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HomeMy WebLinkAboutBuilding Permit #513-14 - 41 SECOND STREET 12/26/2013l p�NOoT6q�C BUILDING PERMIT TOWN OF NORTH ANDOVER - APPLICATION FOR PLAN EXAMINATION ;, , y ,� / Date Received '9 Permit NO: Date Issued: r �9SSAc►+us IMPORTANT: Applicant must complete all items on this page ..3— LOCATION- W S E' C CGQ I C Print PROPERTY OWNER C Q VQ Q> 1 r4 1:1rint WiLlIf MAP NO: PARCEda)5 ZONING DISTRICT: Historic District ye Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential i -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 ILb ,I _vu,, C-t�OOAY.V4 � PSN e%/I -/ . 0 Identification Please Type or Print Clearly) OWNER: Name: GSN £ o 1 4 Phone: Address. 5 S et Q° A CONTRACTOR Name: 4',7 8-95`7 o'1`73 Phone: 5'0 -3 2 0 —3 -7 -76 cr M i c hg� lyl Cis— Uzi Address: Supervisor's Construction License:Oa 3 Exp. Date: l _ a Home Improvement License:1 a 3 Exp. Date: q 13 —o�Y ARCH ITECT/ENGINEER r,#7 F/A u\K£K(_// c -' Phone: Address:R5' x014, k 4? c4 0%,q 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: $ Li% oob — FEE: $ Check No.: 6"'a, Receipt No.:9 i 14 2 dn NOTE: Perss contracting with unregistered contractors do not have access to the aran fund Signature of Ager)tfbwner Signature of contractor/)V.,J41"/,&J cote,, A K Permit NO: LOCATION ' TOV,:N OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received IMPORTANT: Applicant must complete all items on this page Print PROPERTY OWNER - Print 100 Year Old Structure yes no MAP NO: 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 PERFORMEU: Identification Please Type or Print Clearly) OWNER: Name: Phone: ArlrJroce- CONTRACTOR Name: Phone: Address: Supervisor's Construction License: Home Improvement License: ARCHITECT/ENGINEER Address: Exp. Date: Date: Phone: 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 guarantyfund c Signature -of Agent/Owner Signature of contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ Plans Submitted �I" " Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OFSEWERAGE.DISPOSAL Public Sewer Tanning/Massage/Body Art ❑ Swimmin Pools ❑ g 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 COMMENTS i . DATE REJECTED El DATE APPROVED CONSERVATION Reviewed on / Sic natu e COMMENTS HEALTH COMMENTS Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes . Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/si nature & M64�nrjWrrnit NO 172A-IAJ ce!✓A/CCTIo DPW Tow;! Engineer: Signature: o ed 384 Osgood Street SIRE DIEPARTMENt - Temp Dumpster on site yes no Located at 124 Mair Street Fire Departinerit signature/d,at 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 — (F=or department use ® Notified for pickup - Date 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. Roofivg, 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 o Certified Surveyed Plot Plan o Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract o 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) o Building Permit Application ❑ Certified Proposed Plot Plan Li Photo of H.I.C. And C.S.L. Licenses Li Workers Comp Affidavit o 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 apv,,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.4ted with the building application Doc: Doc.Bui?ding Permit Revised 2012 Location 7� No. ��� — c� Date �26 71 Check # TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee Other Permit Fee $ TOTAL $ Building Inspector P: \09\09-18\DWG\CERT.DWG 47' N53.11 "E 100.00' _33,7 4" I LOT AREA 0 0 0 14,050 S.F. N62'20'26"E C4 PD EXISTING N FOUNDATION M v f 20' c0 57.6' 20' 20' C TOP FND. w =114.36 134.95' S62'19'26"W 0 Ln 0 6.3' O SECOND STREET N 00 0 W -P s rn I HEREBY CERTIFY THAT THE LOCATION OF THE STRUCTURE SHOWN ON THIS PLAN WAS LOCATED BY A FIELD SURVEY, CONFORMS TO THE SETBACK REQUIREMENTS OF THE NORTH ANDONER ZONING BY—LAW AND THAT IT IS NOT LOCATED IN A FLOOD PLAIN. I ti REG. PROF. LAND SURVEYOR CERTIFICATION PLAN 41 SECOND STREET NORTH ANDOVER, MASS. Prepared for BAYRIDGE DEVELOPMENT, LLC SCALE:1 "=40' DATE: 2-4-14 TOWN MAP NO.30 LOT NO.35 /�Kandover onsultants inc. 1 East River Place, Methuen, Mass. ,.✓�P�ZN OF Mgssgo� PETER G� o D a GOODWIN o NO. 48133 LSTERo L LAN P: \09\09- 1 8\DWG\CERT. DWG N53.7 11"E 100.00' r •-33.74„ LOT AREA 0 0 0 14,050 S.F. N62.20'26"E .1 (Ai J `0 o Vi 0 0 0 16.3' EXISTING N FOUNDATION v t(A2V (p 57.6' 20' 20' w TOP FND.w =114.36 134.95' S62.19'26"W SECOND STREET I HEREBY CERTIFY THAT THE LOCATION OF THE STRUCTURE SHOWN ON THIS PLAN WAS LOCATED BY A FIELD SURVEY, CONFORMS TO THE SETBACK REQUIREMENTS OF THE NORTH ANDONER ZONING BY-LAW AND THAT IT IS NOT LOCATED IN A FLOOD PLAIN. -- I -- M REG. PROF. LAND SURVEYOR CERTIFICATION PLAN 41 SECOND STREET NORTH ANDOVER, MASS. Prepared for BAYRIDGE DEVELOPMENT, LLC SCALE:1 "=40' DATE: 2-4-14 TOWN MAP NO.30 LOT NO.35 //Tandover consultants inc. 1 East River Place, Methuen, Mass. P\iH Of /fggss� PETER yG� o D GOODWIN o NO. 48133 G /STERo '�\ L LAN DATE (MMIDDIYYYY) "DANCE 111/2013 -.�12 A�r �rxc� CERTIFICATE OF LIABILITY IN Y AMEND, EXTEND OR ALTER THE CO U NG NSURER{S►AFFORDED BY TAU HORIZED THIS CERTIFICATE CATE IS ISSUED AS A MATTER OF INFQRM 4TION ONLY AND CONFERS NO RIGHTS UPON THE SHE CERTIFICATE HOLDER. THIS CIEWTIF CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATlV BELOW. THIS CERTIFICATE UOF CER ANDRTHE CERTINCE EFICATE HOS NOT LIDER.UTE A CONTRAbe Redo endorsed.IfSUBROGATION IS WAIVED, subject to REPRESENTATIVE 0R IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the po►icy(ies) mu the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to e certificate holder in lieu of such endorsement s. _._ T _SeLepl.Rept ext 66807 _ ---- (AIc, Nol:7$1-586_8244, ONE PRODUCER Group LLC -MainAIL P AI o�).F.nR_6 — Pastern Insurance ?_33 West Central Street MA 01760 ADDRESS: F.CtQneast rninsura_Ke.�___—_--- INSURERIS►AFFOROINGCOVERAGE _-_-____ Natick INSURER A :lective- Insurance Goof SC_ _-_ -- - - ---- _---------- - - INSURER B_, -„ t% Fmnlovers lnsurp_nce 25615. INSURED 16697 INSURER C :Charter Oaks -Fir -___ __------ - - McCarthy Bros General Cont Inc INSURER D -i. __ .. --_.--------------- .,._i -- - 483 Nashua Road Dracut MA 01826 INSURERE: - - - INSURER F REVISION NUMBER: HAVE BEEN ISSUE Sul:: M COVERAGES CERTIFICATE NUMBER: 289768320 DOCUM NT WITH THIS IS TO CERTIFY TH7ANDINGI:iOANYIREQUIREMENTES OF NTERM OR CONDITIONED THE CONTRACTTO ALECT L TERMS, DESCRIBED HEREIN S SUBJECT INDICATED. NOTVVITHS BY CLAIMS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFOR SHOWN MAY HAVE BEEN REDUCED PNM -- - EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. iL IMITS POLICY EFF ! POLICY EXP LIMITS DnYrr MSR I POLICY NUMBER LTR TYPE OF INSURANCE IN 'S 1849591 i - { 51,000,000 `712612013 712612014 I EACH OCCURRENCE_ T E TED A GENERAL 1 DA�MA 15100:000 ', PREMf$ESLEaouu�rence,L_! __. ` X COMMERCIAL GENERAL LIABILITY i 1 i MED EXP (Any one person) I sl0,000 CLAIMS -MADE IX. OCCUR i PERSONAL&ADV INJURY S1,00Q000 _ �X'� XCU Ir1CL _____ i I GENERALAGGREGATE 53,000.000__ PRODUCTS _ COMPIOP AGG - 53,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: ---, LI --- -X PRO- i LOC i POLICY ;`BA8181L358 INFO I' 01112f2013 11112/2014 (Ea I ent)—-5 -- ----_..._..---- 4 BODILY INJURY (Per person) $250,000 C AUTOMOBILELIABILIIY i __— -- - BODILY INJURY (Per accident) 5500,000 1 ANY AUTO __ ALL OWNED (X j SCHEDULED I AUTOS I PROPERTY DAMAGE j 5250,000 j (Per accidenq f _ AUTOS — NON -OWNED i �� S ix HIREOAUTOS AUTOS — j EACH OCCURRENCE -- �- — - ! UMBRELLA LIAR OCCUR S I AGGREGATE —�_. - I EXCESS LiAB �, • CLAIMS -MADE i 15 --- - DED �� !� RETENTIONS CC5008162012013A ' VVCSTATU- ' !DTH -I 411812013 A118/2014 fX _j TQg�L1N]IT$ -- --- -- B I WORKERS COMPENSATION E .EACH ACCIOE $10_0.000" E.L. N7 AND EMPLOYERS' LIABILITY YIN NIA ; E L DISEASE - EA EMPLOYE 5100,000 ANY PROPRIETORtPARTNERlEXECUTIVE OFFICERtMEMBEREXCLUDED? �i ---" POLICY LIMIT 1 5500.000 rutaodatory in NH) E.L. DISEASE - DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, it more space is required) KCU coverage included. CANCELLATION CERTIFICATE HOLDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE EXPIRATIONTHE THEREOF, NOTICE O ICE WILL BE DELIVERED IN ACCORDANCE WITH HE POLICY PR AUTHORIZED REPRESENTATIVE ©1988-2010 ACORN CORPORATION. Ali rights reserve. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD AMassachusetts - Department of Public Safety Board of Building Regulations and Standards 4 ' Construction Supervisor ' Lice nse:.CS-023422: NIICHAELF MCC, -XRT -Hy, 483 NASRUA RD" DRACUT MA 01126 f? Expiration Commissioner 06/25/2014 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations UT. 600 Washington Street Boston, MA 02111 www.massgov/d'ia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/individual): P4 OKjQ JP_ 1-4,(. ie 02 0 41 Address: tf'e3 ,A A 9 City/State/Zip: ift c P -H t7 Phone q- ,3 Are you an employer? Check the appropriate box: 1. ❑ I am a employer with. 4• ❑ I am a general contractor and I Type of project (required): 6. New construction employees (full and/or part-time).* 2111 am a sole proprietor or partner- have Hired the sub -contractors listed on the attached sheet. x 1• E] Remodeling ship and'have no employees These sub -contractors have S. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9, ❑Building addition [[No workers' comp. insurance 5. El We are a corporation and its 1011 Electrical repairs or additions required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c.152, § 1(4), and we have no 12.[]Roof repairs insurance required.] i 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 Homeowners who submit this affidavit indicating they aie doing all work and then hire outside contractors must submit anew affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp, policy information. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy anal job site information. Insurance Company Name:. /q 9 A__ 1 Policy # or Self -ins. Lic. M UCC5 ©01i� �GQ 0 1 .1O / 4 Expiration Date: Job Site Address:_ y I stcc1 A S&CEA City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as requiredunder 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains andpenaldes ofperjury Ili at the information provided above is true and correct. Phone #: 5QV — 300 --3 -7 70 v 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. PIumbing Inspector 6. Other - - - Contact Phone #: Information %nd Mstruc tRon"s Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract ofhire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or,other legal entity, employing employees. However the owner of a dwelling house having notmord than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced. acceptable evidence of compliance with the insurance coverage required" Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit maybe submitted to the Department of Industrial Accidents for confirmation of insurance coverage, Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials -Please be sure that -the affidavit is -complete -andprinted legibly: The D epartirienfllas provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number whichwill be. used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. Anew affidavit must be filled out each year. Where a homeowner or citizen is obtaining a license or' -permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Common -0 -tts Department offi dustdat Accidents Moe ofl"Ostigations 6.00 Washivagtou Street Boston, MA 021 It Tel, # 617-727-4900 at 406 or 1:-877:MASgAFE Revised 5-26-05 Fax ## 617-727-7749 www.mass.govfctis a Y i 8 {q8i i juZ O >< tiT4 G .iC1 N S mx 0 z o NX n I{.e' =n� H � x �7 o m Pjs e z � iz N rbc 10.1OV Nle A'N"W Q[ A �i mom Y4 ZN a 8�0 �iiuii82�>v H b8 iS9 —� w � � Imw MV;W .•W i ' =� t7 i �� QN�o�YYap� gg As Am« Hill, 'U >;�� o :.. 2 y O OZY 7 pNm? ��E _ n N G 4 Z n N Z m Z3-0 tp5.etl nte'�'].Y Nq> ZO v r O'Z' o� Ay0 g *�� ,i;i c € f a B Z � 1 CO) m m m y m mm U) a 0 Z CD O Cr Q �. > to .a O v CD CrCL �. sv CD o opo CDo CL O FS, CM CD CD O LW" cn '0 O U n' CD CD CD N� CD cn v Z CD O CCD 0 n Z m 0 C7 Z —1 cn 00 v Z: cn m 0 m m cn z 0 U) 0 0 V c =r --i y~'5 - C D N O CD c 0• CD c0) -N n 0 � _= 0 m 0 s =-o �' 0 a; -n 000�� a, 0 -� cD 0 = ` 1 = 0 rt c0 _Q 0 N 0 • sm CD r.sCD Co 0 z 0 -a �, cr c CD a��� r.L 0 :Q-0 CL cn cQ � a)� . CD CL j rN =� CO) o,,,, o ' c0 � c =cn `° (^ CD C .� rt y 0 �. : Da N o \O cu 0 i CL o Ln < p ID rr N (D O W M m 'i. T Ol ;vT 0 C D z to O S. p� N N W C r m r m 0 T N W C C A 0 T p=j n 3 x C T C O C zc m A 0 N 'O ,Nt 3 T O S 3 p O m r 2 "M Massachusetts - Department of Public Safety p., Board of Building Regulations and Standard i' Construction Supemisor License: CS -023422 MICHAEL F MCC-ARTHy- ' 483 NASHUA RD DRACUT MA 01-826 r � Expiration Commissioner 06/25/2014