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HomeMy WebLinkAboutBuilding Permit #322-2012 - 315 TURNPIKE STREET 10/13/2012 BUILDING PERMIT °� NORTM q ,t`'`° TOWN OF NORTH ANDOVER 3� "� -� °� APPLICATION FOR PLAN EXAMINATION e Permit NO: L� ���o�z Date Received �SSACHUS�� Date Issued: L6')Al—I ` IMPORTANT: Applicant must complete all items on this page LOCATION M E rrr ''k f llveep Fa J6 t 13,458 / e/�l Print PROPERTY OWNEF2 CY'i-1 I u r -,4NU0� 4 Print MAP NO PARCEL: ZONING,DISTRICT. District yes no Machine Shop Village , :yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ii New BuildingOne family Y Addition Two or more family Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other9A17- Septic 1111e11 Floz�dplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: Dvi or aoDLA-- 10-Iq - I I wt'_ cyi// Rem(well /,V/,// 4e ah 161 Identification Please Type or Print Clearly) OWNER: Name: /1/( l l Phone: 837-S5,04 Address: 1 S Turh lk Isfre-e-f 1116,-M Alyuyer ri {i till very t Ga�`r .$ervlreJ CONTRACTOR Namer 5,47 n, jOAn�y Res-),h I Phone. AF . �1/ r1 . Address: L. li t? �'I Y�t�f+�'+ t4 I5; t7 a Supervisors Construction license: Exp. Date: p . . Home lmprovementticense: Exp rt ate: 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: $ SD �— FEE: $ 30. OP Check No.: � Receipt No.: P2 Y 710 r NOTE: Persons contracting-with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contractor 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 - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS DATE REJECTED DATE APPROVED CONSERVATION COMMENTS DATE REJECTED DATE APPROVED HEALTH COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments - a Conservation Decision: Comments Water& Sewer Connection/Signature & Date Driveway Permit Located at 384 Osgood Street FIRE DEPARTMENT Temp Duipste on-site Yes- no .Located at 124 Main Street Fire Department signature/date COMMENTS Dimension Number of Stories: Totals square feet of floor area, based on Exterior dimensions. q 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 - Date Doc.Building Permit Revised 2007 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/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 ❑ 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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 Location No. ��.2� — ,1�/2 Date d 3 °RTM TOWN OF NORTH ANDOVER 3L F w a �o Certificate of Occupancy $ CMUSE�� Building/Frame Permit Fee $ 3 0 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # /S.2r r 1 �' 24705 Building Inspector NORTH TON- M of No. LAKE o . dover, Mass., COCHICMEWICK y�• S RATED p'P4`�,�5 . 7 BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT................ n.�.:�� �Q. 1r f................................................................................. Foundation has permission to erect........................................ buildings on-..� �"^o/�!. (.�................. ......... Rough ................ .. �i l Q & /�O �� ����' "1 �0 a, Chimney to be occupied as � /�....................... ....................15� ........ provided that the person accepting his permit shall in every respect conform to the terms of the application on file in Final 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 CONSTRUCTION STARTS 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. :.<d 4, � c • 7 �e I 'rate of jf YeasRvm`.5tanre„ REGISTERED AZTEC TENTS Date treated or APPucanoN 2665 COLUMBIA ST manufadured CONCERN NO. .. TORRANCE,CA 90503 02�2f?(1� CRL COMMS F-4f9.Of (800)228~'687 T his is fv M- fy that the materials descrlbed below hereof hatre been flame retardant lreabd(or are inberenity nonflammable). FOR CHRISTIAN PARTY RENTAL 18 CLINTON®RWE HOLLIS, NH 03049 Ceca o7 Is lsbY male that (check"a”or b9 (a) The articles described below this certificate have been treated with a flame retardant chemical approved and registered the State Fire Marshal and that the licationof said chemical was done In confor- •' ❑ 9 by aPP - mance with the lasses of the State of California and the Rules and Regulations of the State Fire Marshal. Nameof chemical used-..........................................Chem.Reg.No......................... Meathod of application (b) The articles described below hereof are made from a flame-resistant fabric or material registered and approved be the State Fire Marshal for such use;Fabric has been tested and passes NFPA701-96. ..W: Trade name of flame-resistant fabric or material used..e.ammam FGbrk Reg.No.......E:!M-R!...... , . The Flame Retardant Process Used -�IP1 NOT------- Be Removed by Wftshling ,. Mal or will mt) David Bradley Chuck[Miller- President Name ofAPPh'remora Production Slr rriandant Title - Y Pan CUSTOMER ORDER NO. 8166629 ITEMS MANUFACTURED: 2-20x20 Fes€eval Top UW v dfh Doable Valance 2-20x40 Festival Top dam'with Double Valance 3-40x40 2pc.JumboTrac Top UW 6-46!D O JumboTrac Middle Top UW I -100x30 Sesfes 2000 Middle U 2-20120 Series 1500 fpc.Top UW 2-20130 Sesdes 15001P-- Top UW 2-20x40 Sedies f5001 pc Top.0 PDF created with pdfFactory trial version www.odffactory.com AC40ROCERTIFICATE 4F LIABILITY INSURANCE 8//31/2011 831/2011 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($), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER, IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONEA Luci Fitzpatrick Tebbetts Insurance Agency PHONE (603)465-3333 FAXC. (603)465-6800 P.O. BOX 84$ E-MRCS :lUC7Otebbetteias.COLa 3 Village Marketplace INSURM AFFORDING COVERAGE MAIC# Hollis NH 03049 INSURERA:Citizens Insurance Cgmpany of 31534 INSURED INSURERB:Ha.nOver Insurance COMPany 22292 Christian Delivery & Chair Services, Inc. INSURERC Commerce and Industry Insurance 15172 D/B/A Christian Pasty Rental INSURER D: 18 Clinton Drive INSURER E: Hollis NH 03049 INSURER F: COVERAGES CERTIFICATE NUMBER CL1183101187 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. INSR TYPE OF INSURANCEPOLICY EFF POLICY EXP POLICY NUMBER MMJDD MMID LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1..'0001000 X COMMERCIAL GENERAL LIABILITY PRWE TO EMISES Ea r Me $ 100,000 A CLAIMS-MADE i OCCUR MW0844363 /1/2011 /1/2012 MED EXP(Any onePerson) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE S 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 2,000,000 X POLICY PRO LOC S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT cdden S 11000,000 A X ANY AUTO BODILY INJURY(Per person) S AUTOSLL AUTOS AU70SULED V0716909 J1/2011 /1/2012 BODILY INJURY(Per accident) S HIRED AtlTOS NON-OWNED PROPERTY DAMAGE $ Per a t Untnsuted motadst combined $ 1.000,000 X UMBRELLA LIAB OCCUR4,000,000—d EACH OCCURRENCE $ 4,000,000 B EXCESS LL4B CLAIMS-MADE AGGREGATE $ 4,000,000 DED X I RETENTION S 10,00 0844365 /1/2011 /1/2012 $ C WORKERS COMPENSATIONY4C STATU• OTH AND EMPLOYERS'LIABILITY Y!N X X ANY PROPRIETOR/PARTNERIEXECUTIVE f7 I E.L.EACH ACCIDENT $ 1 000 000 OFFICERIMEMBER EXCLUDED? NIA (Mandatory In NH) 009870539 /1/2011 /1/2012 X es,desWbeuntler E.L.DISEASE-EA EMPLOYE E 1,000,000 DESCRIPTION OF OPERATIONS belowE.L.DISEASE-POLICY LIMIT $ 1.000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remaft Schedule,If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Seth Tebbetts/LUCI CORD 25(2010105) ©1988.2010 ACORD CORPORATION. All rights reserved. 5025 on1nmi nt Thr APtWn nom&anti Innn ora ronrcoarad mnrlrc of Ai nl*n The Commonwealth of Massachusetts Department of Industrial Accidents ' Office of Investigations y 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly ChrisfiAh W ve,-y znc, Name (Business/Organization/Individual): t2MCh rid f-%4» p4►{y /Zt�tizc r Address:/g eb,nArl b ri'M l�l City/State/Zip: 0/1' 30g9 Phone#: 1003 32 Are you an employer? Check the appropriate box: Type of project(required): 1.)n I am a employer with JrD 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. E]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 working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp.insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no r employees. [No workers' 13,,& Other 7>A/� 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 state whether or not those entities have employees. If the sub-contractors 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: CoW mei ce_ qrld I"»duSi-Y T_4 -a ,,4e_ Policy#or Self-ins.Lic.#: WC OO qQ 70 3 9 Expiration Date: 9 / z a/2— Job Job Site Address�f'_ 7_Uet,2W'L Shr2I City/State/Zip://, 4nde%r, I A �8K 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 andpenalties of r' that the information provided above is true and correct.ury Signa re: / Date: Phone M d 8-c?p 3 ` ��2_4 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#: 315 turnpike st north andover ma- Google Maps Page 1 of 1 To see all the details that are visible on the 1 screen, use the"Print'link next to the map. 17 fr 1 4- Abaft st t Y' 3 Y x r a Ta In, t yg. KI i :4 � S V t � y ` x t 77 �}} Al `„ v V Y. S 1 k 'G�,��� �5.^x '_tee, 3 � �� ,� ,i'. �'�• kolr ti :u s vAt ;a !� TO JA a 5 5 y S � T1 Goo ins*fled an /o1i9�2� /o12 httn://mai)s.2oo2le.com/maps?hl=en&ascrl=l&nord=l&riz=1T4GGLL enUS345US345... 10/12/2011