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HomeMy WebLinkAboutBuilding Permit #580-15 - 288 FOSTER STREET 12/30/2014 NORTI� BUILDING PERMITo`tt,F.o ,6'�a TOWN OF NORTH ANDOVER / APPLICATION FOR PLAN EXAMINATION '' z .y Permit No#: ` Date Received �SSACHUS�� Date Issued: l-L�' )® l I P RTANT:Applicant must complete all items on this page LOCATION t' Fn, 5� r, Print PROPERTY OWNER --71—,''1 Print 100 Year Structure yes no MAP _PARCEL: Q , ZONING DISTRICT: Historic District yes Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial J4lteration No. of units: ❑ Commercial 1 ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic []Well ❑ Floodplain ❑Wetlands ❑ WatershedDistrict ❑Water/Sewer ES,PRRIPTI OF WORK TO BE PERFORME CA 4, Wcv-,&yJ Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: Contractor Name: Phone: ) _ `� CLq Address: Supervisor's Construction License: Oq Exp. Dater lzovo. Home Improvement License: 5 Exp. Date: _ZO ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BOLDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 5.900 FEE: $ AJ Check No.: 0 Receipt No.: 2 NOTE: Persons contracting with unregistered co tractors do not have access to the guaranty fund Signature of Agent/Owne = - v - _ignature of contractor i Location res No. Date . - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $_ f Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check#fle- uilding Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TypF 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 ❑ I THE FOLLOWING SECTIONS FOR OFFICE USE ONLY I INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS d 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 Call Email Date Time Contact Name Doc.Building Permit Revised 2014 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 ❑ 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 ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Cross Section/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) i ❑ 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 ❑ 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:Building Permit Revised 2014 NORTFi Town of - :' Andover C - 0 10 No. 6&.SV1'!2 h ver, Mass, COCNICNEWICK y1. �,9 p�Rwteo rPP��S S U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT BUILDING INSPECTOR .... I.W�........ .. .�. ......... .. t . . ........... ... Foundation has permission to erect .... 1L .... ................. buildings on ... ......... .. ..tU....!5 -........... Rough p' . . .. t0 be occupied as ............. .... ....... .............. .. ........■................................................. 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 INCIWONTH ELECTRICAL INSPECTOR UNLESS CONSTRUCT S 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. 119 Burlington Street, Lexington, IIA 02420 M MHN CONSTRUCTION INC. www.mhnconstruction.com Lie#075508 into@mhnconstruction.cam Lie # 95215 RESIDENTIAL ADDITIONS 8 REMODELING p 781.454.5199 f 781.325.4957 Reg#494W TO: Tim Goland DATE: 12/4/2014 288 Foster St JOB NO: 356 North Andover,MA 01845 PHONE: We hereby submit quotes for: The following quote is for the renovation of the first fl bath at 288 Foster St as described below Demo create new opening for window exterior brick opening to match 2nd fl bath above 1 st fl bath wall window opening frame interiorA 9 purchase and install window window detailsto match existing windows install new file floor install Schluter the underlayment � install tiles in basic pattern install new threshold Purchase and install new pedestal sink and toilet provide fittings for exposed pipes under sink install new sconce and mirror purchase and install new bath hardware tp holder,towel bar Paint bath Homeowner to provide tile and lighting $5,800.00 Total Quote 112 of above quote to be paid upon acceptance of quote 2nd 112 of above quote to be paid upon completion of bath and obtaining final building inspection kHN Construction Inc agrees to perform all work as stated in the above quote I as the homeowner agree to all the terms in the above quote I A CERTIFICATE OF LIABILITY INSURANCEF12/4/2014DATEiM ,DD ' 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(les)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 NAMEACT Gale Fanciullo J.J- Ruddy Insurance Agency Inc. PHONE FA7( ) 96_4900 59?o. 153 Main St: a gfanciullo@jjruddyinsurance:coin INSURERS AFFORDING COVERAGE NAIC i. Medford MA 02155 INSURERA:Safety Insurance Company INSURED INSURER B:KaAOVer Insurance Company. 22292 MM construction., Inc.; INSURERC:Travelers Casualty & Surety 119 Burlington :Street INSURER D: INSURER E: Lexin ton MA 02420 INSURER f: COVERAGES CERTIFICATE NUMBER,12/04/14 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 RESPECTTO 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 POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVO POLICY NUMBER MM/DD MMID LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE. O IED PREMISES Ea occurrence $ 100,000 Fi CLAIMS-MADE,.D OCCUR BNA0021325 /15/2014 /15/2015 MEDEXP(Anyonepem") $. 10,000 PERSONAL&ADV INJURY _ $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 i GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOPAGG $. 2,000,000 X POLICY PRO- ECTLoc $ AUTOMOBILELIA131LIT-Y CeMBIfE NE)SINGLE 1 .000 OOO B ANY AUTO BODILY INJURY(Per person) $ ALL OWNED ]( SCHEDULED 8138526 1/18/.2014 1/18/2015 BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OWNED, � PROPERTY 1DAMAGE $ Optional bodily in $ UMBRELLA LIAS OCCUR EACH OCCURRENCE $ I EXCESSUAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION $ C WORKERS COMPENSATION WCSTA- OTH AND EMPLOYERS'LIABILITY YIN Y Y ANY PROPRIETOR/PARTNER/EXECUT`NEaNIA El.EACH ACCIDENT $ 500,000 OFFICERIMEMBER EXCLUDED? : (Mandatory in NH) iJB7038Y681 /29/2014 /29/2015 1f yes,de5dibe under EL.DISEASE-FAEMPLOY t 500,000 DESCRIPTION OF OPERATIONS below EL.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS)VEHICLES(Attach ACORD 101,Additional Remarks Schedule,It more space Is required) i it CERTIFICATE,HOLDER CANCELLATION timgoland@comcar;t.net SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN T >rn Goland ACCORDANCE WITH THE POLICY PROVISIONS. 288 Foster Street North. Andover:, MA 01845 AUTHORIZED REPRESENTATIVE Gale Fanciullo/GAF 7 - ACORD 25(201.0105) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025{201ow.oi The ACORD name and logo are registered marks of ACORD ii The Commonwealth of Massachusetts Pint Foran Department of Industrial Accidents Offue of Investigations I Congress Street,Suite 100 Boston,MA 02114-2017 www.massgov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organizationtindividual): �-,✓T ` ,' ``'�'' � t Address: City/State/Zip: hone 4: Are you an employer?Check the appropriate box: Type of project(required). 1.N I am a employer with 1 4. .[]I am a general contractor and I 6 [:]New construction employees(full and/or part-time).* have hired the sub-contractors listed on the attached sheet. 7. Remodeling ' 2.[� I am a sole proprietor or partner- sub-contractors have ship and have no employees These8. Demolition employees and have workers' working for me in anycapacity. ❑Building addition comp.insurance? [No workers comp.insuranceI0.❑Electrical repairs or additions 5.[3 We are a corporation and its required.] o. fficers have exercised their 11.0 Plumbing repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL myself.(No workers comp. 12.❑Roof repairs insurance required.]t em c. 52,employees. [ and or have no 13.❑Other employees.[No workers' comp.insurance required.] ;Any applicant[hat checks box it 1 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. 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 mit 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.#: �('�1 Expiration Date: Job Site Address: 2J43� J] ,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 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. 1 1.do hereby ceri&under thepains and penalties ofperjury that the information provided above is true and correct. EZWL Signature:[— Da`t�e Phone#: ✓ ct r[Issuing l use only. Do not write in this area,to be completed by city or town official Town: PermittLicense Authority(circle one): . ord of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector G.Other Contact Person: Phone#: Massachusetts-Department of Public Safety Board of Building Regt{fations and Standards Construction Supenisor License CS-095215 PBTBR J MAHON kI ly Lf —+ 119 BURLINGTON 6T s LEXINGTON M.i 024 Expiratibn Commissioner 07/21/2016 ✓I/J!/llN/lI...NI/W./�Il lfl�I(II:IJ!/(INJrIII t%..�ME .A,.,_. Offit—fC—wmer Affairs&B.A.—Regolwtloe IMPROVEMENT CONTRACTOR on: 175937 Type: ation: 5/21I20t5 Corporation MHN CONSTRUCTION INC: PETER MAHONEY - 119 BURLINGTON ST a� LEXINGTON,MA 02420 c � Uederseeretary 1 Existing Bath lV QJ van 4 Proposed Bath Install 3x2x1/4" steel under brick header A* m 4 X install double 2x10 �4 header with 1/2" 01 rigid insulation in the middle vent bath to exterior Framing Plan for Install9 fci outlet window opening 288 Poster 8t North Andover, MA 01845 scale: 1/4% 1' ��_• � � • MHN CONSTRUCTION INC . a 1 1 9 BURLINGTON STREET °Q LEXINC,TON7 MA 02420 'Pa a . .• �D'c 7B 1 -454- 51 9 9