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HomeMy WebLinkAboutBuilding Permit #239-2017 - 326 FOREST STREET 10/6/2016 a NORTH BUILDING PERMIT ��° LP e 1 e OL TOWN OF NORTH ANDOVER ° APPLICATION FOR PLAN EXAMINATION n M H 1 e Permit NO: 7 Date Received ! TE. Date Issued: /U• (P • 0 d I�o �9SSA IMPORTANT:Applicant must complete all items on this page LOCATION_ Print PROPERTY OWNER S r-L :: ,, Print MAP NO: �b PARCEL: lbI ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building 9�One family ❑Addition 0 Two or more family ❑ Industrial VAlteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other 0 Septic D Well 0 Floodplain ❑Wetlands 0 Watershed District 0 Water/Sewer Identification Please Type or Print Clearly) OWNER: Name: Phone:!�F7- �7��� Address: �� � CONTRACTOR Name: Phone: 771 Address: Supervisor's Construction License: Exp. Date: GS -7/30 Home Improvement License: + L+ Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ Q- -;S' FEE: $ %51 — Check 51 —Check No.: E?-7Receipt No.: 31 o6 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner ignature of contractor s Locationf No. �1 _ �2 011 Date f • • TOWN OF NORTH ANDOVER Certificate of Occupancy -$ Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# 7 Building Inspector a 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 PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS I A i i CONSERVATION Reviewed on Signature COMMENTS r i IEALTH Reviewed on Signature COMMENTS O Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp,I umpster on�site yes Y� r%o¢__ Located a£124a Main St" reef Fire ,6pattfidn SignaturelOate,_ r_. COMMENTS, __ r 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) FU Notified for pickup Call Email i F Date Time Contact Name 3 Doe.Building Pennit 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 ❑ Building Permit Application ❑ Workers Comp Affidavit o 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/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 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:Building Permit Revised 2014 c10RTH '9 Town of s _� s ndover O y" soh ver, Mass, COCKICKl WKK 1 7a RATED �' 5 7s u BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System • THIS CERTIFIES THAT ,,,,,,,,,,,, BUILDING INSPECTOR ........................... !e-...............�.0,r4 Foundation has permission to erect .......................... buildings on '���} . � 7 y Rough to be occupied as .��. .. Chimney p ..................Fp %4t.�.........St� D�r../Z.......!:!�..!.�.�!................V 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 CONSTRUCTIO T 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. Page No. of Pages 16 Edpmom Avg. BURLINGTON, ;.rA 01803 (617) 272.1252 PROPOSAL SUBMITTED TO PHONE DATE STREET / - - JOB NAME f CITY, STATE AND ZIP CODE JOB LOCATION 10. ndot ' In 11 1 ARCHITECT DATE OF PLANS JOB PHONE We hereby submit specifications and estimates for: -H4� scJ!rt-�yy !fic f�c✓irt� �G/�l,ri( ' n. `l %� !� ��:�.x� > /�1 SJ la-k-S ��,� ! ��.y� 47 ��'�{ n� �►-► � j n s �v/��,��j /r'7�. d'� `mGY �T-�-—��` �n,L.[ t IVP FropASP hereby to furnish material and labor — complete in accordance with above specifications, for the sum of: rG dollars($ q7'2 Payment to be made as follows: `f 20 3� All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices.Any alteration or deviation from above specifica- Authorized tions involving extra costs will be executed only upon written orders,and will become an Signature �'✓✓" extra charge over and above the estimate.All agreements contingent upon strikes,accidents or delays beyond our control.Owner to carry fire,tornado and other necessary insurance. Note:This proposal may be Our workers are fully covered by Workmen's Compensation Insurance. withdrawn by us if not accepted within days. Arreptattre lit Fropi BMI—The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized Signature to do the work as specified. Payment will be made as outlined above. Date of Acceptance: Signature PRODUCT118-3 .Inc.,Groton,Mau.0147)border PHONE TOLL FREE 1+800-225-6380 Paychex, Inc . RF 8 7/15/2016 3 : 26 : 52 PM PAGE 3/003 Fax Server l CERTIFICATE OF LIABILITY INSURANCE t]6t7' 0715/20 6D/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:If the 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 Paychex Insurance Agency Inc NA Em PAYCHEX INSURANCE AGENCY,INC. PHONEFAX 150 SAWGRASS DRIVE A/c NO.E : 877-266-6850 Arc No. 585-389-7426 ROCHESTER, NY 14620 E-MAILCertsCDpaychex.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: NorGUARD Insurance Company 31470 HOVASSE CONSTRUCTION INC INSURER B: 12 COLBURN ST BURLINGTON, MA 01803 INSURER C: INSURER D: INSURER E: 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. INSR TYPE OF INSURANCE ADDLSUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR WVD (MM/DD/YYYY) (MM/DD/YYYY) GENERAL LIABILITY EACHOCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED CCUR P IS S Ea occurrence $ LAIMS MADE MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY �PROIECT�LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED O SCHED (Per person) $ AUTOS AU��T��OBODILY INJURY ULED S HIRED AUTOS OAUTOSWNED BODILY INJURY $ O (Per accident) PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAB =OCCUR EACH OCCURRENCE $ EXCESS LIAR O CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION AND X WC STATU- OTH- A EMPLOYERS'LIABILITY HOWC645726 12/15/2015 12/15/2016 TORY L IMT E.L.EACH ACCIDENT $ 100,000.00 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 100,000.00 (Mandatory In NH) YY N/A E.L.DISEASE-POLICY UMIT $ 500,000.00 If yes,describe under r7ION OF OPERATIONS b low DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,i1 more space is required) CERTIFICATE HOLDER CANCELLATION TOWN OF NORTH ANDOVER SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 1600 OSGOOD STREET DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY SUITE 2035 PROVISIONS,BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR NORTH ANDOVER,MA 01845 LIABILITY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD