Loading...
HomeMy WebLinkAboutBuilding Permit #550 - 29 GLENWOOD STREET 1/13/2012 BUILDING PERMIT oFttNORORTF,,6gti TOWN OF NORTH ANDOVER �? y` ''' "a'','6 ° APPLICATION FOR PLAN EXAMINATION ° - . t> * Permit NO: � Date Received �sqs RATED 'PP,`'`y r SACHUS� Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION CI Print PROPERTY OWNER �� (Y" Print MAP NO: — t-1 PARCEL: ZONING DISTRICT: Historic District yesKno) o Machine Shop Village yes 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 ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK, TO BE PREFORMED: 5^^-�i i n Identification Please Type or Print Clearly) OWNER: Name: /s j)e I a P, e-Lire, Phone: 751 cF-4/, 'loW a� � Address: 4Y� tv o CONTRACTOR Name: baV" 1) SL S Phone: b/S J$y-3 Address: 4L Supervisor's Construction License: ` Exp. Date:—/J, ? t Home Improvement License: Z;'7 (v( Q Exp. Date: X? 3 � 1. ARCHITECT/ENGINEER Phone: 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: $ '4/D,Sov FEE: $ Check No.: 4-336 Receipt No.:___:)=q c(C1 NOTE: Persons contractipg with Ftnegistered con ors do not have access to the guaranty fund C f-t Signature of Agent/6wner`7i n ure of contractor �; � : Location /���✓ �'� J/— No. Date MORTh TOWN OF NORTH ANDOVER 1 o � s i s Certificate of Occupancy $ 7SfAcNUSE<� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # `!U ' 24995 Building Inspector Plans Submitted ❑ Plans Waived D. Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL ° V 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 INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS I CONSERVATION Reviewed on Signature COMMENTS r HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments I Conservation Decision: Comments I Water & Sewer Connection/Signature& Date Driveway Permit I DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Du m stems-site--yes- Located at 124 Main Street Fire Department signature/date f COMMENTS k. L S )6�DimensionNumber 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 ❑ Notified for pickup - Date Doc.Building Permit Revised 2009 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 o 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 Li 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 o 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 I' 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 2008 I I The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information ` Please Print Legibly Name (Business/Organization/Individual): 32c Address: pc- X 9/l City/State/Zip: ¢ S N-7 4V 04,0hone Arf an employer?Check the appropriate box: Type of project(required): 1. Wam.a employer with 5 4. ❑ I am a general contractor and 1 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet.# 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9. ❑Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12�Roof repairs insurance required.]? employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#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. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. ,/ Insurance Company Name: J'7 A_fL,,J Crb�p Policy#or Self-ins.Lic. 's (o pU 2, 2Pcyr> >5/_�� Expiration Date: Job Site Address: 2_9 Le", City/State/Zip: evf 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. Ido hereby rtif under the pains andpenalties of perjury that the information provided above is true and correct. Si:Tnature. Date 111d11 Phone Official use only. Do not write in this area,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 Contact Person: Phone#: WORTH Tom- M Of Andover 0 No. over, Mass., 0 LAM COC HICHE WICK 0RATE D PY BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System THIS CERTIFIES THAT -Y\ I&Q t ef BUILDING INSPECTOR H .......... ...................................... ................................................................................ Foundation has permission to ere.I Ct........................................ buildings on .A9........... 04 0.4........ ...... Rough to be occupied as............ ...♦... ......... Chimney .............. ......................*­ c provided that the person ac permit shall in every respe onform the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the tion and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final 060 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCI�aS Rough .............................................................................. Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR 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. SEE REVERSE SIDE Smoke Det. 12/13/2011 12:03 PM FROM: Risman Byette Insurance Agency, Inc TO: +1 (978) 640-2997 PAGE: 002 OF 002 RightFax C2-2 12/12/2011 4:27:10 AM PAGE 2/002 Fax Server ACORD. CERTIFICATE OF LIABILITY INSURANCE 1211W011 THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPONTHE 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 NOTCONSTITUTE 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 At the policy,certain policies may require and endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: PHONE FAX BYE CIE ATS AGI3NCY INC (41C,No,Ext): FAX (MC,No): 853;MAIN STREET' E-MAIL ADDRESS: PRODUCER TEWKSBURY,MA 01876 CUSTOMER IO If: 25GSF INSURER(S)AFFORDING COVERAGE NAIC A INSURED INSURER A: HARTFORD GROUP INSURER B: IRC BLJU DERS INC INSURER C: INSURER D: PO BOX 911 INSURER E: TEWKSBURY,MA 01876 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 REOWREMENT,TERMOR CONDITION OF ANY CONTRACTOR 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 ALLTHE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR AOOLsueR POLICY EFF OATE POLICY EXP DATE TYPE OF INSURANCE POUCYNUMBER (MA&DD',YYYY) (MMDDIYYYY) LIMITS LTR INSR WVO GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ CLAIMS MAOE OCCUR. PREMISES(Ea occurrenco) MED EXP(Any one person) $ PERSONAL 88 ADV INJURY S GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PROJECT LOC PRODUCTS-COMP!OP AUG $ AUTOMOBILE LIABILITY COMBINED SINGLE s ANY AUTO LIMIT(Ea accident) ALL OWNED AUTOS BODILY INJURY S SCHEDULE AUTOS (Pet person) HIRED AUTOS BODILY INJURY $ (Per accident) NON-OWNED AUTOS PROPERTY DAMAGE S (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS LIAR CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION S S WC STATUTORYLW.ITS OMER WORKER'S COMPENSATION AND EMPLOYERS LIABILITY YIN UB-6873P217.11 1WW2011 10/062012 E.L EACH ACCIDENT S 100,000 ANY PROPERITORIPARTNERIEXECUTIVE V E.L.DISEASE-EA EMPLOYEE $ 100,000 OFFiCEWMEMBER EXCLUDED? (NbndataryinNH) E.L.DISEASE-POLICYLiMIT S 500,000 11 yes,dendbe Lmder DESCRIPTION OF OPERATIONS Delow DESCRIPTION OF OPERATIONS!LOCATIONSNEHICLESIRESTRICTIONSISPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOIDIRAMMMG WORKERS COW COVERAGE CERTIFICATE HOLDER CANCELLATION TOWN OF BILIERICA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN BOSTON ROAD ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE BILLERICA,MA 01821 Ramani Ayer ACORD 25(2009109) 1988.2009 ACORD CORPORATION. All rights reserved. Th:e ®mmon.wealth of Massachusetts Depart'eat of Fire Services Office of the State Fire Marshal - P.0.Box 1025 St--ite'R.oad,.Stow,MA 01775 ' PERMIT Date: North Andover ]Permit No Dig Safe Num rr . •(Cityof Town) (if Applicable•) In accordance.with the provisions of i_GL-1 4 8 Ghap.ter ]_a_as provided in section S 7 7 (,MR 34 Start Date This Permit is granted to:. 4 Full name ofperson,Firm or Corporation Pcrmissionto locate dumpster - for construction/renovation/demalition of building. Comments: dumpster. must be , 25" from structure if unable to place with required Restrictions:clearance dumps-ter must be covered with plywood or tarp end of 'work -day (Give location by strej and no.,or"e-in such mann ovadequ c idcntilication.of Iocation) FecPaidS 50 .00 '' . Fire Chief This Permit will cxpire- �. _ (Signature of affical granting permit) 5ffical granting permit - (Tide) r Ot�iee4)Lonsamerailm lung . u6 zMOME 1NlPRONEMEM CONTRACTOR iteg"on 427660 'Type:. E*raho;. 1-262012 IndEvnivai: qi) ),SCHAUFUE� a _ flAVIE?SCHAUFUS v- „A4 HAZELWO-C AVE r 3`t �URY, 01835 z' i Pub fi, c_ _iDc;isrtmen#o� .d.% df_. 1i�s+achp :s Re�►lat�+s-�ind r#ICa :� Sn isOf -ccesssr`�" hi5v' Jell'tng5 i}Y C One:and�wO- License 70432BRJS ~° DA, SCHA `. r WQpC AVS itgp Q876 SBR•( - t CONT r� WORK PERFORMED AT: Al { TOAA � HATE YOYR WORK ORDER ISO flUR SID NQ Y A. Y�A �' "4 „x•F - .»+STM - wr+^+" txr oe � 4y.. iraR 7jh ��'�.'3r�. �j✓ I#' �-,� �' } xF �r Jz£ }!1r�F m d-G� �W, 8'yF P ( /" 8 # L l l w4T i lam'i'.�.x� :� r.t��� a*.�' .��'1'" la;:'� � ��• ,, ... , f� Alt Maternal is guaranteed to be as specified,and the above wrork was grertormed to accordance with alp,dralvangs ands ecifications provided fo(r�.the above�arork and waS completed in a substantial workmanlike'manner 9or the agreed surra:cif Dollars{S This is a ©Parliat full invoice due and payablwby ►x � f3 f ,. Mth Day Year in accordance with our D Agreement Proposal too. bated iNor�th Day Year 14 G3822 CONT'RACT®RS ����� A .