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HomeMy WebLinkAboutBuilding Permit #356-13 - 28 STAGE COACH ROAD 10/15/2013 I TOWN OF NORTH ANDOVER j APPLICATION FOR PLAN EXAMINATION r / Permit NO: Date Received Date Issued: �� f IMPORTANT: Applicant must complete all items on this page LOCATION -3 Q 60,QCh G� Dri nt e PROPERTY OWNER SO 2 E Re I Vc-.( j'' Print MAP NO:0`J PARCEL:Q�ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ® Septic []Welly O'Floodplaim m ❑ Wetlauds_ � WatershedDistrctr 0 Water/Sewer, 1 _ .- DESCRIPTION OF WORK TO BE PERFORMED- -7-0 l�CMr) /ecc 0vn /Q�ao i3 _ (Identification P ease Type or Print Clearly) OWNER: Name:,/ ok r1 -4 Sue rG RC t Phone: Address:_ 0?8 Veli 00-1A Rd- A10 tz' 141,A(/Pit� ^4 CONTRACTOR Name: / t('� G��� c� �e�Sri» fgh7/y CQy4hone: yP/- Address: 3 (, 4�"4 L 74' Supervisor's Construction License: (9(®O �i t 9 Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: r Address: Reg. No. FEE SCHEDULE.BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. rt Total Project Coat: $ 97,3- FEE: $ .30. 0-rz!� Check No.: 3 4'C/O Receipt No.: Lee NOTE: Persons contracting w' un istered contractors do not have access to the guarantyfund -ign'at'ureaof�Agent/®Wner- _-, S``nature�of Q.ntractor� I Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL V Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ I Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY I INTERDEPARTMENTAL SIGN OFF - U FORM I: DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS I 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 i 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 2008mi ,I I BuildingDepartment 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 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 Li Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit 1 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) 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) o Building Permit Application Li Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit Li 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 (VOTE: 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 Ynust be submitted with the building application Doc: Doc.Building Permit Revised 2008mi i Location� � 1Li~��&zrff No. Date A0 o - TOWN OF NORTH ANDOVER � Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# 26996 l Building Inspector OORTH own of 2 ndover o . No. 3 _ IANC h ," ver, Mass, 0 3 SCoc"ICNtwltw �'►• 'gArED illi U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT .... ...... .... 111.0rl...�" ........................................... BUILDING INSPECTOR has permission to erect .......................... buildings on &k S ...�►i4i '. k................. Foundation Rough to be occupied as .......... ..� :'`� ..........��..�.a.X..`-(.J......"'........, ��?. ....:'-.... o .. Chimney 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 TA 3L ' UNLESS CONSTRUCTIO Rough Service .................... .......................................................... Final BUILDING 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. SEE REVERSE SIDE �tie� - � '' �s �`�.� 3 0° �, ���� � ��-� © � ��, � �_ � � -�,, �� c�Vs2- 1 r---. � , � � � 1 t�t Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-060219 MARK TRAINA - 33 HANFORD RIY 2 Stoneham MA 0280 Expiration Commissioner 04/27/2015 OfRci i�1-(.vntumcr:l/�ur-s&f5ulniss Zc;;u Ilion U _:=7.,HOME IMPROVEMENT CONTRACTOR 01 l Registration: ,.169922 Type: ==h� --_ ' Expiration: 3/18/2013 Individual MARY'S TRIANH MARK TRAINA 33 HANFORD PD STONEHAM, MA 02180 Lhidcrsccret:u v Liccnsc ur rcgititration salid tin indi>idul Ilse only before the cspiration date. Lf found i cturn lo: Office of Constnner Affairs and 1311siness I cl;,tl ation 10 Park Plaza-Suite 5170 Boston. INIA 02116 _---.-.."-_.._-..---- ------ ------------- Not valid without sicnaturc The Commonwealth of'lllassachusetts Department of Induslrtal,4ecidents Office of Iltl'estigatlons 2 t 600 Washitt lort Street - Boston, 41A 0 111 wtvtv.t1utSs. ov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leaibly Naive ([3u;ine s;`Or_.aniz.ition:'Irdi ideal): e ,S (/Y) Address--__3_L1__ Ct[y/SIflTe!Zlp: [} CJ .1 tzVl IJIGJ p11011z tr: / ��— �a9— yU Uzi Are j-ou an employer? Check the appropriate box: Type of project (required): 1.[Z I am a employer with a CUZ:� 4• ❑ I am a general contractor and 1 employees(full and/or purt-time). + have hired the sub-contractors 6. E] New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have S. El Demolition workinc capacity for me in atiy caity employees unci have wrn-kers' 1 9. ❑ Buildine addition [No workerscomp. insurance comp. ins.rrance.= We are a corp:, tion and its 10.[:J Electrical repairs or additions I 1 am a homeowner doing all work officers have exercised their I l.❑ Plumbing repairs or additions my eit. No�a orkers' com right ot exempton per MGL [ I I-.❑ Roof refers insuran:e rcquirc(1.} � c. 1�_>, l(�'.1, and ave have.nit employ ees. [No workers 1 .[ O?her1e�'J�fJ, �eG� comp. insurance required.] "Atv,applicant that checks box„1 must also till out the secnon be lo•w:a Ii ma inu then t,'orkcr>'en InPell saI ion policy itI forma t ion. I fo nenwners.vL'n submi[this affidavit tndicatine they are doing all work and then,hire nutide cOnueetors mu.at Submit a 1110 a(fidiI%it etdi%::ating such ,('ontmctc,rs that chck this boy must artacheu an additional sheel,host iml rix nam::o tic suh-contractors and state%+hether or not those enures have employees. If the sub-contractors have employees•the.:rout provide their worker,-:err.;)-policy number. 1 am an enrplot'c:r that is prnvidin,nvu;:ers'canrperrsution insruvrrrce for nr� eraipin)'ee.c Geloty is the policy card job site i17 formation. Policy r or Sell-ins. Lic. 9:&,)/12 2 p (jU� (per (�--- -- Expiration Dale:_/U ..�//y-- Job Siic Address: J/�,�-�° �f�lrC� �� City/stale Zip:/ /ov ,Attach a copy of the ttorkers' compensation policy declaration pxTe(shot',ing the pnm olicy uber and expiration date). Failure to secure coverage as required under Section 15A ofM L c, i 52 can lead to the imposition of crintintal penalties of a tine up to SI.500.00 an&r one-year itnprisonmennt, as well as civil pcl)altics in the form of a STOP WORK ORDER and a fine of up to S250.00 a day against the.violator. Be advised that a cop; of this statement may be forwarded to the Office of invesni,ations of the DiA ror insurance coverage verification. I do heerehi•cer•tif:nnder rtthe puir�Td penalties of'pei jmy that i,'w Lr/irrmution provided above is true and correct. Si2mlture: �A! L% v�h Date: ` Phone 4: Official use on/Y. Do not uvrite in this area, to be completed hp city or town official. CitN or Town: Permit/License 4 ---- L Board of Health 2. Building Departmeot 3. City/Town Clcrl; a. Electrical inspector- 5. Plundhir g Inspector- 6. Other Contact Person: -- Phone#: — PAGE 3 OF 4 A�oRo® CERTIFICATE OF LIABILITY INSURANCE 10/l/2013 Y' 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: Michael Bonacorso IC X F Bonacorso Insurance Agency, Inc. PHONE (781)273-3200 AC No:(781)273-0600 83 Cambridge Street aDOR1Ess:mike@bonacorsoins.com P.O. BOX 1502 INSURER(S)AFFORDING COVERAGE NAIC# Burlington MA 01803 INSURER A Acadia Insurance Company INSURED INSURER B:C N A Insurance Co. Peterson Party Center, Inc. INSURER CAIM Mutual Insurance CO. 36 Cabot Road INSURER D: INSURER E, Woburn MA 01801 1 INSURER F: COVERAGES CERTIFICATE NUMBER:2013 Master 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 ADDL SUBR POLICY EFF POLICY EXP TYPE OF INSURANCE LTR D POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000 A CLAIMS-MADE OCCUR }{ }{ PA 5061026 10 10/9/2013 0/9/2014 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY }{ PRO LOC $ AUTOMOBILE LIABILITY Ee aBINEDt SINGLE LIMIT 1,000,000 A ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED X X 5063173 10 10/9/2013 0/9/2014 BODILY INJURY Per accident $ AUTOS AUTOS ( 1 X X NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident $ Uninsured motorist BI split limit $ X I UMBRELLA LIAR X OCCUR X EACH OCCURRENCE $ 10,000,000 13E-CESS LIAB CLAIMS-MADE AGGREGATE $ 10,000,000 _4DED I X RETENTION$ 10,000 5085496458 10/9/2013 10/9/2014 $ C WORKERS COMPENSATIONX WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/NER ANY PROPRIETOR/PARTNER/EXECUTIVE FNI EL EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N I A (Mandatory in NH) Z8006586 10/9/2013 0/9/2019 E.L.DISEASE-EA EMPLOYE $ 1 000 000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/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 --- --- -- —-- — —-- ACCORDANCE WITH THE POLICY PROVISIONS. - — -- SPECIMEN AUTHORIZED REPRESENTATIVE Michael J. Bonacorso ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025 mmnns)nt Tho Annan m—­1 11——ror.i,fo.oa.. L� of Arrnan i I IDrJ9ncPcW99PJ9��IDOCUMENT--,- El 5 5 5 I ISSUED By � �� 5 P57 REGISTRATION 5 APPLICATION Q s Date of Shipment 5 5 L INDUSTRIE INC. 8/28/2006 5 5 I Nu11ABER 5 5 0 EVANSVILLE, INDIANA 47725 Tent Identification 5 5 5 I_ MANUFACTURERS OF THE FINISHED 04337696 5 11.40.1 TENT PRODUCTS DESCRIBED HEREIN 5 Shis is to certify that the materials described have been flame-retardant treated 5 55 (or are inherently noninflammable) and were supplied to: 5 657150 S 5 PETERSON PARTY CENTER INC 5 139 SWANTON ST 5 S � 5 SWINCHESTER MA 1890 5 5 � S S 5 5 5 5 5 � 5 5 Certification is hereby made that: 5 5 The'articles described on this Certificate have been treated with a flame-retardant approved 5 5 chemical and that the application of said chemical was done in conformance with California 5 Fire Marshal Code. All fabric has been tested and passes NFPA 701-99, CPAI 84, ULC 109. 5 ,, Serial # 5 5 81 0900 1 (2) 5 I 5 Description of item certified: 5 5 CENTURY MA'Z'E 30WX45 SNYDER WHITE VINYL I6oz C 5 Flame Retardant Process Used Will Not Be Removed By 5 5 Washing And Is Effective For The Life Of The Fabric 5 5 � 5 S Signed: :;A c �i�dYBE1��4E61+dEP��li11✓:h�E6P��{•�A.9�1 9 ,' � � � 57 5 Name of Applicator of Flame Resistant Finish ANCHOR INDUSTRIES INC. 5 O r�rJ�[J��Pr�rJ�cP[Pry[Pr.J�r�[1�r��P�PrJ�rJ�[J�c1�[1�rJ��P[l[n[.J��P[J7[PcPcJ�rJ�r�rJ�[P[PrJ�rJ�[P[1�[P[.P[PrJ�[.PrJ�[.PrP[PrJ�cP[PSP[.P[P�.([PrJ�[PcP[P[PrJ�[P[�r..P[P[P[P[Pr�r�rJ� i