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HomeMy WebLinkAboutBuilding Permit #1082-15 - 29 BALDWIN STREET 6/22/2015 BUILDING PERMIT O� �ttec �6gtiU TOWN OF NORTH ANDOVER Jo- APPLICATION - A FOR PLAN EXAMINATION Permit NA Date Received 7�A°Rwreu ""c5 gSSAC Date Issued: PORTANT: Applicant must complete all items on this page LOCATION Print j PROPERTY OWNER �de Z-A i��.�.�®!f JL ��Ov Print MO.Year Structure yes n MAP PARCEL: �1 ZONING DISTRICT: Historic District yes Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Resi ential Non- Residential ❑ New Building One family ❑ Addition ❑Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other 0 Septic 0 Well D Floodplain 0 Wetlands 0 Watershed District a d Water/S_ewer. DESCRIPTION OF WORK TO BE PERFORMED: - 1`,Yc 4 ems-- C 41S Identification- Please Type or Print Clearly OWNER: Name: �(/• c-�vUc� h��si`r-� ��I��®err Phone: Address: M®e,�-esl Contractor Name: /i�r�,���"��— �� `�"e Phone: Email: Address: y' ,,c° h vc,.- �! Supervisor's Construction' License: C S �' S Exp. Date: 10 1/0-,.7 f Home Improvement Licenser Exp. Date: ARCHITECT/ENGINEER Phone: .a Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 3� 70 FEE: $ LAS eV- Cheek No.: Receipt No.: "E: Persons con Ing with unregistered contractors do not have access to th guar Ity f' d Location No. 7 �� Date • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee �$ p Foundation Permit Fee MaOther Permit Fee $ TOTAL $ Check#t 0 28954 Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan F1Stamped Plans Fl- 't TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Dody Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Pennanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS i HEALTH Reviewed on Signature "L COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments w Conservation Decision: Comments i Water& Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street es AFIRE DEPARTMEN Wit;'' k $Tem�®um sten on site- es �� p p_ �� : no IjQ cated at 1!24 Main Stree { .. . t p 4wy 4xN �aens gn' frftt ature/date �- _ �IiOM11,��7�`.a.,...._..�—.....` �..„,�,�rt �s_.�......�e,...-. �. t s+sl`,;� .r�',;..•j' i� . ve t�fit.��, yy# s i ''.�# -.J �=r,c i a J 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 e U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature i COMMENTS HEALTH Reviewed on Signature I 1-} "L COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments t Conservation Decision: Comments d Wafter& Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENTfx�;T mp �p est r Ute-, s ��" �` � e um on si tjLo ated at 1x24«Ma n�Stre"et`, � - k en 4,`=}..�-.�-�.�'"�...-..,--3' W.s^r+.� �t e�. ..d " .i `4x, .. x�R+ Fie Depaenu� gnatu�r�e/date "' y ,' � ....tc r..K —+, .... ,,£'• - ',rrua a .F#s.. ;� d V'gig. (d " ;�`, t, ' :' COMMENTS; a _ 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) I� I I ® Notified for pickup Call Email Date Time Contact Name F 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 4, 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 OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks 4 Building Permit Application 4 Certified Surveyed Plot Plan 'II Workers Comp Affidavit 'i 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 OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit i 'I New Construction (Single and Two Family) 6 Building Permit Application Certified Proposed Plot Plan Photo of H.I.C. And C.S.L. Licenses Workers Comp Affidavit 4. Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) Copy of Contract 2012 IECC Energy code Engineering Affidavits for Engineered products OTE: 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 NORT11 Town of E I, Andover 0 h ver, Mass, �2 COCHICHEWICK X01. A0RATE D 1-f' �y S V BOARD OF HEALTH Food/Kitchen . PERMIT T D Septic System ,�/ ...... BUILDING INSPECTOR THIS CERTIFIES THAT ............�....r.... .. . .............................�� .'....�!.I`':............... .. ................... Foundation has permission to erect .......................... buildings on .... .!!.: .!!:�...... /J..................... „ .. Rough to be occupied as ........ �,. ' .�.... ,� f A.. ...................��.... !7 5..................: ... ... ,�LN........ 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 , UNLESS CONSTRUCTI T RTS Rough "I. 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. AMERICAN o5/o6hg CABINET 436 Broadway Methuen,MA 01844 97&-6877-(8z5 Bill To: North Andover.Housing Authority 1 Moreski Meadows North Andover,MA 01845 97$-682-3932. .PROPOSAL-29 Baldwin St. 13135C1t_ffI xAlt+lWNT Contractors choice . [Yetvberry Birch Finish:Autumn Standard Construction ; Square Edge Laminate Travertine_#35a6-58 _.._... . ------------- Hardwame 5 66.00 Allison Kndbs#5go1�EB(a•6) Allison Pulls# 53,?x3_EB(6) Tax nl a Tax Exempt#:o4z427248 delivery-........ . ...... -.•.....•.......• .._.._• --..._._.... ...._..— _.._r__. ... ----�__ -- ......... I ....... ......_---:-__....... .. ----. ___.-___.... ••---•-•--.... _..Y Y _..__..l_.$.. .--•--•-85_00 _.I Installation -700.00 Cabinets and counters only,does not include disposal of cardboard creat x�tai .. ......._. --- ........_ 1749.00 Please sign and date below to confirm shown above and return a signed copy to American Cabinet to place your order. A 500/deposit is required at time of order. The remaining balance is due upon delivery. Please understand that,by signing this proposal,you will not be allowed to cancel or return all or part ofthis order. Price is subject to change once a Meld measurement has been taken, Signature: Date: I �.�. 1 07 It r W1230 W3018 111E3930 . .... � o c a: ct) 0 OD (Y) 29 Baldwin St. Ii dimensI06 sizc designations This is an arisinal drsign and mist Aesigctad:S!S/zd15 given are%ubjcct to vorit'ianuon on tECMNOLa01F.8 not be released or coplea unless Printod 51612015 job,Itc mid adjimtnicnt to£t joh apoliceble Poe has bftn paid or job ---- conditims. order 1y1.gccd. The Commonwealth of Massachusetts :. Department oflndustrialAccidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 y www mass.gov/dia 'O•tM SJ�y ' • Workers'Compensation Insurance Affidavit:BuildexslContractoxs/Electricians/Plum ers. TO BE FILED WITH THE PERM[TTING AUTAORTTY. Please Paint Le ' A '•licant Information ���, Name(Business/OrganizationItcr al): Address. I/ Phone#: City/State/Zip: Type of project(required); Are you an employer?Check the appropriate box: ' em to ees full and/or part-time).* 7. ElNew'dOnstriiction 1• nm a employer with_� P y 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. E]Remodeling any capacity.[No workers'comp.insurance required.] 9, ❑Demolition 3.❑I am a homeowner doing all work myself,.[No workers'comp.insurance required.]t 10 0 Building addition 4.F1 I am a homeowner and will be hiring contractors to conduct all work on my property. I will 11.❑PlulribElectrical repairs or additions ensure that all contractors either have workers'compensation insurance or are sole ees. 12.Q ng rep proprietors with no erripldyairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 110 Ro6f repairs These sub-contractors have employees and have workers'comp.insuranee.t 14.Q Other 6.Q We are a corporation and its,officers have exercised their right of exemption per MGL c. 152,§1(4),and We have no empldydes.[No workers'comp.insurance required] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. 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 of not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. n insurance for my emPlbYees. .Below is the policy and job site X am an employer that is providing workers'compensatio information. a _ Insurance CompanyName: q n Expiration Date: ' S Policy#or Self-ins.Lle p� (a._ S 7e' City/State/Zip: AIC Job Site Address: Attach a copy of the worker's' compensation policy declaration page(showing the policy number and expiration date). e by a fhlb up to Failure to secure coverage as required under MGL enalties2in the form of criminal TOP violation 1RK ORDERIand fine f up to $200.00 50.00 a and/or one-year imprisonment,as well as civil p day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. X do hereby certify nd zep s andpenaldes ofpeiju�^y that the information provided above is true and correct. Date: �5 Si afore: Phon e#: Official use only. Do not write in this area,to he 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 Phone#• Contact Person: �°►C0�1�D� CERTIFICATE OF LIABILITY INSURANCE 6/i9/2015°/YYYY> 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: Ifthe 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 M P ROBERTS INS AGCY INC PHONE 978 683-8073 'FAX (978)683-3147 1060 Osgood Street E:-MAIL .pau a mpro ertsinsurance.com North Andover, MA 01845 INSURERS AFFORDING COVERAGE NAIC# -INSURERMERCHANTS INSURANCE GROUP INSURED AMERICAN CABINET CORPORATION INSURER B:MERCHANTS INSURANCE GROUP _ 436 BROADWAY INSUgEgC,MERCHANTS INSURANCE GROUP METHUEN, MA 01844 INSURER D:MERCHANTS INSURANCE GROUP INSURER . PHILADELPHIA INSURANCE COMPANIES INSURER 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. LTR TYPE OF INSURANCE POLICY EFF POLICY EXP LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCUR_17RENCE $ 2,000,000 CLAIMS-MADE ®OCCUR - $ 500,000 X PRIMARY & BOP9101008 08/01/1408/01/15 MED EXP(Anyoneperson) $ 5 000 A NON-CONTRIBUTORY Y Y PERSONAL&ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 4,000,000 POLICY[E PRO- E]LOC PRODUCTS-COMP/OP AGG $ 4,000,000 $ AUTOMOBILE LIABILITY COMBINEDSING1. LIMIT $ 1,000,000 ANYAUTO BODILY INJURY(Per person) $ ALLOWNED SCHEDULED CAP1055962 08/01/1408/01/15 B AUTOS AUTOS Y BODILY INJURY(Per accident) $ X X HIREDAUTOS ][ NON-OWNED PROPERTY DAMAGE $ AUTOS $ PANY UMBRELLA LIAB X OCCUR CUP9144013 08/01/14 08/01/15 EACH OCCURRENCE $ 3,000,000 CEXCESS LAB CLAIMS-MADE Y AGGREGATE $ 3,000,000 X 10 000 KERS COMPENSATION X PER OTH- EMPLOYERS'LIABILITY YIN D CER PRIETR/PARTNEDEXECUTIVE NIA Y WCA9097934 08/01/14 08/01/15 E.L.EACH ACCIDENT $ 1,000,000 (Mandatory In NH) - E.L.DISEASE-EA EMPLOYEE $ 110001000 Ifdescdbeunder 1,000,000 E EPLI PHSD963395 07/29/14 7/29/15LI: $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,AdditionalRemarks Schedule,maybe attachedif more space is required) JOB: 29 BALDWIN STREET NORTH ANDOVER MA 01845 NORTH ANDOVER HOUSING AUTHORITY IS LISTED AS AN ADDITIONAL INSURED IN RESPECTS TO GENERAL LIABILITY COVERAGE. ERTIFICATE HOLDER CANCELLATION NORTH ANDOVER HOUSING AUTHORITY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1 MORKES•KI MEADOWS THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. NORTH ANDOVER MA 01845 - AUTHORIZED R M TATIVE p� ©1988-2014 ACORD CORPORATION..All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD