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HomeMy WebLinkAboutBuilding Permit #486-12 - 477 ANDOVER STREET 5/1/2018 3co- ftiuc, TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION' � Permit NO: if 6 Z Date Received Date Issued: IMPORTANT:Applicant must complete all items on this age LOCATION �.�d� 75 s, � Print PROPERTY OWNER �h ���� Wul��n- LLC Unit# Print MAP NO: �Z Y PARCEL:ZONING DISTRICT: Historic District yes no Machine Shop Village yes no 100 year-old structure yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑One family ❑Addition ❑Two or more family ❑ Industrial ❑ Iteration No. of units: tYl'Commercial Ef Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other p.- Well �lRloodplain ® Welancls ID Wate shed �istrict s - � '��Water`/Sewer-� - DESCRIPTIO 10T ORK TO BE PERFORMED: I ( II X� �eSS ,e -�rcl ccs i CuofoLs, f� C`uyys PV- comfic-14k C-ds $: bJL 1'. m�..JLirj 1 ,,,,,4r �J Identific tion Please Type or Print Clearly) OWNER: Name: ll, i L �i LC Phone: ci�Fs- 1 f-- �355__ Address: t-p-) A-,,,LQr CONTRACTOR Name: ►'UCS .'1�c Phone: Address: 11Y C ILA '51- Ondyer G I�-Lt C Supervisor's Construction License: l o q ZLI ( Exp. Date: /S ZEt 3 Home Improvement License: '-C, Exp. Date: << i 1 uI Z ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ ZO ., 520 FEE: $_ ,_-V�/� Check No.: 19615—, Receipt No.: NOTE: Persons contracting with unregistered contractors do not have acces t e g d �Sgnature�of�Agent/Owner, ��� ,,,� �=��Signature,of�contracfor�.��_ �: �-' � �; � Location 77 No. 166 ` Z Date Z//6111 40RTq TOWN OF NORTH ANDOVER M* , '• p f � 9 ° Certificate of Occupancy $ cMu9 <� Buildin /Frame Permit Fee $ a y6 s� st Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # �J ` 2 4 E 93 Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑' Tanning/Massage/Body Art ❑ Swimming Pools 0 Well ❑ Tobacco Sales ❑ Food Packaging/Sales 0 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 Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments 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 no Located at 124 Main Street Fire Department signature/date COMMENTS L 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 ❑ Notified for pickup - Date L " Doc:.Building Permit Revised 2011 June/mi 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 Doe: Doc.Building Permit Revised 2008mi T - - - - - NORTH TOo r' over .. f 7, No. 444 4o , dover, Mass., Q - LAKE COCMICMEWICK V s`�'A7ED PC% 9 BOARD OF HEALTH Food/Kitchen Septic System .PE RM.. IT T D /1 BUILDING INSPECTOR THIS CERTIFIES THAT........ �:.............. /�/...... ....... .C ' Foundation J �I has permission to erect.............. buildings on ..... 1 �..... ...... . .. Rough / ,/ to be occupied as..............I�/.:...� .../....1 l! �!�i,���J:......:.....4........� c'/ .!..1`..`. .. sir ...................................... Chimney provided that the person accepting this permit sKall in 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 7 7 7 y� ELECTRICAL INSPECTOR LJNL,ESS CONSTRUCTIO ARTS Rough Service .. ...... . . .................................................. iB DINGS 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 SFDE smoke Det. i f Office of Consumer Affairs and usiness Regulation 10 Park Plaza'- Suite 5170 " Boston, Massachusetts 02116 Home ImprovementContractor Registration ti Y, Registration: 167900 - =� �.) Type: Private Corporation t (f-�� Expiration: 11/17/2012 Tr# 206007 NORTHEAST CONTRACTING SOLUOE` SK`5 ��l NORMAN LEE ; Y; �� 314 CLARK ST - _' J N. ANDOVER, MA 01845 :u ' Update Address and return card.Mark reason for change. ,1 is 50M-04/04-G101216Address E] Renewal 0 Employment Lost Card s� ✓� pp ie -Varevazore �\ Office of Consumer Affairs aq u'siness egulahfionn License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration:;,_,=1.67900 Type: Office of Consumer Affairs and Business Regulation Expiration: �If117/,2012 Private Corporation 10 Park.Plaza-Suite 5170 Boston,M 116 RHeA$T CONTRA.CENOLl1TIONS INC. OMAN LEE r- CLARK ST ADOVER,MA 01845- Undersecretary t valid without signature T Massachusetts - Department of Public Safch Board of Buildinl- Regulations and Standard Construction Supervisor License License: CS 104241 MARK DELGRECO 33 STONEGATE LANE DERRY, NH 03038 Expiration: 8/18/2013 ('unnii i incr Tr#: 104241 • i 9/30/2011 1:15 PM FROM: MTM Insurance TO: 1-978-794-3780 PAGE: 002 OF 002 %c CERTIFICATE OF LIABILITY INSURANCE 9/30//30/ATE DDD/YY2011YYJ `.�� 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(les) 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 Linda Murray y MTM Insurance Associates Al2%Ext: (978)681-5700 FAC No:(978)681-5777 575 Chickering Rd E-MAIOnnRllindam@mtminsure.com nvauraerga)Mrrurtuuv�wvc,wUc rv/aw s North Andover MA 01845 INSURERAAtlantic Casualty Ins Co INSURED INSURERB:Travelers Insurance Group Kaiden Konstruction Ina INSURER C:Technol0 Ins. Co. 14A Sunnyside Lane INSURERD: INSURER E: Derry NH 03038 INSURER F: COVERAGES CERTIFICATE NUMBER:11 - 12 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 IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IPOLICY EXP LTR TYPE OF INSURANCE AD L SUER POLICY NUMBER MMIDDY EFF MM DDIYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 -5WAGL 10 REN I ED X COMMERCIAL GENERAL LIABILITY _ - PREMISES Ea occurrence $ 100,000 A CLAIMS-MADE FOOCCUR 143002338 9/2/2011 /2/2012 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN•L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY PRO- JECT LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident 1,000,000 —g ANY AUTO BODILY INJURY(Per person) $ ALL OWNEDX SCHEDULED 6475X68011SEL /7/2011 /7/2012 AUTOS AUTOS BODILY INJURY Per accident) $ X HIRED AUTOS X NOWOWJED PROPERTY DAMAGE $ AUTOS Per...dent Medical payments $ 5,000 UMBRELLA LAB OCCUR EACH OCCURRENCE $ EXCESS LIAR 11 CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ C WORKERS COMPENSATIONWC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N TORY LIMITS I ER ANY PROPRIETOR/PARTNERIEXECUTIVE E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NH) rBD WC /30/2011 /30/2012 E.L.DISEASE-EA EMPLOYEE $ 100,000 I iEstR(PTTCN OF'UPERATIONS below E.L.DISEASE-POLICY LIMIT $ nuu UUU L -L DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Certificate holder as listed below is also additional insured on the general liability policy. CERTIFICATE HOLDER CANCELLATION (978)794-3780 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Northeast Contracting Solutions, Inc. ACCORDANCE WITH THE POLICY PROVISIONS. 1 314 Clark St, North Andover, MA 01845 AUTHORIZED REPRESENTATIVE, C Traverso, LIA/LINDA 6'ody ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025(201005).01 The ACORD name and logo are registered marks of ACORD SECTION 5: CONSTRUCTION SERVICES 5.1 Licensed Construction Supervisor(CSL) The Commonwealth of Massachusetts �r Board of BuildingRegulations and Standards r C LO License Number Exp' ation ate Massachusetts State Building Code,780 CMR,7t'Edition Namof CSS older List CSL Type(see below 3 �� �� ) Building Permit Application To Construct,Repair,Renovate Or Demolish a � c AJH AddrefftJ_U,k — Type Description One-or Two-Family Dwelling Unrestricted(up to 35,000 Cu.Ft. R Restricted 1&2 FamilyDwellingSECTION 8:ADDITIONAL APPROVALS Signature M MasonryOnly 4►��'�� 2-��2'�Z�. RC Residential Roofing Covering Telephone WS . Residential Window and.Siding 1. Ballardvale Historic District Commission: Date: SF Residential Solid Fuel Burning Appliance Installation D Residential Demolition 5.2 Registered Home Improvement Contractor(RIC) (� 2. Board of Health: Date: &)C_S TAS, HIC�� anyCNrme pr ,C r— Expi&tion s � � O N45- Registration Number Icr+^ t 8 3. Conservation Commission: Date: Addres I 1 t o�1$.�g5_o /p� D to 4. Design Review Board: Date: Signature Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§ 25C(6)) 5. Electrical Permit Number: Date: Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide 6. Fire Prevention: Date: this affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached? Yes .......... ❑ No...........❑ 7. Planning Board Lot Release: Date: SECTION 7a;.OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR AAPPLIES FOR ,BUILDING PERMIT 8. Preservation Commission: Date: I, &UAI , �QV�l1A�,t� VAO 0 Q. as Owner of the subject property hereby authorize C --T-"C- to act on my behalf,in al matters 9. Zoning Board of Appeals: Date: relative to woro Othorized by this building permit application. 1 -zA01/1 Signature o wn r Date SECTION 7b;OWNER'.OR AUTHORIZED AGENT DECLARATION as Owner or Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and behalf. Print Name Signature of Owner or Authorized Agent Date (Signed under the pains and penalties of perjury) NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program and Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations 110.R6 and 110.R5,respectively. 2. When substantia work is planned,provide the information below: Total floors area(Sq.Ft.) (including garage,finished basement/attics,decks or porch) Gross living area(Sq.Ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open I