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HomeMy WebLinkAboutBuilding Permit #794-2017 - 460 OSGOOD STREET 2/22/2017/�n BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION —'16( 1 Date Received TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building IKOne family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other 0 Septic ❑Well ❑ Floodplain. - D Wetlands ❑ � Watershed bistnct i V- S F - DESCRIPTION OF WORK TO BE PERFORMED: ti Identification - Please Type or Print Clearly OWNER: Name: i''�Z LLC, Phone: 9 -TCZ- YNJX Address: O i. Q 1 RqS Contractor Name:' _ � i Phbhe ,Q 78- 29 -_11492.. _ Address: Supervisor s�ConstructionLicense , -'O'� y1� 3;_ f'��Exp, }Date:( • -4 r R Horne lrnprovement, License aExp `Dateri ARCHITECT/ENGINEER Phone: Address: Reg. No.. FEE SCHEDULE: BULDING PERMIT: $92.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $925.00 PER S.F. Total Project Cost: $ /5Z 060• (f,6ey t,(7Lr1 an1y� FEE: $ 00 Check No.:ZZ (� Receipt No.: NOTE: Persons contracti with unregistered contractors do not have: access to e guaranty fund Sign_ , re o .Agen . _ _; ner Sign re of contractor Plans Submitted Plans Waived Certified Plot Plan ❑ Stamped Plans ❑ bF SEWERAGE DISPO^SSAL [TypF Public Sewer u� 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 -.0 FORM PLANNING & DEVELOPMENT Reviewed On)z Signature_ 1 COMMENTS CONSERVATION COMMENTS Reviewed HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: NI J� Zoning Decision/receipt submitted yes e Planning Board Decision: Ak Comments ,Z �1 Conservation Decision: Comments ° Water & Sewer Connection/Signature &Date V'qOV//;tD�riveZ Permit / U w f K x DPW Town Engineer: Signature: FIRE DEPARTMENT - Temp Dumpster on site yes Located at 124 Main Street Fire Department signature/date COMMENTS Locatea jb4 usgooa bireei no limension Number of Stories: 2. Total square feet of floor area, based on Exterior dimensions. Sup S� Total land area, sq. ft.: ,O3� ELECTRICAL: Movement of Meter location, mast or service drop. requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: lies MGL Chapter 166 Section 21A —F and G min.$10041000 fine NOTES and DATA — (For department use) No .moi i 6r>- f 1 S obb 2 oco G.1 Z ------------ F S •6v ❑ Notified for pickup Call Email ate Time Contact Name Doc.Building Pen -nit 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 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 40TE: 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 Revised 2014 HI ,Z c 0 H P-4 SN rA Qn Eq—* r N tT" O = = LL.Z DZ Q m c u ;N Y O LL N A N u aJ Ln o u a Z 0 m c O nz a 7G O LL s O O W ai c U LL o LLA H Z m d s 7 O 0 H Z Q U_ U J W s : O O > /7 L W Z Q fAW r to O O LA- z w LL O m Z v Q Ln + w Yo O N O m O CL a) V: m Q� a - 4,0 Q N d .r 0 0 L CD O = 7 c a •. o s L Cc Cc .-Op- U0 a L m > _ = O LZy O d C 0 'a O C V _ C a .a E c 0 O Z - y - O t 'L _ 3 cc H L Q. Q O QCD 0 ._ m 0 cn O = c a a_' m =a Nw O d o m W = -0 +�-� O O H N N O N= 0.O� LLI«+ Lu � O i U CL O O N Q'>y=c N o H t o a. o U E CL N N .'C U) _ m O a� _ 0 N O L O Z O a O O W CL z .o Co Z O zco� W x O � V cup Lu LU J Q. LS 0 E z 0 A� cn W .E i O d w UL V N U c� CL w w S47'41'28"W OSGOOD STREET inter anite rost OWNER INFORMATION: T1CZ LLC 78 GREAT POND ROAD NORTH ANDOVER, MA 01845 DEED REFERENCE, BOOK. 14895 PAGE. 65 ASSESSOR INFORMA110N. MAP 102 LOT 3 (Part of) ZONING INFORMATON: ZONING DISTRICT.• R2 I CERTIFY THAT THE FOUNDATION SHOWN WAS LOCATED BY AN INSTRUMENT SURVEY AND EXISTS ON THE GROUND AS SHOWN. 173a-7 A x 3'x3 3j V L jL.SLs O 233735 y cc fn 9- tip ' t a" s o k 2 a 0 0 Cat Q C O N w �j K � N V v o Lo� u, w O r W o C'3 uci V ❑ O 0 G � N u r s5 4. gJ x v m m 00 sp & g a 0 0 Cat Q S 3sa O N w K � N V v o Lo� u, w O r W o C'3 uci V ❑ O 0 v m m 00 sp & g L o C'3 uci V ❑ O 0 ACC?R & CERTIFICATE OF LIABILITY INSURANCE2DATE(MM1DD'Y2 ) /2�17 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 NAME:Sandi Munroe M.P. Roberts Insurance Agency piiordE�FAx 1060 Osgood Street E-MAIL' {978) 683-8073 A/Q No). (9 683-3147 ADDRESS: Sandi@ mproberts insurance. com North Andover, MA 01845 INSURERS) AFFORDING COVERAGE NAIC9 INSURED INSURER B; Associated Emplovers Insurance_-_;____ TKZ, LLC INSURERC: v c/o TOM ZAHORUIKO-..__.. _- 78 GREAT POND ROAD -INSURER D: E: NORTH ANDOVER, MA 01845 INSURER F: T j COVERAGES CFRTIFICATF NIIMRFR t�F�nclnnl Ilnnut=c 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. INSR1- -------ADDL'SUBR'. - - - - - - --- -- - POI:ICYEFF '-POUCY�EV -- - LTR , TYPE OF INSURANCE INSR WVDI POLICY NUMBER M/DDN MM/DDIYYYY LIMITS A GENERALLIABILiTY 13EE0829 7/13/.16 7/13/17 EACHOCCURRENCE_ $ 1 000,000 X COMMERCIAL GENERAL LIABILITY � OCCUR CLAIMS -MADE OXO j � DAMAGETORENTED PREMISES (Ea_occurrenc=}_�_ MED EXP (Any ore person) 5�,_Q00 $ rj 000 PERSONALBADV INJURY $ 1 000,QOO Jon GENERAL AGGREGATE __S_2_,000.,_0'00- _2 , 000 �_�00 --V _._ _ - i } PRODUCTS - COMP/OP AGG 1 I( GEN'L.AGGREGATE LIMIT APPLIES PER I X POLICY PRO- LOG - } $ $ AUTOMOBILE LIABILITY I COaBIINED1JSINGLE LIMIT(Ea . !$ ANYAU70 I BODILY INJURY (Per person)! S ALLOWNED SCHEDULED AUUTOSS AUTOS NON -OWNED r_ HIREDAUTOS — AUTOS 4 1 BODILY INJURY Per accident) ( ent -� S PROPERTY DAMAGE Peraccdent) $ $ H. UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE i AGGREGATE$- DED RETENTION $ - $ B WORKERSCOMPENSATION[ AND EMPLOYERS'LIABILITY YIN ANY PROPRIEIOR/PARTNER/EXECUTNE OFFICERIMEMBER EXCLUDED -? (Mandatory in NH) Ryyes, describe under DESCRIPTION OF OPERATIONS below N / A (WCC5005006517-2016A} �( 10/1/16 10/1/17I WCSTATU-� IOTH-j X .ORY-LiMLTS 1 TH E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 — -- E.L. DISEASE -POLICY LIMIT $ 1,000,000 3 r DESCRIPTION OFOPERA71ONS/LOCATIONS/VEHICLES(AHachACORD 101, Additional Rena rksSchedule, ifmore space isreguired) V W\ V GLLM 1 Rill 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. BUILDING DEPT MAIN STREET AUTHORIZED REPRESENTATNE NORTH ANDOVER, MA 01845 l/1 A A n k_8-20 0 AL'nR6 Cr7RPnRATIr1N All Ai hte .00c..., ..1 ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD Phone: Fax: E -Mail: \^ �� _ $� �7 \:� \K =� \. x2 CL 7 <� . . . o e 2 2 2k t ®2 o - «�. ii V� 2w�� (30 to c k� 22 L k e� uc 2LU>_ $� �g Nw§ °© 2kJ 0 m _jk 2 § o zzz 11 L o-� erg . c' -b M w � co 94 g t (� 1ZN- MO � e a tin d B8 xr,01 aef i S a d „}ti r o-� erg . c' -b M 4. w � Aqaa 94 on CA c� ^� s � � art v IN1SSYd ®�( e � av 3 , a �o JtA �� Li 0a4:1 e0-2. c'-6 6-1 9-b -j °�-b ®-Z r Q 4. w � Aqaa 94 on CA c� ^� s � � art v IN1SSYd ®�( e � av 3 , a �o JtA �� Li 0a4:1 e0-2. c'-6 6-1 9-b -j °�-b ®-Z r Location No. 201-7 Date 2 17 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ r r. Other Permit Fee $ TOTAL Check # ; • y --�� Building inspector