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HomeMy WebLinkAboutBuilding Permit #128-16 - 315 CANDLESTICK ROAD 7/30/2015 BUILDING PERMIT of No oT" TOWN OF NORTH ANDOVER �'2 y�?''- •-a6`e o APPLICATION FOR PLAN EXAMINATION _ ' . h /S Permit No#:I 2,� �6 Date Received C �gssgc►+us�`��y Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION 31 Cu\geA & �CX Print PROPERTY OWNER M �< �p?oT3E� Lo,�APARCEL: Print 100 Year Structure yesMAP ZONING DISTRICT: Historic District yes Machine Shop Village yes. no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building 0 One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other 0 Se tic O Well` oFlood-Iain ��WetlancJs_.: � WatershedDistnctr p �p Q Water/Sewer �3 m ESCRIPTION OF WORK TO BE PE FORMED: 0(- SA P- ocx' o L) I rhoar 1^ oil Identification- Please Type or Print Clearly OWNER: Name: MARY (! tarb E0 Phone: -7 ?1 7 66 3 Address: 31,5 C4NIeS�icV- o (1r 6 � 8�s Contractor Nme: PJ S 'V,= Phone: -7 60 2030 _ Email: 2 v.S c' Addres ?.0. 23 a` n Supervisor's Construction License: GS- 7I Exp. Date: -4J-7/Z©1 Home Improvement License: Exp. Date: 7449/`4016 ARCHITECT/ENGINEER b� l 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: $ 21 . 35 FEE: $ Check No.: S� Receipt No.: NOTE: Persons contracting w'h unregistered contractors do not have,accethe aranty fund :,_ -' >YW. .: �, _. - - . ! ,: . . .. . - < 11. .. - _. -. -,,... , .. - ._ •... . . . _ z �s� `. - _ . i V4 i� .. ..'.- ,, -tv Y % - t I...,. � ~i...:: t:t: % ,Y " . _ .: . .__ 1. _. : _ z. 11 ... . ... ... _ ., _ . .7 .-. .. . ._ -- -:. : _. . , / Location .��� t�'"��d�S&'� - : No. _ Dates ' - 6 / jam` ; . . TOWN OF NORTH ANDOVER • CTMD`] , u. 1. $ — .-,:it -, -�, °_ �.%;:;­.�X=;,�­.­� 0 � ""`, �,a Certificate of Occupancy $_;. q 2 Building/Frame Permit Fee $G? r'" t-, `� Foundation Permit Fee $� n • �' , i v Other Permit Fee $ _; TOTAL $ _ - ;,.., __ . .... _. . _k . - _ ._-_ 14 '�. 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I I,- - -.; . .... ..!L��: ,:�_t�. �:_��­.' :.­ "�_. � - -, I— " _,_: I _d� :�.�'­­..:'.-_'..":::7:�� �'­ .�._'��:� ­._ : ,- : . ... . . �� -' "; -'- " , " - ...� I . , I � :1. :. I I-­' '. ': � , .1-1.11. �,,:;�,.!'1,- ' ­- -".��,.. : ��:.,:,,_: - I _� - -- .- :_: , ­­ L,..�� ;. -. ­':�"' - - .-� ...­'. '..p.':- -..:,;,.,:�._;:_: t- : , 1.-- .. .. �,:... . ' -1. .-�'.2.__�--'-���'�,�._-:t: ...1 _; - ,� .-.. _. . _ , ,. ."I , . .. ,_....... ��' .',.,;','..r�:.-,',,,�"-�'- "�-­'��-"-'��­:-.­ f-'­.... � � -,.-- - -- - - ' ,s,;,,e�­ , -:Z, �,r ,.m:-,' � . -.1 - - � , - .-L-.'�-*-. - 4. �;11:�:� :�;:�,�...'�'�".'-_'.'�:�w'-`.':-,.,.% . .� * ' ,::�-,-.-..,- Z- „r:.!' , �!' '.::r. v:: - - ' ­ - . I . , . . � - I __ . - .� ,..,” * , , ..:, , L :. .:. -�, - .. I .1. I -,­.. .. � . .1 I. ;__�_-'�_ � . ... , .. -� � .' . ': I .. ... ' '" ' - . .�. I 1. A��j . ::I .��.�. ..' I � ' ,- I : - . ..I : "!�'. I I.:.:,:... -S . , � -_1 . .�. .. .. . __ _� ,�.::.�1,�. " �� �. � ... "" , .. .:.:. ,:�. %. I :��1. - - ,�. % .- :1._._� ...... ?� ';:-._ - ..I I ,. � I � ­ �..' . . %... ,: - .. .. I , ..: I � � . �, ,� . . . �11 I :­�,":*'��, I, , :'t�_ r s � :.": --:- "`��'.­4­", I .'�.�1! . I � I �' ,.. . . .� , ;'.' ... .:, , . .1� . . ._1 .,, I - ,. -, - . I . � . . I.., . � �'� I .I I . .�:� . . . . -- . . .I I . . hk 1, ,. I�I I.'_'­i.. , .1 r " .. ;I. I ­; -. 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 D=Pstex onsite ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF a U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Si nature COMMENTS HEALTH Reviewed on . Signature , COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes ePlanning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/signature& Date Drivewa Permit DPW Town Engineer: Signature: FRI E DEPARTMENT ''�'" � "`�' Located 384 O e Tern ' «r Osgood Street Wo Dumpsteron siteY � Located at T24 �,', � FM.,rz, 7 Mam Street ft r - ,.,i�vlZe^" t r y a r S.+:ht_ 2"p.�, y jy Fire Departmentjsig atu a/datea ` -_ '"� _�,'+.rsa.;.��,+,.-,•.�...._.w.:+._.-.._ .ter 4 i -e: � ♦ r � , '£$.e+ ''# c6�;tT+ ` � 'k ��. 1W t �':a'i L ' "^• .i ..��+"aE7 e { `ate 91.x.,� ii`y,s, .d ',:� "a - D I { � �, r� LL,� 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 DANCER 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 I it 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 46 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 Certified Surveyed Plot Plan Workers Comp Affidavit Photo Copy of H.I.C. And C.S.L. Licenses Copy Of Contract :rP Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) :re 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 New Construction (Single and Two Family) 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 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 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 i Doc:Building Permit Revised 2014 -I NORTH Town of Ej -" ndover O 0 y o h , ver, Mass, 1 COCHICKt WICK V S V BOARD OF HEALTH I Food/KitchenPERMIT T D j Septic System i i + THIS CERTIFIES THAT „ ... ................ BUILDING INSPECTOR y ..... .. .............. .................... �.. . .. ....... ....................... 1 has permission to erect .. ........ buildings on ...���...1�.�.,.G4'!1` .. . .�.�� Foundation............. � Rough to be occupied as ...5., . .. .. ...... ..1.......b.a.09!t%............. .. ........ ..... ... � Chimney provided that the person accepting this permit shall in every respect conform to the ter s of thea lication 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 CONSTRUCTt T TS 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. 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): C xus L ca Address: V© °60p< 2-22 City/State/Zip: hi 0.�(fin 0t� Phone#: �� �� 2®.� f Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. Rf I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. 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 g, ❑Demolition workingfor me in an capacity. employees and have workers' Y P ty 9. ❑BuiItiing addition [No workers' comp. insurance comp.insurance.# tAC�e- required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself.[No workers'camp. right of exemption per MGL 12.❑ Roof repairs insurance required.]t c. 152,§1(4),and we have no , 13.❑Other employees. [No workers' comp.insurance required.] , *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy inform on. 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 state whether or not those entities have employees. If the sub-coutmctors have employees,they must provide their workers'comp.policy number. I am 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.#: Expiration Date: Job Site Address: 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. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature• ii Date: Phone M 01 -7n d 1 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#: ACOOZ6 CERTIFICATE OF LIABILITY INSURANCE DA7Et , s/9/lois TM CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CE1171FiCATE 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 CERiIFICAT€14OLDEIL IMPORTANT, If the a,Nficats holder is an ADDITIONAL INSURED,the polley(,es)must be endorsed.H SUBROGATION IS WAIVED,subject to the terms and condtlimns of the polky,eeNain policies may require an endorssm nt A sbatemani on!fits Cortifrcate does not confer rights to tho 001 ,cats holder In Nau of such andorserr a"s. PF400 st Lauren Goldman Croaa Insurance-Peabody 'pNONegm . (9?8)532-5445 (979)532-2217 139 Lynnfield Street ++wIL .1goldxanQcrossagency.00m AFF01tDING OOVERAGE NA)C9 Peabody HA 01960 mgmitmAyestern World Ins. Co. OtSUIEo ptsm as:Safe Inde=it 3618 N"Us II Services LLC WSunEaC: P.O. Box 2823 plumKo: MISURI E: Woburn MA 01888 WSUFMIeF; COVERAGES CERTIFICATE NUMBER CLI4121825721 REVISION NUMBER: TH'.S IS TO CERTIFY THAT THE POLICIES OF INSURANCE USTED BELOW HAVE SEEM ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD IHIXCATED NOTMKVANOING ANY REOWREMENT,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 CAN01 TIONS OF sum POLICIES Lusas SHOWN MAY HAVE BEEN REDUCED BY PAID CLNAIS. TYKE OF SOURANX POLICY Wimm Laine - c,EPdMtUAOUM EACHODCURKNCE S 1,000,000 } X GLBIIENGAL i GO(ER�AL t�1ArAriY PR r S A CtwtaL4lLWE. X t OCCLR NPP8236669 /13/2011 /12/2015 ow EXp anF ) S 5.000 PERSONAL I ADV INJURY $ 1,000,000. CENEPALAAGK"TE S 2.000,000 GF_NL AGGREGATE VINT APPLES Piet PROWICTS-COMPA1pAOG S 1,000,000 X r m., DAO LOC S 9.-� I B AIrtO WUS 500 00ALL OWHEDAulm "AM)[ 9f KED 116632 /10/201! 1/10/2018IJU .S500 000 R AvrNal�oS 100 00S 5.00 1siwRltA LJ118R EACH 0oa1RRENCE i f]ICFSaWa a A AGGREGATE 5. oeo : WOIQfDla 00►7HiiATgN S wiu N FR ANY p 'PMTNF1KaSbP1Tn[Vlq Orr>CfRAtHNBtE M C]NJA £.L EACH ACOMHT i 91 /�IIr9 EL OLSEASE-EA EWftCYEd S r�awaa,ar QESY1bvn0M Or or+Eew t>tta. £1.DISEASE-POLICY LAW S DEsoa+vna+oFaver+AT)olrsrLocxwroNirvnr� tAaurAAcauo+a,Aawcrotraw.n.sa.o,e..enon.P.orlFnprw) Racer to po3icy cos eacluaionasy eodnraeasnta and special growisioas. CERTIFICATE HOLDER. _ CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRA71ON DATE THEREOF, NOTICE W)LL BE DELIVERED IN "~ ACCORDANCE WITH THE POLICY PROVISIONS. I Horth Andover, !9L 01845 AumoaaMRATnrE Titwthy Traionto/t4D1 ACORD 25 C2M01 O 1988.2010 AC lOCORPORATION.All reserved rights ± I►tso2a rJnwx.e, 7T,.uxTon.,,.,,....,I1.w........kr..e.I.�..ir...rAmon 9 . I Y n 1,i ' Massachusetts-Department of Public Safety Board of Building Regulations and Standards Construction Saperii%or / k 9 License:CS-0739991) " C$RALD VVli�'�-' 23 GLENDALE Dlt ItAN`VERS rdA 41923 l,' ! % 0` Expiration ' 04107120`16 Commissioner ' t • ' � Of _ *,//[n CrC•NIJJ+f-NliMtf��l/f.�i�/fL:Srrf/tO.iCr�" ficeof Consumer Affairs&Busincss Regulation License or registration valid for individul use only T ( before the expiration date. If found return to: OME IMPROVEMENT CONTRACTOR ' egiistration• 129177 Type: Office of Consumer Affairs and Business Regulation Expiration: 7/1912015 Individual 10 Park Plaza-Suite 5170 Boston,MA 02116 Gerald White i `. Gerald White 1 23 Glendale Dr Danvers,MA 01923 Undersecretary � Not valid without signature a nem d