHUS Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION _ Print PROPERTY OWNER Print 100 Year Structure yesno I MAP PARCEL: 10 ZONING DISTRICT: Historic District ye no. Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New ilding ❑ One family ❑Ad ion ❑Two or more family ❑ Industrial ❑ eration No. of units: ❑ Commercial V'Repair, replacement ❑Assessory Bldg ❑ Others: { ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District Water/Sewer - DESCRIPTION OF WORK TO BE PERFORMED: ( Ald 94-r-u ci-,Iric, ( d—� s e�S Identific tion- Please y e o rint Clearly f OWNER: Name: ( ; + n C r d Phone:�7g'� Address: Contractor Name: /Ve.� ro,/�� xd" Phone: Email: Address: C A r Y 0 b u h ►►� f' O t U t Supervisor's Construction License: ` G�� _,_ Exp. Rater Home Improvement.License: ` `� _ Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 3z 2- _FEE: $ Check No.: 7 -7 7 Receipt No.:3 1 -2-3 0 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contractor �1 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools 11Well ❑ 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 VEALTH 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 TM _ 384 Osgood Street FIRE DEPARTMENT - Temp Dump ter on site_. yes,,-. Located at 124Maini9reet r _ t _ Fire Departrnent 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) ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Pennit Revised 2014 I 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 PP Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Cross Section/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 I 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 Doe:Building Permit Revised 2014 I I I NORTFI Town of LAndover No. so h ver, Mass, / • D/b COC NIC 41WICK �f- 7,q S tl BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT .M.W...V.... ... ....... `x O N BUILDING INSPECTOR . .... ............................................ .......... has permission to erect buildings on � 6 Foundation .......................... ..................... ................. .................................... N Rough to be occupied as . ......................... Chimney ............ ........ ...... rv........... ....... c +.. o 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 CONSTRUCTIO START4-.-, Rough Service ............... .......4. ............................... Final ILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building 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. PAA.Rag x146589 � Contract# CT Reg 4060521 a �� � Fareral ID#20-262512-9 RI Peg 426463 Home Improvement solutions r 70427 C9rPGrate riead:-uaners.25 Cedar St,bVo�.:r�.P.?P.,!P?800-'42-221'.it",7E Ly33-9525.vr.•nsr,;�ev:p�a:om THIS CONTRACT MADE-HE ylday Of I j, 10^,'}�;r _2? i"obetween 3• `U�S53c�t�y2 G`7 c,i� �33 ;horic C;rnersl ivrw4?hon>i (Bu yeti.borer of (Stara; ;Zie! the"Ov/ner"and NEWPRO Ooeratinc,LLC,:,NEWPoO, (E-Mail) is,oroo's:an,use only NEl4'=R0 hereby agrees that it veil;`or the-consideration here:n.yer mentioned,furnish a labor and mate;ial necessa-v tc i^stall the following described work at the premisez iocated at: The jab address is a cordomtnium. (goo Adrlrngs) TOTAL# y NENIPRO WINDO O T#ONS: LNtNDO4""+'S 1 S'eRl€a# U:�,r� Grids: YES Lj iN0 :�CONTOUR LTISDL Yi"EUP.O !Rf DIAMOND Window color QTY mndow color QTY OBSf-imp:lLw-a t w L773� �d 50 .Om nt: I ) I r:`. I� Screens: (Exterior cola FJ:I Scr en S;anCardt �a .AL= FULL Ert s ti Ex': I Vent latches: r!�j [�YcS NO Capping Color: 0 DOORS MODEL QTY Please fnit)al: ! 22 PVC Smooth _f NoMar _J No Capping Sliding Glass Door MODEL NAME tAODEL# QTY Color fn0w: LwUbleUn7 f Ac!ive' Cent.r Rtah' `.Lct m9r-r+s::am:s t!rat:`EWPRO; 2 Lite Slider I HDWR: SN 36 EIGE 3 Lite Stier VA) ' ' Entry Door Style r, t rer.ner.ren3iaM,c�•renlaa:nq+metro; .i Lae Slicer Qr. color tet: ^tr.. sores or sort He!"P?o�:a tri.Casement(Hinged Rian'; rw coj--19 b- 5 J[IrCJ 3tEn:S ! ri.�7ei�n+253 Steel ':51915 _ CaS=Ment iNinde:LeRj HDWR: SKI BB x.33 AB ORS gnu its"x1rd caucin?mndersa ion r-.so- Twin Casement Sidelites Style le l Irg':— rCue lr_s=-eaa•:Ln¢.-orditsans Stationar;Casement I Color In: Out } (circle one;�"":1 Tripe Casemant tr+--.: if-,iStOrtt!Door Style t (,` r+,SH/' Triofe Casement P^.rts.gat Color In:_ Out: czla.�ce pss_tc nne:at cam�:eGon Pict.. -e 1':rinu'oV: H01MP,: S` B6 nG8 A8 Sash Only _ Left Hinge R:aY:,H!noe FINANCE Hop�Fa Entry Door Style - I gaol:xmaieikr'ar�^sign2b at:ns[anr o, .awning " color In: GLi: Garda-,llVirdo' ! �rerglast S;ee: TOTAL " Bay HDWR: SN BS r AGB A:3 0:28 CASH Bob indov c 4,•; .: Other Door Style PRICE Other )galOr In: CL` DEPOSI r Other HDWR: WITH ii l }(D-6-7 ). DESC.?18E rNv^P.K 8 PROvfOTIOpfS APPI;ED_ ORDER (1-FjIL-C-L_ v. r- TOTAL c_ 1 �CVCi..�n 1 .I,, 7 X.i°- r' DUE AT INSTALL 1 rQustptnerur ;lands this is an"estimated date" Owner has read and agrees to the terms and conditions on the front and the reverse of this Agreement. Owner specifically agrees to the(1)Total Cash Price;(2)work being performed;and(3)work not being performed. Owner understands that this Agreement and any attachments contain all of the promises made by NEWPRO. Owner has been orally advised of his right to cancel this transaction at any time prior to midnight of the third business day after the date of this transaction and Owner was provided with two(2)copies of a cancellation form explaining this right. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. (Rhode Island Sales Only): Notice to buyer: (1)Do not sign this Agreement if any of the spaces intended for the agreed terms to the extent of then available information are left blank. (2)You are entitled to a copy of this Agreement at the time you sign it. (3)You may at any time pay off the full unpaid balance du=_under this Agreement. and in so doing you may be entitled to receive a partial rebate of.the finance and insurance charges. (4)The seller has no right to unlawfully enter your premises or commit any breach of the peace to repossess goods purchased under this Agreement. (5)You may cancel this Agreement if it has not been signed at the main office or branch office of the seller,provided you notify the seller at his or her main office or branch office shown in the Agreement by registered or certified mail,which shall be posted not later than midnight of the third calendar day after the day on which the buyer signs the Agreement,excluding Sunday and any holiday on which regular mail deliveries are not made. See the accompanying notice of cancellation ceiiatign form for an explanation of buyer's rights, (Rhode Island Sales Only): Owner acknowledges receipt of required Contractor's Registration and Licensing Board consumer education materials, (Owner's initials) Wodutt Speral st(Printed NarnaJ �^ - Owner J 6y' sq,e.�,— P O Opar�.t`n LLC(Signafulei Owner US-15 ih'H'Tc Brxcn Ca,-,y YELLOW CustcrN6r'8 Cap, PINK: File C:pr GOLD 'Finance Copy R6714 i. i .. " . Ea QUalifled NEWPRO MANUFACTURING chat SERIES G NEWPRO 2000 - — DOUBLEWUNQ Cellular PVC frame,Triple glazed, Nellona]Fenaal(atlan Low E coating(e=0.427,52&5), AatlngCounc9a Kryptonlair filled,Dividers MGM= - M-K27.00081-40001 ENERGY PERFORMANCE RATINGS U-Factor(U,SJI-P) Solar Heat Gain Coefficient 0,180,22 ADDITIONAL PERFORMANCE RATINGS Visible Transmittance Air Leakage(U.S,n-P) 0u35 0a Condensation Resistance 70 6tmuhcluwaOuw�*e ffieaereen7 nkrmtnappfloaDleNFACP tadaanntnl�pehoh �Potenlla�Ao aCpl tAa� amnchairrjW tear t e P rg4unoe�r m0� womadro.orA L. r The Commonwealth of Massachusetts Department of Industrial Accidents �r Office of Investigations 1 Congress Street,Suite 100 �< Boston,M-4 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly i N� �2© DP�� grw - L Name (Business/Organization//Individual): J' Address: vE 7PAP-- �T City/State/Z• : YV OLAN N,4 01F01 Phone#: Are you an employer? Check the appropriate box: Type of project(required): 1. I am a employer with J�� 4• ❑ l am a general contractor and I 6. ❑New construction employees (full and/or part-time)•* have hired the sub-contractors listed on the attached sheet. 7. ❑Remodeling 2.❑ I am a sole proprietor or Partner- These sub-contractors have g, ❑Demolition ship and have no employees employees and have workers' wozrdng for me in any capacity. 9. ❑Building addition comp.insurance.t .To workers' comp.insurance 1p.❑Electrical repairs or additions q required.] 5. ❑ We are a corporation and its officers have exercised their 11.❑Plumbing repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 12.❑Roof repairs myself. [No workers' comp. c. 152, 1(4),and have no insurance required]t 13 ❑Other employee es. [No woror kers' comp.insurance required.] «Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information, I Homeowners who submit this affidavit indicating they are doing all work and then hire outside cormactors must submit a new affidavit indicating such. Icon that check this box must attached an additional sheet showing the name of+he sub-contractors and state whether or not those errrtities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. i I am an employer that is providing workers'compensation insurance for my employees. Below is the policy andjob site information. ! e-e- Cc)Insurance Company Name: . / _ j Policy#or Self-ins.Lic.#: �;0` 0 e - .9�3So60Expiration Date: Job Site Address: �� J r City/State/Zip: 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. Ido hereby cern under thepains and pen allies of perjury that the information provided above is true and correct e' Si tune: Date: I Phone# i Officlal use only. Do not write of this area,to be completed by city or town oj1rcial !f j City or Town: ------------------------------------ Permit/License# I Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Phone#: Contact Person: 1 i DATE(MMIDDIYY'/'() CERTIFICATE OF LIABILITY INSURANCE F9/9/2016 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 NAMEACT Melissa Pflug Mackintire Insurance Agency Inc PHONE (508)366-6161 FAX (508)365-5202 ac No: 11 West Main Street ADDRlEss:melissap@mackintire.com INSURERS AFFORDING COVERAGE NAIC# Westborough MA 01581-1931 INSURER A Netherlands 124171 INSURED INSURERB:Libert Mutual/Peerless 24198 Newpro Operating LLC INSURERcAcadia Insurance Co. 26 Cedar St. INSURER D: INSURER E: Woburn MA 01801 INSURER F: COVERAGES CERTIFICATE NUMBERMaster 15-16 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. IN RI DOL SUEIR TYPE OF INSURANCE POLICY NUMBER MM/DDIYYYY FF MMIODYI'!E`NY LIMITS LTR X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 A CLAIMS MADE ❑X OCCUR DAMAGE 0 RENTED 100,000 PREMISES Ea 3ccurtenceI S CBP8589577 12/31/2015 12/31/2016 MED EXP(Anyone person) S 5,000 PERSONAL&ADV INJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 3 2,000,000 X POLICY❑ PECTRO ❑LOC PRODUCTS-COMP/OP AGG S 2,000,000 J S OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S 1,000,000 Ea accident A ANY AUTO BODILY INJURY(Per person) S ALL OWNED X SCHEDUL=D BA 8584174 12/31/2015 12/31/2015 BODILY INJURY(Per accident) S AUTOS AUTOS TION-OWNED PROPERTYDAMAGE S X HIRED AUTOS X .AUTOS P�raccident r Uninsured motorist Blsplit limit S 250,000 X UMBRELLA LIAB X OCCUR EACH OCCURRENCE S 5 000 000 B EXCESS LIAB rl CLAIMS-MADE AGGREGATE S 5 000 000 DED I X I RETENTIONS 10,000 CU 8582578 12/31/2015 12/31/2016 5 WORKERS COMPENSATION x OH- PER AND EMPLOYERS'LIABILITY Y/N STATUTE E ANY PROPRIETOR/PARTNER/EXECUMVE N/A E.L.EACH ACCIDENT S 500,000 C OFFICER/MEMBER EXCLUDED? y7C-20-20-003506-02 5/1/2016 5/1/2017 (Mandatory In NH) Y E.L.DISEASE-EA EMPLOYEE S 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Excluded Officer: Nicholas Cogliani CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1 600 Osgood St ACCORDANCE WITH THE POLICY PROVISIONS. North Andover, MA 01845 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD ',3 officeonsumer Aff ' ire ss Re latian I �C ams d —.10-Park-Plaza - Suite 5.i 74 Boston;-M achusetts 02116 _.. Home Improve nt toy Registration Reglstmtion: 148589 Type: Supplement Card Explration: 5/5/2017 NEWPRO OPERATING, LLC, THOMAS FOXON 26 CEDAR ST. w WOBURN, MA 01801 sy$ Update A,ddregs and retara card.Mark reason for cheap- SGA 1 hange.SCAT 4 ZG*asrrr � Address Renewsti [ Employment C Lost Card vlto irmaaquvetr�o�9/�ac� _ rflce ofCoasuacer Affairs&Business Regulation License or registration valid for individall use only ME IMPROVE %T COttl MCTOR before the expiration date. If found retRA to: OTwe of Consumer Affairs aad Bushseaa Regulation - aAtatfa�lc. t Tyw- 10 Park Plaza-Suite 5179 ExF� SupplemeA Cart Basion,MA 42116 NEkjVPRi)Opekk THOMAS FOXON 26 CEDAR ST. WOBURN,MA 01601 Undersecretary Notvalid it aignature # Massachusetts ElePartme st Of.Public Safety Board of Building Regulations and Standards License: CS-029090 C—Dnstructior. Supervisor THOMAS PAUL FOXON ; 230 WALNUT ST READING MA 04867 E7(�Irai;r3c1; Ccrnmissioner 19199/2017 I • d r � F i � t Location No. _553`2O/-7 Date 1/ - SOL • - TOWN OF NORTH ANDOVER I w Certificate of Occupancy $ Building/Frame Permit Fee $ � Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# 1057-7 O 2 3 0 U Building Inspector