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HomeMy WebLinkAboutBuilding Permit #234 - 254 CHESTNUT STREET 9/19/2011 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: M RTANT://4,�Applicant must complete all items on this age _LOCATION a s !rJ 6vG1/-r ,S-r P9/0 itPROPERTY OWNER )9X)7_1-t(-04 `� V/1¢ Unit# Print MAP NO: _6L<_) PARCEL:q _ZONING DISTRICT: Historic District yes Machine Shop Village y s no 100 year-old structure y s no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building $Pne family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ,Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑Floodplain ❑ Wetlands ❑ Watershed District ❑ Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: &—eO sY 0' (Identification lease Type or Print Clearly) OWNER: Name: rx 1 Phone: Address: e `YLcl �- /� JJ , CONTRACTOR Name: X� / Phone: _�6 -�qs Address: S--L( D"P- � t3y s avf7�-1 n14. d( P- b Supervisor's Construction License: 14a Exp. Date: 1Z 2- Home Improvement License: 1S 8 3 Z Exp. Date: / ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDINGG PERMIT.•$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ / , �D13 FEE: $ Check No.: 36P Receipt No.: CA-1 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Ownek-Signature of contractor Location i C �, /�� 9r— No. 2*b— Date NORTH TOWN OF NORTH ANDOVER ? �. • p h R }�e Certificate of Occupancy $ c ITS CNUs<� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # ���' 2455 8 Building Inspector 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 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 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 2011 June/mi 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 o Building Permit Application ❑ Workers Comp Affidavit o Photo Copy of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work a 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 o Certified Surveyed Plot Plan o Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract o 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 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 o Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses o 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 ❑ Mass check Energy Compliance Report o 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: Doc.Building Permit Revised 2008mi NORTH Town of 0 o , dover, Mass., COCHICHEWICK �d ADRATED 0' �� S BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT........ 6'0%k......... .................................................. Foundation has permission to erect........................................ buildings on .W% ....... ........................ Rough to be occupied as.. i ... n �!......'r....... .... .......r.. ... � ........�. I......... .......... Chimney y • C e provided that the person accepting this permit shall in eery respect conform to the terms of the applicatio 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 PERL IT EXPIRES IN 5 MQ ELECTRICAL INSPECTOR UNLESS CONSTRV 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. The Commonwealth of Massachusetts Department of Industrial Accidents 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): Address: rV 29d (ter p 0 d ACL City/State/Zip: U/a ,(Phone #: 973 d�— Y Ly Are you an employer?Check the appropriate box: Type of project(required): 1. I am a employer with 4. ❑ I am a general contractor and I 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.1 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.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.0 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 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 their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. '4 Insurance Company Name: ,�I /-C� ✓�� l Policy#or Self-ins.Lic.#: 1`� ?_ �j ��` (��j/_- �/ � Expiration Date: � Z Job Site Address: 1) 7 �'IK S/ City/State/Zip: /V, *ZclyU2J— 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. I do hereby ce ify n�er th)e pains nd enalties of perjury that the information provided a ove is t ue and correct. Si nature: Dl Date: Phone#: 9 7 ci 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#: '4� CERTIFICATE OF LIABILITY INSURANCE 9/16/2011 D '") 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 CONTACT House NAME: Pinney-Linnane Insurance Agency N x ; (978)664-2000 aC No:(978)664-0180 WN 280 Main St. #101 AD RIESS: PRODUCERCUS ER ID 00004201 North Reading MA 01864 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA:Patrons Mutual 14923 INSURER B AIM Mutual - ARWC 26158 G W SIDING INC INSURER C: 54 Delwood Rd INSURER D: INSURER E Tewksbury MA 01876 INSURER F COVERAGES CERTIFICATE NUMBER:CL10102100500 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM/DDIYYYY MM/DD/YYYY GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 50,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ A CLAIMS-MADE 7 OCCUR CTROO10755 9/23/2010 9/23/2011 MED EXP(Anyone person) $ 5,000 9/23/2011 9/23/2012 PERSONAL SADV INJURY $ 11000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY PRO LOC $ 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 $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ B WORKERS COMPENSATION X WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? N I A (Mandatory In NH) WC 7019738012010 9/24/2010 9/24/2011 E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under 9/24/2011 9/24/2012 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. Main St. North Andover, MA AUTHORIZED REPRESENTATIVE M Linnane/LINMSI � 7ve— ACORD 25(2009/09) ©1988-2009 ACORD CORPORATION. All rights reserved. INS025(200909) The ACORD name and logo are registered marks of ACORD De i u t+Hent of Public"SafeO ,,.• �lussuchusctts- I Board of uiin. Re-ulations< <n�Standards construction Supervisor License f� i License: CS 94848 WARD III , GEORGE 54 l 54 DELWOOD ROAD TEWKSB.URY, MA 01876 Expiration: 913/2012 1 Tr#: 7806 y j ('umn�is.iuncr - C-�/f'LPi (POiI9UlY20/LL!/�GLL> �' Office of Consumer Affairs&Business Regulation -_- ME IMPROVEMENT CONTRACTOR Type. gistration; 156832 private Corporation; expiration: 819/2013. - i G.W.SIDING INC r , i GEORGE WARD i 54 DELWOOD RD. g TEWKSBURY,MA 01876 Undersecretary CONTRACT 9/3/11 G. W. SIDING INC. 54 Delwood Road Tewksbury, Ma 01876 TEL: (978) 658-3065 Cs #94848 h.i.c. #156832 To: Anthony Giuffrida Job: SAME . 2-SH Chestnut St. N. Andover, Ma Labor and Materials to: * Remove shutters and siding * Inspect sheathing for damage * Install 3/8" fanfold insulation * Install new P.V.C. cornerboards * Install 6" Hardiboard siding * Caulk with color match caulking * Install vinal soffett over existing soffett * Cover facia with white metal * Install 2-6' gutters ( 1 in front, 1 in back ) ** All scrap materials will be put in a dumpster supplied by C.W. Siding and removed at completion of job *** Permit included **** Payments to be made : $5000.0o Down payment $5000.0o Upon comp. of V2 of job $4900.0o Upon total comp. of job To satisfaction of the owner TOTAL $14,900.00 G.W. Siding OWNER W