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HomeMy WebLinkAboutBuilding Permit #873-13 - 351 WILLOW STREET 6/13/2013BUILDLNG PERMIT TOWN OF NORTH ANDOVER i ►°. y APPLICATION FOR PIAN EXAMINATION it Permit NO: 7 ✓% Date Received? Date issued: PROPOSED USE - IMPORTANT: Applicant imist complete all Items on this Page New Building LOCATION 5 I W; lo Li PROPERTY OWNER �. +ru_+ Sx,�- Addition - Print.. s Alteration MAP NO: PARCEL.: 7d ZONING DISTRICT: _3 7 Historic District yes no Others: Machine Shoo Village ves rP TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration No. of units:mmercial- Re air replacement Assessory Bldg Others: Watershed District Septic Well Floodplain Wetlands Water/Sewer Identification Please Type or Print Clearly) OWNER: Name- Phone: Address: CONTRACTOR Name: Phone: 5�X15 — lfd Address: UCS" C YW\ � T_� Supervisor's Constru ion License: Exp. Date: 9C_5 ` C) Home Improvement License: Exp. Date: RCHITJ/ENGINEER Ay-k-t,,j=I Phone- b17.3��•7-699(x+. 21`� Address:, W 2 l br- ", mA DalL i ^ i & Reg. No. Jul A 116-4 FE£ SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. z Total Projec Cost: $. O Com. e2- FEE: $ 6? Check No.: Receipt No.: -_A%7_, 7_____ NOTE: Persnns contracting with unregistered contractors do not have access t alaeuat-p - _.- — _..-- J-e ignof Agent/Owner Signature cif contractV-V\ J 1 4 Permit NO: Date Issued: >1115iZN_,19IQa TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION `^ i Date Received IMPORTANT: Applicant must complete all items on this page Print PROPERTY OWNER Print 100 Year Old Structure yes no MAP NO: PARCEL: ZONING DISTRICT: _ Historic District yes no Machine Shoo Village ves no TYPE OF IMPROVEMENT PROPOSED USE 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 ❑ Septic ❑ Well ❑ Floodplain - ❑ Wetlands ❑ Watershed District ❑ Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) OWNER: Name: Phone: AririrP-.R- CONTRACTOR Name: Phone: Address: Supervisor's Construction Licen Home Improvement License: Exp. Date: Date: 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: $ FEE: $ _ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owrier Signature of contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ Plans Submitted ❑ e t'lans 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 CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS t Zoning Board of Appeals: Variance, Petition No: Planning Board Decision: ___ Comm Zoning Decision/receipt submitted yes Conservation Decision: Comments Water tis Sewer Connection/Signature & Date Driveway Permit j DPW Tow;! ]Engineer: Signature: FIRE DEPARTMENT - Temp Dumpster on site yes Located at'l24 Mair.,' Street Fire Departmefit signatureldate COMMENTS Located 384 Osgood Street no 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 crop 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 B Notified for pickup - Date Doc.Building Permit Revised 2010 Building Department Tine following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofivg, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract o 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 app, al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must bt-. subm_tted with the building application Dc,c: Doc.BuiJing Permit Revised 2012 Location No. -?7 Check Date TOWN OF NORTH ANDOVER Certificate of Occupancy $- Building/Frame Permit Fee s -:;F4zLj-0'q Foundation Permit Fee Other Permit Fee TOTAL $ Buidi�6 ir(spector 0 ID too c CL Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 209000.00 m $ - $ 240.00 Plumbing Fee $ 30.00 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 30.00 Total fees collected $ 400.00 351 Willow Street 873-13 on 6/14/13 Interior Demo Only x J = LL O D Q m L aU_+ Y \ O LL cu a+ >• N U O. ,N O W a H z Z 0 m C m "O 7 LL L m d' Nv C U f0 C LL lz O W H z Z c G J d t bD 7 d' C ll., cc O0 W a N Z Q U7A u W t to 7 d' U 2 Ln LL O F- u CL a Z Q U) L 7 d' LL W Q W in W 5 LL i O Z — W Ul 0 u O I _ cc • v c IA ,1 CL °' t a �• c E * c N V r d C. ,.y ( N j Y GD x = o O f � V N oo N Iva ci • .01 N J �: d O 4moL m a �• �` �' N _ _ �' ai L N �• � o 0 > N oca'2r a='i -No � v�tm>o = L C.) _LO = N CF) 1c� C"_ F- _ Q L L cc •O O N V m d • co W cu W = 'a +=•+ O O .F LL •w Q wO O m v v O W L v y ._ = H Ci GD 0-0 d co N � •0 r = p H $ mOV .> z m Z W X ujw m O W :a z Z o m c a cn co O CO ujJ ;v a `2 E O O z N � Q � �E m m v O O O CL Q � Q OM a J .V CL O CD CA O CL V v) CL U) 0 0 LLI N W W W ro. tie a i rt N . o 44 \�4-4 V O 4-i - °° ° N ° rl q y W , CU Q Q 0 u �, -P G � o o (� `n b u o n a o U ri _n H t o ai j ry f] Fri .rq fd o rLLJ C)oY ( o 4-1 o .o j h N w q N � a �,� L p 4a 4Jo 0 p c � � ° �., [ b y. 0 J J a) ~�l � P4. ((�� �w� C El El 3 CO 1 o > u b► b EO cd ro o CD o U v a 5 a, P4 V) / n -®° .J ƒ }cam . \c J� 2 2 \ . ._$z IT \\�z o J J. �2c cc/ f / makƒ . ) 3 � � J ; �� ! Client#: 22452 CMCAS ACORD.. CERTIFICATE OF LIABILITY INSURANCEDATE(MM/DD/YYYY) 6/13/2013 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(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 Sullivan Insurance Group, Inc. 10 Chestnut Street Suite 1010 Worcester, MA 01608-2804 CONTACT NAME: a/co No Ext):508 791-2241 A ac, No):5O8-797-3689 E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Travelers Indemnity Company INSURED INSURER B: Starr Indemnity & Liability Com CMC Design Build, Inc. 2 Batterymarch Park One Pine Hill Drive Quincy, MA 02169 INSURER C: Travelers Casualty & Surety INSURER D: Charter Oak Fire Insurance Co. INSURER E: Steadfast Insurance Company 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 CONTRACTOR 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 LTR TYPE OF INSURANCE ADDLSUBR INSR WVD POLICY NUMBER POLICY EFF MM/DD/YYY POLICY EXP MM/DD/YYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 51 OCCUR X PD Ded:2,500 DTC03671 B873COF12 9/29/2012 09/29/2013 EACH OCCURRENCE $1110001000 PREMISES Ea oNcour ence $30O 000 MED EXP (Any one person) s5,000 PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: RO- POLICY PJECTRO LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ D AUTOMOBILE X X LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS X NON -OWNED AUTOS DT8103671 B873TIL12 9/29/2012 09/29/201 COMBINED SINGLE LIMIT Ea accident 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per. accident B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE SISCCCLO1596412 9/29/2012 09/29/201 EACH OCCURRENCE $10,000,000 AGGREGATE $10,000,000 DE I X I RETENTION $10000 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y ANY PROPRIETOR/PARTNER/EXECUTIVE -N OFFICER/MEMBER EXCLUDED? (Mandatory in NH) It yes, describe under DESCRIPTION OF OPERATIONS below N / A DTACRUB977K8128 9/29/2012 09/29/2013 X WC STATU- OTH- T RY LIMIT ER E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 E.L. DISEASE -POLICY LIMIT $1,000,000 E Pollution/ Professional Liab Claims Made Form E00594438404 Retro Date: 11/16/2004 11/16/12 11/16/13 $2,000,000 Each Clalim $2,000,000 Aggregate $25,000 Each Claim Ded. DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Evidence of Liability Insurance for the Named Insured For Informational Purposes 0111 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE p y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S202318/M188232 KJA