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HomeMy WebLinkAboutBuilding Permit #685 - 28 EMPIRE DRIVE 3/29/2012BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: � Date Received TYPE OF IMPROVEMENT:il PROPOSED USE Residential Non- Residential 1' New Building ❑ Addition ❑ Alteration ❑ Repair, replacement ❑ Demolition r p One family ❑ Two or more family. ❑ Industrial No. of units: ❑ Commercial ❑ Assessory Bldg ❑ Others: ❑ Other DESCRIP nON� O, F�W-ORK TO BE PREFORMED: Identification Please Type or Print Clearly) OWNER: Name: Phone: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COAST BASED ON $125.00 PER S.F. FEE: $ l. (� Total Project Cost: $ t Check No.: �[� , Receipt No.: (� NOTE: Persons contracting with unregistered contractors do not have access to aIle guaranty fund 131 Dat,6,9- 46. ....... LORTN I TOWN OF NORTH ANDOVER PERMIT FOR MECHANICAL INSTALLATION This certifies that 9<,-4—ke ..................... has permission for mechanical installation A- ........... in the buildings of . . ................. at .4.jA. 19-2e,57;�4--YA ............. North Andover, Mass. III& Fee. qj... Lic. No.. .��wek!o . .......................... GASINSPECTOR WHITE: Applicant CANARY: Building Dept. I PINK: Treasurer 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 PLANNING & DEVELOPMENT ❑ COMMENTS CONSERVATION COMMENTS HEALTH COMMENTS C 01 DATE REJECTED DATE APPROVED A DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: Comments Comments Water & Sewer Connection/Siclnature & Date Driveway Permit Located at 384 Osgood Street 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 Doc.Building Permit Revised 2007 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 o 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 o 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) o 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 o 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 Doc: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 Commonwealth of Massachusetts Sheet Metal Permit Date: 3 /Z -7//2- Estimated //2Estimated Job Cost: $ 11 5,00 Plans Submitted: YES NO Business License # Business Information: Name: A'A 1,4ecj rd j C a Street: 16 Bomar A41 k ;,v l< City/Town: Oawff -e /I %t' q Telephone: 17,;�' L( 3 3 `S� 7 / Photo I.D. required / Copy of Photo I.D. attached: J-1 /-1-unrestncted license Permit # Permit Fee: Plans Reviewed::YES NO Applicant License # _f { 6 of Property Owner / Job Location Information: Name: 13tq5 .nC551 Street: `2 gr 1i'��f%�� City/Town: /11"'i a/ovClo Telephone: Q ?�? !�13 7 YES V/NO L Jy y of OttnS Staff Initial J-2 / M -2 -restricted to dwellings 3 -stories or less and commercial up to 10,000 sq. ft. / 2 -stories or less Residential: 1-2 family Multi -family Condo / Townhouses Other Commercial: Office Retail Industrial Institutional Other Square Footage: under 10,000 sq. ft. V over 10,000 sq. ft. Sheet metal work to be completed: New Work: Educational Number of Stories: Renovation: HVAC Metal Watershed Roofing Kitchen Exhaust System Metal Chimney / Vents Air Balancing Provide detailed description of work to be done: INSURANCE COVERAGE: I have a current liability insurance policy or its equivalent which meets the requirements of M.G.L. Ch. 112 Yes o No ❑ If you have checked Yes, indicate the type of coverage by checking the appropriate box below: A liability insurance policy Ell," Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: 1 am aware that the licensee does not have the insurance coverage required by Chapter 112 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent Signature of Owner or Owner's Agent By checking this box((, I hereby certify that all of the details and information I have submitted (or entered) regarding this application are true and accurate to the best of my knowledge and that all sheet metal work and installations performed under the permit issued for this application will be in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Date Date By Title City/Town Permit # Fee $ Duct inspection required prior to insulation installation: YES NO Inspector Signature of Permit Approval Progress Inspections Comments Final Inspection Type of License: LTJ Master ❑ Master -Restricted ❑Journeyperson ❑Journeyperson-Restricted ❑ Comments M-0111 ` r Signature of Licensee License Number: 46 5119Z Check at www.mass.gov/dpi E J *)i o •m jib :c o C V Ccc H. �C O cv v r •d C �® _0 l y = omawa. x 0 : t J , L, Jul �. r 1- O G t� a +•' C . Q ; E— ,NG C2 p 4m cm • m C CL= CD m y y cm O c •5 CLOy O ' vi :s= o CDo C.. C Q.. �t ++ Co. CO .y � I • C O. E -C2 CLO - 0O2 O- 0 y ui W C Imp _ LL � , O r �y R /C LU E CL Co. io ED Loo :9 �4 COD o. W • � ci A � o C CD cm 0CD y CD O ® T! .y Y Y �} �;, �37r� _, a eYw1*1i .' ,. and Floor supe/y Sheet 1 Job #: Performed for: % e 1,/,. `!l w RA MECHANICAL INC 16 LOMAR PARK PEPPERELL- MA 01463 Phone:9784338671 Fax 9784334900 ramechanical@aol.com Scale: 1 :74 Page 1 Right-Sufte® Universal 7.1.17 RSU11207 2010-Od-14 11:21:08 uments and Settings%LAM... P VOb� T �6"eq/ l� fPPr: v cv RA MF Cy,4N'C Phone. 9� PpERF AIS PAR ` AHC raech �s.. 1 � 9146 63 C�a°� Corn.?3490 p Sia/e; 1� R�ht.S�P8�9e 2 ?01 t t 7 RS v�"'e1ser O. p U> 12 "17e%a d Sed 9si'q �� 44M... ACORD® CERTIFICATE OF LIABILITY INSURANCE `.�./ DATE (MMIDDIYYYI� 03/26/2012 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 NAME: NORTH ANDOVER INSURANCE AGENCY, INC. (AHI/c°,"ENo, F�,): (978) 686-2266 �p,� N.I; (978) 686-6410 FOSTER INSURANCE SERVICES E-MM.J. ADDRESS: cfernandez@nafins.com 163 MAIN STREET PRODUCER DD A . Mechanical, Inc. CUSTOMER ID �i"• INSURER(S)AFFORDING COVERAGE NAIC# NORTH ANDOVER MA 01845-2508 INSURED INSURER A :PEERLESS INSURANCE CO R.A. . Mechanical, Inc. INSURER a :GUARD INSURANCE 16 Lomar Park INSURER C Suite 1 INSURER D INSURER E Pepperell MA 01463- 1INSURER 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. INSR TYPE OF IN (POLICY iNSR (VY1/D POLICY NUMBER POLICY EFF POLICY EXP (MM/DDNYYY) LIMITS A GENERAL LIABILITY Y AUTHORIZED REPRESENTATIVE ICSP5337500 1/01/2012 1/01/2013 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY / / / / DAMAGE TO Ea RENTED nre $ 100,000 _7PREMISES CLAIMS -MADE a OCCUR / / / / MED EXP (Any one person) $ 15,000 PERSONAL BADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: / / / / PRODUCTS - COMP/OP AGG $ 2,000,000 X POLICY F7PRO- RO LOC JECT / / / / EBLIA $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS BABS32363 1/01/2012 01/01/2013 COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ X X SCHEDULED AUTOS HIRED AUTOS / / / / / PROPERTY DAMAGE $ (Per accident) X NON -OWNED AUTOS / / / / $ $ A X UMBRELLA LIAB Al OCCUR CU8825678 D1/01/2012 101/01/2013 EACH OCCURRENCE $ 1 , 000,000 EXCESS LU1B CLAIMS -MADE / / / / AGGREGATE Is 1,000,000 DEDUCTIBLE $ / / / / RETENTION $ / / / / $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? ❑ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A AAWC231923 1/01/2012 / / / / / / 01/01/2013 / / / / / / WC STATU- OTH- Rte' LIMIT ER _ E.L. EACH ACCIDENT $ 5QQ QQQ E.L. DISEASE - EA EMPLOYEE $ 500,000 E.L. DISEASE - POLICY LIMIT, $ 500 000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedub, it mm space is mquimd) CERTIFICATE HOLDER CANCFI I ATInN ACURD 25 (2009/09) © 1988-2009 ACORD CORPORATION. All rights reserved. INS025 (200909) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. R.A. MECHANCIAL, INC. 16 LOMAR PARK AUTHORIZED REPRESENTATIVE SUITE 1 PEPPERELL MA 01463- ACURD 25 (2009/09) © 1988-2009 ACORD CORPORATION. All rights reserved. INS025 (200909) The ACORD name and logo are registered marks of ACORD l:• -f, Ap. . LTH OF MASSA�IrN $ - L er•�N OF PROFESSIONALBOARD OF TAL WOR =T_ . ?ASI=MAS_TER-UNRESTRICTED t 'ISSUES THE 9dV CENSE T© -- r r - DONALDJ.OUELLETTE _ T-657 MA IMOTH RD ! f _ DRACUT` -MA 01826-4349 ~� 947069 4688 07/28/12 EXPIRATIONLICENSE NO. DATE . .......... _satDOlIM J a � 9 DRACUTMMA Oi8264349 !� ritrvd✓,1d 5 DD 09.03.2010 Rlv 07•162009 - _ Sheet Metal Residential Guidelines / Inspection Checklist Yes No N/A Detailed description and sketch of sheet metal system to be installed has been provided All workers performing sheet metal work onsite has valid Massachusetts sheet metal license All sheet metal work being performed with proper joumeyperson-to- apprentice ratios Equipment sized per heating / cooling load calculations Duct work " o k sized per manual D calculations Bath / shower rooms contain mechanical exhaust fan vented outdoors Electric dryer exhaust properly installed maximum total run 35'-0", maximum flexible run 8'-0" Flexible duct runs installed 14'-0" maximum length. / Volume dampers installed for each supply air branch duct V Ductwork installed using proper gauges and hangers Y g / Ductwork / plenum connections sealed substantial) airtight Ductwork insulated by means of external covering or internal lining New/clean - properly sized filter installed (final inspection) Testing and Balancing report complete (final sign -off)