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HomeMy WebLinkAboutBuilding Permit #037-2017 - 365 BLUE RIDGE ROAD 7/12/2016 i � VORTh � Y/r BUILD+�IG PERMIT °?°��```� `•d�°m 'Tu TOWN OF NORTH ANDOVER „ APPLICATION FOR PLAN EXAMINATION I b Permit N0: Date Received ,:;;�, 9 Date Issued: • � �9SSgc►+us���y IMPORTANT: Ap2licant must complete all items on this page R�:QEATION t it3 PRt�PERTY OWNER x Ern AP'NO PAROL ZQNING DI�TR1CT LH rstoric t7istr�ct '` �, . . , yes �o K MachaneIiop VFEIag .. .yes no man TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ne family ❑Addition Two or more family ❑ Industrial ❑Alteration • No. of units: ❑ Commercial epair, replacement ❑ Assessory Bldg D Others: Demolition . ❑ Other Septic r r 1 Ve11 D FloodpI (� II/etlarEds ;; Cl ll laters ed [?istr�ct. uNaterlSewer ReWvf- -in &+a-0 .Urrfacn- eeS Ankakk Urn ITLI) LRTIMC, N6tEf:,) i 0S ALL 1 C 2440 5e 7 6 6E Identification Please Type or Print Clearly) ,Q OWNER: Name: f- �^-6 Phone: - 6094714 Address: CONTRACTOR Name ho ? • ��, z ' ` ;Address 7777-77 Supervisor's Construct License Exp e Hate IrrcprQvement .�cense Ex Date ARCHITECT/ENGINEER Phone:_ Address: Reg. No.__ FEE SCHEDULE:BULDING PERMIT:$12.000 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: i � ' .� FEE: $ I2 ' Check No.: '0 Receipt No.. a NOTE: Persons contracting with unre is d contractors do not have access t t e gu a fund Signature,of.Agent/OWner' ignature of contractor J p10RTH BUILDINC-'K-ER IIT 0 .1"Eo b�b TOWN OF NORTH ANDOVER ON 0 APPLICATION FOR PLAN EXAMINATION yy ` 7L0 �D± w 1' Permit No#: Date Received gssgAmp cHus�t�5 Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION Print PROPERTY OWNER Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes 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: Address: Contractor Name: Phone: Email: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. 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 `r Signature of contractor I • G—T-� .. ��Y/ NoR7H. ���� BWL G RERMIT �? a`lT`tio TOWN OF NORTH ANDOVER ° APPLICATION FOR PLAN EXAMINATION Permit N0: l Date Received * o Date Issued: 1 � �9SSACHUSfcS�y IMPORTANT Applicant must complete all items on thisage atra.:n. .nA rte+ -' <;s o' 7 �"v'�' z , .r^k'�, v _^,z,� 'Y' ,.ey�•� s t� �" t*[>'..F w`E +-"£ ,y,. y '-kz .r;' e'§x� wfi �v�' r�z`c ���? �,� AK tivre .x LW— ;eIN& q'.r. r i4Et �rs , fy �� � AMR T.. j'a^ Fc4 7 4+h„p '`Y.';:.r%."1 A>'"w .y y, v�. `l.`: 4, ,r °S +R't°(' �.� F` �, ... � �l d �*1'S �" ff Y�i�,. 'K.��� 11�J:< �' �` ` rc�s.:,. i ,s.> �..re'?z' 'tT> �'a M g �,. F`.#a xr � k .a.�aa�� �Z�v ��t :r���i ':;� �K^��Tj���,Y���':'t � �� a .4wA0�'�� k�l�� I�� 'N*'3' ...�Afr i rC �'�• "��*E' �iT'� f,(� �� '� .».; .; '�'L,'^ay;� ,a , ,?'��`:. ,r�,,���„'�>r�s�.��'o-;. �.�a 3.r �t. _ �_.,•,� r:�� x�''+ ��h�w., :��ih�nf. �.:� �����"r �;?y����' �� e��'.:. • TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ne family ❑Addition Two or more family ❑ Industrial ❑Alteration - No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg D Others: Demolition ❑ Other MR. '"' „F,�eT ..�� .�,_�s' .z,2.»c a+.vA�:ak :,.t - a.�a ez' il<c`n ,,,'. rf '�Sr" w,. �a�tr4;:`� "E.. ;✓�Y c'F5'3^` r,£, s��iY, > '":3 ,s.�A'y. '�' -in S . -Cerfiafr,,)�1614. bohl)", b, * atL-�) ,6(:�TmE �J 6 tt2) Identification Please Type.or Print Clearly) OWNER: Name: �� �!/� Phone: - Q 47/ Address: .-s✓csG w'srxc.c ,a. _' �'�, -`w�, sflcp §es:. '.€'�.> 'a Mai .�. a�✓^z rF w. v :;r v> ,y 5 to - .> 5)- � ikt�,��' a•:�:: ��,f�.��'y���'� x ..���� �2,' �.� ws: � y .art � � ?&� �= �(v� ��^���'�� .,.�'`����;a,a �a �w � i , ��� ^a'�"{±� r�`�� z. ��'*sv'� ;t�. � �:• x"fat i :rte � fr < r � ,`raa.� -; xt ��;�y�z.,* �k+„�"'` L a"' kF`� _`'�� „� ��";t� ;•, - it r w.x"P.>'� ax�'•4.''4"'wg+S �SrU,= �c' f1S �,aT+tKv �"�.d^� � �N ARCHITECT/ENGINEER Phone:_ Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$122.00 PER$1009.00 OF THE TOTAL ESTIMATED COS r BASED ON$125.00 PER S.F. Total Project Cost: .� I �`I I 'FEE: $ Check No.: Receipt No.: o NOTE: Persons contractingwith unre is d contractors do not have access t t e gu a fund it'i ,�. �g., t... .. ,. r"µ' rx.,.... ..7: �� � roa�CtxOrr ,Rr"2w �„� • Location No. " t�`. l Date 12 It�o ` • - TOWN OF NORTH ANDOVER • `: Certificate of Occupancy $ Building/Frame Permit Fee $ 142 — Foundation 1`2 `Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# !r Building Inspector Plans Submitted ❑ Plans Waived ''Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimm�ing Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Pennanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ 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 L Conservation Decision: Comments Water& Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - TempQumpster onsite eyes nog _ r Located;at 1241Mbih,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 NOTES and DATA— (For department use) ❑ Notified for pickup Call Email Date Time Contact Name = Doc.Bnilding 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 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 OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks 4. Building Permit Application Certified Surveyed Plot Plan Workers Comp Affidavit Photo Copy of H.I.C. And C.S.L. Licenses ,rF 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 OTE: 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 2012 IECC Energy code Engineering Affidavits for Engineered products OTE: 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 OORTH Town of ) 0 - I No. � ZY 7oh , ver, Mass, (� O �A COCHICMNWIC °RATED ►P��,(5 S U BOARD OF HEALTH Food/Kitchen PERMIT L D Septic System THIS CERTIFIES THAT 3)blkP..... . 0%..�......... „ ......... BUILDING INSPECTOR ............ ................. . has permission to erect .......................... buildings on „� .....14A. . . . i�.............`..... Foundation � Rough tobe occupied as ......... .�...... E................................................................ Chimney provided that the person accepting th4:' ...mis 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 CONST TIO Rough Service ..... .... .... a... ...... ... Final BUILDI PECT R 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. 1 Union Ave K CO ROOFING Sudbury, MA 01776MA License# 102263PEA Tel 978.300.8008 HIC# 123204 , Fax 978.300.8020 AGREEMENT • This Agreement Subject To Insurance Company Approval Name: 6eadoln �Gl�llc, Date:_ 0%g, TIC , 2610 Address: 3165 Blue, 12-ikx, Pd City/ State 81ovfA 111rd eve,v , M.4 Home Phone: Work Phone. SPECIFICATIONS Appf ox Start 2 w Ic. Approx Completion -- ' EYgrade of Shingle: &cW tecNyA1 SPECIAL INSTRUCTIONS �tyle of Shingle: L-"&ylq P— u t' v olor of Shingle: Y Ridge Material: viAAj& c d Valley: I WS Lents: A)y4I Q + ✓i w, V4E*i QPlumbing Stacks: Av uS Metal Ed gi rktw /Tear Off: N Layers 5, Felt: S Ice & Water 5&j Pitch: I n t 2 Stories: 2 • dRemove trash from roof, gutters and yard Protect landscaping where applicable TWO YEAR LIMITED WARRANTY Roll yard and driveway with magnetic roller Two Years on Replacement&One Year on Repairs Furnish Permit Warranty Certificate&Waiver Issued Upon Final Payment SPECIAL ATTENTION AREAS TypeColor E] Skylights N I,-, ❑ Cover.Pool N ❑ Gutter Damage ❑ Driveway Damage ❑ Siding Damage Y N ❑ Emergency Repair Y ❑ Screen Damage Y N Chimney: ❑ Shutter Damage Y N Leaks: ❑ Deck Damage Y ❑ Interior Damage: General Contractor: Homeowner acknowledges PEAK CO ROOFING as a General Contractor and as such,will be entitled to %overhead and—L&—%profit,as allowed by Insurance industry standards. Terms:This agreement does not obligate the homeowner or PEAK CO ROOFING in any way unless it is approved by'the insurance company and accepted by PEAK CO ROOFING.When"price agreeable"is determined it shall become the final contract price of$ (T,IqK. q f (plus supplements)initial and the homeowner authorizes.PEAK CO ROOFING to obtain labor and material in accordance with the price and deductible agreement and the specifications set out herein and on the reverse side hereof to accomplish the replacement or repair.All insurance proceeds to be paid to PEAK CO ROOFING unless otherwise noted. • RIGHT OF RESCISSION-YOU,THE CONSUMER,MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION.SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN. EXPLANATION OF THIS RIGHT. Accepted by Homeowner on Date: /�8/ to BY 0—a gme�� Payment Method: Pay Upon Completion of Each Trade By: Field Rep UY 1 Y �� o , j Cil 1 Management Approval • e The Comtnoni-t•ealth of'.11ctssac.-huserts ' Departmetrt of Industrial:-1 ccirlettts Office t)f'hivestii;atiotas. 600 J-Vashiti;ton S'treer kostotE. .II.1 0 111 1:rTf.rot'.tn:ress.�Q1'/flirt . Workers' Conipensatioii'lnsut Etnce:�ffida%!it: Builders!C'otttractoasi'Electa•ici,,inslPlumbeas • Applictult•Information Please Print Leelbh' r ' Ntllllc 1ili.lCiiill l - � __......- Address: ✓ !` iJ City s ate:Ltp: i�rtl���.�i�y� { !'s�._�._�r� _ Phony' --._.... _.....-- --------_..—,--- I :ire you an emplover?Check the appropriate bos: I j Type of project (required): • I1 l.❑ ( am 8 employer with .1 i 1-am 8 laencral contractor an:.1 i u. [;\.w;construction ,. emplovees ffuil and or Part-time;. n:14"c 1?1rcC the SUb i entractors ( I . ❑Remodelin-a I am a sole proprietor or partner- i(sted on the attar ted sheet. = 'I hese suh-contractors ha�•e �. Demolition :•hip and have no employees. I. ❑ working for ole In an\'capacit%. (1i kers cJtnp. 1P.SUZa7?cc. ; ❑Luildim,addluon y �. �j'1\e are'-a corporai.ion an C:iLs \i.\F'orl:er� COn1P. 1n5Ufani:e I lil,17 Electrical repairs or auditions ' reclui.reu. officers hive exercised their o. t right cif exemption per_\RIL .i I 1 i.❑ PILunbin�g repairs or additions ❑ t•.m a homec�il-ncr x4171..all\t'Jr� , ld� myself. I\���+orkarp s' comc � 5•t 4'.and we have no . . Kc)o( ep'•• s Jj insurance required.J ` emp(r,yees.•(':o;'corers l; ;)theyr So111P. ll1SLlZt?'."icc jet('u1rc.G.�1i f ..•1ny applia:nt that che&s bax=t taus also ell"(wt the scuion belaci sh u iug their corkers'campatiafttion(olio}'intbmtation. Homeowners w1w submit thisaffidavit indi(7 wle thea arc(foie all work-w",;then dire uutaide c.+ntractor moat 1,ibmit a•ficw,itl avit indiustine such. rC ottttmctora itiaL dlc&this bi+R moat ailached w additional sheet:9iawitie the name otlhc*Ub•conuuaors and their workers'comp.policy information, 1 am an emp(o_1'er that is pro'ii;hkg wurkers'compensation insurance far rxl uttplr�t ees. 13c�101r is the poli el•an job sue irtfornmation. li Insurance Compari 'Name: eL_d+� f^' 1��(_CL •i— �011i\' 70 or Self-ins. Lic. ' r t _Li !t� Expli'dllOn Date: �i i ibaLo .lob Site.-address �_.._..._..__.-___.-_----.---___...___....._..-....__.....--.-- � l ---•—' _attach a copy,of the workers'compensation policy declaratidn page(sho1ving the polic}•number and expiration dL,te). Failure ti)secUr e c:o�,era-*e as required under Section 25:'1 of MG.1 c. 1 52 can ie,ad to the imposition of Grin" pc naiiies of a r fine up to S1.5ili).tn.l anchor one-\•ear imprisonment.as\G.ell•as ci�'tl penaities in the torn of a S' UP��012� URI)1=.R:�nd a fine of up t0 5��i?,.It 1 a day against the violator. Be adeised that a con:of 11115 staienlent mai be (or warded to the Office of � inves6L-fations of the.DLA for insurance covera'ae vorification. I.da herei7r cer�ti y ruler the ;urs analpenalties afperjury that the information provided above ' true and correct. 51'�natutc: date '? S ' bb one o0 Ph � ' Official use only Do not write in this area, to be completed br city or town official. Cite or Town: PermitiLicense# Issuing Authority (circle one):- I. Board of Health 2. Building Department 3,Cit"'n'oi'n Clerk -t• Electrical Inspector 5. Plumbing Inspector 6. Mier Contact Person: Phone#: ACo CERTIFICATE OF LIABILITY IN FDATE NY) INSURANCE RAN CE 07/08/2016 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: DAVID A. NICKERSON DAVID A. NICKERSON PHONE' 1.978-443-3332 FAX N„978-443-7527 G.B. NICKERSON INSURANCE AGENCY INC. ;oRess:DN GBNICKERSON.COM 321 BOSTON POST RD, SUITE 4C INSURERS AFFORDING COVERAGE NAIC# SUDBURY,MA 01776INSURER A:TRAVELERS INSURANCE CO INSURED CARL HUME INSURER B:WESTERN WORLD INSURANCE CO ' DBA PEAK ROOFING CO. INsuRERc: __ _ • 119 NECK ROAD INSURERD: LANCASTER,MA 01923 INSURERS: 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. ILTR TYPE OF INSURANCE NSIR ADDL SU POLICY EFF POLICY EXP N D WVDER POLICY NUMBER MM/DDM^/Y MM/DDIYYW LIMITS B X COMMERCIAL GENERALLIABILITY NPP8082316 03/22/201603/22/2017 EACH OCCURRENCE $ 1,000,000 DAMAGE T RENTED CLAIMS-MADE X I OCCUR PREMISES Ea occurrence $ 50,000 MED EXP(Any one person) $ 5,000 PERSONAL 8 ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 1,000,000 RO X POLICY 7jECT 7 LOC PRODUCTS-COMP/OP AGG $ 1,000,000 OTHER: $ 4UTOMOBILELIABILiTY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS Per accident $ UMBRELLA LAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ A WOREMPLOY RS'LIAILIT 7PJUB-96651_15-4-14 09/17./201 5 09/17/2016 X]STATUTE EER” AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? a N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000. If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS7 VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN TOWN OF NORTH ANDOVER ACCORDANCE WITH THE POLICY PROVISIONS; NORTH ANDOVER,MA AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and loao are reoistered marks of ACORD • License: CS-102263 � CARL HUMT ' 119•NECK RD' Lancaster MA 01323 _ Comm,ss.ane; 01/13/2017 office of Consumer.s„rair�&Bdsiness it 5uiai of i'UME IMPROVEMENT CONT RAC—;.OR Registration: ;23204 Type: Expi atiors: 1/2/2017 irdviaual 3 CrCHOME CARL•HUME .119 NECK RD. LANCASTER,MA 01523 I ndersecretary