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HomeMy WebLinkAboutBuilding Permit #569-14 - 36 ASHLAND STREET 1/29/2014 � � z t b, s • NORTh BUILDING PERMIT '�a° �? e..:P, ° OL TOWN OF NORTH ANDOVER t , APPLICATION FOR PLAN EXAMINATION Permit NO: n �* Date Received Date Issued: I "I IM ORTANT: App licant must complete all items on this page LOCATION `2)6A Print PROPERTY OWNER t AmU LK 11' Lu ;�.� Print MAP NO: PARCEL: L ZONING DISTRICT: Historic District yesnno _ Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building O 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 Identification Please Type or Print Clearly) OWNER: Name: �1�1 L7 ��lU�l IUB LU Phone:q` b— L4')S-QLAC A Address: CONTRACTOR Name: M W T lOY " phone: - 5— ()q, = Address: Supervisor's Construction License: Exp. Date: Home Im rovement License: Exp, Date: ILA Lot C)I-A ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:QULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ o)1 W 00 e ()n FEE: $ 30 , Check No.: -t��} Receipt No.: 2 NOTE: Persons contracting with unregistered contractors do not have accesZto heuaran y fund Signature of Agent/Owner ignature of contractor TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION Print PROPERTY OWNER .. Print 100 Year Old Structure yes no PARCEL: ZONING DISTRICT: Historic District yes no MAP NO: - Machine Shop Village yes no TYPE OF IMPROVEMENT- FResiEdential OSED USE 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 ❑V1/etlands ❑ Watershed District ❑Water/Sewer _ DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: _.. CONTRACTOR Name: _.. Phone: Address: _ Supervisor's Construction License: Exp. Date: Home Improvement License: - - Exp. Date: _ �- ARCH ITECT/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 Y Si naturetof A ent/Owner. _ S�gature of contractor Plans Submitted Ej Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ Location No. Date • - TOWN OF NORTH ANDOVER • 5 FD I X46• e Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee Other Permit Fee -fs $ TOTAL $ Check# 2720" Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ _- T'YPE_OF S) WERA-EDISPDSAL Public Sewer ❑ Tanning/Massage/Body Art ❑.... Swimming Pools ❑ Well ❑ Tobacco.Sales -� Food Packaging/Sales ❑ -Private(septic tank,etc. ❑ -PermanentDiimpster 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 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 DEPARTMF-NT Temp D_umpster on site yes.- no a Located at 124iMair,rStreet : , S� �x�Ra# `.t�tf'a x •;k m ' j j»iL , s } : "':•. j .' TaTy•w'.*.�.�` � ' 1 � ,;• rt#. s �•,,,;,r -_ ..y. �s,�2w.r�k .i..�+•�,`�, ..►.'«;:i.� •.-r....s-..i r -.+fit '.e t"' 1':� !«. pt .t'r Y' �' '' -;"`�'• Y'.ti`1 LL,I' }?`"'tfr`+F ':t` ;.�'"' .e 4'�." ''),j' Fire Department signatureldate 3 J .­ IX IL.ao COMMENTS'° { '4• 'rt;.,:t. ia.syv:S. r' ,•Af. t .'.+.t���.:,�.i sf '11-�.,:X .w i k_ .-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.$10041000:fine NOTES and DATA— For department use ® Notified for pickup - Date i Doc.Building Permit Revised 2010 I Building Department The fol wing i 4.1ist of the required.forms to be filled out*for the appropriate permit to'.be obtained. I Roofie�g, Siding, Interior Rehabilitation Permits I ❑ B' ilding Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.1.C. And%OrC.S.L Licenses ❑ 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 j ;❑ 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 I 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 apo,,al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm_ated with the building application i Doc: Doc.Building Permit Revised 2012 . I NORTH Town of 2 t E . ,.. , ndover O - 0 No. 665­ Iq i h ver, Mass A- COCHICH1WICM 7,�AOR�1TEo r`Pp�,�S S U BOARD OF HEALTH Food/Kitchen PERT T L D Septic System t THIS CERTIFIES THAT AN.1.�i.`..... BUILDING INSPECTOR ................... .. 1.0............................................................................... has permission to erect g t't. �.h1�101�l4. w ........... Foundation .......................... buildings .. .... ..... Rough to be occupied as . .....W,n► .1�I1 ....w................................ Chimney ........... �..... ..... ........... .... provided that the person accepting this pe it 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 3Q • PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIOOTAR 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. SEE REVERSE SIDE i Office of Consumer Affairs and Business Regulation „ '10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 146964 = Type: Ltd Liability Partne Expiration: 6/2/2015 Tr# 240532 MORGAN EXTERIORS LLC. _: N_ �`y MARC COUTURE 130 ROCKINGHAM RD. LONDONDERRY, NH 03053 Update Address and return card.Mark reason for change. I _ SCA 1 Co 20M-05/11 Address [:] Renewal E] Employment Lost Card �lzie�pamirrwnuleal,Cf o���aac�i�r�n,Gf.j ffice of Consumer Affairs&Business Regulation II License or registration valid for individul use only ME IMPROVEMENT CONTRACTOR ; before the expiration date. If found return to: egistration: 146964 Type: j Office of Consumer Affairs and Business Regulation xpiration '612/2015"- Ltd Liability Partne; 10 Park Plaza-Suite 5170 .;7 _• Boston,MA 02116 MORGAN EXTERIORS.tLC MARC COUTURE - 130 ROCKINGHAM RD. LONDONDERRY, NH 03053 Undersecretary i Not valid without signature j Massachusetts -Department of Public Safety Board of Building Regulations and.Standards Construction Supervisor License: CS-092194 MARC W COUTU,ft 114 LANGFORD RD. RAYMOND NH 8307 6.�.J ilji-.)1'10\� ,1J Expiration Commissioner 07/1712015 „ Office of Consumer Affairs_and Business Regulation 10 Park Plaza- Suite 5170 Boston, Massac etts 02110 Home Improvement C or Registration Registration: 146964 Type: Ltd Liability Partne w Expiration: .6/2/2015 Tr# 240532 MORGAN EXTERIORS. LLC.. MARC COUTURE a 130 ROCKINGHAM RD. SW , LONDONDERRY, NH 03053 Lgnr s�0 Update Address.and return card.Mark reason for.chainge. 60A f 0 20M-05111 Address ❑ Renewal Employment r-1 Lost Card .__. .. _ . - cls�'anvr)za�uuea�C o�Gr�aaaac�ucaelta gggrmj"O ffice of Consumer Affairs&Business Regulatipn License or registration valid for individul use only ME IMPROVELENT CONTRACTOR beton the expiration date. If found return to: egistration• 4 Type:- Office of Consumer Affairs and Business Regulation xptration: Ltd Liability Partne: 10 Park Plaza-Suite.5170 Boston,MA 02116 MORGAN EXTERIO _. MARC COUTURE 130 ROCKINGHAM RDC , LONDONDERRY,NH 03653' Undersecretary Not valid without signature i . . Okn,a Windows & Doors 1 LA :�s-7et-7000 OH90010 tarmark Double Hung Welded t NOlansl r-,meanem t Foam PVC Frame•8141 Insulated plana Untt• ; ' i Ceram®• I Low-11 NICK Pert.01=5 With Argon On WIthAdda i ' f i t Vetlltstit Slider Window — — — — t ENERGY PERFORMANCE RATINGS U—Factor(ll.A;P) Solar Heat Gain Coefficient 0 ..25 0 .28 - ADDITIONAL PERFORMANCE.RATINGS Visible Transmittance ' • • 0 .51. • . �'�- 1. Manulictnnt slipn ates that 1h all Yatchgo Ocnform to appllnabfe NFRC V0061111111 lit determining whote product performance. NFRC ratings are determindd for ofted set of snrftonmental oondftionrand a eft spangle product ,:NFRC does not recommend any product and does not warrant the snhahillty of any . ;.� product for say spesglo on. Condtft.mandfacturarh meratare for other product performance Information. i www.nfro.org ENERGYSTAR' The Commonwealth of Massachusetts Department of Industrial Accidents 4 Office of Investigations I Congress Street, Suite 100 o� Boston, MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leizibly Name (Business/Organization/Individual): M OC'c O/h E w I—e,,Y,O vi f _ Address: I 3 0 C, c, I., k 1 City/State/Zip: L,onJDC19e! A-4f D3 oS 3 Phone#k603) Treou an employer? Check the appropriate box: Type of project(required): 1I am a employer with Lf 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 workingfor me in an capacity. employees and have workers' Y p ty• 9. E] Building addition [No workers' comp. insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its 10.E]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 employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#I 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. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policv and job site information. Insurance Company Name: (;Uav J J;4Svvcr.,t c e _ Policy#or Self-ins. Lic. #: M ocu)C ty La 3$ &C6- Expiration Date: VISI Job Site Address: 3(, 4 4 S�19,4 ,�k City/State/Zip:,/1/, 4ndoue4- 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 cer ' under the pat' il and penalties of perjury that the information provided above is true and correct. Signature: o� Date: l A7 Phone#: ((�03 R'�,S _-'--0 l�— Official use only. Do not write in this area,to be completed by city or town official. i 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#: I AC"R"® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/Y1/24/2014 4 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 CONTANAME: Terri Truhn, CISR ACSR Foy Insurance - Salem PHONE (603)898-6320 FAC o : (603)898-8269 163 Main St - Suite 102 E-MAIL .terri.truhn@fo insurance.com INSURERS AFFORDING COVERAGE NAIC# Salem NH 03079 INSURERA:Concord General Mutual Ins Cc 20672 INSURED INSURER B:Guard Insurance Group 18331 Morgan Exteriors LLC INSURERC: 130B Rockingham Road INSURER D: INSURER E: iLondonderry NH 03053 1 INSURER F: COVERAGES CERTIFICATE NUMBER:Master 13/14 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE wvnPOLICY NUMBER MMIDDNYYY MM/DDNYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 X COMMERCIAL GENERAL LIABILITY PREMI E Ea occurrence $ 50,000 A CLAIMS-MADE a OCCUR E6157155 6/5/2013 6/5/2014 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 4,000,000 X POLICY F7 PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS AUTONON-S PROPERTY DAMAGE $ Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION AUL COUTURE, TOM BLOCH,& WCSTATI- DTH- AND EMPLOYERS'LIABILITY YIN X LIM T, ER ANY PROPRIETOR/PARTNER/EXECUTIVEMARC COUTURE ARE EXCLUDED E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) MOWC463568 9/15/2013 9/15/2014 es,describe under If E.L.DISEASE-EA EMPLOYE $ 1,000,000 y DESCRIPTION OF OPERATIONS below 3A states NH & MA E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION (978) 688-9542 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN North Andover Building Dept ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood Street North Andover, MA 01845 AUTHORIZED REPRESENTATIVE Natasha Rufe/SNAT ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. Fi' Fbi`b'6tLd with pdfFactory triaTl`'o arioR DOWOV. ff�� >�7V. i3f17 ' �` ^�^