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HomeMy WebLinkAboutBuilding Permit #685-2017 - 46 FOSTER STREET 1/3/2017ACA I I Week_ D BUILDING PERMIT A11=0 TOWN OF NORTH ,AND® APPLICATION FOR PLAN EXAMINATION Date Received 0 PE OF IIVIPROVEIV15TT• PROPOSED USE Residential Non- Residential 0 New Building �Vlbne family Ei Two or more family 0 Industrial 0 Addition No. of units: Ei Commercial Ei Others: Q -Alteration Ei Repair, replacement El Assessory Bldg [I Demolition El Other 777 7 b6dp1ain. : d* District_ 1N5 tdfs 0 Esept*p _ O-Watdr/S�Mer i n r^ r, iz' 'rr-, E2= D=P1=r)PM1=n- ur—ok�Mr- I wl ­_. . — __ - — M Identification - Please OWNER: Name: or Print Clearly I Address: 0 t -f-eP,,.hbhe- _6rif�f it-tbe Nam,,. /Address . Su P c 1b atb - 5 F.6 x p v er ISO s; b -7� P 1-1non ' M*� 0) N f �n i- t License.:.. on , i n ARCHITECT/ENGINEER Phone,______� M'0 Reg. eg. No. FEE SCHEDULE, BULDING PERMIT.- $12-00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED N$125.00PERSY- Cw ,.-__,notal Project Cost: $ Do FEE: $ (9-4 eceip No.: c-4 tog NOTE. Persons contracting with unregistered contract FS n ve: ace e guarantv funa iririafi Of co r for � -- — --- S icd dr _h4 - -I h P. r I M1 I---- Location - t 7��A �= - No. -U% n —%01 Date 1 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ n— Foundation Permit Fee $=� Other Permit Fee $'_ TOTAL $ Check #?� t Building Inspector Plans Submitted ❑ Plans Waived Certified Plot Plan ❑ Stamped Plans ❑ •'TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swi nming 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 CONSERVATION Reviewed on Signature COMMENTS y HEALTH Reviewed on Signature COMMENTS f Zoning Board of Appeals: Variance, Petition No: . Zoning Decision/receipt submitted yes 3 Planning Board Decision: Comments " i - Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: - Located 384 Osgood Street FIRE DEPARTMENT- --Temp Dumpster on site yes Y no Located at 124 Main Street Fire Department signature/date r,nMNAFNTS --- r iimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: - ELECTRICAL: Movement of Meter Iocation, mast or service drop :requires approval of Electrical Inspector Yes No ®ANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine Doc.Buildins Permit Revised 2014 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. r 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/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 DOTE: 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 Pian ❑ 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 ,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 must be submitted with the building application ti Doe: Building Permit Revised 2014 IM .34 r L J Q 2 uj LL O m O t aV O LL Y % N u a N w H Z Z m O a 7 llLL t LL' T c E ULL O Wa of Z Z m J d t cr to LL O a H z V U W W s 0 CC cu N m LL oC U Wa Z H t C' LL Z °c Q W 0 LL m O N 4-+ N Q N n C 0 cc tp C J � (D m .� y (DOgg! ILa w 4b E doe 0 xd Y G o �+ is ��. W • O _cc V : V � 0 QO M' `NGS �P V i �+ to Cc Ncc J C°� U) 0 e, U) — 'a 0 tm cc 0 N 0 o 0 C `,- C 0 •y C > 0 _ ~ �r L �CD_ ._ 1 c °� CO) w 0 0 0 C12 ca =_ Q m in CO) cc N Q to C 1113 W, CA 0 w V 0 LU 0m C v 0. �m �N N U) .0 0 %- 0 t=— .- 0_ o V E N IL N .2 CD d m 0 a� 0 N d t 0 z 0 a J O U) m co Z W W C� C W m 2. TMI .. U O U) W z w ti " qV ` S D 1 PROPOSAL NO. _ �,�� 1SFIEET NO. 00 BATE PROPOSAL SUBMITTED. TO: WORK TO BE PERFORMED AT. NAME ADDRESS d 62v'•1bl', Q ADDRESS f DATE OF PLANS PHONE NO. ARCHITECT We hereby propose to furnish the materials and perform the labor necessary for the completion of 00 414 ilzt d 62v'•1bl', Q o. - All material is guaranteed to be as specified, and the above work to be peed in accordance with the drawings and specifications submitted for above work and completed in a substantial workmanlike manner for the sum of e, Dollars ($ ) with payments to be made as follows. �3 ©r,.��t ,, �3 l-� c� 3 ���0M Any alteration or deviation from above specifications involving extra costs will be executed only upon written order, and will become an extra charge Respectfully over and above the estimate. All agreements contingent upon strikes, submitted A. accidents, or delays beyond our control. Per Note — this proposal may be withdrawn by us if not accepted within days. ACCEPTANCE OF PROPOSAL The above prices, specifications, and conditions are satisfactory and are hereby accepted. You ar authorized to do the work as specified. Payments will be made as outlined above. A Signature 641!!� Date Signature ':adams- D8118 3.12 ne Commonwealth of Massachusetts _ Department of IndustrialAceldents -I Congress Street, ,Sziite 100 M• — = d02114 2017 -Boston, MA A. mass gov1&a 1'Q�AI - SVy y�YVY ry spa kers' Compensationbsuxance Af davz BE �x � AUT O sltiT i'. txxcians/ lura exs. TO BEM DWil PTnaee-Print Dame (Busmass/Ozganizaiionllndivid Address: Phone #: City/date%Zip: Are you an employer? Glieel thpprapxlafe box: e a 1.� a employer with employees (fun and/or part time). 2. a sole proprietor or partamsbiP ane hale no employees Working forme in auy capacity. ENO yaorkers' comp. insurance required ] 3.E] I am. a homeovrner doing all workmyself. RTO workers' comp. insurancereqused ] i 4.[-IIamahomeowneraadwillbebidugeostractorstoconduciallworkonmypropmty- Iwi11 ensure that all contracFbts either have workers' compensation. insurance or are sole proprietors with no employees. 5_� I am a general co acto and Ihave hiredthe sub -contractors listed ° the attached sheet These snb-contractors have employees andhave workers' comp. incur 6.Q We are a corPoration and tis, offic6m have exercised their right of exemption per MGL c. and' e kava no empldyees. jNo workers' comp. insurance required-] Sr -) 5— Type off project (x'egrarecl)= 7. [] 1'T&Vd6nsiriic"on 8. ElRemodeling 9. ElDemolition 10 ❑ Building addition 11.[] Electrical repairs or• additions L2,E plmnbiugrepairs or additions 13'.[]Roofrepairs 14.0 Oilier 152, §I(4), . *Any applicamthat checks box#1 must also fill outihe sectionbelow showingtheirwork-ers' compensationpoficytnformation i homeowners wha submit this affidavit indicatingthey are doing all work a-adthen hire outside contractors must sabm t a new affidavit indicating such ?Contractors that checkihis lio"xorm�e empl y� �ey mustprogide thein workerse comp. of the policy�nrnaber.actors �d s�whe�� or notthose entities;hage - employeos. Iftho sub -coati ' • • . ' X am a� employer• tliatisproviding-wor*Izers' compensation insutancefor° my employees.-8elox� is tliepolzcy arzdjob •site information. Insurance Company policy # or Self -ins. Lic. ExpirationDate, City/State/Zip: Job Site Address: comp ensation poiiey declaration page (showing the policy number and egppzxatxon dais). Attach a copy' of the -worl?vexs' X00.00 Failure to secure coverage as required under nalties2x, §25A is a the form of a STOP WORK O punishableal -violation d a ane o up to $250.00 a and/or one-yearimpxisonment, as -well as P of this �tatPm enf may be forwarded to the Office of Investigations of the DIA for insurance day against the violator. A copy coverage verification. X do riereliy c,Viify� nder• the Matt the in? orrrcation provided above is true ann correcz. official use only. Do not -write in this area, to be completed by city or toren official. I"ermit/LiCense # City or Town` suing Authority (circle one): Inspector 1.. Board of Health 2. Buitdi7xg pepariment 3. CztylTown Clerk 4. Electrical Inspector 5. Plumbing 6. Other Phone Contact person Information and. Instructions 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 of hire, express or implied, oral or written." -An employer is duffi6d as "an individual; partnership, association, corporation or other legal entity, or auy two or more Of the foregoing engaged in a joint enierprisa, and including the legal representatives of a deceased employer, or the receivet'or trustee ofan. individual, partnership, association or other legal entity, employing employees..Howeverthe owner of a dwelling house having not more than three apartments and who resides therein, or the o ccupaut 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 bean employer." MGL chapter 152, §25C(6) also states that "every state or Iocal 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 applican7twh6 has not. produced acceptable evidence of compliance with the insurance coverage requked." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political sub divisions 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 fll out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply su-b=contractor(s)name(s), addresses) andphonenumber(s) along with theircertificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partaers, are not required to carry woxkers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confv oration 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 tTieDepartment atthe number listed below. Solf-insured companies sho-did enter their self-insurance, license number onthe appropriate line. City or Town Officials Please be sure that -the affidavit is complete and printed legibly. The Department has provided a space atthe bottom of the affidavit for you to fill out in the event the Office ofInvestigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will 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 (ifnecessary) 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 filed out each year. Where a horse owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Depa--tnaent of Industrial Accidents 1 Congress Street, Suite ,100 Boston, MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 02-23-15 www.mass.gov%dia C-30-2016 FRI 10;55 AM P. 001 CERTIFICATE OF LIABILITY INSURANCE DATE (MIuI/Ddvmr) 12/30/16 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 endorsements). PRODUCER Joseph 0 Danca Jr Ins Agcy Inc 182A Highland Avenue Malden / MA 02148 CONTACT NAME; Joan Spears PHONE 7g1 322-1322 FAX N (787) 3z2-97713 ADDRESS: 'oan@danaainsurance.com INSURER(S) AFFORDING COVERAGE NAIC N INSURER A: Western World Ins. Co, INSURED John Trulli 149 Cotuit Street North Andover, MA 01845 INSURER B: 1NSU RERC; INSURER 0: INSURER E: INSURER F: OVERAGES 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 15 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TN L R TYPE OF INSURANCE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Andover POUCYNUMMER POLICY OLICY E MWDDNYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY X CIAMIS40ADE 7 OCCUR N N NPP8245955 4/24/16 4/24/17 EACH OCCURRENCE $ 1 000 000 DAMAGE TO RENTED PREMIa $ 100,000 MED EXP (Anyone person) $ 5,000 PERSOmL& ADV INJURY S 1,000,000 GENERAL AGGREGATE S 2,000,000 GEN'L AGGREGATE LIMITAPP LIES PER POLICYF71 P LOC PRODUCTS - COMP/OPAGG $ 1,000,000 $ AUTOMOBILE LIABILITY ANYAUTO ALLOWNED SCHEDULED AUTOS AUTOS NON -OWNED HIREDAUTOS _ AUTOS-(Paraccidettij cop Ee Er RE h fM M= T T $ BODILY INJURY (Per pereon) $ BODILY INJURY (Peracaident) S PROPERTY DAMAGE $ $ UMBRELLA LIAR EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE S AGGREGATE $ DED RETENTION $ VQRKERS COMPENSATION AND EMPLOYERS' LIAVIILITY Y / N ANY PROPRIETORIPARTNER/EXECUTNE OFRCERTvIEMBER EXCLUDED? (Mandatory In NM) ITyyee deecrlbeunder DESCRIPTION OF OPERATIONS below NIA I WC STATU-IMITA OTH- E.L. EACH ACCIDENT DISEASE -EA EMPLOYE E.L. DISEASE - POLICY LIMIT DESCRIPTION OFOPERATIONS /LOCATIONS /VEHICLES (Attach ACORD 101, Additional Re msrksScheduls,ifmore aPere Istagtdred) CERTIFICATE HOLDER CANCELLATION 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are reglste marks of ACORD Phone: Fax: E -Mail: SHOULD ANY OF INE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Andover ACCORDANCE WITH THE POLICY PROVISIONS. Bulding Department AUTHO 190 REPRE6ENTA E 120 Mair, Street North Andover Ma. 01845 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are reglste marks of ACORD Phone: Fax: E -Mail: K. Massachusetts � 90 Board of Building Department of Public Safety Regulations and Standards License: CS -090863 r Construction Supervisor JOHN E TRULLI 149 COTUIT ST NO ANDOVER MA 01845., �^ t? s Commissioner Expi ration: 01/13/2019 r Y'- !,Mass0chusetts - f}epartment:of Pubkc Saftt f Dani of Biiiiding Regulations and Standards ..rs pfiSiiiitiifii5 j�jlcI"�iSf+!_—s License: CS -090863 fs, JOAN E TRULLI 149 COTMT ST, NO ANDOVER IWAL EXpirati& to 011'13/2017. d. Comniissioner 'NAN,RDO.VENR� ,.M.A 0,1845 L =s