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HomeMy WebLinkAboutBuilding Permit #314-2016 - 39-67 Saunders Street 9/8/2015_ Se�i✓wE17 P/arks Na-t t%0RTN BUILDING PERMIT o� qw• tt LED 16 'Y TOWN OF NORTH ANDOVER o APPLICATION FOR PLAN EXAMINATION Permit No#: �31�1-1?616 Date Received q I D " -A �.9 ADRA7E0 .PP,`'�5 SSACHUS� Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION 67 `juyickf lqrAj,PROPERTY OWNER rint&j?l I� 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 XTwo 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: Orda bv- SL4E, Phone: q1b•40q Z2r 7 Address: law. ! ,tr "A- 01010 Contractor Name: .V"coS Lt C, Phone: } •4D z 1 Email: Address: 4-44 /V- A= o Supervisor's Construction License: C1 - 1055 18 _Exp. Date: Home Improvement License: &-J -r2,- Exp. Date: 5 1^7 ARCHITECT/ENGINEER 04& z Phone: ql� `T70 Address: vlti `7 � Q.r !� 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: $ /00 Check No.: Receipt No.: Q7.33( NOTE: Persons contracting with unregistered contractors do not have acces to the guaranty fund tor gent/Owner Siqnature. of contractor 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 PLANNING & DEVELOPMENT Reviewed On �� �� Signature_ COMMENTS C 3 :5k& d0fd- Pe& 30 Z&Y CONSERVATION Reviewed on - - l� Signature r G'V r IM NTS 0 i HBINLTH Reviewed on Siqnature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes t Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/s! nature& Dater4g4� Drivewav Permit DPW Town Engineer: Signature: Located 384 Osgood Street FI_REDEepPAM -Nmerpn,4sie, y"es__stiol a_ Locatedlaf:12:4�Main<Stieet• ; Fire D;ep00_gnt:s.ign_ature/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) C i? ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building 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 SII 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 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/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 m ust be submitted with the building application Doc:Building Permit Revised 2014 Location No. Date w • - TOWN OF NORTH ANDOVER • SLED 16 . +� • Certificate of Occupancy $ Building/Frame Permit Fee $ bo Foundation Permit Fee $ 5. Other Permit Fee $ TOTAL $ M Check# Building Inspector r , NORTFI ve" 'o o .� � � No. - ��� ver, Mass, f�© o / :!5 CONIC Nl WICK �1' �ds RATED PP�,`'�y V BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT � /' 7� A'Al4f BUILDING INSPECTOR ...... .��?.�l.:s ..:G.......... ......�r � ..... ................................................ "7 ��,KG` F,,s Foundation has permission to erect .......................... buildings on..�9::...�../.......................................................... ��� 14 Rough to be occupied as �.. ...........................................................1; !t/ / y ............................. .... ................ . ....... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the a plication 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 CONSTRUCTI TARTS Rough y Service ........... .....G� . . ......................................... Final "z--RUILDING 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. ,4COOR vim® CERTIFICATE OF LIABILITY INSURANCE 9�8�2015) 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 CONTACT Lisa London NAME: MTM Insurance Associates PHONE (978)681-5700 FAX wo,(978)681-5777 1320 Osgood Street EAI ML .lisal@mtminsure.com INSURER(S) AFFORDING COVERAGE NAIC# North Andover MA 01845 INSURERAAtain Specialty Insurance INSURED INSURERB:Safety Insurance Company 9454 Verdeco Designs INSURERC: 1 Elm Square INSURER D: INSURER E: Andover MA 01810 INSURER F: COVERAGES CERTIFICATE NUMBER:15-16 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM/DD MM/DD GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED 100,000 PREMISES Ea occurrence $ A CLAIMS-MADE Fx-1 OCCUR CIP159979002 /17/2015 /17/2016 MED EXP Any one person $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 T POLICY PRO LOC $ BINED AUTOMOBILE LIABILITY Ea accid.n1SINGLE LIMIT 1,000,000 ANY AUTO BODILY INJURY(Per person) $ B ALL OWNED SCHEDULED 5057753 /17/2015 /17/2016 AUTOS AUTOS BODILY INJURY(Per accident) $ XX NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS peracadent UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED I I RETENTION $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY YIN N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? F N I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,'rf more space is required) This certificate of insurance represents coverage currently in effect and may or may not be in compliance with any written contract. 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. 1600 Osgood St. N Andover, MA 01845 AUTHORIZED REPRESENTATIVE M Laorenza/STEPH ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INRn95 r,)ninnsi ni Th.ArnOn —I Innn ern renicfornil—L—of arnRf1 k---- CERTIFICATE OF LIABILITY INSURANCE 7i1512015 THIS CERTIFICATE ISISSUED 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 c Drtificate does not confer rights to the certificate holder in lieu of such endorsements(s) PRODUCER CONTACT NA MTM Insurance Associates,LLC rac No Ext): (978)681-5700 FAX ND.:) 1320 Osgood Street A RIESS: North Andover,MA 01845 PRODUCER CUSTOMER ID#: INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Atlantic Charter Insurance Company VDAC 44326 Verdeco Designs,LLC INSURER B: INSURER C: One Elm Square INSURER D: Andover,MA 01810 INSURER E: 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. INSR TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR INSR WVD DATE(MMIDDIYY) DATE(MMIDDIYY) (In Thousand) GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES $ --1 F-1Ea auunen CLAIMS MADE F] OCCURMED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY ❑PROJECT ❑LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea Accident) BODILY INJURY $ ALL OWNED AUTOS (Per person) SCHEDULED AUTOS El BODILY INJURY $ (Ea Accident) HIRED AUTOS PROPERTY DAMAGE $ NON-OWNDED AUTOS (Ea Accident) IUMBRELLA ❑ OCCUR LIABILITY EACH OCCURRENCE $ EXCESS LIAR❑ CLAIMS MADE ❑❑ AGGREGATE $ DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION AND WCV00951304 03/04/2015 03/04/2016 X LIMITS STATUTORY A EMPLOYERS'LL4BILTTY OTHER ANY PROPRIETORIPARTNEWEXECUTIVE YIN OFFICERIMEMBER EXCLUDED? � WA Policy Coverage State:MA EACH ACCIDENT $ 1,000,000 Mandatory in NH If yes,describe under SPECIAL PROVISIONS below DISEASE-POLICY LIMIT $ 1,000,000 DISEASE-EACH EMPLOYEE $ 1,000,000 OTHER ❑❑ DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLES(Attach ACORD 101,Additional Remarks Schedule,H more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Town of North Andover EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 1600 Osgood Street 12 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. North Andover,MA 01845 BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. UTHORIZED REPRESENTATIVE ACORD 25(2009/09) Page 1 of 1 CERTIFICATE HOLDER COPY ©1988-2009 ACORD CORPORATION.All rights reserved. Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-105187;' Construction Supervisor MARK J YANOWIT2? �rFN ONE ELM SQUARE ANDOVER MA 01810 „ 1 1 Expiration: Commissioner 07/11/2017 i ASSESSQ�S.• MAP 29, LOT 23 REFERENCES: DEED BOOK 14086, PAGE 314 S PLAN 117146 DSR RECORD OWNER.• BRADSTREET PARTNERS, LLC (PUBLIC .- 40' WIDE) STREET o !y rn 2 119.78' 1 9.9' 4ty\ _C0 CLEVELAND STREET LLC Q,�4^ PROPOSED. DEED BK.12791, PG.105 ��� VdC'V THREE PLAN #2815 STORY _T _7 BUILDING o<v COR. N {TO . YP) AMERIQUEST o r MORTGAGE SECURITIES, INC. IL DEED BK.12655, PG.70 C) o PLAN #2815 4.1 44 ry LOT AREA 49,086 S.F.t co4Qo o 1.1269fAc. / Q o 00 oQ o rn m -0 o N 0 DO D J Ul Ul Z0Z O 0 � O (n OD . Q) Y cr mr � n o 0i 198.62' Ai M A I N S T R E E T (PUBLIC - 60' WIDE) (1896 COUNTY LAYOUT) H �f 14Qga,_ w4 PLOT PLAN ' CHK. BY OF LAND WCJ NORTH ANDOVER, MA PREPARED FOR.- BRADS7EET PARTNERS, LLC DA IE' 919115 HANCO CK q.q. 15 Survey Associates, Inc. SCALE.• 1" = 30' JOB 185 CENTRE STREET, DANVERS, MA. 01923 N0. P FES N AND SUR YOR VOICE (978) 777-3050, FAX (978) 774-7816 p . 30 60 �80.90: F.%Land PYa/rc&82118090%ding% A0A0-fW9dW.d•g SW 09 2015- e:17 am