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HomeMy WebLinkAboutBuilding Permit #301 - 45 DANA STREET 10/14/2009 BUILDING PERMIT ttNORORTFfh TOWN OF NORTH ANDOVER 02 - oo� APPLICATION FOR PLAN EXAMINATION 7° Permit NO: Date Received CHU 4t Date Issued: o a IMPORTANT: Appl—iccant must complete all items on this page LOCATIONPdnt rG /fG PROPERTY OWNER 1,1?7-4-z J Print MAP NO: PARCEL:/ ZONING DISTRICT: Historic District` yes n 'Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Iteration No. of units: Commercial --**'Repair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: -4 cation lease Type or Print Clearly) OWNER: Name: /51:7,17; Z�li3O-IZ/ Phone: el Address: 4�� Z&AIW 4/01 .AA,110 ,s CONTRACTOR Name: 1y� l✓z'/k J— Phone: V-r,Y- 1 Address: Supervisor's Construction License: Exp. Date:_, ' /' Home Improvement License: -- Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED CO��Sl!T BASED ON$125.00 PER S.F. Total Project Cost: $ So2�_ c� FEE: $ 7a- Check No.: Receipt No.: da- J- C) NOTE: Persons contracting with unregistered contractors do not have access to th aranty f gnattare of Agent/Owner Signature of contractor Location I-IT Dr9 . S r777No, ,,�G? ! Date MORTM TOWN OF NORTH ANDOM '` 9 Certificate of Occupancy $ 7ssACMVSE<` Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 1 225 %,.10 Building Inspector 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/Safes- Private ackaging/SafesPrivate(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/Si nature& Date Driveway Permit DPW Town Engineer: Signature: 84 FIRE 'DEPARTMENT - Temp DumLocated 3Osgood Street ,pster on site yes 84 Located at 924 Main Street Fire Department signature/date COMMENTS i 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 4 ❑ Notified for pickup - Date Doc.Building Permit Revised 2008 r 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) ❑ 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:Building Permit Application Revised 2.2008 r - NORT#q Town oft 4Andover . No. 8 D/ o z=. dover, Mass.,LAKE ly i COCKICKEWICK Iy �S RATEO 4 BOARD OF HEALTH • Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT j� , ............ ..�%�.r� .......!!.� l..f�.. .�'LSPQ...:.......................................................................... Foundation has permission to erect........................................ buildings on .... ... ..... .�................................... Rough to be occupied as . . d �'� Chimney �............./...... .................................................................. y provided that the,person accepting this permit shall n every respect conform to the terms of the application on file in Final 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 CONSTRUC STARTS Rough IService .......... ................................................................................................. BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR 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. SEE REVERSE SIDE smoke Det. i I I I I PROPOSAL Peter Kalafarski 45 Dana Street North Andover, MA 01845 I.pkalafarski@verizon.net (H) 978-686-5762 (C) 978-390-8775 October 7, 2009 Work to be completed includes: Remove all gutters on house. Replace all rake boards on house. Replace several other facia boards that were noticed rotted. All Trim to be replaced with PVC trimboards. Dispose of all debris. TOTAL LABOR AND MATERIAL $3,525.00 Terms: $ 1,100.00 to start $ 2,425.00 when complete Submitted By: Chris Rivet MA Lic #CS072173 207 Winter Street HIC#139962 North Andover, MA 01845 (c) 508-265-31.15 (h) 978-794-1165 ACCEPTANCE OF PROPOSAL The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payments will be made as outlined above. Owners Signature Datecv�y" Contractors Signature Date Q Massachusetts- Department of Public Safety . Board of Building Regulations and Standards Construction Supervisor License License: CS 72173 Restricted to: 00 CHRISTOPHER F RIVET ', I 207 WINTER ST N ANDOVER, MA 011345 Expiration: 6/2/2010 Commissioner Tr#: 25403 �. _ ✓tte�omt�non/.vea�o�,/t�vac�u�aeCk Ofrice of Consumer Affairs&Business Regulation. HOME IMPROVEMENT CONTRACTOR Registration: 139962 E — Expiration: 918/2011 Tr# 700076 . Type: Individual CHRISTOPHER F.RIVET CHRISTOPHER'RIVET 207 WINTER ST." t N.ANDOVER_,MA 01845 Undersecretary f i. . ACORD,,,, CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 10/07/2009 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION MacDonald & Pangione Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P.O. Box 428 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 104 Main Street North Andover, MA 01845 INSURERS AFFORDING COVERAGE NAIC# INSURED Christopher Rivet INSURERA: PREFERRED MUTUAL INS CO 207 Winter St. INSURER B: N Andover,MA 01845 INSURERC: INSURER D: INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DD'L DA CY EFFECTIVEPOLICYDATE IM PIRATION LIMITS LTR N POLICY NUMBER A GENERAL LIABILITY CPP 0160 57 0105 09/26/2009 09/26/2010EACH OCCURRENCE S 1,000,000 X COMMERCIAL GENERAL LIABILITY -15AMAGE TO PREMISES o=ffence)TR $ 100 000 CLAIMS MADE a OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY S 1,000,000 GENERAL AGGREGATE $ 2, 00.000 GEN'L AGGREGATE LIMO APPLIES PER: PRODUCTS-COMP/OP AGG S 2,000,000 X POLICY PRO- LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) S ALL OWNED AUTOS SCHEDULED AUTOS BODILY $ (Per person) HIRED AUTOS NON-OWNED AUTOS BODILY INJURY S (Per accident) PROPERTY DAMAGE S (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACGDENT $ ANY AUTO OTHER THAN EA ACC S AUTO ONLY: AGG S EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE S OCCUR FICLAIMS MADE AGGREGATE S S DEDUCTIBLE $ RETENTION S _ 3 I WORKERS COMPENSATION AND WC STATU- DTH- EMPLOYERS'LIABILITY TORY LIMIT ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT S OFFICERIMEMBER EXCLUDED? If yes,describe under E.L.DISEASE-EA EMPLOYEE S SPECIAL PROVISIONS below i EL DISEASE-POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS certificate holder as listed below CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Town of North Andover DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN 120 Main Street NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR No Andover, MA 01845 REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2001/08) ©ACORD CORPORATION 1988 N i rsC wmawn►f►eaws o,� �O,fIndustrid AcMents Office ofbir "0 Wirahanstoa Sb ed AWon,MA 02111 wwwmaxgvWd& , Workers' Coon Insumee Affidavit: Banders/Con A olicant Informaffon ,_ Please Print Legibly Name(BttsiaesalOrgatti Qn/indivi&MO: -Address• 0 Ciity/Stdapp:NO, AVdOII Z , 04V-f Pbow*. Argyou an enqIoW.Check ae aplu+up- bon 1.❑ I am a wVloyerwi& ' :; 4. 0 I an a genasl oo o�and I Type°f Pte] (�` (fnIl aad/or pact �s boyo Wnd&.e snb-coif 6. 0 New coal 2.al am a-sole pI r I ip Ir Or puss= Hsfod on So-anached sheet: 9: ffRmDdermg . and have no T Lave , �P �P� 8. O DemoT>tiom . wad mg for me in aniy amdhtcve ' [No V/Od els' � r mn . x camp.iummunnice.1, �' [�Bdaldigg addition relnim&] . S. (] We are a compoation andils 10.0 keemical was or additioamS 3.❑ Ian a humeowner doiwg al wordt oILIOCIM bwe cunised fick 11.Q Plonfift rears or additions mywK[Nowarlacrs'camap. 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Ida herby cm& P efpaOry Brat sJte irrma�xprtvnfdaisle• trace curt POW , OffididAze only. Do rrotw ft in jW artsq ttr OMFIatad cby or 'of)xdd (Sty or Tow= Pel ndK'-ease s Its Au&*AW(chde ones 1.Board of Health 2.Bm'[dit Depar6it 3.CW/Town Clerk 4.ZkfticlO hwPedw &P mmh hopeckw (.Other CotrtactPersoa: Phone#-