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HomeMy WebLinkAboutBuilding Permit #155 - 35 Redgate Lane 5/1/2018 V►ORTH BUILDING PERMIT TOWN OF NORTH ANDOVER or APPLICATION FOR PLAN EXAMINATION 70 Permit NO: Date Received ��SSACHUS�� Date Issued: IMPORTANT:Applicant must complete all items on this page MG—AIMAwl-M. Phn't PROPERTY OWNER. 2 / .y/ l Ii70 Print ', MAP NO: - PARCEL: �= ZONING DISTRICT: Historic district yes Machine Shop Village yes ■n TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ew Bu ing One family Addition wo or more family Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic 1IVe11 Flo pialin 1Ne#lands Vl/ateished Ds�nct Water /Sewer DESCRIPTION OF WORK TO BE PREFORMED: �oruS�aZi/C�i A- S.,/U Identification Please Type or Print Clearly) OWNER: Name: Co*g;vor Ulf,-1 Phone: 971 . 3�.7 3g Address: /Z G s ,w,- vu `a 4e '. z Wo- CONTRACTOR Name: It 2 .hone: 9 - �Address: tF .s= :. �% fl/Supervisors Cons#ruction License: �#•� ExpDate;ome Improvem0:0-i ON: ARCHITECT ENGINE& PIc i. Phone: 9978.2,04. 5-75-3 Address: J;aA46A& , &4 Reg. No. 411&741 FEE SCHEDULE:BULDING PERMIT.$12.00 PER 1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ I= c ' FEE: $ Check No.: 1 Z t Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to th guar ty fund Signature ©fAgent/�Owner. Signatureof contractor + j 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 L3 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 I Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 i I 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 & DEVELOPP�-IIENT COMMENTS r-- REJECTED DATE APPROVED J CONSERVATION COMMENTS DATE REJECTED DATE APPROVED HEALTH COMMENTS) Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comme ` Water & Sewer Connection/signature&Date Driveway Permit Located at 384 Osgood Street g—Z►—�7 �err-p'7 FIRE DEPARTMENT - Temp Dumpster ren site yes ,no�a Located at 924 Main Street Fire Department sgnatureldate 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 ❑ Notified for pickup - Date Doc.Building Permit Revised 2007 i i I 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 e NOTES and DATA– For department use I I ❑ Notified for pickup - Date ......................_-......-- ---...-.............-....._......._._......_....................__.._.__.—. ....-_......................................................_............-........_._........._...._....._..........._..........._.......- -.._._....._... ---- Doc.Building Permit Revised 2007 I 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 �� `.1 -7t4- J',/64 — REJECTED DATE APPROVED J CONSERVATION 22-A'(x1J 2 COMMENTS DATE REJECTED DATE APPROVED HEALTH t E COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comme Water & Sewer Connection/Si nature &DateXA Drivewa Permit 0 Located at 384 Osgood Street FIRE DEF�ARB TIENT Temp Dumpster on site yes nor Located at 124 Main Street Fiire Department sgnatulre/date COMMENTS J 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 t I Location 3S' Zed C,-Ar�- L F4'f1 G— No. I Date Of NORT1y TOWN OF NORTH ANDOVER a • .r Certificate of Occupancy $ EBuilding/Frame Permit Fee 6 AC NUS � s Foundation Permit Fee /,00 Other Permit Fee $ TOTAL $ VP Check # 2- 205 ,6. Building Inspector x%0RTIy omm of o : No. 0 , dover, Mass., . lap T 0 LAKE I� COCHICHEMCK V 7,p ADRATED S BOARD OF HEALTH PERMIT . T D Food/Kitchen Septic System BUILDING INSPECTOR ow THIS CERTIFIES THAT............................ ......�1!f.. ..... .A.1. �/. r.� .................... Foundation 41 has permission to erectV .. ............ ........ ...... ... ..A � Rough tobe occupied as.............. 1 ...... .. .. ........ ... .............�........ .......................... . ........ Chimney ..... . ... ... . .. provided that the person acceptin his permit shall in every r ct conform to the terms of a application on file in Final this office, and to the provisions of the Codes and By-Laws rola mg 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 CONSTRUCTI S Rough t ... . ......................................................................... Service BUILDING INSPECTO 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. Sent By: H & K Insurance Agency, Inc. ; 617-926-0912; Aug-1 -07 15:02; Page 1/1 ACORD CERTIFICATE OF LIABILITY INSURANCE DATE8(M/1/07 "' PRDOUCER THIS CEIM FIC ATE IS ISSLED ASA MATTER OF INFORMATION H & K Ins. Agency, Inc. ONLYAND CONFERS NO RIGHTS IPONTHECERTFICATE P.O. Box 344 HOLDMTHIS CBYTIRCATEDOESNOT AMEND,EXTBDOR 182 Main Street ALTER THE COVERAGE A"ORDEDBYTHE POLICIES BELOW. Watertown, MA 02472 INSURERS AF*FORDING COVERAGE NAIC0 INSURED INSURERa Harleysville Group/Worcester Chestnut WayConstruction LLC --.--- - wsuRER B: Hartford Insurance 12 Chestnut Way INSURER C: ------ '--.....-------- f . INSURER C: Methuen, MA 01844 _.. . __. .... j 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 REOUIREMENT.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,E)CLUSIONS AND CONDITIONS OF SUCH POLICIES-AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. � INSR D'L-..----..__._._.._.....__.-.-....--'---___-_-- ----�—POUCYEFiECTIVE VCY EX N ...--- -- ----------------'-- - L POLICY NUMBER LIMITS GENERAL IJABLITY EACH OCCURRENCE S 1L999-L900DAMAGE TO RENTED -- A 1 COMMERCIAL GENERAL LIABILITY GL8J1252 9/25/06° 9/25/07 PREMISES Eac=mmm) it 100,000 CLAMS MADE IX OCCUR MEOEXP(Anyoneperwv IS _ 5,000 PERSONAL SADYINJURY S GENERALAGGREGATE G�ElTLAGGRE•GATEUMITAPPLIESPER: I PRODUCTS_COMPIOPAGG S _2,000,000 t POLICY -..-:PRC —_-LOC ` _--_.... _. --'-'---'-- M7WO8LELIA0RJ Y I COMBINED SINGLE LIMIT ;S ANY AUTO ' ._ALL OVWEDAUTOS BODILYINJURY ? SCHEDULED AUTOS (PSr PGF—) S + 1 ... HIRED AUTOS D ILY )RY S -NON-OWIED AUTOS i-----._.--.- --.-----_--. € PROPERTY DAMAGE (per ) S iGARAGELW9LRY AUTO ONLY-EA ACCIDENT S i ANY AUTO OTHER THAN EAACC S-- --- AUTO ONLY: AGG S EIICESSA MBRELLALW L17Y EACH OCCURRENCE 5 OCCUR CLAMSMADE AGGREGATE S DEDUCTIBLE I $ RETENTION S E WORKBI3COMPENSATIONANO -_ TORYLIMj­-1-.M.. _ B I EMP.OYlIi -uABILJTY 6S60UB5626C35806 9/12/06 9/12/07 I ANY PRORLIETORIPMTNERIFXECUTNE E.LEACHACCIDENT S 100,000 OFFICEILWMBER EXCLU OED? I E.LDISEASE-EAEMPLOYEE S 100.000 SWVPPR�CNSbWw I E.L.DISEASE-POLICY LMR 6 500,000 I OTIE R I ' 0 ESCRIPTIO N OF OPERATIONS 1 LOCATIONS I VEHCL.ES I EXCLUSIONS ADDED BY ENDCRSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRI BED POLICIESBE CANCELLED BEFORE THE SMATION DATE THEREOF.THE ISSUING INSURER W LL ENDEAVOR TO MNL 10 DAYS W RIT-mW Town of North Andover NOTICETO THE CERTIMATE HOLDER NAMED TO THE LEFT.BUT FAILURE TO DOSO SMALL I MPOSE NO OBLIGA710N OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTA74M AUTHORIZED REPRemTATmE John R. Herlihy AcoRozs t2ooiroal 0 ACORD CORPORATION 1988 ✓fie '(oomvww w eaM of✓acaaaad we& 13oard of Building Regulations and Standards Construction Supervisor License Lic rise: CS 85446 �i t 0 2121/1972 � pir#tIon 2f?,1f2009 fir# 10773 -;V STEVEN E POULIC?T a ��_ 12 CHESTNUT WAY ( r '' METHUEN,MA 01844 Commissioner 1 The Commonwealth of Massachusetts Department of Industrial Accidents a., Office of Investigations '` ''`' ' 600 Washington Street al;,s Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): 67-x ST- WuT Address: /2 C�r`rlT.tli�i Gf/,p-rte City/State/Zip: /0E/W6L)f, lVt,4 Q/9JVy Phone #: 979- -33Z 2,Y3 Are you an employer?Check the appropriate box- Type of project(required): 1.El am a employer with 4. am a general contractor and I 6.XNew construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 1 7• ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers'comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself.[No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.] t employees. [No workers' 13.0 Other 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 their workers'comp.policy information. 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: �• Z�.�J 7 Job Site Address: T City/State/Zip: mai K/Z#UlvIlJ 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=1eandpenalties of perjury that the information provided above is true and correct. Si ature: �/ Phone#: '28 3 3 7 753� 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#: HoweGUvq y '�50AJS1 RvCr,10Cj 1.80 CMR Appendix] Manual Trade-Off Worksheet - Permit# Builder Name Gji'.C/�/i �'�i G�- /i' Cr: :Date _ Builder Address �[Z ' Checked By Site Address _lir AV &,V-- 4.6&6 Zane [312 (]13 []14 Submitted 6y Phone Date 'O'O' i Ceipngs, Skvllahts and Floors Over Outside Air Resgttired Insulation x Net u-Value 0escri tion R-Value U-Value Area R UA (Tibia$2.2h x Area UA Ceiling: Z.jbie j6.2.2a) 30 o d Q3 s 1 /,50v Floor Ov�ir Outside Air Total Area50 rft+ Wall Wn pYa P—nd goors Insulation x R ulred 9 0escri tion^ R-Value U-Value Area UA U-Value x Area = UA Wa!!S - • able'J.®.2'.2b.c, I Z . . 3 . 372 tlav'6 --r Windows ._� fta DOOM NFRC or Table J1:5.3b F Sliding€3Case Doors —.— N✓rRC Or Table J1.8.3a) ,3L/ T5 ft' ; Total Area El.=LjDJ 1=oundations x insulation Insulation Area or a ulyd _ . R � 0e3ci tion Depth R-Value U-Value . Perimeter - ' UA U-Value . x Area =UA Floor)ver Unconditioned (fable Space J6.2.2e) Basement Wail (Table �R95,3 Unhctsted Slab � -------- (Table J6.2.2 In. Heated:Siab ft . able)8,2.2 in. Total Proposed UA must be less Total than arOgual to Total(or Adjusted) Required UA prop oSBd UA "� pR, a qUf*f8d CIA Statement Of Compliance: The proposed building design represented in these documents Is consistent with the building plans, spectticatlons, L'-'"' Adjusted and other calculations submitted with the errnit application Cftlft'ad UA builder/Deslgnor Company Name r —' Date