Loading...
HomeMy WebLinkAboutBuilding Permit #324-14 - 405 CHESTNUT STREET 10/4/2013 TOWN OF NORTH ANDOVER L� APPLICATION FOR PLAN EXAMINATION �) I Permit N0: Date Received Date Issued: J$tbh IMPORTANT:Applicant must complete all items on this page LOCATION'-- U , f ��� �1! 'S-r. Print Y PROPERTY OWNER l � J e°�I-1.41 - - Print 100 Year OId Structure TyeVnQ MAP'NO:A/� PARCEL•: W,ZONING DISTRICT: Historic District-Machine.Shop Village TYPE OF IMPROVEMENT PROPOSED USE Reside � Non- Residential ❑ New Building Rr6ne family: ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well' ❑floodplain ❑Wetlands ❑ Watershed3District� Water/Sewer ESCRIPTION OF WORK TO BE PERFORMED: ©Ifsy Identification Please Type or Print Clearly) OWNER: Name: 0 'she 6 �� T� Phone: s�, 7P3 cl,9� Address: �M,6` tib eoS7,AAl r- l Ale 14-81.)0 -C x MA 0/NS's CONTRACTOR Name: > -1' S6IYS Phone: Address: Supervisor's,Construction License �"� /a� Exp: Date: _ Home.Improvement License: fa3�� Exp. Date: -7Z=711 ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BOLDING PE IT:$12.00 PER(Y290.00 OF THE TOTAL ESTIMATED COST BASED ON 125.00 PER S.F. Total Project Cost: $ �3 W® FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access tofiNr guaranty and &g'ri ure_ofAgent/QwnerSignature of,contractor ', Plans Submitted ❑ Plans Waived 0 Certified Plot Plan ❑ Stamped Plans ❑ Location 4665 G-es�f,44 Mlu& No. Date • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ v Check# �! r r� 2 6 9 5 y Building Inspector i I Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/13ody 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 e Zoning Board of Appeals:Variance, Petition No: Zoning Decisionfreceipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments P- ,.Water&Sewer ConnectioniSignature&Date Driveway Permit 'DPW Tows Engineer: Signature: Located 4 O ood Street FIRE DEPARTMENT -Temp Dumpster on site yes no Located at'124 Main Street Fire Department-signature/date COMMENTS Y 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 I i NOTES and DATA—(For department use i I I i I ® Notified for pickup - Date ` E Doc.Building Permit Revised 2010 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 a 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 o 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) o 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) u Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses o 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 o 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 submAted with the building application Doc: Doc.Building permit Revised 2012 r 1NORTH ve- .. 324— 14ver, 2a13 Mass, C O[NIM HI WICM � S U BOARD OF HEALTH PERMIT T LD Food/Kitchen T-1 Septic System V 'j BUILDING INSPECTOR THIS CERTIFIES THAT a .• 4 o s ` w tc�'�" .r C Foundation has permission to erect .......................... buildings on .................. ..�.............................. .... ............ Rough to be occupied as ......... f7 ........0 ....... . . r1 iGet�etr;�s .............................. Chimney provided that the person accepting this permit shall in every respect conform 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 PTARTS Rough Service ............. ... ...�...................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz 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 �G7RL7� crcm 1 yr 09!11/2013 IIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS _RTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND EXTEND, OR ALTER THE COVERAGE AFFORDED BY THE POLICIES :LOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED ;PRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. PORTANT-. If the certificate holder is an ADDITIONAL INSURED,the pollcy(ies)must he endorsed. If SUBROGATION IS WAIVED,subject to e terms and conditions of the policy,certain policies may require an andorsemenG A statement on this certMasite does not confer rights to the ,rtificate holder In lieu of such endorsement(s). uCER 00775-001 NAME.CT — - 50&Jankowski Insurance rkgr a E«I); (878)682-517$ plC.Ne.: (970)784-0313 Mass Ave Suite 101 B �Elss; — th Andover,MA 01846 .Jt�R1I8F.BIEIAPFOr�p�N9L^�.SL�Cr �,_ Inti. IolSl1BELIA�_ -- A.I.M.(AR)Mutual Insurance Company 33758 .. IED rurwalshINSL1EiEB.4.a_-.. _ --- I Walsh&Sons Pleasant Street — _ — th Andover,MA 01845 sjmRa; VERAGES CERTIFICATE NUMBER: REVISION NUMBER: 4IS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR TME POLICY PERIOD RTIFIC TE MAY BES ISSUED ORNMAYEPE TAIN,NTHE INSURANTERM OR CE AFFORDED BONDITION OF Y THE PO CES CT DESCRIBEER D HEREINisWITH RESPECT TALL TTHHEICTERMS [ELUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, TYPE OF INSURANCE 1 � POUCYNUMBER — A MEW I LIMITS GENERAL LIABILITY EACH OCCURRENCE S _ NTED COMMERCIAL GENERAL LIABILITY D5@3IE�EG -.•-g' CLAIMS MADE OCCUR MED EXP(Any ons person) 6 PERSONAL&AOV INJURY S GENERAL AGGREGATE EN'L AOOREGAT6 UNIT APPLES PER; iI PRODUCTS-COMP/OP ANG 5 OUCY _ RO OC -- -- -- "' '"" -- •COM81NE0 SIN2`,1.1=•LIMIT S AUTOMOBILE LIABILITY 1�)-• . - -•ANY AUTO SOOILY INJURY(per perevr) $ _ _ ALL AUTOS eo AUTOS 60HEDULEC BODILY INJVRY(Per aceWenU S - -' NOA OS NOYMNEO PROPERTY DAMAGE _ HIRED AUTOS AUTOS (PecA>addnz>!ti_ UMBRELLALU9 OCCUR _ EACH OCCURRENCE b EXCESS LIA9 CLAIMS I AGGREGATE $ -_ DED RETENTIONS $ " wy���t�tKKEQ_gqg���.��-��ppENggpp•��pp�� .. . .. _. — yy��ggTTpp���� TH AND EMP WYER�IABIUTY x /ANY qo q�EtQglp�q Eq/E LN, E.L.EACH ACCIDENT ER S 100,000 U�p10ERPtAEPABER EXG DEo7 C� FN I NIA AWC7014648012012 11/14/2012 1111412013 E DISEASE-EA EMPLOYEE S 100,000 IppMondxlo7lA NunHPERATIONSbel d) ... _ .. ._ CffiODPOow El Oi8EASE-POLICYL1M17 $ 600,000 ASCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Adeltlonal Remarks Sahedais,It more space Is req,nred) ,ERTIFICA E HOLDER CANCELLATION own of North Andover 000 Osgood Street SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE forth Andover,MA 01645 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUT10AMOD REPRESENTATIVF ®1 S e-2010 ACORD GORPORATION.All Fights reserved. %CORD 25(2010105) The ACORD name and logo are registered marks of ACORD El 'd ILZCON AONYMNI GhVIDOM Wdz[ :� �10z 'k mr ' � �Aassac� �s�'s "iE at ;�,� +�• -�:., Sar r S . E erase CS-022680 rt ARTHUR J WALSH JR 159A WAVERLY"- N ANDOVER MA 01845 06/09!2014 Office of Consumer Affairs&Busi ess Regulation J/ „ WHOMEIMPROVEMENTCONTRACTOR (v heg istratio n: 103358 Type: MW;Expiration: 7/7/2014 Private Corporatic rte'' A.J.WALSH&SONS,INC. Arthur Walsh,Jr. 55 Pleasant St N Andover,MA 01845 Undersecretary Propomil Page# of pages CS # 022680 978-688-6737 HIC# 103358 A. J. Walsh & sons or 55 Pleasant Street 1-866-AJWALSH .North Andover, MA 01845 Proposal Submitted To-"M Job Name Job# Address r n� Job l.ocatio� Date Date of Plans Phonef#V qqjoFaz# Architect We hereby submit specifications and estimates for._ .......... We propose hereby to furnish material and labor—complete in accordance with the above specifications for the sum of: '� a . goo Dollars with payments to be made as follows:T�f Any alteration or deviation from above specifications involving extra costs will be Respectfully executed Doty upon written order,and wiA become an extra charge over and submitted // ��/ above the estimate.All agreements contingent upon strikes,accidents,or delays U beyond our cohtrol. Note—this proposal may be withdrawn by us if not accepted within days. �cce�tartce of o�o�a(Y�Q�� The above prices,specifications and conditions are satisfactory and are o, Signature hereby accepted.You are authorized to do the work as specified. Payments will be made as outlined above. Date of Acceptance ������ �. Signature i ➢ePar°tnment of Industrial Accidents Office of Investigations ,r 600 Washington Street Boston,IVA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers )plicant Information J/ ` Please Print Legibly tme(Business/Organization/Individual): (/�( �Tp/V ��6�16 [dress: c.5 �Ce4i 8 Al Ar Sr .y/State/Zip: VO 4140GY/e—(� ✓WA Phone#: you employer?Check the appropriate box: Type of project(required): am a employer with_ _ 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6 E]New construction I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. F1 Demolition working for me in any capacity. employees and have workers' 9. ❑BuiIding addition [No workers' comp. insurance comp.insurances required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions I am a homeowner doing all work officers have exercised their 11.❑Plupbing repairs or additions myself [No workers'comp. right of exemption per MGL 12 oof repairs insurance required.] I c. 152, §1(4),and we have no employees. [No workers' 13.0 Other comp.insurance required.] )plicant that checks box 91 must also fill out the section below showing their workers'compensation policy information. owners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ctors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have ,es. If the sub-contractors have employees,they must provide their workers'comp.policy number. !n employer that is providing workers'compensation insurance for my employees. Below is the policy and job site 2ation. nce Company Name:_ #or Self-ins.Lie.#: 7�M/4 r16Q /ADO�,� Expiration Date: :e Address: ��/4(.7' Sr City/State/Zip: Aooell� a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). to secure coverage as required under Section 25A of MGL e. 152 can lead to the imposition of criminal penalties of a to$1,500.00 and/or one-year imprisonment,as well ascivil penalties in the form of a STOP WORK ORDER and a fine D$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of gations of the DIA for insurance coverage verification. !reby certify under the pains and penalties of perjury that the information provided above is true and correct. are: �- p Date: /a 113 72 7 Wal use only. Do not write in this area,to be completed by city or town offrciaL r or Town: Permit/License# iing Authority(circle one): .oard of health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector tther start P4rsnn- Phone#- I