HomeMy WebLinkAboutBuilding Permit #741-13 - 30 WILEY COURT 5/7/2013Permit NO: ,
Date Issued:
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Date Received
IMPORTANT: Applicant must complete all items on this page
LOCATION' '0 V" 4Fir e
P nt
PROPERTY OWNER -_ ��T��//P ;t f t1Q,*-
Print 100 Year Old Structure yes no
MAP NO: PARCEL: n, ZONING DISTRICT: Historic District es 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 ❑ Well
❑ Floodplain ❑ Wetlands
❑ Watershed. District,
❑ Water/Sewer
OWNER: Name:
DESCRIPTION OF WORK TO BE PERFORMED:
or Print Clearly)
1 -P—
Address:
CONTRACTOR Name:.,���� Phone: �4���7/4&/Y 0
Address: ��•Z/✓rih.- /Qi/�./ �y.,✓
Supervisor's Construction License: A9 9 - -7 Exp. Date:
Home Improvement License: �-�3 �r Exp. Date:"
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: $ 6-'-i.- o> FEE: $
Check No.: �� D , Receipt No.: (A
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
;Sgriatule�'of Agent/Owner Signature of contractor _
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑Swimming
Art ❑
Pools El
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
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT ❑ ❑
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH
COMMENTS
Reviewed on Signature
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes -
Planning Board Decision:
Co
Conservation Decision: Comments
Water & Sewer Connection/Signature & Date Driveway Permit
DPW Tow;a Engineer: Signature:
Located 3M Usgood Street
FIRE -DEPARTMENT - Temp Dumpster on site yes no
Located at'124.Main Street . .
Fire Departineet 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
B Notified for pickup - Date
Doc.Building Permit Revised 2010
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
Li Workers Comp Affidavit
Li 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
o Workers Comp Affidavit
o 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)
❑ 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
Li 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 subm'Ated with the building application
Doc: Doc.Buil Jing permit Revised 2012
Location 30 `Ip C—L `+
Date
Check #2— %-'� I
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $ 0-0
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
26363 Building Inspector
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Tie Co_ �,�. _ hlAi01l11VeQjtJi nfM......__z_-_ _ _ - -• - - _
City/State&jp_-
ptor,•
Are you an emPifl3'er? Check the -a Phone #' -�
PP�ptiate hoz:
I &1 am a
1 employ, with
emF Qyees (full and/or s
4. 0 I am a general contractor and I
Type of project (required):
2. ❑ I am a sole Wer-,._
Proprietor
have hand the sub-cacao-a��
6- El New construction
or partner,-,
ship and have no employees
� Listed on the attached sheet-
These Sub-cO Tors have
7 -❑ Rem ddhg
w�� me � - y
cared.]
employees and have workers' "
8 0 Demolition
- comp- Insurance
°i
3• ❑ I am a homeowner doing
-comp_ insurance.t
- 5_ ]] -We we a °mon and its
9. [] Buili ingadditio-n
10.010.0 ElechicW
c Sll work .
myself. [No workers' comp.o
,
o�cers have PxWrised their
�tf extiinlrtion
�� m. additigns
11-0 Plutiu� repairs
insurance required.] t
per MGL
a I52, § l(4), andw- have no
or additions
l` P ofrepain -
'Any
employees. [No workers'
�• kwuMee
.
t3 .�Otht
appliearu gid-
t � inc al mast also no ort �e
affidavit
:onnactots � indicating �,�earo i g an a Work MW �
fime
Po ftyi -
contractors rmasis iir8a a#hrisvic
�PloYas. ifnc- aU&c ram cam
Ployees, they masl)mvideg�pr tenors mid seecatki. have
WnVIWiC
i am as ergploy�t is
miner
-•yannaf biLMUM= .axuraw� of
- j f�
..Insurance Company Name: f? f� S .
eloty it j*e jialicp midi
Policy # or Self -ins. Lic. # _ �f
Job sine Andress: (,/ c 'e Lip` Expiration-Daterff, (3
Attach a cop the workers. con Page Lffig Ctt3'1/z- �'2 ✓1l "/
Failum to n po cy the-poficy. ---.—
Cmc to $I °D;'�e as under Section 25.4 of MGL c. I52 can lead to the ' mon dateXL
up ,500 00 and/or one-year imprisonment, as well as civic on of � mal P of a
If UP to $250.00 a day against the violator, Be lames is the form of a STOP WOE ply and a fuze
nves�ons ofthe DIA for h mnmce cov advised that a copy ofthis. maybe forwarded to the OMW of
m$ge verification.
_.. Me aims r n &W the -
Provided abow is rine asld correct
�ir:rratiae: r -
honeffie
f use Indy. Do not write in area to be completed by city or lama
.. ofizciaL
City or Town: -
h►sntag AtftOrity (drrJe one): p > c #
1- Board of Health Z BuDding Department 3.
6. Other City/Town Clerk 4. Electrical mor S. Phuntlsing Inspectur
Confect Pcrmn:'
Phone#:
N _
Job Nurnber 4665
2A.tNRLTRATM I INSULATION
Client
DomeNC pipe Hot Water Tank 1st 6'
address
Sin Insulation R-19 CF
city /town
Sil Two Part Foam w! Fiberglass Batt
contractor
'-WF-AnMERSTRIpr+i 4WAtMLMN(i
QUANTITY
Door IGts Q -Lon or Equiv.
4
Door Sweeps (Regular)
4
Door Sweeps (Automatic)
0
Reglaae Wtndwm An inLt
0
Window.Weattistr Sddegal per slde
0
Tenmat Rem Can Cover
0
Attic air sufng per manft
2.5
basement and "g spaoe air seating
3
SUBTOTALS
2A.tNRLTRATM I INSULATION
DomeNC pipe Hot Water Tank 1st 6'
1
Sin Insulation R-19 CF
0
Sil Two Part Foam w! Fiberglass Batt
140
DraPe Perimeter R-5 Anch. Sq. R
0
Perimeter 2" T-max or equivalent foam board sq. ft
0
Drape DOOR R-5 or T-max or equivalent on door.
2
Tape Joints (Alma Grip only) per hr.
0
Duct Insulation & Tape sq. IL R-5
0
Rigid Foam Board Andy. 1" per board
0
Hydronic Pipe hr wlatirnr to 1"R-5
0
Hydronic pipe krs.125° 1.5" R-6
0
Steampipe Ins. to1.25' iron pipe R-6
0
SteamPlpe Ina 1.5"- 2" iron pipe R-5
•0
Steampipe Ins. 3" Iron pipe R-5
0
Air Conditioner Meeting Rai
0
Air Conditoner Cover
0
Air Conditioner Cover Spatial Order
0
SUBTOTALS
2B. INSULATION
OPan Unrespicted R 49 0
Open Un WMefed R 38 0
Open Unn?Mcled R 30 0
Open Unrestricted R 20 0
Open Untestrirded R 10 0
Restrkt F !Sloped R 30 0
Restricted FLMoped R 20 0
Rsstrld FUSioped R 10 0
R-19 FGB open raftersMre"kneewafls 0
R-1 I FGB open rafters/waiislimeexrais 0
Attic Staks(stainxen & common wai) 0
Cover Pun Down Statrs Ttiermadome p
SRO bunt pun dawn stairs 2"1►TE ATTIC AND WALLS
USING BLOWN CELLULOSE
JOB TOTALS G S
Hv�C
DATE 29APr--13
ARTHUR BERUBE 978-683-8885 n '
30 WILEY CT IST FL
NORTH ANDOVER MA N
DANETTI
TOTAL
182.00
63.00
0.00
0.00
0.00
0.00
187.50
225.00
657.60
15.78
0.00
306.00
0.00
0.00
102.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.w
0.00
0.00
0.00
0.00
OA7E(L7G7>OD/Yyyy)
ZIACVRQ. CERTOFOYCATE F LOA BOLP U U ONSU ANCE
1HI5 CERTIFICATE IS ISSUED AS A MATTER OF INFORPAATIOM ONLY AMD CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS ��
CERTIFICATE DOES NOT AFFIRMATIVES Y 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: N the certificate holder is an ADDITIONAL INSURED, the poucy((es) must be endorsed. tf SUBROGATION IS WANED, subject to
the tam 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 endorsemengs).
PRODUCER
NAaa�
Duffy Insurance Agency, Inc. E ,(781)593-1200 Arc,No.(791)593-7260
317 Broadway
(,dyoma ware AOBi :
Lynn, NA 01904-2602 WSIRER(S)AFFORMMG COVERAGE N/uc g
INSURER A: Arbella Protection Insurance Co
C/oINSURED Canetti Insulation INSURER B: Travelers Idemnity Company
362 Edward CAalltnue INSURERC: Commerce & Industry Insurance Co
362 Eastern Avenue
Lynn, M& 01902-1626 INsuRetD: INSURERS:
INSURER F •
COVERAGES r_P9M91retr BU nunlcn. nm
W%=V1.jM0jU evulujor m
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 RECRAREPAENT. TERM OR CONDITION OFANY CONTRACTOR OTHER
DOCUMENTVNTH RESPECTTO WHICH THIS
CERTIFICATE MAY 13E ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN
IS SUBJECT TO ALL THE TERMS.
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. t1MITS SHOVV } MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LtR
TYPE OF{NSURANCE
ypyO
POLICYNUV8ER
Ir!*yD
dmD/YYYY}
umrrs
GENERAL LABIL
850004041
06122IM2
0612212013
EACH OCCURRENCE s 1,000, 00
X GENERAL Lt0.61LFTY
corr~rERcwL
L
PRE01
L!ISES o S 50 00
01A
NZHSEJW(Arrym�ePerson} S S,
C1NMS-MADE ®OCCUR
PERSONAL 8 ADV INJURY $ 1,000,0081
G8"sciALAGGREGATE $ 2,000,0001
GEM AGGREGATE APPLIES PE 1:
RMUUCTS-COEVIOP AGG $ 2,000,000
X POLICY ,!ECT LOC
$
LABIurY
AUTO OWLEANY
BA -8B410778-
07/08!2012
07/08/2013
$ 1, 000, 00
ANY AUTO
�v-. _—
XY BAIURY (Per Perron) $
ALL OYISVED SCHEDULED
AUTOS AUTOS
COUXY DUURY (Per aaideM) $
NON -OWNED
HFREDAUTOS )( AUTOS
`. zrYD7B�1
$
U06RS lA LIAB
OCCUR
EXCESS LAB
CIALMS89ADE
V'CH OCCURRENCE $
^:^LEGATE $
DED I IRETENTION$
$
wo 0"LJco�PaLS 1111M
AND <37PLOYERS' LlABIL.ITY
EX00160572
OIIW2013
0110-4=iANY 4
X
E'' RY Li'.1RS ER
C
YIN
O CERIi SlABOERMEXC ? C�
MIA
EL EACHACCIDENT $ 500, 00
(o�ry In I�
ff yes desame erg
E.L. c-sEASE -EA &.IYL $ 500,00
DESCRIPTION OF OPERATIONS beim
E.L. C`3EASE - POUCY LIMIT $ 500,000
DESCRIPTION OF OPERATIO-ASI LOCATIONS / VEHICLES (AHath ACORD 701, Addibmd Rem2dm Sdmcfida, Ef Deme s•�se i� m-? j
reater Lawrence Comity Action Council, BAY STATE GAS, Car --,unity Team tfork Inc. ACTION INC -,NATIONAL
rid Corporate Services LLC, dba National Grid, Boston Gas Company, Colonial Gas Company, and Essex Gas
Dompany are listed as additional insured.
v�.n a ar eve, c "WL V -B% LAr4tiCLLA 1 fun
FAX: 978.681.4980
Greater Lawrence Comumnity Action
Lleatilerization Program Division
ATTN: Energy Director
305 Essex Street
Lararence, NA 01840
ANY OF THE ABOVE DESCRIBED
!RATION DATE n(FREOF, NOTICE
ANCE WITH THE POLICY PROVM1
ACORD 26 (2010105) The ACORD name and logo are re-Os6ered Mrft of ACORD
SCAT Q T7
(92. TL,onranaat[O�[[L[!c a �L�Gai3ac%uGie�3
OHimofConsunerAffa ts& RcgdWon
U IPROVEMMI CON RACWR
bin :135.M Type: _
_91Z$=4-. DBA
EDWARD CHAAWIG --� -)-
362 EASTERN AVE.
'LYNN! MA 019M
- Uaetary
Limme or regoftafies vabd for inSvMd use only
be&re the eniration date. fffomd rs mo to:
02be ofCommuerAffws and bmnt=RWdatm
nParkPl-SinbeSM
Easton, MA 82116