Loading...
HomeMy WebLinkAboutBuilding Permit #500-11 - 27 BALDWIN STREET 12/21/2010TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO:—Qo + Date Received Date Issued: IWORTANT: Applicant must complete all items on this page Print PROPERTY OWNER Print - MAP NO: /3 PARCEL: 0,6ZONING DISTRICT:_ Historic District yes no Machine Shop. Village yes no TYPE OF IMPROVEMENT PROPOSED USE - - Residential Non- Residential ❑ New Building ❑ One family ❑ Addition XTwo or more family 11 Industrial ` _ ❑ Alteration No. of units: - - - - ❑ Commercial ,Repair, replacement ❑ Assessory Bldg ❑ Others: µ ❑ Demolition ❑ Other .�•__cs"3`''r�`sa'•�aamacrz -u"`' a.-' 0>Se tic# 4 ❑well�� _ *_ %: ..t;,-"x.:'fa- 0" 0 FloodplalnWetlandsF s� ry ME pal'L^�'GZ�%..ii.. p.' ; '^+.�^ :` ''`Ua A��9^14- Luw-.s�£,u eCG• -`I,Si�atVr/GJe YY elyC �iJ.�y a5.'�eiau§t�... `�,.::4�_ "r _....5ia_'4�" -"t .. _ ^�.—, ^-''ir. _-�"fa�'3Y++1 `k-F-�` ..-:` OF WORK TO BE PERFORMED: nFSCRIPTION N1k'n e� \ooA�tionom '7 Identification Please Type or Print Clearly) OWNER: Name: 1 ?. "V i Phone: q1 Address: CONTRACTOR Name: �� * v a.5 V, axiom �� �'1 Phone: t Q t1 Z 1 - c Address:. \D\r\r, •�Yncx h i if1 h1 Supervisor's Construction License: �1-Exp. Date: Home Improvement License: Exp. Date: y Z1 ARCHITECTIENGINEER Phone: Address: Reg. No. I: FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00, OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ .�(o FEE: $ �f Check No.: (w / Receipt No.: NOT Person ntracting with u registered contractors 4,o not h4vp access to the guaranty fund VA 50 --... Aun� dnature.of? Sin ure ofconfr"acto <-, ; . 7 Location- �� Z d w.n S%" - No. Date NORTH f 1h TOWN OF NORTH ANDOVER O•'t.•c :•. O • OL S Certificate of Occupancy r $ cHust Building/Frame Permit Fee $ _!( Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 1 (.r )� r 23811 (Building Inspector I rl Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL . •„+ w Public Sewer ❑_ Tanning/MassageBody Art El Swimming Pools F ,.. :❑ • �.a ' 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 ❑ ❑ 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 Con nedtion/Sl nature & Date Driveway Permit DPW Town Engineer: Signaf 4e: Located 384 Osgood Street FIRE DEPARTMENT` Temp Dempster -on site yes _no Located at 124 Main Street Fire Department signature/date i COMMENTS i i Dimension Number of Stories:Totalsq uare feet of floor area, based on Exterior _ dimensions. � _ I Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of . Electrical Inspector Yes No . . 3 DANGER ZONE LITERATURE: Yes No ane 1A—F and G min.$100 $1000 f MGL Chapter ter 166 Section 2 . 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. An 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 la 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 a Certified Proposed Piot 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 . 40TE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit n all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals hat the appeal period is over. The applicant must then .get this recorded at the Registry of Deeds. One copy and proof of recording last be submitted with the building application Doc: Doc.Building permit Revised 2008mi - - �T _ �' --- _ _. Low-Income Multifamily Retrofit Program 9/26/10 Administered by LEAN North Andover - DRAFT Overall Work Order For Program Approval Only North Andover HA Job 10-123-0 Multiple NORTH ANDOVER 01845 Joanne Crawford (978) 862-3432 Section Measure Installed Unit Price Price Attic *Unfloored R-20 open/unrestricted Cellulose 11700 $1.23 $14,391.00 Sub Total 11700 $14,391.00 Wall `All Walls Clapbd/wood/vinyl R-13 18720 $1.70 $31;824:00 Sub Total 18720 $31,824.00 Floor Floor Insulation Basement Overhead - R30 11700 $1.73 $20,241.00 Sub Total 11700 $20,241.00 Infiltration Airsealing w two-part foam 26 $75.00 $1,950.06 Sub Total 26 $1,950.00 Distribution Duct insulation R-5 520 $2.95 $1,534.00 Sub Total 520 $1,534.00 Grand Total $69,940.00/ �Ul1UlYl Attic & Wall insulation savings estimates are based on audit limited access evaluation ofneed;, initial vendor walkthrough will determine the ability to install these measures acid estimates will be updated at that time. i�1 �l,t�lbi� 1 s. • � o as c ;p, o ' ® C V V C C W A O � 3 CF 15 D CL N O= CO MO•. op ti aL c �� E ` r O CD N N N : C 3 cm t ;s a� N O O :Em. L 'C � CL i m V1 O ' cc cm :ccmoQ N m p v m 0 H Occ O Z C � C Q c C, m C p = m ®:53 N ~ y O0 o fa m COD z _W 0 w -0,_ 6L •N O s R C N •ae O H .- Z O� m•N O V •� CD v� v C y C ®:2 O.0 = R 0 O H Z ,- C:10 CA =m i �NL zU) �O Cly U) Z wO U U) F -L1 �I U O O O W w L O O W r a V) O CO) v A co O N GQ cn .0 L a o a -L v a . °° R' �°° U W '�°° "�°° (7 w cG v �-.� o Q W �' z 'a O v w CIO p O G aG U w p G aG w p G w U) w" G w w O co cn cn • � o as c ;p, o ' ® C V V C C W A O � 3 CF 15 D CL N O= CO MO•. op ti aL c �� E ` r O CD N N N : C 3 cm t ;s a� N O O :Em. L 'C � CL i m V1 O ' cc cm :ccmoQ N m p v m 0 H Occ O Z C � C Q c C, m C p = m ®:53 N ~ y O0 o fa m COD z _W 0 w -0,_ 6L •N O s R C N •ae O H .- Z O� m•N O V •� CD v� v C y C ®:2 O.0 = R 0 O H Z ,- C:10 CA =m i �NL zU) �O Cly U) Z wO U U) F -L1 �I U O ul U) W W cz LLIW ww // Y/ C3 E w L O O v CD C. O CO) a' co •E W W 0 ow 0 0 co CD • 0 o m a o- �a h � o ccc v J .0 C Z O C.2 y C — C CL H 0 ul U) W W cz LLIW ww // Y/ The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations d 600 Washington Street Boston, A 4 02111 www.mass.gov/dig Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual):_. Address: City/State/Zip: m\k. \ Phone.#: Un. \ Are you an employer? Check the appropriate box: Type of project (required):, 1. [A I am a employer with \O 4. ❑ I am a general contractor and I - employees (full and/or part-time).* have hired the sub -contractors 6• El New construction 2. ❑ I am a 'sole proprietor or partner- listed on the -attached sheet. 7. p Remodeling ship and have no employees These sub-contractors'have g• ❑ Demolition worldng for mein any capacity.. employees and have workers'_._ co i.$ nsurance _ .. 9.,_0 Building addition �• [No workers' comp. insurance _ required;] S. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3. ❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.E] Roof repairs c 152, 4 , and we have no , insurance required.] t • § 1O 13.[] Other employees. [No workers' comp. insurance required:] "Any applicant that checks box #1 must also fiE 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. 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 subcontractors 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:_ Policy # or Self -ins. Lic. #: `�C� M\aC\C>\C1� Expiration Date: Job Site Address: c 1 &q,_\A U�n f i 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 tip 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 certify under the pains and penalties of erj that the informationprovided above is true and correct Si ature: Date: Phone #: t (1 \1 ' �',1 v?) Official use only. Do not write in th a ea, 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 ACCRD.. CERTIFICATE OF LIABILITY INSURANCE DATE 04!23/4/23/2010 PRODUCER (800) 225-1865 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Fred C. Church, Lic, 41 Wellman Street Lowell, MA 01851 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE, HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, 800-225-1865 GENERAL LIABILITY INSURERS AFFORDING COVERAGE NAIC # INSURED INSURERA: Citation Insurance Company Advantage Weatberization, Inc. Two Adams Place, Suite 100 Quincy, MA 02169 iNsuf2ER B: National Union Fire Insurance Company of Pittsburgh INSURERC- Selective Insurance Company of America INSURER D: INSURER E: 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSRDD' 7 O INSURANCE POLICY NUMBER POLICYEFFOECTIVE POLICEYEXPIRATION LIMBS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY CLAIMS MADE 7 OCCUR PRMAGE TO EM SES Me ocrence S 100,000 MED ECP (Anyone person) S 10,000 C S1928883 412/2010 4/2/2011 PERSONAL $ADVINJURY $ 1,000,000 GENERAL AGGREGATE S 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER, PRODUCTS-COMP/OP AGO $ 3,000,000 POLICY 7 PRO LOC JECT AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT $),OOD,000 (Ea accident) A X X ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS BBNT98 4/2/2010 4/2/2011 _ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTYDAMAGE $ (Per accIdenl) GARAGE LIABILITY AUTO ONLY - FA ACCIDENT S OTHER THAN EP, ACC $ ANY AUTO AUTO ONLY: AGO $ EXCESSIUMBRELLA LIABILITY _R1 OCCUR F� CLAIMS MADE _ _ EACH OCCURRENCE $ 15,000,000. AGGREGATE $ 15,000,000 - B BE1223010 6/20/2010 .6/20/2011 $ S DEDUCTIBLE X RETENTION $ 10,000 $ WORKERS COMPENSATION AND X WC STATU- OTH- EMPLOYERS' LIABILITY E.L. EACH ACCIDENT S 1,000,000 B ANY PROPRIETOR/PARTNERIEXECUTTVE WC001290194 6/20/2010 6/20/2011 E.L. DIS FJiSE - EA EMPLO S 1,000,000 OFFICERIMEMBER EXCLUDED? If yes , describe under SPECIAL PROVISIONS below - f E.L DISEASE -POLICY LIMIT $ I,DD0,000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS Certificate is Issued as evidence of coverage. I.AIMUCLLA I IUry SHOULD ANY OF THEABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LtABIUTY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE �Wrcr-r cu tcw-uuol CLieDt# 17Arl Mst# 2010GL,Auto,WC,Umb Ccrt# ©ACORD CORPORATION 1981 i.t�s:trltusttl Pal fnarnt $n to �! Btiiii#[i�if Rtulati�tti gni!t'antl 'a F& License.: CS., Q722 Restrictedira 00 n JOSE -PH E LAMBAi (?T . 2725 ACUSHNET AVE ; NEW: BEDFORD MA0245 c�G� . •�� xpirat o6 5/1/20' 2 t:': �lenst, iu ra r Tr#: 26917 s i; i, t x In I