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HomeMy WebLinkAboutBuilding Permit #322 - 50 CAMPBELL ROAD 11/13/2008 NORTF/ BUILDING PERMIT o�tt,ao ,6��• TOWN OF NORTH ANDOVER 02 APPLICATION FOR PLAN EXAMINATION '' 7D �0 Permit NO: Date Received 74°�q�rED "y{� �SSACHl1`'Et Date Issued: IMPORTANT: Applicant must complete all items on this page wq1 tdnt PROPERTY OWNER I Nft . .nn K MAP NO: '� 70 � a ,tt PARCEL t5` .ZO I C DISTRIC � F1�storic.D�stri�t��� yes no7777 " $y. Machine Shop Village., yes s rio 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 ` eptic ,W X9 'Flou Iain iWitlands Wate lied�Distnct niter/Sewe_ ME -DESCRIPTION OF WORK T O OBE PREFORMED: Identification Please Type or Print Clearly) OWNER: Name: Phone: 9 24�'— 59S`4u/0 Address: �c& la CONI'RA41 CTORlame %. �s� J " Phone Adtress. Supervisor's{{yConstruction License ffi 1 Exp " J% Ham- lin rovement rcense , -# I=x p Date: ARCHITECT/ENGINEER Phone: Address: \w 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: $ /5! ADO.®`' FEE: $__ Check No.: Receipt No.: "I /(off NOTE: Persons contracting with un egistered contra ors do not have access to the guaranty fund ignature ofAgentfOwne �ry igaure ofcoritracto.�� .�,a .. :_ Location so- No. ^�-3 Ly Date f <' ,.oR•� TOWN OF NORTH ANDOVER �: •• " 09 i Certificate of Occupancy P Y $ s"•��';<� Building/Frame Permit Fee $ � ` Fs +cNus Foundation Permit Fee $ Other Permit Fee $ TOTAL Check # 21684 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/Sales 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/Si nature&Date- , :� VA (t' DrivewayPermit DPW Town Engineer: Signature: Located 384 Osgood Street 1FEN 47 T umpster5on ># es n© � � s Lcatede 4 amb-treetAA W � * ,a ij :-+r -�: ,-�-,'� �,a. ., ..�,.,{f�:,�'"...Y - �•�`,.c.�.�- � ins'; '�.���, 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 2 1 A—F and G min.$100-$1000 fine NOTES and DATA— For department use ❑ Notified for pickup - Date Doc.Building Permit Revised 2008 j 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 o 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 S"42913876 0074F.II CLASS REST HEIGHT SEX 05-23-1959 D. 5.10 1A 05-23-2009 DISALVATORE AM MONY 1591VIAP-L-E ST DANV,EAS;MA 01920 r, ✓1. -f&��o�✓ rd4ae✓u/O d Board of Building .- aiions and Stdndsrds ConstruoWn Stipervi er License L CS 60977 • i /23/19559 r /2809 Tr# 4737 r� ANTHONY C DIL 159 MAPLE ST ` c;7 DANVERS,MA 01923 Commissioner ,per fie �omvmauaeallli a�.�aaaaa/cuoell �-\ Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registr#ftFL 123421 E>pirE �4/2009 Tr# 259738 nig i idual ANTHONY DISALV' ANTHONY DISALV OR.E 159 MAPLE ST. � DANVERS,MA 01923 Administrator. (2ACORDM CERTIFICATE OF LIABILITY INSURAN 08/ 9/20 ' PRODUCER (781)396-4985 FAX (781)395-9454 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Bates Insurance Agency Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 92 High St. , Suite 61 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR g ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Medford, MA 02155 INSURERS AFFORDING COVERAGE NAIC# INSURED Mark Halliday INSURERA: Granite State Insurance Co. DBA: Action Builders INSURERB: 31 Lake St INSURER C: Wakefield, MA 01880 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' TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATIONLTR INqR LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ CLAIMS MADE F7OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PROJECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY_EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR D CLAIMS MADE AGGREGATE $ DEDUCTIBLE RETENTION $ $ WORKERS COMPENSATION AND WC3797926 12/18/2007 12/18/2008 WC STATU- OTH- EMPLOYERS'LIABILITY . TORY LIMITS FZP A ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000 OFFICERIMEMBER EXCLUDED? If yes,describe under E.L.DISEASE-EA EMPLOYEE $ 100.000 SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Mark Halliday BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 31 Lake St OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. Wakefield, MA 01880 [Caroline UTHORIZED REPRESENTATIVE M McAllister ACORD 26(2001/08) ©ACORD CORPORATION 1988 r=te \ The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Wa 'll ;l,`iv shington Street Boston MA 02111 -- www-rriass,gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leoibiy Name (Business/Organization/Individual): Address: soz City/State/Zip: Phone#: ?oLl _J` 3 N 7— Are you an employer?Check the appropriate box: Type of project(required): 1.[.I an a employer with 0 4. ®I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6• New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet $ 7• 52'Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for mein any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. Eland We area corporation its required.] officers have exercised.their I0:❑ Electrical repairs or additions 3.❑ 1 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.] t employees. [No.workers' comp.insurance required.] 13.❑ Other *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. t itiOniCOWnerE who SLiI)n111.i17S alildavil indicating they air;uuiliera"Um attci titer-hi,;;cutsde cor,trruaur's muni submit anew affidavit indicating such. :Contractors 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 no,employees. Below is the police and job site information. Insurance Company Name: r4r-5 S Policy#,or Self-ins. Lic. #:wc- 19 21? `j'Z4 Expiration Date: Job Site Address:_ y c" City/State/Zip: JV,4f�_ Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under 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 may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cert under the pains and penalties of perju'Y that the information provided above is true and correct Signature: Date. � — — 1 Phone#: l �L7 Z. 7 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. Plumbing Inspector 6.Other Contact Person: Phone#: NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit at: Z� A4 is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 1 1, S 150 A. Also, note Permits are required under Fire Prevention laws Chapter 148 Section 1 OA. The debris will be disposed of in: (Location of Facility) Signature of Permit Applicant `fir G� Date 2 L4 � JJ iWV4 AVE i All dimensions size designations given are �® This is an original design and must not be Designed: 11/13/2008 subject to verification on job site and TECHNOLOG Esl released or copied unless applicable fee has Printed: 11/13/2008 {{ r. adjustment to fit job conditions. been paid or job order placed. HAMBOYAN garage Fp 1 Drawing#: 1 ACR. S± � c,` 40 . `. 14 2P�/2 e,74 'Deb```. P; o co ., ,� ���� 2►x. 19 LOT 34A , 412 20 3{ S%. o�d R A BEFORE CONVEYANCE = 0. 02 AC. + PARCEL 3 = 2.00 AC. RE AFTER. CONVEYANCE..=-3.-.0.2.AC. 38.3,' V ;2J '2 Ick 1 f. Ab SV JO PLAN WERE PREPARED IN ACCORDANCE r DURAL AND TECHNICAL STANDARDS FOR THE 9 ' 0 SURVEYING IN THE COMMONWEALTH OF' �� aN ACTION BUILDERS 31 LAKE ST, WAKEFEILD MASS 01880 OFFICE 781-246-2729 CP 781-367-3762 DENNIS AND ELLEN -ian A y ae y 50 CAMBELL RD, N.ANDOVER MASS 01854 CP 617-285-2515 email=den is.d.hamboyan@ustrust corn, emharri ana comcast net scope of work:11-7-08 GARAGE REMODEL .Site work • Cut line in driveway as needed for section in front of garage • Excavate to replace existing driveway • Install new sewer pipe under new driveway through foundation into home but do not connect • Pipe to be set into 3/4'stone • Pave new driveway as discussed tieing into existing driveway New garage Interiors • Remove existing kitchenette • Remove.closet • Remove walls and ceiling as needed to open up garage • Break through outside wall for new garage doors • Note: low clearance only 84" • Frame exterior and interior walls beams etc p • New entrance door 3' x6'6" Ih U "`` S, • New entrance door to mudd room 4"above garage floor 2'4x6'4 steel , hr • Electrical o Clean up wires etc o Provide adequate outlets, door openers, etc 9 o Hookup new heater installed by plumber ,t • Lighting=new ceramic lights • Plumbing !3, Svv 1T� o Remove kitchenette plumbing ` o Remove existing baseboard heat o Add new garage heater in corner supplied by plumber • Insulate,Board and plaster and patch as needed • Provide and install 2 new standard insultated paneled garage doors with openers, key pad, remotes, etc • Paint everything..paints chosen and supplied by others • Flooring to remain as is or perhaps receive a coat of paint?? • Siding patch and exterior trims as needed • Dispose of all debris created by us Total cost 13,500.00 Read and agreed to, Customer Read and agreed to, Contractor t%ORTIy TO" of Andover . No. 3 '-_ LAKE HOo dower, IVlass., COC C NE WICK y1. ADRATED `s BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT ,1............:......:........................... ......... ..............�.�:.................................... ................ ................ Foundation has permission to erect......:: :.:., buildings ons':..( �-�. ' .c�... ...........:.f/`� .... Rough to be occupied as �/ l�7�I l�CJ... .'(. ... Ar.. rliein Chimney provided that the person accepting this permit shall in every respect conform to the t ms of the application onFinal this office, and to the provisions of the Codes and By-Laws relating to the Ins pe tion, 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 PERMF EVIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STNS Rough ! / !�..� ............................ Service BUI� 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.