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HomeMy WebLinkAboutBuilding Permit #895 - 35 MEADOWOOD ROAD 6/24/2011TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Issued: IMPORTANT: Date Received must complete all items on this \N�E Print PROPERTY OWNER M 1 (2-�N C,- U Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yesno Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Phone:S(3� 0 , -7100 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 ? yell' Septic EDW � Floodpla n . q Wetlands: `�� #Watefshed fflstricf ,Water/Sewer 1�,'_ , DE�;U w 11UIN Ur W UK1L t UU j5r� rr to utuvML: e .(mac L` t,-� 6 -�r'-l --��C OWNER: N Address: CONTRACTOR Name: Address: IdentificyAon Please Type or Print Clearly) � Cab DF, W t��UC Supervisor's Construction License: 10 a Exp. Date: le I'D 0 } Home Improvement License: \ 3�P a�5 Exp. Date: c G j ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE. BULDING PERMIT. $12.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED O125.00 PER S.F. Total Project Cost: $ b FEE: $ Check No.: � Receipt No.: NOTE: Persons contracting with unreKistered contractors do not have access to the guara and Phone:S(3� 0 , -7100 Supervisor's Construction License: 10 a Exp. Date: le I'D 0 } Home Improvement License: \ 3�P a�5 Exp. Date: c G j ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE. BULDING PERMIT. $12.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED O125.00 PER S.F. Total Project Cost: $ b FEE: $ Check No.: � Receipt No.: NOTE: Persons contracting with unreKistered contractors do not have access to the guara and Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Well ❑ Private (septic tank, etc. ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENT CONSERVATION COMMENTS HEALTH 0 COMMENTS Reviewed on Signature Reviewed on Signature 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 r DPW Town Engineer;. Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department 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 Doc:.Building Permit Revised 2008 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 MOTE: 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 Chat 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: Doc.Building permit Revised 2008mi Location�3 No. Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ S CHUS Foundation Permit Fee $ Other Permit Fee TOTAL Check # 24616 Building Inspector ri Cd c c �a� c c � o ` C H O_ C y.. O v V C.'C m C ;L O O L V1 Ea L D o .. s o c. ' C E. O m sc y mm L C3 zy :m co c A CIO m CD 0 CLV L N m O o mom WL43 aa 2 c o a a CD y -.m c d F- p y m � 3 W 4;o +_+ C w ma CLIO C +"' oc ma � co H CL CIO FE a L.ti•� I-- z 4-a�m 0 Zj I� tog It 4 U O O .-V 2 0 co L 0 V 03 Q O y co D � I Com_ CO) Q -0 c y c '� m m co CD CL co CD O d CL CMQ C O c CO) m V CO) � C �C C c CO) 0 W 0 OC W W ce W U) o w cn v cn 0 U Z o w o r� U G w W o w G w" OG O W w o w cn Vw 0 o w G w F W w m cn ° Un c c �a� c c � o ` C H O_ C y.. O v V C.'C m C ;L O O L V1 Ea L D o .. s o c. ' C E. O m sc y mm L C3 zy :m co c A CIO m CD 0 CLV L N m O o mom WL43 aa 2 c o a a CD y -.m c d F- p y m � 3 W 4;o +_+ C w ma CLIO C +"' oc ma � co H CL CIO FE a L.ti•� I-- z 4-a�m 0 Zj I� tog It 4 U O O .-V 2 0 co L 0 V 03 Q O y co D � I Com_ CO) Q -0 c y c '� m m co CD CL co CD O d CL CMQ C O c CO) m V CO) � C �C C c CO) 0 W 0 OC W W ce W U) ui z c c �a� c c � o ` C H O_ C y.. O v V C.'C m C ;L O O L V1 Ea L D o .. s o c. ' C E. O m sc y mm L C3 zy :m co c A CIO m CD 0 CLV L N m O o mom WL43 aa 2 c o a a CD y -.m c d F- p y m � 3 W 4;o +_+ C w ma CLIO C +"' oc ma � co H CL CIO FE a L.ti•� I-- z 4-a�m 0 Zj I� tog It 4 U O O .-V 2 0 co L 0 V 03 Q O y co D � I Com_ CO) Q -0 c y c '� m m co CD CL co CD O d CL CMQ C O c CO) m V CO) � C �C C c CO) 0 W 0 OC W W ce W U) 11/16/06 THU 17:04 FAX 617 393 2415 MEDFORD BUILDING DEPT. The Comiwawealih of Na.,Wachusetils Department. oflndastrialAccidenis Office ofInwsbgatrmts t et -54 606 IWasiringlon Street ' - Boston, MA 02111 ``s v www. an SS gov/dia Workers' Compensation Insurance Affidavit-. Buiriders/Contractors/JElcxtrieians/Plumtbers A licant Ynformai>iolu please Print LeAb)v Name (Business/Organi2ation/lndividual): N t✓�t T J-�� n I ; . :� ^r City/State/Zip: (�o � M . 0-1-1-10 Phone #:. G 4 Are you an employer? Check the appropriate box: I . IN 1 am a employer with: __9_1_ 4. ❑ 1 am a general contractor and 1 employees (full and/or part-time).* 2. 0I am a sole proprietor or partner- have hired the sub -contractors listed on the attached sheet t ship and have no employees These sub-conttactors have working for mein any capacity. workers' comp. insurance. [No workers' comp. insurance 5- ❑ We are a corporation and its required.) 3. ❑ I am a homeowner doing all work officers have exercised their right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.) TYP& of project (required): 6. ❑ New constnudion 7. Q Remodeling S. [] Demolition 9. [] Building addition 10.❑ Electrical repairs or additions . 11 -LI Plumbing repairs or additions 12.0 Roof repairs 13.0 Other -T I -rr--• ••�• I must &130 nal our utc secrwn bdow showing their workers' oanpensi tion policy infonnadon- Homoowoers who submit this affidavit indicating they am doing all work and then hiro outside cocmattors must submit a new affidavit indicating such. k-amrWots that chwk.this b6z must atached an additional sheet showing the mm= ofthe sub-eoaizactois and Ihtir workers' comp. polity information. I am an employer tba7 isprovidi,zg workers' compensation insurance for ney mwloyem Below 1s 44e policy and job site ufottntation. Ince Company Policy # or Self -ins. Lic. #: '7 I -) �3Z `6 fS Expiration Date. lob Site Address: City/Statei�p• � � � � - Attach a copy of the workers' Compensation policy declaration page (showing the policy number and expiration date). railure to secure coverage as required tmder 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 violaW Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insaran i vergae P,4ff;&*t;n- I do herefipr cent* under ofperjury that the informatlon provided above n tare an d conrzt offic/a! use Only. Do ant write in. tbls area, to be complded by dry or town o ldol City or Town- Permit/LiccaSc # lssaing Authority (eircle one)- 1. BoUrd of Health 2_ Building Department 3. CitylTown Clerk 4. Clot dell Inspector S. Plumbing Inspector 6. other Contact Person_ Phone#: 0005 CSG CONTRACTOR WORK ORDER Conservation Services Group Printed: 6/6/2011 Contractor Information F Ustomer/Site Details Geoff Chapin MIKE CONSOLI Phone (eve): (978) 688-6191 Next Step Living 35 MEADOWOOD RD Phone (day): 25 Drydock Ave Boston, Ma 02210 NORTH ANDOVER MA 01845 5927 () Site ID: S10001999269 A ointment:[Mails _ Completion Deadline: - Location Description Quantity _ Unit $ Total $_ Notei/RevIlillons — Work Order: IAPNS21 20110606 Combust Safety Test AS 1 40.00 40.00 OVERALL Air Sealing -Hours 10 70.00 700.00 AFL Attic Floor 6.25" Fiberglass Batting 84 9 9 1.40 117.60 CLOSET Hatch: Polyisocyanurate 2" 1 31.00 31.00 AFL Open Attic 9" Cellulose 1282 1.28 1640.96 OVERALL Vent bath fan to roof flapper 2 108.00 216.00 OVERALL 12" Mushroom Vent 3 115.00 345.00 Total for Work Order IAPNS21_20110606 : $3,090.56 Grand Total: $3,080.56 _Road Blocks Asbestos Possible Asbestos Containing Material Observed OLD STEAM PIPES WITH INSULATION Conservation Services Group - 40 Washington Street - Westborough, MA 01581 - 800-480-7472 rrpntti- snag NEXTSTEP ACORD. CERTIFICATE OF LIABILITY INSURANCE 7 DATE (MMIDD1Y`" 11/11/2010 PRODUCER 4. William Gallagher Associates Insurance Brokers, Inc. 470 Atlantic Avenue Boston, MA 02210 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED Next Step Living, Inc. 25 Drydock Avenue 5th Floor Boston, MA 02210-2600 INSURERA: Federal Insurance Company 20281 INSURER B: Great Northern Insurance Compan 20303 INSURER C: Safety Insurance Company 39454 INSURER D: INSURER E: COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. N LTR NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE IMMIDD1YYYYl POLICY EXPIRATION DATE MMIDD LIMITS A GENERAL LIABILITY 35904463 11/11/2010 11/11/2011 EACH OCCURRENCE $1,000,000 DAMAGE MES RENTED ( R NTEDD $1,000,000 X COMMERCIAL GENERAL LIABILITY MED EXP (Any one person) $10,000 CLAIMS MADE ® OCCUR PERSONAL & ADV INJURY $1.00,0.000 GENERAL AGGREGATE $2.000.000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000 POLICY JECT LOC C AUTOMOBILE LIABILITY TBD94446 11/11/2010 11/11/2011 COMBINED SINGLE LIMIT $1,000,000 ANY AUTO (Ea accident) BODILY INJURY $ ALL OWNED AUTOS X SCHEDULED AUTOS (Per person) BODILY INJURY $ T HIRED AUTOS X (Per accident) NON -OWNED AUTOS PROPERTY DAMAGE $ (Per accident) GARAGELIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO AUTO ONLY: AGG $ A EXCESS I UMBRELLA LIABILITY 79870050 11/1112010 11/11/2011 EACH OCCURRENCE s3,000,000 AGGREGATE $3 000 000 X OCCUR FICLAIMS MADE $ DEDUCTIBLE $ RETENTION $ B WORKERS COMPENSATION AND 71733288 11/11/2010 11111/2011 X WC IIMIT ER E.L. EACH ACCIDENT $500,000 EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. DISEASE - EA EMPLOYEE $500,000 CcERIME'gE EXCLUDED? N aFIndatory In NHg E.L. DISEASE - POLICY LIMIT $500,000 If yes, describe under SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS NStar Gas Company is included as an additional insured on general liability as their intersts may appear per written contract. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION EFI - NStar Gas Residential DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL n_ DAYS WRITTEN Weatherization Rebate Program NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL 40 Washington St. Suite 2000 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR Westborough, MA 01581 REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25 (2009/01) 1 of 2 #S185635/M185611 © ASMOVACORD CORPORATION.' All rights reserved. Tho ArnRn name and Ivan are registered marks of ACORD RAD LO 00 LO 0 0 o 0 Q 0� W Q Y 0 p O 0 >m C9 N > 0 co N . U O0 N O a a �v N t.. LU m 0 0 0 0 m m NO O to H CL• w