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HomeMy WebLinkAboutBuilding Permit #277-14 - 37 BRADSTREET ROAD 9/25/2013 T TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: e2-7 7 Date Received Date Issued: 1 IMPORTANT: Applicant must complete all items on this page a. 1 •i 3 2 fi 53-�-�^ S�'k.: "�'' ,,, {, k' i. Y* '' '+d '�' 9 77m" x '' s, lL�OCAT=I®N 3�' 6�t'a.cSlS eek X ter°..'- •aytakw.v :�-.-. .�-�a ..s-.. ,.a .e .tS - -3xrs.+.�..e�.,..a "z'-...�---.�+� Yui,.-P tn,..«...�s=-,.t...�..az�,.-.[ "z 5 [' �`' -r.dr+s•..—asp-r ._.,,te'''e PROPERT>YOWNER �Th ..a a.�-c wR t r , 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 " ❑ llite Floodplain.,� D�Wetlands,;�,�'K O V1latershed District4„ S7 .T. .7. :s.x.>, .�_.c..�'7�:3.-_ DESCRIPTION OF WORK TO BE PERFORMED: Y Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: ;',.^' #T.-r rx 4.+tx�K.�.•-, ,ice,"a+ .�+ 1..Y w+. .{scat.a.P'�X :,� i Pr x.�ncr.+., -r t'a:�=+e4 rt s_ "+az`�---`gra '•z: -rr ,a+..,r ,gh ." ,' • a''xt 1* g+atx:� �s.'Cw Q7 -10M Name i 7..-.-f d � r d�- a'° '' , £s 'mss prs.. �r +.*. z.c���,-'TA '4'C, raw +wr sc"t �, -„ .y ♦y st' • 4191-21 F 1(� AddreSS1�� `l &IrS�� '� 3 r +mos •eco.-,c� t.V O �..�-....r. t..�.�..,A. ..=a �4.- aY,� . ;r..e.t3��{ ,�'7` 'y'.'• ,�a y. �1,�` "-"+ � .w Y.,34 �-'s`-� '-moi a .!T p -7 - I' ;,4#.`®" TSU eIVISO('SCOnStrUCtlO�n Licenses �, *w v�sitr irsw� -s•' u*"# n� �:� 1�� '43 3....y-'� �' .IEXp���te'�i. 1�.. �.+a.l -� I 1 ,.�.*a� �jcaabr�. ' S.� r7a�rs 'S`x ;y�. "5 4);fi,,' "' '''r 3 -� u y''x '.7 -5, -S_-d#s,+., ., �x'`�' ,• t .J.F�- .7' .: �. :`w� ct s:. �.�+.i,�,i-. t� 'S,r; "�„ "A �''# #+ .eye` •'t� 7C *-. ti's 1 '�t C" '',. x L q`;q `a. HomeImprovementLicense �, ll a1� _ -;.'w'..+ya x'i�..t, 'cd.,eWa^-�+.s.+--e.zY.'.-. ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 0 .C) C2 FEE: $ Check No.: Y57 Receipt No.: 0\ NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund `Signature of Agent/Owner Signaftare of contractor `" r ' 't" .. e Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ Location I No. Date !S� • - TOWN OF NORTH ANDOVER x . Certificate of Occupancy $ j Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ E: TOTAL $ Check# 26907 Building Inspector t Location i No. 7 '/y Date . - TOWN OF NORTH ANDOVER DAjbg6� s • Certificate of Occupancy $ =" °R Building/Frame Permit Fee $ /� U Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check.# 26907 Building Inspector f 4 r r t 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 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 DP`'dV Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on siteyes no Located at 124.M0in'.Street Fire Depainent signdturelddte 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 lies No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$10041000 fine NOTES and DATA— (For department use El Notified for pickup - Date Doe.Building Permit Revised 2010 f 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) o 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: Doc.Building permit Revised 2012 NORTii own of E ndover o - to No. Y 10h ," ver, Mass, COCHICHt WICK 'tf,9 A�Rg TED S V BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT ......1...:./ ....G( �5. -2 .................. ......................................................... BUILDING INSPECTOR has permission to erect .......................... buildings on J-Y... ........................................... Foundation Rough to be occupied as /ULl/R/ '.�.`.y..... //a1��5...........!!/ (�Cl .................................... Chimney ................ ............ .... .... ....... provided that the person accepting this 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 CONSTRUCTION STARTS 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 �`' > ' CONTRACTOR WORK OR®ER ,.. J U L I 12013, `iw��JUYY`.'N �i';1hvAld1'1 Services C;ou L ►�� �6 50 Washington SL Suite 3000 BY.- ...... ........ ; Printed: 7/11/2013 Westborough,MA 01581 Work Order Id: S23752P27876C209 Contractor..lrrFormatlon Customer/Site Details A&M Contracting Matthew Walsh Phone(Eve): 978-886-8554 1198 Foster St 38 Bradstreet Rd Phone(Day): 978-835.3435 Peabody, MA 01960 North Andover, MA 01845-3936 Site ID: S00002123752 . ; Total�nstalled::Measu�es` Location Description Quantity Unit$ Total$ Living Space Insulate Buffer Wall From Interior With 4"Den 2,265 $2.11 $4,779.15 Door Sweep 1 $21.17 $21.17 Living Space Perform Air Sealing at Estimated 62.5 CFM50 10 $77.00 $770.00 Exte6or Door Weather Stripping 2 $25.20 $50.40 Installed Measures Total $5,620.72 ...;:: :. : �. � •�.: Road�Bloctcs Type Status Notes Asbestos UNKNOWN steam pipes Knob&Tube Wiring FIXED 5/31 -cleared lic 4 22666E for Ext Wails&attic FL open-AM ....,,.. �., <. ........... .. . . . .: - WorkOrdei• Votes. Payments Incentive Payments Air Sealing Incentive $841.57 Weatherization Incentive $2,000.00 Total Incentive Payments $2,841.57 Customer Share Total Customer Share $2,779.15 Less Deposit Of $0,00 Customer Share Balance(Due Contractor) $2,779.15 Conservation Services Group-50 Washington Street Suite 3000-Westborough, MA 01581 -(508)836-9500 A&MGE-1 OP ID:SM ACORO' CERTIFICATE OF LIABILITY INSURANCEDATE IMMIDOIYYYYI 0311417 3 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!leu of such endorsement(s). PRODUCER 781-914-1000 CNAOMNEACT TGA Cross Insurance,Inc, PHONEFAX 401 Edgewater Place,Suite 220 o�,nl• Wakefield,MA 01880 E-MAIL John Scanlon ADDRESS: - __— INSURER(S)AFFORDING COVERAGE I NAIC p INSURER A:Peerless Insurance CO INSURED A&M General Contracting,Inc. INSURER a:Guard Insurance Group Norman Dube 119R Foster St.Bldg 14 INSURER C Peabody,MA 01960 INSURER D: I INSURER E: -------- -INSURER - i 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. MSIR POLICY EFF I POLICY EXP LIMITS TYPE OF INSURANCE POLICY NUMBER D D/YYYY GENERAL LIABILITY i i ! I EACH OCCURRENCE S 1,000,000 A X COMMERCIAL GENERAL LIABILITY 1 ICBP8833284 03/20/13 I 03120/14 1 PREMISES(Ea occur ance� $ 100,000 ' CLAIMS-MADE i rX 1 I OCCUR (MED EXP(Any one person) $ 5,000 cl PERSONAL&ADV INJURY S 1,000,000 GENERAL AGGREGATE S 2,000,000 1 I GEEN'L AGGREGATE LIMIT APPLIES PER: i PRODUCTS-COMP/OP AGG $ 2,000,000 I POLICY I PR0- `LOC 1 $ iAUTOMOBILE LIABILITY ( i COMBINED SINGLE LIN 1 1 Ea acwjdeni) 000,000�S , A Px ANY AUTO � BA8762301 I 03/20/13 I 03/20/14 BODILY INJURY(Per person) $ ALLOWNED I XII-SCHEDULED i I BODILY INJURY(Per acadent)j$ _AUTOS I AUTOS PROPERTY DAMAGE NON-OWNED HIREDAUTOS X (AUTOS I {Peraccidentl X UMBRELLA UABX i OCCUR ( i { EACH OCCURRENCE $ 11000,000 A ' I{EXCESS LIAR I CLAIMS-MADE! iCU8762501 03120113 03/20/14 AGGREGATE $ 1,000,000 }_DED I X 1 RETENTIONS 100001 ! I i W, S WORKERS COMPENSATION i I i X I WC STATU- OTH- AND EMPLOYERS'LIABILITY 7�1 1_EfZ B ANY�PROPRIETORIPARTNER!EXECUTIVE Y I N I �AMIWC345622 i 03/20/1303120114 E.L EACH ACCIDENT {S 500,000 OFFICERIMEMBER EXCLUDED? N I N I A I 111I (Mandatory in NH) + i E.L.DISEASE-EA EMPLOYE $ 600,000 If yes,descnbe under {II — --------------- _ ..__._. DESCRIPTION OF OPERATIONS below E L.DISEASE-POLICY LIMIT $ 50000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Addliional Remarks Schedule,if more space Is required) CERTIFICATE HOLDER CANCELLATION TOWNAN1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 120 Main Street North Andover,MA 01846 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD q u (R''gulatiun er ASSairs&' pR Consum CpNTRpCT Type: Otr�ccE;MpRpNX-mle 1T rd Supplement Ca ` NpM tion 141124 Regst,{tion: 1112i214 C +M G E RA ENt-CDNTRAC'lING 1N FkVGE�DE � crsecrctarY MlGHpEl Ckp A-lnd ooTN RkD(,E , LYNN,MP p19p4 t ;1. �(lassacouSe ding Reg uiar�� o{ Bu r,i�»r pc } $Oarr stir n ."tire -09g933 �un�trU a CSS%. I �rai1�1018 10 overlook p19t0 dy peab° ,'` 0611912+�1d I The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 1 Congress Street, Suite 100 - Boston,MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl Name (Business/0r aniztttion/individual): ener'm t'c+c Address: T T�f s City/State/Zip:Peo Phone#; e(7�- 71 - 7 7 7 '7 Are you an employer?Check the appropriate box: general contractor and 1 Type of project(required): 1� 4.i am a employer with ❑ I am a g employees(full and/or part-time).* have hired the sub-contractors 6. ❑ 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 8. ❑ Demolition working for me.in any capacity. employees and have workers' [No workers' comp.insurance comp. insurance.* 9• E] Building addition required.] 5. ❑ We are a corporation and its 10.[1 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 insurance required.]f c. 152. §1(4), and we have no 12.0 Roof repairs 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 Homeo„mers 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.poliev number. I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name68 Cross 1�iSUr'a�rc�e 1�� Policy#or Self-ins. Lie.#:�M�1C3 Expiration Dater —a0 Job Site Address: *'ci • Tee T City/State/Zip:Po,rl hode U bI Sys Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).3936 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. Ido herehv cern y under the-pains and Penalties o er ury that the information provided above is true and correct. Si nature:'' w - Date Phone#: 9_2?- 7Y/ --7T77 I i 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#: l �`,�ti 4petBlSOi«i �b 4 w o m � r mass sere PARTFCIPATING CONTRACTOR PERMIT AVTHORIZATION FORM y\ (r ; <7r' ; ,owner of the property located at: (Owner's Name,printed) (Property Street Addr (City) hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed below to act on my behalf and obtain a building permit to perform insulation and/or weatherization work on my property, NQ�•,� t�e�� rr.Afth(of Pdalsn(dun S.2G1 3) X owner's Signature Date Jun 9, 2013 Date FOR CSG OFFICE USE ONLY Conservation Services Group has assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: Participating Contractor -- Date Rev.12132011 A & M General Contracting, Inc. 11.9R. Foster St. Peabody, MA 01960 (978)532-8025 Fax (978)532-1033 Jan. 1, 2013 To whom it may concern, Neil Moore has authorization from 1/01/2013 until 12/31/2013 to pull permits for this company using my licenses. Any questions, feel free to call the office at number listed above, or my cell phone 508-726-1058. Sincerely, Michael Fitzgerald Operations Manager ^ n Signed t S day of -S , 21 N t/'���0 i pre date.