Loading...
HomeMy WebLinkAboutBuilding Permit #579 - 25 COLGATE DRIVE 3/6/2007 NORTMI BUILDING PERMIT o`t,�D bgtio TOWN OF NORTH ANDOVER 3? a' '` °� APPLICATION FOR PLAN EXAMINATION Permit N0: Date Received - p�RAT[o SSACHUS� Date Issueg& Il IMPORTANT: Applicant must complete all items on this page , s LOCATION P'rpt PROPEI:TY Ot1NEl %'' , P r mE gra Print MAP,NO PARCEL. ZONINGe[31STR1CT HISTORIC DISTRICT u TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building One family i ❑ Addition ❑ Two or more family ❑ Industrial Iteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ISeptt 1t1Ie11 µ{ Floodplain elf Wefland I 'iWatershedaC3istrid Water ewer, m " u , F rs , D SCRIPTION OF WORK TO BE PREFORMED: I entification PI se Type r Print Clearly) OWNER: Name: a c ",1 Phone: Address: —2 CCN�"RACTQR. Nrne: , Phone. -- Addre-ss Sitpetvor?s Coristructio License s' Exp=. CSate, ? come Improvement License : �x Date; i I w I ARCHITECT/ENGINEER Phone: . No. Address: Re ,. 9 FEE SCHEDULE:BOLDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PE S.F. 4//P Total Project Cost: $ (706" FEE: $ x Check No.: yp Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access tolh guar ty and Signature of Agent/Owner Signature of contractor I Location�)5- No. Date NORTH TOWN OF NORTH ANDOVER 3?0°a`,O ,•,MOt Certificate of Occupancy $ b'••'°''<� Building/Frame Permit Fee $ 1/0 �SSACHU Foundation Permit Fee $ �— Other Permit Fee $ TOTAL $ Check #�el 2 0 U2 3 ...__� Building Inspector I Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ 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 ❑ ❑ COMMENTS i 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 ❑ <2oning 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 FIRE--DEPARTMI5NT' ernp Dum ster o she�� yes _s n© Located at 124 Main Street PIr De artment si naiture/& e _ G. , M r ,; Dimension I Number of Stories: Total square feet of floor area, based on Exterior dimensions.—i i 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 i i i i i P i I I I I I ❑ Notified for pickup - Date I ............................................................................................................................................................................................................................_........................................._....................................................................._........................._........ ................................................................_......................................: I i f . i Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. l Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application o 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 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) o Engineering Affidavits for Engineered products i New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses o 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 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 f i i NORTH Town of Andover No. ,$-77 - _ over, Mass.,- ' L ' �'� O LA CHIC WIC A. CO0RATED cb WARD OF HEALTH Food/Kitchen PERMIT T D Septic System THIS CERTIFIES THAT..........N. ... ....... ......t4.0%44.........................Cd I........... ............ ............... BUILDING INSPECTOR Foundation has permission to erect........ ....... ........ Rough buildings on ... 4..................................... Chimney (M**W-h* tobe occupied as.......Pu... ....... ....................... ............................................................................. provided that the person accepting this permit shall in every respect 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 PERMIT EXPIRES IN 6 MONTES Final ELECTRICAL INSPECTOR UNLESS CONSTRUCS 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 FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. February 22, 2007 Plot Plan $450.00 Extra Electrical $490.00 Demolition 1,900.00 Remove I Remove tile floor Bath&Kitchen ! Purchase & install correct sub floor I Purchase & install tile floors Install thresholds i Install cabinets Pull permits D.E. Small Electric Repair Kitchen Ceiling Reinstall heating/cooling vents that were blocked During remodel in kitchen#2 I Replace baseboard molding in kitchen&bath Vent ceiling exhaust fans in both baths to code Vent dryer exhaust to code in cellar I Install door frame coming up cellar stairs — I Repair LIVE electrical wires hanging in cellar — Reconnect original cellar light. Finish installing hanging wires on side of house — I Finish electrical work at hutch area including phone Install kitchen lights&down draft motor All electrical work to be done by D.E. Small I I 1 I ► ► i ► Remove and replace whole top of Trex deck . Install with screws and properly spaced Install third step to code Replace back gutter Replace front porch entrance threshold Replace porch window sills Repair loose shower head in master bath I Repair electric outlet in small bedroom ► Repair wall and baseboard in small bedroom Damaged during bath remodel I All materials, labor and permits to be supplied by John Berthold. With the exception of i electrical which will be done by D.E. Small and paid for by Mr. Berthold. Date: GL/u z2 ZDD '� y , Signed: John Be old Signed: Nancy Lamb - G����/ /l�/ �— I I I I I I I I I I I I I li I ! ✓.fes �asnmaan{oealdr o�✓�aaa�/ivaelta r . BOARD OF BUILDING REGULATIONS } i License: CONSTRUCTION SUPERVISOR Number: CS 054526 Birtttttate: 02117/1969 i c Expires:02/17/2008 Tr.no: 16920 Restricted: 00 CHARLES E BESHARA 10 PINEWOOD RD G- SALEM, NH 03079 Commi"loner Ura A y ROVEMENT CONTRA HOMEiMP tidn: 122153 Registra E stratii$r°12612008 K 11NS RtiCTFON JOHN BERTHOLD'.G Berthold Bert 'f John �#' Admiuistratoi'.'. 43 TICKLE FANCY / Deputy SALEM,NH 03079 o` e Date:3/5/2007 05:40 Pivi Sender's Fax ID:603 890-6521 I Page 1 of 1 1 AC®RDn ERTIFICATE OF LIABILITY INSURANCE (MMIDDi YMOP ID FIN JOHNS 1 103/05/07) 3/05 0/ 7)M PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Santo Insurance - Salem HOLDER.THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 224 14ain Street ALTER THE COVERAGE AFFORDED BY THE POLICIES'BELOW. Salem NH 03079 Phone_603-890-6439 Fax:603-890-0315 INSURERS AFFORDING COVERAGE NAIL-4 INSURER.A Western World Insurance Co �! INSURER Nationwide Companies "II Jahn Berthold Construction -- ------- ----------- John Berthold INsuREP c 43 TicklefanLane !rr uRER D ---- -------- -- —-- -- .---- Salem NH 0307 9 --- --------- - IIVSUREP E ------- --- ---------- COVERAGES j HE i=OLIC!ES OF li•ISURANCE L I:;TED BECOM!HAVE SEEN i'_�SUED TO TIE!NSU247D NAMED ABO,iE FOR THE POL!C'( INDICATED NOTWITHSTAfJDIt,-G Afvr'kEiaLq r^1ENT tFM 7F CU�!CnTI t d C:ONf A 7 R OTHc DOr! a EN WI F c FES 0 AVHI�"H THIS CEFTIf Gi_ATE MAY BE ISSUED`JR i•1AY PERI IN THE INSUR,U --E AFIF R:)r.D B,THE POLICIES IE,S DESCr SEED H EII` !: ?I BjE T TO ALL THE TERIAS EX.'.L IS Olv;S AND CC NDiT10NS OF SU;'::H �LTR OLICIEb GGREGATE L!fvl'TS SHOV`AN MA.Y I-t'WE BEEN REDJ!"ED o'i F'AIL LAIM'_; POC1Z5'EFFECTIDE-'PGL(CY IJSR TPE OF INSURAtJCE POLICY NUMBER DATE(MM/DDiYl') I DATE(MM!DDW) LIMITS ——-t- -------- 4GENERAL LIABILITY T EACH OCCURRENCE $ 5,00000 A iX C:L)MivIEF.'C!ALGENERA.L'_,AEILITY' I fDANAL T' E'•vr --- r _ NPP951473 03/29/06 03%29/07 r� "LAIMS rene) — - f 5,0000 MADE — --- J " LMED EXP(Any one person) $ 5000 PERSONAL a And INJURY $500000 —I �_-J--._. -------_---- GENERAL. AGGREG TE $ 1000000 GEN'tAGGPE-A :LIMITAF'F°'ESPER; I I PRODUCTS-COMP.'OPA&i; $ 500000 PRO- -- — — -------- .. r OLif.`f.L_ JEC'T I !LOC ! AUTOMOBILE LIABILITY I COMBINED SINGLELIMI' i e 360 000 B ANY;'�.UT SIBA0073863001 09/03/05 09/03/06 -aa°c'a'r'tl ` ( ' X LLonJrdED ITo --------- ---j ---- -- -I BODILY IHJUPY I X��S`'HEGULED AJ70L: i �fFpr uer;on) HIRED AUTOS — ------- j F3C'DILY }{ N:I'd-ObVNEDA.UTOS --------- - I PROPERTY DAMAGE g {Per accident) . I GARAGE LIABILITYit —Y—� 1 � �`JJTO OIJLY'-EA ACCIDENT [ � ---- �A dY'AUTO — --— OTHER rT IAN � EA ACC V—.�_---- I AUTO EXCESS/UMBRELLA LIABILIT' I — �— 64CH OCCURRENCE $ OCCUR CL AI'✓I:;MADEG�EG----- I I AC' TE ;- �,DEDUCTIBLE - --- f ----- RETEi lllON --- -------- - 1- i f �WORKFRS COMPENSATION AIVD -------------- EMPLOYERS'LIABILITY ATOPY Llbrll'S I ER ! -------- t---- — -- - ANY F R^f RIEfi!P'PAhRdERlEXB�IJTIVE E L EACH ACCiDEh:T a !FFIt-cRt!ti9EkIEER E'�CLUDEC!- - —"— -r----=-------- E.L DISEASE-I ' CPAIFLOYE If ves,d�;cr":e under � ;:,F�Fr'iHl PF;.'Jl i:"!f!i`IS bel��r I Ir------------------ _..__------ E L DISEASE- 'ULf:T UbrI;T f OTHER I I I I DESCRIPTION OF OPERAT'fONS 1 Li CATIOIVS;VEHICLES!EXCLUSIONS ADDED BY ENDORSEMENT;SPECIAL PROVISIONS -- j- I CERTIFICATE HOLDER CANCELLATION TOWNNAN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES RE CANCELLED BEFORE THE EXPIRATIV'i DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE',O DO,$O SHALL Tc Tri of North Andover IMPOSE Ido OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURFR,ITS AGENTS.)R REPRESENTATIVES 1600 Osgood St I _ j North Andover MA 01845 AUTHORIZED REPRESENTATIVE �'� I I The Commonwealth of Massachusetts Department of Industrial Accidents i Office of Investigations j kIt i 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Prinhegibly Name(Business/Organization/Individual): '_i;vt�A- v Address: IG/ �I,n9�was I City/State/Zip: 5;�r/,t- AW,01429 Phone. #: Are you an employer?Check the appropriate box: i 4. I am a general contractor and I Type of project(required):. 1. I am a employer with_�_ ❑ g I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction, 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7.,Remodeling ship and have no employees These sub-contractors have g• (]Demolition working for me in any capacity. employees and have workersg Building addition I [No workers'comp.insurance comp.insurance.t ❑ g required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doingall work officers have exercised their 11.❑Plumbing repairs or additions myself.[No workers'comp. right of exemption per MGL 12.E]Roof repairs insurance required.]t c. 152,§1(4),and we have no employees.[No workers' 13.❑Other comp.insurance required.] , *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. I t Homeowners who subrn it this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors 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-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: 4;Q1 t J:�:U 6,j r^-4j CC Policy#or Self-ins.Lic.#: (l, (�(� 2L 3(„ Expiration Date: e Job Site Address: 2s' 06/c„a-e City/State/Zip: AZ 4z4k-.ex 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 penalti6s 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 I Investigations of the DIA for insurance coverage verification. I I do hereby certify nd the pa nd penalties of perjury that the information provided above is true and correct Si tore / DaI Phone#: &3— �7��2�oJ—/17� OfJlcial use only. Do not write in this area,to be completed by city or town ofJlciat City or Town: Permit/License# Issuing Authority(circle one): I 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: I i ACMCERTIFICATE OF LIABILITY INSURANCE a3/ OS/007 PRO=IR (781)942-222S FAX (781)942-2226 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Gilbert Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 137 Main Street HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES,BELOW. Reading. MA 01867-3922 I INSURERS AFFORDING COVERAGE NAIC 0 INSURED Target tohnstruction LLC MSURERA: HARLEYSVILLE/WORCESTER INS GO. 26192 14 Pine Wood Road INSURERS: AIG Insurance Salem, NH 03079 INSURER C• INSURER a INSURER E AMRAGEM THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDIN 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 LIMBS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. � amTYPR of INBURtIWCi ppL�Y NUMBER POLICY EFFECTME POLICY TI LNIRTS I GENERAL WANUTY MPA437264 OS/21/2006 05/21/2007 EACH OCCURRENCE 6 AN X COMMERCIAL GENERAL LIABAI7Y 6 =1111— CLAIMS MADE M OCCUR MED EXP(Any one Person) 6 AT:: PERSONAL&ADV INJURY $GENERAL AGGREGATE f BERLAGGREGATELIMITAPPLIESPER: PRODUCTS-COMPIOPAGG 6 POLICY J LOC AUTOMOBILELIAD"" BA437264 OS/21/2006 OS/21/2007 CoMBINEDSINGLELIMITANYAUTo (Ea eoddent) ALL OWNED AUTOS BODILY INJURY Ii A X SCHEDULED AUTOS (ftr ) X HIRED AUTO$ i BODILY INJURY $ X NDN-OWNED AUTOS (Per 8-JdeM) PROPERTY DAMAGE {Peraccldelm GARAGE LIABILITY AUTO ONLY•EA ACCIDENT 6 i ANY AUTO EA ACC S OTHER THAN I AUTOONLY. AGO S I EXCESSIUMBIIELI A LIABILITY EACH OCCURAENCE 6 OCCUR p CLAIMS MADE AGGREGATE 6 $ DEDUCTIBLE 1 RETENTION 6 s WORNERBCOMPENSATIONAND WC17GS436 01/05/2007 01/OS/2008 " TH' EMPLOYERS'LIADILWY B E.L.EACH ACCIDENT $ANYPROPRRETOWPARTNERIE)tECUTNE S00.00 OFFICERANEMBER EXCLUDED? E.L.DISEASE•EA EMPLOyrzq$ soo SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT E —$00,00C OTHER DESCRIPTION OP OPERATIONS I LOCATIONS 1 VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT f SPECIAL PROVISIONS i i III L SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE! EXPIRATION DATE THEREOF,THE ISSUING MSURER WILL ENDEAVOR TO MAIL R 1_MAYS WRITTEN NOTICE TO TNI CERTIFICAT!HOLDER NAM10 TO THE I.M. Sid Lamb MN FAILURE TO MAIL MXH NOTICE&HALL IMPM NO OBLIGATION OR UABILm 25 Colgate Street Or ANY RIND UPON THE INSURER,OT$AGENTS OR REPRIESENTATNES, N Andover, MA 01845 AUT?fOWEDREPREWNTATW I RL Fitzgerald ACORD 26(2001/08) OACORD CORPORATION ION I 1 7 I